EYE DISEASES

ALLERGY

Similar to processes that occur with other types of allergic responses, the eye may overreact to a substance perceived as harmful even though it may not be. For example, dust that is harmless to most people can cause excessive tear production and mucus in eyes of overly sensitive, allergic individuals.

What causes eye allergies?

Many allergens (substances that can evoke an allergic response) are in the air, where they come in contact with your eyes and nose. Airborne allergens include pollen, mold, dust and pet dander. Other causes of allergies, such as certain foods or bee stings, do not typically affect the eyes the way airborne allergens do. Adverse reactions to certain cosmetics or drugs such as antibiotic eyedrops also may cause eye allergies.

Eye allergy treatment

Avoidance: The most common “treatment” is to avoid what’s causing your eye allergy. Itchy eyes? Keep your home free of pet dander and dust, and stay inside with the air conditioner on when a lot of pollen is in the air. If you have central air conditioning, use a high quality filter that can trap most airborne allergens and replace it frequently.

Medications. If you’re not sure what’s causing your eye allergies, or you’re not having any luck avoiding them, your next step will probably be medication to alleviate the symptoms.

Over-the-counter and prescription medications each have their advantages. For example, over-the-counter products are often less expensive, while prescription ones are often stronger. Eyedrops are available as simple eye washes; or, they may have one or more active ingredients such as antihistamines, decongestants or mast cell stabilizers.

Antihistamines. These drugs decrease many symptoms caused by airborne allergens, such as itchy, watery eyes, runny nose and sneezing.

Decongestants. These drugs clear up redness. They contain vasoconstrictors, which make the blood vessels in your eyes smaller, lessening the apparent redness. They treat the symptom, not the cause. In fact, with extended use, the blood vessels can become dependent on the vasoconstrictor to stay small. When you discontinue the eyedrops, the vessels actually get bigger than they were in the first place. This process is called rebound hyperemia, and the result is that your red eyes worsen over time.

Mast Cell Stabilizers. These drugs decrease redness and swelling. Mast cell stabilizers are similar to antihistamines. But while antihistamines are known for their immediate relief, mast cell stabilizers are known for their long-lasting relief.

Non-steroidal anti-inflammatory drugs (NSAIDs) or Corticosteroids. In some cases, combinations of medications may be used.

Eye allergies and contact lenses

Even if you are generally a successful contact lens wearer, allergy season can make your contacts uncomfortable. Airborne allergens can get on your lenses, causing discomfort. Allergens can also stimulate the excessive production of natural substances in your tears that bind to your contacts, adding to your discomfort and allergy symptoms.

Ask your eye doctor about eyedrops that can help relieve your symptoms and keep your contact lenses clean. Certain drops can discolor or damage contact lenses, so ask your doctor first before trying out a new brand.

Another alternative is daily disposable contact lenses, which are discarded nightly. Because you replace them so frequently, these lenses are unlikely to develop irritating deposits that can build up over time and cause or heighten allergy-related discomfort.

BLEPHARITIS

Blepharitis is inflammation of the eyelids, occurring particularly at the lid margins. It is a common disorder and may be associated with a low-grade bacterial infection or a generalized skin condition.

Blepharitis occurs in two forms: anterior blepharitis and posterior blepharitis.

Anterior blepharitis affects the front of the eyelids, usually near the eyelashes. The two most common causes of anterior blepharitis are bacteria and a skin disorder called seborrheic dermatitis, which causes itchy, flaky red skin.

Posterior blepharitis affects the part of the eyelid that comes in contact with the eye and is usually caused by problems with the oil glands in the lid margin. Posterior blepharitis is more common than anterior blepharitis and often affects people with a rosacea.

Blepharitis signs and symptoms

Regardless of which type of blepharitis you have, you will probably have such symptoms as eye irritation, burning, tearing, foreign body sensation, crusty debris, dryness and red eyelid margins.

