An eye doctor might mention “white without pressure” after a retinal examination, a term describing a specific appearance in the eye’s periphery. This clinical finding is a visual characteristic of the retina, the light-sensitive layer at the back of the eye. As a medical observation, it is also cataloged within the classification system used for health records and billing, which ensures diagnoses are standardized.
Understanding White Without Pressure
During a dilated eye exam, an ophthalmologist may identify a distinct whitish, gray, or translucent area in the far edges of the retina. This finding is known as white without pressure (WWOP). The name indicates the whitish appearance is an inherent quality of that retinal area and is not a result of the doctor applying pressure to the eye, a technique called scleral depression.
WWOP is found in up to 30% of the population and is considered a benign anatomical variation rather than a disease. It can be thought of as a different texture or shade in the retina’s fabric that does not alter its function. The exact cause is not fully understood, but theories suggest it is related to traction from the vitreous—the gel-like substance that fills the eye—on the retinal surface. Advanced imaging with optical coherence tomography (OCT) has shown that areas of WWOP correspond to changes in specific retinal layers.
Clinical Importance and Patient Management
White without pressure is a harmless and stable finding that does not impact vision and is often discovered incidentally during a routine examination. Historically, there were concerns about a possible link between WWOP and an increased risk for retinal tears or detachments, especially because it is more common in myopic (nearsighted) eyes. This association was often noted when WWOP occurred alongside other peripheral retinal degenerations.
Current understanding indicates that WWOP by itself poses no significant threat. The standard management approach is observation. An eye care provider will document the finding and continue to monitor it during regularly scheduled eye exams. No active treatment is required for the finding itself.
The primary consideration in managing a patient with WWOP is to carefully examine the surrounding retina for co-existing conditions that carry a higher risk, such as lattice degeneration or retinal tears. Patients are advised to be aware of the symptoms of a retinal tear or detachment—like a sudden onset of flashes, floaters, or a curtain over their vision—and to seek immediate care if they occur. This guidance is standard for all patients but reinforces the need for monitoring.
Applying the Correct ICD-10 Code
Proper documentation in medical records and for billing requires a standardized code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Since “white without pressure” is not a disease but a specific clinical sign, it falls under a broader category for retinal disorders.
The appropriate root code used for white without pressure is H35.89, which stands for “Other specified retinal disorders.” This code is considered billable and specific, indicating it can be used for reimbursement purposes. The ICD-10-CM system requires the addition of a seventh character to specify laterality—that is, which eye is affected.
The complete codes are as follows:
- H35.891 for the right eye
- H35.892 for the left eye
- H35.893 for both eyes (bilateral)
- H35.899 for an unspecified eye
While the unspecified code exists, clinical best practices encourage using the most precise code available. Therefore, if the finding is identified in the right eye, the left eye, or both, the corresponding specific code should be used.
Related Peripheral Retinal Findings
It is helpful to distinguish white without pressure from other findings in the peripheral retina. Lattice degeneration, for example, involves patches of retinal thinning and has a stronger association with retinal tears and detachment. Pavingstone degeneration appears as small, well-defined yellow-white areas of atrophy in the outer retina but is not considered a risk factor for retinal detachment. Retinal tears are actual breaks in the retinal tissue and require prompt attention. An accurate diagnosis is important for determining the correct management for each condition.