Comprehensive Eye Care

Common Eye Conditions

Common Eye Conditions

Our physicians diagnose and treat many different eye conditions. Here are some educational tidbits on some common eye concerns.

Nearsightedness (Myopia):

Nearsighted individuals typically have problems seeing well at a distance and are forced to wear glasses or contact lenses to see distant objects clearly. Their near vision is typically good. The nearsighted eye is usually longer than a normal eye, and its cornea may also be steeper. Therefore, when light passes through the cornea and lens, it is focused in front of the retina. This will make distant objects appear blurred. There are several refractive surgery solutions available to correct nearly all levels of nearsightedness.

Farsightedness (Hyperopia):

Farsighted individuals typically develop problems reading up close before the age of 40. The farsighted eye is usually slightly shorter than a normal eye and may have a flatter cornea. Thus, the light of distant objects focuses behind the retina; this creates blur unless the natural lens can flex enough to focus the light onto the retina. Near objects require even greater focusing power than distant objects to be seen clearly and therefore blur more easily. Contact lenses can correct farsightedness, and there are some refractive surgery solutions available as well.

Astigmatism:

Astigmatism is present when the cornea (the front surface of the eye) or natural lens (a structure within the eye that helps to focus light rays) are not perfectly spherical and have areas that are curved more steeply than others. Astigmatism causes light to be focused unevenly, and this creates blur or shadows. Astigmatism can accompany any form of refractive error and is very common. Astigmatism can be corrected with glasses, contact lenses, corneal relaxing incisions, laser vision correction, and special implant lenses.

Presbyopia:

Presbyopia is a condition that typically becomes noticeable for most people around the age of 40. In children and young adults, the lens inside the eye can easily focus on distant and near objects. With age, the lens loses its ability to focus adequately. Although presbyopia is not completely understood, it is thought that the lens and its supporting structures lose the ability to make the lens longer during close vision effort. To compensate, affected individuals usually find that holding reading material further away makes the image clearer. Ultimately, aids such as reading glasses are typically needed by the mid-forties. Aside from glasses, presbyopia can be dealt with in a number of ways. Options include: monovision and multifocal contact lenses, monovision laser vision correction, and presbyopia correcting implant lenses used in cataract surgery.

Dry Eye

Dry Eye

Dry eye is a common condition, which in some instances, can lead to significant difficulties with vision and with eye comfort. Dry eye results from the destabilization of the tear film, the thin layer of oil, water, and mucous that covers the surface of the eye. If any one of the three components of the tear film is deficient, one or more of the following symptoms may occur:

  • irritation or gritty sensation
  • burning, tearing
  • blurred vision
  • transient film over the vision that clears with blinking
  • intolerance of contact lenses

The tear film is very important to the health of the eye, and in advanced cases of tear film deficiency, infections or other serious problems may develop.

What Causes Dry Eye?

There are many causes and risk factors of dry eye, and some are easier to control than others.

  • Aging
  • Female gender
  • Certain medical conditions
  • Autoimmune (rheumatoid arthritis, Sjogren’s syndrome)
  • Thyroid disease
  • Sarcoidosis
  • Diabetes
  • Medications
  • Antihistamines
  • Decongestants
  • Blood pressure medications
  • Antidepressants
  • Inflammatory eyelid conditions
  • Contact lens wear and LASIK refractive surgery as well as some eyelid surgeries can also lead to dryness
  • Environmental conditions such as wind, currents from air vents or fans, and low humidity can contribute to dry eye as can activities such as computer use, reading, watching T.V., and prolonged detailed work at near.

Treatment For Dry Eye

Dryness is a chronic condition in most cases, but there are several available treatments. Staying hydrated and taking fish oil supplements and/or flaxseed (if safe to take from a medical standpoint) can be helpful. Artificial tear drops and/or artificial tear ointments are used as a first-line treatment to add additional lubrication to the eye surface. Prescription drops can be used if topical lubrication is not adequately addressing symptoms; these drops help to diminish inflammation in the glands that produce tears, leading to increased production of natural tears. If there is eyelid inflammation, resulting dryness is often due to the inability of the oil glands in the eyelid margin to properly secrete oils into the tear film. In this situation, daily warm compresses, gentle eyelid scrubs, and artificial tears containing oils can be helpful. More significant eyelid inflammation can be treated with anti-inflammatory drops and ointments, and even oral antibiotics can be helpful in some instances.

