Causes, Symptoms, and Treatment for Eye Diseases
BLEPHARITIS: inflammation of the eyelid
- Blepharitis is a common condition that causes inflammation of the eyelid often producing flaky debris and particles at the base of the eyelashes.
- Most cases of blepharitis are caused by poor eyelid hygiene. Other causes include oily eyelid glands, allergic reactions, bacterial infections, or lice on the eyelashes.
Causes of blepharitis
- Anterior blepharitis affects the outer eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are bacteria (Staphylococcus) and scalp dandruff (seborrheic dermatitis).
- Posterior blepharitis affects the inner eyelid (the moist part that makes contact with the eye) and is caused by problems with the oil (meibomian) glands in this part of the eyelid. Two skin disorders can cause this form of blepharitis: acne rosacea, which leads to red and inflamed skin, and scalp dandruff (seborrheic dermatitis).
Symptoms of blepharitis
- Foreign body or burning sensation
- Excessive tearing
- Sensitivity to light (photophobia)
- Red and swollen eyelids
- Redness of the eye
- Blurred vision
- Frothy tears
- Dry eye
- Crusting of the eyelashes on awakening.
Complications from blepharitis
- Stye: A red tender bump on the eyelid that is caused by an acute infection of the oil glands of the eyelid.
- Chalazion: A usually non-tender firm eyelid lump, caused by clogging and inflammation of the oil glands of the eyelid, often following a stye. Painful and redness can occur if there is also an infection present
- Dry eye: Abnormal or decreased oil secretions that are part of the tear film can result in excess tearing or dry eye. Because tears are necessary to keep the cornea healthy, tear film problems can make people more at risk for corneal infections.
Treatment of blepharitis
- Treatment of blepharitis involves keeping the lids clean and free of crusts. Warm compresses should be applied to the lid to loosen the crusts, followed by a light scrubbing of the eyelid with a cotton swab and a mixture of water and baby shampoo. Because blepharitis rarely goes away completely, most patients must maintain an eyelid hygiene routine for life. Dr. Jeruss may prescribe antibiotic or steroid eye drops and/or ointment, and in more severe cases, an oral antibiotic.
- When scalp dandruff is present, a dandruff shampoo for the hair is recommended as well. In addition to the warm compresses, eyelid massage may be helpful to purge the oil accumulated in the glands. People who also have acne rosacea should have that condition treated at the same time.
CONJUNCTIVITIS: inflammation of the thin transparent layer of tissue that lines the inner surface of the eyelid and covers the white part of the eye.
Causes of conjunctivitis
- Viral infection
- Bacterial infection
- Fungus infection
- Seasonal or product allergy
- Sexually transmitted diseases
- Contact lenses or care solutions
- Exposure to chemical irritants like smoke and other noxious substances
- Underlying systemic auto-immune reaction, like rheumatoid arthritis, sarcoid, lupus
Symptoms of conjunctivitis
- Gritty feeling
- Itching or burning sensation
- Excessive tearing
- Swollen eyelids
- Pink discoloration to the white of the eye
- Increased sensitivity to light
Categories of conjunctivitis
- Allergic conjunctivitis occurs among people who already have seasonal allergies. At some point they come into contact with a substance that triggers an allergic reaction in their eyes. Contact lens wearers may develop a specific type of allergic conjunctivitis called "GPC" (giant papillary conjunctivitis), which is a reaction to the protein film that develops on the surface of the lenses, as well as to just having a foreign object (a contact lens) in the eye. People who have an exposed corneal suture after having some eye surgeries may develop GPC also.
- Bacterial conjunctivitis is an infection most often caused by staphylococcal or streptococcal bacteria from your own skin or respiratory system. Infection can also occur by transmittal from insects, physical contact with other people, poor hygiene (touching the eye with unclean hands), or by use of contaminated eye makeup and facial lotions.
- Viral conjunctivitis is most commonly caused by highly contagious viruses associated with the common cold. The primary means of contracting this is through exposure to coughing or sneezing by people with upper respiratory tract infections. It can also occur as the virus spreads along the body's own mucous membranes connecting lungs, throat, nose, tear ducts, and conjunctiva.
- Fungal conjunctivitis is most commonly seen in agricultural workers, gardeners, or landscape workers who get hit in the eye with branches or leaves that carry a fungus.
- Chemical conjunctivitis is caused by irritants like air pollution, cigarette smoke, chlorine in swimming pools, and exposure to noxious chemicals.
Treatment of conjunctivitis
The appropriate treatment for conjunctivitis depends on its cause:
- Allergic conjunctivitis - The first step should be to remove or avoid the irritant, if possible. Cool compresses and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Cases of persistent allergic conjunctivitis may also require topical steroid eye drops.
- Bacterial conjunctivitis - This type of conjunctivitis is usually treated with antibiotic eye drops or ointments. Improvement can occur after three or four days of treatment, but the entire course of antibiotics needs to be used to prevent recurrence.
