Ophthalmic Images in Diverse Patient Populations

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Ambar Faridi, MD

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Ambar Faridi, MD

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Currently, a disproportionate number of textbook figures and photographs are of eye conditions in white patients. Many ocular conditions can appear differently in individuals of color or those with darker skin. The purpose of this page is to share images of both common and rare pathology of the external, anterior, and posterior segments in patients of color. The American Academy of Ophthalmology's Committee for Resident Education’s DEI workgroup initiated this image collection to serve as a source for education and future versions of the Basic and Clinical Science Course (BCSC) and other texts.

Visit the Academy website to learn more about its commitment to diversity, equity, and inclusion in the ophthalmic community and review educational resources related to DEI in ophthalmology.

A-C

Acanthamoeba keratitis

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  Classic clinical signs of Acanthamoeba keratitis. Ring-shaped infiltrate

Age-related macular degeneration

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  Fundus photographs (A, C, D) and fluorescein (B) and indocyanine green (E) angiographies of typical nAMD (A, B), nnAMD (C), and PCV (D, E) in Japanese patients. nAMD neovascular AMD; nnAMD non-neovascular AMD; PCV polypoidal choroidal vasculopathy.

Amblyopia

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  Strabismus. Strabismus is the most common underlying cause of amblyopia.With constant deviation of one eye, reduced vision occurs. Amblyopia is less likely when the deviation is intermittent or when the two eyes alternate fixation.

Amblyogenic ptosis

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  Amblyogenic ptosis, left eye.

Aniridia-associated keratopathy and nystagmus

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  Pars Planar Tube Surgery for Aniridia-Associated Keratopathy

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  Pars Planar Tube Surgery for Aniridia-Associated Keratopathy

Arlt's line

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  Arlt’s line: a horizontal linear scar found in the watershed area between the marginal and peripheral conjunctival vasculature.

Asteroid hyalosis

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  Asteroid hyalosis. Yellowish-white viterous opacities in Pakistani patient.

Bacterial orbital cellulitis with proptosis

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  Bacterial orbital cellulitis with proptosis (A) secondary to sinusitis (B) in a Black patient

Bardet-biedl syndrome

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  This infant with nystagmus related to retinal dystrophy also had polydactyly (arrow), which led to the diagnosis of Bardet-Biedl syndrome. Systemic features such as renal impairment emerge in later childhood.

Basal cell carcinoma (eyelid)

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  Basal cell carcinoma in Black patient.

Chalazion

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  Chalazion.

Conjunctival melanoma

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  Photographs showing conjunctival melanoma in various races. A, White man with (B) conjunctival melanoma resulting from nevus. C, African American woman with (D) conjunctival melanoma from primary acquired melanosis. E, Hispanic woman with (F) conjunctival melanoma de novo.

Conjunctival nevus

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  Conjunctival nevi are congenital hamartomas that consist of nests of modified melanocytes (nevus cells).

Corneal arcus

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  Corneal arcus.

CRAO (dark choroid)

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  Fundus photograph of right eye showing severe whitening of retina and cherry-red spot at fovea (A 17-year-old female patient of Asian origin)

D-F

Diabetic retinopathy

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  Figure 1. Color fundus photograph of the left eye in case 1 in 1995 showing lipid exudates (arrow), cotton wool spots, and intraretinal hemorrhages of diabetic retinopathy as well as multiple refractile intraretinal crystals (arrowhead). Figure 2. Color fundus photograph of the left eye in case 1 in 2001 after focal photocoagulation for diabetic macular edema. The edema has completely resolved, and there are fewer intraretinal crystals, which are arranged in a pattern different from that in 1995. Figure 3. Color fundus photograph of the right eye in case 2 showing a frond of retinal neovascularization and many iridescent intraretinal crystals within the foveal avascular zone. Figure 4. Mid-phase fluorescein angiogram of the right eye in case 2 showing the perfused retinal neovascularization and the absence of any fluorescein angiographic sign of the crystals. Figure 5. Color fundus photograph of the right eye in case 2 one year after panretinal laser photocoagulation. Most of the crystals have resolved. Figure 6. Color fundus photograph of the right eye in case 3. The distribution of the intraretinal crystals follows the pattern of the distribution of intraretinal lipid from diabetic macular edema. The diabetic lipid exudates (arrow) can be distinguished from the refractile crystals (arrowhead).

Episcleral vessels

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  Indian patient, “arterialized” Episcleral vessels

Exotropia

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  Exotropia, left eye (child)

G-I

Hurler's syndrome

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  Hurler's syndrome, cloudy corneas

Iris melanoma

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  Iris melanoma is the most common primary neoplasm of the iris and accounts for approximately 5% of all uveal melanomas.

