Advanced Eye Care

Pupil size determines the amount of light entering the eye. The size changes to allow the best vision under different light conditions. Normal pupil diameter is 3-4 millimeters, but this varies from person to person and with age. Anisocoria means that the two pupils are unequal in size. Testing is needed to determine whether or not this is abnormal for a particular individual. Many people have slight, totally normal differences in pupil size. Occasionally people have large differences in pupil diameter that are normal. Where testing indicates that the difference in pupil size is abnormal, observation is used to identify which is the abnormal eye. If the difference is greatest in darkness, the smaller pupil is in the abnormal eye. If the difference is greatest in light, the larger pupil is the abnormal one. Neurological examination may be needed to determine the cause of the abnormal difference in pupil sizes, as damage to the optic nerve can create unequal pupils. Injury to the eye and eye medications or ointments can also cause unequal pupils. Skin patches used to control motion sickness can cause a larger pupil on the side the patch was applied.

Synechae are tissue adhesions caused by inflammatory disease inside the eye (uveitis). The structures involved are the clear cap of the eye (cornea), the colored part of the eye (iris) and the crystalline lens of the eye. The peripheral iris sticks to the inside of the cornea in anterior synechias, restricting the outflow of fluid (aqueous) from the eye. In posterior synechias the back surface of the iris adheres to the crystalline lens of the eye causing an irregularly shaped pupil. In both cases, eye pressure may rise (glaucoma) due to obstruction of normal aqueous drainage. Treatment involves treating the underlying inflammation with steroid eye medications combined with pupillary dilation to break the synechae.

Bacterial conjunctivitis is one of the most common ocular infections. It occurs when the natural defenses against infection of the eye are lost. Trauma, aging, tear film abnormalities, chronic viral infection or other irritation, alcohol abuse or immunosuppressive treatment may allow bacterial conjunctivitis to occur. The severity of the conjunctivitis may vary greatly but the hallmark symptom is lids stuck together in the morning from a pus-like discharge. Most people also experience redness of the white part of the eye and swelling of the lids. Treatment usually consists of lid hygiene (warm compresses and scrubs) and short term use of antibiotic eye medication. In severe cases, laboratory culture may be taken to determine the best antibiotic eye medication and/or pills to use.

Blepharitis is a chronic inflammation of the lid margins. Symptoms vary according to the severity of the condition and include irritation, stinging, dryness, burning, redness, and lid swelling. Symptoms are generally worse upon awakening due to the build up of crusts and scales during sleep or at the end of the day because of dry eye problems caused by a disrupted tear film. Treatment for mild cases of blepharitis involves daily cleansing of the lids and lashes with a 50/50 solution of water and baby shampoo or a pre-soaked lid cleansing pad. Moderate cases usually respond to cleansing and adding an anti-dandruff shampoo for the scalp, if dandruff is present, and an antibiotic ointment for the eye. The most severe cases of blepharitis may require the addition of oral antibiotics and topical steroid eye medications. There is no instant cure for blepharitis. To control blepharitis and prevent recurrence requires daily care of your lids.

Blepharoconjunctivitis is an infection that affects the eyelids and the clear membrane of the eye (conjunctiva). The infection may be bacterial or viral. Symptoms include burning, stinging, discharge, irritation, foreign body sensation and occasionally swollen glands. Redness, inflammation and swelling of the lids are common. Scales are often attached to the lashes. Fluid may accumulate underneath the conjunctiva and the blood vessels become red and engorged. Treatment includes warm compresses followed by daily cleansing of the lids and lashes to remove bacteria and scales that might be attached. Antibiotic eye medication are prescribed to control infection and lubricating medication to supplement the tear film.

