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Vision Disorders

  • Condition
    • Allergic reactions occur on the ocular surface.
  • Symptoms
    • Itchy eye is prominent, leading to frequent eye rubbing
    • Watery discharge
    • Red eye with congested blood vessels
    • Feeling something in the eye
    • History of allergy elsewhere in the body is common
    • Might be seasonally related
      • Usually occurring in spring and summer
  • Signs
    • Red eye with dilated blood vessels
    • Swelling and redness of the eyelids
  • Causes
    • Environmental (pollen, ragweed, dust, pet hair, chemicals, etc)
  • Treatment
    • Eliminate the cause, if identifiable
    • Cool compresses as needed
    • Eye drops
      • For mild to moderate cases, use non-steroidal eye drops.
        • Pataday (over-the-counter)
        • Alaway (over-the-counter)
        • Bepreve (prescription needed)
        • Elestat (prescription needed)
      • For moderate to severe cases,
        • Seek medical attention
        • Steroid eye drops are usually prescribed
        • Steroid eye drops should be used only under medical supervision
  • Condition
    • Loss of vision in an eye due to incomplete visual development in childhood
    • At birth, the infant’s visual system (the brain and the eye) is immature, and the complete maturation of the infant’s visual system requires light stimulations (in clear images) from the environment. If this process is interfered with, amblyopia may ensue.
  • Symptoms
    • Usually none
    • Typically amblyopia is discovered when vision in each eye is tested separately such as in eye examination or in eye screening.
  • Signs
    • Decreased vision that cannot be corrected completely with glasses or contact lenses
  • Causes
    • Misalignment of the eyes
      • For example: one eye turned-in or -out
    • Significant refractive error (near-sightedness, far-sightedness, or astigmatism) in one eye while the fellow eye is normal or has much less refractive error.
    • Other conditions that can lead to lazy eye
      • Cataract
      • Corneal scar
  • Treatment
    • Lazy eye develops early in infancy and, if left untreated, can become a lifelong condition.
    • Seek medical attention if lazy eye is suspected.
    • Glasses are prescribed, if significant far-sightedness, near-sightedness, or astigmatism is present.
    • Patch the good eye (should only be done under medical supervision) to ‘force’ the brain to use the lazy eye.
    • Muscle surgery is needed in some cases in order to re-establish proper ocular alignment and depth perception.
  • Condition
    • Loss of the sphericity (or roundedness) of the anterior (front) corneal surface

  • Symptoms
    • Decreased vision
    • Blurry vision with halos
    • Head tilt to clear vision
  • Signs
    • In eyes with astigmatism, the shape of cornea is not round, whereas in a normal eye, the shape of the cornea is round.
    • Useful analogy: a basketball, equally round in all directions, has no astigmatism, whereas an egg has a lot of astigmatism.
  • Causes
    • Astigmatism may develop with age.
    • Astigmatism may be present at birth.
    • Corneal scar
    • Wearing contact lenses for long term
  • Keratoconus:
    • A corneal disorder, characterized by progressive distortion in the shape of the cornea: see section on keratoconus)
  • Treatment
    • Glasses
    • Contact lenses
      • Soft toric contact lens
        • Which compensates for the irregularity of the corneal surface from astigmatism
      • Rigid gas-permeable contact lens
        • Which covers the irregularity of the corneal surface from astigmatism and provides round smooth surface for eye to see through
  • Laser vision correction (LASIK/PRK) is feasible, if
    • The astigmatism is stable.
    • There is no significant corneal scarring.
    • Patients with keratoconus are not candidates for laser vision correction.
  • Condition
    • Loss of vision to the point of significant handicap
  • Legal blindness
    • Defined in two ways
      • Best-corrected (with glasses or contact lenses) vision of 20/200 or worse in the better eye
      • Peripheral vision (side vision) limited to 20 degrees or less, regardless of vision
    • A deduction on federal income tax return
  • Legal driving vision in Illinois
    • Visual acuity for day driving must be 20/40 in the better eye and for night driving 20/70 in the better eye
  • Condition
    • Inflammation of the eyelashes and eyelid margin
    • Usually chronic with periodic exacerbation
  • Symptoms
    • Eye Itching
    • Eye Burning
    • Blurry vision
    • Mild eye pain
    • Feeling something is in the eye
    • Crusting on eyelashes, usually worse upon awakening
  • Signs
    • Crusty eye eyelashes
    • Red, thickened eyelid margins
    • Red eye with dilated vessels
    • Dry eye
  • Causes
    • Can be associated with acne rosacea, a skin condition characterized by the ‘Santa Claus’ complexion – red nose with rosy cheeks and chin.
    • Chronic inflammation of the lids is due to certain bacterial overgrowth and patient’s immunologic reactions to them.
  • Treatment
    • Clean eye lashes
      • With baby shampoo applied with a cotton-tipped applicator or wash cloth, or
      • With eye cleaning pads (Ocusoft), which are available over-the-counter.
