COMMON EYE DISORDERS

ASTIGMATISM
Astigmatism is a condition that exists when an eye has an out-of-round shape. A normal eye has a spherical shape similar to a golf ball. In astigmatism, the cornea or lens is not spherical, but oval like an egg. Astigmatism causes the eye to focus light at many points instead of at a single point, and is frequently found in association with myopia or hyperopia.

BLEPHARITIS
Blepharitis is a chronic inflammatory condition of the eyelid margins. The condition is caused by Staphylococcus bacteria at the lid margins and may be a response to poor lid hygiene or excessive production of the lid's oil glands. Symptoms include red, irritated eyes and eyelid margins. There is often crusting of the lid margins in the morning, and Blepharitis may disrupt the normal tear film and cause dry eye symptoms, as well. It is also the cause for external and internal hordeolum (styes). The treatment for mild cases of Blepharitis is to concentrate on good lid hygiene. This can be achieved by using a warm washcloth with baby shampoo to clean the lid margins (eyes closed) either before bed at night or in the morning. There are also commercially prepared cleaning solutions specifically for this condition. More advanced cases require application of an antibiotic ointment to the lid margins at bedtime. Since Blepharitis is a chronic condition, it may always require some form of treatment. Maintaining good lid hygiene will often keep the inflammation under control and reduce the risk of acute episodes.

CATARACT
A Cataract is an opacity or loss of clarity within the lens inside your eye. This loss of clarity reduces the amount of light that can pass through the eye to the retina (the light sensitive tissue in the back of the eye). A Cataract is generally thought of as a normal aging change, usually affecting those aged 60 and above. However, Cataracts are also found in younger people, and may even be congenital. Other causes of Cataracts include certain medications, injury or trauma, and/or excessive exposure to the sun's harmful ultra violet rays. Symptoms of Cataracts are strictly visual in nature. There is no pain, redness of the eyes, or discomfort to warn that a Cataract is developing. Gradual blurring of vision and increased glare are the most common symptoms, and a nearsighted shift in glasses prescription often accompanies a Cataract. Unfortunately, there are no preventive measures to keep Cataracts from forming. However, cataracts are usually slow to develop, often over many years, and treatment is very effective in most cases. Initial treatment consists of no more than monitoring the eyes for visual changes and adjusting the glasses prescription to maintain good vision. When cataracts become more mature, a change in glasses may not be sufficient to improve vision to an acceptable level. At this point, your optometrist will discuss the possibility of referral to a cataract surgeon. A cataract is not ready for surgery however, until you feel the decrease in vision is adversely affecting your daily activities such as reading, watching TV, or driving.

CONJUNCTIVITIS - RED EYE
Conjunctivitis is an inflammation of the conjunctiva. The conjunctiva is a thin, transparent mucous membrane that covers the inner lining of the eyelids and the sclera, or white portion of the eye. Conjunctivitis can be divided into three main types: infectious, allergic, and chemical. Infectious conjunctivitis is caused by bacteria, or more commonly, a virus (pink-eye). Pollen, cosmetics, or animals can cause allergic Conjunctivitis. Irritants such as air pollution, fumes, or chlorine in swimming pools can produce chemical Conjunctivitis. Symptoms of Conjunctivitis are red, watery eyes or eyelids, foreign body sensation, itching and swelling, and often a pus-like or watery discharge. Although it may be self-limiting, some forms of Conjunctivitis can cause harm to the eye or vision, and in the case of viral infections, is usually contagious. Effective treatment of Conjunctivitis relies on identifying the underlying cause. Allergic Conjunctivitis is treated with over-the-counter drops and cold packs, or when needed, prescription allergy drops. Bacterial Conjunctivitis responds well to antibiotic drops, while drops are relatively ineffective against a virus. Much like the common cold, viral Conjunctivitis must run its course. Caution should be used by keeping hands away from the eyes, and not sharing towels, washcloths or eye drops will also help control the spread of Conjunctivitis.

