Strabismus is a condition in which the eyes point in different directions. Types of strabismus include crossed eyes (esotropia), out-turned eyes (exotropia), or vertical misalignment (hyper or hypotropia). Turning of the eye may be constant or may show up only some of the time. Strabismus should be evaluated and treated.

Symptoms of strabismus

• Double vision
• Eyes that look in different directions
• Head tilt or turn

Causes of strabismus

Strabismus is caused by a lack of coordination between the eyes. In children, the cause of strabismus is not known, although the condition runs in families and occurs more commonly in children with neurological problems.

In adults, causes of strabismus include injury to an eye muscle or the nerves controlling those muscles; head trauma; conditions such as diabetes or high blood pressure; loss of vision; an eye or brain tumor; Graves’ disease, stroke or other muscle and nerve disorders.

Treating strabismus

Children with strabismus must be identified and treated at a young age in order to prevent permanent vision problems.  In children, when the two eyes fail to focus on the same image, the brain may learn to ignore the input from one eye. If this is allowed to continue, the eye that the brain ignores will never see well. Children do not grow out of strabismus.

Treatment options depend upon the type of strabismus and may include glasses, patching one eye, prism lenses and/or surgery.

Photo courtesy of National Eye Institute, National Institutes of Health

Symptoms of a pterygium:

• Tissue growing over the eye
• Irritation
• Redness
• Tearing

Causes of a pterygium:

The exact cause of pterygia isn’t known, but it’s thought to be linked to:

• Long-term exposure to sunlight
• Dry, dusty conditions
• Age: Ptergia is typically found in adults over the age of 30.

Diagnosing a pterygium:

Chances are, you’ll notice a pterygium. Your eye doctor can also diagnose it during a routine eye exam.

Treatment of a pterygium:

Eye drops or ointment can be used to reduce the irritation caused by a pterygium. If the pterygium grows toward the central cornea, it may need to be removed surgically. Prevention is important. It’s a good idea to protect your eyes with sunglasses if you’ll be in the sun or a dusty, dry environment.

Conjunctivitis is an inflammation of the conjunctiva, the thin, transparent membrane covering the surface of the inner eyelid and the front of the eye. The conjunctiva has many small blood vessels. It lubricates and protects the eye while the eye moves in its socket. When the conjunctiva becomes inflamed, this is called conjunctivitis.

Bacterial conjunctivitis, often called pink eye, typically causes swelling of the eyelid and a yellowish discharge. Sometimes it causes itching and/or matting of the eyelids. Bacterial conjunctivitis is very contagious and can be easily transmitted by rubbing the eye and then infecting household items such as towels or handkerchiefs. It is common for entire families to become infected.

Symptoms of conjunctivitis:

• Red, watery eyes
• Inflamed eye lids
• Blurred vision and a sandy or scratchy feeling in the eyes
• Pus-like or watery discharge around the eyelids
• Matting of the eyelids

How can conjunctivitis be prevented?

Certain precautions can to taken to avoid the disease and stop its spread. Careful washing of the hands, the use of clean handkerchiefs, and avoiding contagious individuals are all helpful. Children frequently get conjunctivitis because of their poor hygiene.

If you or someone in your household has contracted conjunctivitis, follow these steps to prevent the spread of the infection:

• Every time you touch your eyes or face, including when using medicine in your eye(s), wash your hands thoroughly.
• Wash any clothing touched by infected eyes including clothes, towels and pillowcases.
• Do not share make-up. If the infection is caused by bacteria or a virus, you must throw away your used make-up and buy new make-up.
• Do not touch the infected eye because the infection will spread to the other eye.

Diagnosing conjunctivitis:

Your eye doctor can easily detect conjunctivitis at an exam.

Treatment for conjunctivitis:

Antibiotic drops and compresses can ease discomfort and clear up the infection, normally within just a few days. Sometimes, the inflammation does not respond well to the initial treatment with eye drops. In those rare cases, a second visit to the office should be made. When there is severe infection, oral antibiotics are necessary. If left untreated, conjunctivitis can create serious complications such as infections in the cornea, eyelids and tear ducts.