It is important to see an eye doctor and get treatment. If your blepharitis is bacterial, possible long-term effects are thickened lid margins, dilated and visible capillaries, misdirected eyelashes, loss of eyelashes and a loss of the normal position of the eyelid margin against the eye. Blepharitis can also lead to styes and infections or erosions of the cornea.

Blepharitis treatments

Blepharitis can be difficult to manage because it tends to recur. Treatment depends on the type of blepharitis you have and the severity of the condition. Treatment options include the following:

• Applying warm compresses to the eyelids
• Cleaning your eyelids frequently
• artificial tears
• Antibiotic drops, pills, or ointments
• Steroid drops or ointments
• Immunomodulator eyedrops
• Nutrition supplementation with omega-3 fatty acids
• Massaging the lids to help express oil from the meibomian glands

Because blepharitis tends to be chronic, prolonged therapy may be required to control the condition. If you normally wear contact lenses, you may need to discontinue wearing them during the treatment period and even beyond. Sometimes, changing from soft contact lenses to rigid gas permeable contact lenses can help – since rigid lenses are less likely to accumulate lens deposits. In other cases, contact lens discomfort caused by blepharitis can be relieved by replacing soft contact lenses more frequently or changing to one-day disposable lenses.

CONTACTS

Cataracts are one of the leading causes of vision loss in people over 45. A condition that commonly develops as the eye ages, by the time we reach 80, more than half of us will have developed a cataract.

A cataract is a clouding of the lens in your eye which is normally transparent. The lens, located inside the eye, behind the iris and the pupil, focuses light onto the retina at the back of your eye, where it is converted to nerve signals that are passed to the brain, allowing you to see. When your lens becomes cloudy, the images projected onto your retina become blurry and unfocused and therefore the signal to the brain is also unclear. You can compare this to looking through a dirty or cloudy window. If the window is not clear, you can’t see well.

Usually cataracts develop slowly over time so your vision gradually worsens. While the majority of cataracts are a result of the aging process, there are also congenital cataracts that are present at birth, secondary cataracts that result from eye surgery or diseases such as glaucoma or diabetes and traumatic cataracts that result at any age from an injury to the eye.

While you may be able to live with mild or moderate cataracts, severe cataracts are treated with surgery. The procedure involves removing the clouded lens and replacing it with an intraocular lens (IOL) implant. Cataract surgery is a common procedure that has a very high success rate of restoring vision to patients. Modern cataract surgery is frequently done as an outpatient procedure. Patients will have greatly improved vision the next day, and will continue to improve over the next few weeks. Surgery is often done in one eye first, and surgery on the second eye, if needed, may be done 2 weeks later.

Learn more about the specifics of Cataracts on the links below:

• Signs & Symptoms of Cataracts Understand the warning signs and symptoms of cataracts to prevent them from affecting your daily life.
• Risk Factors of Cataracts Learn more about the risk factors associated with cataracts and what measures you can take to prevent or delay them.
• Treatment for Cataracts and Cataract Surgery Treatment options for living with cataracts. Learn more about cataract surgery and how to know if it is right for you.
• Intraocular Lenses (IOLs) If you are getting cataract surgery, there are a variety of IOLs to choose from including presbyopia-correcting IOLs, which can also correct for near vision loss associated with aging.
• Preventing Cataracts Additional information including lifestyle factors that could impact cataracts.
• Symptoms of Cataracts Decreased vision is the most common symptom of cataracts. If you have other abnormal vision-related symptoms, cataracts may be the cause.
• Cataract Surgery Modern cataract surgery is a treatment option for many patients. Review the procedure and its normal recovery period.
• Premium Intraocular Lenses

If you need cataract surgery, you may have the option of getting new presbyopia-correcting IOLs that potentially can restore a full range of vision without eyeglasses.”

CONJUCTIVITIS

The term “pink eye” is often used to refer to any or all types of conjunctivitis.

Signs and symptoms of conjunctivitis

The hallmark sign of conjunctivitis is a pink or reddish appearance to the eye due to inflammation and dilation of conjunctival blood vessels.

