Disease & Treatment of Eye Disorders

Seasonal allergic conjunctivitis, or hay fever, is the most common allergic eye problem. Various antihistamine and decongestant eyedrops and sprays can soothe your irritated eyes and nose.

Make every effort to avoid allergens. An allergist can help determine what you are allergic to so you can stay away from it. Staying away from outdoor pollen may be impossible, but remaining indoors in the morning when the outdoor pollen levels are highest may help control symptoms. If you are allergic to house dust, open the windows and keep household filters clean.

Applying cool compresses to the eyes helps decrease swelling and itching. Artificial tears dilute the allergens and form a protective barrier over the surface of the eye. Avoid rubbing the eyes, which makes symptoms worse.

If seasonal allergic conjunctivitis is a problem, schedule an appointment with one of our highly skilled eye doctors who can prescribe several safe and effective anti-allergy drops. In some cases, oral medications are needed. Our doctors will also make sure that your symptoms are not being caused by a more serious problem.

Either a bacterial or a viral infection may cause conjunctivitis. Viral conjunctivitis is much more common. It may last several weeks and is frequently accompanied by a respiratory infection (or cold). Antibiotic drops or ointments usually do not help, but symptomatic treatment such as cool compresses or over-the-counter decongestant eyedrops can be used while the infection runs it course. Unlike viral conjunctivitis, bacterial conjunctivitis can be treated with a variety of antibiotic eyedrops or ointments, which usually cure the infection in a day or two.

Conjunctivitis can be very contagious. People who have it should not share towels or pillowcases and should wash their hands frequently. They may need to stay home from school or work, and they should stay out of swimming pools.

Not all cases of conjunctivitis are caused by an infection. Allergies can cause conjunctivitis, too. Typically, people with allergic conjunctivitis have itchy eyes, especially in spring and fall. Eyedrops to control itching are used to treat allergic conjunctivitis. It is important not to use medications that contain steroids (names of steroids usually end in “-one” or “-dex”) unless prescribed by qualified eye doctor. Finally, not all cases of pink eye are caused by conjunctivitis. Sometimes more serious conditions, such as infections, damage to the cornea, very severe glaucoma, or inflammation inside the eye will cause the conjunctiva to become inflamed and pink. Visionc an be affected when pink eye is caused by conjunctivitis. If your vision has changed or you experience eye pain, it is recommended that you see a qualified eye doctor.

Your eyes constantly produce tears at a slow and steady rate so that they stay moist and comfortable. Some people are not able to produce enough tears or the appropriate quality of tears to keep their eyes healthy or comfortable. This condition is known as dry eye.

Symptoms of dry eye include scratchiness, stinging, stringy mucus in or around the eyes, and blurry vision.

Sometimes people with dry eye will experience excess tearing. This is the eye’s response to the discomfort from dry eye. When the eyes get irritated, the gland that makes tears releases a larger than usual volume of tears, which overwhelm the tear drainage system. These excess tears then overflow from your eyes.

Dry eye often increases with age as tear production slows. For women, this is especially true after menopause. Dry eye can be associated with other problems like Sjögren’s syndrome, which can cause dry eyes along with dry mouth and arthritis.

Our eye doctors can diagnose dry eye by examining your eyes. Sometimes tests that measure tear production are necessary. The Schirmer tear test measures tear production by placing filter-paper strips between your eyeball and your lower lid. Your ophthalmologist might also test you for dry eye using diagnostic drops to check for patterns of dryness on the eye’s surface.

Treatments for dry eye include eyedrops called artificial tears to lubricate the eyes and help maintain moisture. Your ophthalmologist may conserve your tears by closing the channels through which your tears drain. You can also try to prevent tears from evaporating by avoiding wind and dry air from overheated rooms and hair dryers. Smoking irritates dry eyes and should be avoided.