- Viral Conjunctivitis - There are no available drops or ointments to eradicate the virus for this type of conjunctivitis. Antibiotics will not cure a viral infection. Like a common cold, the virus just has to run its course, which may take up to two or three weeks in some cases. The symptoms can often be relieved with cool compresses and artificial tear solutions. For the worst cases, topical steroid drops may be prescribed to reduce the discomfort.
- Fungal Conjunctivitis - Natamycin ophthalmic suspension is the drug of choice for filamentous fungal infection. Fluconazole ophthalmic solution is recommended for Candida infection of the cornea. Amphotericin B eye drops may be required for non-responding cases but can be quite toxic and requires an expert pharmacist for preparation.
- Chemical Conjunctivitis - Treatment for chemical conjunctivitis requires careful flushing of the eyes with saline and may require topical steroids. The more acute chemical injuries are medical emergencies, particularly alkali burns, which can lead to severe scarring, intraocular damage or even loss of the eye.
Contact lens wearers may need to discontinue wearing their lenses while the condition is active. If the conjunctivitis developed due to wearing contact lenses, Dr. Jeruss may recommend that you switch to a different type of contact lens or disinfection solution.
Practicing good hygiene is the best way to control the spread of conjunctivitis. Once an infection has been diagnosed, follow these steps:
- Don't touch your eyes with your hands.
- Wash your hands thoroughly and frequently.
- Discard eye cosmetics, particularly mascara.
- Don't use anyone else's eye cosmetics.
- Follow our instructions on proper contact lens use and care.
KERATITIS: inflammation of the cornea
Signs and symptoms of keratitis include:
- Eye redness
- Eye pain
- Excess tears or other discharge from your eye
- Difficulty opening your eyelid because of pain or irritation
- Blurred vision
- Decreased vision
- Sensitivity to light (photophobia)
- A feeling that something is in your eye
Causes of keratitis include:
- Injury. If any object scratches or injures the surface of your cornea, noninfectious keratitis may result. Chemical splashes can also cause keratitis. In addition, an injury may allow microorganisms to gain access to the damaged cornea, causing infectious keratitis.
- UV photokeratitis. Inadequate protection from UV light can cause a “corneal sunburn”.
- Contaminated contact lenses. Bacteria, fungi or parasites — particularly the microscopic parasite acanthamoeba — may inhabit the surface of a contact lens or contact lens carrying case. The cornea may become contaminated when the lens is in your eye, resulting in infectious keratitis. Over-wearing your contact lenses can cause keratitis, which can become infectious.
- Bacteria. Pseudomonas aeruginosa and Staphylococcus aureus are the two most common types of bacteria that cause bacterial keratitis.
- Viruses. Herpes simplex and Herpes zoster are the 2 main causes of viral keratitis.
- Fungi. Fungal keratitis is typically caused by eye injuries from vegetation that harbor Aspergillus, Candida, or Fusarium fungi.
- Contaminated water. Parasites in water — particularly in oceans, rivers, lakes and hot tubs — can enter your eyes when you're swimming and result in keratitis. However, even if you're exposed to these parasites, a healthy cornea is unlikely to become infected unless there has been some previous breakdown of the corneal surface — for example, wearing a contact lens too long. Acanthamoeba is a particularly devastating parasite that can cause permanent vision loss quickly.
Factors that may increase your risk of keratitis include:
- Contact lenses. Wearing contact lenses — especially sleeping in the lenses —increases your risk of both infectious and noninfectious keratitis. The risk typically stems from wearing them longer than recommended, improper disinfection or wearing contact lenses while swimming.
- Reduced immunity. If your immune system is compromised due to disease or medications, you're at higher risk of developing keratitis.
- Corticosteroids. Use of corticosteroid eye drops to treat an eye disorder can increase your risk of developing infectious keratitis or worsen existing keratitis.
- Eye injury. If one of your corneas has been damaged from an injury in the past, you may be more vulnerable to developing keratitis.
Potential complications of keratitis include:
- Chronic corneal inflammation and scarring
- Chronic or recurrent viral infections of your cornea
- Open sores on your cornea (corneal ulcers)
- Temporary or permanent reduction in your vision
If you wear contact lenses, proper use, cleaning, & disinfecting can help prevent keratitis. Follow these tips:
- Choose high oxygen transmitting contacts and take them out before going to sleep.
- Wash, rinse and dry your hands thoroughly before handling your contacts.
- Follow our recommendations for taking care of your lenses.
- Use only sterile products that are made specifically for contact lens care, and use lens care products made for the type of lenses you wear.
- Gently rub the lenses during cleaning to enhance the cleaning performance of the contact lens solutions. Avoid rough handling that might cause your lenses to become scratched.
- Replace your contact lenses as recommended.
- Replace your contact lens case every three to six months.
- Discard the solution in the contact lens case each time you disinfect your lenses. Don't "top off" the old solution that's already in the case.
- Don't wear contact lenses when you go swimming.
