Gory Eye Picture - Dermoid from Hell

This is a weird growth that some people are born with.  It's called a dermoid.  It can enlarge over time, as this one has.  (This guy walked in this week is in his 20's.  Time to remove it, don't ya think?)  You can see it has hair growing on it.  Sometimes there's bone and teeth and cartilage and other Frankensteinian components in them.   Growths like this that consist of tissue not normally found at the site are called "choristomas".   One choristoma made it to the big screen in the movie, "My Big Fat Greek Wedding," where the Aunt is telling the fiance of the lump that was removed from her back that had teeth and hair in it, and that it was the remnants of her twin that was never born.  It was a great scene, and a proud day for choristomas everywhere.

Often, ocular dermoids go deep into the substance of the eye wall, so despite it's "stuck-on" appearance, you can't just slice it off, (or lacking instruments, pluck it off), because you could end up with a hole in the eye.  So you have to have donor tissue available to patch up the hole at the time of surgery.  They occur in about one per 10,000 people.  

Gory Eye Picture

I'm amazed by how many people complain to me that I don't warn them that these pictures might give them nightmares and why don't I warn them of the graphic nature. What do you think it means when the title of the post is "gory eye picture," kittens?

Without further warning, here it is:

(photo credit)

Gory Finger Picture

It's been a long time since I've posted a gory eye picture. Having had nothing gory to present, I'm resorting to gory finger pictures.

Remember that story about the guy who was wearing his class ring, and went up to dunk the basketball, but got his ring stuck on the rim? Not urban legend. Photos courtesy of this site. Dr. Ramona Bates, over at Suture for a Living, tipped me off to this story (pun intended).

Irritated eye

When provoked, an eye will on rare occasion stick its tongue out at the examiner.

Lid Lift

Watch Your Mouth!

Now I know many of you visit this blog just for the gory eye pictures, and that I've been remiss in posting them lately, so here is one. This is a picture of a young woman who visited our office last week with severe diabetic eye disease. This is the retina. The white round thing in the middle is the optic nerve head (or "disc"). The 1.2 milliion nerve fibers of the retina leave the eye through the optic nerve and go to the brain (the eye is technically part of the brain -- an extension -- so yes, I'm a brain surgeon). The arteries and veins also enter and leave the retina through the center of the optic nerve. The darker spot is called the macula (which means "spot" in Greek or Latin or something). It's the specialized part of the retina that's involved with the sharpest clearest vision.

Diabetes affects blood vessels, and you can see all the massive intra-retinal hemorrhages from the diabetic damage. The retina is the one place in the body we can look directly at the blood vessels, but this same damage is taking place all over the body -- brain, heart, kidneys, feet, everywhere. Bummer.

Diabetes is a bad disease, and if I've said it once, I've said it a million times, it's a lifestyle disease. You get it by eating too much, eating fat, eating simple carbs, eating animal prodcuts, eating, eating, eating. It's prevented by keeping less than one inch of fat around your middle. It can be cured by losing the extra weight and exercising. The stage is set when you're young. So pay attention. You're not invincible. This is the reason the life expecancy for the indigenous population is 54 years. That makes 28 "middle age."

Pink Eye Epidemic Quieting Down

It seems like the epidemic that struck Saipan about a month ago is starting to quiet down. We're still seeing a steady trickle of cases, but nothing like the huge numbers we were seeing at first. Here is the worst case I saw. Yes, that stuff on the left side is the conjunctiva (the white tissue on the surface of the eye -- here really really red) actually coming out from between the eyelids. She couldn't close her eye because of the tissue hanging out.

Pars Plana Vitrectomy

That's the name of this procedure. The jelly in the back chamber of the eye is called the vitreous, and in some circumstances, like bleeding into the vitreous from diabetes, you want to take the vitreous out -- "vitrectomy" it. Right adjacent to the cornea, on the white part of the eye (the sclera) there is an area that is a few millimeters wide that doesn't have any retina behind it. This area is called the pars plana. It's a perfect place to insert instruments. If you insert an instrument further back, where the retina begins, you put a hole through the retina and cause a detachment. Not good. So, this is a pars plana vitrecomy.

The tube on the left is connected to an elevated bag of fluid that keeps the eye inflated so it doesn't collapse like a squished grape when you make your other incisions. Those two metal things on either side of the cornea and short hollow tubes that go through the pars plana into the vitreous chamber. We use these two tubes to place instruments through. Usually one hand has a fiberoptic light so you can see what you're doing in there. The other hand has an instrument, like a cutter, or a pick or a laser, or whatever you need at the moment.

It used to be that you would make an incision and just push the instruments in and out of the eye through the cuts. With this new "hollow tube" technique, you just stab the tubes in, do the surgery and then take them out at the end. You don't even need to put any stitches in. It's very cool surgery.

The little lens suspended above the cornea is actually attached to a huge operating microscope. The microscope usually focuses light onto the cornea, but this lens allows you to focus it further back into the vitreous.

Oh, and the big metal thing is a lid speculum. When I operate, people often tell me they're afraid they'll close their eyes. Not to worry. We just pry them open with metal instruments.

One more subtle, but important detail. In the lower right corner of the photo, above the eyebrow, next to the blue drape, there is a purple arrow. That arrow says "operate on this eye." It's bad form to operate on the wrong eye. Especially if you're doing an enucleation. (Look that one up. It gives me the shivers just thinking about it.)

I do have to say that I love my job!

Gory Eye Picture: Caption Contest

Hyphema

I nearly forgot about the last gory eye picture. Bree was the winner of the Hollywood Theatre tickets for two and as a bonus, a Crabby Pattie.

The photo showed that the cornea, that front clear layer of the eye is normal. But the front chamber of the eye -- that space between the cornea and the iris -- is full of blood. That's why you can't see the colored iris or the pupil. Blood inside the front chamber of the eye is called a hyphema. He has a finding that threw most of you for a loop, and that was an air bubble floating up there at the top of the chamber. I put the air bubble there by sticking a needle into the chamber and injecting the air to try to tamponade the bleeding. The yellow-green stuff on the lashes is a dye that is used during the exam to help assess the surface of the eye and to check the pressure inside the eye. The white part of the eye is red just from the general trauma.

Hyphemas usually do well, clearing themselves over a week or two. The dangers are that the blood can clog the eye's drainage system, causing a high intraocular pressure, or that the blood can be there so long that it stains the cornea. This young man did well, with his vision returning to normal over two weeks.

I'll let you guys sort this one out

Here is a young woman who I have been seeing every day for the past 10 days or so. She was a passenger in a motor vehicle accident and got popped in the eye by the airbag. Now before you go home and dismantle your airbag, keep in mind that this is a little like getting chaffed by a life jacket.

What do you see? What happened? Get it right (or even close) and I'll buy you two matinée passes to the movies.

And no, Mark, Melonie, Thelma, Joanne, Emilly, Lin, Yvonne, and all the rest of you at Marianas Eye Institute cannot play.