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When a chalazion is small and without symptoms, it may disappear on its own. If the chalazion is large, it may cause blurred vision. Chalazions are treated with any or a combination of the following methods:

• Warm compresses help to clear the clogged gland
• Antibiotic ointments may be prescribed if bacteria infect the chalazion
• Steroid injections may be used to reduce inflammation
• Surgery may be used to drain a large chalazion if it does not respond to other treatments. The procedure is usually performed under local anesthesia by one of our ophthalmologists. Chalazia usually respond well to treatment, although some people are prone to recurrences. If a chalazion recurs in the same place, our ophthalmologists may suggest a biopsy to rule out problems that are more serious.

The exact cause of pterygia is not well understood. They occur more often in people who spend a lot of time outdoors, especially in sunny climates. Long-term exposure to sunlight, especially to ultraviolet (UV) rays, and chronic eye irritation from dry, dusty conditions seem to play an important role. Dry eye also may contribute to pterygium.

When a pterygium becomes red and irritated, eyedrops or ointments can be used to help reduce the inflammation. If the pterygium grows rapidly or is large enough to threaten sight, it can be removed surgically.

Despite proper surgical removal, a pterygium may return, particularly in young people. Protecting the eyes from excessive ultraviolet light with proper sunglasses, avoiding dry, dusty conditions, and using artificial tears can also help.

A pinguecula is a yellowish patch or bump on the white of the eye, most often on the side closest to the nose. It is not a tumor but is an alteration of normal tissue resulting in a deposit of protein and fat. Unlike a pterygium, a pinguecula does not actually grow onto the cornea. A pinguecula can also be a response to chronic eye irritation or sunlight.

No treatment is necessary unless the pinguecula becomes inflamed. A pinguecula does not grow onto the cornea or threaten sight. On rare occasions, a pinguecula can be surgically removed if it is particularly annoying.

Over time, the lens of our eye can become cloudy, preventing light rays from passing clearly through the lens. The loss of transparency may be so mild that vision is barely affected, or it can be so severe that no shapes or movements are seen—only light and dark. When the lens becomes cloudy enough to obstruct vision to any significant degree, it is called a cataract.Eyeglasses or contact lenses can usually correct slight refractive errors caused by early cataracts, but they cannot sharpen your vision if a severe cataract is present.

The most common cause of cataract is aging. Other causes include trauma, medications such as steroids, systemic diseases such as diabetes, and prolonged exposure to ultraviolet light. Occasionally, babies are born with a cataract.

Cataracts typically develop slowly and progressively, causing a gradual and painless decrease in vision. Other changes you might experience include blurry vision; glare, particularly at night; frequent changes in your eyeglass prescription; a decrease in color intensity; a yellowing of images; and in rare cases, double vision.

As the eye’s natural lens gets harder, farsighted (presbyopic) people, who have difficulty focusing up close, can experience improved near vision and become less dependent on reading glasses. However, nearsighted (myopic) people become more nearsighted, causing a worsening in their distance vision. Some kinds of cataracts affect distance vision more than reading vision. Others affect reading vision more than distance vision.

Reducing your exposure to ultraviolet light by wearing a wide-brimmed hat and sunglasses may reduce your risk for developing a cataract, but once one has developed, there is no cure except to have the cataract surgically removed.

With a routine, outpatient surgical procedure, our highly skilled affiliated ophthalmologists can remove the cataract, making either a small incision (phacoemulsification) or a larger incision (extracapsular extraction). A synthetic intraocular lens (IOL) is inserted at the time of cataract extraction to replace the focusing power of the natural lens. IOLs can be monovision (fixed-focus for a preset distance) or multifocal, which allows focused vision at many distances. The time to have cataract surgery is when the cataract is affecting your vision enough to interfere with your normal lifestyle.

Cataract surgery is a very successful operation. One and a half million people have this procedure every year in the United States, and 95% have a successful result. As with any surgical procedure, complications can occur during or after surgery, and some are severe enough to limit vision. But in most cases, vision, as well as quality of life, improves.

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In phacoemulsification, an ultrasonic oscillating probe is inserted into the eye. The probe breaks up the center of the lens. The fragments are suctioned from the eye at the same time. A small incision that often does not require sutures to close can be used, since the cataract is removed in tiny pieces. Most of the lens capsule is left behind and a foldable intraocular lens (IOL) is implanted permanently inside to help focus light onto the retina. Vision returns quickly and one can resume normal activities within a short period of time.

