Blepharitis – Blepharitis is an inflammatory condition of the eyelid margin and eyelashes and can be commonly referred to as ‘eyelash dandruff’. It generally causes itching, redness, and a foreign body sensation of the eyelid margin. It is most commonly caused by an excess of staphylococcal bacteria on the skin in this area however, it can also be caused by a dysfunction of nearby tear and sweat glands. Blepharitis is usually treated by addressing lid hygiene. The use of warm compresses and a lid scrub (Ocusoft lid scrubs) twice daily is usually sufficient to control the condition. At times, it is necessary to use antibiotics or anti-biotic/steroid combinations to limit more severe forms of the condition.
Giant papillary conjunctivitis (GPC)
GPC is characterized by large nodules, or bumps on the underside of the upper eyelid. These nodules are usually an inflammatory response to contact lens wear. They can produce symptoms of itching, burning, foreign body sensation, and contact lens discomfort. Treatment is aimed at eliminating the symptoms. Many times, the use of artificial tears or anti-histamines is very successful. However, steroids may be indicated for resistant cases. When GPC is caused by contact lens wear, the lens material and design must be changed to eliminate the symptoms.
“Red eyes”
“Red eyes” (or ‘pink eye’) may be the result of any of the following conditions: bacterial infection, viral infection, fungal infection, allergies, or inflammatory conditions. Most of these conditions will look the same and may cause symptoms of burning, itching, blurred vision, redness, tearing, mattering, or colored discharge. It is important to distinguish which condition is causing the symptoms so that the appropriate treatment can be initiated. (Note: whenever these symptoms occur in contact lens wearers, the contacts must be discontinued until treatment is complete). Most of these conditions, while serious and potentially sight-threatening, can be easily treated if detected early. Treatement is based upon which condition is causing the symptoms and can include the use of anti-biotics, anti-virals, anti-inflammatories, anti-histamines, anti-fungals, or artificial tears.
Pterygium and pinguecula
Pterygium and pinguecula are both excess growths of conjunctival tissue (the clear membrane that covers the white part of the eye). A pinguecula is excess growth that is limited to the white part of the eye and a pterygium is that growth which extends over the cornea itself. Both conditions are relatively benign and are thought to be a by-product of wind exposure and UV light exposure from the sun. At times, they may become red and irritated and may require anti-inflammatories to eliminate the redness. No treatment is required for most cases. In those cases where the pterygium grows into the line of sight (or those cases where it is cosmetically undesirable) it can be surgically removed.
Corneal ulcers
Corneal ulcers are caused by infections (either bacterial, viral, or fungal) that invade the corneal epithelium (outer corneal layer) and cause an infection of the cornea itself. Eyes with a corneal ulcer are usually very red, painful, and photophobic (sensitive to light) with decreased vision and discharge. These ulcers are usually caused by contact lens wear, thus the contacts must be discontinued immediately until treatment is completed. Treatment is usually aggressive, as the condition can be severely sight-threatening, and can include anti-biotics, anti-virals, anti-fungals, and anti-inflammatories. The most common form of contact lenses that cause corneal ulcers are extended-wear lenses worn overnight. Sleeping in a soft contact lens overnight increases the chance of getting a corneal ulcer by 15 times!
Keratoconus
Keratoconus is an inherited degenerative disease that causes thinning of the central cornea. This thinning leads to severe corneal steepening and warpage. In later stages of keratoconus, the cornea assumes the shape of a cone (as indicated in the picture). In these severe cases, clear vision cannot be obtained by glasses or soft contact lenses. The only corrective modality that can yield useful vision is a special design rigid-gas-permeable (RGP) contact lens. When the RGP has been fit successfully, useful vision can be obtained for many years (and possibly forever) without the need for surgery. In some cases, however, a corneal transplant becomes necessary.
Foreign body
A foreign body is described as any foreign particulate matter that enters the eye. Many times, foreign bodies can be flushed with saline. However, there are times when the object will become embedded in the eye (usually the cornea) and must be surgically removed. The picture here shows a piece of metal which has become embedded in the cornea. This can be removed in the office with relative ease. Foreign bodies must, however, be removed immediately (or as soon as possible) to prevent infection and loss of vision.
Glaucoma
Glaucoma is often known as the ‘silent thief of sight’ because it takes away the vision so slowly (over years), it’s hard to recognize the loss. Glaucoma is most likely inherited and causes a progressive degeneration of the optic nerve which results in permanent loss of peripheral vision. The top figures to the left indicate the appearance of a normal optic nerve and a gluacomatous optic nerve, respectively. Note that the glaucomatous optic nerve has a much larger ‘white hole’ in the center representing nerve fiber loss. The bottom figures to the left indicate a normal visual field and a glaucomatous visual field, respectively. Note that there is much more peripheral vision loss (black) in the glaucomatous field. The figure to the left Represents what a person with severe glaucoma might see. Glaucoma is a severe sight-threatening disease that must be diligently treated over many years to prevent severe vision loss and blindness. The treatment is initiated with daily eye-drops containing special medications. The treatment may progress to surgery in later years if progressive vision loss continues despite the medical therapy.
Retinal detachment
Retinal detachments can occur in anyone, but are more prevalent in those with high near-sightedness or diabetic retinopathy. They occur when the retina itself is pulled away from the back of the eye. As the retina is pulled away from it’s blood supply, it begins to die from lack of oxygen and nutrients. This can lead to permanent vision loss in a short amount of time. Therefore, a retinal detachment is a true ocular emergency and requires immediate surgical intervention.
Macular degeneration
Macular degeneration is the leading cause of blindness in the United States in persons over the age of 65. Macular degeneration is caused by an deterioration of the retinal pigment epithelial cells in the macula. These cells would normally give us protection from light rays. When they are absent, damage can occur leading to impairment of the central vision. Persons with this disease generally have good peripheral vision, however, central vision is distorted or lost. There are two forms of macular degeneration based upon the appearance and amount of ‘bleeding’: the dry form and the wet form. The wet form of the disease may be treated with laser therapy to try to prevent the vision from deteriorating. There is currently no known treatment for the dry form. Persons with this disease can, however, take measures of prevention. It is thought that taking vitamins or eating foods (such as kelp, spinach, etc.) that are high in lutein and zeaxanthin, can nourish the macular cells. Special lenses embedded with synthetic melanin may also protect the macula from harmful light rays.