Depending on the type of conjunctivitis, other signs and symptoms may include a yellow or green mucous discharge, watery eyes, itchy eyes, sensitivity to light and pain.

How can you tell what type of pink eye you have?

• Viral conjunctivitis. Usually causes excessive eye watering and a light discharge.
• Allergic conjunctivitis. Affects both eyes and causes itching and redness in the eyes and sometimes the nose, as well as excessive tearing.
• Bacterial conjunctivitis. Often causes a thick, sticky discharge, sometimes greenish.
• Giant papillary conjunctivitis. Usually affects both eyes and results in contact lens intolerance, itching, a heavy discharge, tearing and bumps on the underside of the eyelids.

What causes conjunctivitis?

Conjunctivitis may be caused by a virus, an allergic reaction (to dust, pollen, smoke, fumes or chemicals) or, in the case of giant papillary conjunctivitis, a foreign body on the eye, typically a contact lens. Other causes include exposure to infected persons and bacterial and viral infections elsewhere in the body.

Treatment of conjunctivitis

• Avoidance. Your first line of defense is to avoid the cause of conjunctivitis. Both viral and bacterial conjunctivitis, which can be caused by airborne sources, spread easily to others.
• Medication. Topical antibiotics, steroids, antihistamines, and/or vasoconsrictors can be used to treat conjunctivitis.
• Palliative. Cool compresses and unpreserved artificial tears can decrease symptoms and increase comfort for most types of conjunctivitis.
• Change contact lenses. If you develop giant papillary conjunctivitis while wearing contact lenses, your eye docor may recommend that you switch to a different type of contact lens.

Usually conjunctivitis is a minor eye problem. However, the disease can develop into a more serious condition if it is not treated properly. If you think you have conjunctivitis, see your eye doctor for a medical diagnosis before using any eye drops in your medicine cabinet.

Prevention tips

Though conjunctivitis can affect people of any age, it is especially common in preschoolers and school children. Because young children often are in close contact in day care centers and school rooms, it can be difficult to avoid the spread of bacteria causing conjunctivitis. However, these tips can help concerned parents, day care workers and teachers reduce the possibility of a conjunctivitis outbreak in institutional environments:

• Adults in school and day care centers should wash their hands frequently and encourage children to do the same. Soap should always be available for hand washing.
• Personal items, including hand towels, should never be shared at school or at home.
• Encourage children to use tissues and cover their mouths and noses when they sneeze or cough.
• Discourage eye rubbing and touching, to avoid spread of bacteria and viruses.
• For about three to five days, children (and adults) diagnosed with conjunctivitis should avoid crowded conditions where the infection could easily spread.
• Use antiseptic and/or antibacterial solutions to clean and wipe surfaces that children or adults come in contact with, such as common toys, table tops, drinking fountains, sink/faucet handles, etc.

CORNEAL ENDOTHELIAL DYSTROPHY

Fuchs’ endothelial dystrophy is the most common primary disease of the corneal endothelium. It is caused by a gradual degeneration of the endothelial cells and can produce significant visual disturbances.

Symptoms of Fuchs’ Dystrophy

• Increased sensitivity to light
• Increased glare in your vision
• Fluctuating vision
• Vision that stays blurred all day

Treatment Options

• Monitor condition with corneal pachymertry
• Monitor condition with specular microscopy
• Hypertonic eyedrops
• Hyperosmotic eyedrops
• Endothelium transplant surgery
• Full-thickness corneal transplant

CORNEAL NEOVASCULARIZATION

The most common cause of corneal neovascularization in patients without pre-existing eye disease is contact lens wear.

Contact lens-induced corneal neovascularization

• A history of overnight contact lens wear
• Poor compliance with proper contact lens hygiene
• Poor follow-up care with an eye doctor while wearing contact lenses

Treatment Options

• Monitor condition if it is mild in severity
• Modify initiating insult (e.g., different contact lenses, decrease wearing time, etc.)
• Discontinue contact lens wear if the condition is severe and vision-threatening

DIABETIC RETINOPATHY

Diabetes is a disease that affects the way we process food. With all forms of diabetes, the body has trouble converting sugar in the blood into energy.

