Eye Conditions and Treatment
Amblyopia, commonly known as lazy eye, is an eye condition that results in reduced vision in one eye. This condition affects two to three percent of the population as a result of genetic causes, related conditions or trauma. When this condition occurs, the unaffected eye usually becomes stronger and suppresses the amblyopic eye, often rendering it useless.
Patients with amblyopia may experience eyestrain, squinting, headaches and overall poor vision. This condition usually develops in children before the age of six, and can significantly affect central vision if left untreated. While many cases are caused by a misalignment of the eyes, such as strabismus or crossed eyes, amblyopia can also be caused by trauma to the eye or a very strong refractive error.
Effective treatment for amblyopia depends on the underlying cause of the condition, but may include glasses to improve focusing or eye exercises to correct improper vision habits. Eye drops and patching may also be prescribed. More serious cases or those that do not respond to conservative treatment may need surgery to straighten the eyes so that they can focus together and see properly.
Astigmatism occurs when the cornea, the front surface of the eye, is curved slightly in one direction and causes blurred vision. The cornea refracts (bends) light so it focuses on the retina in the back of the eye. With astigmatism some of that light focuses in front of or behind the retina, so your vision may be blurry for nearby (hyperopia), far-away (myopia) or all objects.
Indications of astigmatism can include headaches, eye strain, fatigue, and blurred or distorted vision. The severity of symptoms depends on the degree of astigmatism in your eyes.
Routine eye exams include testing for astigmatism, which affects many people. Once diagnosed, astigmatism can usually be corrected with prescription eyeglasses or contact lenses. Corneal modification techniques such as LASIK (laser vision correction) are also useful treatment options.
Blepharitis is a chronic inflammation – a long-term swelling – of the eyelids and eyelash follicles. It may be caused by seborrheic dermatitis, acne, bacterial infection, allergic reaction or poor eyelid hygiene. The eyes may become red or blurry, as well as tear frequently. The eyelids crust, flake, scale or redden, and the smooth inside lining of the lids may become rough. In more serious cases, sores can form when the crusting skin is removed, the eyelashes may fall out, the eyelids can deform, the infection can spread to the cornea, and patients often suffer from excessive tearing. Blepharitis can also cause styes, chalazions and problems with the tear film.
Treatment and preventative care for blepharitis involves thorough but gentle cleaning of the eyelids, face and scalp. Warm compresses can be applied to loosen crust and dandruff shampoo can help keep the eyelids clear. This may be combined with antibiotics if a bacterial infection is causing or contributing to the problems.
Dry eye occurs when the eyes are not sufficiently moisturized, leading to itching, redness and pain from dry spots on the surface of the eye. The eyes become dry and irritated because tear production is low or because the tears themselves have a chemical imbalance.
Non-surgical treatments for dry eye include over-the-counter artificial tears, gels and lubricating ointments. Restasis®, a prescription eye drop, increases tear production and successfully relieves dry eye 80% of the time. Inserting plugs into the tear drains in the corner of the lids in order to limit tear drainage is equally successful. Eyelid surgery is also a solution if an eyelid condition is causing the eyes to dry out.
Dry Eye Syndrome
Dry Eye is a condition that commonly affects many of us, especially as we age. Tears are produced to lubricate the eyes and provide a smooth surface for optical clarity. Tears are produced to lubricate the eyes and provide a smooth surface for optical clarity. Tears are composed of three layers: the outer oily layer, the middle watery layer, and the inner mucous layer. Dry eye is caused by either decreased tear production or poor tear stability (excessive tear evaporation).
Common conditions that may result in dry eye include certain medical problems such as Rheumatoid Arthritis, Lupus, Sjogren’s syndrome (associated with both dry eye and dry mouth), and Thyroid Disorders. Certain medications may also commonly cause dry eye including antihistamines, decongestants, antidepressants, and oral contraceptives. Other problems such as poor blinking, eyelid abnormalities, extended contact lens wear, dry climates, and previous ocular injuries or surgery may also result in dry eye.
Symptoms of dry eye can include pain, redness and burning, itching, a gritty or foreign body sensation, blurred vision, and tearing. Since the eye waters when it is irritated, the irritation caused by poor lubrication causes the eye to water as a result.
