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Diagnosis and Management of Eye Disease

Amblyopia (Lazy Eye)

Amblyopia, also known as "lazy eye" is the lack of normal visual development in an eye, despite the eye being healthy. Amblyopia generally starts at birth or during early childhood. The most common cause of amblyopia is strabismus (intermittent or constant misalignment of the eyes). Another common cause is a significant difference in refractive errors in the two eyes. Amblyopia can be treated with vision therapy, patching one eye, eyeglasses and surgery.

Astigmatism

Astigmatism is one of the most common vision problems, but most people don't know what it is. Many people are relieved to learn that astigmatism is not an eye disease. Like nearsightedness and farsightedness, astigmatism is a type of refractive error - a condition related to the shape and size of the eye that causes blurred vision. In addition to blurred vision, uncorrected astigmatism can cause headaches, eye strain and make objects at all distances appear distorted. This common visual problem can be corrected with eyeglasses, contact lenses and refractive surgery.

Blepharitis

Red, swollen eyelids and crusty debris at the base of your eyelashes are signs you may have blepharitis. Blepharitis is inflammation of the eyelids, occurring particularly at the eyelid margins. It's a common disorder and may be associated with a low-grade bacterial infection or a generalized skin condition. Blepharitis occurs in two forms: anterior blepharitis and posterior blepharitis. Anterior blepharitis affects the front of the eyelids, usually near the eyelashes. The two most common causes of anterior blepharitis are bacteria and a skin disorder call seborrheic dermatitis, which causes itchy, flaky red skin. Posterior blepharitis affects the inner surface of the eyelid that comes in contact with the eye. It is usually caused by problems with the oil (meibomian) glands in the lid margin. Blepharitis can be difficult to manage because it tends to recur. Treatment depends on the type of blepharitis you have. It may include applying warm compresses to the eyelids, cleaning your eyelids frequently, using an antibiotic and/or massaging the lids to help express oil from the meibomian glands. If your blepharitis makes your eyes feel dry, artificial tears or lubricating ointments may also be recommended. In some cases anti-bacterial or steroid eye drops or ointments may be prescribed.

Cataracts


A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away. The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and allows light to pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens making it harder to see. Most cataracts occur gradually as we age and don't become bothersome until after age 55. However, cataracts can also be present at birth (congenital cataracts) or occur at any age as the result of an injury to the eye (traumatic cataract).Cataracts can also be caused by diseases such as diabetes or can occur as the result of long-term use of certain medications, such as steroids. Cataracts are treated surgically. Surgical correction is safe and effective and offers several new options for better vision.

CMV Retinitis

Cytomegalovirus (CMV) retinitis is a sight threatening disease associated with late-stage AIDS. In the past, about 25% of active AIDS (Acquired Immunodeficiency Syndrome) patients developed CMV retinitis. However, this figure appears to be dropping thanks to a potent combination of drugs that help restore the function of the immune system.

Corneal Transplant


People with serious vision problems from an eye injury or disease affecting the front surface of the eye can often regain vision with a cornea; transplant. A cornea transplant, which replaces damaged tissue on the eye's clear surface, also is referred to as keratoplasty, penetrating keratoplasty (PK) or corneal graft. A cornea transplant replaces central corneal tissue, damaged due to disease or injury, with healthy corneal tissue donated from an eye bank. An unhealthy cornea affects your vision by scattering light and causing blurred or distorted vision. In some cases, a cornea can be so damaged or scarred that a transplant is necessary to restore your functional vision. Cornea transplants are performed routinely. In fact, of all tissue transplants, the most successful is a corneal transplant. A new version of corneal transplant, known as Descemet's Stripping Endothelial Keratoplasty (DSEK), also has been introduced as a new surgical method that uses only a very thin portion of the cornea for transplant. In certain cases, this type of procedure may be preferred because it has advantages such as being less likely to create an irregular corneal surface (astigmatism) as a side effect.

Diabetic Retinopathy

If you have diabetes, you probably know that your body can't use or store sugar properly. When your blood sugar gets too high, it can damage the blood vessels in your eyes. This damage may lead to diabetic retinopathy. In fact, the longer someone has diabetes, the more likely they are to have retinopathy (damage to the retina) from the disease. In its advanced stages, diabetes may lead to new blood vessel growth over the retina. The new blood vessels can break and cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as retinal detachment, and it can lead to blindness if untreated. In addition, abnormal blood vessels can grow on the iris, which can lead to glaucoma. People with diabetes are 25 times more likely to lose vision than those who are not diabetic, according to the American Academy of Ophthalmology, Diabetic retinopathy can be treated with a laser to seal off leaking blood vessels and inhibit the growth of new vessels.

Dry Eye Syndrome


Dry eye syndrome (DES or "dry eye") is the chronic lack of sufficient lubrication and moisture on the surface of the eye. Its consequences range from minor irritations to the inability to wear contact lenses and an increased risk of corneal inflammation and eye infections. Dry eye is a common condition, especially in women over age 40. There are many treatment options ranging from artificial tears to punctal plugs to nutritional supplements to prescription drugs.

