Eye Care Education
Common Conditions
Blepharitis-
Cataracts
- Chalazion
- Dry Eye
- Floaters and Flashers
- Glaucoma
- Macular Degeneration
- Pterygium and Pinguecula
- Thyroid Eye Disease
- image from www.blepharitisfoundation.org
- Eye and eyelid irritation;
- Itchiness of the eye;
- Redness of the eye;
- Burning sensation.
- image from www.seewithlasik.com
- A growth or film over the eye.
- A cause of irreversible blindness.
- A result of overusing the eyes.
- A contagious disease spread from eye to eye or person to person.
- Painless clouded, blurry or dim vision.
- Increasing difficulty seeing at night or in low light.
- Sensitivity to light and glare, seeing halos around lights.
- Colors seem faded or yellowed.
- The need for brighter light for reading and other activities.
- Frequent changes in eyeglass or contact lens prescription.
- Double vision within one eye.
- Congenital or developmental cataracts. Can occur in children. They may be hereditary or can be associated with some birth defects. Some occur without any obvious cause.
- Secondary cataracts. Caused by other eye diseases or previous surgery within the eye. Formation of secondary cataracts may be accelerated by a chronic disease, such as diabetes, or excessive use of steroid medications.
- Traumatic cataracts. Related directly to an eye injury. Traumatic cataracts may appear immediately following injury, or develop several months or even years later.
- Slit-lamp. This device allows your Eye M.D. to closely examine the eye's cornea, iris, lens and the space between the iris and cornea. The doctor is able to examine the eye in small sections, making it easier to see abnormalities.
- Retinal exam. When your eye is dilated, the pupils are wide open so the doctor can more clearly see the back of the eye. Using the slit lamp and/or an instrument called an ophthalmoscope, the doctor looks for signs of cataract and if present, the extent of the clouding. Your Eye M.D. will also look for signs of glaucoma and other potential problems with the retina and optic nerve.
- Refraction and visual acuity test. This refers to the sharpness and clarity of your vision. Each eye is tested individually for the ability to see letters of varying sizes.
- Have an eye exam every year if you're older than 65, or every two years if younger.
- Protect your eyes from UV light by wearing sunglasses that block at least 99 percent UV and a hat.
- If you smoke, quit; smoking can increase cataract progression.
- Use brighter lights for reading and other activities; a magnifying glass may be useful, too.
- Limit night driving once night vision, halos or glare become problems.
- Take care of any other health problems, especially diabetes.
- Get the right eyeglasses or contact lenses to correct your vision; when it becomes too difficult to complete your regular activities, consider cataract surgery.
- image from www.aurorahealthcare.org
- A red bump along the edge of the eyelid at the base of the eyelashes.
- A feeling as if something is in your eye.
- Sensitivity to light.
- Eyelid tenderness.
- Tearing.
- An oily layer;
- A watery layer;
- A layer of mucus.
- Stinging or burning eyes;
- Scratchiness;
- Stringy mucus in or around the eyes;
- Excessive eye irritation from smoke or wind;
- Excess tearing;
- Discomfort when wearing contact lenses.
- Diuretics for high blood pressure;
- Beta-blockers for heart or high blood pressure;
- Antihistamines for allergies;
- Sleeping pills;
- Medications for "nerves";
- Pain relievers.
- image from www.eyesandeyesight.com
- Small specks or clouds moving in your field of vision;
- Dots, circles, lines or "cobwebs" in your field of vision;
- Seeing flashes of light or "stars."
- You suddenly see an increase in the size and number of floaters;
- You suddenly see flashes of light.
- Are nearsighted;
- Have undergone cataract operations;
- Have had YAG laser surgery of the eye;
- Have had inflammation (swelling) inside the eye.
- A sudden increase in size and number of floaters;
- A sudden appearance of flashes;
- Having a shadow appear in the periphery (side) of your field of vision;
- Seeing a gray curtain moving across your field of vision;
- Having a sudden decrease in your vision.
- Severe eye or brow pain;
- Redness of the eye;
- Decreased or blurred vision;
- Seeing colored rainbows or halos;
- Headache;
- Nausea;
- Vomiting.
- Age;
- Family history of glaucoma;
- African or Hispanic ancestry;
- Farsightedness or nearsightedness;
- Elevated eye pressure;
- Past eye injury;
- Having a thinner central cornea (the clear, front part of the eye covering the pupil and colored iris);
- Not having eye examinations when they are recommended;
- Low blood pressure;
- Conditions that affect blood flow, such as migraines, diabetes and low blood pressure.
- Measures the pressure in your eye (tonometry);
- Inspects your eye's drainage angle (gonioscopy);
- Inspects your optic nerve (ophthalmoscopy);
- Tests your side, or peripheral, vision (visual field test);
- Measures the thickness of your cornea — the clear window at the front of the eye (pachymetry).
- image from www.mayoclinic.org
- image from www.killarneyvision.com
- 1. Cover one eye.
- 2. Look directly at the center dot with the uncovered eye and keep your eye focused on it.
- 3. While looking directly at the center dot, note whether all lines of the grid are straight or if any areas are distorted, blurry or dark.
- 4. Repeat this procedure with the other eye.
- 5. If any area of the grid looks wavy, blurred or dark, contact your ophthalmologist immediately.
- Blurry distance and/or reading vision;
- Distorted vision — straight lines will appear bent, crooked or irregular;
- Dark gray spots or blank spots in your vision;
- Size of objects may appear different for each eye;
- Colors do not look the same for each eye.
- Vitamin C – 500 mg
- Vitamin E – 400 IU
- Beta carotene – 15 mg (25,000 IU)
- Zinc oxide – 80 mg
- Copper (as cupric oxide) – 2 mg (to prevent copper deficiency, which may be associated with taking high amounts of zinc)
- image from www.4smart.net
- image from www.oahulasik.com
- Staring appearance with upper and lower eyelid retraction, resulting in more white of the eye being apparent.
- Bulging or proptotic eyes, where the eyes protrude forwards and look very big.
