Allergies and the Eyes More >
Many 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 anytime. 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. Avoiding 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. Rubbing the eyes makes symptoms worse and should be avoided. If seasonal allergic conjunctivitis is a problem, make an appointment with one of our doctors – there are several new, safe, and effective anti-allergy drops that can be prescribed. Also, a doctor can ensure symptoms are not being caused by a more serious problem.
Blepharitis/Meibomitis (Lid Margin Disease) More >
These conditions are caused by persistent inflammation of the eyelids. Symptoms include irritation, itching, and occasional red eye(s). It occurs commonly in people who have a tendency towards oily skin, dandruff, or dry eyes. Acne, rosacea, and eczema are frequently associated with some form of lid margin disease.
Bacteria normally resides on everyone’s skin, but in some people it thrives in the skin at the base of the eyelashes. Nearby oily glands may be overactive, causing dandruff-like scales and particles to form along the lashes and the eyelid margins, resulting in redness, stinging, or burning. The dryness that results from these entities might also result in discomfort and, occasionally, blurred vision.
Lid margin disease may not 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 about 5 minutes. Rewet it as it cools, two or three times. This will soften and loosen scales and debris. More importantly, it helps liquefy the oily secretions from the eyelids’ oil glands that help prevent the development of a chalazion (stye), an inflamed lump in the eyelid oil gland.
- With your finger or a cotton swab or commercial lint-free pad, gently scrub the base of the lashes about 15 seconds per lid using warm water and diluted Johnson and Johnson Baby Shampoo.
When medications are necessary, they may include:
- Artificial tears to relieve symptoms of dry eye. (These are eye drops which are available without a prescription)
- Antibiotics (ointments or drops) to decrease bacteria on the eyelids. Occasionally, even oral antibiotics are employed in this task.
- Steroids (ointment or drops) to decrease inflammation.
However, medications alone are not sufficient in the treatment of these conditions. The application of warmth and careful cleansing of the lashes daily is key to controlling lid margin disease.
Computer and Eye Strain More >
Complaints of eye discomfort and fatigue are becoming more common with the increased use of computer screens. While it is true that this may cause eye strain, there is no convincing evidence that computer screen use can harm the eyes.
Some people fear that computer screens emit damaging ultraviolet light or radiation, but the amount of ultraviolet light emitted by computer screens is a fraction of what is emitted from a fluorescent light and radiation levels from computer screens are so low that a lifetime of exposure will not damage the eyes. Symptoms of eye strain are eye irritation (red, watery, or dry eyes), eye fatigue (tired, aching heaviness of the eyelids, or forehead), difficulty in focusing, and headaches. However, eye strain does not result in permanent eye damage.
Eye strain, backache, and muscle spasms may improve with proper arrangement of the computer screen and seating area. The Occupational Safety and Health Administration (OSHA) provides helpful suggestions on workstation arrangement.
It is important to wear appropriate glasses adjusted for the distance you sit from the computer screen. Most people prefer to position the screen farther from where they normally read – make an appointment with one of our Optometrists to have your prescription glasses adjusted accordingly. Using a computer requires an unchanging body, head, and eye position that can be fatiguing, so be sure to take periodic breaks. Lubricate the eyes by blinking frequently or using artificial tears (lubricating eye drops) and keep workstations clean to minimize eye irritation from dust. Standard office lighting may be too bright for comfortable computer use, so minimize light glare by adjusting office lights or using hoods or filters on the screen.
Diabetic Retinopathy More >
Diabetes affects blood vessels throughout the body, particularly in the kidneys and the eyes. Diabetic retinopathy is the name we give to diabetes’ adverse affects on the blood vessels in the eye. In the United States, diabetic retinopathy is the leading cause of blindness among adults.
Risk of developing diabetic retinopathy increases over time. An adult who has had diabetes for 15 years or longer stands an 80% chance of experiencing damage to retinal blood vessels.