Preventing viral outbreaks
Some forms of viral keratitis can't be completely eliminated. But the following steps may control viral keratitis occurrences:
- If you have a cold sore or a herpes blister, avoid touching your eyes, your eyelids and the skin around your eyes unless you've thoroughly washed your hands.
- Only use eye drops that have been prescribed by an eye doctor.
- Washing your hands frequently prevents viral outbreaks.
Treatment of keratitis
Treatment depends on the type and severity:
- Non-infectious keratitis may be treated with steroid (anti-inflammatory) eye drops.
- Bacterial infections, especially corneal ulcers, typically require a 1-2 week course of frequent use of antibiotic eye drops.
- Herpes virus infections require a 1-2 week course of frequent use of antiviral eye drops or oral medication.
- Fungal infections require a 1-2 week course of frequent use of antifungal eye drops.
EPISCLERITIS: inflammation of the episclera (the tissue layer between the conjunctiva & sclera)
- The red appearance caused by this condition looks similar to conjunctivitis, although there is no discharge.
- There is no apparent cause, but it can be associated with underlying systemic auto-immune inflammatory conditions such as rosacea, lupus, sarcoidosis, or rheumatoid arthritis.
- Symptoms include generalized or local redness of the eyes that may be accompanied by mild soreness or discomfort but no visual problems.
- Episcleritis generally clears without treatment, but topical or oral anti-inflammatory agents may be prescribed to relieve pain.
- A systemic blood work-up may be needed in some cases (such as recurring) to uncover a possible underlying medical condition.
Dry eye syndrome is caused by a chronic lack of sufficient lubrication and moisture on the surface of the eye. Persistent dryness, scratchiness, red eyes, and a burning sensation are common symptoms of dry eyes, although excessive tearing may also be a symptom as a result of an overproduction of tears in a protective response to chronic dryness.
Tears consist of three essential components:
- The outer, oily lipid component, produced by the meibomian glands in the eyelids
- The middle, watery, lacrimal component, produced by the lacrimal glands above the outer corners of the eyes
- The innermost component, consisting of mucous or mucin, produced by goblet cells in the conjunctiva.
Each component of the tear film serves a critical purpose. Tear lipids prevent evaporation and increase lubrication, while mucins help anchor the tears to the ocular surface. A problem with any of those sources can result in tear instability and dry eyes.
In dry eye syndrome, the lacrimal gland doesn't produce enough tears, or dysfunction of the meibomian glands reduces oil output, leading to excessive evaporation of the tears. This is called evaporative dry eye and is now considered to be the primary cause or a contributing factor of most cases of dry eye.
Dry eye syndrome has many causes:
- It occurs as a part of the natural aging process (especially during menopause in women); as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills; or because you live in a dry, dusty or windy climate.
- Air conditioning or heating can dry out your eyes as well. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.
- Dry eye syndrome is more common among women, possibly due to hormonal fluctuations. A recent study also indicates that the risk of dry eyes among men increases with age.
- Recent research suggests that smoking, too, can increase your risk of dry eyes.
- With increased popularity of cosmetic eyelid surgery (blepharoplasty) for improved appearance, dry eye complaints now occasionally are associated with incomplete closure of eyelids following such a procedure.
- Dry eyes also are a symptom of systemic diseases such as lupus, rheumatoid arthritis, ocular rosacea or Sjogren's syndrome (a triad of dry eyes, dry mouth and rheumatoid arthritis or lupus).
- Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among contact lens wearers.
- Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and evaporation of moisture from contact lenses worsens dry eye symptoms. Newer contact lens materials and lens care products can help reduce contact lens dryness.
Treatments for Dry Eyes
- Artificial tear drops and gels are lubricants that may provide relief. Some artificial tears are formulated to address specific tear deficiencies, such as insufficient lipids.
- Nutritional supplements containing omega-3 fatty acids and flaxseed oil can decrease dry eye symptoms. Good natural sources of omega-3s include cold-water fish, such as sardines, cod, herring and salmon. Drinking more water can help, too. Mild dehydration often makes dry eye problems worse. This is especially true during hot, dry and windy weather. Simply drinking more water sometimes reduces the symptoms of dry eye syndrome.
- LipiFlow treatment (TearScience) is an in-office procedure that clears blocked meibomian glands and restores normal function. Meibomian gland dysfunction (MGD) is now recognized as a primary cause of or contributor to most cases of dry eye.
- Warm compresses applied to the eyes, followed by manual expression of the meibomian glands helps in treating MGD and evaporative dry eye.
- Combination antibiotic/ steroid anti-inflammatory drops may relieve underlying low-grade eyelid infections and provide relief.
- Restasis® (cyclosporine) is a prescription eye drop that helps to produce more tears by reducing inflammation.
- Lacrisert, a tiny rod filled with a lubricating ingredient (hydroxypropyl cellulose) is placed just inside the lower eyelid, where it continuously releases lubrication for the eye.