Presbyopia is a vision condition in which the lens loses its flexibility, making it difficult to focus on close objects. During the early and middle years of life, the crystalline lens of the eye has the ability to focus both near and distant images by getting thicker for near objects and thinner for distant objects. When this ability is lost, presbyopia results.

Symptoms of presbyopia:

• Blurry close vision that starts after age 40
• Difficulty adjusting focus when switching from near to distance vision
• Eye fatigue along with headaches when doing close work

Causes of presbyopia:

• Age: As we age, the lenses in the eyes lose some of their elasticity, and without elasticity they lose some of their ability to change focus for different distances. Presbyopia may seem to occur suddenly, but the actual loss of flexibility takes place over a number of years. Long before an individual is aware that seeing close up is becoming more difficult, the lenses in the eyes have begun losing their ability to flatten and thicken. Only when the loss of elasticity impairs vision to a noticeable degree is the change recognized. Presbyopia usually becomes noticeable in the early to mid-forties.

Diagnosing presbyopia:

A comprehensive examination will include testing for presbyopia. Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and near. A visual acuity test will determine your ability to see sharply and clearly at all distances. Your eye doctor will also check your eye coordination and muscle control, as well as your eyes’ ability to change focus. All of these are important factors in how your eyes see.

Treatment of presbyopia:

Reading glasses and contact lenses are used by many for the temporary treatment of presbyopia. However, there are a number of vision correction procedures that can surgically reduce or eliminate the effects of presbyopia. Some presbyopic patients like monovision, which allows them to see distance clearly in one eye and close-up clearly with the other eye.

Presbyopia can be present in combination with other types of refractive errors such as nearsightedness, farsightedness and astigmatism.

Myopia, unlike normal vision, occurs when the cornea is too curved or the eye is too long. This causes light to focus in front of the retina, resulting in blurry distance vision.

Myopia is a very common condition that affects nearly 30 percent of the U.S. population. It normally starts to appear between the ages of eight and 12 years old, and almost always before the age of 20. As the body grows, the condition often worsens. It typically stabilizes in adulthood.

Symptoms of myopia:

• Blurry distance vision

Causes of myopia:

• Heredity

Diagnosing myopia:

Many times, myopia is diagnosed during school screenings. Sometimes parents notice that their children are having difficulty seeing street signs or the television. Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and near. A visual acuity test will determine your ability to see sharply and clearly at all distances. Your eye doctor will also check your eye coordination and muscle control, as well as your eyes’ ability to change focus. All of these are important factors in how your eyes see.

Treatment of myopia:

Glasses and contact lenses are used by many for the temporary treatment of myopia. However, there are a number of vision correction procedures that can surgically reduce or eliminate myopia.

Other types of refractive errors include: nearsightedness, farsightedness and presbyopia.

The human eye gives us the sense of sight, allowing us to learn more about the surrounding world than any of the other five senses. The eye allows us to see and interpret the shapes, colors and dimensions of objects by processing the light they reflect or give off.

The cornea (the clear window on the front of the eye) and the lens of the eye (the transparent structure inside the eye) are both critical to normal vision. The goal of these two lenses is to focus light onto a layer on the back of the eye known as the retina. As light enters into the eye it is focused by the cornea and the lens so that images appear clearly on the retina. The retina then transmits these images to the brain where they are processed. If the images focus perfectly on the retina, this results in 20/20 vision; focusing in front or behind the retina results in nearsightedness or farsightedness. If the cornea is shaped like a football instead of a sphere, this is called astigmatism. When any of these conditions occurs, images are perceived by the brain as being blurry. This is due to “refractive error” which means the eyeball is not the right size or the cornea does not have the right curve. Presbyopia is a vision condition in which the lens loses its flexibility, making it difficult to focus on close objects.

During childhood, people with normal vision have the ability to focus on objects as close as their nose and also on objects very far away. They can rapidly, without conscious thought, switch focus from near to far vision. This is called accommodation. As each year passes, that ability to focus and to switch focus decreases. By the time most people reach their forties, they need an aid, such as reading glasses or bifocals, to focus on objects close up. This condition is called presbyopia.

