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Diseases
AMBLYOPIA
ASTIGMATISM
BLEPHARITIS
CATARACTS
CHALAZION
CONJUCTIVITIS (BACTERIAL)
CORNEAL ABRASION
DETACHED RETINA
DIABETES
DRY EYES
FLASHES & FLOATERS
FUCHS' DYSTROPHY
GLAUCOMA
HERPES SIMPLEX
HERPES ZOSTER (SHINGLES)
IRITIS
KERATOCONUS
MACULAR DEGENERATION
MACULAR EDEMA
MYOPIA (NEARSIGNTEDNESS)
OCULAR MIGRAINES
OPTIC NEURITIS
PRESBYOPIA
RETINITIS PIGMENTOSA
STRABISMUS
STYE
TWITCHING EYELIDS
VIRAL CONJUNCTIVITIS (PINK EYE)
AMBLYOPIA
Amblyopia is defined as poor vision in an eye that did not develop
normal sight during early childhood. It is sometimes called a "lazy
eye." This condition is common, affecting approximately 2 or
3 out of every 100 people. The best time to correct amblyopia is
during infancy or early childhood.
Amblyopia is caused by any condition that affects normal use of
the eyes and visual development. In many cases, the condition associated
with amblyopia may be inherited. Children in a family with a history
of amblyopia or misaligned eyes should be checked by an ophthalmologist
early in life.
Amblyopia has three major causes:
- Strabismus (misaligned eyes) — Amblyopia
occurs most commonly with misaligned or crossed eyes. The crossed
eye "turns off" to avoid double vision and the child uses
only the better eye.
-
Unequal focus (refractive error) —
Refractive errors are eye conditions that
are corrected by wearing glasses. Amblyopia
occurs when one eye is out of focus because it is more nearsighted,
farsighted or astigmatic than the other.
The unfocused eye "turns off" and becomes amblyopic. The eye can look normal but one eye has poor vision. This is the most difficult type of amblyopia to detect since it requires careful measurement of vision.
- Cloudiness in the normally clear eye tissue — An eye disease such as a congenital cataract may lead to amblyopia. Any factor that prevents a clear image from being focused inside the eye can lead to the development of amblyopia in a child. This is often the most severe form of amblyopia.
Amblyopia cannot usually be cured by treating the cause alone. The
weaker eye must be made stronger in order to see normally. Successful
treatment mostly depends on your interest and involvement, as well
as your ability to gain you child's cooperation. In most cases,
parents play an important role in determining whether their child's
amblyopia is to be corrected.
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ASTIGMATISM
Astigmatism may be one of the most misunderstood words in the English
language. To illustrate what astigmatism really is, compare an egg
to a ping-pong ball, or a football to a basketball. Because they
are not perfectly round, the egg and the football have lots of astigmatism,
whereas the ping-pong ball and the basketball have none.
Similarly, two round surfaces in the eye are responsible for focusing
light: the clear outer window of the eye called the cornea and the
lens, which resides just behind the colored part of the eye (the
iris). If one or both of these surfaces are not perfectly spherical
or round, we say that astigmatism is present.
The usual site of this irregularity in the eye is the cornea. Rarely
astigmatism is caused by lid swellings such as chalazia (chronic
stye), and corneal scars, or by keratoconus (a rare condition in
which the cornea becomes misshapen and pointed rather than smooth
and rounded).
Astigmatism may cause blurred vision, eye strain
or even headaches. Small amounts of astigmatism can be ignored,
but if any of its symptoms are present, astigmatism can be corrected
by glasses or contact lenses. In most patients hard contact lenses
do a better job of correcting for astigmatism than soft contact
lenses.
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BLEPHARITIS
Blepharitis is a common, chronic infection and inflammation of the
eyelids. Symptoms include irritation, itching, and occasionally,
a red eye. Symptoms may disappear for months or even years and then
recur.
The most important factor in controlling blepharitis
is keeping your lashes meticulously clean. This can be accomplished
by daily cleaning with a mild baby shampoo solution (a few drops
of baby shampoo in a cup of warm water) or commercially available
eye scrubs.
Once the symptoms are under control, this cleaning may be decreased
from daily to twice weekly. However, if the symptoms return, daily
cleansing should be resumed immediately. Medication is of secondary
importance in the treatment. In some cases, eye drops or ointment
will be prescribed to be used along with the daily cleansing.
Warm, moist compresses can also help relieve the symptoms of blepharitis
when used in conjunction with regular eyelid cleansing. It is often
helpful to place a warm moist compress over the eyelids for 3 to
5 minutes prior to performing the eyelid cleaning procedure.
There are three main causes of blepharitis: staphylococcus
bacteria, seborrhea and rosacea. Staphylococcus bacteria
commonly begins in childhood and continues throughout adulthood.
Common symptoms include dandruff-like scales on lashes, crusting,
and chronic redness at the lid margin. Also seen are dilated blood
vessels, loss of lashes, sties, and chalazia. If left untreated,
infection and scarring of the cornea and conjunctiva can occur.
Seborrhea is secondary to overactive glands causing greasy, waxy
scales to accumulate along the eyelid margins. Seborrhea may be
a part of an overall skin disorder that affects other areas. Hormones,
nutrition, general physical condition and stress are factors in
seborrhea.
Blepharitis can also be associated with a
chronic disorder of the facial skin called rosacea. Skin
affected by rosacea has one or more of the following features: a
redness that looks like a blush, pimples, knobby lumps on the nose,
and/or thin red lines due to enlarged blood vessels. Rosacea develops
slowly over time and will often gradually worsen, but it can be
treated. Treatment may include oral antibiotics or antibiotic ointments
in association with the lid cleansing treatments for blepharitis.
