Diseases of the Eye

There are two types of blepharitis. Seborrheic blepharitis is often part of an overall skin condition called seborrhea, which may also affect the scalp, chest, back and the area behind the ears. The second form of blepharitis – staph blepharitis – is a more severe condition, caused by bacteria, that begins in childhood and may continue through adulthood.

Causes

Hormones, nutrition, general physical condition, and even stress may contribute to seborrheic blepharitis. Build-ups of naturally occurring bacteria contribute to staph blepharitis.

Symptoms

Blepharitis could be described as dandruff of the eyelids. Seborrheic blepharitis results in redness of the eyelids, flaking and scaling of eyelashes, and greasy, waxy scales caused by abnormal tear production. Staph blepharitis can cause small ulcers, loss of eyelashes, eyelid scarring, and even red eye.

Treatment

Careful cleaning of the eyelids can reduce seborrheic blepharitis. Application of hot packs to the eyes for 20 minutes a day can also help. Staph blepharitis may require antibiotic drops and ointments.

A cataract is an opacity of the lens of the eye. The body's natural lens is similar to an onion, with many layers. These layers contain protein and as the proteins clump together, they cover the lens and make it difficult to see clearly. Cataracts are generally seen in the older population, but they can occur at any age, even birth. By age 60, over half of the population has some symptoms of cataracts due to the natural aging process.

Cataracts are painless but if left untreated can lead to blindness. Cataract surgery is done on an outpatient basis with little or no downtime afterwards. The surgery is performed by a medical doctor known as an ophthalmologist, who specializes in surgery of the eye. The aftercare or postoperative care can be administered by an ophthalmologist or an optometrist.

Symptoms of Cataracts

There can be a myriad of symptoms when a person develops a cataract.  It is common for vision to be blurry, as though you are looking through a foggy window. Color vision changes occur in which the brightness of colors fade, especially blue and green. Patients with cataracts also experience difficulty in reading small print. They also feel like they need brighter light or possibly a new glasses prescription. Double vision or vision that seems like halos around the letters also occurs, as well as sensitivity to light.

Causes of Cataracts

The exact physiological cause of cataracts is unknown, but there are many risk factors. Aging and trauma are known to cause cataracts. A blunt trauma or injury to the eye can cause a cataract at any age. The effect of aging on the cells of the lens contributes to cataracts usually after age 60. There is also a direct correlation between the sun's UV rays and certain radiation exposures that contriibute to cataract growth. Smoking is a big risk factor for developing cataracts as well.

Poor nutrition can add to the risk of developing cataracts. Lack of vitamin C has been shown to increase the genesis of cataract formation. Some prescription medicines, especially prednisone, can cause cataracts. Diabetes and other chronic disease processes are also factors in cataract formation. Finally, there are genetic factors that contribute to a cataract.

Treatment of Cataracts

The standard of care for the treatment of cataracts is typically surgery. Cataract surgery, which is an outpatient procedure, removes the protein accumulation from the eye by replacing the cloudy natural lens with an artificial lens. This artificial lens, known as an IOL or intraocular lens, will have your prescription, which in most cases, makes you less dependent on glasses. Lens technology has evolved over the years to also accommodate prescriptions for astigmatism and bifocal prescriptions. Cataract surgery is one of the most commonly performed surgeries in the United States, and it has a success rate of over 98%.

There are many types of cataracts that form on the eye, with different levels of density. This can affect the post-operative care of cataract patients. After cataract surgery, it might be necessary to use a laser to clear an after-cataract membrane that can occur weeks to months after the procedure. This treatment uses a YAG laser and is a painless, low risk, in-office procedure. Most patients can return to work or normal activities within days after the procedure. Your doctor will likely prescribe eyedrops to prevent infection and swelling.

Recent Findings

New technology in cataract surgery includes a bladeless customized procedure that allows for faster healing and clearer vision after the procedure. This computer assisted surgery uses a laser to make the incisions. The laser also divides the cataract efficiently so that the surgeon can remove the old lens and replace it with a new state-of-the-art IOL ( Intraocular lens). This technology uses a femtosecond laser which emits cool pulses of energy. This technology has been used for decades in LASIK surgery for the correction of myopia or nearsightedness. This form of cataract surgery now allows the procedure to be more precise, and reproducible.

Citations
1. What is a cataract? Educational website release. Triadeye.com. January 13, 2013.
2.Bladeless cataract laser surgery. LenSX press release. October 4, 2012.

