ANTERIOR CHAMBER HYPHEMA

“This cloudiness is blood in your eye’s anterior chamber, which is the space between the iris and your cornea’s surface, called the endothelium. It contains a fluid that sustains the cornea and lens and provides your eye’s shape. This blood may, for a time, clog the normal outflow of fluid from the anterior chamber, causing increased eye pressure, which can lead to glaucoma, causing gradual irreversible loss of vision. To promote healing, I’ll prescribe anti-inflammatory drops; to reduce the eye pressure, I’ll prescribe glaucoma drops, both to be used twice a day. I’d like you to return in one week to assess the drugs’ efficacy.”

*Performing UBM on eyes with hyphema can increase the risk of worsening the condition via the temporary IOP rise during image acquisition. Evaluate risk and acquire images quickly and gently.

IRIS PLATEAU

“If you look here, you’ll see your cornea, which is like the glass of a watch. Your iris, which is here, is like the watch’s face. Some people have a watch face that is closer to the glass than others. In your case, it is dangerously close, meaning that if it gets any closer, you’ll be at risk of a severe increase in eye pressure, which can cause glaucoma and permanent loss of vision.”

(Depending on the extent of the plateau, I’d recommend conservative observation, treatment with drops or surgical consultation to consider iridoplasty or peripheral iridotomy if the plateau is significant. UBM images can further help me graphically explain the goals of surgery.)

NEGATIVE BOW IRIS

“Mother Nature can be unkind. Things can be too small, too large, etc. Your iris, which is like the face of a watch, is too far from the cornea, which is like a watch’s glass, and too close to the lens zonules, which are fine threads that hold the lens in position. When the iris is too far from the cornea, the iris’ backside ‘sand papers’ against the lens zonules, and it frees pigment that may significantly clog the eye’s angle, causing increased eye pressure. Called pigment dispersion, the process is similar to leaves shaken from trees and clogging drains. With the angle clogged, you can develop pigmentary glaucoma, which can cause gradual and irreversible vision loss.”

PUPIL BLOCK

“You were born with an iris that is too close to the cornea. Your iris is like a watch’s face, and your cornea is like a watch’s glass. As your eye matured, the lens behind your iris, which enables you to see, grew larger and thicker and pushed your iris forward until just a sliver of it was left. If this sliver closes, your eye’s outflow system, which sustains the cornea and lens and provides the eye shape, disastrously fails, making it difficult or impossible for fluid to pass through the outflow mechanism, increasing eye pressure, which can lead to glaucoma and permanent vision loss.”