- Punctal occlusion. We can insert small plastic plugs into the tear drainage canals to block the tears from flowing out of the eye, allowing your own tears to lubricate the eyes longer. This is a painless, quick procedure done at the doctor's office. Dr. Jeruss uses a new type of punctal plug that changes shape from the warmth of your eye to conform to the size of your tear drainage canal. Advantages of this type of plug are that one size fits all, so measurement is unnecessary, and nothing protrudes from the tear duct that could potentially cause irritation. With some people, however, punctal plugs aren't effective enough, so their tear ducts need to be closed surgically (punctal cautery).
Sometimes people use eye drops that are advertised to "get the red out" to treat their dry eyes. While these drops can reduce or eliminate eye redness temporarily, they may or may not be effective at lubricating your eyes, depending on the formulation. Also, your eyes can develop a tolerance or "rebound effect" to the eye-whitening agents (vasoconstrictors) in these drops, which can cause even more redness over time. Redness-relieving eye drops can cause other adverse effects as well, especially if you use them too often.
For contact lens wearers, you will likely benefit from switching to a better soft lens that resists drying out or switching to an RGP (rigid gas permeable) lens. Scleral lenses are especially helpful to improve eye comfort for people with dry eye and other ocular surface abnormalities.
Welcome to Atlanta, the Allergy Capital of the Universe!
We have THE most beautiful springtime of any place in the world, but unfortunately our springtime pollen counts defy the imagination...and it doesn't end there. Every season here seems to have something to be allergic to. And the eyes have had it...swollen, itchy, red, and runny.
Fortunately, there is help. There are numerous excellent topical prescription ocular allergy relief medications available. Drs. Jeruss and Zaunbrecher are very experienced at treating ocular allergies. We'll see you in March!
PTERYGIUM (pronounced “tuh-RIDGE-ee-yum”)
A pterygium is a wing-shaped fibrovascular connective tissue that grows from conjunctiva over the cornea. It is typically associated with exposure to ultraviolet light and wind and is frequently found in individuals who spend significant time outdoors in sunny areas.
Growth of the pterygium can cause ongoing irritation and can often affect the vision by pulling on the cornea, causing astigmatism. If the vision is affected or symptoms are significant, the tissue can be surgically removed.
Corneal abrasion or laceration (scratched eye)
As anyone who has accidentally been poked in the eye can attest, there is not much else that is more debilitating. The cornea has more nerve endings than any other part of the body, making it extremely sensitive. So, when your baby suddenly reaches out to your face and scratches your eye with a fingernail, your reaction can be enough to set you both crying out loud!
Fortunately, the cornea is a very tough piece of tissue, and we are usually lucky enough to end up with a superficial scratch or cut, as opposed to a deeper injury that penetrates thru the cornea. Corneal abrasions and lacerations are painful, but they are readily treatable.
After numbing the eye with a topical numbing eye drop, we place a "bandage contact lens" on the eye and prescribe a topical antibiotic and anti-inflammatory eye drop to be used for 4-7 days. Often the eye reacts to trauma with internal inflammation and deep boring painful eye muscle spasms, which must be relieved with a cycloplegic eye drop to relax them.
A corneal abrasion or cut makes the eye more susceptible to infection, since fingernails usually carry bacteria, and tree branches may carry fungi. Certain types of bacteria and fungi can enter the eye through a scratch and cause serious harm in as little as 24 hours. Don't delay...you need to be seen right away.
Subconjunctival hemorrhage (bleeding)
A poke to the eye can also cut the blood vessels under the conjunctiva, the clear membrane covering the white of the eye. This is usually a self-limiting problem, which means that the bleeding ends pretty quickly and causes no further problems. It may look horrible, especially as the blood that has already leaked out begins to spread under the conjunctiva and make it appear as if the bleeding is getting worse...but this is usually a normal occurrence and is usually not a danger. It can take up to 3 weeks for the blood to fully reabsorb and disappear.
Depending on the severity of the blow, it may be necessary to dilate the eye to look for any possible internal damage.
A subconjunctival hemorrhage can occur sometimes from trying to remove a contact lens that is stuck to the eye, or from accidentally rubbing the eye too hard, even possibly while asleep.
If you get recurring subconjunctival hemorrhages, this could mean that there is some underlying vascular problem such as diabetes or hypertension. Please let us know if such is the case.
Penetrating or embedded foreign objects in the eye
If a large foreign object such as a stick or a fishhook penetrates or becomes embedded in your eye, visit the emergency room/urgent care center right away. You could cause even more injury to your eye if you attempt to remove the object yourself or if you rub your eye.
Small bits of metal or other material can sometimes get blown or sprayed into the eye. If these become embedded, they can cause considerable irritation, and will need to be removed by a doctor. Metal bits quickly start to rust and cause permanent scars that can permanently affect the vision. We have a special tool for removing embedded foreign objects and rust rings before they leave a scar.
