Abscess and Ulcer Depth

In small circumscribed ulcers, corneal depth can be easily examined with a focal slit-beam. However, when the ulcer is opaque or large and especially when necrotic tissue is present, it can be difficult to judge exact depth of involvement.


This is case of a suture abscess after a 10-0 nylon suture was left after a clear corneal incision after cataract surgery. OCT clearly demonstrates 50% thinning and a full-thickness inflammatory reaction concerning for an impending focal melt and perforation. The angle of the beveled incision is clearly seen.

An older study in the journal Eye (Danjoux JP & Reck AC, 1994) found that ~ 25% patients followed over 3 years had either a loose or broken suture and 45% of these patients were asymptomatic.

Loose or broken sutures must be immediately removed, as flora from the lid and conjunctiva can crawl into the suture tract and form a suture abscess such as the one shown in this case.

Images  courtesy of Brett Levinson, MD of Specialized Eye Care.

Iridocorneal Endothelial Syndrome (ICE) Syndrome

Our inaugural post comes from Brett Levinson, MD of Specialized Eye Care. The images are of a patient in her 30s who noted a triangular shaped left pupil for 2 years which is getting worse. On clinical exam, she has three areas of iris atrophy. Cornea exam was normal. On OCT, there is complete loss of the iris stroma and the residual iris pigment epithelium, and the anterior synechae.

The images are consistent with Essential iris atrophy. This diagnosis is one of three iridocorneal endothelial (ICE) syndromes. Changes affect one eye. Attachments of the iris to the cornea (anterior synechiae) can lead to secondary glaucoma with closure of the angle.