    • Place warm compresses on upper eyelids with eyes closed.
    • Apply Artificial tears if dry eye is present.
    • Seek medical attention if above treatment is not effective or if acne rosacea is suspected.
    • Eye drops (such as Azasite) or oral medications (such as doxycycline), are usually prescribed in moderate to severe cases.
    • A short course of steroid eye drop or ointment is prescribed in some cases to control acute inflammation of eyelid margins.
  • Condition
    • Involuntary contractions of the eyelids
  • Symptoms
    • Uncontrolled twitching, blinking, or closure of eyelids
    • Both eyes are usually affected
    • Worsen under stress
  • Signs
    • Intermittent, forceful, involuntary closure of eyelids
    • The contractions could be so frequent and forceful in some cases that these patients are functionally blind
  • Causes
    • Unknown
    • Should be distinguished from lid closure due to eye irritation (such as allergy, foreign, dry eye, misdirected eye lash, etc).
  • Treatment
    • Botox injections, usually given every three to six months.
    • Eye lid surgery is considered in cases unresponsive to Botox injections.
    • For more information:
  • Condition
    • Loss of clarity in the natural lens of the eye
  • Symptoms
    • Decreases vision, usually slowly progressive
    • Glare and halos, especially looking at lights in the dark
    • Some cataract patients have difficulty distinguishing colors
  • Signs
    • Cloudiness in the natural lens of the eye
    • Yellowish to amber discoloration of the lens
    • Some patients become more near-sighted as their cataracts progress.
  • Causes
    • In most cases, cataract comes with age, although cataracts may affect all age groups.
    • Eye Trauma
    • Diabetes
    • Prolonged use of certain medications (such as steroids)
  • Treatment
    • Glasses, if vision can be corrected to an adequate level for patient to function well visually.
    • Cataract surgery (see Cataract Center and Presbyopia Center)
  • Condition
    • Characterized by abnormal color perception
    • Usually hereditary
    • More common in male
  • Symptoms
    • Usually none
    • Typically discovered on eye screening or examination
  • Signs
    • Fail to identify numbers correctly on the color plates
  • Causes
    • Genetic: about 7% of males and 0.5% of females are color blind.
    • Typically, color blindness starts from birth.
  • Treatment
    • None, if color blindness in present since birth
    • Seek medical attention if color blindness is newly onset and involves only one eye (this could be signs of an optic nerve disorder, such as optic neuritis).
  • Condition
    • Inflammation of the conjunctiva
    • Conjunctiva is the clear mucus membrane that covers the white part (sclera) of the eye. Conjunctiva helps the eyelid to glide smoothly over the front surface of the eye.
  • Symptoms
    • Red eye with congested blood vessels
    • Sticky eye lids
    • Itching may be present
    • Burning
    • Feeling something in the eye
  • Signs
    • Dilated blood vessels in the white part of eye
    • Eye Discharge (usually stringy, sticky and mucus-like)
    • Swollen eye lids in moderate to severe cases
  • Causes
    • Viral in most cases
    • Bacterial in some cases
      • More commonly seen in group settings (nursing homes, dormitories)
  • Treatment
    • Frequent hand washing
      • Hand sanitizers are also helpful and are more convenient.
    • Conjunctivitis can be contagious
      • Avoid body contact
      • Do not share towels, eating utensils, etc
    • In mild cases
      • Artificial tears
      • Cold compresses applied to eye lids (with eyes closed)
      • May use anti-allergy eye drops (see Allergy of the Eye) if eye itching is present
    • In moderated to severe cases
      • Seek medical attention.
      • Antibiotic eye drop or ointment is prescribed if a bacterial cause is suspected.
      • Steroid eye drops may be used to control acute inflammation.
      • Steroid eye drops should be used only under medical supervision.
  • Condition
    • Eye disorders due to:
      • Over-wearing contact lenses
      • Improper care of contact lenses
      • Poorly fitted contact lenses
  • Symptoms
    • Eye pain
    • Decreased vision
    • Hazy or steamy vision
    • Sensitive to light
    • Feeling something in the eye
    • Itchy Eye
    • Eye Discharge
    • Burning sensation in the eye
    • Decreased wear time
  • Signs
    • Red eye with congested blood vessels
    • Loss of clarity of cornea
    • Breakdown of corneal surface
    • Inflammation inside the eye (such as iritis)
    • New blood vessel growth on the cornea
      • Starts in the periphery of the cornea.
      • If untreated, these blood vessels may grow toward the center of cornea and may potentially interfere with vision.
  • Causes
    • Infection
      • Usually bacterial
      • Fungi and Acanthamoeba are other causes
        • In order to avoid infection from Acanthamoeba, only sterile saline should be used with contact lenses.
    • Allergy
      • Inflammation and discharge from eye allergy may make wearing contact lens difficult.
      • Wearing contact contacts may make eye allergy worse
      • In some cases, chronic allergic reaction can occur on the under side of the upper eyelid; this is known as giant papillary conjunctivitis (GPC).