Your eye’s natural lens plays an important role in focusing images on the retina. When a cataract develops, the lens loses its clarity. Light rays cannot focus clearly, and the image you see is blurry. Eyeglasses or contact lenses usually can correct slight refractive errors caused by early cataracts, but they cannot sharpen your vision if an advanced cataract is present.

The only treatment for a severe cataract is to remove the eye’s natural lens and replace it with an IOL. Intraocular lenses offer many advantages. Unlike contact lenses, which must be removed, cleaned, and reinserted, the IOL remains in the eye after surgery.

An IOL may be implanted either in front of or behind the iris. Behind the iris is the most frequent placement site. IOLs can be made of hard plastic, soft plastic, or soft silicone. Soft, foldable lenses can be inserted through a small incision, which shortens recovery time following surgery.

The rapid evolution of IOL designs, materials, and implant techniques has made them a safe and practical way to restore normal vision after cataract surgery.

The most common type of IOL is the monofocal or fixed-focus IOL. The monofocal lens helps you attain clearer vision at one distance. Note that eyeglasses and contact lenses are still required in order for you to see clearly at all ranges of distance.

Another type of IOL is the multifocal IOL. The multifocal lens has several rings of different powers built into the lens. The part of the ring you look through will determine if you can see clearly at far, near, or intermediate distances.

A third type of IOL is the accommodative IOL. The accommodative lens has a hinge designed to work with your eye muscles, allowing the lens to move forward as the eye focuses on near objects and backward as the eye focuses on distant objects. This movement allows you to focus clearly at different distances.

During cataract surgery, part of the front (anterior) capsule of the eye’s natural lens is removed to gain access to and remove the lens. The clear, back (posterior) capsule remains intact and supports an intraocular lens (IOL), a plastic or silicone disc that is implanted in the eye and replaces the natural lens. As long as that capsule stays clear, you will experience good vision. But in 10% to 30% of cases, the posterior capsule loses its clarity. When this happens, the ophthalmologist can create an opening in the capsule using a laser in order to restore normal vision. This procedure is called a posterior capsulotomy.

Before the laser procedure, the ophthalmologist does a thorough ophthalmic examination to make sure there is no other reason for vision loss.

The posterior capsulotomy is painless and takes approximately five minutes. Eye pressure is measured 30 minutes after the operation to make sure it is not elevated, and anti-inflammatory medicated eyedrops are usually prescribed for three days following the procedure. Vision usually improves within hours.

Potential but rare complications following laser posterior capsulotomy are increased intraocular pressure and retinal detachment.

The visual symptoms of AMD involve loss of central vision. While peripheral (side) vision is unaffected, with AMD, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and looking at detail.

Although the specific cause is unknown, AMD seems to be part of aging. While age is the most significant risk factor for developing AMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors. AMD accounts for 90% of new cases of legal blindness in the United States.

Nine out of 10 people who have AMD have atrophic or “ dry” AMD, which results in thinning of the macula. Dry AMD takes many years to develop. A specific vitamin regimen has been shown to slow progression of dry AMD.

Exudative or “ wet” AMD is less common (occurring in one out of 10 people with AMD) but is more serious. In the wet form of AMD, abnormal blood vessels may grow in a layer beneath the retina, leaking fluid and blood and creating distortion or a large blind spot in the center of your vision. If the blood vessels are not growing directly beneath the macula, laser surgery is usually the treatment of choice. The procedure usually does not improve vision but tries to prevent further loss of vision. For those patients with wet AMD whose blood vessels are growing directly under the center of the macula, a procedure called photodynamic therapy (PDT), which causes fewer visual side effects, is sometimes used. Intravitreal injections of certain medications can also be used in these cases.

Promising AMD research is being done on many fronts. In the meantime, high-intensity reading lamps, magnifiers, and other low vision aids help people with AMD make the most of their remaining vision.

Although the exact causes of AMD are not fully understood, a recent scientific study shows that antioxidant vitamins and zinc may reduce the effects of AMD in some people with the disease.