Chemical burns to the eye
If you ever get splashed or sprayed in the eye by a chemical substance, the first thing you should do is put your head under a steady stream of lukewarm water for about 10-15 minutes, letting it run into your eyes. Then either call us or the emergency room/urgent care center to let us know what the chemical was, or come in right away. Some chemicals burn or sting but are fairly harmless in the long run, while others can cause serious injury. Chemicals fall into 2 basic categories:
- Acid- In general, acids can cause considerable redness and burning but can be washed out fairly easily without causing permanent devastating damage. One of the more common chemical accidents we see are hydrogen peroxide burns from some contact lens disinfecting systems.
- Alkali- Substances or chemicals that are basic (alkali) can cause much more serious permanent injury, even though they don't cause as much immediate eye pain or redness as acids. Some examples of alkali substances are oven cleaners, toilet bowl cleaners and chalk dust.
- Blunt trauma to the eye - Getting struck in the eye by a blunt object, such as a ball or a fist, can often cause the eyelids and surrounding tissue to swell and become discolored. The best immediate treatment for this type of eye injury is an ice pack. As described above, sometimes the internal muscles may become inflamed and spasm, resulting in deep throbbing pain. It is best to have a doctor look inside the eye to make sure that there is no internal inflammation or bleeding or retinal break. It is also important to evaluate for any fractures of the bones that surround the eyeball.
Steps To Take in Case of Eye Injury
If you suffer an eye injury, contact our office immediately. If we are not in the office, our voice message recording will give you the emergency phone numbers for both Dr. Jeruss and Dr. Zaunbrecher.
In certain extreme situations such as a penetrating eye injury or an eye knocked out of the socket, we advise that you get to the hospital immediately.
The ability to adjust our focusing ability back and forth from near to far is the function of the eye's crystalline lens, located behind the iris and the pupil. Much like an adjustable focus camera lens, our crystalline lens changes power to accommodate to different distances by constantly focusing light onto the retina at the back of the eye. It is able to adjust focus because it is elastic, which allows it to change shape, and thus its power.
The lens is made of mostly water and collagen proteins. The collagen is arranged in fibers that keeps the lens clear and allows light to pass through it without distortion. As we get older, these collagen fibers gradually become stiffer. This stiffening causes the lens to gradually lose its elasticity, and our adjustable focusing ability deteriorates. You will notice that with your distance prescription on you will begin needing to hold your reading material further away from you. Eventually, some of the collagen proteins clump together and form cloudy areas, and these are called cataracts.
Most cataracts develop slowly and don't affect your vision in the early stages. As they grow, the vision becomes like looking thru a fogged up window, and at night it will cause glare and haloes around lights. Cataracts are painless.
Signs and symptoms of cataracts include:
- Clouded, blurred or dim vision
- Increasing difficulty with vision at night
- Sensitivity to light and glare
- Haloes and starbursts around lights
- The need for brighter light for reading and other activities
- Frequent changes in eyeglass or contact lens prescription
- Fading or yellowing of colors
- Double vision in a single eye
Cataracts don't typically cause any change in the appearance of your eye. Pain, redness, itching, irritation, aching in your eye or a discharge from your eye aren't signs or symptoms of a cataract, but may be signs and symptoms of other eye disorders.
A cataract isn't dangerous to the physical health of your eye unless the cataract becomes completely white, a condition known as an overripe (hypermature) cataract. This can cause inflammation, pain, and headache. A hypermature cataract requires removal if it's associated with inflammation or pain.
A cataract can develop in one or both of your eyes. However, in most cases — except for those caused by injury or trauma — cataracts tend to develop fairly symmetrically in both eyes. A cataract may or may not affect the entire lens.
There are 3 types of cataracts, based on their location:
- Nuclear. A nuclear cataract occurs in the center of the lens. In its early stages, as the lens changes the way it focuses light, you may become more nearsighted or even experience a temporary improvement in your reading vision. Some people actually stop needing their glasses. Unfortunately, this so-called "second sight" disappears as the lens gradually turns more densely yellow and further clouds your vision. As the cataract progresses, the lens may even turn brown. Seeing in dim light and driving at night may be especially troublesome. Advanced discoloration can lead to difficulty distinguishing between shades of blue and purple.
- Cortical. A cortical cataract begins as whitish, wedge-shaped opacities or streaks on the outer edge of the lens cortex. As it slowly progresses, the streaks extend to the center and interfere with light passing through the center of the lens. Problems with glare are common for people with this type of cataract.
- Subcapsular. A subcapsular cataract starts as a small, opaque area just under the capsule of the lens. It usually forms near the back of the lens, right in the path of light on its way to the retina. A subcapsular cataract often interferes with your reading vision, reduces your vision in bright light and causes glare or haloes around lights at night.
Scientists don't know exactly why a lens changes with age. One possibility is damage caused by unstable molecules known as free radicals. Smoking and exposure to ultraviolet (UV) light are two sources of free radicals. General wear and tear on the lens over the years also may cause the changes in protein fibers.