    • Sensitivity to contact lens cleaning or storage solutions
      • Sensitivity can be related to the active ingredients or preservatives in these solutions.
    • Tight contact lenses
      • A well-fitted contact lens moves slightly with each eye blink, allowing a healthy circulation of tear under the contact lens.
      • A tight contact lens does not allow such circulation of tear and can lead to debris build-up and eye irritation.
    • Loosely fitted contact lens
      • A contact lens that moves too much may lead to eye irritation.
      • In some cases, the contact can move off the cornea completely and become dislodged under the eyelids.
    • Damaged or torn contact lenses
      • The torn edge of a contact lens could be sharp, and it may scratch or abrade the surface of eye (such as corneal abrasion).
    • Warping of corneal contour (distortion of the shape of cornea)
      • The shape of the cornea may be altered with chronic contact lens wear.
      • Usually corneal warpage is seen with hard or gas-permeable contact lenses, although corneal warpage can also occur with soft contact lenses.
      • The corneal warpage is usually reversible after stopping wearing contact lenses.
      • In rare cases, the corneal warpage could be permanent.
    • Deposits on contact lenses
      • Proteins from tear and eyelids accumulate on contact lenses after prolonged contact lens wear
      • These deposits can irritate the eye
  • Treatment
    • Seek medical attention IMMEDIATELY.
    • Only an eye professional can distinguish the various causes of contact lens-related disorders and provide the proper regimen.
    • Follow proper protocol in the caring and cleaning of contact lenses.
    • Replace contact lenses as prescribed.
    • Have regular contact lens checkups.
  • Condition
    • Breakdown of the corneal surface layer
  • Symptoms
    • Eye Pain
    • Sensitivity to light
    • Feeling something in the eye
    • Scratchiness with blinking
  • Signs
    • Breakdown of the surface layer of cornea
    • Red eye with congested blooded vessels
    • Eyelid swelling
  • Causes
    • Trauma is most common. Corneal surface can be injured from:
      • Foreign body in the eye, especially if it is under the upper eyelid
      • Chemicals
      • Misdirected eye lash
      • Fingernail
        • Typically seen in mothers
        • Caused by the sharp fingernails of infants and toddlers
    • From previous eye injury
      • In some patients, spontaneous corneal abrasions can develop months to years after the original corneal injury
      • The original corneal injury is commonly caused by a sharp edge (such as fingernail or paper cut)
      • This condition is known as recurrent corneal erosion
  • Treatment
    • Seek medical attention IMMEDIATELY.
    • Remove the contact lens if wearing one.
    • Antibiotic eye drop or ointment is usually applied.
    • Eye may be dilated if light sensitivity is present.
    • Apply artificial tears as needed to relieve scratchiness in the eye.
    • Apply eye drops (e.g., Acular) may be prescribed to relieve pain.
    • Eye may be patched if patient has moderate to severe discomfort.
    • Bandage contact lens may be used to cover the corneal abrasion in some cases.
    • For recurrent corneal erosion, Muro-128 eye ointment (available over-the-counter) may be applied at bedtime as a preventive measure.
  • Condition
    • Loss of deep corneal tissue with breakdown of overlying corneal surface
  • Symptoms
    • Usually rapid in onset
    • Red eye with congested blood vessels
    • Pain, usually moderate to severe
    • Feeling something in the eye
    • Sensitivity to light, frequently moderate to severe
    • Mucus discharge, usually in copious amount
  • Signs
    • Red eye with congested blood vessels
    • White infiltrates (spots) in cornea
    • Breakdown of corneal surface
    • Loss of corneal tissue, leading to thinning of the cornea
    • Thick mucus Discharge
    • Corneal swelling
    • Loss of corneal clarity (hazy cornea)
    • Inflammation inside the eye (such as iritis)
    • Eyelid swelling
  • Causes
    • Bacterial
      • Most common
      • Frequently seen in patients who wear soft extended-wear contact lenses
    • Other causes include: fungus, Herpes simplex, Herpes zoster (shingles), and Acanthamoeba
  • Treatment
    • Seek medical attention IMMEDIATELY.
    • Remove the contact lens.
    • Treat with frequent antibiotic eye drops (to be used under close medical supervision).
    • Eye drops are prescribed to relieve pain and light sensitivity
    • Close follow-up is vital.
    • If left untreated, corneal ulcer can lead to perforation of the eye and possibly blindness.
  • Condition
    • Retinal disorder from pathological changes in the retinal blood vessels from longstanding diabetes mellitus
  • Symptoms
    • Normal vision to severe loss of vision
    • Fluctuation in vision
    • Floators
  • Signs
    • Bleeding in the retina
    • Swelling of retina
    • Growth of abnormal retinal blood vessels
    • Bleeding into the vitreous (jelly in the eye, which fills the space between the lens and retina)
    • Retinal tear
    • Retinal detachment
    • Retinal scarring
    • Growth of abnormal iris blood vessels
    • Glaucoma
  • Causes
    • Diabetic retinopathy is caused by injury to the retinal blood vessels from chronically elevated blood sugar level.
