Amblyopia is often referred to as ‘lazy eye.’ It can be caused by a visual obstruction such as cataracts, a refractive error that occurs when the curve of the eye is incorrect, or by strabismus which is an abnormal alignment of the eyes. The effects of amblyopia are: abnormal vision (less than 20/20), eye misalignment, uncoordinated eye movement, loss of depth perception, and squinting or closing one eye while focusing.

Newborn babies cannot focus properly on an object at birth. Babies learn to focus both eyes in the same way that they learn to control their motor skills. If they are incapable of focusing both eyes, they will experience double vision or other visual disturbances. Because this is a difficult way to view the world around them, they will learn to rely on only one eye for vision.

Treatment of this condition is determined after a thorough exam by an ophthalmologist (eye doctor who is an M.D.). Tests are often used to determine how misaligned the eyes are and how much depth perception is affected.

If amblyopia is detected in an infant, certain testing may not be possible. The doctor may choose to attempt to strengthen the misaligned eye by placing a patch over the stronger eye so that the baby is forced to use the weaker eye. If this doesn’t correct the problem as the child grows up, then glasses will probably be prescribed to help correct and balance the eyes.

It is extremely important to the correction of amblyopia that treatment begins as early as possible. A child’s nervous system continues to develop during infancy, and amblyopia can only be corrected during this sensitive period. Doing nothing and waiting will only cause permanent, irreversible damage.

Amblyopia pdf (60k)

Age Related Macular Degeneration is a disease that affects your central vision. It is a common cause of vision loss among people over the age of 60. Because only the center of your vision is usually affected, people rarely go blind from the disease. However, age related macular degeneration can sometimes make it difficult to read, drive, or perform the other daily activities of life that require fine central vision.

The macula is the center of the retina which is the light sensitive layer of tissue at the back of the eye. As you read, light is focused onto your macula. In the macula, millions of cells change the light into nerve signals that tell the brain what you are seeing. This is called your central vision. With good central vision, you are able to read, drive, and perform other daily activities that require fine, sharp, straight ahead vision.

Age Related Macular Degeneration occurs in two forms:
Dry Age Related Macular Degeneration affects about 90% of those with the disease. Slowly, the light sensitive cells in the macula break down. With less of the macula working, you may start to lose central vision in the affected eye over time. It usually occurs in just one eye at first, but you may get the disease later in the other eye. Doctors have no way of knowing if or when both eyes will be affected.

Wet Related Macular Degeneration only affects about 10% of those with the disease. However, it accounts for 90% of all the severe vision loss from the disease. It occurs when new blood vessels behind the retina start to grow toward the macula. Because these new blood vessels tend to be very fragile, they will often leak blood and fluid under the macula. This causes rapid damage to the macula that can lead to the loss of central vision in a short period of time.

Neither type of Age Related Macular Degeneration causes any pain.
The most common symptom of dry AMD is slightly blurred vision. You may need more light for reading and other tasks. Also, you may find it difficult to recognize faces until you are very close to them. As dry AMD gets worse, you may see a blurred spot in the center of your vision. This spot occurs because a group of cells in the macula have stopped working properly. Over time, the blurred spot may get bigger and darker, taking more of your central vision. Often people with dry AMD do not notice any changes in their vision. With one eye seeing clearly, they can still drive, read and see fine detail. Some people may notice changes in their vision only when AMD affects both of their eyes.

An early symptom of wet AMD is that straight lines appear wavy. This happens because the newly formed blood vessels leak fluid under the macula. The fluid raises the macula from its normal place at the back of the eye and distorts your vision. Another sign that you may have wet AMD is the rapid loss of your central vision. You may also notice a blind spot. If you notice any of these changes in your vision, you should contact your ophthalmologist at once for an eye exam.

Dry AMD cannot be treated currently, but this does not mean that you will lose your sight. Fortunately, dry AMD develops very slowly. You may lose some of your central vision over the years. However, most people are able to lead normal, productive lives, especially if dry AMD only affects one eye.

Some cases of wet AMD can be treated with laser surgery. The treatment involves aiming a high energy beam of light directly onto the leaking blood vessels. Laser treatment is more effective if the leaky blood vessels have developed away from the fovea which is the central part of the macula. However, even if the blood vessels are growing right behind the fovea, the treatment can be of some value in stopping further vision loss.

Another treatment for wet AMD is Visudyne ™ therapy. In this procedure, a light-activated drug called Visudyne™ is injected into the patient’s blood stream. Once the drug reaches the retina, it is activated by a non-thermal laser (a laser that does not burn the retina). This produces a clot that closes the abnormal vessels without causing damage to the overlying sensory retina. The abnormal vessel may return after several months. However, the Visudyne™ therapy can be reapplied at up to 3 month intervals if necessary.

AMD pdf (108k)

As we age, the delicate skin around the eyes can appear puffy or saggy. Eyelid skin stretches, muscles weaken, and the normal deposits of protective fat around the eye bulge. The surgical procedure to remove excess eyelid tissues (skin, muscle, or fat) is called blepharoplasty.

Blepharoplasty can be performed on the upper eyelid, lower eyelid, or both. This surgery can be performed for either functional or cosmetic purposes. Sometimes the excess upper eyelid tissue obstructs the upper visual field or can weigh down the eyelid and produce tired-feeling eyes. When blepharoplasty is performed to improve vision, rather than for cosmetic reasons, it may be covered by some insurance companies.

Blepharoplasty pdf (56k)

Blepharitis is a common and chronic inflammation of the eyelids that causes redness, itching, and the potential for secondary eye infection. It is more commonly seen in people who have oily skin, dandruff, or dry eyes. It can be seen in both young children and adults.

Everyone has bacteria on the surface of the skin, but some people are more sensitive to it than others. As the bacteria replicates, it causes burning, itching, and flaking along the lashes and eyelid margins. More often the irritations are minor, however, some people can develop an allergic response to the bacteria leading to inflammation of the cornea.

The swelling and inflammation around and at the edges of the eyelids can cause these symptoms in and around the eyes:

• Dandruff-like flaking
  
• Crusty layer of dried discharge
  
• Swelling and puffiness
  
• Redness (bloodshot eyes and eyelids)
  
• Irritation (discomfort)
  
• Burning
  
• Grainy or coarse sensation under the eyelid (foreign body sensation)
  

Blepharitis pdf (60k)

When used with care and proper supervision, contact lenses can provide a safe and effective alternative to eyeglasses. With today’s new lens technology, more people than ever can successfully wear contacts.

Contact lenses are thin, clear discs that float on the tear film that coats the cornea. The cornea is the curved front surface of the eye. Contacts correct the same refractive conditions that eyeglasses correct: myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (unequal curvature of the cornea).

Contact lenses can be made from a number of different plastics. The main distinction among them is whether they are hard or soft. Most people wear soft lenses. These may be daily wear soft lenses, extended wear soft lenses, or disposable lenses. Toric soft lenses provide a soft lens alternative for people with slight to moderate astigmatism.

Hard lenses are usually not as comfortable as soft lenses and are not as widely used. However, rigid gas permeable lenses provide sharper vision for people with higher refractive errors or larger degrees of astigmatism.

Conditions that might prevent an individual from successfully wearing contact lenses include dry eye, severe allergies, frequent eye infections, or a dusty and dirty work environment.

Proper cleaning and lens care is absolutely essential to protect eye health if you wear contact lenses. You must follow the instructions given to you by your doctor and optician!

Contact Lenses (78k)

The Cornea is the eye’s outermost layer. It is the clear, dome-shaped surface that covers the front of the eye. Although the cornea is clear and seems to lack substance, it is actually a highly organized group of cells and proteins. Unlike most tissues in the body, the cornea contains no blood vessels to nourish or protect it against infection. Instead, the cornea receives its nourishment from the tears and aqueous humor that fills the chamber behind it. The cornea must remain transparent to refract light properly, and to see well, all layers of the cornea must be free of any cloudy or opaque areas.

The cornea is arranged in five basic layers, each having an important function. These layers are:

Epthelium:
The epithelium is the cornea’s outermost region, comprising about 10% of the tissue’s thickness. The epithelium functions primarily to block the passage of foreign material such as dust, water, and bacteria into the eye and other layers of the cornea, and to provide a smooth surface that absorbs oxygen and cell nutrients from tears and then distributes these nutrients to the rest of the cornea. The epithelium is filled with thousands of tiny nerve endings that make the cornea extremely sensitive to pain when rubbed or scratched. The part of the epithelium that serves as the foundation on which the epithelial cells anchor and organize themselves is called the basement membrane.

Bowman’s Layer:
Lying directly below the basement membrane of the epithelium is a transparent sheet of tissue known as Bowman’s Layer. It is composed of strong layered protein fibers called collagen. Once injured, Bowman’s Layer can form a scar as it heals. If these scars are large and centrally located, some vision loss can occur.

Stroma:
Beneath Bowman’s Layer is the stroma, which comprises about 90% of the cornea’s thickness. It consists primarily of water (78%) and collagen (16%), and does not contain any blood vessels. Collagen gives the cornea its strength, elasticity, and form. The collagen’s unique shape, arrangement, and spacing are essential in producing the cornea’s light-conducting transparency.

Descemet’s Membrane:
Under the stroma is Descemet’s Membrane, a thin but strong sheet of tissue that serves as a protective barrier against infection and injuries. Descemet’s membrane is composed of collagen fibers (different from those of the stroma) and is made by the endothelial cells that lie below it. Descemet’s Membrane is regenerated readily after injury.

Endothelium:
The endothelium is the extremely thin, innermost layer of the cornea. Endothelial cells are essential in keeping the cornea clear. Normally, fluid leaks slowly from inside the eye into the middle corneal layer (stroma). The endothelium’s primary task is to pump this excess fluid out of the stroma. Without this pumping action, the stroma would swell with water, become hazy, and ultimately opaque. In a healthy eye, a perfect balance is maintained between the fluid moving into the cornea and fluid being pumped out of the cornea. Once endothelium cells are destroyed by disease or trauma, they are lost forever. If too many endothelial cells are destroyed, corneal edema and blindness result, with corneal transplantation the only available treatment.

