Ocular Disorders

Astigmatism

A condition where the surface of the eye is oval shaped, like a football, rather than round. This uneven curvature of the eye causes light to be refracted (bent) differently in one direction than another, resulting in distorted vision. Astigmatism can occur alone, with nearsightedness or farsightedness, and can usually be corrected with glasses, contact lenses or refractive surgery, such as laser vision correction. For more information about refractive errors please click here.

Blepharitis

A chronic inflammatory condition of the eyelids, common in children and adults, which causes redness, burning, itching, swollen and/or crusty lid margins and dry-eye symptoms. Maintaining very clean eyelid margins is one of the easiest treatments. In more severe cases, antibiotic drops and ointments are used to control the condition.

Blepharitis is a common condition that involves an inflammation of the eyelids (blepharo-lid, itis-inflammation). The causes of blepharitis are usually noninfectious. In unusual cases it may be due to bacterial, viral, chlamydial or fungal organisms. Most commonly it is due to inflammation associated with skin problems or systemic disorders.

The lids contain skin, eyelashes (cilia), and meibomian glands. At the base of the lashes (lash follicles) are special glands, which, along with the meibomian glands, secrete an oil or lipid material that, floats on the tear film and prevents evaporation of the tears. Blepharitis involving these glands can affect the oily layer of the tear film leading to increased evaporation and dry eye symptoms.

The common symptoms of blepharitis are mattering or mucus discharge from the eye upon awakening from sleep, redness and irritation of the lid margins, foreign body sensation and stinging, itching of the lids, blurred or decreased vision, and pain or discomfort with bright lights (photophobia). There may also be crusting of the lid margins and, in cases of prolonged blepharitis, there may be sty or chalazion formation. Symptoms tend to be worse upon arising, improving over the next 4-5 hours and then worsening later in the day.

Other factors that are important in the cause of blepharitis include scalp and facial skin diseases such as seborrhea, rosacea, psoriasis or other eczema-like skin diseases.

Evaluation

Careful evaluation of the eyelids and the eye by the eye doctor is used to determine what is causing the symptoms that you may have. At times, samples are taken from the surface lining the lids and the secretions from the meibomian glands to determine if there is any infection.

Treatment

The mainstay of treatment for blepharitis is lid hygiene. Oftentimes, there is dry, crusted material along the lid along with plugged meibomian glands. The application of heat helps to dissolve these secretions. This is accomplished by applying a warm washcloth to the closed eye for 5 minutes at bedtime and upon awakening.

At bedtime, an ointment may be prescribed for you to apply in the eyes and to the lids. Before using the ointment, gently warm the closed tube under warm water or in your hand. This will make the ointment easier to apply. Ointment may be gently placed in the eye by gently pulling the lower lid down and depositing small amounts of the ointment on the inside of the lid. Alternatively, ointment may be placed on a cotton-tipped applicator or a finger and applied to the lids.

Artificial tears, antibiotic and or cortisone drops may be used if there is significant infection or inflammation. These drops should be used only as directed by the eye doctor.

Cataracts

A gradual opacity or clouding of the normally clear crystalline lens of the eye, caused by the natural aging process, metabolic changes, injury, various forms of radiation, toxic chemicals and certain drugs. Symptoms may include the following: blurring of vision; sensitivity to light; double vision in one eye; frequent changes in eyeglass prescription; difficulty in reading in low light; declining night vision; and/or fading or yellowing of colors. Treatment of cataracts today is an outpatient, surgical procedure that takes only a short time.. In most cases, daily activities, such as driving and reading, can be resumed almost immediately, usually within a day or two.

Cataracts are an opacity or clouding of the normally crystalline lens of the eye, caused by the natural aging process, metabolic changes, injury, various forms of radiation, toxic chemicals and certain drugs. The leading cause of vision loss among adults age 60 or older, cataracts impair vision, making everyday activities increasingly difficult.