    • Diabetic retinopathy is divided into two stages:
      • Non-proliferative stage
        • This is the earlier stage.
        • Characterized by retinal hemorrhages and retinal swelling
        • Loss of vision is usually from swelling of macula (the central part of retina that provides the sharp central vision).
      • Proliferative stage
        • This is the later stage, after the non-proliferative stage.
        • Characterized by abnormal retinal vessel growth, which can lead to vitreous hemorrhage, retinal tear, retinal detachment, retinal scarring and glaucoma
  • Treatment
    • Laser is used to treat macular edema, abnormal retinal blood vessels, abnormal iris blood vessels and retinal tears.
    • Intraocular injections of medications (such as Avastin) are used to treat macular edema and abnormal vascular growth.
    • Surgery is performed to remove vitreous hemorrhage and to repair retinal detachment.
    • Tight control of blood sugar level is imperative in the preventing the development of serious diabetic retinopathy.
    • Regular medical follow-ups and blood tests is a must.
    • Regular eye examination is a must for every diabetic patient.
      • In diabetic retinopathy, early detection and treatment outcome leads to better outcome.
  • Condition
    • Characterized by a lack of tear production or instability of tear film
  • Symptoms
    • Eyes Burning
    • Scratchiness in the eye
    • Feeling something in the eye
    • Decreased vision, usually mild to moderate
    • Exacerbated by:
      • Environmental conditions
        • Pollution
        • Low humidity
        • Wind
      • Prolonged use of eye
        • Reading
        • Working on computer
  • Signs
    • Decreased tear film on surface of eye
    • Unstable tear film
    • Rough corneal surface with loss of luster
  • Causes
    • Age-related
      • With age, tear production decreases
      • Particularly prevalent in women who are in menopause or post-menopause
    • Associated with other diseases
      • Dry eye can a part of Sjogren’s syndrome, which is defined as having concomitantly dry eye and dry mouth
      • Primay Sjogren’s syndrome
        • Having dry eye and dry mouth without a known associated underlying disorder
      • Secondery Sjogren’s syndrome
        • Having dry eye and dry mouth associated with an associated underlying disorder, which is usually arthritic or inflammatory in nature
      • Disorders associated with Secondary Sjogren’s Syndrome include:
        • Rheumatoid arthritis (most common)
        • Systemic lupus erythematosus
        • Scleroderma
        • Sarcoidosis
    • Drug-related
      • Contraceptives
      • Anti-histamines (such as Benadryl)
      • Beta-blockers (used to treat high blood pressure or heart arhythmias)
  • Treatment
    • Artificial tears in mild cases
      • Preservative-free artificial tears are recommended for patients who use artificial tears frequently or are sensitive to preservatives present in some artificial tears.
    • Lubricating eye ointment in moderate to severe cases
      • Lubrication eye ointment may cause blurry vision.
      • Lubrication eye ointment can be applied at bedtime to minimize its effect on vision (patient may use artificial tears during waking hours).
      • Lacrisert is an alternative to lubricating eye ointment.
        • Lacrisert is a pellet placed under the lower eyelids.
        • As Lacrisert dissolves, it lubricates the ocular surface
        • Lacrisert is replaced once to twice daily.
    • Intense Pulsed Light (IPL)
      • Works by restoring normal oil gland function which is essential to normal tear function
      • Most patients see significant improvement after only one treatment
    • Restasis eye drop
      • Works by increasing tear production from the tear glands on the ocular surface
      • Used in moderate to severe dry eye
      • Takes about six weeks before achieving full effect
    • Mild topical steroids
      • Are prescribed sometimes for dry eye (usually in conjunction with Restsis)
      • Should be used only under medical supervision
    • Closure of lacrimal puncta
      • Lacrimal puncta are openings located at the nasal end of each eye lid.
      • Lacrimal punta drain tear from the eye into the back of the throat.
        • This is why we can taste our tear when we cry.
      • After closing the lacrimal punta, more tear can be retained on the surface of the eye.
      • Larcimal puncta can be closed permanently with cautery (hyfercation).
      • Lacrimal puncta can be closed temporarily with dissolvable collagen punctal plugs.
      • Collagen punctal plugs last about three to four months.
    • Regular dental checkup if dry mouth is present (Sjogren’s syndrome)
      • Chronic dry mouth can lead to dental problems (dental caries and gum disorders)
    • Treat the underlying system disorders if present
  • Condition
    • Seeing double with one eye only or with both eyes open
  • Symptoms
    • Seeing two or more images
      • Monocular diplopia
        • Seeing two or more images in one eye only
        • Halos or ghost images may also be present.