The Function of the Cornea:
Because the cornea is as smooth and clear as glass, but is also strong and durable, it helps the eye in two ways: First, it helps to shield the rest of the eye from germs, dust, and other harmful matter. The cornea shares this protective task with the eyelids, the eye socket, the tears, and the sclera (white part of the eye). Second, the cornea acts as the eye’s outermost lens. It functions like a window that controls and focuses the entry of light into the eye. The cornea contributes between 65-75% of the eye’s total focusing power.

When light strikes the cornea, it bends, or refracts, the incoming light onto the lens. The lens further refocuses that light onto the retina (a layer of light sensing cells lining the back of the eye that starts the translation of light into vision). For you to see clearly, light rays must be focused by the cornea and the lens to fall precisely on the retina. The retina converts the light rays into impulses that are sent through the optic nerve to the brain, which interprets them as images.

The cornea also serves as a filter, screening out some of the most damaging ultraviolet (UV) wavelengths in sunlight. Without this protection, the lens and the retina would be highly susceptible to injury from UV radiation.

Refractive Errors:
About 120 million people in the U.S. wear eyeglasses or contact lenses to correct myopia (nearsightedness), hyperopia (farsightedness), and/or astigmatism (unequal curvature). These vision disorders are called refractive errors, and they affect the cornea and are the most common of all vision problems.

Refractive errors occur when the curve of the cornea is irregularly shaped (too steep or too flat). When the cornea is of normal shape and curvature, it bends, or refracts, light on the retina with precision. However, when the curve of the cornea is irregularly shaped, the cornea bends light imperfectly on the retina. This affects good vision.

When the cornea is curved too much, or if the eye is too long; faraway objects will appear blurry because they are focused in front of the retina. This is called myopia, or nearsightedness. Myopia affects over 25% of all adult Americans.

Hyperopia, or farsightedness, is the opposite of myopia. Distant objects are clear, but close up objects appear blurry. With hyperopia, images focus on a point beyond the retina. Hyperopia results from an eye that is too flat or too short.

Astigmatism is a condition in which the uneven curvature of the cornea blurs and distorts both distant and near objects. A normal cornea is round, with even curves from side to side and top to bottom. With astigmatism, the cornea is shaped more like the back of a spoon, curved more in one direction than another. This causes light rays to have more than one focal point and to focus on two separate areas of the retina, distorting the visual image. Two-thirds of Americans with myopia also have some degree of astigmatism.

Refractive errors are usually corrected comfortably by eyeglasses or contact lenses. Although these are the safest methods to correct refractive errors, refractive surgeries are becoming an increasingly popular option.

Corneal Injuries
The cornea copes very well with minor injuries or abrasions. If the highly sensitive cornea is scratched, healthy cells slide over quickly and patch the injury before infection occurs and vision is affected. If the scratch penetrates the cornea more deeply, however, the healing process will take longer, at times resulting in greater pain, blurred vision, tearing, redness, and extreme sensitivity to light. These symptoms require professional treatment. Deeper scratches can also cause corneal scarring, resulting in a haze on the cornea that can greatly impair vision. In this case, a corneal transplant may be needed.

Allergies:
Allergies affecting the eye are fairly common. The most common allergies are those related to pollen, particularly when the weather is warm and dry. Symptoms can include redness, itching, tearing, burning, stinging, and watery discharge, although they are not usually severe enough to require medical attention. Antihistamine decongestant eyedrops can effectively reduce these symptoms, as does rain and cooler weather which decreases the amount of pollen in the air.

An increasing number of eye allergy cases are related to medications and contact lens wear. Also, animal hair and certain cosmetics, such as mascara, face creams, and eyebrow pencil, can cause allergies that affect the eye. Touching or rubbing eyes after handling nail polish, soaps, or chemicals may cause an allergic reaction. Some people have sensitivity to lip gloss and eye makeup. Allergy symptoms are temporary and can be eliminated by not having contact with the offending cosmetic or detergent.

Conjunctivitis (Pink Eye):
Conjunctivitis describes a group of diseases that cause swelling, itching, burning, and redness of the conjunctiva, the protective membrane that lines the eyelids and covers exposed areas of the sclera, or white of the eye. It can spread from one person to another and affects millions of Americans each year. Conjunctivitis can be caused by a bacterial or a viral infection, allergy, environmental irritants, contact lens products, eyedrops, or eye ointments.

At its onset, conjunctivitis is usually painless and does not adversely affect vision. The infection will clear in most cases without requiring medical care. But for some forms of conjunctivitis, treatment will be needed. If treatment is delayed, the infection may worsen and cause corneal inflammation and a loss of vision.

Corneal Infections:
Sometimes the cornea is damaged after a foreign body has penetrated the tissue. At other times, bacteria or fungi from a contaminated contact lens can pass into the cornea. Situations like these can cause painful inflammation and corneal infections called keratitis. These infections can reduce visual clarity, produce corneal discharges, and perhaps erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant.

As a general rule, the deeper the corneal infection, the more severe the symptoms and complications. It should be noted that corneal infections, although relatively infrequent, are the most serious complication of contact lens wear.

Minor corneal infections are commonly treated with antibacterial eye drops. If the problem is severe, it may require more intensive antibiotic or antifungal treatment to eliminate the infection, as well as steroid eye drops to reduce the inflammation. Frequent visits to the eye doctor may be necessary for several months to eliminate the problem.

Dry Eye:
The continuous production and drainage of tears is important to the eye’s health. Tears keep the eye moist, help wounds heal, and protect against eye infection. In people with dry eye, the eye produces fewer tears and is unable to keep its surface lubricated and comfortable.

The tear film consists of three layers: an outer, oil (lipid) layer that keeps tears from evaporating too quickly and helps tears remain on the eye; a middle (aqueous) layer that nourishes the cornea and conjunctive; and a bottom (mucin) layer that helps to spread the aqueous layer across the eye to ensure that the eye remains wet. As we age, the eyes usually produce fewer tears. Also, in some cases, the lipid and mucin layers produced by the eye are of such poor quality that tears cannot remain in the eye long enough to keep the eye sufficiently lubricated.

The main symptom of dry eye is usually a scratchy or sandy feeling as if something is in the eye. Other symptoms may include stinging or burning of the eye; episodes of excess tearing that follow periods of very dry sensation; a stringy discharge from the eye; and pain and redness of the eye. Sometimes people with dry eye experience heaviness of the eyelids or blurred, changing or decreased vision, although loss of vision is uncommon.

Dry eye is more common in women, especially after menopause. Surprisingly, some people with dry eye may have tears that run down their cheeks. This is because the eye may be producing less of the lipid and mucin layers of the tear film which help to keep tears in the eye. When this happens, tears do not stay in the eye long enough to thoroughly moisten it.

Dry eye can occur in climates with dry air, as well as with the use of some drugs, including antihistamines, nasal decongestants, tranquilizers, and antidepressant drugs. People with dry eye should let their health care providers know all the medications that they are taking, since some of them may intensify dry eye syndrome.

People with connective tissue diseases, such as rheumatoid arthritis, can also develop dry eye. It is important to note that dry eye is sometimes a symptom of Sjogren’s syndrome, a disease that attacks the body’s lubricating glands, such as tear and salivary glands. A complete physical examination may diagnose any underlying diseases.

Artificial tears which lubricate the eye, are the principal treatment for dry eye. They are available over-the-counter as eye drops. Sterile ointments are sometimes used at night to help prevent the eye from drying. Using humidifiers, wearing wrap-around glasses when outside, avoiding outside windy and dry conditions may bring relief. For people with severe cases of dry eye, temporary or permanent closure of the tear ducts (small openings at the inner corner of the eyelids where tears drain from the eye) may be helpful.

Fuchs’ Dystrophy:
Fuchs’ Dystrophy is a slowly progressing disease that usually affects both eyes and is slightly more common in women than in men. Although doctors can often see early signs of Fuchs’ Dystrophy in people in their 30s and 40s, the disease rarely affects vision until people reach their 50s and 60s.

Fuchs’ Dystrophy occurs when endothelial cells gradually deteriorate without any apparent reason. As more endothelial cells are lost over the years, the endothelium becomes less efficient at pumping water out of the stroma. This causes the cornea to swell and distort vision. Eventually, the epithelium also takes on water, resulting in pain and severe visual impairment.

Epithelial swelling damages vision by changing the cornea’s normal curvature, and causing a slight impairing haze to appear in the tissue. Epithelial swelling will also produce tiny blisters on the corneal surface. When these blisters burst, they are extremely painful.

At first, a person with Fuchs’ Dystrophy will awaken with blurred vision that will gradually clear during the day. This occurs because the cornea is normally thicker in the morning; it retains fluids during sleep that evaporate in the tear film while we are awake. As the disease worsens, this swelling will remain constant and reduce vision throughout the day.

When treating the disease, doctors will try first to reduce the swelling with drops, ointments, or soft contact lenses. They also may instruct a person to use a hair dryer, held a arm’s length or directed across the face, to dry out the epithelial blisters. This can be done two or three times a day.

When the disease interferes with daily activities, a person may need to consider having a corneal transplant to restore sight. The short-term success rate of corneal transplantation is quite good for people with Fuchs’ Dystrophy. However, some studies suggest that the long-term survival of the new cornea can be a problem.

Corneal Dystrophies:
A corneal dystrophy is a condition in which one or more parts of the cornea lose their normal clarity due to a buildup of cloudy material. There are over 20 corneal dystrophies that affect all parts of the cornea. These diseases share many traits:

• They are usually inherited.
  
• They affect the right and left eyes equally.
  
• They are not caused by outside factors, such as injury or diet.
  
• Most progress gradually.
  
• Most usually begin in one of the five corneal layers and may later spread to
  nearby layers.
  
• Most do not affect other parts of the body, nor are they related to diseases
  affecting other parts of the eye or body.
  
• Most can occur in otherwise totally healthy people, male or female.
  

Corneal dystrophies affect vision in widely differing ways. Some cause severe visual impairment, while a few cause no vision problems and are discovered during a routine eye exam. Other dystrophies may cause repeated episodes of pain without leading to permanent loss of vision. Some of the most common corneal dystrophies include Fuchs’ Dystrophy, keratoconus, lattice dystrophy, and map-dot-fingerprint dystrophy.