- Peri-ocular swelling, with puffiness of the eyelids, sub-brow area and peri-ocular region.
- Orbital ache, particularly on eye movements.
- Double vision (diplopia), either looking straight ahead, or on extremes of gaze.
- Bloodshot appearance to the eyes associated with one or more of the above.
- Reduced vision, particularly for colour vision, if the optic nerve is compressed
- Medical control of thyroid gland and thyroid hormone, so that the patient is not hyper or hypothyroid.
- Treatment of active thyroid eye disease if moderately severe, or severe, with tablets, such as steroids and other immuno-suppression drugs, +/- low dose orbital radiotherapy.
- Surgical rehabilitation in the acute phase, or stable phase.
- Restore normal function to the orbit and eyelids.
- Restore normal comfort.
- Restore normal cosmesis and symmetry.
At the Aesthetic Eyecare Institute, patients of all ages receive the finest eye care available today. From basic eye exams to the most advanced diagnostic tests and sophisticated surgery, we provide comprehensive eye care services at one convenient location. Dr. Wirta and Dr. Kurteeva are board-certified ophthalmologists and will personally make sure you receive first-rate eye care.
Our practice is certified by the American Board of Optholmology and has years of experience in laser and cataract surgery. Combining our experience with the most modern technologies in eye care, we will give you the best eye care that you can find. We know that you have a choice when it comes to choosing an eye doctor, and we work hard every day to make sure our patients feel they are making the right decision for comprehensive eye care services every time they visit us. We hope you will also find that our office is the best place for your eyes too.
Blepharitis
What is blepharitis?
Blepharitis is an ongoing inflammation (swelling) of the eyelids. Both the upper and lower eyelids become coated with oily particles and bacteria near the base of the eyelashes. This common condition may cause irritation, itchiness, redness, and stinging or burning of the eye.
What are the symptoms of blepharitis?
Symptoms include:
Who is at risk for blepharitis?
Blepharitis frequently occurs in people who have a tendency toward oily skin, dandruff or dry eyes. This condition also is associated with meibomianitis — a problem of the nearby oil glands of the eyelids (called meibomian glands).
What causes blepharitis?
Everyone has bacteria on the surface of their skin, but in some people, bacteria thrive in the skin at the base of the eyelashes. Large amounts of bacteria around the eyelashes can cause dandruff-like scales and particles to form along the lashes and eyelid margins.
How is blepharitis diagnosed?
A close examination of your eyelids and eyelashes by an ophthalmologist (Eye M.D.) is usually all that is needed to diagnose blepharitis. Your Eye M.D. may test your vision, perform a slit-lamp microscope exam, and test your eye pressure as well.
How is blepharitis treated?
Blepharitis is often a chronic, or ongoing, condition, but it can be controlled with the following treatments:
Warm compresses
Wet a clean washcloth with warm water, wring it out, and place it over your closed eyelids for at least one minute. Repeat two or three times, rewetting the washcloth as it cools. This will loosen scales and debris around your eyelashes. It also helps break down oil from nearby oil glands. This prevents development of a chalazion (pronounced kuh-LAY-zee-un) — an enlarged lump caused by clogged oil secretions in the eyelid.
Eyelid scrubs
Using a clean washcloth, cotton swab or commercial lint-free pad soaked in warm water, gently scrub the base of your eyelashes for about 15 seconds per eyelid.
Antibiotic ointment
Your ophthalmologist may prescribe an antibiotic ointment. Using a clean fingertip or cotton swab, gently apply a small amount at the base of the eyelashes before bedtime.
Artificial tears or steroid eyedrops may also be prescribed temporarily to relieve dry eye or inflammation. A new antibiotic drop that also helps improve the oil secretions of the meibomian glands may be prescribed by your Eye M.D.
Nutritional therapy
Research suggests that a lack of certain nutrients may contribute to meibomian gland blepharitis. An imbalance of omega fatty acids has been found to cause abnormal secretions of the oil glands that help lubricate your eyes. Ask your ophthalmologist about a proper diet and nutritional supplements to help treat this imbalance.
Good hygiene
Because blepharitis can be an ongoing problem, you should regularly clean your skin and eyelids to keep blepharitis from returning. In addition to carefully cleansing your eyelashes, you can also wash your hair, scalp and eyebrows with antibacterial shampoo to help control blepharitis.
Cataracts
What are Cataracts?
If your vision has become cloudy or things you see are not as bright as they used to be, a cataract may have developed in one or both of your eyes. A cataract is a clouding of the eye's naturally clear lens. Your eye becomes like a window that is frosted or yellowed.
The amount and pattern of cloudiness within the lens can vary. If the cloudiness is not near the center of the lens, you may not be aware that a cataract is present.
There are many misconceptions about cataract. A cataract is not:
Cataracts are a common cause of vision loss, especially as we age, but they are treatable. Your ophthalmologist (Eye M.D.) can tell you whether cataract or some other problem is the cause of your vision loss and can help you decide if cataract surgery is appropriate for you.
What are the symptoms of Cataracts?
Most age-related cataracts develop gradually. As a result, you may not immediately notice changes in your vision when cataracts first develop.
In time, you may have symptoms such as:
What causes Cataracts?
The design of the human eye is much like that of a camera. Light rays are focused through the lens onto the retina, a layer of light-sensitive cells at the back of the eye that is similar to film. In a normal eye, light rays pass through a clear lens and are focused onto the retina. This produces a bright, clear image.
As the body ages, the lens continues to grow layers onto the existing surface. Over time the lens hardens and becomes cloudy, which often results in dull, cloudy or blurred vision. This condition, known as an age-related cataract, is normal and occurs eventually in most people. If the clouding is mild or affects only a small area of the lens, your vision may be only slightly affected. If there is more clouding and it affects the entire lens, your vision will become severely limited.
What else causes cataracts?
Less common types of cataracts, not related to normal aging, include:
How are cataracts diagnosed?
Once I know I have cataracts, what should I do?