Surgical options are available when medical treatment is not adequate. Small plugs called punctal plugs can be placed in the tear ducts, the small passageways in the inner corner of each lid that carry tears away from the eye and into the nose. Plugging the tear ducts keeps the tears, which are coating the eye surface, from draining into the nose as quickly as they normally would. Some patients who respond well to punctal plugs can actually have their tear ducts cauterized so that the ducts are closed permanently. If there are other problems with the eyelids (becoming too lax, lower lids turning out, etc.), repair of these lid conditions can help to make the eye surface healthier.

Less common and less readily available treatments are reserved for patients with severe dry eye, including the Boston scleral lens and autologous serum drops.

Sjögrens Syndrome

Sjögrens Syndrome

Sjögren’s Syndrome is a chronic autoimmune condition in which white blood cells attack moisture-producing glands. The most common resulting symptoms are dry eye and dry mouth. Additionally, patients may experience joint pain, fatigue, and dysfunction of other organs including the kidneys and liver. This condition affects roughly 4 million people, most of which are undiagnosed.

SjöTM is an in-office test for the diagnosis of Sjögren’s Syndrome. The test involves a finger-prick blood test that measures for seven markers for Sjögren’s Syndrome. Test results are usually available after 10-14 days. To schedule your dry eye evaluation including the SjöTM test, please request an appointment here.

Corneal Ulcers

Corneal Ulcers

What is a Corneal Ulcer?

A corneal ulcer is a sore or defect in the cornea, the clear structure at the front of the eye that is located in front of the pupil and the iris (the colored part of the eye). Corneal ulcers can be very serious and must be evaluated and treated, as severe damage to the eye and even blindness can sometimes occur. Signs and symptoms of a corneal ulcer often include eye redness, pain, foreign body sensation/irritation, eyelid swelling, blurred vision, sensitivity to light, tearing, and mucous discharge or pus. If an ulcer is large enough, it may be visible to the naked eye as a white spot located over the iris.

The Cornea

The cornea is an important structure that aids in focusing images clearly, and it is an important first line of defense against eye infection or injury. The layer of cells that lies on the surface of the cornea (epithelium) forms an important protective barrier; however, certain conditions can degrade the integrity of the epithelium and increase the risk of corneal ulcers. The risk of corneal ulcer increases for people who are contact lens wearers, have dry eye, have a history of cold sores, chicken pox, shingles, or diabetes, use steroid drops, have eyelid disorders (such as Bell’s Palsy) that do not allow the lids to open and close properly, or have had injuries or burns to the cornea.

Cause of Ulcers

Ulcers can be caused by infectious agents such as bacteria, viruses, fungi, and parasites, but they can also be noninfectious, developing in corneas that do not have normal sensation (such as following some episodes of shingles or in some diabetic patients). An eye exam will confirm the diagnosis of an ulcer by highlighting damaged areas using fluorescein dye eyedrops and by observing thinning or inflammatory signs in the corneal tissue.

Treatment

Treatment typically involves the use of antibiotic, antifungal, or antiviral drops, but sometimes other treatments such as oral medications or injections of medications in the area around the eye may be required. Once an ulcer has healed, steroid or anti-inflammatory drops are sometimes used to resolve any residual inflammation or to try to reduce or prevent scarring. Steroid drops, however, should never be prescribed by anyone other than an eye care professional, as steroids can sometimes lead to worsening of infections or to corneal thinning. If ulcers have resulted in significant scarring that has caused vision loss, surgical intervention may be required.