In simple terms, a cataract is usually part of the normal aging process that changes the natural, clear lens of the eye into a cloudy, opaque structure that inhibits or diminishes the passage of light to the retina. The condition can be compared to a window that is frosted or "fogged" with steam. 
Symptoms:
Patients with cataracts often experience the following symptoms:

• Blurring of vision
• Glare, or sensitivity to light
• Double vision in one eye
• Frequent changes in eyeglass prescription
• Difficulty in reading in low light
• Declining night vision
• Fading or yellowing of colors

Detection: Adults over the age of 40 should schedule routine eye examinations on an annual basis to determine whether cataracts or other eye disorders are present. A thorough examination by an ophthalmologist or qualified eye care professional usually includes:

• A visual acuity test to measure clarity at various distances
• Pupil dilation to examine the lens and retina for other eye problems
• Tonometry, a standard procedure to measure fluid pressure inside the eye

Safe Surgery; Speedy Recovery: Not long ago, cataract surgery required a hospital stay and was usually postponed as long as possible. Today, the procedure is performed on an out-patient basis and takes only a few minutes. Patients are free to return home to rest in comfort and avoid the inconvenience and expense of a hospital stay. In most cases, daily activities such as driving and reading can be resumed almost immediately.

During the surgery, the cloudy lens is removed from the eye. In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens implant.

Cataract surgery is considered one of the most popular and highly successful procedures, with improved vision occurring in over 90 percent of cases. In fact, a study by the American Society of Cataract and Refractive Surgery recently reported that more than 98 percent of cataract patients had their vision successfully improved following surgery. Many patients report vision that is even better than before they developed cataracts. Results are permanent; once removed, cataracts will not reoccur. For more information click here.

Conjuctivitis

An inflammation of the eye's white outer membrane, which causes redness, swelling, itching and watering. In allergic conjunctivitis, both eyes are usually affected. Viral or bacterial conjunctivitis can affect a single eye or both eyes. There are several medications available to relieve the symptoms. Most of the medications are topical, such as eye drops or ointments. For more information please click here.

Corneal Disease (Keratitis)

A deep infection or inflammation of the cornea caused by an abrasion or the presence of bacteria or fungi in the cornea. The condition may cause severe pain, reduce vision, produce a corneal discharge or even erode the cornea. Minor corneal infections can be treated with eye drops. If the problem is more serious, the patient may receive more intensive medical treatment to eliminate the infection and reduce inflammation.

Corneal Ulcer

A condition of the cornea that occurs when localized tissue has eroded, and may cause a red, painful eye. There are a number of treatment options, depending on the severity of the problem. Often times this is due to an infection and it requires immediate treatment from an ophthalmologist.

Diabetic Retinopathy

Diabetic Eye Disease

Diabetes is the leading cause of blindness in working-age Americans. Approximately 29 million Americans age 20 or older have diabetes. But many, almost one-third, don't know they have the disease and are at risk for vision loss and other health problems.

Diabetic eye disease, a group of eye problems that affects those with diabetes, includes diabetic retinopathy, cataracts and glaucoma. The most common of these is diabetic retinopathy, which affects 5.3 million Americans age eighteen and older.

Diabetic retinopathy is a potentially blinding condition in which the blood vessels inside the retina become damaged from the high blood sugar levels associated with diabetes. This leads to the leakage of fluids into the retina and the obstruction of blood flow. Both may cause vision loss. More than one-third of those diagnosed with diabetes do not receive the recommended vision care and are at risk for blindness. Often early symptoms are unnoticed, therefore your vision may not be affected until the disease is severe and less easily treatable.

Once you are diagnosed with diabetes, schedule a complete dilated eye examination with your Eye M.D. at least once a year. Make an appointment promptly if you experience blurred vision and/or floaters that:

• Affect only one eye
• Last more than a few days
• Are not associated with a change in blood sugar

In advanced cases of diabetic retinopathy, laser treatment has been shown to reduce the chance of severe vision loss and blindness. This surgery does not cure diabetic retinopathy or restore vision that has already been lost, nor does it prevent future vision loss, especially if diabetes or blood pressure is not well controlled.