The retina, the multiple layers of tissue located at the back of the eye, detects visual stimuli and transmits signals to the brain. When diabetes affects the ocular blood vessels, they may develop leaks or contribute to the formation of scar tissue; these problems reduce the retina’s ability to detect and transmit images.
There are two main types of diabetic retinopathy: background (BDR) and proliferative (PDR). Treatment is available for both types.
Laser Treatment of Diabetic Retinopathy
When diabetes causes new blood vessels to form in the retina, they are often fragile and tend to leak blood. A laser procedure may be used to painlessly destroy the new growth and seal the blood vessels.
Dry Eye Syndrome More >
What is dry eye syndrome?
The eye depends on the flow of tears to provide constant moisture and lubrication to maintain vision and comfort. Tears are a combination of water (for moisture), oils (for lubrication), mucus (for even spreading), and antibiotics and special proteins (for resistance to infection). These components are secreted by special glands located around the eye. When there is an imbalance in this tear system, a person may experience the symptoms of dry eye syndrome.
What are the symptoms of dry eye syndrome?
When tears do not adequately lubricate the eye, a person may experience:
- Light sensitivity
- A gritty sensation
- A feeling of a foreign body or sand in the eye
- Blurred vision
- Watering or tearing
Paradoxically, a person with dry eye syndrome will have excess tears running down the cheeks. This “reflex tearing” actually occurs when the eye is not receiving sufficient lubrication. The eye sends a distress signal through the nervous system for more lubrication and, in response, the eye is flooded with reflex tears to try to compensate for the underlying dryness. These tears, however, are composed mostly of water and do not have the lubricating qualities or the rich composition of normal tears. They will wash away debris, but they will not coat the eye surface properly.
What causes dry eye syndrome?
In addition to a decrease in the production of lubricating tears by the tear glands, dry eye syndrome can be caused by the drying out of the tear film. This can be due to air conditioning, heat, or other environmental conditions. Other conditions that may cause dry eye syndrome are:
- The natural aging process
- Side effects of certain medications such as antihistamines and medications that treat high blood pressure and elevated cholesterol
- Diseases that affect the ability to make tears, such as rheumatoid arthritis and collagen vascular diseases
- Structural problems that prevent the eyes from closing properly
- Blocked meibomian glands that secrete the natural oils needed for proper lubrication in the tear film
How common is dry eye syndrome?
“Dry eye” is an extremely common eye condition, with incidences and symptoms that increase with age. In the United States, approximately six million women and three million men experience moderate or severe dry eye symptoms, and scientists estimate that an additional 20 to 30 million people in this country have mild cases of dry eye. Diabetes is the number one systemic disease implicated in dry eye.
How is dry eye syndrome treated?
Although dry eye syndrome cannot be cured, there are a number of steps that can be taken to treat it. We specialize in treating dry eye syndrome and will discuss your options with you to individualize your dry eye therapy.
Treatment options include the following:
Artificial tear drops and ointments
The use of over-the-counter artificial tear eyedrops is the primary treatment for dry eye syndrome. We offer many samples of artificial tears for you to try, because no one brand works for everyone and you might have to try more than one to find the drop that works best for you. Some artificial tear brands contain more preservatives than others, and an individual may find these preservatives irritating. Preservative-free artificial tears are available and may be less irritating. If you have chronic dry eye, it is important to use the drops even when your eyes feel fine, to keep them lubricated. If your eyes dry out while you sleep, you can use a thicker lubricant, such as an ointment or gel, at bedtime.
Temporary tear savers
Tear savers are small plugs placed in the ducts that drain tears out of the eye. They help to “save” or “conserve” the eye’s natural tears to maintain lubrication, so tears do not drain too quickly. Temporary collagen tear savers are easily placed in the tear ducts via a painless procedure. The various type of tear savers available can last from one week to several months. Your doctor may place these temporary plugs to determine whether permanent plugs can provide an adequate supply of tears.