Herpes Zoster (Shingles):
This infection is produced by the varicella-zoster virus, the same virus that causes chickenpox. After an initial outbreak of chickenpox (often during childhood), the virus remains inactive within the nerve cells of the central nervous system. But in some people, the varicella-zoster virus will reactivate at another time in their lives. When this occurs, the virus travels down long nerve fibers and infects some part of the body, producing a blistering rash (shingles), fever, painful inflammations of the affected nerve fibers, and a general feeling of sluggishness.

Varicella-zoster virus may travel to the head and neck, perhaps involving an eye, part of the nose, cheek, and forehead. In about 40% of those with shingles in these areas, the virus infects the cornea. Doctors will often prescribe oral anti-viral treatment to reduce the risk of the virus infecting cells deep within the tissue which could inflame and scar the cornea. The disease may also cause decreased corneal sensitivity, meaning that foreign matter, such as eyelashes, in the eye are not felt as keenly. For many, this decreased sensitivity will be permanent.

Although shingles can occur in anyone exposed to the varicella-zoster virus, research has established two general risk factors for the disease: advanced age; and a weakened immune system. Unlike herpes simplex I, the varicella-zoster virus does not usually show up more than once in adults with normally functioning immune systems.

Be aware that corneal problems may arise months after the shingles are gone. For this reason, it is important that people who have had facial shingles schedule follow up eye examinations.

Iridocorneal Endothelial Syndrome:
More common in women and usually diagnosed between ages 30-50, iridocorneal endothelial (ICE) syndrome has three main features: visible changes in the iris, the colored part of the eye that regulates the amount of light entering the eye; swelling of the cornea; and the development of glaucoma, a disease that can cause severe vision loss when normal fluid inside the eye cannot drain properly. ICE is usually present in only one eye.

ICE syndrome is actually a grouping of three closely linked conditions; Iris nevus (or Cogan-Reese) syndrome; Chandler’s Syndrome; and Essential (progressive) iris atrophy (hence the acronym ICE). The most common feature of this group of diseases is the movement of endothelial cells off the cornea onto the iris. This loss of cells from the cornea often leads to corneal swelling, distortion of the iris, and variable degrees of distortion of the pupil, the adjustable opening at the center of the iris that allows varying amounts of light to enter the eye. This cell movement also plugs the fluid outflow channels of the eye, causing glaucoma.

The cause of this disease is unknown. While we do not yet know how to keep ICE syndrome from progressing, the glaucoma associated with the disease can be treated with medication, and a corneal transplant can treat the corneal swelling.

Keratoconus:
This disorder, a progressive thinning of the cornea, is the most common corneal dystrophy in the U.S., affecting one in every 2000 Americans. It is more prevalent in teenagers and adults in their 20s. Keratoconus arises when the middle of the cornea thins and gradually bulges outward, forming a rounded cone shape. This abnormal curvature changes the cornea’s refractive power, producing moderate to severe distortion (astigmatism) and blurriness (nearsightedness) of vision. Keratoconus may also cause swelling and a sight-impairing scarring of the tissue.

There are several possible causes of keratoconus:

• An inherited corneal abnormality. About 7% of those with the condition
  have a family history of keratoconus.
  
• An eye injury (excessive eye rubbing or wearing hard contact lenses for
  many years).
  
• Certain eye diseases, such as retinitis pigmentosa, retinopathy of
  prematurity, and vernal keratoconjunctivitis.
  
• Systemic disease, such as Leber’s congenital amaurosis, Ehlers-Danios
  Syndrome, Down Syndrome, and osteogenesis imperfecta.
  

Keratoconus usually affects both eyes. At first, people can correct their vision with eyeglasses. But as the astigmatism worsens, they must rely on specially fitted contact lenses to reduce the distortion and provide better vision. Although finding a comfortable contact lens can be an extremely frustrating and difficult process, it is crucial because a poorly fitting lens could further damage the cornea and make wearing a contact lens intolerable.

In most cases, the cornea will stabilize after a few years without ever causing severe vision problems. But in about 10 to 20% of people with keratoconus, the cornea will eventually become too scarred or will not tolerate a contact lens. If either of these problems occur, a corneal transplant may be needed. This operation is successful in more than 90% of those with advanced keratoconus. Several studies have also reported that 80% or more of these patients have 20/40 vision or better after the operation.

Lattice Dystrophy:
Lattice dystrophy gets its name from an accumulation of amyloid deposits, or abnormal protein fibers, throughout the middle and anterior stroma. During an eye examination, the doctor sees these deposits in the stroma as clear, comma-shaped overlapping dots and branching filaments which create a lattice effect. Over time, the lattice lines will grow opaque and involve more of the stroma. They will also gradually converge, giving the cornea a cloudiness that may also reduce vision.

In some people, these abnormal protein fibers can accumulate under the cornea’s outer layer, the epithelium. This can cause erosion of the epithelium. This condition is known as recurrent epithelial erosion. These erosions alter the cornea’s normal curvature, resulting in temporary vision problems; and they expose the nerves that line the cornea, causing severe pain. Even the involuntary act of blinking can be painful.

To ease the pain, doctors may prescribe eye drops and ointments to reduce the friction on the eroded cornea. In some cases, an eye patch may be used to immobilize the eyelids. With effective care, these erosions usually heal within three days, although occasional sensations of pain may occur for the next six to eight weeks.

By about age 40, some people with lattice dystrophy will have scarring under the epithelium, resulting in a haze on the cornea that can greatly obscure vision. In this case, a corneal transplant may be needed. Although people with lattice dystrophy have an excellent chance for a successful transplant, the disease may also arise in the donor cornea in as little as three years. In one study, about half of the transplant patients with lattice dystrophy had a recurrence of the disease from between two to twenty-six years after the operation. Of these, 15% required a second corneal transplant. Early lattice and recurrent lattice arising in the donor cornea responds well to treatment with the excimer laser.

Although lattice dystrophy can occur at any time in life, the condition usually arises in children between the ages of two and seven.

Map-Dot-Fingerprint Dystrophy:
This dystrophy occurs when the epithelium’s basement membrane develops abnormally. The basement membrane serves as the foundation on which the epithelial cells, which absorb nutrients from tears, anchor and organize themselves. When the basement membrane develops abnormally, the epithelial cells cannot properly adhere to it. This, in turn, causes recurrent epithelial erosions, in which the epithelium’s outermost layer rises slightly, exposing a small gap between the outermost layer and the rest of the cornea.

Epithelial erosions can be a chronic problem. They may alter the cornea’s normal curvature, causing periodic blurred vision. They may also expose the nerve endings that line the tissue, resulting in moderate to severe pain which can last several days. Generally, the pain will be worse on awakening in the morning. Other symptoms include sensitivity to light, excessive tearing, and foreign body sensation in the eye.

Map-dot-fingerprint dystrophy, which tends to occur in both eyes, usually affects adults between the ages of forty and seventy, although it can develop earlier in life. It gets its name from the unusual appearance of the cornea during an eye examination. Most often, the affected epithelium will have a map-like appearance. There may also be clusters of opaque dots underneath or close to the map-like patches. Less frequently, the irregular basement membrane will form concentric lines in the central cornea that resemble small fingerprints.

Typically this dystrophy will flare up occasionally for a few years and then will go away on its own, with no lasting loss of vision. Most people never know that they have map-dot-fingerprint dystrophy, since they do not have any pain or vision loss. However, if treatment is needed, doctors will try to control the pain associated with the epithelial erosions. They may patch the eye to immobilize it, or prescribe lubricating eye drops and ointments. With treatment, these erosions usually heal within three days, although periodic flashes of pain may occur for several weeks thereafter. Other treatments include anterior corneal punctures to allow better adherence of cells; corneal scraping to remove eroded areas of the cornea and allow regeneration of healthy epithelial tissue; and use of the excimer laser to remove surface irregularities.

Ocular Herpes:
Ocular herpes (herpes of the eye) is a recurrent viral infection that is caused by the herpes simplex virus and is the most common infectious cause of corneal blindness in the U.S. Studies have shown that once people develop ocular herpes, they have up to a 50% chance of having a recurrence. This second flare-up could come weeks or even years after the initial occurrence.

Ocular herpes can produce a painful sore on the eyelid or surface of the eye and cause inflammation of the cornea. Prompt treatment with anti-viral drugs helps to stop the herpes virus from multiplying and destroying epithelial cells. However, the infection may spread deeper into the cornea and develop into a more severe infection called stromal keratitis, which causes the body’s immune system to attack and destroy stromal cells. Stromal keratitis is more difficult to treat than the less severe ocular herpes infections. Recurrent episodes of stromal keratitis can cause scarring of the cornea, which can lead to loss of vision and possibly blindness.

Like other herpetic infections, herpes of the eye can be controlled. An estimated 400,000 Americans have had some form of ocular herpes. Each year, nearly 50,000 new and recurring cases are diagnosed in the U.S., with the more serious stromal keratitis accounting for about 25%.

Pterygium:
A pterygium is a pinkish, triangular-shaped tissue growth on the cornea. Some pterygia grow slowly throughout a person’s life, while others stop growing after a certain point. A pterygium rarely grows so large that it begins to cover the pupil of the eye.

Pterygia are more common in sunny climates and in the twenty to forty age group. Scientists do not know what causes pterygia to develop. However, since people who have pterygia usually have spent a significant time outdoors, many doctors believe ultraviolet (UV) light from the sun may be a factor. In areas where sunlight is strong, wearing protective eyeglasses, sunglasses, and/or hats with brims are suggested.

Because a pterygium is visible, many people want to have it removed for cosmetic reasons. It is usually not too noticeable unless it becomes red and swollen from dust or air pollutants. Surgery to remove a pterygium is not recommended unless it affects vision. If a pterygium is surgically removed, it may grow back, particularly if the patient is less than 40 years of age. Lubricants can reduce the redness and provide relief from the chronic irritation.