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CATARACTS
Cataracts occur as part of the normal aging process. Studies show
that about 50% of all people will have some cataract formation before
age 60 and close to 100% will develop them by age 70. Cataracts
are the leading cause of vision loss in the world. However, not
all cataracts require surgery. They can severely impair your vision,
but luckily, it's also the most curable form of vision loss. Today,
modern surgical techniques, intraocular lens implantation and "same
day surgery" make cataract surgery safe, fast and effective.
A cataract is a clouding of the normally clear lens in your eye
that blocks the passage of light needed for vision and can cause
cloudy or hazy vision. Currently, there is nothing you can do to
prevent the formation of cataracts.
How do you know if you have a cataract? Some
people notice a gradual dimming of vision or distortion or "ghost"
images. They may also become increasingly sensitive to bright lights
or glare and have trouble driving at night.
Treatment is indicated when decreased vision
affects your everyday activities or hobbies. There are several
techniques to remove the clouded lens. The most widely used technique
is phacoemulsification. A very small incision is made and a tiny
ultrasonic probe is used to break up the cataract and gently suction
it away. A clear membrane, called the lens capsule bag, is left
in your eye where an intraocular lens is placed (IOL). This lens
is necessary to replace the powerful lens that turned cloudy and
has been removed. The IOL has almost eliminated the need for thick
cataract glasses and contact lenses that were used years ago.
The benefits to this small incision surgery are the short period
of time the procedure takes and the quick recovery time. Patients
are able to eat a light snack and drink immediately after the surgery.
The results of the surgery are almost immediate. Most people notice
an improvement in their vision soon after surgery. You may still
need glasses after the surgery for some activities such as driving
or reading, but your vision should be much clearer. Your new glasses
prescription will be given several weeks after the procedure.
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CHALAZION
Along the upper and lower lids are located a number of glands that
manufacture part of the tear film that protects and lubricates the
eyeball. If one of these glands becomes blocked, a small lump forms.
This is called a chalazion.
Chalazia may vary in size from small, almost invisible lumps, to
rather large masses as big as a little fingernail. Sometimes tender
in their early stages, they are later painful and frequently will
form a firm swelling in the lid. This lump can distort the eyeball,
causing blurred vision if left untreated.
Chalazia are not caused by infection.
They may become a site for infection once they have become established,
however.
Their exact cause remains unknown. Several conditions are associated
with chalazia: seborrhea, chronic lid inflammation, dry eyes, and
acne. Once a chalazion has formed, the chances of getting another
one in the next two years are very high.
Most chalazia will disappear in a few weeks without any special
therapy. To help them go away, frequent hot packs throughout the
day and drops are helpful, especially in the early stages. In some
cases, oral medications can help prevent recurrences.
If a chalazion persists, a simple in-office surgical procedure can
be performed to remove it. The chalazion is drained from the inside
or the outside of the lid after a small injection of a local anesthetic.
The eye is often patched overnight to insure proper healing. Healing
tends to be uncomplicated with minor pain only, but chalazia can
recur and excision cannot guarantee complete resolution.
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CONJUCTIVITIS (BACTERIAL)
The conjunctiva is the clear membrane that encircles and protects
the eyeball. When you look at the white of the eye you are really
looking through the conjunctiva at the sclera, the tough, leathery
outer coat of the eye. The conjunctiva has many small blood vessels
running through it. The purpose of the conjunctiva is to lubricate
and protect the eye and allow it to move in its socket. Conjunctivitis
is an inflammation of this lining of the eye. Conjunctivitis
can be caused by a number of different agents: bacteria (as in "pink
eye"), viruses, chemicals, allergies, and more. It is
sometimes difficult to tell exactly which is the real cause. This
page deals with Bacterial Conjunctivitis.
Bacterial Conjunctivitis is characterized by swelling of the lid,
a yellowish discharge, sometimes a scratchy feeling in the eye,
and itching and mattering of the lids, especially in the mornings
upon awakening. The conjunctiva is red and sometimes thickened.
Often both eyes are involved.
The bacteria most commonly at fault are the Staphylococcus, the
Streptococcus, and H. Influenza. This disease is very contagious,
and sometimes entire families are infected. Laboratory cultures
are not typically used to make the diagnosis since this is expensive
and time consuming. Most infections are over by the time the results
of the lab tests come back.
Treatment is curative. Usually antibiotic drops and compresses ease
the discomfort and clear up the infection in just a few days. Occasionally,
the infection does not respond well to drops. In those rare cases
a second visit to the office should be made and other measures taken.
In severe infection, oral antibiotics are necessary. Covering the
eye is not a good idea because that incubates the germs. If left
untreated, conjunctivitis can create serious complications, such
as infections in the cornea, lids, and tear ducts.
Prevention is important for avoiding the disease and stopping its
spread. Careful washing of the hands, the use of clean handkerchiefs,
and the avoidance of contagious individuals are all helpful. Young
children frequently get conjunctivitis because of their lack of
understanding about hygiene and contact with germs.
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CORNEAL ABRASION
One of the most common injuries to the eye is an abrasion. In this
condition, the surface layer of the eye (epithelium) is removed
by items such as baby's fingernails, tree limbs, bushes and the
like.
Abrasions are very painful. They cause excessive
tearing, redness, blurred vision and light sensitivity. These usually
heal in a short period of time. A good night's sleep is the cure
is most instances. Treatment consists of a tight patch to keep the
lids from moving and pain relievers as needed for comfort.