Age-related changes in the lens aren't the only cause of cataracts. Some people are born with cataracts or develop them during childhood. Such cataracts may be the result of the mother having contracted German measles (rubella) during pregnancy. They may also be due to metabolic disorders. Congenital cataracts, as they're called, don't always affect vision, but if they do they're usually removed soon after detection.
Everyone is at risk of developing cataracts simply because age is the greatest risk factor. By age 65 about half of all Americans have developed some degree of lens clouding, although it may not impair vision. After age 75, as many as 70 percent of Americans have cataracts that are significant enough to impair their vision. An eye specialist can detect and track the development of cataracts during routine eye exams.
Factors that increase your risk of cataracts include:
- Family history of cataracts
- Previous eye injury or inflammation
- Previous eye surgery
- Prolonged use of corticosteroids
- Excessive exposure to sunlight
- Exposure to ionizing radiation
The only effective treatment for cataracts is surgery to remove the clouded lens and replace it with a clear intraocular lens implant (IOL). Sometimes cataracts are removed without reinserting implant lenses. In such cases, vision can be corrected with eyeglasses or contact lenses. Cataract surgery is successful in about 95 percent of all cases, and it is the most frequently performed surgery in the United States, with more than 3 million Americans undergoing cataract surgery each year.
In the past, people were advised to wait until their vision had deteriorated to about 20/200, which would seriously impact their vision. Today, because surgical techniques have improved and the risks from cataract surgery are much lower, surgery is generally recommended when cataracts begin to affect your quality of life or interfere with your ability to perform normal daily activities. Also, cataract surgeons are now able to implant bifocal (multifocal) lenses, which reduce and sometimes eliminate the need for post-op reading glasses.
Surgery is done on only one eye at a time. It's generally done on an outpatient basis, usually with local anesthesia. Recovery is fast. You can often resume your normal daily activities beginning the night of your surgery. You may be able to start driving again the day after surgery, after your postoperative checkup.
Cataracts can't be cured with medications, dietary supplements, exercise or optical devices. In the early stages of a cataract when symptoms are mild, a good understanding of the condition and a willingness to adjust your lifestyle can help:
- If you have eyeglasses or contact lenses, make sure they're the most accurate prescription possible.
- Improve the lighting in your home with more or brighter lamps, for example, lamps that can accommodate halogen lights or 100- to 150-watt incandescent bulbs.
- When you go outside during the day, wear sunglasses to reduce glare.
- Limit your night driving.
- Regular eye exams remain the key to early detection. Dr. Jeruss, as do most eye doctors, recommends yearly exams. Although most cataracts occur with age and can't be avoided altogether, you can take steps to help slow or possibly prevent the development of cataracts:
- Don't smoke. Smoking produces free radicals, increasing your risk of cataracts.
- Eat a balanced diet. Include plenty of fruits and vegetables in your diet. Eating lots of fruits and vegetables may have a modest effect in preventing cataract development.
- Take antioxidant supplements, such as omega-3 fatty acids, vitamins A, C, and E, and green tea.
- Protect yourself from the sun. Ultraviolet light may contribute to the development of cataracts. Whenever possible, wear sunglasses that block ultraviolet B (UVB) rays when you're outdoors.
- Take care of other health problems. Follow your treatment plan if you have diabetes or other medical conditions.
Glaucoma is the disease process where the pressure inside the eyeball becomes high enough that the optic nerve fibers become damaged, resulting in vision loss and, if left untreated, total blindness. It is estimated that approximately 2.5 million Americans have glaucoma, and half of those who have glaucoma are unaware that they have it. The reasons for this are that there are no pressure receptors inside the eye, so we can't feel when our intraocular pressure (IOP) rises, and the vision loss begins in our peripheral side vision, so we don't notice we're losing vision until the disease is in an advanced state. By then, vast numbers of optic nerve fibers have already suffered irreversible damage and the result is permanent vision loss.
Why does the intraocular pressure rise?
Either the eye is producing too much aqueous fluid into the anterior chamber (between the cornea and iris), or the aqueous fluid is not draining out of the anterior chamber enough. We don't have all the answers yet as to why either of these occurs.
Types of glaucoma
The two major types of glaucoma are chronic or primary open-angle glaucoma (POAG) and acute angle-closure glaucoma. The "angle" in both cases refers to the drainage channels circling the eyeball between the iris and the cornea that control aqueous outflow. Other variations include normal-tension glaucoma, pigmentary glaucoma, secondary glaucoma, and congenital glaucoma.
- Primary or chronic open-angle glaucoma (POAG, COAG) is the most common type. About half of Americans with chronic glaucoma don't know they have it. The drainage angle is open, but more fluid is being produced than can drain out of the eye, so the pressure gradually rises, causing irreversible damage and permanent vision loss without any symptoms.