Stevens-Johnson Syndrome (SJS):
SJS, also called erythema multiform major, is a disorder of the skin that can also affect the eyes. SJS is characterized by painful, blistery lesions on the skin and the mucous membranes (the thin, moist tissues that line body cavities) of the mouth, throat, genital region, and eyelids. SJS can cause serious eye problems, such as severe conjunctivitis, iritis (and inflammation inside the eye), corneal blisters and erosions, and corneal holes. In some cases, the ocular complications from SJS can be disabling and lead to severe vision loss.

Scientists are not sure why SJS develops. The most commonly cited cause of SJS is an adverse allergic drug reaction. Almost any drug, but most particularly sulfa drugs, can cause SJS. The allergic reaction to the drug may not occur until 7-14 days after first using it. SJS can also be preceded by a viral infection, such as herpes or the mumps, and its accompanying fever, sore throat, and sluggishness. Treatment for the eye may include artificial tears, antibiotics, or corticosteroids. About one-third of all patients diagnosed with SJS have recurrences of the disease.

SJS occurs twice as often in men as women, and most cases appear in children and young adults under 30 years of age, although it can develop in people at any age.

Corneal Transplants:
A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light-sensitive retina. Poor vision or blindness may result.

In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea, unusually donated through an eye bank. A trephine, an instrument like a cookie cutter, is used to remove the cloudy cornea. The surgeon places the new cornea in the opening and sews it with a very fine thread. The thread stays in for months or even years until the eye heals properly (removing the thread is quite simple and can easily be done in the surgeons office). Following surgery, eye drops to help promote healing will be needed for several months.

Corneal transplants are very common in the U.S. About 40,000 are performed each year. The chances of success of this operation have risen dramatically because of technological advances, such as less irritating sutures (threads) which are often finer than a human hair; and the surgical microscope. Corneal transplantation has restored sight to many, who a generation ago would have been blinded permanently by corneal injury, infection, or inherited corneal disease or degeneration.

Even with a fairly high success rate, some problems can develop, such as rejection of the new cornea. Warning signs for a rejection are decreased vision, increased redness of the eye, increased pain, and increased sensitivity to light. If any of these last for more than six hours, you should immediately call your ophthalmologist. Rejection can be successfully treated if medication is administered at the first sign of symptoms.

Alternatives to Cornea Transplant:
Phototherapeutic keratectomy (PTK) is one of the latest advances in eye care for the treatment of corneal dystrophies, corneal scars, and certain corneal infections. By combining the precision of the excimer laser with the control of a computer, doctors can vaporize microscopically thin layers of diseased corneal tissue and etch away the surface irregularities associated with many corneal dystrophies and scars. Surrounding areas suffer relatively little trauma. New tissue can then grow over the now smooth surface. Recovery from the procedure takes a matter of days, rather than months as with a transplant. The return of vision can occur rapidly, especially if the cause of the problem is confined to a layer of the cornea. Studies have shown close to an 85% success rate in corneal repair using PTK for well-selected patients.

Cornea & Corneal Diseases (508k)

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of their disease. All of them can cause severe vision loss or even blindness. These diabetic eye diseases point to the importance of diabetic patients having an annual eye exam as part of their health plan.

Diabetic Retinopathy:
Diabetic retinopathy is the most common eye disease associated with diabetes. This disease is the leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

The longer someone has diabetes, the more likely they will develop diabetic retinopathy. Nearly half of all people with diabetes will develop some degree of diabetic retinopathy during their lifetime.

Symptoms:
Often, in the early stages of the disease, there are no symptoms. Vision may not change until the disease becomes severe. This is no pain.

Blurred vision may occur when the macula (the part of the retina that provides sharp, central vision) swells from leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. But, even in more advanced cases, the disease may progress a long way without symptoms. That is why regular (annual) eye examinations for people with diabetes are so important!

Treatment:
Your ophthalmologist may suggest laser surgery in which a strong light beam is aimed onto the retina to shrink the abnormal vessels. Laser surgery has been proven to reduce the risk of severe vision loss from this type of diabetic retinopathy by 60%.

If you have macular edema, laser surgery may also be used. In this case, the laser beam is used to seal the leaking blood vessels. However, laser surgery often cannot restore vision that has already been lost. This is why diagnosing diabetic retinopathy early is the best way to prevent vision loss.

Prevention:
The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

The study found that the group that tried to keep their blood sugar levels as close to normal as possible had much less eye, kidney, and nerve disease. This level of blood sugar control may not be best for everyone, including some elderly patients, children under 13, or people with heart disease. So ask your doctor if this program is right for you.

Other Diabetic Eye Disease:
If you have diabetes, you are also at risk for other diabetic eye diseases. Studies show that you are twice as likely to get a cataract as a person who does not have the disease. Also, cataracts develop at an earlier age in people with diabetes. Cataracts can usually be treated by surgery.

Glaucoma may also become a problem. A person with diabetes is nearly twice as likely to get glaucoma as other adults. And, as with diabetic retinopathy, the longer you have diabetes, the greater your risk of getting glaucoma. Glaucoma may be treated with medications, laser or other forms of surgery. (read more about Glaucoma in that section)

Diabetic Eye Disease (228k)

Diabetic retinopathy is a potentially blinding complication of diabetes that damages the eye’s retina. It affects nearly half of all Americans diagnosed with diabetes.

At first, you may notice no changes in your vision. But don’t let diabetic retinopathy fool you. It could get worse over the years and threaten your vision! With timely treatment, 90% of those with advanced diabetic retinopathy can be saved from going blind.

The National Eye Institute (NEI) is the federal government’s lead agency for vision research. The NEI urges all people with diabetes to have an eye examination through dilated pupils at least once a year.

Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. At this point, most people do not notice any changes in their vision.

The retina is a light-sensitive tissue at the back of the eye. When light enters the eye, the retina changes the light into nerve signals. The retina then sends these signals along the optic nerve to the brain. Without a retina, the eye cannot communicate with the brain, making vision impossible.

Some people develop a condition called macular edema. It occurs when the damaged blood vessels leak fluid and lipids onto the macula (the part of the retina that lets us see detail). The fluid makes the macula swell, blurring vision.

As the disease progresses, it enters its advanced, or proliferative, stage. Fragile, new blood vessels grow along the retina and in the clear, gel-like vitreous that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina.

All people with diabetes are at risk, including those with Type I diabetes (juvenile onset) and those with Type II diabetes (adult onset). During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision.

Diabetic retinopathy often has no early warning signs. At some point, though, you may have macular edema. It blurs vision, making it hard to do things like read and drive. In some cases, your vision will get better or worse during the day.

As new blood vessels form at the back of the eye, they can bleed (hemorrhage) and blur vision. The first time this happens it may not be very severe. In most cases, it will leave just a few specks of blood, or spots, floating in your vision. They often go away after a few hours.

These spots are often followed within a few days or weeks by a much greater leakage of blood. The blood will blur your vision. In extreme cases, a person will only be able to tell light from dark in that eye. It may take the blood anywhere from a few days to months or even years to clear from the inside of your eye. In some cases, the blood will not clear. You should be aware that the large hemorrhages tend to happen more than once, often during sleep.

Diabetic retinopathy is detected during an eye examination that includes:

Visual Acuity Test: This eye chart test measures how well you see at various distances.

Pupil Dilation: The eye doctor places drops into the eye to widen the pupil. This allows them to see more of the retina and look for signs of diabetic retinopathy. After the examination, close-up vision may remain blurred for several hours.

Ophthalmoscopy: This is an examination of the retina in which the eye care professional looks through a device with a special magnifying lens that provides a narrow view of the retina. The doctor may also wear a headset with a bright light, and look through a special magnifying glass to gain a wide view of the retina.

Tonometry: This is a standard test that determines the fluid pressure inside the eye. Elevated pressure is a possible sign of glaucoma, another common eye problem in people with diabetes.

Your doctor will look at your retina for early signs of the disease, such as: leaking blood vessels; retinal swelling (such as macular edema); pale, fatty deposits on the retina (signs of leaking blood vessels); damaged nerve tissue; and any changes in the blood vessels.

Should your doctor suspect that you need treatment for macular edema, they may ask you to have a test called fluorescein angiography. In this test, a special dye is injected into your arm. Pictures are then taken as the dye passes through the blood vessels in the retina. This test allows your doctor to find the leaking blood vessels.

There are two treatments for diabetic retinopathy. They are very effective in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 90% chance of keeping their vision when they get treatment before the retina is severely damaged.

Laser Surgery:
Laser surgery is performed in the doctor’s office. Before the surgery, your ophthalmologist will dilate your pupil, and apply drops to numb the eye. In some cases, the doctor may also numb the area behind the eye to prevent any discomfort.

The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes may eventually create a stinging sensation that makes you feel a little uncomfortable.

You may leave the office once the treatment is finished, but you will need someone to drive you home. Because your pupils will remain dilated for a few hours, you also should bring a pair of sunglasses.

For the rest of the day, your vision will probably be a little blurry. If you eye hurts a bit, your doctor can suggest a way to control this.

Laser surgery is often used to treat macular edema and proliferative retinopathy.

For Macular Edema:
Timely laser surgery can reduce vision loss from macular edema by half. But you may need to have laser surgery more than once to control the leaking fluid.

During the surgery, the doctor will aim a high-energy beam of light directly onto the damaged blood vessels. This is called focal laser treatment. This seals the vessels an stops them from leaking.

For Proliferative Retinopathy:
In treating advanced diabetic retinopathy, doctors use the laser to destroy the abnormal blood vessels that form in the back of the eye.

Rather than focus the light on a single spot, your doctor will make hundreds of small laser burns away from the center of the retina. This is called scatter laser treatment. The treatment shrinks the abnormal blood vessels. You will lose some of your side vision after this surgery to save the rest of your sight. Laser surgery may also slightly reduce your color and night vision.

Once you have proliferative retinopathy, you will always be at risk for new bleeding. This means you may need treatment more than once to protect your sight.

Vitrectomy:
Instead of laser surgery, you may need an eye operation called a vitrectomy to restore your vision. A vitrectomy is performed if you have a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a salt solution. Because the vitreous is mostly water, you will notice no change between the salt solution and normal vitreous.

Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to protect their vision than someone who waits to have the operation. Early vitrectomy is especially effective in people with insulin dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the eye.

