Allergies

A
pproximately 22 million people in the US suffer from seasonal itchy, swollen, red eyes. Airborne allergens, such as house dust, animal dander, and mold, constantly bombard the eyes and can cause ocular allergies at any time. But when spring rolls around and the plant pollen starts flying, it seems like everyone starts crying.

Seasonal allergic conjunctivitis, or hay fever, is the most common allergic eye problem. Various antihistamine and decongestant drops and sprays can soothe 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 windows and keep household filters clean.

Cool compresses decrease swelling and itching. Artificial tears dilute the allergens and form a protective barrier over the surface of the eye. Avoid rubbing the eyes. It makes the symptoms worse.

If seasonal allergic conjunctivitis is a problem, see an ophthalmologist. There are several new safe and effective anti-allergy drops that can be prescribed. An ophthalmologist can also make sure symptoms are not being caused by a more serious problem.

Blepharoplasty (Eyelid Surgery)

B
lepharoplasty is an eyelid lifting procedure performed by an ophthalmologist when the eyelid droops to the point of obstructing your field of vision. To determine whether or not you would be a candidate for eyelid surgery, an examination and testing would be done to determine your field of vision with the eyelid taped up (eliminating the obstruction) and without taping.

Chalzion

A
chalazion is a swelling in the eyelid caused by inflammation of one of the small oil producing glands located in the upper and lower eyelids. A chalazion is sometimes confused with a stye, which also appears as a lump in the eyelid, but is an infection of a lash follicle that forms a red, sore lump.

Chalazion tend to occur farther from the edge of the eyelid than styes, and tend to “point” toward the inside of the eyelid. Sometimes a chalazion can cause the entire eyelid to swell suddenly, but usually there is a definite tender point.

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 can be applied. The simplest way is to hold a clean washcloth, soaked in hot water, against the closed lid. Do this for five to ten minutes, three or four times a day. Repeatedly soak the washcloth in hot water to maintain adequate heat. The majority of chalazions will disappear within a few weeks. Sometimes antibiotic ointments are used in combination with warm compresses.

A surgical incision or excision may be used to remove large chalazions that do not respond to other treatments.

Chalazions usually respond well to treatment, although some people are prone to recurrences. If a chalazion recurs in the same place, your ophthalmologist (Eye M.D.) may suggest a biopsy to rule out more serious problems.

Conjunctivitis (Pink Eye)

P
ink eye, the common name for conjunctivitis, is an inflammation or infection of the conjunctiva, the outer, normally clear covering of the sclera, the white part of the eye. The eye appears pink in conjunctivitis because the blood vessels are dilated. Pink eye is often accompanied by a discharge, but vision is usually normal, and discomfort is mild.

Either a bacterial or a viral infection may cause conjunctivitis. Viruses, which are more common and last several weeks, may cause an upper respiratory infection (or cold) at the same time. Unlike viruses, bacterial conjunctivitis is treated with a variety of antibiotic eye drops 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 should stay out of swimming pools.

Not everyone with conjunctivitis has an infection. Allergies can cause conjunctivitis too. Typically, people with allergic conjunctivitis have itchy eyes, especially in spring and fall. Eye drops to control itching are used to treat allergic conjunctivitis. It is important not to use medications that contain steroids (they usually end in "-one" or "-dex") unless prescribed by an ophthalmologist.

Finally, not everyone with pink eye has conjunctivitis. Sometimes more serious diseases, such as infections, damage to the cornea, severe glaucoma, or inflammation on the inside of the eye cause the conjunctiva to become inflamed and pink. Vision is usually normal if the pink eye is really conjunctivitis. If vision is affected, or if the problem does not get better in a few days, see an ophthalmologist.

Detached or Torn Retina

A
retinal detachment is a very serious problem that almost always causes blindness unless treated. The appearance of flashing lights, floating objects, or a gray curtain moving across the field of vision are all indications of a retinal detachment. If any of these occur, see an ophthalmologist right away.

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 increase the chance of developing 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 procedure requires 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 surgery removes the vitreous gel from the eye, replacing it with a gas bubble, which is slowly replaced by the body's fluids.

Diabetic Eye Disease (Diabetic Retinopathy)

A
s the name indicates, diabetic retinopathy is a condition that people with diabetes are at risk for. It causes damage to the blood vessels in the retina, which can lead to blurry vision and blindness. Diabetics (both type 1 and type 2) are recommended to have comprehensive eye exams at least once a year. Early detection and treatment can significantly reduce the risk of vision loss.