Monovision is a technique where one eye (usually the dominant eye) is corrected for clear distance vision, and the other eye is corrected for comfortable near vision. Monovision allows a person to see close objects clearly with one eye and distance objects clearly with the other eye. The vision part of the brain tends to filter out the image from the eye that is not in clear focus, so those who have monovision eventually do not pay attention to the eye that is not as clearly focused. Those who have monovision are often able to see well enough both at distance and near to do things at any age without corrective lenses.

Monovision can be achieved with contact lenses or with vision correction procedures by correcting the non-dominant eye for near vision and the dominant eye for distance vision. If you are considering a vision correction procedure, your doctor can put you into monovision contact lenses so you can try it before you permanently correct your eyes with monovision.

Most people’s brains automatically get used to monovision within a couple of weeks or months. In our experience, most people over the age of 40 to 45 who try monovision and take the time to fully become accustomed to it, like it and find it very useful.

Keratoconus, often referred to as “KC” is an eye disease that causes the cornea to become progressively thinner. A normal cornea is round or spherical in shape, but with keratoconus the cornea bulges forward, assuming more of a cone shape. As light enters the cone shaped cornea it is bent and distorted and unable to come to a point of clear focus on the light-sensitive retina.

Keratoconus usually affects both eyes but the two eyes often progress at different rates. This disease typically begins during teenage years. In most patients, it progresses for several years before stabilizing in the third to fourth decade of life. In severe cases it can continue to worsen. In these cases the cornea continues to thin and bulge outward, further blurring vision. Scarring of the cornea can also develop.

Symptoms of keratoconus:

• bulging, cone-shaped cornea
• nearsightedness
• astigmatism
• glare and light sensitivity
• the need for frequent prescription changes

Who is at risk:

Researchers believe that approximately three million people worldwide have keratoconus. It affects males and females of all races throughout the world. The causes are still being researched, but the likelihood of developing keratoconus is greater if you:

• have a relative with keratoconus
• have had excessive laser eye surgery
• have hay fever, eczema, asthma or food allergies

Treatment

In mild cases, glasses and soft contacts can be effective, but in more advanced cases, these no longer work well.

Gas permeable (GP) contact lenses

These are the primary treatment for keratoconus. To counteract the distortion of the cornea, most keratoconus patients require special GP lenses to provide a smooth surface that can focus light in place of their own cornea’s distorted surface. Because the pattern of distortion in keratoconus is as unique as a fingerprint, the GP lenses are custom prescribed and manufactured.

A proper contact lens fitting is crucial to ensure optimal vision, comfort, and eye health. Poor fitting lenses can lead to corneal abrasions, scarring, and infection.

Surgery

Many keratoconus patients will never require surgery, but it is an option in severe and advanced cases. If your doctor determines you have significant scarring of the cornea, he or she may recommend corneal transplant surgery. In this procedure, the scarred tissue is replaced with a section of donated cornea that is clear. About 10 to 20% of keratoconus patients will eventually require a corneal transplant. However, corneal transplantation is not a cure. Following a successful corneal transplant, most patients still need glasses, soft contacts, or GP lenses for adequate vision.

Intacs prescription inserts

Your doctor may recommend a relatively new surgery for keratoconus using Intacs prescription inserts. This surgery is sometimes called intra-stromal corneal ring segment implantation. It is a procedure for patients who can’t wear GP lenses but whose disease has not progressed to the point of needing to have a corneal transplant. During this surgery, tiny plastic segments are placed inside the cornea beneath the surface to reduce nearsightedness and astigmatism. Normally, eyeglasses are still required after the procedure to give you the best possible vision.

Precautions

Patients with keratoconus must not have LASIK or PRK laser eye surgery due to an unacceptable risk of a poor outcome. The cornea in keratoconus is unusually thin and weak. For patients with keratoconus, LASIK surgery thins and weakens their corneas further. This can irreversibly destabilize the cornea and accelerate its distortion. Rubbing the eyes may also increase the progression of keratoconus. Eye rubbing can often be very vigorous with patients using excessive force with their knuckles. Corneas already weakened by inflammation may develop thinning and protrusion as a result of rubbing.