Diabetes can also affect your vision by causing cataracts and glaucoma. If you have diabetes, you may get cataracts at a younger age and your chances of developing glaucoma are doubled.

Early diagnosis of diabetes and most importantly, maintaining strict control of blood sugar and hypertension through diet, exercise and medication can help to reduce your risk of developing eye diseases associated with diabetes.

An Eye M.D. is an ophthalmologist — a medical doctor who provides the full spectrum of eye and vision care. From eyeglasses and contact lenses to medication and surgery, your Eye M.D. will help you keep your sight for life. For more information click here.

Dry Eye Syndrome

A condition caused by the reduction in quality and quantity of tears. Common symptoms include pain from eye irritation; a sandy or gritty sensation; decreased tolerance to contact lenses; and sensitivity to light. In early stages, the symptoms may seem to appear and disappear, but generally worsen as the day progresses. The condition is typically treated with artificial tears and/or prescription drops or ointments. Closure of the tear drainage system (punctal occlusion) may also improve symptoms. The use of high-quality Omega-3 fatty acids have been found to be beneficial in many cases. Dry eyes affect millions of people throughout the world. The condition is most common in women after menopause, but it can affect both sexes and all age groups, including children.

The symptoms of dry eyes are well known to sufferers — irritation, redness, sensitivity to light, and the constant sensation of foreign matter in the eye. However, these symptoms are less frequently recognized by health care professionals, who often neglect or minimize them. A clearer understanding of the nature and causes of dry eyes may enable sufferers to cope with their condition and participate in the care and treatment of their eyes.

Causes of Dry Eyes

There are many causes of dry eyes. Aging is certainly a factor; as people age, they secrete fewer tears, leading to dryness. Hormones probably play a role, as dry eyes are also more common in women than men, especially post-menopausal women. Systemic diseases, like Sjogren's syndrome, rheumatoid arthritis, lupus and Riley-day syndrome, and diseases of the eye that affect the eyelids, the eye's surface or the cornea can also cause or aggravate dry eyes. Similarly, conditions which affect the eye's ability to close or to blink completely also dry out the surface of the eye.

Antihistamines, tranquilizers, blood pressure, heart medications, and other types of drugs can lead to dry eyes. Even the topical artificial teardrops used to treat dry eyes can actually aggravate the condition, due to the detergent-like preservatives they contain.

There is a decrease in tear production following LASIK and Phototherapeutic Refractive Surgery that can persist 3-6 months. This can be significant enough that it requires frequent administration of artificial tear substitutes.

The Tear Film: The tear film protects the eye by cleansing and flushing harmful chemicals and environmental contaminants from the surface. This anti-infectious film, which covers the surface of the eye, is like a three-layer sandwich.

The outer, or lipid, layer is very thin and oily. This layer, which floats on the surface of the tear film, is secreted by the meibomian glands located just behind the lashes in the lids. The outer layer prevents evaporation of the tear film; abnormalities and diseases of the eyelids, such as blepharitis, styes, and chalazia, cause increased evaporation and dry eyes.

The middle, or aqueous, layer is secreted by the lacrimal glands and accounts for most of the tear film. This layer provides the eye surface with oxygen and various nutrients. Sjogren's syndrome, a systemic disease characterized by dry eyes and dry mouth, affects the lacrimal gland leading to a decrease in aqueous tear secretion.

The inner, or mucin, layer is secreted by goblet cells normally present on the surface of the eye. This layer coats the eye's surface (epithelium) with a substance called mucin, which enables tears to "stick" to the surface of the eye. Deficiencies in mucin can cause dry eyes in patients with eye disorders caused by chemical injuries, Steven-Johnson syndrome, and ocular pemphigoid and systemic diseases caused by nutritional deficiencies.