Vitrectomy is done under local anesthesia. This means that you will be awake during the operation. The doctor makes a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye. It removes the vitreous and inserts the salt solution into the eye.

You may be able to return home soon after the vitrectomy; or, you may be asked to stay overnight. Your eye will be red and sensitive. After the operation, you will need to wear an eyepatch for a few days or weeks to protect the eye. You will also need medicated eye drops to protect against infection.

Diabetic Retinopathy pdf (56k)

If you see two versions simultaneously of an object that you are looking at, you may have a condition known as double vision, also referred to as diplopia. Double and blurred vision are often thought to be the same, but they are not.

There are two possible causes of double vision. The first is a refractive cause. Light from an object is split into two images by a defect in the eyes’ optical system. Cataracts might, for example, cause such a defect. The second is failure of both eyes to point at the object being viewed, a condition referred to as ‘strabismus” or “squint.” In normal vision, both eyes look at the same object. The images seen by the two eyes are fused into a single picture by the brain. If there is a defect in the muscles which control the movement of the eyes or in the control of these muscles through the nerves and brain, then double vision can be a symptom.

Double vision can be extremely discomforting. In young children, the brain acts to alleviate the discomfort by suppressing, or blanking out, one of the images. If this suppression persists over a continued length of time, it can lead to an impairment of the development of the visual system.

The suppressed eye may get to the point where it is unable to see well, no matter how good the spectacle or contact lens correction. Doctors call this condition amblyopia. Since it is a result of a defect in the interpretive mechanisms of the eye and brain, it is more difficult to treat than a refractive condition (one having to do with the eyes’ ability to bend light).

Treatment of double vision consists of prism glasses and/or surgical straightening of the eye, or a combination of the two.

Double Vision (Diplopia) pdf (45k)

Dry eye is a condition that affects millions of people every day. It is often a normal part of the aging process. Other causes include exposure to environmental conditions, injuries to the eye, or general health problems. For example, people with arthritis and diabetes are more prone to dry eye. Some other specific causes of dry eye include:

• Sun
  
• Wind
  
• Cold
  
• Dry air
  
• Indoor heating and air conditioning
  
• Computer screens
  
• High altitudes
  
• Eye surgery
  

Dry eye syndrome is literally the eye’s inability to lubricate and tear correctly. Oddly enough, some people who have dry eye syndrome actually tear excessively. Unfortunately, the pH or acidity of their tears is altered so that the eyes still feel dry and itchy, causing them to tear continuously.

It is a very common condition, especially in the older population, particularly older women. Women often experience dry eye syndrome during and after menopause, due to a decrease in female hormone levels. Other hormone altering events such as pregnancy, menstruation, and the use of birth control can contribute to dry eye syndrome.

The use of certain medications can also alter the eye’s ability to lubricate. Some of the most common medications are:

• Antihistamines
  
• Decongestants
  
• Blood pressure medication
  
• Antidepressants
  
• Anti-anxiety medication
  

Certain types of diseases can also alter the eyes. These include:

• Thyroid deficiencies
  
• Sjorgrens syndrome
  
• Rheumatoid arthritis
  
• Autoimmune disorders (i.e. lupus, HIV)
  
• Bell’s palsy
  
• Myasthenia gravis
  

The severity and symptoms of dry eye vary from person to person, although there are three distinct degrees of dryness: mild, moderate, and severe. Symptoms of dry eye include:

• Redness
  
• Burning
  
• Itching
  
• Scratchiness
  
• Tearing
  
• Sensitivity to light
  
• Mucus secretion
  

It is important to note that some people suffer from all the symptoms, while others may experience only a few. If you are experiencing any of the above symptoms, be sure to ask your eye doctor about dry eye. If you have dry eye, you doctor can help you choose an eye lubricant that’s right for you. You ophthalmologist may prescribe one or more of the following treatments:

• Artificial tears
  
• Restasis™ eye drops for chronic dry eyes associated with inflammation
  
• Long lasting lubricating gels
  
• Ointments placed in the eyes to lubricate
  
• Temporarily or permanently plugging the tear ducts while manually replacing the tears with drops or ointments. This is an excellent option for patients with chronic dry eye. A simple and safe treatment which can be done in the office, it is covered by most insurance plans. It decreases the need for constant use of lubricants in cases with significant dry eye.
  
• Change in birth control prescription, if applicable.
  

No cure currently exists for dry eye syndrome. Your doctor can help make your symptoms more comfortable.

Dry Eye Syndrome pdf (104k)

A healthy eye is a wet eye, thanks to the workings of the lacrimal (tear duct) system around the eyes. The lacrimal gland is found above the outer edge of the eye under the eyebrow. The lacrimal duct, which forms tears, is found on the inside corner of your eye and down the side of the nose. For various reasons, this system can malfunction and cause the eyes to be continuously wet.

The tear duct is the passage through which the tears drain off the eye. When it becomes blocked or plugged, it may lead to:

• Constant tearing
  
• Redness and swelling in and around the eyes
  
• Infection
  
• Pain
  

The blockage may be due to:

• Mucous buildup in the lacrimal duct at birth and in infancy
  
• Ingrown eyelashes
  
• Thick or hardened discharge from an eye infection such as conjunctivitis
  
• Continued exposure to allergens that irritate the eye
  
• Obstruction due to airborne irritants, especially in the work environment (dust, chemicals, smoke, or pollution)
  
• Other eye conditions, such as a stye, that cause the eye to have an unusual discharge that can harden and plug the lacrimal duct.
  

Treatment:
Your ophthalmologist will examine the eye and may probe the tear duct to determine if a blockage exists. Initially, amtibiotic drops may be prescribed to treat the infection, and possibly corticosteroid drops to treat any swelling. The blockage can often be worked loose my massaging the tear duct along the side of the eye and down the nose.

If the blockage persists, the ophthalmologist may choose to probe the duct with a small metal wire that can force the blockage loose, and the duct can be thoroughly washed out. This is usually a painless procedure and can be performed in the office.

If the blockage continues to return over and over again, the ophthalmologist may suggest surgery to implant an artificial tear duct called a “Jones tube” to permanently open the lacrimal duct. A surgeon who specializes in ophthalmic reconstruction and plastic surgery usually performs this surgery.

Excessive Tearing pdf (68k)

Infections, inflammation, glaucoma, and many other eye disorders are treated with eye drops. Surprisingly, even the small amount of medication in an eye drop can create significant side effects in other parts of the body. It is important to remember that all medicines have side effects, even eye drops! There are ways to decrease the absorption of the eye drop into the system, and to increase the time the eye drop is on the eye, making the medicine more safe and effective.

Inserting eye drops may seem difficult at first, but it becomes easier with practice. To put in an eye drop, tilt the head back. Then create a pocket in front of the eye by pulling the lower lid down with an index finger or gently pinch the lower lid outward with the thumb and index finger. Let the drop fall into the pocket without allowing the bottle to touch your eye or eyelid (to prevent contamination of the bottle).

Immediately after instilling the drop, squeeze the bridge of your nose for two to three minutes with your thumb and forefinger. This prevents most of the drop from traveling down the tear duct to the rest of your body.

Keep your eyes closed for three to five minutes after instilling the drop. Because the volume of a single drop exceeds the capacity of the surface of the eye, it serves no purpose to use two drops at the same time.

Before opening your eyes, dab unabsorbed drops and tears from the closed lids with a tissue. If you are taking two different kinds of eye drops, wait at least five minutes before instilling the second drop.

Eye Drops pdf (60k)

If you can see objects at a distance clearly but have trouble focusing well on objects close up, you may be farsighted. Your eye doctor may refer to farsightedness as hyperopia which is the medical term used to describe the condition. Hyperopia causes the eyes to exert extra effort to see close up. After viewing nearby objects for an extended period, you may experience blurred vision, headaches, and eyestrain. Children who are farsighted may find reading difficult. Being farsighted is not a disease and it does not mean that you have ‘bad eyes.’ It simply means that you have a variation in the shape of your eyeball. The degree of variation will determine whether or not you will need corrective lenses.

Hyperopia most commonly occurs because the eyeball is too short; that is, shorter from front to back than is normal. In some cases, hyperopia may be caused by the cornea having too little curvature.

Exactly why eyeball shape varies is not known, but the tendency for farsightedness is inherited. Other factors may be involved too, but to a lesser degree than heredity. Many people have a degree of farsightedness, yet it is only a problem if it significantly affects our ability to see well, or causes headaches or eyestrain.

How Farsightedness Affects Sight:
Our ability to ‘see’ starts when light enters the eye through the cornea. The shape of the cornea, lens, and eyeball help bend (refract) light rays in such a manner that light is focused into a point precisely on the retina.

If, as in farsightedness, the eyeball is too short, the ‘point of light’ focuses on a location behind the retina, instead of on the correct area of the retina, known as the fovea. As a result, at the point on the retina where a fine point of light should be focused, there is instead a disk-shaped area of light. Since light is not focused when it hits the retina, vision is blurred.

Convex lenses are prescribed to bend light rays more sharply and bring them to focus on the retina. If you do not have other vision problems such as astigmatism, you may only need glasses for reading or other tasks done at close range.

To determine the best avenue of treatment, your doctor may ask a number of questions about your lifestyle, occupation, daily activities, and general health status. For instance, you may be asked whether or not you frequently need near vision in your daily activities. Providing candid, considered answers to the questions and working with your eye doctor will help assure that your corrective lenses contribute to clear sight and general comfort.

Hyperopia pdf (78k)

The most common type of eye injury that needs immediate action is a chemical burn. Alkaline materials (lye, plasters, cements, and ammonia), solvents, acids, and detergents can be harmful to the eye. Eyes should be flushed liberally with water if exposed to any of these agents.

If sterile solutions are readily available, use them to flush the affected eye. If not, go to the nearest sink, shower, or hose and begin washing the eye with large amounts of tap water. If the eye has come in contact with an alkaline agent, it is important to flush the eye for ten minutes or more. Make sure water is getting under the upper and lower eyelids.