DIABETIC RETINOPATHY
Diabetes is a condition that interferes with the body's ability to use and store sugar. Over time, Diabetes may cause weakening of the small blood vessels found in the retina. These blood vessel changes are called Diabetic Retinopathy. Early stages of Diabetic Retinopathy, called Background Retinopathy, cause small hemorrhages to form throughout the retina. These vascular changes may also cause areas of swelling, or edema, in various parts of the retina. Vision is usually not effected at this stage unless the swelling occurs in the central region of the retina called the macula. This stage may last for years without progression, and may require laser treatment only if retinal swelling occurs in the macula. As the disease progresses, areas of retinal ischemia (tissue damage caused from a lack of blood supply) begin to develop. Ischemia causes the formation of new and fragile blood vessels called neovascularization. These blood vessels are very weak and prone to bleed, sometimes heavily, causing a pronounced and often sudden loss of vision. Scar tissue also begins to develop in areas of neovascularization that can eventually pull or tug on the retina, causing retinal detachment. This advanced stage is called Proliferative Retinopathy and may be treatable with extensive retinal laser, or when needed, more aggressive surgical techniques. Not every diabetic patient develops Diabetic Retinopathy. However, the longer one has diabetes the more likely Retinopathy will develop. Poor control of blood sugar, pregnancy, high blood pressure, and smoking may promote development or worsening of Retinopathy. Early diagnosis and treatment is critical in maintaining stable ocular health.

DRY EYE
The eye's tears are a necessity to maintain good ocular health and clear vision. An eye that is dry either does not produce enough tears, or the tears that are present evaporate too rapidly. Dry Eye is usually considered a normal part of the aging process, and may also be caused by certain medications such as antihistamines, oral contraceptives, and antidepressants. Systemic health problems like arthritis, or trauma secondary to chemical or thermal burns are other causes of Dry Eye. There may be instances when the tear film is adequate, but due to eyelid problems, the tears are unable to properly coat the front surface of the eye. Symptoms of Dry Eye include redness, burning, a scratchy foreign body sensation, or intermittent blurred vision. On many occasions, a dry eye will water excessively. When the front surface of the eye becomes irritated due to dryness, reflex tears are produced in an attempt to wash out the source of irritation. An inadequate tear film can increase the risk of infection, and in extreme cases can cause scarring of the conjunctiva and cornea. Unfortunately, Dry Eye cannot be cured, but there are effective treatments available in most instances. Artificial teardrops or ointments are usually sufficient to alleviate symptoms. When these are ineffective, the tear ducts may be closed either by small plugs or surgically, to slow or stop the normal drainage of the tears.

FLASHES & FLOATERS
Floaters are small particles suspended within the vitreous gel in the back of the eye. The vitreous is a clear gel-like fluid that fills the space inside the back of the eye and in front of the retina. The small particles will typically appear as strands, spots, or cobwebs that float freely in your line of sight. Many patients will actually say they swat at what appears to be a bug or gnat. Floaters are most visible when looking at a light, uniform background such as a cloudless sky or empty wall. Floaters are caused by small particles that are trapped during the formation of the eye. They can also be caused by an aging change in the normal composition of the vitreous gel. Certain eye diseases or trauma may also contribute to the appearance of Floaters. Floaters are mostly untreatable, and are usually no more than a nuisance. They will either move out of the line of sight or you just get used to them and block them out. On occasion, Light Flashes will accompany Floaters. The most common cause of this occurrence is Posterior Vitreous Detachment or PVD. PVD is a normal aging change that results when the vitreous gel becomes more watery, shrinks, and detaches from the back of the eye. If the process tugs on the retina, Light Flashes will be seen. If the tugging on the retina is excessive, a retinal tear can occur. This requires immediate attention. The tear can usually be repaired with a laser, but if left undetected or untreated, a retinal detachment can develop. Most Floaters, and even Flashes are harmless, but a thorough retinal exam is a must when symptoms first develop.

GLAUCOMA
Glaucoma is a disease of the eye generally thought to be caused by high intraocular pressure that leads to optic nerve damage. Increased pressure is caused when the passages that allow the fluid inside the eye to drain become blocked. Over time, the fluid pressure builds, leading to nerve damage that causes gradual loss of peripheral vision and if untreated, blindness. Chronic Open Angle Glaucoma is the most common form, and it develops slowly and painlessly with no symptoms. Without warning signs, the only way to know the disease exists is through a thorough eye examination. A much less common form of Glaucoma is Acute Angle Closure. This type of Glaucoma occurs when the drainage angle inside the eye becomes blocked, causing a sudden elevation in pressure. Symptoms include extreme pain, headache, nausea, redness of the eye, and blurred vision. This is considered an ocular emergency requiring immediate treatment and often surgical management. Glaucoma may also be caused by an anatomically narrow drainage angle, intraocular inflammation, certain medications, and trauma. Unfortunately, in the vast majority of cases, Glaucoma cannot be cured, but can be controlled effectively with early diagnosis and treatment. Eye drops are the most common form of treatment for Glaucoma, and work either by reducing the amount of fluid the eye produces, enhancing outflow, or both. When medication does not effectively decrease the intraocular pressure to acceptable levels, laser treatment and filtering surgeries may be necessary.