Do not use eyedrops or other treatments that claim to dissolve or remove cataracts. There is no proven way to dissolve cataracts with eyedrops. Surgery is the only way to remove cataracts.
How are Cataracts treated?
If your vision is only slightly blurry, a change in your eyeglass prescription may help for a while. However, if you are still not able to see well enough to do the things you like or need to do after the change in eyeglass prescription, cataract surgery should be considered.
Cataract surgery is often performed as an outpatient procedure and does not require an overnight stay. There are usually few restrictions, and you will be able to resume your normal activities almost immediately.
Before surgery, the length of your eye will be measured in what is called an A-scan, and the curve of your cornea will be measured in a technique called keratometry. These measurements help your Eye M.D. select the proper lens implant for your eye.
The most common procedure used for removing cataracts is called phacoemulsification. A small incision is made in the side of the cornea (the front part of your eye). Your Eye M.D. inserts a tiny instrument through the incision that uses high-frequency ultrasound to break up the center of the cloudy lens and suction it out. The lens is removed in one piece, using a technique called extracapsular extraction.
After the cloudy lens has been removed, the surgeon will replace it with an intraocular lens (IOL) implant made of plastic, silicone or acrylic. This new lens allows light to pass through and focus on the retina. The IOL becomes a permanent part of your eye. In most cases, the IOL is inserted behind the iris, the colored part of your eye, and is called a posterior chamber lens.
Sometimes, the IOL must be placed in front of the iris. This is called an anterior chamber lens. When the IOL is in place, the surgeon closes the incision. Stitches may or may not be used.
Chalazion
What is a chalazion?
The term chalazion (pronounced kuh-LAY-zee-un) comes from a Greek word meaning "small lump."
A chalazion is an enlarged oil-producing gland in the eyelid called the meibomian gland. It forms when the gland opening becomes clogged with oil. It is not caused by an infection from bacteria, and it is not a cancer.
A stye is a red, sore lump near the edge of the eyelid.
What is the difference between a chalazion and a stye?
A chalazion is sometimes confused with a stye, which also appears as a lump on the eyelid. A stye often appears as a red, sore lump near the edge of the eyelid. It is caused by an infected eyelash follicle. Chalazia tend to develop farther from the edge of the eyelid than styes. In some cases, a stye can develop under the eyelid. In these situations it may be difficult to distinguish between a chalazion and stye, but both conditions are usually treated the same way at first.
What are the symptoms of chalazia and styes?
About 25 percent of chalazia have no symptoms and will go away without any treatment. Sometimes, however, a chalazion may become red, swollen and tender. A larger chalazion may also cause blurred vision by distorting the shape of the eye. Occasionally, a chalazion can cause the entire eyelid to swell suddenly.
Symptoms of a stye include:
Styes typically heal without any treatment.
Who is at risk for chalazia or styes?
Anyone can develop a chalazion or stye. If you have blepharitis — chronic inflammation of the upper and lower eyelids which become coated with oily particles and bacteria near the base of the eyelashes — you may be more likely to get a chalazion or stye.
What causes chalazia and styes?
A chalazion is caused when the opening of an oil-producing gland in the eyelid called the meibomian gland gets clogged with oil and becomes enlarged.
Styes often are caused by infected eyelash follicles.
How are chalazia and styes diagnosed?
Your ophthalmologist (Eye M.D.) can diagnose a chalazia or stye by carefully examining your eyelid.
How are chalazia and styes treated?
It is important not to squeeze or try to "pop" a chalazion or stye. Symptoms of a chalazion or stye are treated with one or more of the following methods:
Warm compresses: Soak a clean washcloth in hot water and apply the cloth to the lid for 10 to 15 minutes, three or four times a day until the chalazion or stye is gone. You should repeatedly soak the cloth in hot water to maintain adequate heat. With a chalazion, when the clogged gland opens, you may notice increased discharge from the eye. This should improve.
Antibiotic ointments: An antibiotic ointment may be prescribed if bacteria infect a chalazion, or if a stye does not improve after treatment with warm compresses or if it keeps coming back.
Steroid injections: A steroid (cortisone) injection is sometimes used to reduce swelling of a chalazion.
Surgical removal: If a large chalazion or stye does not heal after other treatments or if it affects your vision, your Eye M.D. may need to drain it in surgery. The procedure is usually performed under local anesthesia in your ophthalmologist's office.
Chalazia and styes usually respond well to treatment, although some people tend to have them recur. If a chalazion comes back in the same place, your ophthalmologist may suggest a biopsy (where a tiny piece of tissue is surgically removed and studied) to rule out more serious problems.
Dry Eye
What is dry eye?
When you blink, a film of tears spreads over the eye, making the surface of the eye smooth and clear. Without this tear film, good vision would not be possible. Sometimes people don't produce enough tears or the right quality of tears to keep their eyes healthy and comfortable. This condition is known as dry eye.
The tear film consists of three layers:
Each layer has its own purpose. The oily layer, produced by the meibomian glands, forms the outermost surface of the tear film. Its main purpose is to smooth the tear surface and reduce evaporation of tears.
The middle watery layer makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal glands in the eyelids, cleanses the eye and washes away foreign particles or irritants.
The inner layer consists of mucus produced by the conjunctiva. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain moist. Without mucus, tears would not stick to the eye.
Normally, the eye constantly bathes itself in tears. By producing tears at a slow and steady rate, the eye stays moist and comfortable.
The eye uses two different methods to produce tears. It can make tears at a slow, steady rate to maintain normal eye lubrication. It can also produce a lot of tears in response to eye irritation or emotion. When a foreign body or dryness irritates the eye, or when a person cries, excessive tearing occurs.
It may not sound logical that dry eye would cause excess tearing, but think of it as the eye's response to discomfort. If the tears responsible for maintaining lubrication do not keep the eye wet enough, the eye becomes irritated. Eye irritation prompts the gland that makes tears (called the lacrimal gland) to release a large volume of tears, overwhelming the tear drainage system. These excess tears then overflow from your eye.