      • Binocular diplopia
        • Seeing two or more images with both eyes open
  • Signs
    • Monocular diplopia
      • Uncorrected astigmatism
      • Corneal scars
      • Cataracts
      • Retinal distortion (such as macular pucker)
    • Binocular diplopia
      • Eye muscle imbalance between two eyes
      • Two eyes not looking in the same direction
      • Significant difference in glass prescription between the eyes
  • Causes
    • Monocular diplopia
      • Caused by disturbance along the path of light as it travels from the front to the back of the eye
      • Corneal distortions
        • Astigmatism
        • Corneal scar
        • Keratoconus
    • Cataract
    • Macular pucker
      • Wrinkling of the macula, the central part of retina that gives us the sharp central vision
    • Binocular diplopia
      • Many disorders can cause muscle imbalance, common causes include
        • Thyroid eye disease (Graves’ diseases)
        • Myasthenia gravis
        • Diabetes mellitus
        • High blood pressure
        • Atherosclerosis
        • Trauma
        • Elevated intracranial pressure
        • Brain aneurysm
      • Some patients can develop binocular diplopia when wearing glasses with significant prescription differences between the eyes.
  • Treatment
    • Seek medical attention IMMEDIATELY.
    • Only eye professionals can diagnose the underlying cause of diplopia and determine the proper treatment regimen.
    • Treatment depends on the underlying cause.
    • Treating and monitoring the underlying disorder is a must.
    • Surgical correction (such as cataract surgery or muscle surgery) may be needed in some cases.
    • Glasses with prism are prescribed in some cases with binocular diplopia due to muscle imbalance.
    • Contact lenses or laser vision correction may be helpful in cases with binocular diplopia due to significant difference in glasses prescription between two eyes.
  • Ectropion (margin of lower eyelid turning out)
    • Condition
      • Margin of lower eyelid not in apposition to the ocular surface
    • Symptoms
      • Tearing
      • Red eye with congested vessels
        • Especially prominent in the lower part of the eye
      • Scratchiness in the eye
    • Signs
      • Outward turning of the lower eyelid margin away from the eye
      • Rough corneal surface, especially prominent in the lower part of the ocular surface
    • Causes
      • Age-related
        • With age, the lower eyelid loses elasticity, in some patients, to the point that the lower eyelid margin sags and falls away from the surface of the eye.
        • Sagging of the lower eyelid leads to instability of the tear film, which normally stretches from upper to lower eyelids.
      • Eyelid scars
        • Scarring of the lower eyelid can pull the eyelid margin away from the eye.
      • Paralytic
        • In Bell’s palsy, the paralysis of facial muscles can lead to laxity and sagging of the lower eyelid, resulting in chronic eye irritation from extended exposure of the ocular surface.
    • Treatment
      • Artificial tears or eye lubrication ointment to relieve scratchiness in the eye.
      • Antibiotic eye ointment may be used for lubrication and to prevent infection.
      • Surgery is the definitive treatment for ectropion from age or scarring of the eyelid.
      • In Bell’s palsy, it is usually customary to wait three to six months before considering surgical intervention, because many of these cases, significant amount of facial paralysis recover spontaneously.
  • Entropion (margin of lower eyelid turning in)
    • Condition
      • The margin of the lower eyelid rolls into the eye and causes irritation of the ocular surface.
    • Symptoms
      • Eye irritation
      • Scratchiness in the eye
      • Red eye with congested blooded vessels
    • Signs
      • Inward turning of the lower eyelid margin
      • Eyelashes rubbing the surface of eye
      • Rough corneal surface
      • Can be elicited or worsened with forceful closure of the eyelids
    • Causes
      • Age-related
        • With age, the muscles that maintains the position of lower eyelid margin atrophy, causing the eyelid margin to roll into the surface of the eye.
      • Eyelid scars
        • Scarring of the lower eyelid may cause the eyelid margin to roll in.
      • Eyelid spasm
        • Forceful closure of the eyelids may cause the lower eyelid margin to roll in.
        • Could be associated with eye irritation from trauma or allergy.
    • Treatment
    • Pull the lower eyelid margin from the eye by placing adhesive tape on lower eyelid.
      • A temporizing measure
      • Tape needs to be replaced few times daily.
    • Lubrication of eye surface with artificial tears or ointment
    • Surgery is the definitive treatment for entropion.
  • Floppy eyelid syndrome
    • Condition
      • Excessive looseness and laxity of upper eyelid leading to easy eversion (tuning inside out) of the upper eyelid
    • Symptoms
      • Usually both eyes are affected
      • Scratchy sensation in the eye
      • Red eye with congested vessels
      • Discharge from the eye
      • Worst upon awakening
      • Commonly associated with sleep apnea
        • Characterized by excessive snoring and temporary cessation of breathing during sleep
    • Signs
      • The upper eyelid is loose and can be turned inside out easily with gentle lifting of the upper eyelid.
      • Inflammation of the inner lining (palpebral conjunctiva) of the upper eyelid
      • Droopy upper eyelids
      • Rough corneal surface
    • Causes
      • In floppy eyelid syndrome, the upper eyelid is so stretched and lax that it turns inside out easily or spontaneously while patient is asleep.