Conjunctivitis, commonly called pink eye, is a redness of the eye. It is often accompanied by a discharge (clear, yellow, or white) and itching in the eye.

Causes

Pink eye is most often a viral infection, but it can also be caused by bacteria or an allergic reaction. Viral pink eye is highly contagious.

Prevention and Treatment

To avoid spreading conjunctivitis, wash your hands often, do not touch the infected area with your hands, do not share washcloths or towels, and avoid using makeup which may become contaminated. A child with pink eye should be kept from school for a few days. Sometimes an eye doctor will need to prescribe antibiotic eye drops and ointments to clear up conjunctivitis.

Diabetic retinopathy is a condition associated with diabetes. High levels of blood sugar may damage tiny blood vessels in your eye. New vessels may form to replace the damaged vessels. The new vessels can burst, resulting in blurred vision or even blindness.

Symptoms

Symptoms of diabetic retinopathy include:

• "Floaters” – small specks that pass across your field of vision, made up of cells floating in the transparent gel of your eyeball
• Difficulty reading or seeing things close-up
• Sudden loss of vision
• Flashes
• Blurred or darkened vision

Risk Factors and Treatment

If you have diabetes, make sure you control your blood sugar level. This will reduce your risk of getting diabetic retinopathy. If you are experiencing some of the symptoms listed above, give us a call. If diagnosed properly, diabetic retinopathy can be treated with a laser procedure or a vitrectomy.

If your eyes are constantly itchy or dry, you may have dry eye syndrome, which affects many millions of Americans. Dry eye syndrome is caused by a lack of, or poor quality of, tears. Tears lubricate the outer layer of the eye called the cornea. If the tears are not adequate or are not composed of a proper balance of mucous, water, and oil, the eye becomes irritated.

Symptoms

Dry eye syndrome leads to a number of symptoms, including itchiness, irritation, burning, excessive tearing, redness, blurred vision that improves with blinking, and discomfort after long periods of watching television, using a computer, or reading.

Risk Factors

There are many factors that can contribute to dry eye syndrome. These include dry, hot, or windy climates; high altitudes; air-conditioned rooms; and cigarette smoke. Contact lens wearers, people with abnormally dry skin, and the elderly are more likely to develop dry eye syndrome. You may also be more at risk if you take certain medications, have a thyroid condition, a vitamin-A deficiency, Parkinson’s or Sjorgen’s disease, or if you are a woman going through menopause.

Glaucoma is a serious sight-threatening condition in which there is an abnormal pressure inside the eye. Typically, the pressure or IOP (intraocular pressure) is too high for the blood vessels and optic nerve to function normally, leading to loss of vision.

There are some forms of glaucoma that can occur with normal pressure in the eye. The average IOP for a healthy eye is 10 to 22 mm of Mercury. Just as a physician’s office tests your blood pressure annually, the eye doctor tests your IOP during annual eye examinations.

Types of Glaucoma

There are several varieties of the disease, with primary open-angle glaucoma being the most common. Primary open-angle glaucoma (POAG) occurs when the IOP is higher than normal. As the pressure increases, it destroys vital nerve tissue that is irreparable. POAG usually occurs over a long period of time, months to years, and slowly causes peripheral visual field loss.  If left untreated, a sufferer progresses to tunnel vision and then to total blindness.

A second type of glaucoma is acute-angle closure. This is considered a medical emergency because the interocular pressure spikes suddenly to anywhere from 30-70 mm or higher. This causes extremely sharp pain, nausea and vomiting, and cloudy vision. The IOP needs to be lowered within hours to prevent permanent vision loss.

Juvenile open-angle glaucoma, or JOAP, is similar to POAG, in that is causes a gradual visual field loss. The most common form is in children from ages 3 to 21. Infantile or congenital glaucoma is a type of glaucoma that manifests itself between birth to 3 years of age.  A typical sign is an enlarged bluish-gray cornea, the front dome of the eye.  Excessive tearing of the eye and sensitivity to light are also symptoms.  Finally, secondary glaucoma is caused from trauma, eye disease, or certain medications.

Causes of Glaucoma

Many theories on the cause of glaucoma exist, but the exact cause is unknown. Glaucoma can be a hereditary condition. It also can be caused by malformed anatomical structures in the eye. Certain risk factors such as hyperopia and cataracts cause a higher incidence of certain types of glaucoma.