People with diabetes are more likely to develop vision-threatening conditions

• Cataractsr
• Glaucoma
• Macular degeneration
• Diabetic retinopathy

Diabetes Statistics

• Almost 26 million people in the United States have diabetes.
• There has been an 89% increase in the number of people with diabetic retinopathy from 2000 to 2010.
• Over 4.2 million adults were diagnosed with diabetic retinopathy as recently as 2008.
• People with diabetes are 25 times more likely to go blind than those who are not diabetic.

Nonproliferative Diabetic Retinopathy

This common form of diabetic retinopathy affects 50% of people that have had diabetes 10 years or longer. Nonproliferative diabetic retinopathy occurs when diabetes damages the small blood vessels in the retina. The damaged vessels leak blood and fluid and cause the retina to swell.

Symptoms of Diabetic Retinopathy

• Blurred vision
• Difficulty reading
• Floaters
• Double vision

Proliferative Diabetic Retinopathy

This is the most severe form of diabetic retinopathy and usually requires surgical intervention.

Diabetic Macular Edema

Permanent damage from diabetic macular edema is the number one cause of diabetes-related blindness. Diabetic macular edema is a severe form of diabetic retinopathy and laser surgery is usually the preferred treatment option.

Symptoms of Macular Edema

• Decreased vision
• Distortion of images
• Difficulty reading
• Missing areas of vision
• Changes in contrast sensitivity

MACULAR DEGENERATION

As a disease usually associated with aging, macular degeneration is also called age-related macular degeneration (AMD), though there are other, less common types of macular degeneration.

Macular Degeneration Symptoms

The primary symptom of macular degeneration is a gradual loss of central vision.

The disease presents in two forms: dry macular degeneration and wet macular degeneration. Of the two, the dry form is far more common. Both types affect the macula, the light-sensitive area in the central region of the retina.

Macular Degeneration Statistics

• Currently, 2.1 million people ages 50 and older have late age-related macular degeneration.
• People of European ethnicity are far more likely to lose vision from AMD than African-Americans, and studies show that obesity, smoking, and exposure to ultraviolet rays may also be risk factors for developing the disease.
• Macular degeneration tends to affect women more than men, and has also been linked to heredity.

Dry Macular Degeneration

The “dry” form of the disease affects up to 90% of patients with macular degeneration. For most patients, the earliest clinical sign of macular degeneration is the formation of retinal drusen in the back of the eye. At this stage of the disease, there are usually no vision symptoms.

Symptoms of macular degeneration

• No vision loss early in the disease
• Reading small print becomes difficult as the disease progresses
• Problems driving at night increase as the disease progresses
• Complaining of a “dark spot” in your vision is a symptom in the late stage of the disease

Treatment Options

• Early, age-related dry macular degeneration is treatable with nutrition therapy
• Decrease exposure to ultraviolet light
• Behavior modification
  • lose weight
  • stop smoking
  • improve diet
  • increase exercise

Wet Macular Degeneration

The “wet” form of macular degeneration is characterized by rapid progression and permanent vision loss.

About 10% of patients with macular degeneration have the “wet” form of the disease. In wet macular degeneration, abnormal blood vessels leak fluid or blood into spaces beneath the retina. The accumulated fluid damages the retina and the structural damage results in a loss of vision.

In wet macular degeneration, early diagnosis is critical because modern treatment options can reduce or prevent permanent vision loss if they are administered early in the course of the disease.

Symptoms of Wet Macular Degeneration

• Rapid progression
• Blurred vision
• Wavy vision
• Distorted vision
• Treatment Options
• Intravitreal injections
• Laser surgery

Retinal Drusen

The small defects in the retina are a common finding in early age-related macular degeneration. Although retinal drusen is a common finding in early macular degeneration, their presence is only a risk factor and does not guarantee that the person will develop the disease.

