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Ophthalmology Illustrated Review

July 23, 2012

Swiss cheese:

swiss cheese

Swiss cheese is a cheese from Switzerland, often termed as emmental or emmentaler, is a yellow, medium-hard cheese, with characteristic large holes. Few bacterias are used for the production of these cheeses. In the late stage of cheese production, there is release of carbon dioxide gas, which slowly forms the bubbles that make holes. In ophthalmology, the word, swiss cheese is used to describe a variety of lesions. In Band Keratopathy, small lucid areas are noted in the opacity, representing regions where corneal nerves penetrate Bowman’s layer. This characteristic picture of band keratopathy is described as “swiss cheese” appearance. Also in resolving stages of acute retinal necrosis, retinal pigment epithelium perturbation develops with areas of clearing in fundus  which form a characteristics “Swiss- cheese appearance”.

Pizza pie:


Pizza is a world-popular dish of Italian origin. The term pizza pie is dialectal, and pie is used for simplicity in some contexts, such as among pizzeria staff. In ophthalmology this word is used to describe the typical lesions of cytomegalovirus retinitis which resembles a pizza pie with an admixture of white (retinal inflammation) and red (hemorrhage) colors . The juxtaposition of large zones of whitish, granular necrosis, next to red retinal hemorrhage has led this presentation of CMV retinitis to be called either “pizza-pie” or “cheese and ketchup.”

Salt and pepper:

salt and pepper

The combination of salt and pepper can be found in every dining table. The tradition of using this combination was originated from 17th century French cuisine. In ophthalmology the word “salt and pepper” is used to denote fundus picture. For example,  fundus picture of congenital rubella, in which focal patches of retinal pigment epithelial hypopigmentation (salt) alternate with hyperpigmentation (pepper)is seen.

Tomato Ketchup:

tomato catchup

Ketchup is used as  a general term for sauce. In Sturge-Weber syndrome, diffuse choroidal hemangioma appears as a broad red-range thickening of the posterior choroid. The tumor appears more red than the background fundus, a finding sometimes called the “tomato ketchup” fundus.

Scrambled egg:

Scrumbled egg

The solid yellow egg yolk macular lesion is neither common in vitelliform macular dystrophy/ Best’s disease nor is it pathognomonic for this disorder. When it does occur the patient is usually asymptomatic with 6/6 vision. When this egg yolk “ruptures” the vision will then diminish. The appearance of the “scrambled egg”  or “pseudohypopyon” maculopathy is well recognized.

Port-wine :


The hallmark of Sturge-Weber syndrome is the nevus flammeus or port-wine stain which is found in the distribution of first, first and second, or first, second and third divisions of the trigeminal nerve. It is most often unilateral and respects the midline. It is present at birth and sometimes darkens with age. Histologically, the nevus flammeus is a cavernous hemangioma.

Cracked Mud:

cracked mud

In end-stage Progressive Outer Retinal Necrosis(PORN), dense white, plaque-like scarring with retinal atrophy occurs which is described as “cracked-mud” appearance.

Sunset glow:


The convalescent or recovery or chronic stage of Vogt-Kayanagi-Harada is characterized by pale fundus which is described as sunset-glow fundus.



In toxoplasmosis the acute lesions are elevated with indistinct hyperpigmented borders and most often are located in the posterior pole. Ophthalmoscopy is frequently obscured by a dense vitreous exudateor haze, giving the classic “headlight-in-a-fog” appearance.

Candle wax drippings:

candle wax

Yellow-white, waxy retinal exudates that appear to stream along retinal veins are seen in sarcoidosis. These are known as candle wax drippings and are often found in the inferior equatorial retina and occasionally in the posterior pole.

Bread Crumb:


Bread crumbs are small particles of dry bread, which are used for breading or crumbing foods. Granular corneal dystrophy shows discrete stromal opacities with the appearance of snow-flakes or bread crumbs.

Tobacco Dust:

Tobacco dust

Pigmented cells in the vitreous seen in retinal detachments are often described as tobacco dust.



The foveal schisis characteristically creates a cartwheel pattern formed by folds in the internal limiting membrane overlying microcyst within the nerve fiber layer.

Bag of worms:

Bag of worms

Plexiform neurofibroma consists of a proliferation within a nerve sheath, which produces a markedly thickened, tortuous nerve. On palpation, it has been described as resembling a bag of worms.

Champagne cork:


In the late stages of papilloedema, the optic disc takes the appearance of the dome of a champagne cork

Mutton Fat:


Large greasy-appearing aggregates of inflammatory cells on the corneal endothelium, typically seen in Granulomatous uveitis are termed as “Mutton Fat” Keratic precipitates.

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