Epiretinal Membrane More >
Epiretinal membrane, or “ERM,” is the technical name for “macular pucker.” The macula is the portion of the retina responsible for central, straight-ahead vision. Sometimes, a membrane resembling scar tissue grows on the macula. This membrane shrinks and contracts (puckers), distorting and/or reducing central vision.
We don’t know why some people develop this condition, but some people who experience it have had a retinal detachment, a blockage of a blood vessel in the eye, or certain inflammatory eye problems in the past.
Your surgeon may recommend a procedure to remove the puckered membrane.
Glaucoma More >
Glaucoma is a disease that can slowly destroy the delicate nerve fibers that carry signals from the back of the eye to the brain. Generally, high pressure within the eye is responsible for the damage, but even patients with normal pressure can experience loss of this important nerve function due to glaucoma.
It’s important to be checked yearly to ensure glaucoma is not present, because patients do not always feel the symptomatic elevated eye pressure as it slowly robs them of their sight. Because it can be inherited, if one family member has glaucoma, other family members should be checked.
While glaucoma typically affects people age 40 and older, it can strike at any age. Glaucoma is called “the silent thief” because there is no pain or noticeable change in vision during the early stages of the disease.
No treatment can restore vision already lost to glaucoma. The goal of treatment is to prevent further vision loss.
Treating Glaucoma with Medication
Various medications are sometimes useful in treating glaucoma. Beta-blocker eye drops may reduce the amount of fluid produced by the eye. Prostaglandin analogs and alpha-2 agonists may also lower intraocular pressure.
Treating Glaucoma with Trabeculectomy
Your surgeon may recommend a surgical procedure called “trabeculectomy” if medication, eye drops, or another procedure have not been effective in lowering the pressure within your eye.
This procedure helps to lower pressure by altering the eye’s drainage system and creating a controlled leak of fluid.
Treating Glaucoma with Peripheral Iridotomy
Iridotomy is another surgical procedure that may be recommended to lower pressure within your eye. When the eye’s iris blocks the drainage of fluid, the surgeon uses a laser to create a tiny hole in the iris to improve drainage.
Selective Laser Trabeculoplasty (SLT)
Selective laser trabeculoplasty (SLT) is a laser procedure used to help lower the intraocular pressure (IOP) of patients with open angle glaucoma. SLT is used to treat the eye’s drainage system, known as the trabecular meshwork. Treating this area of the eye’s natural internal draining system is designed to improve the outflow of fluid from the eye, helping to lower eye pressure—failing to resolve the intraocular pressure can cause damage to the optic nerve and eventually result in loss of vision.
This type of laser surgery may be effective in some patients but not others. Your response may be different than other glaucoma patients, and it is not possible to predict how well the procedure will work before the laser surgery. The laser used in SLT works at very low levels and treats specific cells “selectively,” leaving untreated portions of the trabecular meshwork intact. For this reason SLT, unlike other types of laser surgery, may be safely repeated many times.
For your convenience the procedure may be performed in our office or outpatient surgery center. SLT typically takes about 10 minutes. Once you are settled in, drops will be used to numb the eye and prevent any discomfort. The laser itself makes a little noise, and you may experience a flash of light with each laser application. Although you may feel a little pressure, nearly all patients find the procedure comfortable and pain free.
You may need to use drops both before and after the laser treatment. The pressure in the eye will be checked after the procedure as there is a risk of increased IOP after the procedure. If this does occur, additional medicines may be necessary to lower the eye pressure. Rarely, the pressure in the eye could elevate to a level that may require surgery in the operating room to relieve the glaucoma.
Drops will be used after the laser surgery to help the eye heal correctly, typically for about 1 week. Most people notice some blurring of their vision after the laser treatment. This usually clears within a few hours. Following the procedure it is suggested that you relax for the rest of the day and follow-up visits will be scheduled to continue to monitor your eye pressure. The chance of your vision being permanently affected by this procedure is very, very small.