- Angle-closure or narrow angle glaucoma is a TRUE OCULAR EMERGENCY! It produces sudden symptoms when the drainage channels abruptly close, causing the IOP to quickly rise to extremely high levels. Severe eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting come on within minutes to hours. These signs may last for a few hours, and then return again for another round. Each attack takes with it part of your vision. If you have these symptoms, make sure you see an eye doctor or go to the emergency room immediately so steps can be taken to prevent permanent vision loss. Total blindness can result within 24 hours without treatment. Fortunately, angle-closure glaucoma can be prevented beforehand. A routine eye exam can detect a narrow drainage angle, and a prophylactic laser iridotomy or iridoplasty can be performed by a glaucoma surgeon to create an alternative drainage opening BEFORE the angle might unexpectedly close in the future.
- Normal-tension glaucoma (also called normal-pressure glaucoma, low-tension glaucoma, or low-pressure glaucoma) is an open-angle type of glaucoma that can cause visual field loss due to optic nerve damage, but the IOP remains in the normal range. The cause of normal-pressure glaucoma is not known, though many doctors believe it is related to poor blood flow to the optic nerve. Normal-pressure glaucoma is more common in those who are Japanese, are female, and/or have a history of vascular disease.
- Pigmentary glaucoma is a rare form of glaucoma caused by pigment that flakes off the iris and clogs the drainage angles, preventing aqueous humor from leaving the eye. Over time, the inflammatory response to the blocked angle damages the drainage system. The only symptoms with pigmentary glaucoma may be eye pain and blurry vision after exercise, when pigment may be released from exertion. Pigmentary glaucoma affects mostly white males in their mid-30s to mid-40s.
- Secondary glaucoma may develop following an eye injury, eye infection, inflammation, eye tumor, or a large cataract.
- Congenital glaucoma is an inherited form of glaucoma that is present at birth, with 80 percent of cases diagnosed by age one. These children are born with narrow angles or some other defect in the drainage system of the eye. It is difficult to spot signs of congenital glaucoma, because children are too young to understand what is happening to them. If you notice a cloudy, white, hazy, enlarged or protruding eye in your child, consult your eye doctor. Congenital glaucoma typically occurs more in boys than in girls.
Diagnostic tests for glaucoma
- We use a tonometer to measure your intraocular pressure, or IOP. Your eye may be numbed with eye drops, and a small probe gently touched to the eye's surface. Other tonometers send a puff of air onto your eye's surface. Normally, IOP should be below 21 mmHg (millimeters of mercury) — a unit of measurement based on how much force is exerted within a certain defined area. Anything above 21 is considered statistically abnormal and indicates that further testing should be performed.
- A pachometer is a device that we use to measure the corneal thickness. A thicker cornea will result in a higher IOP reading, while a thinner cornea will result in a lower IOP reading. A person's TRUE IOP may therefore be lower or higher than what is measured.
- Visual field testing determines if you are experiencing peripheral side vision loss. You straight ahead at a fixation target inside the machine and click a button when you notice a blinking light or a block of vibrating lines in your side vision. The resulting map of your peripheral vision will indicate any areas where your retina has lost sensitivity. This loss of sensitivity is the result of damaged nerve fibers. The visual field test is repeated at regular intervals to determine the extent or progression of vision loss from glaucoma.
- Gonioscopy utilizes special angled mirrored lenses to view the "drainage angle" to make sure the fluid ("aqueous humor" or "aqueous") can drain freely from the eye.
- Optic nerve stereo photography is used to document changes in the appearance of the optic nerve head, the place where the optic nerve fibers exit the eyeball on their way back to the brain's visual center. Excessive IOP causes permanent nerve fiber damage, which ultimately shows up as a hollowing out of the optic nerve head and wedge shaped gaps in the retina surrounding it.
- Optical Coherence Tomography (OCT) scanning of the optic nerve and surrounding nerve fiber layer as well as the ganglion cell layer in the macula are performed to measure changes in their thickness caused by excessive pressure in the eye. Damage to these layers leads to vision loss if the eye pressure is not lowered and controlled.
Currently there is no cure for glaucoma. The goal is to lower the eye pressure to some level where the slow steady damage it produces over a person’s lifetime is slowed down significantly enough that the vision loss is minimized. It is therefore extremely important to be examined regularly, typically every 6 months to 1 year for the rest of a person’s life.
There are a number of ways to lower the eye pressure:
- Eyedrops that decrease the production of aqueous fluid.
- Eyedrops that increase the outflow of aqueous fluid.
- Periphery laser iridotomy (small hole in the iris to create a secondary drainage because the normal drainage is restricted in narrow angle glaucoma. Also done prophylactically as a precaution in patients whose narrow angles might suddenly undergo an angle closure attack.
- Laser trabeculoplasty (opens up larger drainage passages in the trabecular meshwork in the drainage angle).
- Shunts and stents inserted into the eye to bypass the inefficient drainage system.