For More Information

Your eye doctor is the best resource for specific questions about your diagnosis and treatment. Remember that regular eye examinations are crucial for preserving your eye health and vision.

Overview

The cornea is the clear “window” in the front of the eye that allows light rays to enter.

The cornea is the clear “window” in the front of the eye that allows light rays to enter.

The cornea has three layers – the outer epithelium (or skin), a middle area called stroma and a delicate, single celled inner lining called the endothelium. The endothelium acts as a barrier to prevent water inside the eyeball from moving into and swelling the other layers of the cornea. The cells of the endothelium actively pump water from the cornea back into the eye.

If the endothelium does not function normally, then water moves into the cornea causing swelling. Swelling causes clouding of the cornea and blurred vision. The more corneal swelling or “edema,” the more severely the vision is blurred. Eventually, the outer corneal layer (epithelium) also takes on water, resulting in pain and more severe vision impairment. Epithelial swelling reduces vision by changing the normal curvature of the cornea. It causes a sight-limiting haze to develop. Epithelial swelling may also form small “blisters” on the corneal surface. When these “blisters” burst, extreme pain can occur.The cornea has three layers – the outer epithelium (or skin), a middle area called stroma and a delicate, single celled inner lining called the endothelium. The endothelium acts as a barrier to prevent water inside the eyeball from moving into and swelling the other layers of the cornea. The cells of the endothelium actively pump water from the cornea back into the eye.

Endothelial cells can be counted with special photographic methods. Most people are born with approximately 4,000 cells per square millimeter of the endothelial surface. These cells do not divide and cannot reproduce or replace themselves. As we age, we gradually lose endothelial cells.

Age	Endothelial Cell Density
Infant	3,000 – 4,000 / sq. mm
Teenager	3,000 / sq. mm
Adult	2,500 – 3,000 / sq. mm
Elderly	2,000 – 2,500 / sq. mm

Once lost, endothelial cells do not grow back. The remaining cells spread out to cover the empty spaces, trying to pump water from a larger area. The pump system becomes less efficient, causing corneal clouding, swelling and eventually, reduced vision. Fortunately, most people have enough endothelial cells throughout life to prevent corneal swelling or edema. If the cells are healthy and functioning properly, as few as 500 cells per square millimeter can maintain a clear cornea. If the cells are not healthy, fewer than 1000 cells per square millimeter may result in corneal swelling or edema.

Fuchs’ Dystrophy

Fuchs’ dystrophy (named after Dr. Fuchs) is an inherited condition that affects the delicate inner layer (endothelium) of the cornea. Patients with Fuchs’ dystrophy have endothelial cells that:

1. Do not function as efficiently as normally
2. Age and deteriorate more rapidly than normal cells

Fuchs’ dystrophy affects both eyes and is slightly more common in women then men. On average, half of the family members of an affected person may carry or suffer from the condition. The exact cause of Fuchs’ dystrophy is unknown. Hereditary, hormonal and inflammatory factors probably all play a role.

Signs and Symptoms

In early stages, people with Fuchs’ dystrophy may wake up with blurred vision, which gradually clears over the day. That’s because during the day, water continuously evaporates from the surface of the eye and is replaced with water drawn from the inner compartments of the eye. Overnight, when we sleep with closed eyes, water cannot evaporate from the surface of the eye and accumulates in the cornea, causing slight swelling which blurs vision. Once eyes are opened throughout the day, evaporation reduces the water content and the thickness of the cornea, allowing for clearing of vision. In later stages, as the dystrophy worsens, evaporation is not enough to remove accumulated water in the cornea, and swelling and blurred vision last all day.

Typical complaints among people with Fuchs’ dystrophy include:

• Hazy vision that is often most pronounced in the morning
• Fluctuating vision
• Glare when looking at lights
• Light sensitivity
• Sandy, gritty sensation
• Episodes of sharp, sometimes incapacitating pain

Detection and Diagnosis

Although doctors can often see early signs of Fuchs’ dystrophy in people in their 30s and 40s, the dystrophy rarely affects vision until people reach their 50s and 60s. Fuchs’ dystrophy is detected by examining the cornea with a slit lamp microscope that magnifies the endothelial cells thousands of times. The health of the endothelium is evaluated and monitored with pachymetry (which measures the thickness of the cornea) and specular microscopy (which photographs the cells for counting). As the dystrophy becomes more advanced, corneal clouding may make counting the cells impossible.

