All images in these pages are © copyright Andrew Gasson 1998-2016 and may not be reproduced without permission.
This image was the winner of the British Contact Lens Association photographic competition in June 2004; and featured in the 2013 International Images for Science exhibition.
This image was the winner of the Bausch & Lomb international photographic competition in 2005.
One of the early techniques for refractive surgery to reduce short sight. Here we see the scars left by eight corneal incisions viewed with the aid of fluorescein and blue light.
This is the left eye of a patient who had worn contact lenses for some 70 years. She was originally fitted at the age of 13 by Josef Dallos in the 1930s. Her first lenses were glass sclerals and over the years she had been refitted with many other types. She ultimately wore silicone hydrogels for extended wear to overcome age related difficulties in lens handling. When she died in her eighties about two years ago she had used contact lenses for something like 70 years.
Is this a record? There are certainly people who have worn contact lenses at an older age but contact firstname.lastname@example.org if you know of someone who has used lenses for longer than this.
A small subconjunctival haemorrhage at the upper limbus. Despite the dramatic appearance, the problem is relatively unimportant and there is no treatment. It is frequently cause by bruising to the eye, perhaps by clumsy lens handling. Sometimes it may occur spontaneously. The small amount of blood cannot escape and may take several days to resolve. It is not an infection and the vision should remain perfectly normal. As long as there is no discomfort, contact lens wear can continue as normal.
This shows a traditional hard lens bifocal with a D-shaped segment. As the patient looks down the lens is moved upwards by the lower lid to bring the reading portion into the line of sight.
Most modern bifocal or multifocal contact lenses do not have a discrete segment but are concentric in design. There is a gradation from distance in the centre to reading in the periphery. The opposite is also feasible.
The picture shows two blood vessels growing to a clinically unacceptable degree from the limbus at 7 and 8 o’clock into the cornea. This patient had used for several years a traditional 70% water content soft lens for extended wear. She was asymptomatic and illustrates the need for regular contact lens checkups, particularly with overnight wear.
The patient above was refitted with modern silicone hydrogel disposable soft lenses which transmit about six time the oxygen of the former type. This second photograph shows the cornea after six weeks. The blood vessels are almost invisible and have become ‘ghost vessels’. The patient continues to use monthly disposable lenses for extended wear.
In this much more dramatic example, the patient was taking warfarin as an anti-coagulent so that what would have been a minor haemorrhage was unable to clot. There was no discomfort and the vision remained normal.
The picture shows an accumulation of mainly protein and calcium deposits on the front surface of a monthly disposable soft contact lens. These are often associated with poor and incomplete blinking where the lens surface isn’t lubricated by lid closure. They also illustrate the importance of proper cleaning by manual rubbing even with disposable lenses.
These white spots are typical of those seen on conventional (non-disposable) high water content soft lenses. They are sometimes referred to as mulberry deposits. Where conventional lenses are still used, a more rigorous cleaning routine is essential and hydrogen peroxide is often the recommended storage solution.
Rust spots are generally picked from the atmosphere and represent metallic particles which have settled on the lens surface. They are more commonly found in people who travel by train.
Meibomian glands are present on upper and lower lids. If as here they become blocked, their oily secretions are prevented from entering the tear film and the condition frequently causes symptoms of dry eyes. Treatment consists of lid wipes and hot compresses.
The condition consists of papillae on the inside surface of the upper lid (palpebral conjunctiva) and is more commonly found in hay fever sufferers. The cause is usually allergy to solutions, deposits on the lens surface or occasionally the lens material. It may also be mechanical in origin. The symptoms are usually intense itching, particularly on removal of the lenses, and a yellowish discharge in the morning. Mild anti-allergy preparations such as opticrom (sodium cromoglycate) are very helpful but it is essential to remove the cause of the problem.
The photograph shows a much more severe example with very large or ‘giant’ papillae. It is similar in appearance to that seen with some hay fever sufferers including those who do not actually wear contact lenses.
The photograph shows a small central infiltrate as a result of a corneal infection. The symptoms are usually pain, redness, sensitivity to bright light and constant watering. The cornea should always be transparent and any painful white spot is potentially serious, requires urgent investigation and should be treated as an emergency.
The picture shows the unfortunate result of neglecting a small corneal ulcer. The extensive scarring has reduced vision to the top three lines of the letter chart. The cornea should always be transparent and any painful white spot is potentially serious, requires urgent investigation and should be treated as an emergency.
Some makes of soft lens, particularly daily disposables, are quite fragile. Sometimes they may break in the eye on removal and leave a large portion trapped under the top lid. This is generally not serious and although not an emergency may cause mild discomfort. The use of fluorescein stains the lens fragment and makes it more visible and easier to remove.