Often an antibiotic is instilled into the eye because an abrasion
invites infection. Abrasions covering small areas heal rapidly;
those covering more than one-third of the cornea may take an extra
day or two to completely cover over again. Sometimes small corneal
abrasions do not require a patch and are treated with antibiotic
ointment alone.
In the office, a local anesthetic is instilled into the eye for
temporary relief and for ease in making a reasonable examination
of the injury. (Repeated use of anesthetic can harm the eye and
is therefore not used in the treatment of abrasions.) Permanent
loss of vision is very rare with superficial abrasions, however, It may take
several weeks for all the blurriness to resolve.
It is important to not rub the eyes during the
healing phase. The new cells have poor connections to the
underlying tissue and can easily be rubbed off. When this occurs,
the pain returns and repatching is necessary.
Occasionally, long after an abrasion has healed it recurs spontaneously,
often upon awakening in the morning. This is called a recurrent
erosion and represents an area of the epithelium that is not "glued"
down well to the deeper parts of the cornea.
The treatment is similar to that for the abrasion. Sometimes the
surface of the cornea is treated with a special instrument in order
to help form better connections between the corneal layers. Extended
use of bedtime ointments or lubricants may also help in preventing
recurrent erosions.
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DETACHED RETINA
The retina lines the inside of your eye and is responsible for sending
images to your brain. This is similar to the film inside of a camera.
When the retina pulls away from the eye, a retinal detachment occurs.
The symptoms may include flashing lights, a "curtain"
over the vision, or many floaters. Sometimes these symptoms are
present without a retinal detachment. An immediate exam is necessary
if you experience these symptoms.
If a retinal tear is diagnosed, treatment
is done with a laser or freezing technique (cryotherapy) that seals
the detachment. This will usually prevent a retinal tear. If the
retina is detached, surgery is performed to place the retina back
into position.
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DIABETES
If you have diabetes mellitus, your vision can be affected by cataracts,
glaucoma and/or damage to the blood vessels in the eye. The latter
is called diabetic retinopathy.
The retina lines the inside of your eye and is responsible for sending
images to your brain. When the blood vessels are damaged, they may
leak fluid or blood and grow scar tissue. This affects the quality
of images sent to your brain and, therefore, your vision.
Diabetic Retinopathy is the leading cause of new blindness among
adults in the United States. The longer one has diabetes, the higher
the incidence of developing diabetic retinopathy. Approximately
80% of people who have diabetes for 15 years have some damage to
their retina. With today's treatment options, only a small percentage
of people have serious vision problems.
There are two types of diabetic retinopathy.
Background retinopathy
is the early stage. Usually vision is not affected, but it can advance
and cause vision problems. There usually are no symptoms with background
diabetic retinopathy. An exam is the only way to diagnose changes
in your eyes.
Proliferative retinopathy causes new and
abnormal blood vessels to grow on the retina. These vessels may
bleed causing the vision to become hazy and sometimes causing a
total loss of vision. There is no pain but this stage requires immediate
medical attention. New vessels may also form scar tissue and pull
the retina away from the back of the eye resulting in a retinal
detachment. Treatment is necessary to prevent severe loss of vision.
The disease can improve with treatment.
If you are diabetic, regular eye exams are crucial. Your eyes should
be checked at least once a year. Sometimes, more frequent examinations
are necessary if problems are detected.
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DRY EYES
Probably, the most common problem seen in the eye doctor's office
is dry eyes. As we age, the protective tear film on the surface
of the eye diminishes. This leaves the delicate tissues of the eye
exposed to the drying effects of air, wind, dust and sun. The eye
can still make tears; in fact, many patients complain of wet eyes
and tearing with this malady. That's because the dryness produces
a reflex tearing in an effort to keep the eye well lubricated.
For many people the dryness is worse in the afternoon and evening.
Since we blink less frequently when we read, reading or computer
use can also aggravate the symptoms of dry eyes. Sometimes environmental
factors play a role as well. Dry weather, either in hot or cold
temperatures, robs the eye of needed lubricants. Cigarette smoke,
fumes, dust and airborne particles are common irritants. In most
patients, this condition is not associated with any systemic disease.
Symptoms include burning, stinging or a gritty sensation which may
come and go depending on many factors. Itching, tearing and light
sensitivity may bother other patients. Occasionally, long strings
of mucus can be found in a person with dry eyes.
Treatment helps in most patients. We cannot cure this condition,
so treatment must be an ongoing project.
Usually, artificial tears, available over-the-counter, soothe the
eyes and give temporary relief. The problem is that they only work
for an hour or two, at best, and must be repeated at frequent intervals.
Ointments last longer, but they blur vision and are most effective
at night. Occasionally, punctual plugs to block the outflow of tears
away from the eye are needed. This is analogous to putting a plug
in the bathtub drain.
Newer methods of treatment for seriously dry eyes are soft contact
lenses in combinations with artificial tears. Sometimes a slow-release
medicine under the lower lid is helpful as well. Much research is
being done on this subject because it is such a problem. Time-release
artificial tears seem to hold the most promise, but details of its
use are still being worked out.
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FLASHES & FLOATERS
You may sometimes see small specks or clouds moving in your field
of vision. They are called floaters. You can often see them when
looking at a plain background, like a blank wall or a blue sky.
Floaters are actually tiny clumps of gel or cells inside the vitreous,
the clear jelly-like fluid that fills the inside of your eye.