The eyelids are also important in maintaining the tear film. Eyelids, which open and close normally, spread tears over the surface of the eye (epithelium). That does not occur in patients with abnormal lid position, poor lid closure, or an incomplete blink.

The Surface of the Eye: The epithelium keeps bacteria and other microorganisms, chemicals and pollutants from entering the eye. The epithelium and the tear film form the major refracting surface of the eye and are responsible for sharp, clear vision.

Damage to the surface of the eye accounts for the pain, foreign body sensation, difficulties with bright lights, decreased or blurred vision, increased risk of infection and problems with allergic or toxic reactions to topical eye drops in patients with dry eyes.

Treatment of Dry Eyes

Initially, dry eyes are usually treated with topical lubricating drops (artificial tears) applied up to six times daily. Ointments are at times prescribed for nighttime use. Commercially available drops cannot be used more frequently because they contain detergent-based preservatives. Overuse of these drops can cause tears to break up rapidly, actually aggravating a dry eye condition. Artificial tears must be used to prevent irritation and other symptoms. Using the drops only after the eyes become irritated is not effective.

If discomfort continues, the next step is closing the tear drainage ducts. This is done with silicone or collagen plugs inserted in the tear ducts which can be removed if needed. At times, permanent cautery occlusion may be done. Prescription ophthalmic drops may also be helpful as they improve the production of the body’s natural tears. High quality Omega-3 fatty acid supplementation has been shown to be of benefit in some patients.

Patients with dry eyes must take an active role in the treatment of their dry eyes. They must use the prescribed medications. They must protect their eyes from irritation. They must note when and where their symptoms are worse or better so their doctor can discover what contributes to their dry eyes.

For more information about dry eyes, please click here to visit www.dry-eye-syndrome.net

For even more information click here.

Flashes and Floaters

The eye is filled with a jelly-like substance called vitreous gel. With age, this gel becomes increasingly more liquid-like in nature, causing small particles, called floaters, to become visually evident. Flashes originate from the tugging on the retina as the vitreous gel liquefies. This process is normal; however, significant flashes and floaters may indicate a more serious retinal condition, calling for prompt medical attention. For more information click here.

Glaucoma

A vision-threatening disease that can cause optic nerve damage, most often from high pressure caused by poor drainage of a fluid (aqueous humor) which supplies nutrients to the cornea and lens. Treatment involves medications, laser procedures and/or surgery to lower internal eye pressure by opening drainage passageways for the trapped fluid. A complete annual eye exam is the best and earliest means to detect glaucoma.

Glaucoma, one of the leading causes of vision loss, involves progressive and irreversible damage to the optic nerve. Fortunately, glaucoma is highly treatable. The key to preventing serious vision loss or blindness from glaucoma is early detection. An annual, fully dilated eye examination is recommended.

There are two basic types of glaucoma. They include:

Open-angle glaucoma, the most common type that occurs in approximately 90 percent of those who suffer from the disease. This condition can develop gradually and undetected for years, slowly damaging vision. In early stages of open-angle glaucoma, medicated eye drops are usually prescribed to lower the eye's pressure. If the condition worsens, a laser procedure called a trabeculoplasty is performed to lower pressure further. Laser therapy usually takes approximately 10 minutes and has achieved excellent success rates in select patients.

Angle-closure glaucoma, which is much more rapid in the onset, affects less than ten percent of glaucoma patients. Symptoms occur suddenly and are much more severe, but vision can be preserved with prompt, effective treatment. The treatment for angle-closure glaucoma, or narrow-angle glaucoma, is generally initiated with laser iridotomy to open the drainage channels of the eye.

How do I know if I am at risk for glaucoma?

There are several segments of the general population are at risk for glaucoma. They include advancing age, particularly individuals over the age of 60; African Americans; siblings or children of glaucoma patients; people who are extremely nearsighted or farsighted; and patients with diabetes.