The lens inside the eye is normally almost transparent. Its function is to help focus light onto the retina, the back lining of the eye. The term cataract refers to any loss of transparency. Cataracts occur in many forms and are due to a variety of causes. Most commonly, cataracts are associated with aging. They may also be caused by trauma, radiation, ultraviolet light, medications, and systemic diseases (such as diabetes) and some cataracts are congenital. Not all cataracts are progressive, but those that are cause a gradual, painless loss of vision. In the early stages of cataracts, frequent changes in prescription can often help preserve vision. Cataract surgery is indicated when the decrease in vision starts to interfere with the patient’s normal activities. Cataract removal, one of the most frequently performed surgeries in the United States, has very good results and low complication rates.

Chalazia are firm round moveable lumps located within the eyelid. These non-tender nodules are due to glands that plug up and retain their secretions. Chalazia can dramatically vary in size. Some are barely noticeable while others may grow to the size of an aspirin. If large enough they may cause blurred vision due to pressure against the eye. Most chalazia will disappear with frequent use of warm compresses followed by massage of the lump. Topical antibiotic medications are of little value. Some chalazia fail to respond to heat and massage and may be removed by a simple in office surgical procedure or injected with steroid solution to dissolve the material inside. Oral antibiotics are of some benefit to prevent recurrence.

Color vision problems may be broken down into two general categories: congenital, existing prior to or at birth and acquired, developing later in life. Total or true color blindness is extremely rare with an incidence of approximately 1:100,000. The term color blindness therefore is a misnomer usually referring to an individual who is color deficient. In color deficiencies there is no total lack of perception of color but a weakness. Protanopia (loss of red) and deuteranopia (loss of green) are the most common. Tritanopia (blue deficiency) is very rare. Approximately 8.0 percent of all men and 0.4 percent of women have some form of color deficiency. Acquired color vision defects generally indicate an underlying eye health problem. Red-green color disturbances point to problems affecting the optic nerve of the eye while blue defects suggest problems of the retina. Many occupations require normal color vision. The two most popular tests to determine normal color vision are the pseudoisochromatic plates (Ishihara Plates) and color matched discs (Farnsworth D-15). With the color plates the patient is asked to identify a number or figure of generally similar color concealed in a back-ground of dots of another color. With the D-15 test the patient is required to match standardized colored paper discs mounted in plastic caps in order according to hue.

Contact dermatitis is a well-named skin problem. It is caused by “contact” with substances such as eye medicines, cosmetics, other chemicals, clothing, jewelry, metals and plastics. The fine, thin texture of the eyelids makes them especially susceptible to such allergy problems. Contact dermatitis appears after exposure to one of the above items and is characterized by itching, redness and swelling of the lids. The immediate treatment may include antihistamine or steroid preparations applied to the affected skin (avoiding getting these into the eyes). The long-term treatment is to identify and avoid exposure to the source of the irritation.

The word converge means to move inward toward one point. In the vision system, convergence takes place when the eyes deviate inward so that the lines of sight meet. In order to read comfortably, use a computer or do cross stitch, you must be able to turn your eyes in easily and sustain convergence and focusing. Convergence insufficiency is the inability to move the eyes inward adequately. It is one of the most common muscle imbalance problems. Individuals with convergence insufficiency may exhibit symptoms including headaches, double vision and ocular fatigue. Treatment of convergence insufficiency in young people involves home eye exercises. Individuals with more complicated muscle imbalance problems require more aggressive in-office (orthoptic) vision training or reading lenses with prisms to maintain clear single vision at near.

Corneal ulcer is a serious ocular infection of the clear cap of the eye (cornea). It occurs when the natural defenses against infection of the eye are lost. Trauma, aging, tear film abnormalities, chronic infection or irritation, contact lens problems, alcohol abuse or immunosuppressive treatment set the stage for corneal ulcer. Most ulcers are assumed to be bacterial in origin although viruses, fungi and acanthamoeba (parasites) cause corneal ulceration. Laboratory studies are required to determine the reason. Symptoms include moderate to severe pain, redness, light sensitivity, mucus discharge and decreased vision. Treatment is dependent on the severity of the infection and the cause. If the ulcer is sight threatening the patient may be hospitalized. Antibiotics (medication, ointments and/or pills) are used to reduce the infection. Dilating medication and oral pain medications (e.g., aspirin) improve comfort. Careful daily monitoring is required until the ulcer resolves.