Normal Retinal Appearance

• Optic nerve
• Blood vessels
• Macula

Abnormal Retinal Appearance

• Optic nerve
• Blood vessels
• Retinal drusen in the macula

OCULAR MIGRAINE HEADACHES

Ocular migraine headaches are usually caused by a temporary spasm of the blood vessels in the back of the brain. The condition can create episodic neurovisual disturbances called a visual aura.

Symptoms of Visual Aura

• Blank spots in your vision
• Flickering colored lights
• Zig-zag lines in your vision
• Blurred area of vision – “like looking through a heat wave

Treatment Options

• Usually benign and require no treatment
• Medical consultation if post-aura symptoms do not resolve properly”

PINGEUCULA & PTERYGIUM

A pinguecula consists of an abnormal degeneration of the collagen fibers in the conjunctival stroma.

• They present in a variety of forms
• Characterized by a nodular shape
• May enlarge slowly over time
• Most lesions are benign and do not require treatment
• Normal pinguecula can become inflamed

SPOTS & FLOATERS

Have you ever seen small specks or debris that looks like pieces of lint floating in your field of view? These are called “floaters,” and they are usually normal and harmless. They usually can be seen most easily when you look at a plain background, like a blank wall or 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.

Symptoms of floaters and spots

Floaters may look like specks, strands, webs or other shapes. If a spot or shadowy shape passes in front of your field of vision or to the side, you are seeing a floater. Because they are inside your eye and suspended within the gel-like vitreous, they move with your eyes when you try to see them.

What causes floaters and spots?

Some floaters and spots are present since birth as part of the eye’s development and others occur over time. When people reach middle age, the gel-like vitreous begins to liquefy and contract. Some parts of the vitreous form clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment – a common cause of floaters.

Floaters and spots are also more common among people who:

• Are highly nearsighted
• Have undergone cataract surgery
• Have had laser surgery of the eye
• Have had inflammation inside the eye

Treatment for floaters and spots

Most spots and floaters in the eye are harmless and merely annoying. Many will fade over time and become less bothersome. In severe cases, people may become interested in a surgical procedure called a vitrectomy to remove the floaters. Although beneficial, this invasive procedure has some risks and most retinal surgeons are usually not willing to perform the procedure unless the floaters disrupt daily activities.

Flashes of light

You may also see flashes of light. These flashes usually are caused by mechanical stimulation of retinal cells when the vitreous membrane pulls on the retina. Flashes of light may be a warning sign of a detached retina – a very serious problem that could lead to blindness if not treated quickly.

Some people experience flashes of light that appear as jagged lines or “heat waves” in both eyes, often lasting 10-20 minutes. These types of flashes are usually caused by a spasm of blood vessels in the brain, which is called a migraine. If a headache follows the flashes, it is called an ocular migraine headache. However, jagged lines or “heat waves” can occur without a headache. In this case, the light flashes are called an ocular migraine, or a migraine without a headache.

The sudden appearance of a significant number of floaters, especially if they are accompanied by flashes of light or other vision disturbances, could indicate a retinal detachment or other serious problem in the eye. If you suddenly see new floaters associated with fashes of light, visit your eye doctor immediately.”

STYES & CHALAZION

A stye (known by eye doctors as a hordeolum) is an infection of an oil gland which forms a pimple-like bump on the base of the eyelid or within the eyelid itself. Sytes can be uncomfortable, causing swelling, pain, redness, discomfort, and sometimes excessive tearing. If the stye is large and it distorts the front surface of the eyes, it can cause blurred vision.

What causes a stye?

The oil glands on the eyelid sometimes become blocked with dirt, dead skin, or a buildup of oil. When this occurs, bacteria can grow inside. Blockage is also commonly from eye cosmetics that block the orifices within the lid. This blockage causes the gland to become infected and inflamed, resulting in a stye. A stye can form on the inside or the outside of the eyelid and can cause swelling around the eye, sometimes affecting the entire eyelid.