- Cataract surgery
If Dr. Jeruss or Dr. Zaunbrecher suspects that you have developed glaucoma, they will usually prescribe IOP lowering eye drops as first line treatment. But because glaucoma is painless and the vision loss is slow and not noticeable because it occurs in the periphery, sometimes patients don’t understand that using these drops is a lifetime commitment …. and they stop using them. When this happens, we try to emphasize the vital importance of using the drops as advised, but it may be that a laser or surgical procedure is now indicated. If your eye drops ever become uncomfortable or inconvenient, consult Dr. Jeruss or Dr. Zaunbrecher before discontinuing them.
This is a debilitating eye disease affecting the central retina where your 20/20 vision comes from. There is so much new information about the causes and treatments of macular degeneration that I have simply posted a link to a very informative web page below:
There is a lot of information on these topics on the internet. Here are 2 websites to check out:
Keratoconus is a progressive vision disorder that occurs when the normally round cornea (the front part of the eye) becomes thin and irregular (cone) shaped. This abnormal shape prevents the light entering the eye from being focused correctly on the retina and causes distortion of vision.
In its earliest stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to glare and light. These symptoms usually appear in the late teens or early 20s. Keratoconus may progress for 10-20 years and then slow in its progression. Each eye may be affected differently. As keratoconus progresses, the cornea bulges more and vision may become more distorted. In a small number of cases, the cornea will swell and cause a sudden and significant decrease in vision. The swelling occurs when the strain of the cornea's protruding cone-like shape causes a tiny crack to develop. The swelling may last for weeks or months as the crack heals and is gradually replaced by scar tissue. If this sudden swelling does occur, eye drops can be prescribed for temporary relief, but there are no medicines that can prevent the disorder from progressing.
Eyeglasses or soft contact lenses may be used to correct the mild nearsightedness and astigmatism that is caused by the early stages of keratoconus, but eventually only specially designed RGP (rigid gas permeable) contact lenses can correct the vision adequately. Frequent checkups and lens changes may be needed to achieve and maintain good vision. Scleral RGP lenses are the preferred correction due to their much better comfort and stability than corneal RGP lenses. Because scleral lenses vault the cornea completely without touching it, this lack of stress on the cornea makes it quite possible to continue successfully wearing scleral RGP lenses throughout one’s lifetime without ever having to resort to corneal surgery.
Ultimately, a corneal transplant may be necessary, but after the surgery, eyeglasses or contact lenses will usually be able to fully correct the vision.
Surgical procedures to treat keratoconus:
- Corneal cross-linking: The reason that a keratoconic cornea starts to thin and bulge is because it has insufficient stromal collagen fiber links. Cross-linking strengthens and stabilizes the cornea by creating new links between collagen fibers. The procedure involves applying a riboflavin (vitamin B2) solution to the cornea (either after removing the outer epithelium first to increase penetration of the riboflavin, or leaving the cornea intact) followed by a controlled exposure to UV light for up to 30 minutes. The best candidates for cross-linking are those in the earliest stages of keratoconus before the corneal shape has become too irregular and the cause significant vision loss.
- Intrastromal rings (Intacs): A ring is inserted in the cornea to flatten the cone and restore more normal vision.
- Deep Anterior Lamellar Keratoplasty (DALK): A partial transplant technique where only the corneal epithelium and stroma are replaced, leaving the endothelium intact. Graft rejection is greatly reduced.
- Descemet Stripping Automated Endothelial Keratoplasty (DSAEK): A partial thickness corneal transplant that involves selective removal of the patient’s Descemet membrane and endothelium, followed by transplantation of donor corneal endothelium and stroma. There is even less graft rejection than with DALK.
- Penetrating Keratoplasty (PK): Highly successful full thickness corneal transplant. Needed if there is significant scarring present. Slow visual recovery 1-2 years. Risk of graft rejection.
- Artificial Prosthetic Corneal implants: Used in full thickness transplants in place of human donor corneas when the risk of graft failure is high.
Chalazion and Stye
Chalazion and hordeolum (stye) are both sudden-onset localized swellings of the eyelid. A chalazion is caused by non-infectious meibomian gland blockage, whereas a hordeolum is caused by infection. Both conditions initially cause eyelid redness, swelling, and tenderness. With time, a chalazion becomes a small non-tender nodule, whereas a hordeolum remains painful and can reach toward the eyelid margin.
Treatment is with hot compresses. (We recommend a Bruder mask, which is a washable, microwaveable double eye patch with adjustable strap that contains small heatable beads that maintain their heat for much longer than a typical washcloth compress.) Both conditions usually improve spontaneously, but sometimes an incision to drain the stye, or a corticosteroid injection to reduce the size of the chalazion, may be needed.
Papilloma (viral wart)
This is the most common benign lesion of the eyelid. They are readily removed with chemical or other cautery. We have had a lot of success using dichloroacetic acid. There may be some momentary slight stinging upon application, but no anesthetic is ever needed. The lesions immediately turn white and then soon form a dark scab, falling off within 10 days.
Other Lumps and Bumps
These links will take you to the Skinsight website, which has photos and information on a huge number of skin conditions:
Dr Jeruss TV Interview