      • The eye becomes irritated as the inner lining (palpebral conjunctiva) of the upper lid rubs against sheets or pillow.
    • Treatment
      • Apply lubricating eye ointment prior to sleep
      • Tape the eye closed or covering the eye with a shield prior to sleep.
      • Surgery to tighten the floppy upper eyelid
      • Check patient for sleep apnea
  • Condition
    • Refractive error characterized by poorer (blurrier) vision at near compared that in distance

  • Symptoms
    • None in mild cases
      • Young patients with hyperopia are commonly asymptomatic because their eyes can compensate for hyperopia by contracting the eye muscles that control focus.
      • Mild hyperope may become more symptomatic as they approach their 40’s to 50’s as their eyes are beginning to lose range of focus.
    • Decreased vision in moderate to severe cases
      • Both distance and near vision are affected.
      • Near vision is worse than distance vision.
    • Eye fatigue worsen significantly after prolong reading or computer work.
  • Signs
    • Vision correctable with plus lenses
    • In some children with moderate to severe hyperopia, the eyes may cross
      • Eye crossing may be more prominent with fatigue or with prolonged near tasks
  • Causes
    • In hyperopic eyes, the length of the eye is too short or the corneal curvature is too flat.
    • Short eye and flat cornea cause the light to be focused behind the retina in hyperopia.
      • In order for us to see clearly, the light has to be focused on the retina.
    • Highly hyperopic eyes are at risk to develop angle-closure glaucoma.
      • Many highly hyperopic eyes are smaller than average and have less room to accommodate the growth of the nature lens with age.
      • Also see section on Glaucoma
  • Treatment
    • Glasses
    • Contact lenses
    • Laser vision correction (LASIK/PRK) is possible in cases of mild to moderate hyperopia with stable glasses prescription.
    • Regularly scheduled eye examinations to
      • Update glasses prescription.
      • Check for amblyopia (lazy eye), especially in children.
      • Check for the risk of developing angle-closure glaucoma, especially in patients with high hyperopia.
  • Condition
    • Flashes and floaters are due to the traction on the retina from the vitreous (the jelly of the eye).
  • Symptoms
    • Sudden onset
    • Flashes appear as light streaks, usually to the side.
      • Flashes last usually a few seconds.
      • They are more prominent in the dark.
      • They can be triggered with rapid eye movements.
    • Floators appear as black, gray, or translucent dots or strings.
      • The shape of floaters may be point-like, circular, or part of a circle.
      • They are freely mobile and move with eye movement.
  • Signs
    • Debris in the vitreous (which is “the jelly of the eye” filling the space inside the eye, between the lens and the retina).
    • The vitreous is partially or completely separated from the retina.
  • Causes
    • Due to aging of the vitreous
      • With ages, vitreous changes from a jelly-like consistency at birth to a liquid-like consistency.
      • As result, the vitreous eventually separates from the retina, leading to formation of floaters in the vitreous and flashes from the retina, which is being pulled by the vitreous.
      • This process of vitreous separating from the retina is known as posterior vitreous detachment, occurring usually in 50’s and 60’s of age.
  • Treatment
    • Seek medical attention IMMEDIATELY
      • Flashes and floaters could be early symptoms and signs of retinal tear or detachment.
    • Only an eye professional can determine whether a retinal tear or detachment is present.
      • Retinal tears can lead to retinal detachment.
      • Retinal detachment, if left untreated, can lead to rapid and complete loss of vision.
  • Condition
    • Swelling of cornea due to degeneration of corneal endothelial cells (a layer of cells on the inner surface of cornea)
    • Can be hereditary in some families
  • Symptoms
    • In mild cases,
      • Hazy or blurry vision
      • Fluctuation in vision
        • Usually is worse in morning.
        • Becomes better later in the day, afternoon or evening.
    • In moderate and severe cases
      • Visual impairment becomes persistent.
      • Progressively worsening eye pain and scratchiness eventually develop.
  • Signs
    • Small bumps (called guttae, singular: guttata) first develop on the inner surface of cornea (the corneal endothelium)
    • Loss of corneal endothelial cells
    • Cornea swelling with increased corneal thickness
    • Rough cornea surfaces with formation of bullae (blisters)
  • Causes
    • Due to degeneration of the inner layer of cornea
      • The inner layer of the cornea is the corneal endothelium.
      • Normally corneal endothelium works like a water pump, which keeps the cornea clear by removing water from the cornea.
      • When the corneal endothelium fails, the cornea swell like a sponge, leading to hazy vision and formation of blisters on the corneal surface.
      • As the blisters on the corneal surface rupture, the patient experiences eye scratchiness and pain.
  • Treatment
    • In mild cases, Muro-128 eye ointment is applied prior to sleep.
      • Muro-128 ointment is made from hypertonic saline that reduces the corneal swelling by drawing excess water from the cornea.