Flashes and Floaters

F
loaters can appear in different shapes and sizes. They are tiny clumps of cells floating in the inside of the eye as the vitreous (the filling of the inside of the eye) detaches, in clumps, from the inside surface of the eye. Flashes appear as flashing or streaking lights caused by the vitreous pulling away from the inside surface of the eye. This is most common as we get older and the vitreous begins to shrink causing these detachments and pulling. Not all floaters or flashes are serious, however, if you experience either you should have a medical vision exam by an ophthalmologist to rule out more serious retinal damage.

Flourescein Angiography

F
luorescein angiography, a clinical test to look at blood circulation inside the back of the eye, aids in the diagnosis of retinal conditions associated with diabetes, age-related macular degeneration, and other eye abnormalities. The test can also help follow the course of a disease and monitor its treatment. It may be repeated on multiple occasions with no harm to the eye or body.

Fluorescein, a harmless orange-red dye, is injected into a vein in the arm. The dye travels through the body to the blood vessels in the retina, the light-sensitive nerve layer at the back of the eye. A special camera with a green filter flashes a blue light into the eye and takes multiple photographs of the retina. The technique uses regular photographic film. No X-rays are involved.

If there are abnormal blood vessels, the dye leaks into the retina or stains the blood vessels. Damage to the lining of the retina or atypical new blood vessels may be revealed as well. These abnormalities are determined through a careful interpretation of the photographs by an ophthalmologist.

The dye can discolor skin and urine until it is removed from the body by the kidneys. There is little risk in having fluorescein angiography, though some people may have mild allergic reactions to the dye. Severe allergic reactions have been reported but very rarely. Being allergic to X-ray dyes with iodine does not mean you'll be allergic to fluorescein. Occasionally, some of the dye leaks out of the vein at the injection site, causing a slight burning sensation that usually goes away quickly.

Glaucoma

G
laucoma is a condition that is caused by high intraocular pressure causing damage to the optic nerve. If gone untreated, glaucoma can cause blindness. It is recommended that people over 40 with a family history of glaucoma have a complete eye exam at least every two years. Other health problems can increase the risk of glaucoma, and more frequent visits to the eye doctor may be needed.

The more common types of glaucoma are:

  • Open-Angle Glaucoma: This is the most common type of glaucoma, also referred to as primary or chronic glaucoma. This is a chronic condition that develops slowly over time. The wide angle between the iris and cornea causes slow clogging of the drainage canals resulting in increased pressure in the eye.
  • Closed-Angle Glaucoma: Also called acute, narrow angle, or angle closure glaucoma. The angle between the iris and cornea are closed, blocking the drainage canals, leading to increased eye pressure. Symptoms are quite noticeable and develop quickly. Immediate medicate attention is required for treatment of this type of glaucoma.
  • Normal-Tension Glaucoma: This is a low-tension or normal-pressure glaucoma where there is nerve present damage without high pressure. Not much is known about this type of glaucoma, but treatment is required for nerve damage maintenance.
  • Congenital Glaucoma: This is a rare form of glaucoma that occurs in babies that may be inherited. Incomplete or incorrect development of the drainage canals while in the womb cause congenital glaucoma. Microsurgery for simple cases can be done to correct defects, while medication and surgery are necessary for more serious cases.

Other types of glaucoma can be caused by trauma to the eye, medications, diseases such as diabetes, etc.

Laser Vision Correction

L
aser vision correction, such as Lasik, is a refractive surgery to correct vision by reshaping the cornea (the clear outer layer of the eye) to eliminate the need for glasses and contacts. This surgery is performed under local anesthesia and is an out-patient procedure. You will need to schedule a consultation prior to surgery. Please note that if you wear contacts they cannot be worn for several days prior to your consultation exam (1 week for soft lenses and 3 weeks for air permeable/hard contacts.)

Lid Margin Disease

L
id margin disease is a common, persistent inflammation of the eyelids. Symptoms include irritation, itching, and occasionally, a red eye. This condition frequently occurs in people who have a tendency towards oily skin, dandruff, or dry eyes.