Treatment

Fuchs’ dystrophy cannot be cured. Doctors are unable to treat the endothelial cells to make them work better or to become more numerous. However, blurred vision resulting from the corneal swelling can be controlled with medication. Salt solutions containing sodium chloride (Muro 128 drops or ointment, 2% or 5%) are often prescribed to draw fluid from the cornea and reduce swelling. Steroid eye drops may be helpful in specific situations.

Another simple technique that reduces moisture in the cornea is to hold a hair dryer at arm’s length, blowing air towards the face with the eyes open. This warm air flow increases evaporation of water from the cornea, temporarily decreases swelling, and may improve vision. Often very helpful in early stages, this technique may not be effective when swelling is severe, as in advanced stages.

Corneal transplantation is considered when vision deteriorates to the point that it interferes with daily activities and impairs a person’s ability to function normally. This surgery replaces the full thickness of the cornea, including the endothelium, with healthy layers. The cloudy cornea is replaced with clear corneal tissue.

Hyperopia, unlike normal vision, occurs when the cornea is too flat in relation to the length of the eye. This causes light to focus at a point beyond the retina, resulting in blurry close vision and occasionally blurry distance vision as well. Usually this condition is undetected until later in life because the young eye is able to compensate for the hyperopia by contracting the internal lens of the eye.

Symptoms of hyperopia:

Blurry close vision

• Occasionally, blurry distance vision

Causes of hyperopia:

• Heredity

Diagnosing hyperopia:

Many people are not diagnosed with hyperopia without a complete eye exam. School screenings typically do not detect this condition because they test only for distance vision. Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and near. A visual acuity test will determine your ability to see sharply and clearly at all distances. Your eye doctor will also check your eye coordination and muscle control, as well as your eyes’ ability to change focus. All of these are important factors in how your eyes see.

Treatment of hyperopia:

Glasses and contact lenses are used by many for the temporary treatment of hyperopia. However, there are a number of vision correction procedures that can surgically reduce or eliminate hyperopia.

Other types of refractive errors include: nearsightedness and presbyopia.

We were all born with smooth, baby-soft skin. When we were children, the muscles under our skin contracted to display facial lines of emotion, signifying happiness or sadness. As soon as our emotions returned to normal, our expression lines disappear.

But as we go through a lifetime of emotions and our skin begins to lose its elasticity, those facial lines do not go away completely, making us look older than we feel. Our skin becomes a road map showing the effects of where we have been and what we have done

Causes of facial wrinkles:

• Age
• Sun exposure
• Alcohol use
• Smoking
• Poor nutrition
• Heredity

Treatment for facial wrinkles:

There are several cosmetic procedures that can reduce facial wrinkles.

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Most likely, your eyes are the first thing people notice about your appearance. They are probably the most important aspect of facial attractiveness. Unfortunately, even with a good night’s sleep, loose skin over your eyes or bags under your eyes can make you look tired or sad, or older than you really are. As we go through life, even if we have taken care of ourselves, the skin around our eyes stretches and wrinkles. Fatty deposits cause the upper lids to sag, while under the eye the tissue bulges forward and becomes discolored. In severe cases, vision can become partially blocked.

Causes of droopy eyes:

• Age
• Sun exposure
• Alcohol use
• Smoking
• Poor nutrition
• Heredity

Treatment for baggy eyes:

The most common treatment for baggy eyes is called blepharoplasty or eyelid surgery.

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The front portion of the eye is covered with a thin, transparent membrane called the cornea, which protects the interior of the eye. If there is a break or defect in the surface layer of the cornea, called the epithelium, and damage to the underlying stroma, a corneal ulcer results. The ulcer is usually caused by microorganisms, which gain access to the stroma through the break in the epithelium.