What are the symptoms of dry eye?
While it may sound strange, people with dry eye may find their eyes water quite a bit. This is because the eye is responding to the irritation of this condition. Dry-eye sufferers may find that they feel like they cannot keep their eyes open for very long. They may also find their eyes feel more uncomfortable after reading or watching television.
General symptoms of dry eye usually include:
What causes dry eye?
Hormonal changes are a main cause of dry eye, causing changes in tear production. The hormonal changes associated with menopause are one of the main reasons why women are most often affected by dry eye.
Conditions that affect the lacrimal gland or its ducts — including autoimmune diseases like lupus and rheumatoid arthritis — lead to decreased tear secretion and dry eye.
Tear secretion also may be reduced by certain conditions that decrease corneal sensation. Diseases such as diabetes and herpes zoster are associated with decreased corneal sensation. So is long-term contact lens wear and surgery that involves making incisions in or removing tissue from the cornea (such as refractive surgery).
A wide variety of common medications, both prescription and over-the-counter, can cause dry eye by reducing tear secretion. Be sure to tell your ophthalmologist (Eye M.D.) the names of all the medications you are taking, especially if you are using:
Since these medications are often necessary, the dry eye condition may have to be tolerated or treated with eyedrops called artificial tears.
People with dry eye are often more likely to experience the side effects of eye medications, including artificial tears. For example, the preservatives in certain eyedrops and artificial tear preparations can irritate the eye. These people may need special, preservative-free artificial tears.
Another cause for dry eye is exposure to a dry, windy climate, as well as smoke and air conditioning, which can speed tear evaporation.
How is dry eye diagnosed?
An ophthalmologist is usually able to diagnose dry eye by examining the eyes. Sometimes tests that measure tear production are necessary. A test called the Schirmer tear test involves placing filter-paper strips under the lower eyelids to measure the rate of tear production under various conditions. Another diagnostic method involves putting special dye drops in the eye then studying how long it takes for dry spots to develop on the cornea. The dye test can also be used to look for certain staining patterns that show any damage to the surface of the cornea.
How is dry eye treated?
The eye's tear drainage system.
Adding tears: Eyedrops called artificial tears are similar to your own tears. They lubricate the eyes and help maintain moisture. Artificial tears are available without a prescription. There are many brands on the market, so you may want to try several to find the one you like best.
Preservative-free eyedrops are available for people who are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands may be better for you.
You can use the artificial tears as often as necessary — once or twice a day or as often as several times an hour.
Conserving your tears: Conserving your eyes' own tears is another approach to keeping the eyes moist. Tears drain out of the eye through a small channel into the nose (which is why your nose runs when you cry). Your ophthalmologist may close these channels either temporarily or permanently with punctal plugs. This method conserves your own tears and makes artificial tears last longer.
Other methods: Tears evaporate like any other liquid. You can take steps to prevent evaporation. In winter, when indoor heating is in use, a humidifier or a pan of water on the radiator adds moisture to dry air. Wraparound glasses may reduce the drying effect of the wind.
A person with dry eye should avoid anything that may cause dryness, such as an overly warm room, hair dryers or wind. Smoking is especially bothersome.
Some people may find dry-eye relief by supplementing their diet with omega-3 fatty acids, which are found naturally in foods like oily fish (salmon, sardines, anchovies) and flax seeds. Ask your Eye M.D. if you should take supplements of omega-3 fatty acids and, if so, in what form and dosage.
If other methods do not give you adequate relief from dry eye, your ophthalmologist may suggest that you use a prescription medication. One such medication, cyclosporine, works by stimulating tear production. Steroid eyedrops may also be used, but are generally not recommended for long-term treatment. Other treatment options may include ointments, gels and inserts.
Dry eye due to lack of vitamin A in the diet is rare in the United States but is more common in poorer countries, especially among children. Ointments containing vitamin A can help dry eye if it is caused by unusual conditions such as Stevens-Johnson syndrome or pemphigoid. Vitamin A supplements do not seem to help people with ordinary dry eye.
If you are bothered by dry eye, talk with your Eye M.D. for ways to find relief.
Floaters and Flashers
What are floaters and flashes?
Floaters
You may sometimes see small specks or clouds moving in your field of vision. These are called floaters. You can often see them when looking 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, gel-like fluid that fills the inside of your eye.
While these objects look like they are in front of your eye, they are actually floating inside it. What you see are the shadows they cast on the retina, the layer of cells lining the back of the eye that senses light and allows you to see. Floaters can appear as different shapes, such as little dots, circles, lines, clouds or cobwebs.
Flashes
When the vitreous gel rubs or pulls on the retina, you may see what look like flashing lights or lightning streaks. You may have experienced this same sensation if you have ever been hit in the eye and seen "stars." The flashes of light can appear off and on for several weeks or months.
As we grow older, it is more common to experience floaters and flashes as the vitreous gel changes with age, gradually pulling away from the inside surface of the eye.
What are the symptoms of floaters and flashes?
Symptoms of floaters and flashes include:
If the vitreous gel shrinks and pulls away from the wall of the eye, the retina can tear. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters.
A torn retina is always a serious problem, since it can lead to retinal detachment. You should see your ophthalmologist (Eye M.D.) as soon as possible if:
Some people experience flashes of light that appear as jagged lines or "heat waves" in both eyes, often lasting 10 to 20 minutes. These are not flashes from the vitreous gel rubbing or pulling on the retina; instead, these types of flashes are usually caused by a spasm of blood vessels in the brain, called a migraine.
If a headache follows the flashes, it is called a migraine headache. However, jagged lines or heat waves can occur without a headache. In this case, the light flashes are called ophthalmic migraine, or migraine without headache. Contact your ophthalmologist if you experience these symptoms.
If you notice other symptoms, like the loss of side vision, you should see your ophthalmologist.
Who is at risk for floaters and flashes?