Among people at high risk for late-stage macular degeneration (those with intermediate AMD in both eyes or advanced AMD in one eye), a dietary supplement of vitamins C, E, and beta-carotene, along with zinc, lowered the risk of the disease progressing to advanced stages by about 25% to 30%. However, the supplements did not appear to benefit people with minimal AMD or those with no evidence of macular degeneration.

Light may affect the eye by stimulating oxygen, leading to the production of highly reactive and damaging compounds called free radicals. Antioxidant vitamins (vitamins C and E and beta-carotene) may work against this activated oxygen and help slow the progression of macular degeneration.

Zinc, one of the most common minerals in the body, is very concentrated in the eye, particularly in the retina and macula. Zinc is necessary for the action of over 100 enzymes, including chemical reactions in the retina. Studies show that some older people have low levels of zinc in their blood. Because zinc is important for the health of the macula, supplements of zinc in the diet may slow down the process of macular degeneration.

The levels of antioxidants and zinc shown to be effective in slowing the progression of AMD cannot be obtained through your diet alone. These vitamins and minerals are recommended in specific daily amounts as supplements to a healthy, balanced diet.

It is very important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision you may have already lost from the disease. However, specific amounts of certain supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision. We can determine if you are at risk for developing advanced AMD and prescribe supplements if needed.

In most cases, floaters are part of the natural aging process. Floaters look like cobwebs, squiggly lines, or floating bugs. They appear to be in front of the eye but are actually floating inside. As we get older, the vitreous (the clear, gel-like substance that fills the inside of the eye) tends to shrink slightly and detach from the retina, forming clumps within the eye. What you see are the shadows these clumps cast on the retina, the light-sensitive nerve layer lining the back of the eye.

The appearance of flashing lights comes from the traction of the vitreous gel on the retina at the time of vitreous separation. Flashes look like twinkles or lightning streaks. You may have experienced the same sensation if you were ever hit in the eye and “saw stars.”

Floaters can get in the way of clear vision, often when reading. Try looking up and then down to move the floaters out of the way. While some floaters may remain, many of them will fade over time.

Floaters and flashes are sometimes associated with retinal tears. When the vitreous shrinks, it can pull on the retina and cause a tear. A torn retina is a serious problem. It can lead to a retinal detachment and blindness. If new floaters appear suddenly or you see sudden flashes of light, see an ophthalmologist immediately.

As one gets older, the vitreous (the clear, gel-like substance that fills the inside of the eye) tends to shrink slightly and take on a more watery consistency. Sometimes as the vitreous shrinks, it exerts enough force on the retina to make it tear.

Retinal tears can lead to a retinal detachment. Fluid vitreous, passing through the tear, lifts the retina off the back of the eye like wallpaper peeling off a wall. Laser surgery or cryotherapy (freezing) are often used to seal retinal tears and prevent detachment.

If the retina is detached, it must be reattached before sealing the retinal tear. There are three ways to repair retinal detachments. Pneumatic retinopexy involves injecting a special gas bubble into the eye that pushes on the retina to seal the tear. The scleral buckle procedurerequires the fluid to be drained from under the retina before a flexible piece of silicone is sewn on the outer eye wall to give support to the tear while it heals. Vitrectomy surgeryremoves the vitreous gel from the eye, replacing it with a gas bubble, which is slowly replaced by the body’s fluids.

The vitreous, a clear, gel-like substance that fills the inside of the eye, is contained in a sac loosely attached to the retina. As one ages, the vitreous takes on a more fluid consistency, and the sac sometimes separates from the retina. In lattice degeneration, there are places where the sac is strongly attached to the retina and pulls on it. This pulling weakens the retina and creates “lattice” lesions, which look like white, crisscrossing lines on the retina.

If part of the vitreous sac becomes detached from the retina, the friction and pulling at the attachment site can create a tear in the retina. Lattice degeneration can sometimes causeretinal detachments when holes or tears in the lattice formation permit vitreous fluid to flow under the retina.

Fortunately, most people with lattice degeneration do not develop a retinal detachment. Preventive treatment of lattice degeneration is indicated in some cases, but usually, our doctors will only need to monitor the condition. If you have a history of lattice degeneration, you should be aware of the symptoms of retinal tears and detachment.