Tears drain from a single opening, on each lid, located at the inner nasal corner of the eye. They travel through a small canal and collect in a pouch (lacrimal sac) before ending up in the nose and throat. Dacryocystitis is an acute bacterial infection of the lacrimal sac. The nasal area of the eye appears red, tender and a lump may form in that region. The bacteria produce inflammation and mucus which may lead to secondary infection. Tears occasionally spill over onto the cheeks due to obstruction of the drainage system. Treatment with hot compresses, gentle massage and antibiotic eye mediation is usually effective. Repeated episodes of dacryocystitis that do not respond to medical therapy may require surgery to reconstruct the tear drainage system.

Diabetes is the leading cause of blindness in adults under the age of 65. It is a complex disorder involving small blood vessels. These blood vessels provide nutrients to all the structures in the body, including the eyes. In diabetes, the blood vessels begin to leak fluid and blood. This causes damage to the surrounding structures, and interferes with the transport of needed nutrients. Research findings show that complications can be delayed with proper care and monitoring of the disease. Diabetes can affect many structures in the eye, causing double vision from muscle palsies, fluctuations in vision from sugar level changes, and decreased vision from cataracts. The most serious vision problems arise from hemorrhages in the retina, from swelling of the retina, and from blood vessel growth under the retina. Laser therapy is used, when possible, to treat the retina. Regular examinations are critical for early diagnosis and to determine when treatment will be most effective. Vision can be preserved in the majority of patients who are diagnosed early and examined regularly.

Diabetes is the leading cause of blindness in adults under the age of 65. It is a complex disorder involving small blood vessels. These blood vessels provide nutrients to all the structures in the body, including the eyes. In diabetes, the blood vessels begin to leak fluid and blood. This causes damage to the surrounding structures and interferes with the transport of needed nutrients. Research findings show that complications can be delayed with proper care and monitoring of the disease. Diabetes can effect many structures in the eye, causing double vision from the muscle palsies, fluctuations in vision from sugar level changes and decreased vision from cataracts. The most serious vision problems arise from hemorrhages in the retina, from swelling of the retina and from blood vessel growth under the retina. Laser therapy is used, when possible, to treat the retina. Retinal disease in diabetes is divided into two forms: (1) Non-proliferative and (2) Proliferative. Non-proliferative retinopathy is present when there are hemorrhages, small dilations of the vessel walls and leakage of fluid into the surrounding retina. Proliferative retinopathy has the added problem of new blood vessels forming. These vessels will leak and bleed if left untreated. The most common cause of decreased vision is swelling of the retina from leaky blood vessels. Lasers are used to treat these leaks when possible. Regular examinations are critical for early diagnosis and to determine when treatment will be most effective. Vision can be preserved in the majority of patients who are diagnosed early and examined regularly.

Distichia is a condition with more than one row of lashes on the eyelids. Occasionally this second row of lashes turns in and touches the front surface of the eye. This contact with the front surface of the eye can cause corneal abrasions and discomfort that ranges from mild to severe. Treatment may involve epilation or “plucking” of the lashes or a surgical removal of the hair follicle itself. The course of this condition tends to be chronic so that regular evaluation by an eye care professional is needed.

Eccymosis means “black eye”. Black eye is caused most often by blunt trauma. The purplish-black appearance of the lids is due to blood accumulating just underneath the skin. Eye pain and tenderness of the bony rim of the socket are common. Other serious eye complications must not be overlooked when a patient has a black eye. The eye muscles, the pupils and other external structures of the eye must be carefully examined. Dilation is recommended to rule out detachment of the retina from the blow. Cold compresses applied the first 24 hours slow down the bleeding. Hot packs are then recommended to improve absorption of the remaining blood.

