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Differential diagnosis of white lesions seen within the eye

Disease
In Part 1 of a two-part series, Christina A Rennie, Sam Khandhadia and Richard Newsom look at the differential diagnosis of white lesions seen within the eye

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Fundus examination

Macular lesions are best examined using stereo-biomicroscopy through a dilated pupil using a non-contact lens. The authors use a high magnification lens, such as the Volk super 66 lens. Use of biomicroscopy gives a stereoscopic 3-D view, essential to gauge the depth of the lesion within the retina. A reasonable level of illumination is required to enhance the detection of any associated thickening or thinning of the retina. Many patients find the full beam uncomfortable, so a smaller slit 3mm in height and 1mm in width can be used. A relatively short macular examination is recommended to avoid any photopic damage.

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