Interesting Retinal Cases

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Oxidative stress drives AMD
• Key triggers: UV exposure, smoking, and poor diet.
• 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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• Definition
Progressive corneal ectasia → stromal thinning + anterior protrusion → irregular astigmatism

• Epidemiology
→ onset: teens to early adulthood
→ often bilateral, asymmetric

• Pathophysiology
→ structural weakening of corneal collagen
→ non-inflammatory

• Risk factors
→ eye rubbing
→ atopy (allergies, eczema, asthma)
→ family history
→ connective tissue disorders

• Symptoms
→ progressive blur
→ increasing astigmatism
→ frequent Rx changes
→ ghosting, halos, monocular diplopia

• Refraction clues
→ increasing cyl
→ irregular astigmatism
→ reduced BCVA with glasses
→ scissors reflex on retinoscopy

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

• Topography / Tomography
→ inferior steepening
→ asymmetric bow-tie
→ posterior elevation (early detection)

• Complication
→ acute corneal hydrops (Descemet break → stromal edema)

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

• Key clinical pearl
Young patient with changing astigmatism + ↓ BCVA → think keratoconus and get topography early

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