Can glaucoma be prevented?

No. However, if glaucoma is detected early enough, the damage to the eye can be stabilized.

Can glaucoma be treated?

Yes. With early detection and treatment, we can usually prevent serious vision loss or blindness from glaucoma.

Does glaucoma testing take long?

Not at all. You can be screened for glaucoma in less than 30 minutes.

Does glaucoma testing hurt?

No. The tests are painless and leave no after-effects. Results of the tests will be discussed by the eye doctor during the visit.

What if the screening shows that there is a problem?

At that point, further examination is recommended to confirm glaucoma. If the diagnosis of glaucoma is confirmed, the sooner we begin treatment, the better.

What are the treatment options for glaucoma?

That's the good news. There are a number of highly effective treatment options for glaucoma patients. Most patients are started on eye drops as the initial treatment. Laser therapy may be appropriate for certain forms of glaucoma. Finally, if medical or laser therapy fails to control the disease, surgical therapy may be necessary. Fortunately, with early detection, most forms of glaucoma can be successfully treated and visual loss may be halted. Dr. Schneider has the latest in diagnostic and treatment options available for the earliest detection and most effective treatment. For more information about Glaucoma click here.

Herpes Zoster (Shingles)

An infection, which is produced by the same virus that causes chicken pox. After an initial outbreak of chicken pox, the virus remains dormant within the nerve cells of the central nervous system. In some cases, however, the virus will reactivate in the eye. This can cause painful blisters on the skin and, sometimes, the eye. Early anti-viral treatment may reduce inflammation and scarring in the cornea when the skin around the eye is affected.

Hordeolum (Stye)

Definition: A stye (hordeolum) is a red, painful, swollen, cyst-like bump of the eyelid caused by a localized inflammatory process and low grade infection. A chalazion is a nodule of scar tissue that can remain after a stye resolves.

Causes: A stye usually results from a clogged or malfunctioning oil gland in the eyelid. Bacteria may cause a small infection around the clogged gland, creating a painful, swollen abscess in the lid. This may resolve without further problems, but sometimes causes a nodule of scar tissue or inflammatory material to form in the same area, which is called a chalazion. Some patients with blepharitis or ocular rosacea may have recurrent styes or chalazia.

Symptoms: A stye usually develops over a few days into a swollen, red, tender bump on the eyelid. Often, the lid will droop because of the associated swelling. Sometimes blurry vision also occurs. A chalazion may remain after the stye resolves, or may occasionally form gradually in the lid, without a previous stye in the same area. The bump formed by a chalazion is usually not very painful or red, but may be mildly tender. Both a stye and chalazion can cause mild blurry vision from the bump pressing on the eye.

Treatment: A stye is treated with warm compresses and over-the-counter pain medication, such as acetaminophen (Tylenol) or ibuprofen (Advil). Warm compresses should be used several times daily, and help to open up the obstructed oil gland in the lid. If the stye hasn’t resolved in a week or two, or, if it grows larger, the redness and swelling spread beyond the lid onto the face or cheek, or you develop a fever, you should contact your doctor, as antibiotics or occasionally, surgical drainage of the stye may be needed. A chalazion may resolve on its own over may weeks or months without treatment. However, a chronic, unresolving chalazion may need to be removed with a minor surgical procedure.

Prognosis: Styes and chalazion are usually not sight or life threatening, and often resolve on their own with simple treatment measures. Those requiring surgical excision usually heal without further problems.

Iritis

An inflammation of the colored part of the eye, or iris, resulting in an eye that is red, painful and sensitive to light. The condition may be recurrent and linked to a systematic disease. Medical diagnosis and treatment are necessary to decrease pain and to prevent other eye structure damage. For more information please click here.

Keratoconus

Definition: Keratoconus is a condition where the cornea thins and gradually bulges forward, assuming a cone-like shape.