Abrasions or scratches of the eyelids or cornea (the clear covering of the eye) occur frequently and can be quite uncomfortable. If the abrasion is dirty, gently cleanse the area with a stream of clean water.

Do not attempt to treat severe blunt trauma or penetrating injuries to the eye. Tape a paper or styrofoam cup over the injured eye to protect it until proper care can be obtained.

In the case of a blow to the eye, do not assume the injury is minor. The eye should be examined thoroughly by your eye doctor because vision-threatening damage could be hidden.

First aid is only the first step for emergency treatment. If you experience pain, impaired vision, or any possibility of eye damage, call your eye doctor or go to the emergency room immediately!

First Aid for Eye Injuries pdf (60k)

Glaucoma is an eye disease that is one of the leading causes of blindness in this country. Essentially, glaucoma is a disease of the optic nerve. The optic nerve is responsible for carrying image information from the retina in the back of the eye to the visual centers in the brain. This information is processed in the brain into what we would perceive as things we are seeing. Glaucoma typically interferes with this system by damaging the optic nerve in the area of the optic disc or where the optic nerve is visualized by your eye doctor when he looks into your eyes. This may cause a progressive visual loss to your peripheral vision, eventually leading to central vision loss and blindness. This process is usually very slow progressing over many years; although there are certain types of glaucoma where visual damage occurs very quickly. Glaucoma is not always a disease of elevated intraocular pressure, since many glaucoma patients may have normal or low pressure. Glaucoma is a disease that causes progressive optic nerve damage and loss of visual field (peripheral vision).

Diagnosing Glaucoma:
Often the diagnosis of glaucoma is dependent on the type of glaucoma. There are two main types of glaucoma, open angle and angle closure. The angle is referring to the drainage area where the clear protective lining of the front chamber of the eye, the cornea, and the iris (the colored portion of the eye) join. If this area is closed or narrow, one could develop angle closure glaucoma. If this area is physically open and the individual has glaucoma, it is termed open angle.

Intraocular Pressure:
In either classification of glaucoma, there are three main things the doctor will do to make the diagnosis. First, and most commonly known to many patients is taking the intraocular pressure. This is done with the aide of a tonometer, which measures the pressure inside the eye using one of two methods: contact and non-contact. The non-contact tonometer is more commonly called the ‘air puff’ test. It is a good screening device, but if glaucoma is suspected, doctors will generally use the next device to make sure of the reading. This is the applanation tonometer or Goldmann type. This necessitates the use of an eye drop to numb the front surface of the eye before contact is made. This instrument can be hand held or attached to the doctor’s microscope used for examining eyes. Typically, a normal pressure reading is between 10 and 21 mmHg (millimeters of Mercury). If someone’s pressure is higher than 21 mmHg, they may be suspect for glaucoma. It is important to note, that even though the pressure is higher than 21, the patient may not have glaucoma. Additional tests are required to confirm the diagnosis.

Dilated Eye Exam:
The second test typically done during a glaucoma evaluation is to examine the optic nerve. The optic nerve enters the back of the eye and forms a visible portion called the optic disc. The disc can be viewed by looking inside the eye with a variety of different lights and instruments. The doctor will exam the nerve disc for evidence of damage. In glaucoma, typically the nerve will exhibit an enlarged cupping. The cupping is the centrally excavated area of the nerve when viewed from the inside of the eye. The average healthy nerve has anywhere from 0 to 30% of its surface area cupped or excavated. If someone has a larger cupping or has cupping that is significantly different between the two eyes or is suspicious in its shape, that person may be a suspect for glaucoma.

Risk Factors for Glaucoma:
There are other risk factors for development of glaucoma. These include:

• High myopia (nearsightedness)
  
• Family history of glaucoma
  
• Vascular disease (like diabetes and high blood pressure)
  
• Age
  
• African ancestry
  
• Use of certain medications (like steroids) and a history of eye trauma
  

Visual Field Testing:
The visual field (automated perimetry) will help make the diagnosis by determining if there is indeed damage to the optic nerve. In open angle glaucoma, the early stages produce a slow deterioration of the peripheral vision. Most patients cannot recognize this change until significant portions of their vision are destroyed. The visual field test, however, can find subtle defects in the periphery of the vision making early detection possible. The test itself resembles a simple video game where the patient directs his/her gaze at a target and is directed to press a button when they see small lights off to the side of the target. The computer will vary the size and intensity of the peripheral light stimuli to test how sensitive that area of the patient’s vision is. Additionally, the program will try to trick the patient by not shinning a light or giving a much brighter stimulus to test for the patient’s reliability. The computer will then map out the findings for analysis by the doctor. Glaucoma has certain characteristic defects that can be detected this way, and therefore be diagnosed. Other neurologic conditions may be diagnosed by the visual field, but those field defects have different characteristics than glaucoma.

Nerve Fiber Analysis:
This test is one of the more recent advances in evaluating and quantifying the amount of nerve fibers that exit the optic nerve. It has been found that 20-40% of the nerve can have damage before showing defects on the visual field.

Gonioscopy:
When glaucoma is diagnosed or if a suspicion of closed angles is present, the doctor may wish to perform another test to actually view the angle structures to tell if the drainage angle is open or closed. This test is called gonioscopy. The gonioscopy lens is placed on a numbed eye and viewed with the biomicroscope enabling the doctor to view the structure of the angle.

Open Angle Glaucoma:
In open angle glaucoma, a patient usually presents without complaints. The intraocular pressure may or may not be elevated, but there is a definable visual field defect present. Gonioscopy and optic nerve evaluation may or may not be normal as well. In fact, the patient may have fairly advanced visual field defects with only minimal observable changes to the optic nerve. Patients usually do not complain of pain or other visual change. Over 90% of patients with glaucoma have this type. An important subcategory of open angle glaucoma is normal tension glaucoma. This often presents in people who are older and may have some sort of vascular disease such as hypertension. These patients present with statistically normal pressures but with visual field and optic nerve defects consistent with glaucoma. This illustrates why it is so important to have a thorough eye exam and not just ‘the glaucoma test’ that most patients refer to screening exams.

Angle Closure Glaucoma:
In angle closure glaucoma the drainage angle becomes blocked from a variety of causes. When this occurs, there is a rapid rise in pressure to very high levels above normal. Unlike open angle glaucoma, this can be associated with pain (often severe), blurred vision, headaches, haloes and glare around lights and even extreme nausea. In addition, unlike open angle disease, if not treated rapidly, blindness can result. A subclass of angle closure glaucoma is chronic angle closure glaucoma. In the chronic form, more commonly occurring in patients of Asian and African descent, there may be episodes of incomplete blockage of the angle. This results in similar symptoms as angle closure but are less severe and short lived. Often the cause of this chronic condition is the anatomy of that patient’s drainage angle resulting in intermittent blockages often when the pupil is dilated. This most often occurs during nighttime or times when the patient is in low light such as in a movie theater. The attack can actually resolve as the patient goes to a well-lit area and the pupil constricts. These patients should also seek urgent care to rule out a complete closure and find out whether treatment is urgently needed or not.

Glaucoma Treatment:
Oral Medication Treatment: Glaucoma treatment is always evolving. Traditionally, if a patient needed treatment urgently, a combination of drops used for chronic conditions are utilized and may be added to oral medications if the patient is not responding. The oral medications include pills and liquids that are taken by mouth that act to drain fluid from the body resulting in a quick lowering of pressure. The pills are called diuretics or ‘water pills.’ These pills do have several side effects including numbness and tingling of fingers and toes, fatigue, kidney stones, bleeding and intestinal upset. If the angle closure patient is stabilized with drops and oral medications, they may still need an additional more permanent treatment with a laser or other surgical correction to help widen the drainage angle.

Topical Medical Treatment: Fortunately, oral medications are not usually needed for chronic conditions. In the chronic open angle patient, the first line of treatment is usually an eye drop. These eye drops help to either lessen the fluid being produced in the eye or increase the fluid draining from the eye and thereby lowering the pressure. Recently, research has been done to help find a new class of drops that do not treat glaucoma by lowering the pressure but by making the optic nerve more resistant to damage. This is a new category of treatment called neuroprotection. Some of the existing drops have also been shown to serve this function as well. This is especially important in the normal tension glaucoma patient. Unfortunately, while the additional medications (eye drops) give us more choices of treatment, there are still some potential side effects to them. These range from benign symptoms such as mild stinging and red eyes to more severe blurred vision, headaches, and general systemic changes such as shortness of breath, change in heart rate, and changes in eye color and retinal edema. It is therefore very important that when on any of these medications, either oral or topical (drops), the patient is monitored regularly for any changes or problems. Unfortunately, there is no medical cure for glaucoma. At best, we control the disease effectively. This usually means the glaucoma patient must be prepared to take some form of medication on a regular basis.

Surgical Treatment for Glaucoma:
There are also some surgical options available for the treatment of glaucoma. The most common procedures are laser treatments. In one procedure (iridotomy) a small opening is made in the iris allowing fluid to pass more easily from the back of the eye to the front, lessening the risk of future angle closures. For open angle patients, it may be necessary to have better pressure by performing a laser treatment (trabeculoplasty) to the drainage angle itself. This allows easier fluid drainage from the eye, thereby lowering pressures. There are still more invasive surgical procedures that actually create alternative fluid drainage sites from the eye. Given their increased risks, these last more invasive procedures are usually only performed if all other options have been exhausted.

Glaucoma pdf (188k)

If you can see objects up-close clearly but have trouble focusing well on objects at a distance, you may be nearsighted. Your eye doctor may refer to nearsightedness as myopia which is the medical term used to describe the condition. Myopia causes the eyes to exert extra effort to see at a distance. Being nearsighted is not a disease and it does not mean that you have ‘bad eyes.’ It simply means that you have a variation in the shape of your eyeball. The degree of variation will determine whether or not you will need corrective lenses.

Myopia most commonly occurs because the eyeball is longer than normal; that is, longer from front to back than is normal. In some cases, myopia may be caused by the cornea having too much curvature.

Exactly why eyeball shape varies is not known. Many people have a degree of nearsightedness, yet it is only a problem if it significantly affects our ability to see well, or causes headaches or eyestrain.