When the vitreous gel rubs or pulls on the retina, you may see what
look like flashing lights or lightning streaks. You may have experienced
this same sensation if you have ever been hit in the eye and seen
"stars".
Are flashers and floaters ever serious?
Flashes and floaters often indicate a Posterior Vitreous Detachment
(PVD) which is a rather dramatic event in the normal aging process
of the human eye.
As we age, the watery elements in the vitreous separate from the
fibrous components. With this comes a contraction of the fibrous
elements away from the retina--a Posterior Vitreous Detachment.
This contraction on the retina is responsible for the characteristic
"flashes" that often accompany PVD's. The "floaters"
frequently reported are from the reorganization of the fibrous elements
as well as from some fragments of retina that may have been dragged
into the vitreous cavity by this separation. Besides age, other
contributing factors include nearsightedness and injuries to the
eye. Both may speed up the normal aging process.
All patients who experience a recent onset of
flashes and floaters should be examined carefully by an ophthalmologist.
Most of the time nothing unusual is found, and simple reassurance
is all that is needed. The flashes eventually go away, and the floaters
usually diminish and become less bothersome with time.
However, a tear in the retina is found in about 2 - 3% of eyes with
a PVD. If left untreated, these tears may lead to a retinal detachment,
a very serious sight threatening condition requiring a major surgical
procedure to repair. When symptoms appear, it is important to examine
the eye within a day of their onset. Changes can occur rapidly,
and time can be of the essence if a retinal detachment is present.
Usually this process will occur in both eyes. Even if all is normal
in the first eye, patients cannot assume that all will be well with
the second one. It also should be carefully examined and treated
if necessary.
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FUCHS' DYSTROPHY
Fuchs' Dystrophy is a disorder of the cornea. The
disease causes the cornea to thicken and become hazy. This
process occurs because a single layer of cells on the back part
of the cornea is no longer able to function correctly. This layer
of cells, called the endothelium, normally pumps fluid out of the
cornea in order for it to maintain its clarity. If too much water
enters the cornea, the cornea begins to swell and lose its transparency.
When the problem becomes chronic, further symptoms may appear. Painful
corneal blisters and decreased vision are the most common and can
occur because the cornea is not able to maintain its normal structure.
Fuchs' Dystrophy tends to be a slow process because the endothelium
(cell layer) slowly becomes non-functional. Several eyedrops and
ointments can be prescribed to keep the cornea clear by drawing
the water out of it. Sometimes a soft bandage contact lens is used
to improve the patient's vision and comfort.
At some point, it is often necessary to perform a corneal transplant
in which the opaque cornea is replaced by a clear normal cornea
from a donor eye. This is sometimes combined with cataract surgery,
replacing the lens within the eye with a clear implant.
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GLAUCOMA
Glaucoma is a leading cause of blindness in the
United States, especially for older people. Loss of vision
is preventable if treatment begins early enough.
It is a disease of the optic nerve. High pressure in the eye causes
loss of optic nerve tissue. The higher the pressure in the eye,
the greater the likelihood that damage to the optic nerve will occur.
High pressure can not be felt, but is measured with a special instrument
called a tonometer which should be a part of every routine eye exam.
Glaucoma rarely has symptoms before it affects vision. This is the
reason that routine eye exams are critical. Early detection is the
key to preventing vision loss or blindness from glaucoma.
Types of Glaucoma
Chronic open-angle glaucoma is the most
common type of glaucoma. It occurs with aging and is a result of
poor drainage of the clear liquid (aqueous humor) from the inside
of the eye. This liquid is not part of the tears that we normally
have in our eyes. Poor draining increases pressure which causes
optic nerve damage. It is so gradual and painless that you are unaware
there is a problem until the nerve is badly damaged. This damage
is not reversible. Over 90% of adult glaucoma patients have this
type of glaucoma.
Angle-closure glaucoma is when the drainage
system is completely blocked. This occurs very quickly and has symptoms
that include blurred vision, severe pain in the eye, headache, rainbows
or haloes around lights and nausea and vomiting. Angle-closure glaucoma
is an emergency. If it is not treated immediately, blindness may
result.
The risk factors for glaucoma include age, myopia (nearsightedness),
family history of glaucoma, diabetes, African ancestry, past injury
to the eyes, and a history of severe anemia or shock.
Glaucoma is usually treated with eye drops that are taken several
times a day. Laser surgery may be used for glaucoma. Sometimes a
surgery called trabeculectomy is performed if the eye drops and/or
laser do not control the pressure. This surgery creates a filter
or "trap door" for fluid drainage out of the eye.
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HERPES SIMPLEX
WHAT IS HERPES SIMPLEX?
Herpes simplex is a virus that infects the skin, mucous membranes
and nerves. There are two major types of herpes
simplex virus (HSV). Type I is the most common and is responsible
for herpes simplex eye disease and the familiar "cold sore"
or "fever blister". Type II
is responsible for sexually transmitted herpes and rarely causes
infection above the waist.
An original infection with herpes simplex type I (HSV type I) occurs
in 90% of the population, usually during childhood or adolescence.
The infection, sometimes only a mild sore mouth or throat, comes
from close personal contact with an infected person and usually
passes without notice. After the original infection, the virus goes
into a quiet or dormant period, living in nerve cells that supply
the skin or eye. Occasionally, the virus reactivates and causes
a recurrent "cold sore" or "fever blister".
WHAT IS HERPES SIMPLEX EYE DISEASE?