Ectropion occurs when the lower lid of the eye moves away from the globe and no longer makes contact. This results in symptoms of tearing, discomfort, redness, irritation and dryness. The most common cause of ectropion is an age-dependent loss of lid muscle tone. It also may be caused by scarring due to chronic lid disease, trauma, surgery or paralysis of the lid muscles (Bell’s palsy). Treatment is aimed at reducing dryness and discomfort with artificial tears and ointments, or applying soft contact lenses to protect the cornea. Surgery may be necessary to tighten up the loose muscles and skin, resolving the problem.

Trichiasis is an uncomfortable condition caused when one or more of the lashes turn inward and touch the globe of the eyeball or rub against the cornea (cap of the eye). The most common cause of trichiasis is from misdirected lashes due to chronic eyelid infection (blepharitis). When blepharitis is present, lashes grow the wrong way. Lid scarring, trauma and diseases of the conjunctiva (clear membrane of the eye) may cause the lid margin to roll inward (entropion). Treatment involves removal of the offending lashes with tweezers. The lashes are firmly grasped at the base and plucked out. Clipping the lashes is not recommended. This provides temporary relief but the lashes will usually grow back in 4-6 weeks. Destruction of the lash follicle is the only permanent solution. Electrolysis, cryosurgery or laser cauterization may be used to permanently destroy the follicles, but recurrence is possible.

The episclera lies under the clear outer layer (conjunctiva) and over the white (sclera) of the eye. Episcleritis is an inflammation of this layer of tissue. It generally affects one eye only and is 30% of the time associated with other generalized conditions such as allergy, shingles, collagen or other auto-immune diseases. Symptoms include a concentrated redness of the white of the eye with or without tenderness. The doctor sometimes sees a raised nodule in the red area. Treatment includes warm or cool compresses for comfort and short term eye medication to decrease the inflammation. Unfortunately the condition may recur over a period of years.

People with floaters are aware of one or more dark shapes that move around their field of vision. These shapes may take many forms, and are often seen as spots, threads, cobwebs and flies. They are called floaters because they continue to move after the eye has come to rest. Floaters are particles in the vitreous, the gel that fills the back of the eye and gives the eye its shape. Light coming through the pupil strikes the particles. The particles then cast shadows, which are seen as floating specks. Floaters are generally seen against bright backgrounds, as there is a greater contrast between the shadow and the background. They are extremely common, and may appear in any part of the visual field. Those closer to the center of the visual field can be extremely annoying. There is no treatment for floaters. However, any sudden change in the floaters requires careful evaluation to rule out tears, detachments, hemorrhages, and inflammation, all of which can be sight threatening. The appearance of flashing lights, with the floaters, requires immediate evaluation, as this could indicate a serious retinal detachment.

Objects which fly into the eye may lodge on the lid, the clear covering of the white of the eye (conjunctiva), the clear cap of the eye (cornea) or may penetrate any of these. These objects are called ocular “foreign bodies”. If superficial, the foreign body may be removed by the doctor wiping it away or picking it out. If the foreign body is metallic, the surrounding tissue may “rust” and this must be removed. Antibiotic eye medication or ointment may be used to prevent infection. The eye may be patched or a bandage contact lens may be used to promote healing if the foreign body was lodged in the cornea. Long-term use of artificial tears and ointment may be recommended to prevent future irritation.

Angle closure glaucoma occurs when there is a sudden increase in fluid pressure inside the eye. Normally, fluid is secreted into the eye to help nourish structures inside the eye. When the drainage channel is blocked, fluid pressure increases, causing severe pain and loss of vision. Rainbow colored haloes are seen around lights, and the severe pain often causes nausea and vomiting. Patients who are pre-disposed to this condition generally have a narrow area through which the fluid drains, making it more easily blocked by the iris, the colored part of the eye. Angle closure glaucoma requires immediate treatment. Every effort is made to reduce the fluid pressure in the eye, by using eye medication and oral medication. Laser surgery is used to make a small permanent hole in the iris, so that fluid can pass through to the drainage channel, even if it is again blocked by the iris. If this glaucoma is left untreated, permanent loss of vision occurs.