Although rare, the risks associated with SLT include:
- Increased eye pressure, possibly requiring medication or surgery
- Bleeding within the eye
- Inflammation in the eye
- Damage to the cornea, iris, or retina from the laser light
- Failure to adequately lower the eye pressure
It will take several weeks to determine how much SLT will lower your eye pressure. It is possible that you may require additional laser surgery, or other glaucoma surgery, if your response is insufficient. You may need to continue glaucoma medications in order to control your IOP; however, SLT may lessen, or eliminate, the need for medication.
Keratoconus More >
Keratoconus is a disorder that is characterized by a progressive steepening of the cornea, typically just below the center. This results in a more pointed, cone-shaped center and blurred vision. Rarely, a medical condition can be associated with keratoconus, but the most common link to this disorder is that of allergic eye disease. Research has shown that eye rubbing, perhaps in response to itchy eyes, can worsen or even cause keratoconus. Eye-rubbing is never advocated by your eye physician and itchy eyes can be treated more effectively with drops or systemic allergy medications when necessary.
The treatment for the blurred vision which results from keratoconus is spectacles followed by hard contact lenses when spectacle correction becomes ineffective. Over time, the progressive corneal thinning may lead to breaks in the cornea and subsequent scarring or discomfort. When this occurs, or the vision cannot be corrected effectively with contacts or glasses, a corneal transplant can be performed.
Macular Degeneration and Amsler Grid More >
The inside layer of the back of the eye is called the retina. The retina is like the film of a camera. The central 10% of the retina is called the MACULA. The macula is responsible for sharp, central vision required for “straight ahead” vision activities, such as driving, reading, recognizing faces, and performing close up work.
MACULAR DEGENERATION (AMD) is a deterioration or breakdown of the macula and is one of the most common causes of poor vision after age 60. The visual symptoms of AMD involve the loss of central vision (reading, recognizing faces, etc.), while peripheral vision is unaffected. Although a specific cause is unknown, AMD seems to be a part of aging. While age is the most significant risk factor for developing AMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors.
While AMD is one disease, it may be categorized into two forms.
The most common form of AMD is the DRY FORM (called atrophic or non-exudative). Dry AMD is associated with thinning and slow deterioration of the retinal cells in the macula. It is usually slowly progressive and may take many years to develop. You may hear terms like drusen (whitish deposits on the inside layer of the retina), retinal pigment epithelial changes, and atrophy. These terms describe the appearance of the macula in dry AMD.
The wet form of AMD (called exudative) is much less common, but can produce rapid visual distortion and loss, and can be much more serious. This is not a separate condition, but is a complication of dry AMD. All patients with dry AMD should be monitored for the development of the wet form.
In this condition, abnormal blood vessels may grow into the macula from a layer beneath the retina, leaking fluid and blood, creating distortion or a large blind spot in the center of your vision.
TREATMENT of “Wet” AMD: If the blood vessels are not growing beneath the center of the macula, laser treatment is sometimes effective. In many cases, the location of the blood vessels make laser treatment unsafe. In these cases, treatment with injections of lucentis or avastin may be appropriate. These monthly injections have shown a significant benefit in the treatment of wet AMD.
Some factors involved in the degenerative process of the macula, such as our gender and genetics, are beyond our control. However, clinical studies have shown that the effect of one important factor, free radicals, can be reduced to some extent.
Every day, our eyes are exposed to blue light waves that generate “free radicals” that can damage DNA and the light-sensing structures of the eye’s retina. Vitamins E and C, minerals zinc, copper, and selenium, and plant pigments lutein and zeaxanthin appear to have some protective value. Lutein and zeaxanthin, in particular, have been shown to be effective in reducing the effects of free radicals by helping the macula to filter out blue light.
Egg yolks and dark green, leafy vegetables such as spinach are rich in these minerals. Taking a nutritional supplement that contains these vitamins, minerals, and pigments can make it easier to include the proper amounts in your every day diet. Use common sense and consult your physician before adding nutritional supplement to your diet, particularly if you are pregnant, breastfeeding, have a medical condition, or are taking a conflicting medications. Be aware that the concentration of zinc in these supplements has been shown to be effective in protecting eye health but may not be appropriate for everyone.