The most common herpes simplex eye disease caused by HSV type I
is a recurrent eye infection of the cornea -- the clear front window
of the eye -- which can potentially threaten sight. The infection
varies in duration, severity and response to treatment, depending
in part on which of several different strains of HSV type I caused
the original infection. It can be considered a "cold sore"
or "fever blister" of the eye.
The disease usually begins on the surface of the cornea. The eye
turns red, is uncomfortable and sensitive to light. For most people
this will be the only episode. Unfortunately, one out of four people
who have a corneal infection is likely to have a recurrence within
two years. The process may go deeper into the cornea and cause permanent
scarring or inflammation inside the eye. Chronic ulcers, which are
sometimes very difficult to heal, may also develop on the cornea.
Herpes simplex eye disease usually occurs in only one eye and rarely
spreads to the other eye. Spreading the infection to another
person is unlikely. In people with poor immunity, the herpes simplex
virus may infect other parts of the eye or body, such as the retina
or brain, but this occurs infrequently. It is important to remember
that herpes simplex eye disease is not usually caused by HSV type
II, the sexually transmitted herpes. While possible, sexual transmission
of herpes eye disease is extremely rare.
Treatment depends on the extent of the disease. Antiviral eye medications
are commonly used and may need to be applied as frequently as one
drop per hour. At times, it may be necessary to scrape the surface
of the cornea, to patch the eye, or to use a variety of medications.
In cases of severe scarring and vision loss, a corneal transplant
may be required.
It is very important to consult an ophthalmologist
before beginning any treatment since some medications may actually
make the disease worse.
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HERPES ZOSTER (SHINGLES)
WHAT IS HERPES ZOSTER?
Herpes zoster, commonly known as "shingles", is a viral
disease that causes a characteristic skin rash of small fluid-filled
blisters (vesicles) which form scabs and can leave permanent scars.
The first symptom is often severe pain or itching, followed by redness
of the skin, and finally, the appearance of a few or many of the
characteristic blisters.
The distribution of the blisters follows the route of the infected
nerve. Pain is often severe, accompanied by burning, throbbing and
extreme skin sensitivity. The rash lasts a few weeks but some people
experience pain months or years later. This extended involvement
is called "post-herpetic neuralgia".
WHAT CAUSES HERPES ZOSTER?
Varicella-zoster, the same virus that causes chicken pox, is responsible
for herpes zoster. After years of dormancy, the virus reactivates,
usually attacking older people or those with reduced immunity.
HOW DOES HERPES ZOSTER AFFECT THE EYE?
Herpes zoster commonly attacks the nerves around the eye, especially
the nerve that supplies the upper eyelid and forehead. If the virus
affects the nerves that go directly to the eyeball, it can cause
serious eye problems, including corneal ulcers, inflammation and
glaucoma. These problems may appear at the same time as the skin
rash or weeks after the vesicles have disappeared. Lingering pain
is the result of injured sensory nerves, which may remain overly
sensitive for years after the attack.
WHAT IS THE TREATMENT FOR HERPES ZOSTER?
The usual procedure is to control pain and prevent further skin
infection with soaks, scrubs and other treatments. Antiviral drugs,
steroids taken by mouth or other medicines may be helpful in some
circumstances. If the eyeball is affected, eyedrops, eye ointments
or oral medication may be necessary. Most people recover without
complications.
Unfortunately, despite all available medicines, some people have
permanent visual damage and continue to have pain even after the
skin rash has gone away.
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HYPEROPIA (FARSIGHTEDNESS)
Hyperopia (Farsightedness) occurs when light rays focus behind the
retina, instead of on the retina. The reason for this is that the
eye is too short or the cornea is too flat. This is often inherited.
A person with hyperopia is unable to see objects clearly up close
like books or newspapers. Many people are not diagnosed with hyperopia
until they have a complete eye exam. School screenings do not discover
this because they test for vision in the distance.
Treatment includes glasses for near work such as reading, contact
lenses or Laser Vision Correction.
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IRITIS
Iritis is a descriptive term for an inflammatory
disorder of the colored part of the eye (iris).
Sometimes iritis is just one symptom of a disease that affects other
organ systems: arthritis and spinal degenerative disease, juvenile
rheumatoid arthritis, psoriasis, sarcoidosis, ulcerative colitis,
Crohn's disease, lupus, and other collagen vascular diseases. Most
often, however, iritis appears by itself.
The symptoms of iritis include light sensitivity, red eye, blurred
vision, tearing, pain, and sometimes floaters. The pupil may appear
smaller in the affected eye when compared to the normal pupil. Frequently,
iritis is a recurrent problem; after a few episodes patients become
very astute at early diagnosis. Iritis is sometimes confused with
conjunctivitis, a much less serious disorder of the clear outer
lining of the eye.
The secrets to the successful treatment of iritis are early detection
and proper choice of medications. Therapy consists of cortisone
and dilating drops. These medicines quell the inflammation and reduce the scarring that
can occur. Persistent cases may require more intensive treatment,
such as injections of cortisone into the soft tissues around the
eye. These injections help to avoid the potential serious systemic
side effects of large doses of oral cortisone. Other oral medications
are being investigated to better understand their role in treating
this disease. Aspirin may prove to be very helpful.
In serious cases, complications may arise. Cataracts, glaucoma,
and corneal changes are possible consequences of both the disease
and the medication used to treat it. The best advice is "just
enough medicine to get the job done, but not too much".
Careful observation is needed in the resolving phase to monitor
potential problems. If the medicines are withdrawn too rapidly,
recurrence is very possible
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KERATOCONUS
WHAT IS KERATOCONUS?