Iris nevus

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  Slit-lamp photograph of a 4-year old Hispanic girl (case 1) shows multiple nodules distributed diffusely on the iris surface

J-L

Lens-induced glaucoma

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  Lens-induced glaucoma. Old man presented with spontaneous anterior dislocated cataract which was extracted on emergency after instilling pilocarpine eye drops to prevent posterior dislocation and after one month a secondary IOL was placed with good visual recovery.

M-O

Melanoma (conjunctiva)

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  Photographs showing conjunctival melanoma in various races. A, White man with (B) conjunctival melanoma resulting from nevus. C, African American woman with (D) conjunctival melanoma from primary acquired melanosis. E, Hispanic woman with (F) conjunctival melanoma de novo.

Metastatic carcinoma

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  A 37-year-old presented with ocular metastasis with primary ductal carcinoma of the left breast. The case presented with complaints of redness and pain OS for 1 month, and there was a past history of a left modified radical mastectomy 3 years previously at the same institution where the patient didn’t complete the chemotherapy. On examination, OD-within normal limits, OS lids appeared edematous, circumcorneal congestion with prominent episcleral vessels seen, anterior chamber had exudative deposits and 1+ grade of cellular activity present, iris was atrophied from 3’o-5’o clock hours.

Molluscum contagiosum

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  Giant eyelid molluscum contagiosum in a child with AIDS. A 6-year-old boy presented with a 3-month history of multiple, pedunculated, nodules with a central umbilication (Fig 1A). A clinical diagnosis of molluscum contagiosum was made and investigations revealed HIV infection with a CD4 count of 124/ml3. Highly active antiretroviral therapy (HAART) was initiated. The larger lesions were excised (Fig 1B). Characteristic eosinophilic intracytoplasmic inclusion bodies were seen on histopathologic examination (Fig 1C; hematoxylin-eosin 40). The child is currently on maintenance therapy with HAART with no recurrence of the lesions.

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  Molluscum contagiosum lesions on eyelid in Black patient

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  Molluscum contagiosum in an African American patient

Neovascular glaucoma

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  Rubeosis iridis in a Pakistani patient

Nevus of ota (eyelids)

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  The slate-gray pigmentation involving the sclera and periorbital area is characteristic of oculodermal melanocytosis (nevus of Ota). Oculodermal melanocytosis is associated with an increased risk of pigmented tumors, such as choroidal melanoma.

Overaction of left inferior oblique

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P-R

Papillary conjunctivitis

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  Papillary reaction of bulbar conjunctiva. Conjunctival papillae are most commonly found on bulbar conjunctiva, have a vascular core and are a sign of inflammation.

Primary acquired melanosis (PAM)

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  PAM in a Black patient

Pterygium

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  A Case of inflamed nasal pterygium with cystic degeneration. ccentuates tear film abnormality causing adjacent Dellen or excavation of cornea.

Congenital ptosis

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  Congenital ptosis

S-Z

Scleromalacia perforans

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  Scleromalacia Perforans from Long-Standing Bulbar Conjunctival Rhinosporidiosis. A 12-year-old child presented with a 6-month old painless, reddish-blue swelling superior to the upper limbus (Fig 1A). Scleral thinning with uveal show and a conjunctival mass with dot-like, yellowish-white surface excrescences were noted. Excision with a donor scleral patch graft was performed (Fig 1B). Histopathology showed partially separated squamous metaplastic epithelium(Fig 1CeD,), edematous stroma, and numerous thick walled sporangia indicating rhinosporidiosis. Several of these appeared degenerated and empty. Others showed granular debris material (Fig 1C, Hematoxylin-Eosin; Fig 1D, Gomori’s MethenamineSilver 400). Ocular rhinosporidiosis most commonly involves the tarsal conjunctiva. Scleral melt from bulbar conjunctival rhinosporidiosis is known but extremely rare.

Squamous cell carcinoma

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  Ethmoid sinus squamous cell carcinoma in a Black patient. A, Photograph shows fullness of the medial canthal area overlying the mass. Axial (B) and coronal (C)

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  Squamous cell carcinoma (SCC) grade 1 in a Black patient

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  Squamous cell tumor of conjunctiva in African patient.

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  Conjunctival SCC with prominent leukoplakia developed in a 64-year-old African American man with 5 years of known HIV

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  Slightly pigmented conjunctival SCC developed in a 44-year-old Hispanic man with 3 years of known HIV