Risk with Contact Lenses

A special note for contact lens wearers: contact lenses do carry a risk of eye infection, and this risk can be reduced by following professional lens care guidelines. Extended wear of lenses, dryness, dusty/dirty environments, and poor hygiene all contribute to an increased risk of infection, which, if serious enough, can cause permanent vision problems or an inability to wear contact lenses in the future. Make sure to replace lenses and storage cases frequently, do not reuse solution or use expired solution, store contacts in disinfecting solutions, not saline, and avoid contact with water while wearing your lenses. Never wear contact lenses that were not prescribed by an eye care professional

Eye Allergies

Eye Allergies

Eye allergy ( allergic conjunctivitis) is a common condition resulting from exposure to a substance or environmental irritant (allergen). The eyelids and conjunctiva (the thin filmy covering of the white part of the eye) become itchy, red, and swollen. Although this condition has features that mimic bacterial and viral conjunctivitis, eye allergies cannot be transferred from person to person. Many people who suffer from eye allergies also have nasal symptoms such as congestion, sneezing, and post-nasal drip when exposed to an allergen.

Eye allergies can be related to seasonal allergies, like pollen, grass, trees, and ragweed. They can also be due to dust mites, molds, and pet dander. Some allergies are related to cosmetics, medications or preservatives in eye drops.

Your doctor will examine your eyes and discuss your medical history to determine if you have eye allergies. If you have eye allergies, it is important to avoid the substance causing the problem. If necessary, your doctor may recommend that you see an allergist to determine the specific substances you should avoid.

Avoidance of Allergens

To minimize pollen exposure, avoid going outside when pollen counts are high. Wear glasses or sunglasses when you go outside to limit your eye exposure. Keep your windows closed while inside and in your car.

For dust mites, you can use special allergen-reducing bedding covers. Wash your bedding often in hot water. Avoid using dry brooms to clean your floors—instead, use mops or wet cloths that trap allergens.

To decrease exposure to mold, aim to keep the humidity level in your house low. This will discourage mold growth. Also, consider dehumidifiers in areas that are particularly humid, such as basements.

If pet dander is a problem for you, keep your pets outside as much as possible. Most importantly, keep pets out of your bedroom so you have an allergen-free sleeping space. Always wash your hands after touching a pet.

Eyedrops and Medicines for Treating Eye Allergies

Artificial Tears

These drops are available without a prescription and can help eye allergy symptoms by temporarily washing out allergens and soothing the surface of the eye.

Decongestant Eye Drops

Decongestants are also available over the counter. They decrease the redness from eye allergies, but do not improve other symptoms. These drops should be used sparingly, as long term use can cause more irritation.

Oral Antihistamines

Oral antihistamines may have a minimal effect on eye allergies, but are most useful for nasal symptoms.

Antihistamine/Mast Cell Stabilizer Eye Drops

These can come in a prescription or other the counter formulations and have a dual mechanism for fighting allergy symptoms. They are intended to relieve redness, itching, burning, and watering associated with eye allergies.

Steroid Eye Drops

These drops are typically used only in more severe or chronic types of allergic conjunctivitis. They help reduce redness, itching, burning, and watering associated with eye allergies.

Immunotherapy (Allergy Shots)

If the above measures do not effectively control allergy symptoms, immunotherapy may be an option.

Subconjunctival hemorrhage

A subconjunctival hemorrhage is a bleed that occurs on the surface of the eye. The bleed actually occurs in the conjunctiva, which is a thin clear layer of tissue and blood vessels lying over the sclera, the white area of the eye. Subconjunctival hemorrhages can look very concerning and serious; however, most of these hemorrhages are of minimal concern to eye health and resolve quickly.

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Causes

Subconjunctival hemorrhages are most frequently caused by heavy coughing, vomiting, or straining, high blood pressure, bleeding disorders, injury, and the use of blood thinners such as aspirin, clopidogrel, and warfarin. Rarely, a subconjunctival hemorrhage can be caused by a mass within the orbit, the bony area surrounding the eye. Sometimes no obvious cause can be determined.