Keratoconus is an uncommon condition in which the cornea (the clear
front window of the eye) becomes thin and protrudes. Keratoconus literally
means a cone shaped cornea. This abnormal shape can cause serious
distortion of vision.
WHAT CAUSES KERATOCONUS?
Despite continuing research, the cause of keratoconus remains unknown.
Although keratoconus is not generally considered an inherited disorder,
the chance of a blood relative having keratoconus is thought to be
as high as one in 10. Vigorous eye rubbing, although not the cause
of keratoconus, can contribute to the disease process. Therefore,
patients with keratoconus are advised to avoid rubbing their eyes.
WHAT ARE THE SYMPTOMS OF KERATOCONUS?
Blurring and distortion of vision are the earliest
symptoms of keratoconus. Symptoms usually appear in the late
teens or early twenties. The disease will often progress slowly for
10 to 20 years, then stop. In the early stages, vision may be only
slightly affected, causing glare, light sensitivity and irritation.
Each eye may be affected differently. As the disease progresses and
the cornea steepens and scars, vision may become distorted.
A sudden decrease in vision can occur if the cornea swells. The cornea
swells when the elastic part of the cornea develops a tiny crack,
created by the strain of the cornea's protruded cone-like shape. The
swelling may persist for weeks or months as the crack heals and is
gradually replaced by scar tissue.
HOW IS KERATOCONUS TREATED?
Mild cases are successfully treated with glasses or specially designed
contact lenses. When vision is no longer satisfactory with glasses
or contact lenses, surgery, usually a corneal transplant, is recommended.
Other surgeries such as special heating of the cornea (thermokeratoplasty)
or adding additional corneal tissue (epikeratophakia) can also be
done. If sudden corneal swelling occurs, your ophthalmologist may
prescribe eye drops for temporary relief.
Unfortunately, there are no medicines known which prevent progression
of the disease. If a corneal transplant is necessary for advanced
keratoconus, vision usually improves dramatically. As in any eye surgery,
complications such as transplant rejection, infection and loss of
vision can occur, so results cannot be guaranteed.
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MACULAR DEGENERATION
Macular degeneration affects the portion of the retina that is responsible
for our fine, close up vision and color perception. It usually affects
both eyes but often begins in one eye. Many people develop age related
macular degeneration as part of the body's natural aging process.
Often people are unaware that they are having problems
until the second eye has symptoms because the other eye compensates
for the weak one. Macular Degeneration does not lead to total
blindness but affects only the central vision. Your ability to read,
see fine detail and drive can be affected. Macular degeneration does
not affect the eyes side vision, or peripheral vision. For example,
you can see the outline of a clock but not be able to tell what time
it is.
The two most common types of age-related macular
degeneration are "dry" (atrophic or non-exudative) and "wet"
(exudative). Most affected people have dry macular degeneration.
It is caused by aging and thinning of the tissues of the macula. Vision
loss is usually gradual.
Wet macular degeneration accounts for about 10% of all cases. It results
when abnormal blood vessels form at the back of the eye. These new
blood vessels leak fluid or blood and blur central vision. Vision
loss may be rapid and severe.
Your eye doctor can detect early stages of macular
degeneration during a medical eye examination that includes
the following: viewing the macula with an ophthalmoscope, a simple
vision test in which you look at a grid resembling graph paper (Amsler
grid), and sometimes special photographs called flourescein angiograms
using dye to find abnormal blood vessels.
There is no cure yet for "dry" macular degeneration. A national
study did show a benefit, to some people, in slowing the progression
of macular degeneration by giving them a nutritional supplement containing
zinc oxide, copper, Beta-carotine, Vitamin C, and Vitamin E. Wet macular
degeneration can sometimes be treated with laser surgery and/or special
medications.
Macular degeneration alone does not result in total
blindness. People continue to have some useful vision and are
usually able to take care of themselves. Special optical devices or
low vision aides can often help these people maintain a satisfying
lifestyle.
You can check your vision daily by printing the
Amsler grid located at:
www.macular.org/chart.html
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MACULAR EDEMA
Cystoid macular edema, CME, is a painless disorder
which affects the retina, the light-sensitive inner lining of the
eye. When this condition is present, multiple cyst-like (cystoid)
formations appear in the portion of the retina responsible for central
or "straight-ahead" vision and cause retinal swelling or
edema.
Although the exact causes of CME are not known, it may accompany a
variety of diseases such as retinal vein occlusion, uveitis or diabetes.
It most commonly occurs after cataract surgery. About three percent
of those who have cataract extractions will experience decreased vision
due to CME in the first year, usually from two to four months after
surgery. If the disorder appears in one eye, there is an increased
risk - as high as 50% - that it will also affect the second eye. However,
most people recover their vision in time.
The most common symptom of cystoid macular edema is blurred or decreased
central vision. There may also be painless retinal inflammation or
swelling.
Since many factors can lead to CME, it is not possible to say which
treatment, if any, will prove effective. Treatments include anti-inflammatory
medications, laser surgery, or a surgical procedure call a vitrectomy.
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MYOPIA (NEARSIGHTEDNESS)
Myopia (Nearsightedness) occurs when the light rays focus in front
of the retina instead of on the retina. This is caused because the
eye is too long or the cornea is too steep.
Myopia occurs usually between eight and twelve
years of age and almost always before twenty years of age. As the body grows, the myopia often increases and levels as
an adult. Changes in glasses or contact lens prescriptions are necessary
during growth periods.
The symptoms include an inability to see objects in the distance such
as street signs, chalk boards and television. Most often this is diagnosed
during the screenings at school.