Open angle glaucoma is a slowly progressive disease which causes decreased vision, ranging from only slight loss to absolute blindness. Both eyes are affected. There are no symptoms until loss of vision occurs, at which point the structures in the eye have already been substantially damaged. Damage inside the eye occurs when there is an increase in the fluid pressure inside the eye. Normally, fluid is secreted into the eye to help nourish structures inside the eye. When drainage from the eye is reduced, pressure inside the eye increases. Increased pressure inside the eye causes damage by interfering with the blood supply in the small blood vessels serving the optic nerve. When the blood supply to the nerve is decreased, degeneration of the nerve and loss of vision result. Increased pressure on the nerve also damages the delicate tissue through which the nerve fibers pass from the retina. This causes damage to the nerve fibers and loss of vision. People who have a family history of glaucoma, and those who are diabetic, nearsighted, or black have a higher risk of developing glaucoma. Treatment is aimed at lowering the pressure inside the eye, in order to prevent further nerve damage. There are no set rules about when to begin therapy or which therapy to use. Eye medications are typically the first type of medication used. If they are not effective, oral medication or surgery is indicated. Using the medication as prescribed is extremely important in controlling the disease. If left untreated, glaucoma can lead to blindness.

Graves’ disease is due to an overactive thyroid gland (hyperthyroidism) causing weight loss, insomnia, heat intolerance and hyperactivity. The disease causes exophthalmos (bulging of the eyes) and ophthalmoplegia (limitation of the eye movement). As the disease worsens, the connective tissue in the muscles increases, pushing the eye forward. Closing the lids becomes more difficult, because of lack of space in the orbit. Exposure and dryness of the front surface of the eye (cornea) occur. Muscles gradually loose their full range of movement. Initial eye symptoms of Graves’ disease include dryness, discomfort, and forward protrusion of the eyes. A goiter (swollen area in the neck) may be present. Advanced eye problems from Graves’ include corneal problems, double vision, increased eye pressure (glaucoma) and eventual loss of sight. Primary treatment of Graves’ disease involves treating the hyperthyroidism. Medical management with drugs usually provides adequate control. Eye surgery and radiation of the thyroid may be necessary in more advanced cases.

Hordeolum or sty is a common acute localized infection of an eyelid gland. The lid becomes red, swollen and tender. Treatment consists of warm compresses applied for 5-10 minutes, three to four times a day. Antibiotic medications or ointments do not directly affect hordeola but they are useful in preventing secondary infection. Oral antibiotics are used for styes that are resistant to standard treatment or when infection spreads to adjacent tissues. Surgical removal and expression of the contents is seldom required.

It is estimated that more than 50 million people in the United States have high blood pressure. Many factors are thought to contribute to high blood pressure, but the exact cause remains unknown. Untreated high blood pressure speeds up artery-clogging, and is a major risk factor for heart disease and stroke. The organs most commonly affected by high blood pressure are the heart, brain, kidneys and eyes. The eye is an important diagnostic tool in assessing the effects of high blood pressure elsewhere in the body. Hardening of the arteries, hemorrhages, and fluid leakage seen in the eye will also be occurring in the other organs. There is no known cure for hypertension, but the pressure can be controlled and the complications reduced. In addition to prescribed medications, reducing salt intake, losing weight, exercising regularly, limiting alcohol intake, and eating potassium rich foods all help to control high blood pressure. These dietary and exercise measures also help to prevent typical age-related increases in blood pressure.

It is estimated that more than 50 million people in the United States have high blood pressure. Many factors are thought to contribute to high blood pressure, but the exact cause remains unknown. Untreated high blood pressure speeds up artery-clogging and is a major risk factor for heart disease and stroke. The organs most commonly affected by high blood pressure are the heart, brain, kidneys and eyes. The eye is an important diagnostic tool in assessing the effects of high blood pressure elsewhere in the body. Hardening of the arteries, hemorrhages and fluid leakage seen in the eye are known as hypertensive retinopathy. These changes to the eye reflect changes occurring in the other organs of the body. There is no known cure for hypertension, but the pressure can be controlled and the complications reduced. In addition to prescribed medications, reducing salt intake, losing weight, exercising regularly, limiting alcohol intake and eating potassium rich foods all help to control high blood pressure. These dietary and exercise measures also help to prevent typical age-related increase in blood pressure.