Treating a stye

Styes are treated with antibiotics, often in moderate and severe cases with a prescription for oral antibiotics to reduce the bacteria responsible for the infection. Treatment for a stye is recommended otherwise there is a likelihood of recurrence. Applying a hot compress to the eye for 10-15 minutes a few times throughout the day will bring some relief and speed up the healing process.

Similar to a pimple, the stye will likely rupture, drain and heal on its own. Occasionally a stye, especially one on the inside of the eyelid will not resolve itself and may require the assistance of an eye doctor for additional treatment. In such a case the stye is surgically opened and drained to reduce the swelling and cosmetic issues associated with the style.

You should never pop a stye! This can cause the bacteria to spread and worsen the infection. The infection can then spread around the top and bottom eyelids and even reach the brain. If a stye is getting worse, painful, or irritated, contact your eye doctor for treatment.

In cases where styes occur frequently, your eye doctor may decide to prescribe topical antibiotic ointment or a cleansing regimen to prevent recurrence.

Chalazia: Another type of bump on the eyelid

Similar to a stye, a chalazion is a blocked oil gland on the eyelid that becomes enlarged. The main difference between a chalazion and stye is that the chalazion is usually non-infectious. A chalazion in most occasions is an old hordeolum that did not resolve. Treatment involves lid hygiene, warm compresses, and lid massage. In most cases, a chalazion requires surgical removal.

SUBCONJUCTIVAL HEMORRHAGE

A subconjunctival hemorrhage occurs when blood is visible between the conjunctiva and the sclera of the eyeball.

What causes subconjunctival hemorrhages?

• Coughing
• Heavy lifting
• Throwing up
• Eye surgery
• Trauma
• High blood pressure
• Anemia
• Spontaneous (unknown cause)

Risk Factors

• Patients with vascular diseases such as diabetes or high blood pressure have a higher risk of developing subconjunctival hemorrhages.
• Also, patients taking blood thinners and patients with certain systemic diseases have a higher risk of developing subconjunctival hemorrhages.

UVEITIS

Uveitis is inflammation of the eye’s uvea, an area that consists of the iris, the ciliary body and the choroid.

• The iris is the colored part of the eye that forms the pupil.
• The ciliary body is located behind the iris and produces the fluid that fills the anterior part of the eye.
• The choroid is the layer of blood vessels in the back of the eye that nourishes the retina.

Many cases of uveitis are chronic, and they can produce numerous possible complications that can result in vision loss, including cataracts, macular edema, glaucoma and retinal detachment.

Uveitis signs and symptoms

These signs and symptoms may occur suddenly and worsen quickly.

• Red eyes
• Eye pain
• Sensitivity to light
• Blurred vision
• Dark spots moving across your field of vision

If you experience any of these potential warning signs of uveitis, see your eye doctor immediately.

What causes uveitis?

The cause of uveitis is often unknown. However, in some cases, it has been associated with:

• Eye injuries
• Inflammatory disorders, such as multiple sclerosis, Crohn’s disease or ulcerative colitis
• Viral infections, such as herpes simplex or herpes zoster
• Autoimmune disorders, such as rheumatoid arthritis or ankylosing spondylitis
• Other infections, including toxoplasmosis and histoplasmosis

Uveitis treatment

To treat uveitis, your eye doctor may prescribe a steroid to reduce the inflammation in your eye. Whether the steroid is in eye drop, pill or injection form depends on the type of uveitis you have. Because most cases of uveitis affect the front of the eye, it’s most commonly treated with eye drops.

Episodes of uveitis can recur. See your eye doctor immediately if signs and symptoms of uveitis reappear after successful treatment.”

VITREOUS DETACHMENT

Posterior Detachment

• Vtreous gel inside the eye contracts as we get older
• Vitreous membrane separates from the retina
• Separation produces vitreous debris seen as “spots” by the patient
• Traction at attachment points may produce symptoms of “flashes of light”

Treatment Options

• Monitor the condition until the vitreous detachment stabilizes
• Retinal consultation for prolonged vitreomacular traction or peripheral retinal disease