The treatment for nearsightedness is corrective lenses that allows
the light rays to focus on the retina. This is accomplished through contact lenses or glasses. Once the vision has stabilized, laser vision
correction is an option for many.
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OCULAR MIGRAINES
Ocular migraines (or retinal migraines) can cause symptoms related
to the classic or common migraine. In fact,
ocular migraines generally occur in young adults who have had a previous
history of common migraines. Also,
older people can experience ocular migraines without headache symptoms.
Symptoms of ocular migraine can be in one or both eyes. Quite often,
a gray or visual disturbance which starts centrally and moves off
to the side marks the beginning of an ocular migraine. The visual
disturbances can appear to the person as heatwaves, C-shaped or shimmering
lights, or multiple dark spots. Usually, this lasts five to sixty
minutes. Other common symptoms are loss of vision in one eye and increased
sensitivity to bright lights.
In general, there is no serious ocular complications caused by ocular
migraine. Treatment, in most instances, is not necessary unless, the
ocular migraine is linked to the common or headache type migraine.
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OPTIC NEURITIS
The optic nerve is the nerve of vision.
It carries images of what we see coded as electrical impulses, from
our eye to our brain. The brain then interprets what we see. The optic
nerve is like a cable of electrical wires, and consists of about 1,200,000
separate tiny wires, or nerve fibers. Each of these carries a part
of the information. If some or all of the nerve fibers do not do their
job, our vision becomes blurred.
Optic neuritis is the medical term used to describe
an inflammation of the optic nerve. The nerve tissue becomes
swollen, and the nerve fibers do not work properly. If many of the
nerve fibers are involved, the vision may be very poor, but if the
optic neuritis is mild, vision can be nearly normal. Many diseases
and conditions may cause optic neuritis, which may affect the optic
nerve of one or both eyes.
Some people, especially children, develop optic
neuritis following a virus illness such as mumps, measles, or a cold.
In others, optic neuritis may occur as a sign of a neurologic disease
affecting nerves in various parts of the body such as multiple sclerosis.
In a rare condition called Leber's optic neuropathy, which often runs
in families, a special kind of optic neuritis may appear in both eyes
within a short span of time. Most of the time, however, we cannot
discover a cause for optic neuritis. In those cases, we call the neuritis
idiopathic, meaning that no particular cause can be found.
Optic neuritis usually comes on suddenly, and the
patient notices vision is blurred in one or both eyes. The
vision is also dim, like somebody turned down the lights, and colors
may appear to be washed out. There may be pain in the area of the
eye socket, especially when moving the eyes. The vision may continue
to get worse over a week or two, and may seem worse after exercising
or a hot bath.
A careful description of these symptoms is important to your doctor
in the diagnosis of optic neuritis. Since the optic nerve enters the
back of the eye where it appears as a small disc, your eye doctor
can examine it by looking in your eye with a special instrument called
an ophthalmoscope. Swelling of the optic nerve may or may not be visible
depending on whether the optic neuritis is affecting the optic nerve
near the eyeball.
Since optic neuritis can be confused with many
other causes of poor vision, an accurate medical diagnosis is important. If a cause can be found and treated, further damage may be
prevented. Ultrasound, CT scans or visual brain wave recordings might
be ordered. Other tests which may be performed include color vision,
side vision, and pupil reactions to light.
Unfortunately, there is no good treatment for optic neuritis. Cortisone-like
medications (steroids) can be prescribed, but in most cases they are
not effective.
Fortunately, most patients with optic neuritis improve without treatment.
In some cases, the vision may return to normal. In other cases, good
but incomplete improvement occurs. A few patients fail to recover
normal vision, especially those with special conditions.
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PRESBYOPIA
The lens inside the eye changes shape when we look at an object up
close. When we focus up close the lens becomes thicker and as we look
into the distance, the lens becomes thinner.
Presbyopia occurs when the lens inside of the eye loses its flexibility.
The symptoms occur around age forty, are a normal part of the aging
progress and include blurred vision with up close tasks such as reading.
You may also notice difficulty changing focus from near to far.
If you are nearsighted, you may be able to take off your glasses and
see better up close. If you are not nearsighted, you will need reading
glasses or bifocals to see well up close.
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RETINITIS PIGMENTOSA
Retinitis Pigmentosa (RP) refers to a group of related diseases which
tend to run in families and cause slow but progressive loss of vision.
The retina is the tissue which lines the inside of the eye and sends
visual images to the brain. In retinitis pigmentosa, there is gradual
destruction of some of the nervous sensors in the retina along with
abnormal pigment clumping.
The first symptoms usually occur in youth or young adulthood although
it may be first seen at any age.
Night blindness and loss of side vision are
the most common symptoms in retinitis pigmentosa. People with
normal vision adjust to the dark after a short period of time and
are able to distinguish forms. People with night blindness adjust
to darkness very slowly, if at all. Loss of side vision (peripheral
vision) is a hindrance to those with retinitis pigmentosa, as mobility
becomes more difficult.
Most forms of retinitis pigmentosa are inherited.
Different patterns of heredity are associated with different degrees
of progression.
In general, there is no specific treatment, although one rare form
might benefit from proper vitamin therapy. Much research is directed
toward solving this problem. Until there is a cure, it is important
that patients with this disease not be deceived by those who claim
a "secret cure" or "miracle drug." Periodic examinations
by an ophthalmologist are advised.
Patients with retinitis pigmentosa may develop other treatable diseases,
such as glaucoma or cataract. Low vision aids may be prescribed. In
some cases, retinitis pigmentosa may be associated with other disease
processes which might need evaluation by other medical specialists.