Corneal ulcers generally heal well if treated early and aggressively. However if neglected, corneal clouding and even perforation (a hole in the cornea) may develop, resulting in serious loss of vision and possibly loss of the eye. Corneal ulcers are a serious vision-threatening condition and require prompt medical attention.

Symptoms of corneal ulcers:

• Watery eyes
• Acute pain
• Sensitivity to light
• Blurry vision
• The feeling that there’s something in your eye
• Discharge from the eye

Causes of corneal ulcers:

• Infection
• Wearing contact lenses for excessive periods of time
• Inadequate contact lens sterilization
• Eye injury
• Lack of tear production
• Complications of herpes simplex keratitis, neurotrophic keratitis, chronic blepharitis, conjunctivitis, trachoma, bullous keratopathy and cicatricial pemphigoid
• Vitamin A deficiency or protein malnutrition
• Eyelid abnormalities

Diagnosing corneal ulcers:

Corneal ulcers are a serious vision-threatening condition and require prompt medical attention. If left unattended, corneal ulcers may penetrate the cornea allowing infection to enter the eyeball, which can cause permanent loss of vision and possible loss of the eye. Your eye doctor can identify corneal ulcers by examining your eyes with magnifying instruments and performing a culture study to identify infection. Your doctor will check your eye, including under your eyelid, to make sure there are no foreign materials present. Depending on the initial exam, fluorescein dye may be used to identify the corneal defects. A test called the Seidel test (painting the wound with dye and observing for leakage) may be performed to uncover possible deeper injuries.

Treatment for corneal ulcers:

If treated early, corneal ulcers are usually curable in two to three weeks. They are typically treated with antibiotic eye drops. Sometimes, topical steroids will also be used to decrease the risk of scarring and inflammation.

The cornea is the clear front window of the eye. It transmits light to the interior of the eye allowing us to see clearly. Corneal disease is a serious condition that can cause clouding, distortion and eventually blindness. There are many types of corneal disease. The three major types are keratoconus, Fuchs’ endothelial dystrophy and bullous keratopathy.

Symptoms of corneal disease:

• With keratoconus, as the cornea protrudes or steepens, vision becomes increasingly blurred and contact lens wear, which is often an early treatment for the disease, becomes difficult. The contact lens may not stay on the eye due to the irregular shape of the cornea.
• A person with Fuchs’ endothelial dystrophy or bullous keratopathy may first notice glare with lights at night or in bright sunlight. As these conditions progress, vision may be foggy or blurry in the morning and clear up as the day progresses. As the diseases further progress, vision will stay blurrier later into the day and eventually may not clear at all.
• Some corneal diseases can be very painful.

Keratoconus is a weakening and thinning of the central cornea. The cornea develops a cone-shaped deformity. Progression can be rapid, gradual or intermittent. Keratoconus usually occurs in both eyes, but can occur in only one eye.

Fuchs’ endothelial dystrophy is a hereditary abnormality of the inner cell layer of the cornea called the endothelium. The purpose of this layer is to pump fluids out of the cornea, keeping it thin and crystal clear. When the endothelium is not healthy, fluids are not pumped out and the cornea develops swelling, causing it to become cloudy and decrease vision.

Bullous keratopathy is a condition in which the cornea becomes permanently swollen. This occurs because the inner layer of the cornea, the endothelium, has been damaged and is no longer pumping fluids out of the tissue.

Causes of corneal disease:

• Infection: Bacterial, fungal and viral infections are common causes of corneal damage.
• The cause of keratoconus in most patients is unknown.
• Age: Aging processes can affect the clarity and health of the cornea
• Cataract and intraocular lens implant surgery: Bullous keratopathy occurs in a very small percentage of patients following these procedures.
• Heredity
• Contact lenses
• Eye trauma
• Certain eye diseases, such as retinitis pigmentosa, retinopathy of prematurity, and vernal keratoconjunctivitis.
• Systemic diseases, such as Leber’s congenital amaurosis, Ehlers-Danlos syndrome, Down syndrome and osteogenesis imperfecta.

Diagnosing corneal disease:

Your eye doctor can check for corneal disease and trauma by examining your eyes with magnifying instruments. Using a slit lamp and advanced diagnostic technology such as corneal topography, your doctor can detect early cataracts, corneal scars, and other problems associated with the front structures of the eye. After dilating your eyes, your doctor will also examine your retina for early signs of disease.