As we grow older, it is more common to experience floaters and flashes. Floaters and flashes are also caused by posterior vitreous detachment, where the vitreous gel pulls away from the back of the eye. This condition is more common in people who:
What causes floaters and flashes?
When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. This is a common cause of floaters. As we grow older, it is also more common to experience flashes.
The appearance of floaters and flashes may be alarming, especially if they develop very suddenly. To find out if a retinal tear or detachment is occurring, you should call your ophthalmologist right away if you notice the following symptoms (especially if you are over 45 years of age) :
How are floaters and flashes diagnosed?
Floaters and flashes become more common as we grow older. While not all floaters and flashes are serious, you should always have a medical eye examination by an ophthalmologist to make sure there has been no damage to your retina.
When an ophthalmologist examines your eyes, your pupils may be dilated (enlarged) with eyedrops. During this painless examination, your ophthalmologist will carefully observe areas of your eye, including the retina and vitreous. If your eyes have been dilated, you will need to make arrangements for someone to drive you home afterward.
How are floaters and flashes treated?
Floaters may be a symptom of a tear in the retina, which is a serious problem. If a retinal tear is not treated, the retina may detach from the back of the eye. The only treatment for a detached retina is surgery.
Other floaters are harmless and fade over time or become less bothersome, requiring no treatment. Surgery to remove floaters is almost never required. Vitamin therapy will not cause floaters to disappear.
Even if you have had floaters for years, you should schedule an eye examination with your ophthalmologist if you notice a sudden increase in the size or amount of floaters or a sudden appearance of light flashes — especially if these symptoms are accompanied by any change in your vision.
The American Academy of Ophthalmology recommends that adults with no signs or risk factors for eye disease get a baseline eye disease screening at age 40 — the time when early signs of disease and changes in vision may start to occur. Based on the results of the initial screening, an ophthalmologist will prescribe the necessary intervals for follow-up exams.
For individuals at any age with symptoms of or at risk for eye disease, such as those with a family history of eye disease, diabetes or high blood pressure, the Academy recommends that individuals see their ophthalmologist to determine how frequently their eyes should be examined.
Glaucoma
What is glaucoma?
Glaucoma is a disease that damages the eye's optic nerve. The optic nerve is connected to the retina — a layer of light-sensitive tissue lining the back of the eye. The optic nerve is made up of many nerve fibers, like an electric cable is made up of many wires. The optic nerve sends signals from your retina to your brain, where these signals are interpreted as the images you see.
In the healthy eye, a clear fluid called aqueous (pronounced AY-kwee-us) humor circulates inside the front portion of your eye. To maintain a constant healthy eye pressure, your eye continually produces a small amount of aqueous humor while an equal amount of this fluid flows out of your eye.
The fluid flows out through a very tiny drain called the trabecular meshwork, a complex network of cells and tissue in an area called the drainage angle.
If you have glaucoma, the aqueous humor does not flow through the trabecular meshwork properly. Fluid pressure in the eye builds up and over time causes damage to the nerve fibers.
Types of glaucoma:
Open-angle glaucoma: The most common form of glaucoma is called primary open-angle glaucoma. It occurs when the trabecular meshwork of the eye gradually becomes less efficient at draining fluid. As this happens, your eye pressure, called intraocular pressure (IOP), rises. Raised eye pressure leads to damage of the optic nerve. Damage to the optic nerve can occur at different eye pressures among different patients. Your ophthalmologist (Eye M.D.) establishes a target eye pressure for you that he or she predicts will protect your optic nerve from further damage. Different patients have different target pressures.
Typically, open-angle glaucoma has no symptoms in its early stages and your vision remains normal. As the optic nerve becomes more damaged, blank spots begin to appear in your field of vision. You usually won't notice these blank spots in your day-to-day activities until the optic nerve is significantly damaged and these spots become large. If all of the optic nerve fibers die, blindness results.
Closed-angle glaucoma: A less common form of glaucoma is closed-angle, or narrow-angle, glaucoma. Closed-angle glaucoma occurs when the drainage angle of the eye becomes blocked. Unlike open-angle glaucoma, eye pressure usually goes up very fast. The pressure rises because the iris — the colored part of the eye — partially or completely blocks off the drainage angle. People of Asian descent and those with hyperopia (farsightedness) tend to be more at risk for developing this form of glaucoma.
If the drainage angle becomes completely blocked, eye pressure rises quickly resulting in a closed-angle glaucoma attack. Symptoms of an attack include:
A closed-angle glaucoma attack is a medical emergency and must be treated immediately. Unfortunately, people at risk for developing closed-angle glaucoma often have few or no symptoms before the attack.
People at risk for closed-angle glaucoma should avoid over-the-counter decongestants and other medications where the packaging states not to use these products if you have glaucoma.
Who is at risk for glaucoma?
Some people are at greater risk for developing glaucoma and should see their ophthalmologist on a regular basis, specifically for glaucoma testing. Risk factors for glaucoma include:
How is glaucoma diagnosed?
One of the problems with glaucoma, especially open-angle glaucoma, is that there are typically no symptoms in the early stages. Many people who have the disease do not know they have it. This is why it is important, especially as you get older, to have regular medical eye exams by an ophthalmologist.
The eye examination
In a glaucoma evaluation, your doctor:
How is glaucoma treated?
How your glaucoma is treated will depend on your specific type of glaucoma, the severity of your disease, and how it responds to treatment.
Medicine: Medicated eyedrops are the most common way to treat glaucoma. These medications lower your eye pressure in one of two ways — either by slowing the production of aqueous humor or by improving the flow through the drainage angle.
These eyedrops must be taken every day. Just like any other medication, it is important to take your eyedrops regularly as prescribed by your ophthalmologist.
Never change or stop taking your medications without consulting your doctor. If you are about to run out of your medication, ask your doctor if you should have it refilled.
It is important to tell your ophthalmologist about your other medical conditions and all other medications you currently take. Bring a list of your medications with you to your eye appointment. Also tell your primary care doctor and any other doctors caring for you, what glaucoma medication you take.