Causes: The cause of keratoconus is likely multifactorial, with genetics playing part of the causative role. Some non-genetic factors, like constant eye rubbing, have also been implicated in the cause of keratoconus. Keratoconus may develop in the setting of other diseases, such as Down’s Syndrome and Marfan’s Syndrome.

Symptoms: The abnormal, cone-like curvature changes the cornea's refractive power in an irregular way, producing mild or even moderate to severe astigmatism and blurriness. Symptoms often begin in to a mild degree in the teens or twenties, and may slowly worsen over the next several decades. The astigmatism may slowly worsen or, occasionally, a scar may slowly form in the middle of the cornea, decreasing vision. Occasionally, the thinning in keratoconus disrupts the delicate layer of cornea responsible for keeping it clear, causing the cornea to suddenly swell and the eye to become very irritated. This acute swelling, called corneal hydrops, usually resolves over several weeks, but can leave a corneal scar behind, causing decreased vision. For more information, click here.

Treatment: In its earliest stages, keratoconus can be treated with glasses. As the astigmatism worsens, patients are fitted with special contact lenses to reduce the distortion and improve vision. In some patients, the condition may progress to the point where glasses or contact lenses are not effective in improving vision, and a corneal transplant may be required to gain improved vision.

Prognosis: Keratoconus generally first appears in the teens through early thirties. It may slowly progress over the next 10 to 20 years, but often stops progressing by late middle age. Most people with keratoconus can be effectively treated with glasses or contact lenses. However, about 20% of keratoconus patients eventually require surgery to help correct their vision.

Macular Degeneration

Definition: Macular degeneration is an age-related degradation of the retina. The area of the retina which is responsible for the center of vision, called the macula, is preferentially involved in this disease, while other parts of the retina are generally spared. Macular degeneration is classified as “Dry” or “Wet.” In Dry Macular Degeneration, pebble-like calcifications in the retina, called drusen, may form in the retina, and the retinal cells may slowly waste away through a process called atrophy. In Wet Macular Degeneration, new blood vessels may begin to grow under the retina, causing swelling and scarring of the retinal tissues.

The leading cause of poor vision among seniors, this condition is caused by the breakdown of the macula, the center part of the retina. It can cause gray, hazy or missing areas in the vision. For persons over 60, age-related macular degeneration (ARMD) is the leading cause of poor vision.

Cause: The cause of macular degeneration is unknown. It occurs almost exclusively in older persons, and is the leading cause of poor vision in persons over age 60. Smoking, high cholesterol or having family members with the disease may increase a person’s risk of developing macular degeneration.

Symptoms: Macular degeneration causes a decreased function of the central retina, the part which is used to see when looking directly at an object. A patient may notice that objects they are looking at are becoming gray or hazy, rather than clear. Later, parts of the object may appear to be missing. Sometimes, lines that should be straight, such as door frames, suddenly become wavy or blurred.

Treatment: While there is no cure for macular degeneration, there are a number of medical and laser treatment options available that may slow or even halt the process. A new class of drugs has shown great promise in helping prevent further damage from Wet Macular Degeneration. A specific formulation of vitamins, studied by the National Institutes of Health, has also been shown to slow the progression of Dry Macular Degeneration in patients with moderate to severe disease. Patients at risk for macular degeneration may benefit from these to help prevent blindness. For more information on eye vitamins, please visit http://www.nei.nih.gov/amd/ or http://www.WantWellness.com

Prognosis: Macular Degeneration is typically slowly progressive. Most patients will suffer only mild to moderate degrees of visual loss over a long course of time. However, if Wet Macular Degeneration develops, vision loss can occur more quickly and be more severe. Patients may occasionally regain a little vision with laser and drug treatments, but generally, vision that is lost cannot be restored. For more information click here.