How Nearsightedness Affects Sight:
Our ability to ‘see’ starts when light enters the eye through the cornea. The shape of the cornea, lens, and eyeball help bend (refract) light rays in such a manner that light is focused into a point precisely on the retina.

If, as in nearsightedness, the eyeball is too long, the ‘point of light’ focuses on a location in front of the retina, instead of on the correct area of the retina, known as the fovea. Since light is not focused when it hits the retina, vision is blurred.

Concave lenses are prescribed to bend light rays and bring them to focus on the retina.

To determine the best avenue of treatment, your doctor may ask a number of questions about your lifestyle, occupation, daily activities, and general health status. For instance, you may be asked whether or not you frequently need distance vision in your daily activities. Providing candid, considered answers to the questions and working with your eye doctor will help assure that your corrective lenses contribute to clear sight and general comfort.

Myopia pdf (56k)

When young, the lens of the eye is soft and flexible; allowing people to see objects both close and far away. After the age of 40, the lens of the eye becomes more rigid, making it more difficult for the lens to change its shape, or accommodate, to do close work such as reading. This condition is known as presbyopia and is the reason reading glasses or bifocals are necessary at some point after age 40. Hold the book up close and the words appear blurred. Push the book farther away, and the words snap back into sharp focus. That’s how most of us first recognize a condition that is called presbyopia, a name derived from Greek words meaning “old eye.” Eye fatigue or headaches when doing close work, such as sewing, knitting or painting are also common symptoms. Because it is associated with aging, presbyopia is often met with a groan, and the realization that reading glasses or bifocals are inevitable.

Regardless of your eye condition in your youth, your eyes will most likely begin to change as you reach your mid-40s and beyond. You will find yourself holding the newspaper a little farther away in order to focus better on the words. This common age-related condition is presbyopia, or farsightedness brought on by the changing shape and flexibility of the eyes’ lens. The eyes continue to change the older you get and corrective glasses or contact lenses are inevitable.

Presbyopia does not happen over night. It is a progressive condition that probably started in your 30s and became a nuisance later on. Regular eye exams are very important so that corrective glasses or contacts can be prescribed. Some telltale signs that you need to see your doctor or renew your prescription are:

• Holding reading material out at arms length to focus on the words
  
• Problems reading the dashboard while driving in the evening or at night
  
• Difficulty reading in dim light (at a restaurant)
  
• Experiencing headaches and eye strain after reading
  

Depending on your eyesight before the onset of presbyopia, you will be fitted with bifocals, half glasses, or prescription reading glasses or contact lenses that also correct any previously diagnosed vision problems. Bifocals divide the lenses in half so that when reading material is close, you look down into the lower half of the glasses into magnified lenses and then when you look up the lenses are clear. Half glasses are just as they sound, a half circle that magnifies the words that you are reading. Most people continue to enjoy reading well into retirement. Your prescription will continue to change, so visit your ophthalmologist yearly.

New Treatments for Presbyopia:
Improvements in contact lenses now offer a bifocal prescription for contact lens wearers. There is also the possibility that you would enjoy a monocular prescription in your contacts. In that type of prescription, one eye is corrected for distance vision and one eye is corrected for reading and close work. Your doctor can talk to you about these options.

There is a new procedure called Conductive Keratoplasty (CK) which offers a new tool in vision correction for the 86 million Americans with presbyopia. CK represents a safe, minimally invasive option for correcting these vision problems. For more information on CK, please see our page on this website.

Presbyopia pdf (56k)

Any activity where something is flying at the eye puts the eye at risk for an injury. Over one million people suffer eye injuries each year in the U.S. Almost 50% of these accidents occur at home and over 90% of them could have been prevented.

Minor injuries to the cornea (the clear, protective covering over the front of the eye) can be quite painful. A corneal abrasion is a scratch. Appropriate treatment may include an antibiotic drop or ointment and an eye patch for comfort. Sand or other particles can stick to the cornea. Such foreign bodies may be removed by your doctor. Do not rub the eye.

Regular prescription glasses or contact lenses do not protect the eyes from injury. Some glasses and some types of contact lenses shatter if the eye is hit. People who play sports and wear prescription glasses can have special glasses or prescription goggles made to protect their eyes.

Unfortunately, many people do not think they are at risk for an eye injury until the injury occurs. The majority of eye injuries are easily prevented. Follow safety precautions and use common sense to reduce the risk.

• Wear safety goggles when using powerful chemicals. Goggles should fit properly to prevent chemicals from getting under them, but still allow air to circulate between the eye and the lens.
  
• Polycarbonate sports goggles are recommended for all participants of high-impact sports or activities where there is a high risk of eye injury.
  
• Never use fireworks. Attend public firework displays instead of using fireworks at home. Amateur backyard displays are dangerous to the person lighting the fireworks, nearby family and friends, and neighbors.
  
• Supervise children when they are handling potentially dangerous items, such as pencils, scissors, and penknives. Be aware that even common household items such as paper clips, elastic cords, wire coat hangers, rubber bands, and fishhooks can cause serious eye injury.
  
• Avoid projectile toys such as darts and bows and arrows. Do not allow children to play with air-powered rifles, pellet guns and BB guns. They are extremely dangerous and have been reclassified as firearms and removed from toy departments.
  
• Wear eye protection while mowing the lawn or using a weed eater. Stones and debris thrown from moving blades can cause sever eye injuries.
  
• Always check to make sure any spray nozzle faces away from the face.
  
• Use grease shields to cover frying pans and protect eyes from splattering liquids.
  
• Wear opaque eyeglasses or goggles to shield eyes and block UV light in tanning booths.
  
• Read instructions before using tools, chemicals, ammonia, etc.
  
• Be sure you read the instructions while jump-starting a car. Attach the negative ground of the dead battery last. This cable should be attached to the engine away from the dead battery terminal. Never attach a cable to the negative terminal of the dead battery.
  
• Never use a match or lighter to look under the hood of a car.
  

When an eye injury does occur, have an eye doctor or urgent care doctor examine the eyes as soon as possible. If specialized surgical intervention is required, referral to a surgeon who performs such procedures would be indicated.

Preventing Eye Injury pdf (100k)

A pterygium is an over growth of tissue which encroaches upon the cornea. This is an abnormal process that is thought to be caused by excessive exposure to ultraviolet rays or from long-term irritations to dry, dusty environments. Besides the burning, itching, redness, and tearing, people who are affected by this development are unhappy with the cosmetic appearance of the eye.

Early treatment for a pterygium includes eye drops and ointments to help reduce the inflammation. When the growth impairs vision, surgical removal may be necessary. However, even with proper technique, the fleshy growth may return. Avoiding dry, dirty environments and shielding the eyes from UV rays with sunglasses and brimmed hats are effective ways to prevent pterygia from growing.

For more detailed information on Pterygium, please see the section on our website titled:
Cornea & Corneal Disease.

Pterygium pdf (34k)

Ptosis is drooping of the upper eyelid. The lid may droop only slightly or it may cover the pupil entirely. In some cases, ptosis can restrict and even block normal vision.

Congenital ptosis, or ptosis that is present at birth, requires treatment for normal visual development. Uncorrected congenital ptosis can cause amblyopia, or lazy eye. If left untreated, amblyopia can lead to permanently poor vision.

Except in mild cases, the treatment for childhood ptosis is usually surgery to tighten the levator muscle that lifts the eyelid. In severe ptosis, when the levator muscle is extremely weak, the lid can be attached or suspended from under the eyebrow so the forehead muscles do the lifting. Children with ptosis, whether they have had surgery or not, should be examined annually by an ophthalmologist for amblyopia, refractive disorders, and associated conditions.

Ptosis in adults is commonly caused by separation of the levator muscle from the eyelid as a result of aging, cataract or other eye surgery, an injury, or an eye tumor. Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as diabetes. If treatment is necessary, it is usually surgical. Sometimes a small tuck in the levator muscle and eyelid can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle.

The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications occur very infrequently. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return.

Ptosis pdf (56k)

The eye normally creates a clear image because the cornea and lens bend (refract) incoming light rays to focus them on the retina. The shape of the cornea is fixed, but the lens changes shape to focus on objects at various distances from the eye. By becoming thicker, the lens allows near objects to be focused; by becoming flatter, the lens allows objects farther away to be focused. A refractive error occurs when the cornea and lens cannot focus the image of an object sharply on the retina.

Refractive errors may be myopia (nearsightedness), hyperopia (farsightedness), astigmatism (irregular curvature), or presbyopia (aging eye). Refractive errors can be treated with eyeglasses, contact lenses, or refractive surgery.

Refractive Disorders pdf (45k)

Detachment of the retina from the outer supportive layer of the eye is a very serious condition. It is caused by a tear in the retina that allows the retina to separate from the eye wall.

It is usually an emergency procedure when the tear is large or when the detachment does not involve the macula. In all cases it needs to be repaired. A surgery called scleral buckling with or without vitrectomy is necessary to preserve eyesight. Without surgery, vision is usually completely lost.

The retina is the light-sensitive tissue at the back of the eye. When light enters the eye, the retina changes the light into nerve signals. The retina then sends these signals along the optic nerve to the brain. Without retina function, the eye cannot communicate with the brain, making vision impossible.

Symptoms of Retinal Detachment:
Retinal detachment is often spontaneous or may result from trauma, severe nearsightedness, a thinned retina, or just the normal process of aging that causes small tears in the retina. The tears allow vitreous fluid to leak between the retina and the outer layers of the eye. When the fluid causes enough pressure and the layers split, the end result is retinal detachment. The symptoms may be one or more of the following:

• Sudden vision changes
  
• Blurred vision
  
• Flashes of bright light often at the outer edges of vision range (peripheral vision)
  
• Blind spot(s) that are characterized as floaters or specks of dust floating in the eye
  
• Curtain or shade blocking part of the vision
  
• Near or total blindness in the eye
  

Treatment of Retinal Detachment:
Immediate surgical treatment is necessary. This surgical procedure is called a scleral buckling often in conjunction with cryotherapy. Laser or vitrectomy surgery is performed by an ophthalmologist in the operating room.

Scleral buckling surgery for retinal detachment is generally performed under local anesthesia. General anesthesia (the patient is asleep for the entire procedure) is less commonly used.