Surgery: In some patients with glaucoma, surgery is recommended. Glaucoma surgery improves the flow of fluid out of the eye, resulting in lower eye pressure.
Laser trabeculoplasty:To treat open-angle glaucoma, a surgery called laser trabeculoplasty is often used. There are two types of trabeculoplasty surgery: argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT).
During ALT surgery, a laser makes tiny, evenly spaced burns in the trabecular meshwork. The laser does not create new drainage holes, but rather stimulates the drain to function more efficiently.
With SLT, a laser is used at different frequencies, allowing it to work at very low levels. SLT treats specific cells and leaves the mesh-like drainage canals surrounding the iris intact. SLT may be an alternative for those who have been treated unsuccessfully with traditional laser surgery or with pressure-lowering drops.
Even if laser trabeculoplasty is successful, most patients continue taking glaucoma medications after surgery. For many, this surgery is not a permanent solution. Nearly half who receive this surgery develop increased eye pressure again within five years. Many people who have had a successful laser trabeculoplasty have a repeat treatment.
Laser trabeculoplasty can also be used as a first line of treatment for patients who are unwilling or unable to use eyedrops.
Age-related Macular Degeneration (AMD)
What is AMD?
Age-related macular degeneration (AMD) is a deterioration or breakdown of the eye's macula. The macula is a small area in the retina — the light-sensitive tissue lining the back of the eye. The macula is the part of the retina that is responsible for your central vision, allowing you to see fine details clearly.
Even though the macula makes up only a small part of the retina, it is much more sensitive to detail than the rest of the retina, called the peripheral retina. The macula is what allows you to thread a needle, read small print, and read street signs. The peripheral retina gives you side (or peripheral) vision.
With AMD, you may have blurriness, dark areas or distortion in your central vision, and perhaps permanent loss of your central vision. It usually does not affect your side, or peripheral vision. For example, with advanced AMD, you could see the outline of a clock, yet may not be able to see the hands of the clock to tell what time it is.
AMD alone almost never causes total blindness. People with more advanced cases of AMD continue to have useful vision using their side, or peripheral vision. In many cases, macular degeneration's impact on your vision can be minimal. When AMD does lead to loss of vision, it usually begins in just one eye, though it may affect the other eye later.
Many people are not aware that they have macular degeneration until they have a noticeable vision problem or until it is detected during an eye examination.
There are two types of AMD:
Dry, or atrophic, AMD (also called non-neovascular AMD)
Most people who have AMD have the dry form. This condition is caused by aging and thinning of the tissues of the macula.. With dry AMD, vision loss is usually gradual.
People who develop dry AMD must carefully and constantly monitor their central vision. If you notice any changes in your vision, you should tell your ophthalmologist (Eye M.D.) right away, as the dry form can change into the more damaging form of AMD called wet (exudative) AMD.
Monitoring your vision
If you have been diagnosed with dry AMD, you should use a chart called an Amsler grid every day to monitor your vision, as dry AMD can change into the more damaging wet form.
To use the Amsler grid, wear your reading glasses and hold the grid 12 to 15 inches away from your face in good light.
If you detect any changes when looking at the grid, you should notify your ophthalmologist immediately.
Wet, or exudative, AMD (also called neovascular AMD)
The wet form of macular degeneration occurs in about 10 percent of all macular degeneration cases, but it can cause more damage to your central or detail vision than the dry form.
Capillaries, or tiny blood vessels, extend into all tissues of the body, bringing in nutrients and Wet AMD occurs when abnormal blood vessels begin to grow underneath the retina. This blood vessel growth is called choroidal neovascularization (CNV) because these vessels grow from the layer under the retina called the choroid. These new blood vessels may leak fluid or blood, blurring or distorting central vision. Vision loss from this form of AMD may be faster and more noticeable than that from dry AMD.
The longer these abnormal vessels leak or grow, the more risk you have of losing more of your detailed vision. Also, if abnormal blood vessel growth happens in one eye, there is a risk that it will occur in the other eye. The earlier that wet AMD is diagnosed, the better chance you have of preserving some or much of your central vision. That is why it is so important that you and your ophthalmologist monitor your vision in each eye carefully.
What are the symptoms of AMD?
In its earliest stages, macular degeneration may cause the following symptoms:
What causes AMD?
Doctors and researchers don't know the exact causes of AMD but it is clear that this disease is strongly associated with age, since AMD occurs as people grow older. One large study found that the risk of getting AMD jumps from about 2 percent of middle-aged people in their 50s to nearly 30 percent in people over age 75.
Our bodies constantly react with the oxygen in our environment. Over our lifetimes, as a result of this activity, our bodies produce tiny molecules called free radicals. These free radicals affect our cells, sometimes damaging them. This is called oxidative stress and is thought to play a major role in how AMD develops.
How is AMD diagnosed?
Many people do not realize they have a macular problem until they notice they have blurred or distorted vision. Regular eye examinations by an ophthalmologist may help to detect problems before you are even aware of them. Your ophthalmologist can see early stages of AMD during a comprehensive eye examination.
To check for macular degeneration, your eye doctor will dilate (widen) your pupils using eyedrops and examine your eyes with an ophthalmoscope, a device that allows him or her to see the retina and other areas at the back of the eye. If AMD is detected, your doctor may have you use an Amsler grid to check for wavy, blurry or dark areas in your vision.
Fluorescein angiography
If your ophthalmologist finds an abnormality during an exam and suspects the wet form of AMD, he or she will take special photographs of your eye called fluorescein angiography. These photographs determine if abnormal blood vessels are under the retina.
How is AMD treated?
Unfortunately, at this time there is no single proven treatment for the dry form of AMD. However, a large scientific study has shown that antioxidant vitamins and zinc may reduce the impact of AMD in some people by slowing its progression toward more advanced stages.
The AREDS nutrient supplementation shown to be beneficial includes:
Another large study in women showed a benefit from taking folic acid and vitamins B6 and B12. And a large study evaluating the possible benefits of lutein and fish oil (omega-3) is ongoing.