Near Vision Problems

Aging of the Lens -- the cause of Presbyopia

When we are born, the natural lens inside each of our eyes is very soft and pliable. This lens is an elastic structure that changes shape, or accommodates, to focus on objects at various distances. As we age, this lens loses some of its elasticity and becomes more rigid, making it increasingly difficult to see things clearly at near and intermediate distances.

Presbyopia may seem to occur suddenly, but the actual loss of flexibility is gradual, taking place over a number of years. Long before we become aware that seeing up close is becoming more difficult, the lenses in our eyes have begun losing their elasticity and their ability to change shape (accommodate). Only when the loss of elasticity impairs the vision to a noticeable degree do we recognize the change. Presbyopia typically begins to interface with near vision between the ages of 40 and 45, and is particularly disturbing to people that have had excellent natural vision all their life.

Options to handle Presbyopia

Options for Presbyopia include magnifying glasses, bifocal, tri-focal, and progressive spectacles, bifocal and monovision contact lenses, and several surgical approaches. Your eye doctor can help you understand the best option to handle your particular situation. To learn more about the surgical approaches please discuss this with Dr. Schneider at your next appointment. For more information click here.

Pinguecula

Definition: A pinguecula is a slightly raised, benign yellowish thickening of the white part of the eye (conjunctiva) adjacent to the cornea.

Cause: Pinguecula are typically caused by repeated sun and wind exposure. For this reason, they are more common in people who have worked outside for their occupations or come from more southern climates.

Symptoms: Pinguecula are usually asymptomatic. Occasionally, they may become inflamed, causing irritation and redness of the eye. Sunglasses may be helpful in preventing further growth. Some pinguecula may slowly get bigger, growing onto the cornea and becoming a pterygium, which can cause decreased vision.

Treatment: Most pinguecula do not need treatment. Occasionally, artificial tears and possibly ibuprofen drops will be prescribed if the pinguecula is inflamed, irritated or causing dryness. Occasionally if they are very highly elevated, surgery may be used to remove the pinguecula.

Prognosis: Most pinguecula do not increase in size or progress to pterygia. Some may decrease in size with time.

Presbyopia

Definition: Presbyopia is the aging-associated loss of the ability of the eye to focus on near objects. Similar to the “zoom” on a camera, the young eye has the ability to accomodate, or change its focus from far to near objects and visa versa. This accommodative ability slowly declines with age.

Cause: The cause of presbyopia is unknown, but is thought to be due to a progressive hardening of the lens of the eye with age. This progressive hardening makes the lens less able to change its shape and increase its near focusing power.

Symptoms: Presbyopia results in decreased ability to see up close. A person may notice that they have to hold newspapers farther away from their eyes than they used to in order to see them clearly. The onset of presbyopia is typically in the mid to late 40s. For people who are hyperopic, symptoms may occur as early as the late 30s.

Treatment: The most common treatments for presbyopia are reading glasses or bifocals. Monovision contact lenses can also be used, in which one eye is corrected for near vision and the other eye for distance vision. Surgical treatment options are also available, including monovision LASIK, multi-focal intraocular lens implants and accommodating intraocular lenses.

Prognosis: Near vision slowly decreases with presbyopia until age 65 to 70, when all near focusing power of the eye is lost. Eventually, most patients require a different lens prescription for distance, intermediate vision (computer screen) and near vision (reading). It is a benign condition, however, and does not cause loss of vision other than the need to use near vision glasses. Excellent distance vision can be maintained, even with presbyopia.

Retinal Detachment

Definition: Retinal detachment is a condition that occurs when the retina separates from the supporting structures in the back portion of the eye.

Cause: Retinal detachment usually occurs because one or more small holes have formed in the retina. The fluid in the eye can then enter this hole, and like wallpaper peeling off a wall, become detached from the back wall of the eye. Holes in the retina can form with trauma, degenerations in the edge of the retina or may occur after eye surgery.