While there is no cure for dry eye, several options are available for treatment. Artificial tear drops and lubrication ointments are often recommended for mild causes of dry eye. Other options may include prescription medications that may increase tear production or actually improve the stability of the tear film. Lacrimal plugs to decrease tear drainage, ocular nutrition with supplements, and rarely, surgery may be required for further alleviation of symptoms.
Ectropion & Entropion
Ectropion is a “turning out” of the eyelid that causes redness, irritation, tearing and an increased likelihood of infection. Common causes of ectropion include aging, sun damage, tumors, burns. Artificial tears can help provide temporary relief from dryness. Ectropion can be corrected in a quick procedure in which the lid is tightened. Occasionally, the surgeon needs to graft a small segment of skin to ensure that the eyelid is fully repaired.
Entropion is a “turning in” of the eyelid. The lid and lashes rub painfully against the cornea. Entropion usually occurs as a result of aging, but other causes can include injury, congenital defect and various inflammatory conditions. A spasm can cause the lid to turn inward. Entropion can be corrected with a brief surgical procedure under local anesthesia.
The eye is a complex organ that works much like a camera, focusing light rays and forming an image. On the surface of the eye is the cornea, a thin, spherical layer of tissue that provides a clear window for light to pass through. In a healthy eye, the cornea bends or refracts light rays so they focus precisely on the retina in the back of the eye.
Beneath the cornea is the iris, the colored part of the eye which we refer to when we say a person has brown or blue eyes. In the center of the iris is the pupil, which is the opening of the iris. The iris functions like a shutter, adjusting pupil size to control the amount of light entering the eye.
Located behind the iris is the lens, which works together with the cornea and vitreous to focus light. Like the lens in a camera, it adjusts light rays as vision shifts between nearby and distant objects in a process called accommodation.
Light then passes through the vitreous, the gelatinous substance that fills most of the eye and gives it its shape.
The back of the eye is lined with a thin layer of tissue containing millions of photoreceptor (light-sensitive) cells. This is the retina, where light rays focus into an upside-down image. In the center of the retina is the macula. Less than 1/4 of an inch in diameter, the macula is responsible for clear central vision. The retina converts the image into an electrical signal that travels down the optic nerve to the brain.
Flash & Floaters
Flashes and floaters are common eye symptoms that occur as a result of age-related changes to the vitreous gel. At birth, the vitreous is firmly attached to the retina and is a thick, gelatinous substance without much movement. But as we age, the vitreous begins to liquefy and debris that was once secure in the gel can now float around, casting shadows on the retina. Floaters can be specks, strands or webs and most visible when looking at a uniform light background like the sky or lightly-colored wall.
Eventually the vitreous get begins to shrink and separate from the retina. At this point, head or eye movement can cause the vitreous to make intermittent contact with the retina, resulting in occasional light flashes or lightening streaks. As the vitreous continues to peel free, it might reach a point where it is firmly attached to the retina and the traction can cause rapid-fire flashes like a strobe. Sometimes, the vitreous tugs so forcefully that it causes a tear in the retina.
If you experience an increase or onset of floaters of if you see flashing lights, it is important to be examined promptly. Although most eyes with these symptoms do not have a retinal tear, those that do require treatment to seal the tear and prevent a more serious problem; at detached retina.
Farsightedness, or hyperopia, is a condition in which the eye focuses on distant objects better than on objects closer to the eye, so nearby objects appear blurry. This happens when light rays refract, or bend, incorrectly in the eye. The eye is designed to focus images directly on the surface of the retina; when the cornea is incorrectly curved or the eye is small, light rays focus behind the surface of the retina, producing a blurry image.
Hyperopia can be treated in a variety of ways. The most common is with glasses or contact lenses. Hyperopia can also be treated with non-invasive medical procedures, including the laser surgeries PRK (photorefractive keratectomy) and LASIK (laser-assisted in situ keratomileusis).
The macula is a small spot in the center of the retina that focuses light at a sharp point and allows us to see objects in detail. This is especially useful for reading, driving and other everyday activities that require clear vision. A macular hole often develops as part of the natural aging process, when the vitreous gel thins and separates from the macula. This can pull on the macula and cause a hole to form. Macular holes can also develop from injury, inflammation, retinal detachment or other eye diseases.
