Interesting Retinal Cases

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06/18/2026

A 66 y/o patient with large cups and thin rims OU, cataract and measurement artifact on OCT, the results are surprising πŸ˜…

By π·π‘Ÿ. π‘†π‘‘π‘’Μπ‘β„Žπ‘Žπ‘›π‘’ πΉπ‘–π‘‘π‘œπ‘’π‘ π‘ π‘– πŸ‡«πŸ‡·, π‘€π‘–π‘Žπ‘šπ‘–, πΉπ‘™π‘œπ‘Ÿπ‘–π‘‘π‘Ž
With ΰ£ͺ Λ– βœ©π’΅π’Άπ’Ύπ“‡π’Άβœ© ΰ£ͺ Λ–
At Blinking Owl Eyecare ℒ️

06/13/2026

Join me on Patreon!

After months of working on this behind the scenes, I’m excited to finally launch my Patreon.

You’ll find educational podcasts, clinical pearls, case discussions, OCT reviews, imaging, retina, glaucoma, contact lenses, refraction, and much more.

I’ve already uploaded a significant amount of content, and I’ll be adding new material regularly.

The link is in my bio. I’d love to have you there!

06/08/2026

Another episode of Glaucoma Yes or No

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05/27/2026

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05/22/2026

I am wearing color Navy blue.
πŸ‘•: All-day scrub zip polo
πŸ‘–: All-shift scrub jogger

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05/14/2026

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Oxidative stress drives AMD
β€’ Key triggers: UV exposure, smoking, and poor diet.
β€’ Guide patients on prevention: Advise quitting smoking, consistent UV protection, and encouraging a diet rich in leafy greens for long-term eye health.

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05/11/2026

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β€’ Location of drusen
Normal aging: may be outside the macula, scattered in peripheral retina
Dry AMD: drusen primarily within the macula

β€’ Laterality
Normal aging: can be unilateral or asymmetric
Dry AMD: typically bilateral (often asymmetric)

β€’ Size / appearance
Normal aging: small, isolated drusen
AMD: larger, more numerous drusen often with RPE changes

β€’ Macular involvement
Normal aging: macula unaffected
AMD: macular pathology present β†’ central retinal involvement

β€’ Visual impact
Normal aging: usually asymptomatic
AMD: gradual ↓ central vision, reduced contrast sensitivity

β€’ Associated findings
Normal aging: no significant pigmentary abnormalities
AMD: RPE mottling, pigment migration, geographic atrophy (advanced cases)

β€’ Progression
Normal aging: often stable over time
Dry AMD: progressive degenerative macular disease

β€’ Key clinical pearl
Not all drusen = dry AMD
Small clusters of extramacular, unilateral drusen without macular changes may simply represent normal age-related retinal changes rather than dry AMD.

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05/08/2026

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β€’ Definition
Progressive corneal ectasia β†’ stromal thinning + anterior protrusion β†’ irregular astigmatism

β€’ Epidemiology
β†’ onset: teens to early adulthood
β†’ often bilateral, asymmetric

β€’ Pathophysiology
β†’ structural weakening of corneal collagen
β†’ non-inflammatory

β€’ Risk factors
β†’ eye rubbing
β†’ atopy (allergies, eczema, asthma)
β†’ family history
β†’ connective tissue disorders

β€’ Symptoms
β†’ progressive blur
β†’ increasing astigmatism
β†’ frequent Rx changes
β†’ ghosting, halos, monocular diplopia

β€’ Refraction clues
β†’ increasing cyl
β†’ irregular astigmatism
β†’ reduced BCVA with glasses
β†’ scissors reflex on retinoscopy

β€’ Slit lamp signs
β†’ Vogt’s striae (fine vertical stress lines)
β†’ Fleischer ring (iron deposition)
β†’ corneal thinning, conical protrusion
β†’ Β± apical scarring (advanced)

β€’ Topography / Tomography
β†’ inferior steepening
β†’ asymmetric bow-tie
β†’ posterior elevation (early detection)

β€’ Complication
β†’ acute corneal hydrops (Descemet break β†’ stromal edema)

β€’ Management
Early: glasses / soft toric CL
Moderate: RGP / scleral lenses
Progression: corneal cross-linking (CXL)
Advanced: INTACS or corneal transplant

β€’ Key clinical pearl
Young patient with changing astigmatism + ↓ BCVA β†’ think keratoconus and get topography early

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05/06/2026

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β€’ Anatomic location
Preseptal: infection anterior to orbital septum (eyelid/periorbital tissues)
Orbital: infection posterior to septum (orbit)

β€’ Common source
Preseptal: skin trauma, insect bite, chalazion/hordeolum
Orbital: sinusitis (especially ethmoid) β†’ direct spread

β€’ Pain
Preseptal: localized, anterior (eyelid), no pain with EOMs
Orbital: deep orbital pain + pain with EOMs

β€’ Eye movements
Preseptal: full, painless
Orbital: restricted, painful EOMs

β€’ Vision
Preseptal: normal
Orbital: ↓ VA possible, Β± RAPD

β€’ Proptosis
Preseptal: absent
Orbital: present

β€’ Systemic signs
Preseptal: mild or none
Orbital: patient looks systemically ill, not just a swollen eyelid

β€’ Anterior segment
Preseptal: lid edema/erythema only
Orbital: may have chemosis, conjunctival injection

β€’ Imaging
Preseptal: not routinely needed
Orbital: CT orbit/sinuses indicated

β€’ Management
Preseptal: oral antibiotics, close follow-up
Orbital: admission to hospital with IV antibiotics + urgent imaging

β€’ Key clinical pearl
Any pain with EOMs, ↓ vision, or proptosis β†’ treat as orbital cellulitis until proven otherwise

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05/04/2026

β€’ Etiology
Chalazion: sterile granulomatous inflammation from blocked meibomian gland
Hordeolum: acute bacterial infection (usually staph)

β€’ Onset
Chalazion: gradual, chronic
Hordeolum: rapid, acute

β€’ Pain
Chalazion: typically painless
Hordeolum: painful, tender

β€’ Location
Chalazion: deeper, within tarsal plate/ Meibomian gland
Hordeolum:
β€’ External: lash follicle / Zeis or Moll gland
β€’ Internal: meibomian gland

β€’ Appearance
Chalazion: firm, non-erythematous nodule (may have mild redness)
Hordeolum: erythematous, swollen, may point with pustule

β€’ Course
Chalazion: persists, may enlarge slowly
Hordeolum: often drains spontaneously within days- release of pus

β€’ Management
Chalazion: warm compress, lid hygiene, consider steroid injection or surgical removal if persistent

Hordeolum:
External: warm compress, topical antibiotics
Internal: warm compress, oral antibiotics may be needed

Clinical pearl:
Beware of preseptal spread in internal hordeolum

Clinical pearl:
Recurrent/persistent β€œchalazion” β†’ rule out sebaceous gland carcinoma

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