One cause of glaucoma is an insufficient drainage system of the aqueous fluid. The aqueous imbalance causes a gradual buildup of pressure which destroys vision. Another cause is an insufficient flow of blood to the optic nerve. Ocular trauma or injury that damages the anterior segment for the lens and drainage mechanism of the eye can also lead to glaucoma. In the case of normal tension glaucoma, pressure readings are in the normal range. The cause of this is unknown.

Treatment

Even though in most cases there is no way to prevent glaucoma, there are many treatment options. Medications in the form of eyedrops are commonly prescribed. Different combinations of agents act on mechanisms of action to lower IOP or to slow the production of fluid.

Advanced surgical and laser procedures can also be viable options for the treatment of glaucoma.  An in-office procedure called laser trabeculoplasty can cause the meshwork in the eye to work more efficiently. This treatment has a temporary effect and may need to be done multiple times. Another effective surgery uses a drainage implant to facilitate better outflow and inflow of aqueous fluid in the eye. These procedures help keep the pressure stabilized. Conventional surgery for glaucoma is done in an operating room scenario. A flap in the eye is created to facilitate outflow of the pressure. This pressure-controlling surgery is known as a trabeculotomy.

Furthermore, some oral medications can also be used in the treatment of glaucoma.

Methods of Testing for Glaucoma

During a comprehensive eye examination, eye pressure can be tested through various methods. Tonometry gives a pressure reading of the eye. A tomometer has different methods such as a probe that gently touches the front of the eye after the eye doctor has administered anesthetic eyedrops. Another method of testing uses a puff of air. For children, there is a tonometer that is quick and does not require anesthesia.

A pachometer, which measures the thickness of the front of the eye called the cornea, can also aid in diagnosis. A visual field device can measure for early or late damage in the peripheral fields of vision. Lastly, newer technology called OCT, or optical coherence tomography, counts the nerve fibers, which can help detect early changes in the disease.

Prevalence of Glaucoma

There are approximately 3 million individuals in the United States with glaucoma. It is the second leading cause of blindness in the country. Most cases are found in the population over age 40, and more women than men have the disease. Two thirds of glaucoma cases are in the Caucasian population, approximately 20% are African-American, and 10% are Hispanic. Glaucoma continues to rise every year in the population.

The key to success in the treatment of glaucoma is early detection and progressive monitoring of the condition. Comprehensive eye examinations and diligent monitoring will help protect from vision loss with this disease.

Citations

1. Glaucoma. AOA pdf. AOA.org.
2. I Care Tonometry in Children. JAAPOS. Sciencedirect.com. April 2011
3. Glaucoma, open -angle. NEI source press release. 2010.

Macular degeneration is a disease which affects a small area of the retina known as the macula. The macula is a specialized spot on the retina that allows us to see the fine detail of whatever is directly in front of us. Macular degeneration occurs when the macula begins to deteriorate.

“Wet” vs. “Dry”

Most often, macular degeneration is accompanied by formation of yellow deposits, called “drusen,” under the macula, which dry out or thin the macula. This is called “dry” macular degeneration. In rare cases, abnormal blood vessels develop under the macula and leak fluid. This is called “wet” macular degeneration.

Causes

A number of uncontrollable factors contribute to macular degeneration, including age, sex, eye color, farsightedness, and race. Risk factors you can control include smoking, high blood pressure, exposure to harmful sunlight, and diet.

Symptoms

It is difficult to detect dry macular degeneration in its early stages. The most common symptoms, when detected, include a spot of blurry vision, dark vision, or distorted vision. Wet macular degeneration progresses much faster than the dry variety. Both forms of macular degeneration can cause blindness.

Treatment

Currently, there is no cure for macular degeneration, but treatment is available to slow the effects.

The part of the eye which collects light and transmits the light messages to the optic nerve and brain is the retina. It lines the inner back wall of the eye. When the retina separates from the back wall, it is known as retinal detachment. It is a serious condition which can cause permanent damage and vision loss if not treated quickly.

Symptoms

A retinal detachment often causes sudden defects in your vision. It may just cause a blind spot too small to notice, or it may cause a noticeable shadow which obscures your vision. An increase in “floaters,” which look like small particles or fine threads, may also be noticed. Finally, flashes of light are associated with retinal detachment.

Risk Factors

Eye injuries, tumors, and cataract surgery can cause retinal detachment. Nearsighted individuals and the elderly are at greater risk for spontaneous detachment. Also, diabetic retinopathy, a condition associated with diabetes, can cause bleeding which leads to retinal detachment.