In its early stages, a macular hole may cause a small blurry or distorted area in the center of vision. As the hole grows over time, central vision progressively worsens, and peripheral vision may also be affected. There are three different stages of macular holes, including foveal detachments, partial-thickness holes and full-thickness holes. Each stage can progress to the next if left untreated.
Most macular holes can be successfully treated through vitrectomy, a surgical procedure to remove the vitreous gel and stop it from pulling on the retina. The doctor then inserts a mixture of air and gas into the area to keep its shape. Vitrectomy is performed on an outpatient basis under local anesthesia and is considered a safe and effective treatment for a macular hole.
Nearsightedness, or myopia, is a vision condition in which nearby objects are clear and distant objects appear blurry. This may be caused by excess corneal curvature or an oblong rather than a spherical shape to the eye, both of which affect the way light is bent upon entering the eye and whether it focuses properly on the retina.
Almost a third of people in the U.S. experience some degree of nearsightedness, which normally emerges by age 20. Symptoms include difficulty focusing on objects in the distance, such as a chalkboard or television. There is some evidence that it is caused or worsened by sustained focus on nearby objects. Nearsightedness may also be hereditary.
Eyeglasses and contact lenses are common methods of correcting nearsightedness. Eyewear may be used for certain activities, like watching television or driving, or for all activities. Alternatively, vision correction procedures such as refractive and laser surgery are available depending on your doctor’s recommendation.
You may have noticed that you need to hold reading materials further away than usual, or that your vision is blurry at a distance that never used to be a problem. Or maybe you’ve been suffering from eye fatigue and headaches when working with materials at a close range. These are classic symptoms of presbyopia.
Presbyopia is a natural change in our eyes’ ability to focus. It occurs when the crystalline lens of the eye loses its flexibility, causing objects to appear blurry. Symptoms take years to develop and typically begin to show in the early- to mid-40s.
The effects of presbyopia can be corrected with bifocal or progressive glasses, multifocal or monovision contact lenses, conventional surgery with multifocal or monovision intraocular lenses or laser surgery with PRK or LASIK.
Retinal detachment is a serious eye condition that occurs when the retina becomes separated from the wall of the eye and its supportive underlying tissue. The retina cannot function when these two layers are detached, and without prompt treatment, permanent vision loss may occur. Retinal detachment can occur from injury to the eye or face, or from very high levels of nearsightedness.
Patients with retinal detachment may experience a blind spot, blurred vision or shadows forming in their peripheral vision. Other symptoms may include an increase in flashes and floaters. It is important to see your doctor at the first sign of symptoms in order to minimize the damage caused by this condition.
To prevent permanent vision loss, the retina must be quickly reattached. Treatment for retinal detachment can be done through surgery or laser photocoagulation. Photocoagulation seals off leaking blood vessels and destroys new blood vessel growth, allowing the retina to reattach. Pneumatic retinopexy, a procedure that creates a gas bubble within the vitreous gel and then expands to place pressure against the retina, can also help with reattachment.
These procedures can preserve vision and may also allow lost vision to return in some patients. The sooner the retina is re-attached, the more effective the treatment tends to be. If you are experiencing symptoms of retinal detachment, please call us immediately.
Located at the back of the eye, the retina is attached to the vitreous, the gel-like substance that makes up for most of the eye’s volume. Although the vitreous begins as a thick substance with a firm shape, the consistency of the gel changes and becomes thinner and more watery as we age. A change in the shape of the vitreous can cause it to pull away from the retina and leave a tear. A retinal tear leaves the retina unprotected and can allow fluid to travel between the retina and the wall, which may lead to retinal detachment.
Retinal tears may occur in patients with myopia (nearsightedness), as the condition may cause the vitreous to pull away from the retina. Although a retinal tear does not cause pain, patients may experience flashes or floaters in their field of vision, a reduction of vision, a shadow or curtain forming in the peripheral vision, or other vision changes. It is important to see your doctor at the first symptom of a retinal tear.
Early detection and prompt treatment of a retinal tear can often prevent the retina from detaching through prompt treatment. A retinal tear is usually treated with a laser to burn the area around the tear, causing it to scar and seal the retina to the tissue underneath it. This prevents fluid from flowing through the tear and leading to retinal detachment. Treatment for a retinal tear is usually effective in relieving symptoms and preventing retinal detachment from occurring.