    • In moderate to severe cases, corneal transplantation is usually performed to restore vision.
    • A bandage contact lens can be used to give patient pain relief by protecting the surface of the swollen cornea.
  • Patients with glaucoma usually have abnormally high eye pressure that leads to optic nerve (the nerve that connects the back of the eye to the brain) damage. If glaucoma is left untreated,
    • Loss of side (peripheral) vision occurs first, followed by
    • Loss of central vision and eventually blindness
  • Glaucoma comes in two general types:
    • Open-angle glaucoma
    • Angle-closure glaucoma
    • Angle is part of the eye that
      • Regulates the pressure of the eye by draining fluid inside the eye out
      • Is located where iris (color part of the eye) and sclera (white part of the eye) joins
  • Open-angle glaucoma
    • Condition
      • Optic nerve injury with angle of the eye being open
      • The eye pressure is frequently elevated but in some cases the eye pressure may be in normal range.
      • Normal eye pressure ranges between 8 mmHg and 21 mmHg with an average of 16 mmHg
      • Open-angle glaucoma with eye pressure in normal range is also known as normal- or low-tension glaucoma
    • Symptoms
      • Early stages: none
      • Late stages: loss of side (peripheral) vision, followed by loss of central vision
      • Family history positive for open-angle glaucoma
    • Signs
      • High eye pressure
      • Thinning of the optic nerve
      • Loss of peripheral vision
    • Causes
      • In most cases, there are no inciting causes and diagnosis is usually made in a routine eye examination.
      • Prolonged steroid use
        • Most commonly associated with steroid eye drops
        • May also occur with oral, intravenous, nasal, injected steroids
      • Inflammation of the eye
      • Eye trauma (also see section on Hyphema)
      • Genetic: in many open-angle glaucoma patients, there is also positive family history for glaucoma.
    • Treatment
      • The main goal in the treatment of glaucoma is to lower the eye pressure to a lower and safer level.
        • Once diagnosis is made, patients with glaucoma are seen every three to six months to ensure that the eye pressure remains controlled.
        • Regular visual field testing and optic nerve imaging is important in following glaucoma patients.
      • Eye drops is most commonly used to lower the eye pressure into a safe range. The usual treatment goal is to reduce the intraocular pressure by 25% to 33%.
      • Oral medications are prescribed if
        • Immediate and rapid lowering of the eye pressure is desired, or
        • The eye drops are no longer effective
      • Laser treatment (laser trabeculoplasty) is recommended if medical therapy is no longer effective.
      • Glaucoma shunt surgery is usually reserved for patients, who no longer respond to medical therapy or laser treatment, or medical therapy is no longer an option. Placing or creating a shunt in the eye lowers the intraocular pressure by making an extra passage for the fluid inside of the eye to drain.
  • Angle-closure glaucoma
    • Condition
      • High eye pressure due to closure of the angle of the eye
    • Symptoms
      • Usually acute onset
      • Eye Pain, usually severe and boring in nature
      • Decreased vision
      • Halos around lights
      • Headaches, usually severe
      • Nausea and vomiting
    • Signs
      • Sudden rise in eye pressure
      • The angle of the eye is closed.
        • The angle of the eye is located inside the eye at where the sclera (the white part of the eye) and iris (the color part of the eye) joins.
        • The angle of the eye drains the fluid from inside of the eye out and keeps the eye pressure in a normal range in healthy eyes.
      • Corneal swelling from high eye pressure
      • Far-sightedness (hyperopia) or short eye are prone to develop angle-closure
    • Causes
      • Short eye are prone to develop angle-closure and are usually far-sighted.
        • As eye ages, the lens inside of the eye enlarges. If the eye is too short, there may not be enough spare room in the eye to accommodate the growth of lens.
        • As result, the eye becomes over-crowded and the angle of the eye could be closed.
      • Abnormal blood vessels in the angle of the eye
        • Abnormal blood vessels in the angle of the eye can lead to closure of the angle.
        • Patients with proliferative diabetic retinopathy and central retinal vein occlusion are prone to develop angle-closure glaucoma.
      • Drug-related
        • Antihistamines and Topomax may induce angle-closure glaucoma in patients with narrow angles.
    • Treatment
      • Angle-closure glaucoma is a medical emergency. Seek IMMEDIATE medical attention.
      • The mainstay treatment for angle-closure glaucoma is laser therapy.
        • If angle closure is due to a over-crowded short eye, laser is used to create a small opening in the iris (laser iridotomy), which relieves the angle closure and lowers the intraocular pressure.
        • If angle closure is due to abnormal blood vessels in the angle, retinal laser is performed to make these vessels regress.
      • Topical and oral medications are also prescribed during the acute stage when rapid lowering of the eye pressure is needed.
      • If eye pressure remains unresponsive to laser treatment, glaucoma shunt surgery might be considered.
      • Stop histamines and Topomax.
      • Check the fellow unaffected eye. If it has similar anatomy as the affected eye, laser iridotomy is performed to prevent angle-closure glaucoma attack.