Treatment

In most cases where a bleed has occurred for the first time, artificial tear drops are recommended to help with any irritation, and patients are advised that the bleed will typically resolve in 2-3 weeks. Patients may be asked to have their blood pressure checked if they are not certain of their blood pressure readings. If the bleed is caused by a trauma, a detailed exam is performed to rule out any serious injury to the eye. In the case of bleeds caused by trauma, patients may need follow up visits for monitoring. Otherwise, patients are asked to return if the bleed does not resolve, or if there is any recurrence. In instances of recurrences, a work up may be initiated to look for any bleeding disorders or orbital or conjunctival masses that may be causing the hemorrhages.

Pink Eye

Pink Eye

What is Pink Eye?

Pink eye is an infection or inflammation that has developed in the conjunctiva, the thin, clear membrane that covers the inside of the eyelids and white part of the eye (sclera). The medical term for pink eye is “conjunctivitis.” Pink eye and conjunctivitis are general terms that refer to the common signs and symptoms experienced in the several different forms of pink eye that can occur.

Symptoms

The most common symptoms and signs of pink eye include redness of the eye or inner eyelid (caused by dilation of the blood vessels within the conjunctiva), increased tearing, mucous or development of pus, irritation or foreign body sensation (“sand in the eyes”), itching, mild eyelid swelling, blurred vision, and crusting of the eyelids upon awakening. The treatment of pink eye depends on the cause.

Causes

The primary causes of pink eye are infections (viral or bacterial), allergies, and irritants in the environment. Viral infections are the most common, and they are caused by the same viruses that lead to the common cold. Symptoms usually include redness, watery discharge or mild mucous discharge, and crusting and can last anywhere from a few days to a few weeks. These infections are very contagious, and it is important to maintain good hygiene so as not to spread the infection to others (see below). While one eye may be affected, it is very common for the infection to spread to the fellow eye. Aside from viral infections that may be caused by herpes viruses, there are no eye drops that will cure the infection, just as there are no medications to cure the common cold. Therefore, emphasis is placed on maximizing comfort as much as possible with cold compresses or artificial tears and using gentle lid scrubs to clear crusting.

Treatment

If symptoms are severe, anti-inflammatory drops can be prescribed by an eye care practitioner to help improve comfort and sometimes to help improve vision. Bacterial infections are highly contagious and cause red eyes, pus, and crusting of the eyelids. Staphylococcus and Streptococcus are bacteria that commonly cause pink eye. These infections often respond nicely to antibiotic drops, and drops are given to quicken the resolution of the infection, prevent eye damage, and reduce the risk of spreading the infection. It may be hard to distinguish, based on the eye examination, between viral and bacterial infections, and sometimes a culture using a sterile swab technique is performed to help in diagnosis and treatment. Allergic conjunctivitis is caused by the body’s reaction to an allergen or irritant, including pollen or other environmental allergens and pet dander. The primary symptoms are itching, redness, and tearing. Sometimes the eyelids can become mildly swollen, as can the conjunctiva itself. Cool compresses, refrigerated artificial tears, and allergy eyedrops can be effective in treating the allergy symptoms. Avoidance of the causative allergens, when possible, is also helpful. Sometimes oral allergy medications can reduce symptoms, although use of these medications can sometimes lead to dry eye. Environmental irritants (smoke, fumes, dust, chemicals, etc.) can also lead to redness, burning, irritation, and tearing. Reducing exposure to these irritants is the primary treatment; protective eye wear can often be helpful.

Prevention

The key to preventing the spread of infection is practicing good hygiene. Patients with contagious infections need to wash their hands often and avoid touching their eyes with their hands, avoid reusing or sharing towels, washcloths, and tissues, change bed linens frequently, and throw away any used make up or contact lens materials. A special note for contact lens wearers: contact lenses do carry a risk of eye infection, and this risk can be reduced by following professional lens care guidelines. Extended wear of lenses, dryness, dusty/dirty environments, and poor hygiene all contribute to an increased risk of infection, which, if serious enough, can cause permanent vision problems or an inability to wear contact lenses in the future. Make sure to replace lenses and storage cases frequently, do not reuse solution or use expired solution, store contacts in disinfecting solutions, not saline, and avoid contact with water while wearing your lenses. Never wear contact lenses that were not prescribed by an eye care professional.

Click here to read more about contact lens-related eye infections from the Academy of Ophthalmology’s EyeSmart website.