Treatment for corneal disease:

As with any serious eye infection, corneal disease should be treated immediately. Although corneal transplant is almost always the necessary treatment to restore vision when the cornea becomes clouded, there are other measures that can be taken to prolong vision in the early stages of disease.

The cornea is the clear, outer window of the eye. A corneal abrasion is simply a scratch in the epithelium (skin), or the thin, outer layer of the cornea. Abrasions usually heal in a short time period, sometimes within hours. Deeper or larger scratches may take up to a week. The cornea has a tremendous number of nerve endings, which makes any damage to the cornea very painful.

Symptoms of corneal abrasions:

• History of a recent eye trauma
• Watery eyes
• Acute pain
• Sensitivity to light
• Blurry vision
• The feeling that there’s something in your eye
• Twitching eyelid

Causes of corneal abrasions:

• Foreign body in the eye
• Contact lenses
• Chemicals
• Blow to the eye
• Scratched eye (fingernails, hairbrushes, tree branches, etc).

Diagnosing corneal abrasions:

Your eye doctor can identify corneal abrasions by examining your eyes with magnifying instruments. Your doctor will check your eye, including under your eyelid, to make sure there are no foreign materials present. Depending on the initial exam, fluorescein dye may be used to help locate and identify the corneal abrasions. A test called the Seidel test (painting the wound with dye and observing for leakage) may be performed to uncover possible deeper injuries.

Treating corneal abrasions:

Your doctor may apply a topical anesthesia to help relieve the pain. Usually, a tight patch will be placed over the eye and if the abrasion is small, the epithelium should heal overnight. If the abrasion is large, it may take a few days and your doctor may prescribe antibiotics to help prevent infections. It is important that you do not rub your eye, especially during the healing process.

Blepharitis means inflammation of the eyelids.  Some doctors call it granulated eyelids. Almost everyone gets blepharitis at some time in his or her life. Some people get it repeatedly. Fortunately, blepharitis is relatively easy to treat.

Types of blepharitis:

Staphylococcus blepharitis is caused by a germ called Staphylococci, commonly known as “staph.” It often begins in childhood and continues throughout adulthood. This form of the condition results in collar scales on lashes, crusting, and chronic redness at the lid margin. Dilated blood vessels, loss of lashes, sties, and chalazia (nodules on the eyelids) also occur.

Seborrhea blepharitis is the most common and least severe form of this condition. It is not an infection but is caused by improper function of the oil glands, which causes greasy, waxy scales to accumulate along the eyelid margins. Seborrhea may be a part of an overall skin disorder that affects other areas. Hormones, nutrition, general physical condition and stress are factors in seborrhea.

Ulcerative blepharitis is a less common but more severe condition that may be characterized by matted, hard crusts around the eyelashes, which, when removed, leave small sores that may bleed or ooze. There may also be a loss of eyelashes, distortion of the front edges of the eyelids and chronic tearing.

In severe cases, the cornea, the transparent covering of the front of the eyeball, may also become inflamed.

Symptoms of blepharitis:

• Itchy, burning, watery eyes
• Sore eyes
• Sticky discharge that causes the eyelashes to stick together
• Redness of the eyelid edges
• Frequent sty formation
• Tiny pimples on the eyelid edges
• Scaly skin flakes along the eyelid margins
• Gritty sensation leading to irritated eyes and light sensitivity
• Blurred vision

Causes of blepharitis:

• Poor eyelid hygiene
• Excess oil produced by the glands in the eyelid
• Bacterial infection (often staphylococcal)
• Allergic reaction

Treating blepharitis:

In addition to eliminating redness and soreness, treatment can prevent potential infection and scarring of the cornea. You doctor will perform a complete eye examination to determine the most effective treatment.

Cleaning
Usually, blepharitis can be controlled by careful, daily cleaning of the eyelashes. You can do this by moistening a clean washcloth with tap water as warm as you can stand without burning. Hold the washcloth against the eyelids until it cools, then rewarm and repeat for five to ten minutes.

