lesions in the deep stroma and endothelium

[AlexEvans]

Is there a medical professional out there who can help with this specialist query?

Gatwick optometrist:

"Slit lamp showed multiple round lesions in the deep stroma and endothelium spread across both cornae. Large blebs were seen on the endothelium (query Fuch's endothelial dystrophy?). Slit lamp examination showed no other anomalies."

On AMD's advice I saw a Consultant Opthalmic Surgeon for a diagnosis.

Consultant: "Slit lamp examination revealed subtle scattered discreet posterior corneal stromal granular lesions with underlying discreet corneal endothial guttata. The rest of his ocular examination appeared normal with otherwise clear media, normal intraocular pressures and healthy looking optic discs and fundi."

He told me that there was a very slim chance that things could progress in the future but that most likely there was nothing to worry about.

My question is this: If things do progress, will there be any signs that I can notice? When I look up at a bright overcast sky, I can see what I can only describe as "scratches", like looking through specs that are scratched. They are out of focus and of course when I try to look directly at them they move with my eyeball. Does this have anything at all to do with the price of bread?

I should have mentioned this to the eye Doc when I saw him!

[Loose rivets]

Non professional I'm afraid, but a couple of quick questions.

Are you sure that what you are seeing are not feint floaters and nothing to do with the original problem? ( Floaters tend to over-swing as you pan and suddenly stop your eyes in azimuth for example. I would expect a fixed mark to stop abruptly as you locked onto a subject.)

Have you ever subjected your eyes to high levels of radiation of one sort or another? Anything from welding arc, to laser light for instance.

[AlexEvans]

Yeah, I wondered if what I am seeing could be floaters. The truth is I can't really tell if what I am seeing is a fixed mark or if it floats around to an extent. Can floaters appear like long, thin scratches or are they always small dots?

And no, I haven't been exposed to arc welders, laser light or anything else along those lines.

[Capetonian1]

AlexEvans your post raises a few questions. First of all, what was your reason for you firstly consulting the Gatwick optometrist, and are you a contact lens wearer? Did you contact the optometrist in the beginning because you noticed the "scratches" or was it at a routine check-up that the optometrist first detected the lesions?

In terms of "floaters", there are basically two groups. The first group is due to debris in the vitreous jelly in the back of the eye. Depending on their origin they could range from being totally harmless to possibly indicating a potentially very serious condition such as a retinal detachment, retinal haemorrhage, or vitreous detachment etc. Their appearance is more likely to be noticed as a dark spot or smudge as the physical floater casts a very definite shadow on the retina as it moves around in the vitreous. Often one can fixate on this type of floater and watch it passing down through your light of sight.

The second group of "floaters" is actually what is referred to as an entoptic phenomena and is a "normal" aspect of vision due to the physiology of the retina. Their appearance is like a fine wisp of hair, light or colourless in appearance, and they always move out of your line of vision no matter how hard you try to follow it. They are also frequently noticed when looking at a clear blue sky or a blank white/light blue wall etc. One cannot fixate on them because the location of the phenomenon is in the retinal blood vessels and as you move your eye, the blood vessels also move as part of the eye and will always be out of your line of sight. This phenomenon is summarised according to "wikipedia" as follows and is a totally normal aspect of vision in a perfectly healthy eye:

"The white blood cells (http://en.wikipedia.org/wiki/White_blood_cell) in the capillaries (http://en.wikipedia.org/wiki/Capillaries) in front of the photoreceptors can be perceived as tiny bright moving dots when looking into blue light. This is known as the blue field entoptic phenomenon (http://en.wikipedia.org/wiki/Blue_field_entoptic_phenomenon) (or Scheerer's phenomenon)." SOURCE: http://en.wikipedia.org/wiki/Retina

Could you indicate if you do, or recently wore contact lenses?

[AlexEvans]

Thanks for the reply and information.

I was at Gatwick for my Class 1 initial. I've never worn contact lenses because my astigmatism means my eyes are unsuitable for them. I wasn't a forceps delivery either in case that question was next. :)
I first noticed this phenomenon when I was 15 or so. (I'm 29 now). I'd always dismissed them as floaters - It's only since Gatwick raised concerns about the possibility of Fuch's Dystrophy that I started to wonder if what I have been seeing is a symptom of my abnormal endothelium.

I've done a little research and the symptoms of Fuch's dystrophy are something like this:

"Epithelial swelling damages vision by changing the cornea's normal curvature, and causing a sight-impairing haze to appear in the tissue."

This would not seem to be consistent with what I have been noticing.

However, your description of the second group of floaters seems to describe what I have been seeing:

"Their appearance is like a fine wisp of hair, light or colourless in appearance, and they always move out of your line of vision no matter how hard you try to follow it."

Thank you for that, you've been very helpful.

So unless a medical professional or someone with direct experience suspects otherwise, I'll assume that they're just harmless floaters, rather than the visible symptoms of my "bilateral mild corneal endothelial dystrophy". :8

[Capetonian1]

From your description it appears that what you are seeing are more than likely the entoptic phenomena of the retinal blood vessels also known specifically as muscae volitantes or "flying gnats"! This is supported by the fact that you noticed them already at age 15.

Its also unlikely that the microscopic lesions in the deep stroma and endothelium would be seen as the floaters as you described them.

Your optometrist at Gatwick should be commended for detecting the endothelial anomalies in the first place and for referring you, and you seem to have received good advice from the ophthalmologist. One of the other signs of Fuchs Endothelial Dystrophy is a beaten metal or "beaten bronze" appearance of the endothelium which has not been mentioned so far. It would be advisable to have this checked out by the ophthalmologist as part of your annual eye examination in case things progress, but the advice that its probably nothing to worry about sounds well founded.