Bacteria normally reside on everyone's skin, but in some people they thrive in the skin at the base of the eyelashes. Nearby oil glands may be overactive, causing dandruff-like scales and particles to form along the lashes and eyelid margins, which can cause redness, stinging or burning.

Lid margin disease cannot be cured, but it can be controlled with a few simple daily hygienic measures:

At least twice a day, place a warm, wet washcloth over the closed eyelids for a minute. Rewet it as it cools. With your finger covered with a thin washcloth, cotton swab, or commercial lint-free pad, gently scrub the base of the lashes about 15 seconds per lid.

When medications are necessary, they may include:

  • Artificial tears to relieve symptoms of dry eye. (These are eye drops that are available without a prescription.)
  • Antibiotics (oral or topical) to decrease bacteria on the eyelids.
  • Occasionally steroids (short-term) to decrease inflammation.

Medications alone are not sufficient; the application of warmth and detailed cleansing of the lashes daily is the key to controlling lid margin disease.

Low Vision

O
ver three million people in the United States do not have normal vision even with corrective lenses. If ordinary eyeglasses do not provide clear vision, one is said to have low vision. This should not be confused with blindness. People with low vision still have useful vision that can often be improved with low-vision devices.

Low vision can result from birth defects, inherited diseases, injuries, diabetes, glaucoma or macular degeneration. Although reduced central or reading vision is most common, a person can have low vision in their side (peripheral) vision, or a loss of color vision or contrast sensitivity.

Low vision devices or aides are available in optical and non-optical types. Optical devices use lenses or combinations of lenses to provide magnification. They should not be confused with standard eyeglasses. There are five main kinds of optical devices: magnifying spectacles, hand magnifiers, stand magnifiers, telescopes and closed-circuit television. Different devices may be needed for different purposes. If possible, try the optical device before purchasing it and be sure you understand how to use it.

The simplest non-optical technique is to bring the object of interest closer. Non-optical low vision devices include large print books, check writing guides, enlarged phone dials, talking appliances (timers, clocks, computers), and machines that scan print and read out loud.

Government and private agencies have social services available for people with low vision. For more information, contact the following resources:

  • American Academy of Ophthalmology

    Website : http://www.aao.org

  • American Foundation for the Blind

    Phone : (800) 232-5463

  • National Association for Visually Handicapped

    Phone : (212) 889-3141

  • National Library Service for the Blind and Physically Handicapped

    Phone : (800) 424-8567/p>

  • Lighthouse International

    Phone : (800) 334-5497

  • National Eye Institute

    Phone : (301) 496-5248

  • Prevent Blindness America

    Phone : (800) 331-2020

  • Vision/Services for the Blind and Visually Impaired

    Phone : (212) 425-2255

  • Veterans may contact the Visual Imapairment Services coordinator at their local VA facility.

Pterygium and Pinguecula

A
pterygium is fleshy tissue that grows over the cornea (the clear front window of the eye). It may remain small or may grow large enough to interfere with vision. A pterygium most commonly occurs on the inner corner of the eye, but can appear on the outer corner as well. The exact cause is not well understood. Pterygium occurs more often in people who spend a great deal of time outdoors, especially in sunny climates. Long-term exposure to sunlight, especially ultraviolet (UV) rays, and chronic eye irritation from dry, dusty conditions seem to play an important causal role. A dry eye may contribute to pterygium. When a pterygium becomes red and irritated, eye drops or ointments may be used to help reduce the inflammation. If the pterygium is large enough to threaten sight or grows rapidly, it can be removed surgically.

Despite proper surgical removal, the pterygium may return, particularly in young people. Protecting the eyes from excessive ultraviolet light with proper sunglasses and avoiding dry, dusty conditions and use of artificial tears may 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 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 may also be a response to chronic eye irritation or sunlight.

No treatment is necessary unless it becomes inflamed. A pinguecula does not grow onto the cornea or threaten sight. If particularly annoying, a pinguecula may on rare occasions be surgically removed, but the postoperative scar may be as cosmetically objectionable as the pinguecula.

Refractive Errors

T
o see clearly, light rays must be bent or refracted to focus on the retina, the light- sensitive nerve layer that lines the back of the eye. The cornea and lens of the eye work together to bend or refract light rays and bring them together on the retina. If a refractive error is present, the light is not focused directly on the retina, so images appear blurry.

