Eagleview Eye Clinic

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FUCH’S SPOT

Fuchs spot = Fuchs’ spot. It’s a pigmented scar in the macula caused by bleeding from choroidal neovascularization (CNV). Almost always seen in people with pathologic myopia.

What it is

  • Location: Center of the macula, the part of your retina used for sharp central vision
  • Appearance: Round or oval dark spot. Color ranges from gray-black to reddish-brown depending on how old it is
  • Cause: End result of a subretinal bleed that healed. The blood gets replaced by scar tissue + pigment

How it forms

  1. High myopia stretches the eye: Eyeball gets too long, >26.5 mm
  2. Bruch’s membrane cracks: Lacquer cracks develop from the stretching
  3. CNV grows: New, fragile blood vessels from the choroid grow through the cracks
  4. Bleeding occurs: Those vessels leak or burst, causing subretinal hemorrhage under the macula
  5. Scar formation: As blood clears over weeks to months, fibrovascular tissue + RPE hyperpigmentation forms. That’s the Fuchs spot

Who gets it

  • Pathologic myopia: Main group. Usually -6.00D or worse
  • Age: Typically 30s to 50s, younger than regular AMD
  • Other names: Sometimes called Forster-Fuchs’ spot. Not related to Fuchs’ endothelial dystrophy of the cornea

Symptoms

  • Central vision loss: Blur or a dark/empty spot right in the middle of vision
  • Distortion: Straight lines look bent or wavy before the scar fully forms
  • Scotoma: Once scarred, you’ll have a permanent blind spot in the center
  • Often unilateral first: Can happen in the other eye later if myopia is severe in both

Diagnosis

  • Dilated fundus exam: Doctor sees a pigmented macular lesion
  • OCT scan: Shows subretinal scar tissue and disrupted retinal layers
  • Fluorescein/ICG angiography: Used early to find active CNV before it scars. Once it’s a Fuchs spot, the vessels are usually inactive
  • History: Patient usually reports a prior episode of sudden central vision drop from the bleed

Treatment

  • No reversal: A true Fuchs spot is a scar. Vision in that exact spot doesn’t come back
  • Goal is prevention: Treat the CNV before it bleeds and scars
    • Anti-VEGF injections: Avastin, Lucentis, Eylea injected into the eye if active CNV is caught
    • Photodynamic therapy: Rarely used now, but was an option before anti-VEGF
  • Low vision aids: If central vision is lost, magnifiers and rehab help with daily tasks

Prognosis

  • Vision impact: Depends on size and location. A small spot off-center may leave 6/12 vision. One dead center can drop to 6/60 or worse
  • Other eye risk: 30-35% chance of CNV in the second eye within 8 years if you have high myopia
  • Stability: Once scarred, it usually doesn’t grow. But new CNV can form at the edge

Fuchs spot vs other macular scars
Condition Cause Age group
Fuchs spot Myopic CNV bleed 30s-50s, high myopes
Disciform scar AMD CNV 60+, non-myopes
Toxoplasmosis scar Infection Any age, often kids/young adults
Bottom line: Fuchs spot is the “tombstone” left after a myopic CNV bleed. The key is catching CNV early with regular OCT scans if you’re a high myope, because once the spot forms, central vision loss is permanent.

LACQUER CRACKS

Lacquer cracks are breaks in Bruch’s membrane, a thin layer in the back of your eye. They’re mostly linked to high myopia but can show up in other conditions too.

What exactly breaks?

  • Location: Bruch’s membrane sits between the retinal pigment epithelium (RPE) and the choroid. It’s like the “basement membrane” for the retina
  • The crack: Think of paint on a wall. If the wall stretches too much, the paint develops hairline cracks. Same idea when the eyeball elongates in high myopia
  • Appearance: On eye exams, they look like yellowish, irregular lines in the back of the eye, often near the macula

Main causes

  • Pathologic myopia: Biggest cause. Eyes longer than 26.5 mm or stronger than -6.00D stretch Bruch’s membrane until it tears
  • Trauma: Blunt injury to the eye can cause acute cracks
  • Angioid streaks: Associated with systemic diseases like pseudoxanthoma elasticum, Ehlers-Danlos, Paget’s disease. Angioid streaks can develop lacquer cracks
  • Choroidal neovascularization: Sometimes new blood vessels form around the cracks

Symptoms

  • Often none early: Many people have lacquer cracks with no vision change
  • If macula involved: Blurred vision, distorted vision where straight lines look wavy, or a blind spot
  • Sudden vision drop: Usually means a complication like bleeding or CNV has started

Complications to watch for

  • Choroidal neovascularization (CNV): New, leaky blood vessels grow through the crack. This is the main threat to vision and can cause bleeding/scarring
  • Subretinal hemorrhage: Blood under the retina from CNV, causes sudden central vision loss
  • Fuchs’ spot: Pigmented scar that forms after a bleed heals. Leaves permanent central scotoma

How doctors diagnose

  • Dilated fundus exam: Doctor sees yellow lines
  • OCT scan: Shows the break in Bruch’s membrane and any fluid/blood
  • Fluorescein angiography: Dye test to check for CNV leaking through the crack
  • ICG angiography: Better for seeing deeper choroidal vessels