These vitamins and minerals are recommended in specific daily amounts in addition to a healthy, balanced diet. Some people may not wish to take large doses of antioxidants or zinc because of medical reasons. Beta carotene has been shown to increase the risk of lung cancer in smokers or recent past smokers, so this supplement should not be used by people who currently smoke or recently quit smoking.
It is very important to remember that vitamin supplements are not a cure for AMD, nor will they give you back vision that you may have already lost from the disease. However, specific amounts of these supplements do play a key role in helping some people at high risk for developing advanced (wet) AMD to maintain their vision. Talk with your ophthalmologist to find out if you are at risk for developing advanced AMD, and to learn if supplements are recommended for you.
Treating wet AMD
Treating the wet form of AMD may involve the use of anti-VEGF treatment, thermal laser treatment or photodynamic therapy (PDT). Treatment of wet AMD generally reduces the risk of severe vision loss, but it does not eliminate this risk.
Anti-VEGF treatment
A common way to treat wet AMD targets a specific chemical in your body that causes abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor, or VEGF. Several new drugs (called anti-VEGF drugs) have been developed that can block the trouble-causing VEGF. Blocking VEGF reduces the growth of abnormal blood vessels, slows their leakage, helps to slow vision loss, and in some cases improves vision.
Following laser treatment, vision may be more blurred than before treatment, but often it will stabilize within a few weeks. A scar forms where the treatment occurred, creating a permanent blind spot that might be noticeable in your field of vision.
Photodynamic therapy (PDT)
In some cases, a type of treatment for wet AMD called photodynamic therapy, or PDT, may be an option. This therapeutic procedure uses a combination of a light-activated drug called a photosensitizer and a special low-power, or cool, laser to treat wet AMD right at the center of the macula. After PDT, the abnormal blood vessels may reopen, so multiple treatments may be required.
What happens when AMD cannot be treated?
It is important to remember that only about 10 percent of all AMD cases are exudative, or wet form, and about 75 percent of these cases cannot be treated. People with wet or dry AMD who cannot be treated will not become blind, as they will still have peripheral, or side, vision.
If you have untreatable AMD, you can make the most of your remaining vision by learning to "see again" with the vision you do have and with the help of special low-vision rehabilitation, devices and services. People with low vision can learn new strategies to accomplish daily activities. These skills, including mastering new techniques and devices, help people with advanced AMD regain their confidence and live independently despite loss of central vision.
While there is little that can be done to improve the eyesight of someone who has AMD, with early detection, the rate of vision loss can be slowed. The keys to slowing vision loss are to understand your condition and work closely with your ophthalmologist to monitor your vision. Even with macular degeneration, you can still maintain an enjoyable lifestyle.
Pterygium and Pinguecula
Pinguecula
Pingueculae are yellowish, slightly raised lesions that form on the surface of the white part of your eye (sclera) close to the edge of the cornea. They are typically found in the open space between your eyelids (palpebral fissure), which also happens to be the area exposed to the sun.
While pingueculae are more common in middle-aged or older people who spend a lot of time in the sun, they can also be found in younger people and even children — especially those who are often outdoors without protection such as sunglasses or hats.
Pinguecula Signs and Symptoms
In most people, pingueculae cause few symptoms. But a pinguecula that is irritated might create a feeling that something is in the eye.
In some cases, pingueculae become swollen and inflamed, a condition called pingueculitis. Irritation and eye redness from pingueculitis usually result from exposure to sun, wind, dust or extremely dry conditions.
Treatment of Pinguecula
Pinguecula treatment depends on how severe the symptoms are. Everyone with pingueculae can benefit from sun protection for their eyes. Lubricating eye drops may be prescribed for mild pingueculitis, to relieve dry eye irritation and foreign-body sensation. Steroid eye drops or nonsteroidal anti-inflammatory drugs may be needed to relieve significant inflammation and swelling.
Surgical removal of the pinguecula may be considered in severe cases when it interferes with vision, contact lens wear or blinking. Frequently, pingueculae can lead to the formation of pterygia.
Pterygium
Pterygia are wedge- or wing-shaped growths of benign fibrous tissue with blood vessels (fibrovascular), typically located on the surface of the sclera. In extreme cases, pterygia may grow onto the eye's cornea and interfere with vision.
Because a pterygium resembles tissue or film growing over the eye, a person who has one may become concerned about personal appearance.
As with pingueculae, prolonged exposure to ultraviolet light from the sun may play a role in the formation of pterygia.
Pterygium Signs and Symptoms
Many people with pterygia do not experience symptoms or require treatment. Some pterygia may become red and swollen on occasion, and some may become large or thick. This may cause concern about appearance or create a feeling of having a foreign body in the eye.
Large and advanced pterygia can actually cause a distortion of the surface of the cornea and cause astigmatism. If a pterygium becomes large or inflamed, surgical removal may be necessary.
How a Pterygium Is Treated
Treatment depends on the pterygium's size and the symptoms it causes. If a pterygium is small but becomes inflamed, your eye doctor may prescribe lubricants or possibly a mild steroid eye drop to reduce swelling and redness. In some cases, surgical removal of the pterygium is necessary.
The pterygium may be removed in a procedure room at the doctor's office or in an operating room setting. A number of surgical techniques are currently used to remove pterygia, and it is up to your eye doctor to determine the best procedure for you.
For milder pterygia, a topical anesthetic can be used before surgery to deaden feeling in your eye's surface. Your eyelids will be kept open with an eyelid speculum while the pterygium is surgically removed. After the procedure, which usually lasts no longer than half an hour, you likely will need to wear an eye patch for protection for a day or two. You should be able to return to work or normal activities the next day.
Exposure to ultraviolet light from the sun is a suspected cause of pingueculae and pterygia. Wrap sunglasses, such as these from Oakley, will protect your eyes from all angles.
Unfortunately, pterygia often return after surgical removal. In fact, the recurrence rate is between 3 and 40 percent. To prevent regrowth after the pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, is very safe and has a low recurrence rate.