Inclusion (chylamydial) conjunctivitis is a sexually transmitted disease, occurring after contact with an infected person or by hand-to-eye transmittance. The symptoms are typically chronic and may include redness of the white part of the eye, swelling of the upper lid and a mucous like discharge. Eye examination shows bumps under the lids (follicles) and a swollen gland in front of the ear. The most effective treatment is oral antibiotics for approximately 3 weeks. The patient and his/her partner should be evaluated for an accompanying genital infection.

Keratoconus is a slowly progressing disease that leads to a bulging forward and thinning of the cornea of both eyes. The cornea is the clear surface of the eye, which is most responsible for focusing light in the eye. As the cornea bulges forward and becomes cone shaped, vision blurs. In the early stages of keratoconus, eye glasses correct the blurred vision. As the condition progresses, rigid gas permeable lenses become the treatment of choice, and require frequent changes. Corneal transplants are needed occasionally, when contact lenses cannot be tolerated, or when corneal scarring develops. Prognosis following corneal transplantation is excellent.

Macular degeneration is the leading cause of vision loss after the age of 50. The disease occurs equally in men and women, and is more common among Caucasian people. There is some evidence that heredity plays a role. In macular degeneration, central vision is lost, but good peripheral vision may continue. While both eyes are affected, one eye may be more affected than the other. There are two types of macular degeneration: the nonexudative (dry) form and the exudative (wet) form. In the dry form, there is a slow loss of central vision. No treatment has proven to be effective. However, recent studies suggest that eating spinach and kale reduces the rate of deterioration. Many patients benefit from low vision aids, especially for reading. It is important to look daily for any changes in the size and shape of the area of vision loss. Such changes may signal onset of the wet form of macular degeneration, so they require immediate evaluation. To monitor for changes, patients are instructed in the use of an Amsler grid. In the wet form of macular degeneration, there is a rapid deterioration of vision, often accompanied by distortion of straight lines, or by the appearance of a blind spot, at or near the center of the visual field. The sudden onset of vision loss is caused by hemorrhage or fluid leakage close to or into the area of central vision. Laser treatment may be advised and should be performed within 72 hours after the initial onset.

The macular is the part of the eye that is necessary for sharp vision. The retina, the back lining of the eye, is very thin at the center of the macula, and this makes it prone to holes. Holes may be caused by localized swelling, by trauma, or by an abnormal pulling on the retina. The amount of vision loss resulting from these holes depends on the size and depth of the holes. Women are more commonly affected. Fortunately, the condition rarely occurs in both eyes. Visual loss was irreversible until recently, when surgery was shown to benefit some people. Frequent follow-up on patients with macular holes is needed to monitor for complications, such as retinal detachment.