Treatment

  • No fix for the crack itself: Bruch’s membrane can’t be stitched back. Goal is to manage complications
  • If CNV develops: Anti-VEGF injections like Avastin, Lucentis, or Eylea into the eye to stop new vessels
  • Monitor: Regular OCT scans if you have lacquer cracks, especially with high myopia
  • Lifestyle: No proven way to prevent them, but controlling myopia progression in kids may help reduce future risk

Who’s at risk

  • High myopes: -6.00D or worse, or axial length >26.5 mm
  • Age: Usually appears in 20s-40s in myopic patients
  • Family history: Pathologic myopia runs in families

Bottom line: Lacquer cracks themselves don’t always hurt vision. The danger is when new blood vessels grow through them. If you have high myopia, get yearly dilated eye exams so any CNV gets caught early.

P50 and N95

P50 and N95 are key waves in pattern ERG (PERG), reflecting retinal ganglion cell (RGC) function:

  • P50: Early positive wave, mainly from RGCs and inner retinal layers. Reduced amplitude or delayed timing suggests ganglion cell dysfunction, common in early glaucoma or optic neuropathies.
  • N95: Later negative wave, more specific to optic nerve health. A drop in N95 amplitude often signals optic nerve damage or axonal loss.

Both waves together help gauge severity and progression of optic nerve diseases. For example, in glaucoma, P50 might reduce first, then N95 drops as damage worsens.

B – SCAN

A B-scan ultrasound 👀 is a diagnostic test that uses sound waves to create images of the eye’s internal structures, especially the posterior segment.

Key uses

  • Retinal detachment: Shows if the retina is detached or torn.
  • Vitreous hemorrhage: Visualizes blood in the vitreous.
  • Tumors: Helps identify and measure eye tumors.
  • Foreign bodies: Locates objects inside the eye.
  • Trauma assessment: Evaluates damage when the eye’s hard to examine.

How it works

  1. Probe placement: Gel is applied; the probe is placed on the eyelid (closed or open).
  2. Sound waves: Echoes bounce off structures, creating images.
  3. Interpretation: Images show structures like the retina, vitreous, and orbit.

Types of scans

  • Axial scan: Shows structures along the eye’s axis.
  • Longitudinal scan: Images are taken in different meridians.

Tips

  • Painless and non-invasive.
  • Coupling gel is used for better contact.
  • Results are immediate.

VIRAL CONJUNCTIVITIS

Viral keratitis = corneal infection caused by a virus (most often herpes simplex virus type 1). It’s a common cause of corneal inflammation and can lead to recurrent episodes.

Causes

  • Herpes simplex virus type 1 (HSV-1): Most common
  • Varicella-zoster virus (VZV): Shingles can affect the eye
  • Other viruses like adenovirus can cause keratitis too

Symptoms

  • Watery eyes
  • Eye pain or discomfort
  • Redness
  • Sensitivity to light (photophobia)
  • Blurred vision
  • Feeling of something in the eye
  • Sometimes tiny corneal ulcers or dendritic lesions (branching pattern)

Diagnosis

  • Slit-lamp exam: Look for typical dendritic ulcers with fluorescein stain
  • Viral PCR testing (corneal scraping) if needed

Treatment

  • Antivirals: Acyclovir ointment, ganciclovir gel, or oral antivirals for HSV
  • Steroids: May be used cautiously to reduce inflammation, but need monitoring
  • Supportive care: Lubricating eye drops for comfort

Complications

  • Recurrent episodes (HSV can hide in nerves and reactivate)
  • Corneal scarring → vision loss
  • Stromal keratitis (deeper corneal inflammation)

Prevention

  • Good hand hygiene
  • Avoid touching or rubbing eyes
  • Antiviral prophylaxis may be used for recurrent cases

DARK EYE CIRCLES

Dark eye circles 👀🖤 can be tricky. Here’s the lowdown:

Causes:

  1. Thin skin: Shows underlying blood vessels
  2. Allergies: Histamines cause swelling
  3. Fatigue: Lack of sleep shows!
  4. Genetics: Some skin tones show darker circles
  5. Aging: Skin loses collagen

Fixes & hacks:

  1. Sleep: Aim for 7-9 hrs 💤
  2. Cold compress: Shrink those vessels ❤️‍🩹
  3. Concealer: Quick cover-up 💄
  4. Allergy meds: If allergies are the culprit 🤧
  5. Eye creams: With retinol or vitamin K 🌿

EYE BAGS

😴 Eyebags are those pesky puffy areas under your eyes 👀

What causes ’em?

  1. Fluid retention: Salt, allergies, or hormones
  2. Lack of sleep: Hello, tired eyes 🛋️
  3. Genetics: Blame your parents 😂
  4. Aging: Skin loses elasticity over time

How to tackle?

  1. Cold compress: Reduce puffiness ❤️‍🩹
  2. Get sleep: Catch those Z’s 😴
  3. Cucumber slices: Soothe and refresh 🥒
  4. Tea bags: Caffeine can help constrict 🍵