Retinal Vein Occlusion
Blood and nutrient circulation to and from the surface of the retina is mostly done through one vein and one artery. If these passages or any of the smaller branches connected to them are blocked, blood flow to the retina can become seriously disrupted. Blockage of one of these passages is known as occlusion, and can result in sudden vision loss.
The retinal vein carries blood away from the body, and may cause blood to build up and hemorrhage if it is blocked. Retinal vein occlusion, also known as venous stasis retinopathy, can also cause swelling, bleeding and growth of abnormal blood vessels, which can in turn lead to other serious eye diseases.
This condition is most common in men and women over the age of 50, although the risk continues to increase with age. Other risk factors may include high blood pressure, high cholesterol, diabetes, smoking, glaucoma and, rarely, blood clotting and inflammatory conditions.
Although there is no cure for retinal vein occlusions, there are several treatment options available to help minimize risks, treat symptoms, and prevent further vision loss. The best treatment for each patient depends on the severity and location of the blocked vein, but may include laser photocoagulation or intraocular steroids.
The vitreous is the gel-like substance that makes up approximately two-thirds of the eye’s volume and is located in between the lens in the front of the eye and the retina in the back of the eye. In normal, healthy vitreous gel, there are no blood vessels, but diseases such as diabetic retinopathy can lead to the development of new blood vessels which can grow into the vitreous gel. These blood vessels are often fragile and susceptible to leaking blood and fluids.
A vitreous hemorrhage occurs when one of these blood vessels ruptures and causes bleeding within the vitreous gel, causing visual symptoms. Normal blood vessels may also rupture, although less common, as a result of force from a retinal tear or detachment. Patients with vitreous hemorrhage usually notice a sudden, significant increase in the number and size of floaters blocking their vision. Severe bleeding can also cause vision to appear blurry, cloudy or hazy.
When symptoms occur, it is important for patients to seek prompt medical attention. Your doctor will examine your eye along with your medical history to determine the cause of the hemorrhage and then recommend an appropriate treatment. Treatment for a vitreous hemorrhage may include vitrectomy, cryotherapy, laser photocoagulation, or intravitreal injections.
Glaucoma is the leading cause of blindness and visual impairment in the US, and can affect patients of all ages, many of whom do not experience any symptoms and may not be aware that they have the disease. Glaucoma actually refers to a group of diseases that cause damage to the optic nerve as a result of increased pressure within the eye, but can also be caused by a severe eye infection, injury, blocked blood vessels or inflammatory conditions of the eye.
There are two main types of glaucoma, open-angle and angle-closure. Open-angle glaucoma is the most common type of glaucoma and involves fluid in the eye not draining properly through the trabecular meshwork. Angle-closure glaucoma involves a sudden buildup of pressure in the eye and poor drainage because the angle between the iris and the cornea is too narrow.
Many patients do not experience any symptoms during the early stages of glaucoma, including no pain and no vision loss. This makes it difficult for many patients to know if they have the disease. But as glaucoma progresses, patients may experience a loss of peripheral or side vision, along with sudden eye pain, headache, blurred vision or the appearance of halos around lights.
While some patients may experience symptoms from glaucoma as the disease progresses, others do not learn they have the condition until they undergo a routine eye exam. There are several different exams performed to diagnose glaucoma, including a visual field and visual acuity test. These tests measure peripheral vision and how well patients can see at various distances. Other tests may also be performed, such as tonometry to measure the pressure inside the eye and pachymetry to measure the thickness of the cornea, and optic nerve scans to evaluate the health of the nerve.
Treatment for Glaucoma
Once glaucoma has been diagnosed, treatment should begin as soon as possible to help minimize the risk of permanent vision loss. There is no cure for glaucoma, so treatment focuses on relieving symptoms and preventing further damage from occurring. Most cases of glaucoma can be treated with eye drops, laser surgery or microsurgery. The best treatment for your individual case depends on the type and severity of the disease, and can be discussed with your doctor.
- Eye drops are used to reduce fluid production in the front of the eye or to help drain excess fluid, but can lead to redness, stinging, irritation or blurry vision. Patients should tell their doctor about any drug reactions to minimize the risk of side effects.
- Laser surgery for glaucoma aims to increase the outflow of fluid from the eye or eliminate fluid blockages (such as laser trabeculoplasty, iridotomy and cyclophotocoagulation.)