Migraine headaches are a common problem that affect nearly 20% of the population. People of all ages are affected but the first episode of migraine usually occurs between the ages of 10 and 30, and rarely after 40. Women are affected more than males. After the age of 50, migraine sufferers may experience partial or total remission. Genetics plays an important role; greater than 50 percent of those affected may have a positive family history. The word migraine means “half of the head”. The headache usually starts in and about the eye, on one side of the forehead, and gradually radiates to the entire head, causing intense gripping pain and sometimes total incapacitation. Migraines may occur anywhere from daily to once in several months, and may last from a few hours to days. Migraine is diagnosed by the pattern of symptoms (prodromata) that precede the headache. Mood swings, depression, irritability, vomiting, nausea, diarrhea and visual disturbances (zigzag distortion) are common. Less common symptoms include dizziness, ringing in the ears, and numbness or tingling on one side of the body (hemiparesis). In classic migraine, the visual complaints are of special importance. Light sensitivity, holes in the vision, floaters, mysterious fireballs, blurred vision, or double vision have been described by sufferers. Certain mechanisms appear to trigger migraines. Foods such as cheeses, chocolate, red wine, and coffee may initiate an attack. Menstruation, stress, psychological illness and the use of oral contraceptive are other trigger mechanisms. Although the cause of migraine is not known, it is thought that arteries in the brain narrow, decreasing blood flow to the eye and other parts of the brain, resulting in the visual disturbances and wide variety of other symptoms. Keeping a diary of frequency and duration of the headaches, as well as relevant aspects of lifestyle (bedtime, meals, alcohol, caffeine, etc.) is useful in establishing triggers. The most severe cases of migraine are best handled by a physician who is skilled in the treatment of migraines and aware of the potential side-effects of the medicines involved.

Fluid is secreted into the eye to help nourish structures inside the eye. After circulating, the fluid drains out of the eye. When drainage from the eye is reduced, the pressure inside the eye increases. Increased pressure causes damage by interfering with the blood supply in the small blood vessels serving the optic nerve. When the blood supply to the nerve is decreased, degeneration of the nerve and loss of vision result. Increased pressure on the nerve also damages the delicate tissue through which the nerve fibers pass from the retina. This causes damage to the nerve fibers and loss of vision and is termed glaucoma. Ocular hypertension describes a condition where the fluid pressure inside the eye is above normal but there is no clinically detectable loss of vision or damage to the optic nerve and retinal fibers, the changes which would indicate glaucoma and the need for treatment. Patients with ocular hypertension require no treatment, but frequent evaluation is critical to determine if damage is occurring.

Ocular rosacea occurs secondary to the skin problem Acne Rosacea. Acne rosacea is most common in women between the ages of 30-50 and appears as skin eruptions over the mid face, nose and cheeks (butterfly rash) and sometimes the chin and forehead. When acne rosacea affects the eyes, it appears as chronic redness, itching and irritation of the lid margins, clear cap of the eye (cornea) and covering over the white of the eye (conjunctiva). Recurrent lid bumps called styes and chalazia may be associated. In the worst cases the cornea becomes scarred. The treatment is meticulous hygiene of the affected skin along with antibiotic skin preparations and pills. Short term application of steroid eye medication or ointment may help decrease inflammation secondary to the underlying skin problem.

Pinguecula is a small, raised yellowish mass which forms on the issue overlying the white of the eye (conjunctiva). It may occasionally become red and irritated. It is more common in older age groups and in warmer climates. People are sometimes unaware of the presence of pinguecula until it becomes red or the eye feels like it has something in it. Treatment then usually consists of lubricating eye medication, or occasionally, antibiotic or steroid eye medication. Surgical removal is rarely recommended.

The vitreous is the clear jelly-like structure that fills the back of the eye and gives it shape. As the gel ages, it breaks down gradually, becomes filled with pockets of fluid, and collapses. As the gel collapses, it may pull on the optic nerve, one of the places to which it is attached. This pulling may cause it to be torn loose (or detached) from the nerve, giving rise to the appearance of cobweb-like floating particles. These “floaters” move when the eye moves and come to rest after the eye has stopped moving. There is no treatment for posterior vitreous detachment. As the gel collapses, it may also pull on the retina, the inner lining of the eye which gives rise to vision. The retina is, itself, only loosely attached to the back of the eye, and is, therefore, subject to tears and detachments. Pulling on the retina causes the appearance of flashing lights. Any increase in floaters, or the appearance of flashing lights, requires immediate evaluation, as this may indicate a retinal tear or detachment. Retinal detachments may occur at any time, but are more likely to occur up to several months following the initial appearance of floaters.

Ptosis is a drooping of the upper eyelid. It may be present from birth or, more commonly, is age related. It may occur secondary to thyroid disease, myasthenia gravis or muscular disorders such as myotonic dystrophy or a progressive loss of eye muscle function (external ophthalmoplegia). When the ptosis affects the person’s appearance or vision to an intolerable degree, surgical intervention is recommended.