Steps to take:
- Ensure proper diet and nutritional supplement
- Protect your eyes from sunlight (sunglasses, hat, etc.)
- Don’t smoke
High intensity reading lamps, magnifiers, and other low-vision aids help people with AMD make the most of limited vision.
Also, consider large print reading materials and books on tape.
Directions for Amsler Grid
- With your reading glasses on, test ONE eye at a time while holding grid at normal reading distance.
- Look at the dot in the center of the page for three seconds with each eye.
- All the lines should be straight.
- If the lines become wavy, or if part of the grid is missing, notify our office immediately.
- Test each eye for three seconds, once per week.
Pinguecula and Pterygium More >
A pinguecula is a yellowish patch or bump on the white part 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 be a response to chronic eye irritation or sunlight.
A pterygium is ﬂeshy tissue that grows over the cornea (the clear dome in the front 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, but pterygia occur more often in people who spend a great deal of time outdoors, especially in sunny climates. In areas of the world in which the population are predominantly ﬁshermen or farmers, pterygia are extremely common. 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. Sunglass wear with UV protection and the use of artiﬁcial tears might reduce the incidence and growth rate of pterygia.
When a pterigium becomes red and irritated, eyedrops or ointments may be used to help reduce the inﬂammation. If the pterygium is large enough to threaten sight or grows rapidly, it should be removed surgically. Despite proper surgical removal, the pterygium may return.
The diagnosis of pinguecula or pterygium should be made by your eye doctor. Although rare, certain eye cancers mimic the appearance of a pinguecula or pterygium. A thorough eye exam by an eye professional will determine the appropriate treatment.
Posterior Vitreous Detachment (PVD) More >
A posterior vitreous detachment (PVD) is a condition of the eye in which the vitreous gel (gel that fills the center of the eye) gradually liquefies and shrinks over time and separates from the retina (inside layer of back of the eye). Broadly speaking, the condition is common for older adults and over 75% of those over the age of 65 develop it. Although less common among people in their 40s or 50s, the condition is not rare for those individuals.
Causes and Risk Factors
The vitreous is a gel which fills the eye behind the lens. Between it and the retina is the vitreous membrane. Over time the vitreous changes, shrinking and developing pockets of liquefaction. At some stage, the vitreous membrane may peel away from the retina. Where the vitreous is attached at the optic nerve, it is thicker. When the vitreous detaches, this thickening, along with other opacities, will float in the center of the eye. When light comes into the eye, these opacities cast a shadow on the retina. These are “floaters” and will usually be more obvious in brighter light. As the vitreous peels from the retina, it may stimulate the retina causing flashing lights. Rarely, it may pull a piece of retina with it, causing a retinal hole or tear. This may lead to a retinal detachment. This is usually a sudden event, but may also occur slowly over months.
Age and refractive error play a role in determining the onset of PVD in a healthy person. People with myopia (nearsightedness) greater than 6 diopters are at higher risk of PVD at all ages. Posterior vitreous detachment does not directly threaten vision and most of the time is benign. Occasionally, a PVD may cause a membrane to form on the retina (epiretinal membrane), which may affect vision to varying degrees.
PVD may also occur with trauma or around the time of cataract surgery, within weeks or months of the surgery.
When this occurs there is a characteristic pattern of symptoms:
- Flashes of light (photopsia)
- A sudden dramatic increase in the number of floaters
- A ring of floaters or hairs just to the temporal side of the central vision
The flashes usually subside in the first week. Sometimes, an occasional flash, especially when going from light to dark, may persist for a while, but will almost always resolve completely. The floaters will always be present, but, almost always, become a non-issue, showing up occasionally, especially in brighter light.
If you develop a new onset of floaters, especially if associated with a new onset or worsening of flashing, you should be reevaluated as soon as possible.
