Pupil Pod

Ogul Uner, MD, invites Aristomenis “Aris” Thanos, MD, to review a case of vitreous hemorrhage in a 62-year-old man who presented with sudden painless vision loss and floaters in his right eye. The patient denied any past trauma, had a history of type 2 diabetes and hypertension, and was taking apixaban (Eliquis, Bristol Myers Squibb/Pfizer) for atrial fibrillation. Visual acuity was counting fingers in the affected right eye, there was no relative afferent pupillary defect, and the anterior segment was unremarkable. Dr. Thanos discusses causes of vitreous hemorrhage along with common risk factors and comorbidities. He breaks down acute versus long-term treatment considerations, when to send a patient to surgery, and strategies for at-home care. Ogul Uner, MD Financial disclosure: None Aristomenis Thanos, MD Financial disclosure: None

Sila Bal, MD, MPH, invites Caroline Watson, MD, to review a case of blepharitis in a 64-year-old woman who presented with chronic burning, tearing, irritation, and fluctuating, blurry vision in both eyes. Visual acuity is 20/25 OU, and examination showed an unstable tear film, debris at the lash base, mild lid-margin telangiectasia, capped meibomian glands, collarettes, and trace inferior punctate epithelial erosions. Dr. Watson shares her advice for managing blepharitis and ocular surface disease. She breaks down how to define blepharitis, how its symptoms can overlap with other dry eye conditions, what to ask patients to determine their symptoms’ underlying causes, and how to approach treatment.

Ogul Uner, MD, invites Rehan M. Hussain, MD, to review a case of central serous chorioretinopathy (CSCR) in a 36-year-old man who presented with blurred central vision and distortion in his right eye with no associated pain or photophobia. The patient reported recent personal stress and use of intranasal fluticasone. OCT revealed serous retinal detachment with clear subretinal fluid and retinal pigment epithelium irregularity. Dr. Hussain describes the typical presentation of CSCR and reviews its major risk factors, which include high stress and steroid use. He also discusses acute versus chronic CSCR, where it fits in the pachychoroid spectrum of diseases, and how he would approach imaging and treatment.

Ogul Uner, MD, invites Arsham Sheybani, MD, to review a case of lens-induced glaucoma in an 82-year-old woman who presents with pain, redness, and blurry vision in her left eye. Visual acuity is hand motion, IOP is 48 mm Hg, and an examination revealed a deep anterior chamber with 3+ cells and white particles and a dense, hypermature cataract. Gonioscopy showed an open angle and intact lens capsule. Dr. Sheybani shares his thoughts on the case and describes the presentations of secondary angle-closure and open-angle glaucomas, including phacomorphic, phacoantigenic, and phacolytic glaucomas. He covers differentiating from primary angle-closure and open-angle mechanisms and how to proceed with surgical treatment.

Maura Di Nicola, MD, joins Ogul Uner, MD, to talk about white dot syndromes, a group of inflammatory chorioretinopathies. They begin with a case of a 32-year-old woman who presents with blurry vision in the right eye for 2 weeks, with new onset floaters with mild pain and photophobia. Examination showed 2+ vitreous cells and multiple yellow-white chorioretinal lesions in both eyes. Dr. Di Nicola shares what questions to ask about the patient’s history and what factors to consider when forming a differential diagnosis. Drs. Uner and Di Nicola further discuss the signs of multifocal choroiditis, distinguishing between different presentations of white dot syndrome, and what can be learned from multimodal imaging.