Despite visual impairment, patients with retinitis pigmentosa can
live meaningful and rewarding lives with the many rehabilitative services
that are available today.
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STRABISMUS
Strabismus is a visual defect in which the eyes are misaligned and
point in different directions. One eye may look straight ahead, while
the other eye turns inward, outward, upward or downward. Patients
may always notice the misalignment or it may come and go. The turned
eye may straighten at times and the straight eye may turn.
Strabismus is a common condition among children. About 4% of all children
in the United States have strabismus.
It occurs equally in males and females. Strabismus can run in families.
The exact cause of strabismus is not fully understood.
Six eye muscles, controlling eye movement, are attached to the outside
of each eye. In each eye, two muscles move the eye right and left.
The other four muscles move it up and down and at an angle.
To line up and focus both eyes on a single target, all of the muscles
in each eye must be balanced and working together. In order for the
eyes to move together, the muscles in both eyes must be coordinated.
The brain controls the eye muscles. Strabismus is especially common
among children with disorders that affect the brain, such as: cerebral
palsy, Down's syndrome, and brain tumors. However, most children with
strabismus are otherwise healthy.
Although glasses, exercises or prisms may reduce or help control the
outward turning eye in some children, surgery is often needed. During
surgery, the ophthalmologist makes a small incision in the tissue
covering the eye to reach the eye muscle. Certain muscles are repositioned
during the surgery, depending on which direction the eye is turning.
As with any surgery, eye muscle surgery has certain risks including
infection, bleeding, excessive scarring and other rare complication
that can lead to vision loss.
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STYE
Stye is the common term used for an acute infection of the oil glands.
They are located on the eyelid margins. The correct medical term is
hordeolum. Sties are usually caused by the Staphylococcus germ and
are very common among the following groups of people: children, those
with chronic lid infections, diabetics, and sometimes in debilitated
patients with poor hygiene.
Sties tend to be painful, especially in the early stages when swelling
and redness are prominent. With time, they often form an abscess which
points to the skin, more rarely toward the eyeball itself.
Treatment consists of frequent hot packs, which usually speed up the
formation of white heads and pointing to the surface. Antibiotic drops
help to decrease the number of germs present and prevent spread.
Rarely is surgical drainage necessary. If the tissues surrounding
the stye are swollen and seem infected as well, oral antibiotics may
be helpful in clearing up the condition more rapidly. Scarring is
a very rare consequence of sties.
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TWICHING EYELIDS
Most of us have noticed a "twitching" in our eyelids at
one time or another. This can be annoying and sometimes embarrassing
but the good news is it usually not serious.
The most common causes of a "twitching" lid are stress,
tiredness or dry eyes. Most people find the nerve twitching will disappear
when stress is relieved or after catching up on sleep. Artificial
tears drops may also help.
Two other conditions that can cause eyelid twitching are benign essential
blepharospasm and hemifacial spasm. Benign essential blepharospasm
is a condition manifesting as uncontrolled blinking, twitching, or
closure of the eyelids. It always involves both eyes and may make
driving and reading difficult.
Hemifacial spasm results in uncontrolled blinking and twitching of
the entire side of the face. It involves only one side of the face
unlike benign essential blepharospasm. Both of these conditions require
further evaluation by an ophthalmologist. They can often be treated
with Botox injections.
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VIRAL CONJUNCTIVITIS (PINK EYE)
Probably the most common infection seen in the eye doctor's office
is a viral infection of the conjunctiva. The conjunctiva is the clear
lining that covers the surface of the white part of the eye. Sometimes
this infection is described as a "cold" in the eye.
Dozens of viruses can cause this type of infection. Sometimes only
the eye is infected; at other times the eye condition is part of a
more generalized problem, such as the "flu" or a cold. Both
eyes are usually involved, although one eye may become infected several
days prior to the other. Usually symptoms are mild and not serious.
Infrequently, however, the eye complaints are incapacitating and extremely
bothersome.
Symptoms of Viral Conjunctivitis include a wide
spectrum of complaints. Tearing, redness, swelling of the conjunctiva,
and a clear discharge are characteristic. Light sensitivity can also
be a prominent symptom. Sometimes a lymph node on the cheek in front
of the ear swells in response to the virus, (an important clue that
the patient has viral, not bacterial conjunctivitis).
If there is involvement of the cornea (the clear front window of the
eye) blurred vision may result. Fortunately, this blurriness usually
resolves over a few days to weeks and rarely leaves permanent scars.
Occasionally, the lids become swollen and the patient experiences
serious ocular pain, and very rarely there is bleeding into the lids.
Treatment is aimed at making the patient comfortable during the first
few days. Cool compresses soothe the eyes and lids, pain relievers
help with discomfort, and occasionally artificial tears will help;
but the real treatment is time and rest. Antibiotic drops do not help
to treat viral conjunctivitis. Symptoms may last up to two to three
weeks. If the blurred vision is significant, driving and work activities
should be done only with great caution and care.
Cortisone eye drops are sometimes of great assistance in controlling
the symptoms of this infection. Since this disease is very contagious,
prevention of spread is very important. The incubation period for
viral conjunctivitis is only one or two days, making rapid spread
very easy.
Hand washing is critical to avoid spreading the germ. Direct contact
with the infected eye should be avoided. Indirect contact through
hand towels, wash cloths, and clothing should be carefully eliminated.
Complete resolution is expected in almost all patients. Only rarely
do symptoms persist causing scarring and blurred vision.
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