  • Myopia (nearsightedness): Distance vision is impaired when the eye is too long in relation to the curvature of the cornea. This causes light to focus before it reaches the retina. Close objects look clear but distant objects appear blurry.
  • Hyperopia (farsightedness): Close vision is impaired, with some impairment of distance vision, as well. The eye is too short in relation to the curvature of the cornea. Light rays are not yet in focus when they reach the retina, so images appear blurry.
  • Astigmatism (the cornea is oval shaped instead of round): The irregular curvature of the cornea causes light to focus on more than one point on the retina. Uncorrected astigmatism impairs both distance and near vision.
  • Presbyopia (aging eyes): When young, the lens of the eye is soft and flexible, allowing people to see objects both close and far away. After the age of 40, the lens of the eye becomes more rigid, making it more difficult for the lens to change its shape, or accommodate, to do close work such as reading. This condition is known as presbyopia and is the reason reading glasses or bifocals are necessary at some point after age forty.

Visual Field Test

T
he visual field is the entire area one can see. It includes central and peripheral (side) vision. A visual field test can detect problems with vision in any part of the visual field. Changes in the visual field may be difficult to notice since both eyes are generally used at the same time. One eye can sometimes compensate for some vision loss in the other. A problem may not be detected until each eye is tested separately.

The visual field test provides information that no other test can. It is used to detect many diseases, such as glaucoma or retinitis pigmentosa, which affect the eye, optic nerve, and brain. It can also help diagnose brain tumors, strokes, and other conditions. Visual field testing helps diagnose the disease and can follow the progress of the disease and its treatment.

During a visual field test, one eye is temporarily patched while the other eye is being tested. You are asked to look straight ahead at a fixed spot and watch for targets to appear in your field of vision.

There are two kinds of visual field tests. One method uses moving targets. Targets are moved from outside the visual field (where you can't see them) toward the center of your vision. When you see them, you press a button. The test can be done using a dark screen on a wall (called tangent screen testing) or using a large bowl-shaped instrument (called Goldmann testing).

The other testing method uses small fixed targets that appear briefly as bright or dim lights (called computerized static perimetry). You sit in a chair facing either a bowl-shaped instrument or a computer screen and indicate when you see the targets appear.

Vitrectormy Surgery

V
itrectomy is a type of eye surgery used to treat disorders of the retina (the light-sensing cells at the back of the eye) and vitreous (the clear gel-like substance inside the eye). It may be used to treat a severe eye injury, diabetic retinopathy, retinal detachments, macular pucker (wrinkling of the retina) and macular holes.

During a vitrectomy operation, the surgeon makes tiny incisions in the sclera (the white part of the eye). Using a microscope to look inside the eye and microsurgical instruments, the surgeon removes the vitreous and repairs the retina through the tiny incisions. Repairs include removing scar tissue or a foreign object if present.

During the procedure, the retina may be treated with a laser to reduce future bleeding or to fix a tear in the retina. An air or gas bubble that slowly disappears on its own may be placed in the eye to help the retina remain in its proper position or a special fluid that is later removed may be injected into the vitreous cavity.

Recovering from vitrectomy surgery may be uncomfortable but the procedure often improves or stabilizes vision. Once the blood- or debris-clouded vitreous is removed and replaced with a clear medium (often a saltwater solution), light rays can once again focus on the retina. Vision after surgery depends on how damaged the retina was before surgery.

YAG Laser Posterior Capsulotomy

A
posterior capsulotomy is a surgical laser procedure that may be necessary after cataract surgery.

During cataract surgery part of the front (anterior) capsule that holds the lens is removed. The clear back (posterior) capsule remains intact. As long as that capsule stays clear one has good vision. But in 10 to 30% of people, the posterior capsule loses its clarity. When this happens, an opening can be made in the capsule with a laser (posterior capsulotomy) to restore normal vision.

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

A posterior capsulotomy is painless and takes five minutes. Vision should improve within hours.

YAG Peripheral Iridotomy

YAG peripheral iridotomy is a laser procedure to treat or prevent closed-angle glaucoma. An opening is made on the outer edge of the iris (the colored part of the eye) with a laser to decrease pressure that has built up in the eye due to closed-angle glaucoma. This procedure may also prevent future build-up of pressure in that eye.

The YAG peripheral iridotomy is done in the office as an outpatient procedure. While there may be some mild discomfort during the procedure, there is usually no pain after the peripheral iridotomy.