Eye Allergies

Similar to processes that occur with other types of allergic responses, the eye may overact to a substance perceived as harmful even though it may not be. For example, dust that is harmless to most people can cause excessive tear production and mucus in eyes of overly sensitive, allergic individuals. Eye allergies are often hereditary. Allergies can trigger other problems such as conjunctivitis (pink eye) and asthma. Most of the more than 22 million Americans who suffer from allergies also have allergic conjunctivitis. Allergies may be treated by many different medications as well as by immunotherapy.

Floaters and Spots

Have you ever seen small specks or debris that look like pieces of lint floating in your field of view? These are called "floaters," and they are usually normal and harmless. They usually can be seen most easily when you look at a plain background, like a blank wall or blue sky. Floaters are actually tiny clumps of gel or cells inside the vitreous - the clear, jelly-like fluid that fills the inside of your eye. Floaters may look like specks, strands, webs or other shapes. Actually, what you are seeing are the shadows of floaters cast on the retina, the light-sensitive inner lining of the back of the eye. Most spots and floaters in the eye are harmless and merely annoying. However, if you see a lot of floaters with flashes of light, this may be a warning sign of a detached retina and should be checked immediately.

Glaucoma

Glaucoma refers to a category of eye disorders often associated with a dangerous buildup of internal eye pressure (intraocular pressure or lOP), which can damage the eye's optic nerve-the structure that transmits visual information from the eye to the brain. Glaucoma typically affects your peripheral vision first. This is why it is such a sneaky disease. You can lose a great deal of your vision from glaucoma before you are aware anything is happening. If uncontrolled or left untreated, glaucoma can eventually lead to blindness. Glaucoma is currently the second leading cause of blindness in the United States. Glaucoma is often referred to as the "silent thief of sight," because most types typically cause no pain and produce no symptoms. For this reason glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss. But there are other forms of the disease (specifically, acute angle-closure glaucoma), where symptoms of blurry vision, halos around lights, intense eye pain, nausea, and vomiting occur suddenly. Glaucoma is usually treated with medications (eyedrops) and laser surgery.

Hyperopia


Hyperopia, or farsightedness, is a common vision problem affecting about 25% of the U.S. population. People with hyperopia can usually see distant objects well, but have difficulty seeing objects that are up close. Farsighted people sometimes have headaches or eyestrain, and may squint or feel fatigued when performing work at close range. Hyperopia is treated with eyeglasses, contact lenses and refractive surgery.

Keratoconus

Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on Its way to the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes. Keratoconus is relatively rare. Onset of the disease usually occurs in people in their teens or early twenties. For the mildest farm of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses or soft contacts no longer provide adequate vision correction. The next step in the treatment of keratoconus is usually fitting the patient with gas permeable contact lenses and/or hybrid gas permeable contact lenses. When these lenses no longer provide adequate vision correction, corneal transplant surgery is the final option.

Macular Degeneration

Macular degeneration (also called AMD, ARMD, or age-related macular degeneration) is an age related condition in which the most sensitive part of the retina, called the macula, starts to break down and lose its ability to create clear visual images. The macula is responsible for central vision-the part of our sight we use to read, drive and recognize faces. So although a person's peripheral vision is left unaffected by AMD, the most important aspect of vision is lost. AMD is the leading cause of vision loss and blindness in Americans of ages 65 and older. Older people represent an increasingly larger percentage of the general population, and vision loss associated with macular degeneration is a growing problem. Macular degeneration can be classified as either dry (non-neovascular) or wet (neovascular). Neovascular refers to growth of new blood vessels in an area, such as the macula, where they are not supposed to be. The dry form of AMD is more common-about 85% to 90% of all cases of macular degeneration are the dry variety. There is as yet no outright cure for macular degeneration, but some treatments may delay its progression or even improve vision. There are no FDA-approved treatments for dry AMD, although nutritional intervention may be valuable in preventing its progression to the more advanced, wet form. For wet AMD, there are several FDA-approved drugs aimed at stopping abnormal blood vessel growth and vision loss from the disease. In some cases, laser treatment of the retina may be recommended.

Myopia


Myopia or nearsightedness is a very common vision problem. It's estimated that up to one third of Americans are nearsighted. Nearsighted people have difficulty reading road signs and seeing distant objects clearly, but can see well for up-close tasks such as reading or sewing. Nearsightedness may be corrected with eyeglasses, contact lenses or refractive surgery. Depending on the degree of your myopia, you may need to wear eyeglasses or contact lenses all the time, or only when you need sharper distance vision, like when driving, viewing a chalkboard or watching a movie.

Ocular Hypertension

Ocular hypertension means the pressure in your eye, or your intraocular pressure (lOP), is higher than normal levels. Elevated lOP is also associated with glaucoma, which is a more serious condition that causes vision loss and optic nerve damage. By itself, however, ocular hypertension doesn't damage your vision or eyes. People with ocular hypertension are at increased risk for developing glaucoma, so some eye doctors prescribe medicated eye drops to lower lOP in cases of ocular hypertension. Other eye doctors choose to monitor your lOP and only take action if you show signs of developing glaucoma.