While there are no surefire ways to prevent glaucoma from developing, regular screenings and early detection are the best forms of protection against the harmful damage that the disease can cause. While anyone can develop glaucoma, some people are at a higher risk for developing disease. These people may include those who:
- Are over the age of 60
- African Americans over the age of 40
- Have a family history of glaucoma
- Have poor vision
- Have diabetes
Patients should have a comprehensive, dilated eye exam at least once every two years, especially if they have a higher risk of developing glaucoma. Older patients may be encouraged to be tested more frequently.
To learn more about glaucoma and how you can be tested for this serious condition, please call us today to schedule an appointment with one of our doctors.
Diabetic Eye Diseases
Patients with diabetes are at a higher risk for developing eye conditions because a high blood sugar level can damage blood vessels in the eye. Over 40 percent of patients diagnosed with diabetes develop some form of eye disease as a result. These conditions can cause blood or fluid to leak from the retina or new blood vessels to grow on the surface of the retina which can lead to significant damages to your vision and overall quality of life.
It is important for patients with diabetes to have dilated eye exams once a year to detect any signs of diabetic eye disease as soon as possible. You can also minimize your risk of developing diabetic eye disease by keeping your blood sugar and blood pressure under control, eating a healthy diet and exercising regularly.
Your eyes can be affected by several different eye diseases related to diabetes. Some of these conditions include:
Diabetic retinopathy is the most common diabetic eye disease and is a leading cause of blindness in adults. Diabetic retinopathy develops as a result of changes in blood sugar levels or simply the presence of long-term diabetes. Most patients don’t develop this condition until they have had diabetes for at least 10 years. If high blood sugar levels cause blood vessels in the retina to leak blood or fluid, the retina may become swollen and form deposits.
Patients who develop diabetic retinopathy may not notice any changes to their vision at first. In its earliest stages, this condition causes tiny areas of swelling in the small blood vessels of the retina. More and more blood vessels can become blocked, and the retina may send signals for new blood vessels to be grown.
Early stages of diabetic retinopathy do not usually require treatment, just that patients monitor their blood sugar level to prevent the disease from progressing. If the disease does progress, treatment may be necessary to preserve your vision.
Proliferative Diabetic Retinopathy
Proliferative diabetic retinopathy is the most advanced stage of diabetic retinopathy, and is classified by the growth of new blood vessels on the retina. These blood vessels are abnormal and fragile, and are susceptible to leaking blood and fluid onto the retina, which can cause severe vision loss and even blindness.
If blood leaks onto the retina, patients may begin to notice floaters in their vision, which are actually specks of blood that appear in front of your vision. While floaters can sometimes clear up on their own, it is important to see your doctor as soon as you notice them, as they can recur and lead to severely blurred vision and vision loss.
Patients with proliferative diabetic retinopathy usually seek laser surgery to treat their condition. This treatment is known as scatter laser treatment and is used to shrink the newly developed abnormal blood vessels using up to 2,000 laser burns in the area of the retina. This treatment is usually performed in two or more sessions because of the high number of laser burns necessary. Scatter laser treatment is most effective before new blood vessels have started to leak, and may slightly reduce patients’ color and night vision, while preserving your central vision. Severe bleeding may require a vitrectomy, or removal of the vitreous, to remove blood from the center of the eye.
Diabetic Macular Edema
Macular edema is a serious condition that can occur at any stage of diabetic retinopathy and involves a buildup of fluid in the macula, the light-sensitive part of the retina that allows us to see objects with great detail. Macular edema can cause difficulty reading or doing close work, and can often greatly affect a patient’s quality of life by interfering with regular activities.
Your doctor can diagnose macular edema during your regular eye exam before symptoms are present, but you should seek prompt medical attention at the earliest signs of this condition. Retinal swelling may indicate an early sign of macular edema.
Treatment for macular edema usually includes a laser procedure called focal laser treatment. During this procedure, several hundred small laser burns are placed in the areas of retinal leakage around the macula to prevent leakage from occurring and reduce the amount of fluid in the retina. This helps reduce the risk of vision and can even improve lost vision in a small number of cases. Focal laser treatment is performed in your doctor’s office and can usually be completed in just one session.