After soaking, scrub each eyelid gently for one minute using a clean washcloth wrapped around your index finger and moistened with warm tap water. Cotton-tipped applicators, like Q-tips, are also useful to remove accumulated material from the eyelashes.

To remove excessive amounts of material from your eyelids, use a few drops of a non-irritating shampoo, such as baby shampoo, mixed in lukewarm water. Being careful to avoid getting shampoo in your eye, scrub back and forth along the eyelashes of all eyelids, and then rinse with plain tap water. Once the redness and soreness are under control, this cleaning may be decreased from daily to twice weekly. However, if the symptoms return, return to daily cleansing immediately.

Medication
In some cases, your doctor may prescribe eye drops or ointment to be used along with the daily cleansing regimen. For ointments, use a clean fingertip to rub a small amount into the eyelashes. Be careful to follow recommended dosages; excess medication will cause temporary blurring of vision. And with any medication, there is a small possibility of allergy or other reaction. If you think this is happening, stop the medication and contact your doctor immediately.

For certain types of blepharitis, medications taken by mouth are helpful. Most of these medications are antibiotics that also improve or alter the oil composition of the eyelid oil glands. When taken properly, they are safe. However, side effects may occur in some individuals, including skin rash, slight nausea and increased sensitivity to sun.

Although medications may help control the symptoms of blepharitis, they alone are not sufficient; keeping the eyelids clean is essential.

If you think you may have blepharitis, your eye doctor can determine the cause and recommend the right combination of treatment specifically for you.

Astigmatism, unlike normal vision, occurs when the cornea is shaped like a football (more curved in one direction than the other) and often occurs in combination with myopia (nearsightedness) and hyperopia (farsightedness). This causes light to focus in more than one point on the retina, resulting in blurry and distorted vision.

Symptoms of astigmatism:

• Blurry, distorted vision at all distances

Causes of astigmatism:

• Heredity
• Lid swellings such as chalazia
• Corneal scars
• Keratoconus

Diagnosing astigmatism:

Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and near. A visual acuity test will determine your ability to see sharply and clearly at all distances. Your eye doctor will also check your eye coordination and muscle control, as well as your eyes’ ability to change focus. All of these are important factors in how your eyes see.

Treatment of astigmatism:

Glasses and contact lenses are used by many for the temporary treatment of astigmatism. However, there are a number of vision correction procedures that can surgically reduce or eliminate astigmatism.

Astigmatism

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Blepharitis

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Cataracts

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Corneal Abrasions

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Corneal Disease

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Corneal Ulcers

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Droopy Eyes

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Facial Wrinkles

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Farsightedness (Hyperopia)

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Fuchs’ Corneal Dystrophy

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Narrow-Angle Glaucoma

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Open-Angle Glaucoma

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Keratoconus

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Monovision

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Normal Vision

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Nearsightedness (Myopia)

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Presbyopia

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Pink Eye (Conjunctivitis)

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Pterygium

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Strabismus

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Education is the key to patient satisfaction at Eye Physicians of Virginia.

The benchmark for choosing a healthcare provider should be surgeon experience, diagnostic technology, location, and how well they educate their patients. We feel, the more you know about eye care, the tougher questions you will ask eyecare providers when searching for eye care services. In addition to the massive amount of information on our website, we want to provide you with even more information from other reliable sources.

Here are a few links to those sites we feel offer unbiased information about eyecare. If you find another Web site that you feel has helped educate you about your eyes, please email us at eyadlithe@netzero.net.

Other Vision Correction Resources on the Web:

• • • www.usaeyes.org: Council for Refractive Surgery Quality Assurance
    • www.fda.gov/cdrh/lasik/: U.S. Food and Drug Administration

Other General and Senior Eye Health Resources on the Web:

• • • www.medem.com: Medem
    • www.webmd.com: Web MD
    • www.myhealthyeyes.com: My Healthy Eyes
    • www.nei.nih.gov: National Eye Institute
    • www.allegretto.ca : Allegretto
    • www.myclearvision.com: MyClearVision.com
    • www.intralasefacts.com: Intralase Facts

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