Pingueculae


Pingueculae (singular form = pinguecula} are yellowish, slightly raised lesions that form on the surface tissue of the white part of your eye (sclera}, close to the edge of the cornea. They are typically found in the open space between your eyelids, which also happens to be the area exposed to the sun. While pingueculae are more common in middle-aged or older people who spend significant amounts of time in the sun, they can also be found in younger people and even children-especially those who spend a lot of time in the sun without protection such as sunglasses or hats. The treatment for pingueculae depends on the severity of the growth and its symptoms. Everyone with pingueculae can benefit from sun protection for their eyes. Lubricating eye drops may be prescribed for those with mild pingueculitis to relieve dry eye irritation and foreign body sensation. To relieve significant inflammation and swelling, steroid eye drops or non-steroidal anti-inflammatory drugs may be needed. Surgical removal of the pinguecula may be considered in severe cases where there is interference with vision, contact lens wear or normal blinking.

Pink Eye (Conjunctivitis)

Technically, pink eye is the acute, contagious form of conjunctivitis - inflammation of the clear mucous membrane that lines the inner surface of the eyelids and overlies the white front surface of the eye, or sclera. Bacterial infection causes the contagious form of conjunctivitis; however, the term "pink eye" is often used to refer to any or all types of conjunctivitis, not just its acute, contagious form. The hallmark sign of pink eye is a pink or reddish appearance to the eye due to inflammation and dilation of conjunctival blood vessels. Depending on the type of conjunctivitis, other signs and symptoms may include a yellow or green mucous discharge, watery eyes, itchy eyes, sensitivity to lights and pain. Conjunctivitis is generally treated with different medications depending on the type of conjunctivitis you may have.

Presbyopia

Some time after age 40, people begin to experience blurred near vision when performing tasks such as reading, sewing or working at a computer. This change is called presbyopia. There's no getting around it - presbyopia happens to everyone at some point in life, even those who have never had a vision problem before. With the onset of presbyopia, you'll find you need to hold books, magazines, newspapers, menus and other reading materials farther away in order to see the print clearly. Headaches and eyestrain when reading or performing other near work after age 40 are other symptoms of presbyopia. Presbyopia is an age-related loss of flexibility of the lens inside the eye. This is different from astigmatism, nearsightedness and farsightedness, which are related to the shape of the eyeball and occur early in life. When the lens becomes hardened and less elastic, the eye has a harder time focusing up close. Presbyopia is corrected with eyeglasses, contact lenses and refractive surgery.

Ptosis


Ptosis (pronounced "toe-sis") refers to the drooping of an eyelid. It affects only the upper eyelid of one or both eyes. The droop may be barely noticeable or the lid can descend over the entire pupil. Ptosis can occur in both children and adults, but happens most often due to aging. The most obvious sign of ptosis is a lower-than-normal positioning of one or both of the upper eyelids. Depending on how severely the lid droops, people with ptosis may have difficulty seeing. Surgery is usually the best treatment for drooping eyelids. The surgeon tightens the levator muscles to restore the eyelids to their normal position. In very severe cases involving weakened levator muscles, the surgeon attaches the eyelid under the eyebrow to allow the forehead muscles to substitute for the levator muscles. Eyelid surgery is also known as blepharoplasty.

Retinal Detachment


A retinal detachment is a serious and sight-threatening event, occurring when the retina - the light-sensitive inner lining of the back of the eye - becomes separated from its underlying supportive tissue. The retina cannot function when it detaches and, unless it is reattached soon, permanent vision loss may result. If you suddenly notice spots, floaters and flashes of light, you may be experiencing a retinal detachment. Your vision might become blurry, or you might have poor vision. Another symptom is seeing a shadow or a curtain coming down from the top of the eye or across from the side. These symptoms can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches immediately. There is no pain associated with retinal detachment. If you experience any of the above symptoms, consult your eye doctor right away. Immediate treatment increases your odds of regaining lost vision. Surgery is the only effective treatment for a torn or detached retina.

Retinitis Pigmentosa


Retinitis pigmentosa (RP) is a rare, inherited eye disease in which the light-sensitive retina slowly and progressively degenerates. This causes progressive peripheral vision loss, night blindness, central vision loss and in some cases, blindness. No treatments currently are available for retinitis pigmentosa, although some practitioners believe that vitamin A supplements may delay vision loss.

Styes

A stye (or hordeolum) develops when an eyelid gland at the base of an eyelash becomes infected. Resembling a pimple on the eyelid, a stye can grow on the inside or outside of the lid. Styes are not harmful to vision, and they can occur at any age. Most styes heal within a few days on their own. You can encourage this process by applying hot compresses for 10 to 15 minutes, three or four times a day over the course of several days. This will relieve the pain and bring the stye to a head, much like a pimple. The stye ruptures and drains, then heals.

Uvetitis

This inflammatory eye disease can cause permanent vision loss if not promptly treated.

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