Before surgery begins, the eyelid will be pulled away from the eye with the use of a speculum, and the eye that is not being treated will be covered with a patch. The surgeon will first treat the tear with either cryotherapy or laser photocoagulation.

Cryotherapy uses a probe and extremely cold temperatures to weld shut and repair the retinal tear. Photocoagulation is similar to cryotherapy in that it welds the retinal tear closed, but instead of cold, it uses laser treatment. A silicone band (scleral buckle) is sewn to the sclera (outside layer of the eye) so that it indents the eye wall to support the retinal tear(s). The silicone buckle will never be removed.

Various alternative methods may be used to ensure the retina properly re-attaches to the outer layers including injected gas inside the eye to help push the retinal tear closed and/or removing the vitreous jelly inside the eye to remove traction on the retinal breaks (vitrectomy).

The procedure may require an overnight stay in the hospital. As with any procedure, a risk of adversely reacting to the anesthesia always exists. Other risks include:

• Recurrence of retinal detachment
  
• Development of glaucoma (increased pressure in eye)
  
• Bleeding and/or infection inside or outside of eye
  
• Red or painful eye
  
• Loss of depth perception, blurring of vision, double vision, or blindness
  
• Loss of eye
  
• Tissue loss due to poor blood supply (anterior segment necrosis)
  
• Swelling of the layer under the retina (choroidal effusion)
  
• Change in focus, requiring new spectacle or contact lenses (refractive change)
  
• Erosion of implant into the eye
  
• Loss of contrast sensitivity
  
• Infection around implant
  
• Double vision
  
• Developing cataract
  
• Wrinkling of retina (macular pucker)
  
• Swelling within retina (cystoid macular edema)
  
• Distortion of vision, loss of peripheral vision (side vision)
  

Since the biggest risk of retinal detachment surgery is re-detachment of the retina, physical activity will be restricted after the surgery. To reduce the risk of infection, antibiotic drops will be instilled in the eye and should be continued until your doctor instructs you to stop them. Recovery of vision may take several months and may never recover to pre-detachment levels. Vision is usually blurry immediately after surgery.

Scleral buckling surgery has a greater than 80% success rate after the first surgery. With additional surgery, more than 90% of cases can be successfully reattached.

It is important to understand that successful surgery does not necessarily correlate with good vision. The amount of visual recovery depends on how long the center of vision was detached before reattachment. It may take months before vision returns.

Retinal Detachment pdf (144k)

Every year, hospital emergency rooms treat nearly 40,000 victims of sports eye injuries. All professional and recreational athletes participating in eye hazardous sports need to wear eye protection. To help prevent sport eye injuries, protective polycarbonate eyewear should be worn whether or not prescription eyewear is needed.

The sports that cause the most eye injuries are basketball, baseball, and racket sports, but any sport where something flies at the eye is considered hazardous. Unbreakable glasses, goggles, or facemasks are required when there is a potential for eye injury. Polycarbonate lenses are unbreakable and make excellent protection for the eyes.

Helmets with eye shields are recommended for football and other contact sports. Many sports, such as baseball, hockey, and men’s lacrosse require a helmet with polycarbonate facemask or wire shield. Face guards can be worn over glasses and are used primarily for football, ice hockey, and similar high-risk sports. Some sports at the national level, such as hockey, have established standards for eye protection.

Goggles or sports glasses protect eyes while playing basketball, racquet sports, handball, and soccer. These goggles should be made of polycarbonate, which is 20 times stronger than ordinary eyeglass material. Prescription eyewear used during sports should be made from polycarbonate.

For high-speed sports such as skiing, wear special frames sturdy enough to protect the eyes from any impact. Wear ultraviolet absorbing goggles or sunglasses while skiing to protect the eyes from glare, ultraviolet rays, and exposure to weather.

Boxing presents a high risk for eye injury, and unfortunately, there is no adequate protection available.

Contact lenses are not a form of protective eyewear. Contact lens wearers require additional protection when participating in sports.

People with only one eye should very carefully consider the risks of contact sports. Wearing adequate eye protection is essential for people with only one eye.

Sports & Eye Injuries pdf (60k)

Strabismus refers to misaligned eyes. If the eyes turn inward (crossed), it is called esotropia. If the eyes turn outward (wall-eyed), it is called exotropia. Or, one eye can be higher than the other which is called hypertropia (for the higher eye) or hypotropia (for the lower eye). Strabismus can be subtle or obvious, intermittent (occurring occasionally), or constant. It can affect one eye only or shift between the eyes.

Strabismus usually begins in infancy or childhood. Some toddlers have accommodative esotropia. Their eyes cross because they need glasses for farsightedness. But most cases of strabismus do not have a well-understood cause. It seems to develop because the eye muscles are uncoordinated and do not move the eyes together. Acquired strabismus can occasionally occur because of a problem in the brain, and injury to the eye socket, or thyroid eye disease.

When young children develop strabismus, they typically have mild symptoms. They may hold their heads to one side if they can use their eyes together in that position. Or, they may close or cover one eye when it deviates, especially at first. Adults, on the other hand, have more symptoms when they develop strabismus. They have double vision and may lose depth perception. At all ages, strabismus is disturbing. Studies show school children with significant strabismus have self-image problems.

Amblyopia:
Amblopia, or lazy eye, is closely related to strabismus. Children learn to suppress double vision so effectively that the deviating eye gradually loses vision. It may be necessary to patch the good eye and wear glasses before treating strabismus. Amblyopia does not occur when alternate eyes deviate, and adults do not develop amblyopia. (For more information, please see the page about amblyopia on our website)

Strabismus is often treated by surgically adjusting the tension on the eye muscles. The goal of surgery is to get the eyes close enough to perfectly straight that it is hard to see any residual deviation. Surgery usually improves the conditions though the results are rarely perfect. Results are usually better in young children. Surgery can be done with local anesthesia in some adults, but requires general anesthesia in children, usually as an outpatient. Prisms and Botox™ injections of the eye muscles are alternatives to surgery in some cases. Eye exercises are rarely effective.

Strabismus pdf (64k)

The eye is surrounded by small oil-producing glands that help lubricate the eye. Occasionally, a gland becomes plugged and hard, forming a chalazion, and at other times the gland becomes infected, in which case the resulting abscess is called a stye.

A stye can cause the following symptoms:

• Pain
  
• Redness
  
• Excess tearing
  
• Blurred vision
  
• Granular sensation in the eye
  
• Oozing pus, which can spread to other areas around the eyes
  

Luckily, most styes stay small and are just a minor annoyance. They can be treated at home with warm compresses applied directly to the eye several times a day. They often resolve on their own within a few days. Styes that become more infected can be treated with antibiotics. Only in the very worst cases is surgical intervention needed to drain and/or remove the stye. This can be done in the doctor’s office.

Stye pdf (56k)

Sunglasses are popular for comfort and fashion, but now there is medical evidence supporting the use of sunglasses to protect the long-term health of the eyes. Studies have shown that spending hours in the sun without proper eye protection can increase the chances of developing age-related eye diseases like cataracts and macular degeneration. Ophthalmologists now recommend wearing UV absorbent sunglasses and brimmed hats when in the sun long enough to get a suntan or sunburn.

People mistakenly confuse the ability of sunglasses to block UV light with the color and darkness of the lenses. In truth, UV protection comes from a chemical coating applied to the surface of the lens. Shop for sunglasses that absorb 99% to 100% of all ultraviolet (UV) light. Some lens manufacturers’ labels say “UV absorption up to 400 nm.” This is the same thing as 100% UV absorption. In addition to UV light, sunlight also has low levels of infrared rays. Infrared wavelengths are invisible and produce heat. The eye seems to tolerate infrared well. Research has not shown a connection between eye disease and infrared light ray exposure.

Polarized lenses cut reflected glare, like sunlight bouncing off water, pavement, or snow. Sunglasses with polarized lenses are popular and useful for fishing, driving, and skiing. Polarization has nothing to do with UV light absorption, but many polarized lenses are now made with a UV blocking substance.

Wraparound glasses are shaped to keep light from shining around the frames and into the eyes. Studies have shown that enough UV rays enter around ordinary eyeglass frames to reduce the benefits of protective lenses. Large-framed, close fitting, wraparound sunglasses protect the eyes from all angles. Wraparound sunglasses should be considered by commercial fishermen, mountain climbers, or anyone who spends time at high altitudes or on the water.

Sunglasses pdf (60k)

Tanning beds produce high levels of ultraviolet (UV) light that tan the skin and burn the cornea (the clear covering of the eye). The burn is not felt until 6-12 hours after exposure, so you can suffer a severe burn without realizing it. UV light may also cause cataracts, and be a factor in the development of macular degeneration.

Of course, an ounce of prevention is worth a pound of cure, so always use protective eyewear while using a tanning bed. Closing your eyes, wearing regular sunglasses, and using cotton pads on your eyelids does not protect your cornea from the intensity of the UV radiation in tanning devices.

Tanning facilities are required by the Food and Drug Administration (FDA) to provide goggles, but it is best to obtain your own pair so you will always be prepared. Make sure your goggles fit snugly and cover your eyes properly. If you borrow the salon’s goggles, be sure that they are thoroughly cleaned after each use to prevent the spread of infection.

Since you do not usually burn under tanning devices, most people do not realize the potential damage to their eyes. If you experience eye pain after UV exposure, contact your eye doctor immediately.

Tanning Beds pdf (60k)

A vitrectomy is a surgical procedure that removes the vitreous in the central cavity of the eye so that vision can be corrected. It is beneficial in many disease states including diabetic eye disease (diabetic retinopathy), retinal detachments, macular holes, macular pucker, and vitreous hemorrhage.

The vitreous is normally a clear, jelly-like fluid that fills the inside of the eye. Various disease states can cause the vitreous to cloud, fill with blood, or even harden so that light entering the eye will be misdirected and not reach the retina properly.

The vitrectomy procedure is usually performed as an outpatient procedure. Rarely, an overnight stay in the hospital in required. Local or general anesthesia may be used. The eye will be held opened using a special speculum, and the eye that is not being operated on will be covered wit