Symptoms: The sudden onset of many new floaters or flashes of light may indicate a retinal tear has occurred. Bleeding from the tear can cause floaters, and tugging on the retina by the vitreous jelly that fills the back of the eye can cause flashes. If the retina begins to detach, the patient may say a fuzzy, oily smudge in the far edge of the vision that may slowly progress toward the center of vision. If the retina responsible for the center of vision, the macula, becomes detached, the vision will decrease dramatically. People experiencing these symptoms should be evaluated by an eye doctor as soon as possible.

Treatment: Small tears in the retina that have not progressed to a retinal detachment can usually be treated with laser and observed closely. If a retinal detachment has occurred, surgery in the operating room is usually needed. A silicone band, called a scleral buckle, may be placed around the eye behind the eyelids to help the retina reattach. A vitrectomy, or surgical removal of the vitreous gel may also be needed to help repair the retina.

Prognosis: If a retinal detachment involves only the peripheral retina, then surgical repair usually helps maintain excellent vision. If the detachment has progressed to involve the center of vision, the macula, then some vision may be lost, even after surgical reattachment of the retina. For more information please click here.

Subconjunctival Hemorrhage

Definition: A subconjunctival hemorrhage occurs when a blood vessel of the white part of the eye (conjunctiva) breaks and bleeds, resulting in a reddened eye. The condition is analogous to a bruise on the skin, where vessels have broken and caused a localized discoloration.

Cause: Typically, no cause can be identified for subconjunctival hemorrhages. Sometimes older people are more prone to this condition due to aging changes in the small blood vessels of the conjunctiva, which make them more prone to bleed. Straining or heavy lifting can sometimes cause this condition to occur. If hemorrhages recur repeatedly over several months or longer, an underlying medical condition, such as high blood pressure, may be the cause.

Symptoms: A subconjunctival hemorrhage usually appears as new area of dark red coloration on the eye. Often, the eye will be white next to the area of hemorrhage, with a fairly well defined border between the hemorrhagic area and the white, uninvolved area. Typically there is no discomfort, or only a mild feeling of irritation. The vision almost never decreased from a subconjunctival hemorrhage.

Treatment: No treatment is required for subconjunctival hemorrhage. If mild irritation is present, artificial tears may help sooth the eye. If hemorrhages occur frequently, a person should receive a medical evaluation to ensure they do not have high blood pressure or other, rare causes of bleeding. Patients are encouraged to pursue a consultation for proper diagnosis and treatment for any eye redness that is concerning or does not improve in short time.

Prognosis: Like a bruise on the skin, a subconjunctival hemorrhage resolves with time. It may take a few weeks to completely resolve, during which time the involved area may turn yellowish in color, just like a resolving bruise.

Pterygium

Definition: A pterygium is a wedge-shaped growth on the cornea that can cause irregular warpage of the corneal curvature, called irregular astigmatism. Pterygium often arise from pingueculua that have progressively grown from the conjunctiva onto the cornea.

Cause: Pterygia, like pinguecula, are typically caused by repeated sun and wind exposure. For this reason, they are more common in people who have worked outside for their occupations or come from more southern climates.

Symptoms: Pterygia are usually asymptomatic. Occasionally, they may become inflamed, causing irritation and redness of the eye. UV-protective sunglasses may be helpful in preventing further growth. Sunglasses that block light from the side as well as the front may be helpful. Some pterygia may slowly grow onto the center of the cornea, blocking light and causing decreased vision.

Treatment: Most pterygia do not need treatment. Occasionally, artificial tears and possibly ibuprofen drops will be prescribed if the pterygium is inflamed, irritated or causing dryness. If the pterygium is causing severe astigmatism, or has grown onto the center of the cornea and is blocking light from entering the eye, a surgical procedure to remove the pterygium may be needed.

Prognosis: Though most pterygia do not cause severe symptoms or grow larger, those that do may require surgical removal. About 10-20% of the time, the pterygium may grow back after surgery, requiring a second removal procedure.