The retina is the back lining of the eye and is necessary for vision. It is firmly attached to the inner layers of the eye only at its most forward part and at the optic nerve. The rest of the retina is loosely attached, and can be torn away or detached easily from its blood supply. Since the retina has no pain receptors, any tears are painless. Retinal tears can occur when the vitreous, the gel-like part of the eye, pulls on the retina. Scarring, trauma, or liquification of the vitreous can cause increased pulling or traction on the retina, with resulting tears. Fortunately, most tears are small, and the retina remains attached to the inner layers of the eye. But occasionally, large tears occur, with resulting retinal detachment. If capillaries are ruptured in the tear, a shower of black spots is seen. Retinal traction also stimulates the visual receptors in the retina, which causes light flashes to be seen. Symptoms of light flashes need to be clinically evaluated. It is important to seek immediate care if there are associated “floaters,” (floating particles in the visual field) as this usually indicates a tear. Your doctor will evaluate the retina and determine whether or not treatment is needed.

Retinitis pigmentosa is a genetically transmitted disease, in which light receptors in the retina slowly lose function and are destroyed. The first area of vision to be affected is in the mid-periphery, but the entire field of vision gradually becomes smaller. Night blindness and loss of peripheral vision are the most common symptoms. One eye may be more affected than the other. There is no known treatment for retinitis pigmentosa. Some individuals have been helped by specially tinted lenses. If research underway is successful in growing retinal tissue, replacement of the retina may become possible. A retinitis pigmentosa society has been established to keep people updated and to offer support.

Accommodation is the ability to focus your eyes to increase their refractive power. A normally sighted person must accommodate in order to read. This is achieved when the ciliary muscle of the eye contracts causing a thickening in shape (more convex) of the crystalline lens. A clear image on the retina is formed. The most common cause of accommodative spasm is failure of the ciliary muscles to completely relax after prolonged near work. This may result in fatigue, headaches or temporary blur of distance vision after prolonged close work. Treatment includes exercises to relieve the accommodative spasm and/or reading glasses.

A subconjunctival hemorrhage occurs when a blood vessel breaks in the clear tissue overlying the white of the eye (conjunctiva). It may be associated with any illness where sneezing, coughing and vomiting are occurring. It does not affect vision and rarely causes any discomfort. A subconjunctival hemorrhage will clear on its own within 1-2 weeks. Treatment of the underlying illness, warm compresses to help dissipate the hemorrhage or artificial tears to decrease dryness and irritation may be recommended.

Toxoplasmosis is caused by toxoplasma gondii, a small parasite which can infect any warm blooded animal. People become infected by eating under cooked meat containing the cysts of the parasite, or by being exposed to feces from infected cats. Pregnant women can transmit the disease to the fetus. During the first trimester of pregnancy, this causes serious disabilities. Infection during the third trimester usually does not affect the fetus.Toxoplasmosis is believed to be one of the most common causes of inflammation of structures in the back of the eye. Symptoms include blurred vision, floaters (seeing floating particles) and pain. A permanent decrease in central vision occurs in half of the active inflammations. Blood tests are sued to confirm that an infection is, or has been, present. Typically, topical medications are used to treat toxoplasmosis. Oral medication may be advised, depending upon the site of the lesion.

Viral conjunctivitis is an infection of the covering over the white of the eye (conjunctiva) caused by exposure to a number of viruses. It is spread through the air by sneezing and coughing or when an already infected person touches another person’s eyes. The conjunctivitis generally starts in one eye and may spread to the other. The white of the eye is usually red and there may be lid swelling and a watery discharge. The doctor may find lumps under the lid (follicles) and a swollen lymph node by the ear. Unfortunately, no eye medications are available to kill these viruses. Treatment is directed at comfort, so cool compresses, artificial tears or eye whitening eye medication may be used.