Therapy is not required or indicated in posterior vitreous detachment, unless there are associated retinal tears, which need to be repaired. Prompt examination of patients experiencing vitreous floaters combined with expeditious treatment of any retinal tears has been suggested as the most effective means of preventing certain types of retinal detachments.
Refractive Error More >
When the eyeball is too long, light rays focus in front of, rather than on, the retina. Under these circumstances, near objects are perceived clearly, but distant objects are not.
When the eyeball is too short, light rays entering the eye focus behind the retina. Distant objects are seen clearly but near objects are not.
Vision becomes distorted when the surface of the cornea has an uneven curvature; sometimes it is the eye’s lens that is irregularly shaped. This type of irregularity causes light to focus on more than one spot on the retina at the back of the eye, causing blurred vision.
Treatment Options for Refractive Errors:
- Bladeless LASIK
Glasses and or contacts are great options for correcting refractive errors. In some cases, however, patients may be contact lens intolerant or may simply elect to be less dependent on their glasses. For those who ﬁt the criteria, Bladeless LASIK is an option.
What is Bladeless LASIK?
Bladeless LASIK is a surgical treatment for nearsightedness, farsightedness, and astigmatism that reshapes the cornea to improve visual focus. This advanced treatment is safe, quick, and precise. Are you a Candidate?
Retinal Detachment More >
When light enters the eye and makes its way to the retina that lines its back interior, it passes through a gel-like substance (sometimes called “vitreous”or “vitreous gel”) that fills the center of the eye. Sometimes this vitreous gel shrinks and pulls away from the retina, causing a posterior retinal detachment (“PVD”). PVD is not necessarily an emergency. However, the tugging that occurs as the vitreous gel pulls away sometimes causes the retina to tear or detach from the inside. The tear may allow vitreous gel to move behind the retina and interfere with its access to the blood and oxygen it needs to function properly. Permanent loss of vision may result unless the retina is reattached promptly.
Common Symptoms of Retinal Detachment: Floaters & Flashes
Vitreous gel often develops clumps that are perceived as dark spots, specks, or string-like shapes that float across the visual field. These “floaters” are most often the normal result of the gel aging and breaking down and are not necessarily an indication that there is a problem , but they can be caused by blood or other debris released into the vitreous when the retina is torn.
Brief flashes or sparks of light that appear suddenly at the edge of the visual field can be a sign that the retina is becoming detached.
Floaters and flashes are often the first signs of the risk of retinal detachment. However, a detachment can take place without warning.
Don’t ignore these symptoms!
While flashes and floaters do not necessarily mean that there is a problem, these symptoms should NOT be ignored.
Call our office if you experience:
- More floaters than usual, particularly if you notice the sudden appearance of many small dark dots.
- Brief flashes or sparks of light at the edge of your vision.
- A shadow (sometimes described as a “curtain”) across a portion of your vision that doesn’t go away.
- Any new, sudden loss of a portion of your vision.
These symptoms constitute a MEDICAL EMERGENCY. Call us or your regular doctor immediately!
Yag Capsulotomy More >
A yag capsulotomy is a surgical laser procedure that may be necessary to restore vision at some point months to years after cataract surgery.
The capsule is like a clear bag that is the natural outer portion of the lens of the eye. During cataract surgery (in which the discolored natural lens of the eye is removed) part of the front (anterior) capsule is removed, while the remainder of the capsular bag remains intact. The lens implant is inserted inside this capsular bag. As long as that capsule stays clear, one has good vision. But in 10 – 30 % of people, the back (posterior) of the capsule loses its clarity over time. When this happens, an opening can be made in the posterior capsule with a laser (yag capsulotomy) to restore normal vision.
Before the laser procedure, one of our doctors does a thorough ophthalmic examination to make sure there is no other reason for vision loss.
A yag capsulotomy is painless and takes less than 5 minutes. Vision may be blurry for a short while afterwards, but usually improves during the ﬁrst 24 hours.
Potential but rare complications following the procedure include infection and retinal detachment.