A drug that slows metabolic processes (antimetabolite) contributing to tissue growth, such as mitomycin, may be applied topically.
After removal of the pterygium, steroid eye drops may be used for several weeks to decrease swelling and prevent regrowth.
Note that pterygium removal also can induce astigmatism, especially in people who already have astigmatism.
Thyroid Eye Disease
What is thyroid eye disease?
Other names of thyroid eye disease (TED) are Graves' ophthalmopathy (GO), Graves' orbitopathy (GO), thyroid ssociated orbitopathy (TAO). Thyroid eye disease is an orbital disease and is most commonly associated with a disorder of the thyroid gland, hyperthyroidism. It is an auto-immune eye condition. It can sometimes occur in patients who have no thyroid dysfunction, or patients who have thyroid hypo-function. Most patients with thyroid diseases do not develop thyroid eye disease or, if they do, it is only mild. A small proportion develop thyroid eye disease, which may go on to require treatment either with eye drops or surgery.
Risk factors for thyroid eye disease include smoking, which results in a more severe form of the disease.
What are the signs and symptoms of thyroid eye disease?
Etiology:
Thyroid eye disease is an auto-immune disorder, in which there is a reaction within the orbit which results in local inflammation, swelling and fibrosis of structures in the orbit, including the fat around the eye ball and the muscles that move the eyes.
What is active thyroid eye disease?
Thyroid eye disease has well recognised stages. There is an early active phase, in which there is inflammation, and usually this can last between 3 and 12 months before beginning to stabilise and become inactive. During the active phase maximal symptoms will develop, with eyelid retraction, eye protrusion, possible double vision and redness. If the active thyroid eye disease is treated early enough, it may be possible to reduce the severity of the disease and need for surgery. It is important to stop smoking and to have good control of the thyroid hormones, so that they are in the normal range and there is no over-action, or under-action, of the thyroid gland.
How is thyroid eye disease managed?
Treatment is aimed at improving the symptoms of the orbital involvement.
Mild thyroid eye disease:
Patients with mild involvement, such as irritation, foreign body sensation and only a very small amount of protrusion of the eyes (proptosis) and no double vision, may just require reassurance, artificial tears during the day and lubricant ointment at night. If the eyelids do not close fully at night, the eyelids can be taped, to protect the surface of the eye.
Moderate thyroid eye disease:
If there is more marked eyelid malposition, with retraction and proptosis, difficulty closing the eyes and corneal problems, surgery may be required.
How is the condition managed?
The oculoplastic surgeon will monitor the colour vision, eyelid measurements, degree of proptosis, examine the surface of the eye and behind the eye, look at the optic nerve and do special radiological investigations, as required.
Severe thyroid eye disease:
Lid and orbital surgery may be required.
The principle of management is:
What type of surgery is available for thyroid eye disease?
In the acute phase, if there is optic nerve compression with the vision being affected, or there is severe exposure of the front of the eye because of such severe eyelid retraction and eye protrusion (proptosis), urgent surgery may be required to decompress the orbit and retain vision. Some younger patients who have healthy, tight tissue may have reduction of vision from optic nerve compression, but not have particularly protruding eyes, and this group must be recognised and urgent medical treatment, and/or decompression, carried out to preserve the nerve function.
Stable thyroid eye disease – rehabilitation of thyroid eye disease:
Once the patient has overcome the acute phase, the oculoplastic surgeon will do rehabilitative surgery. The goal of rehabilitative surgery is to:
There are several operations available for rehabilitation of thyroid eye disease:
1. Orbital Decompression.
Orbital decompression is surgery to reduce the protrusion, or proptosis, of the eyes by making the orbits larger internally by creating openings into the adjacent air cells (air sinuses). This is done by an oculoplastic orbital surgeon through a small eyelid incision at the outer corner of the eye, with most of the incision hidden on the inside of the lower eyelid. Sometimes an additional approach is done through the inside of the nose, in order to open up into the medial, or ethmoid, sinus, in preference to opening that sinus via the eyelid. A balanced decompression is aimed for, in which the orbit is widened horizontally, thus reducing the risk of causing double vision. This is the same operation that is done in the acute phase if there is an optic nerve compression, in which the pressure, or tension, on the optic nerve is reduced by increasing the internal size of the orbit by operating surgically on the bony walls of the orbit.
2. Eye Muscle Surgery
If there is a squint (strabismus) with double vision and the eyes cannot be easily corrected with small prisms, eye muscle surgery, or strabismus surgery is necessary. The oculoplastic surgeon waits until the double vision, or eye motility, is completely stable before carrying out eye muscle surgery. The aim of this surgery is to restore a good field of binocular i.e. two eyes seeing together of single vision, when both eyes look straight ahead and in the reading position. Squint surgery may not completely remove all double vision and the patient may still notice some double vision in extremes of gaze. Squint surgery is usually done under general anaesthetic and may involve an adjustable stitch on the eye muscle, which is then locally adjusted with the patient awake a few hours after surgery to give the best possible single vision.
3. Eyelid Retraction.
If the upper eyelids are too high, or the lower eyelids too low, resulting in white of the eye appearing either above or below the coloured iris and difficulty in closing the eyes, eyelid surgery can be done to correct the eyelid position. The upper eyelid is lowered, or the lower eyelid raised, the latter sometimes requiring a small spacer using placement of tissue from the patient's roof of mouth, for instance, to help restore the normal position of the eyelids and eyelid closure.
4. Further Eyelid Surgery - Blepharoplasty & Peri-Ocular Surgery.
Debulking of peri-ocular puffiness may be required by upper eyelid and sub-brow removal of fatty tissue and lower eyelid removal of fatty tissue. Further treatment can also be done to the lower eyelid skin, to tighten it where it has been swollen by the thyroid eye disease. This is known as blepharoplasty, and is done as part of rehabilitative surgery for patients with thyroid eye disease. Lid and orbital surgery may be required.