HYPEROPIA
Hyperopia is the clinical name for farsightedness, and is a condition in which light is focused at a point behind the retina. Therefore, people with Hyperopia have trouble seeing things up close. When a person is farsighted, the eye must focus all the time to see clearly. The condition is caused by a cornea that is flatter than normal or by the eye being shorter than normal.

KERATOCONUS
Keratoconus is a corneal (the clear tissue at the front of the eye) disorder that causes the normally round cornea to thin at its apex and develop an irregular curvature. This abnormality causes light entering the eye to focus improperly on the retina, leading to a distortion of vision. In its earliest stages, Keratoconus causes a mild decrease in vision and increased glare and light sensitivity. Symptoms usually develop in the late teens or twenties, and may progress for 10 to 20 years. Initially, glasses or soft contact lenses provide adequate correction of vision, but as the corneal shape becomes more irregular, glasses and soft contacts become ineffective. At this point, it is necessary to wear rigid gas permeable contacts that help provide a false spherical surface and do an excellent job in correcting the visual distortion. The disease sometimes progresses to the point where the corneal curvature becomes so steep that scar tissue develops at the corneal apex and patients become intolerant of their contact lenses. At this stage, a corneal transplant becomes the only option to regain normal vision.

LAZY EYE & CROSSED EYES
Amblyopia, commonly called Lazy Eye, is a condition in which one eye is unable to see as well as the other in the absence of pathology, and is not correctable with glasses or contact lenses. The condition is caused when the two eyes cannot be used together, and usually develops before the age of 6. The condition is often present with crossed eyes or when one eye has a much higher refractive error (nearsighted, farsighted or astigmatism) than the other. The double image from the crossed eye, or the blurry image in the eye with the higher refractive error, is suppressed by the brain. When this happens during infancy or early childhood, the eye does not "learn to see" and becomes "lazy." Treatment for Amblyopia includes prescription glasses, prism, and patching of the "good" eye. Patching trains the Amblyopic eye to see and is not as effective after age 7 or 8. Crossed eyes, called Strabismus, occurs when there is poor control of the eye muscles that align the eyes. The result is that one or both of the eyes will turn in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia). The eye misalignment usually occurs before age 2, but may develop several years later. Development of Strabismus in an adult is uncommon and may be secondary to trauma or other pathology. Treatment for Strabismus may include glasses, prism, vision therapy, or surgery. Early detection and treatment for both Amblyopia and Strabismus often leads to excellent results.

MACULAR DEGENERATION
Macular Degeneration is the leading cause of blindness in the United States, and it is caused by changes that develop in the macula. The macula is the most visually sensitive portion of the retina, and is responsible for clear, sharp central vision and is the most sensitive to color. There are two forms of Macular Degeneration. The first and most common is Dry Macular Degeneration. The dry form generally causes a slow and gradual loss of central visual acuity. It may appear initially as though there is a smudge on your glasses that cannot be cleaned off, or straight lines may develop a wavy or distorted appearance. Vision loss may be subtle and not cause significant problems, or there can be a drastic decrease in central acuity over the years. Although there is no treatment for Dry Macular Degeneration, research indicates certain vitamins and minerals may help prevent or at least slow the progression of the disease process. The second, and less common form of Macular Degeneration is the wet form, which is caused when the macular tissue becomes damaged to the point where abnormal blood vessels from the underlying choroid grow and hemorrhage within the layers of the central retina. Scar tissue eventually forms in the area, leading to a large blind spot. If detected early enough, laser treatment may help to slow or stop its progression. Approximately 10% of patients with Dry Macular Degeneration will develop the wet form, and in either case, total blindness will never be the result because Macular Degeneration affects only central vision. Vision devices such as magnifiers and telescopes may be prescribed to enhance the remaining vision.

MYOPIA
Nearsightedness, or Myopia, occurs when light entering the eye focuses in front of the retina instead of directly on it. A person with Myopia can see up close, but distance vision is not clear. This is caused by a cornea that is steeper than normal, or an eye that is longer than a normal eye. Myopia is often detected in school-age children who have difficulty seeing the chalkboard. Myopia typically worsens through adolescence until stabilizing in early adulthood. Myopia is an inherited condition.

PRESBYOPIA
Presbyopia is a condition in which distant objects are focused clearly on the retina, but close objects are not, because the focusing ability of the eye has diminished due to the aging process. One of the great injustices of getting older is that around the age of 40, the lens of the eye becomes less flexible, and accommodation (the focusing ability of the eye) is gradually lost. Presbyopia is a normal process that everyone eventually experiences.