Common Eye Conditions
COMMON EYE CONDITIONS
Here is a review of some common conditions we see in our office.
ALLERGIC CONJUNCTIVITIS Patients usually notice itchy, watery and red eyes. (See photo of Daisy Cat above, as she spreads cat dander all around the house.) Sometimes there is swelling of the eyelids or the white part of the eyes. Symptoms may be isolated to a certain season (especially springtime), or they may be year-round. Sources of allergic conjunctivitis are typically pollens or pets. If the cause cannot be removed, we can treat mild symptoms with cool compresses and artificial tears. For moderate symptoms, we prescribe an antihistamine drop. For severe symptoms, a corticosteroid drop or allergy pill may work best. We advise against the use of most of the over-the-counter allergy drops, which can be harmful if used long-term.
DRY EYE This is something we see almost every day. Patients report dryness (sometimes alternating with a flood of tears), foreign body sensation or irritation. Sometimes the eyelids will be stuck together upon awakening. There are many causes of dry eye, including certain medications (such as antihistamines, beta blockers or oral contraceptives), aging, systemic disease (such as rheumatoid arthritis), or blockage of the oil-producing glands in the eyelids. The mainstay of treatment is lubrication with artificial tears, gels or ointments, or various anti-inflammatory drops. Other treatments include removing the cause (if possible), treating the underlying medical condition, or punctal occlusion (i.e., plugging the drainage holes in the eyelids where tears exit the eye). Also, it is sometimes helpful to wear glasses or sunglasses when outside to decrease the effects of wind or blowing air upon the eyes.
BLEPHARITIS/MEIBOMITIS - This is inflammation of the eyelids. Patients may notice burning, tearing, crusting, or painful and red eyes. The doctor may see red and thickened eyelids, flakes along the eyelashes, and clogged oil glands behind the eyelashes. Sometimes this condition is associated with facial rosacea, a dermatological disease. Treatments include eyelid scrubs with special pads, warm compresses, antibiotic ointments and drops, and in severe or recurrent cases, oral antibiotics.
AGE-RELATED MACULAR DEGENERATION (AMD) AMD has undergone a dramatic treatment revolution lately (see below). In mild AMD, patients may notice no symptoms, but later on may notice distortion of straight lines or a blind spot in or near the center of vision. AMD is the breakdown of the macula, which is the central, most important and most sensitive part of the retina. (The retina is the inner layer of the eye.) Dry AMD starts with drusen (waste products) that are deposited below the macula, and pigmentary changes in the area. Dry AMD usually progresses fairly slowly and can cause scarring and vision loss. If dry AMD is diagnosed, we give advice that may slow vision loss (including dietary suggestions, the avoidance of smoking and second-hand smoke, and certain vitamin supplements). You should not take these vitamin supplements without first discussing the subject with your doctor. We also advise home monitoring of vision with an Amsler grid.
Sometimes dry AMD converts to wet AMD, which is known for quicker and more severe vision loss. In wet AMD, a network of abnormal blood vessels grows under the retina. Up until recently, lasers were used to slow vision loss, but nothing could be done to restore vision already lost. There are now two drugs that in many cases can restore vision lost due to wet AMD!
GLAUCOMA There are many forms of glaucoma. The most common form is open angle glaucoma, which usually has no symptoms until much visual field (side vision) loss has already occurred. Glaucoma has traditionally been thought to be a disease of high eye pressure causing damage to the optic nerve. We now know that there are many people whose pressure never gets high and yet they still develop glaucoma. One of the main reasons to have a yearly eye exam is to test for glaucoma, which involves more than just an eye pressure test. One of the most important tests is the observation of the optic nerve by the doctor when he or she looks inside your eyes. If glaucoma is suspected, a referral is made to a specialist for a detailed workup, which involves very high-tech testing and analysis. If glaucoma is diagnosed, the mainstay of treatment is the use of one or more eye drops to lower eye pressure.
CATARACT The development of a cataract is usually a normal aging process. Our eyes contain two lenses: one on the outside of the eye (the "cornea") and the other on the inside (the "lens"). This second lens gradually becomes cloudy throughout life, and when it becomes too cloudy for light to pass through it easily and focus precisely onto the retina, then it has become a visually significant cataract. An eye with a significant cataract receives many times less light than an eye with a clear lens. Some people are born with cataracts, and some people develop cataracts after injury or due to disease. Also, excessive exposure to UV (ultraviolet) radiation from the sun is associated with earlier or worse cataracts. (Don't forget to wear your sunglasses!) People with cataracts may notice blur or increased glare symptoms, and they may lose some color perception. Fortunately, cataract surgery has become very common and quick. The procedure usually takes about 15 minutes and is done on an outpatient basis. During cataract surgery, the lens is removed and a lens implant is inserted in its place. Traditionally, the lens power was chosen to provide good distance vision. Intraocular lens technology has undergone an amazing advance recently in that multifocal lens implants are now available that can provide vision at near and far, thus reducing dependence on reading glasses.
IF YOU HAVE ALREADY HAD LASIK - It is still necessary to have an eye exam every year because it is possible to develop eye health problems, even if your vision seems wonderful. This is especially important if you were previously very near sighted. Very myopic eyes are more at risk for retinal problems and even after LASIK, your eye retains the properties of a myopic eye.