  • Condition
    • Ocular infection and inflammation due to Herpes simplex virus
  • Symptoms
    • Red eye with dilated vessels
    • Eye Pain
    • Sensitivity to light
    • Decreased vision
    • Previous history of attack
      • Herpes simplex eye disorders may be recurrent
    • History of cold sores or fever blisters
    • Usually involving only one eye
  • Signs
    • Congested eye blood vessels
    • Corneal surface breakdown (classically in a branching pattern)
    • Hazy cornea due to swelling of the cornea
    • Inflammation of deep tissue of cornea
    • Scarring and thinning of cornea from previous attacks
    • Inflammation inside of the eye
    • Elevated eye pressure
  • Causes
    • Reactivation of Herpes simplex virus in the eye
      • By adulthood, we all harbor Herpes simplex virus in our nerve systems.
      • At times, Herpes simplex virus reactivates and leads to canker sores on the skin or in the mouth.
      • Herpes simplex eye disease occurs, when Herpes simplex virus reactivates in the eye.
  • Treatment
    • Antiviral eye drops are the mainstay for surface corneal lesions.
    • Oral anti-viral medications (such as acyclovir and Valtrex) are prescribed in some cases both for therapy and prevention.
    • Pupil may be dilated in cases with inflammation in the eye to prevent scar formation inside the eye and to relieve eye pain.
    • Topical steroids are used to reduce inflammation of the cornea and in the eye.
    • Glaucoma eye drops are prescribed if the eye pressure is too high.
    • Treatment of Herpes simplex eye disease has to be carried out under close medical supervision.
    • Prompt treatment is necessary in order to prevent corneal scarring that can lead to permanent visual loss.
    • To restore vision, corneal transplantation may be necessary in cases of significant corneal scarring from Herpes simplex.
    • Close monitoring and taking medication as prescribed are important in the management of Herpes simplex eye disease.
  • Condition
    • Hyphema occurs when blood accumulates in the anterior chamber of the eye.
      • Anterior chamber is the space in the eye, between the cornea and the iris
      • Normally, the anterior chamber is filled with clear fluid, called aqueous humor.
  • Symptoms
    • Hyphema usually occurs after trauma to the eye.
      • Spontaneous hyphema is rare
    • Eye pain
    • Sensitivity to light
    • Tearing
    • Decreased vision
    • Red eye with congested vessels
  • Signs
    • Blood is present in the anterior chamber of the eye.
    • The eye pressure may be high.
    • Pupil might be dilated and distorted due to injury to iris from the force of eye trauma.
    • Cataract may form from eye trauma or elevated eye pressure.
  • Causes
    • Blunt trauma to the eye is most common cause.
      • Forces from the trauma distort and tears the structures in the eye (such as iris and the angle) leading hemorrhaging and accumulation of blood in the anterior chamber.
    • Spontaneous hyphema can occur from
      • Intraocular lens implant from previous cataract surgery
      • Juvenile xanthogranulomatosis
      • Diabetes eye disease
      • Eye tumors
  • Treatment
    • Seek medical attention IMMEDIATELY.
    • Limit physical activities.
    • Apply topical steroid eye drop to reduce inflammation in the eye.
    • Pupil is dilated with eye drops to reduce eye pain and light sensitivity
    • In children with hyphema, the injured eye may need to be covered with a clear shield in order to prevent a second injury.
    • Avoid blood thinning medication: aspirin, ibuprofen, or Aleve
    • Close medical follow-ups is a must.
    • Imaging studies (ultrasound and CT scan) might be necessary in some cases to check for other injuries (laceration to the eye or fractures of the eye socket).
    • In hyphema patients of Mediterranean or African-American descent, sickle-cell disease or trait should be considered. Sickle-cell patients are at particularly high risk of developing serious eye complications from hyphema.
  • Condition
    • Keratoconus is a corneal disorder with progressive distortion of the corneal contour. The age of onset is usually between late teens and 20’s.
    • As keratoconus progresses, the shape of cornea changes from spherical (the normal shape) to cone-shaped.
  • Symptoms
    • Decreased vision
      • Progressive in nature with increasing nearsightedness
      • Usually starting in adolescence
    • Some keratoconus patients might develop sudden onset of:
      • Pain
      • Red eye
      • Light sensitivity
      • Tearing
  • Signs
    • Irregular astigmatism
    • Corneal thinning and scarring
      • Characteristically in the center or close to the center of cornea
    • Mild to severe distortion of corneal contour with bulging of the cornea
    • In some keratoconus patients, sudden onset of pain, tearing, and light sensitivity (also known as acute corneal hydrops) may develop.
      • In corneal hydrops from keratoconus, the cornea becomes hazy from severe swelling.
  • Causes
    • The exact cause of keratoconus is unknown.
    • Wearing contact lenses has been associated with keratoconus.
    • Chronic eye rubbing has been claimed to contribute to developing keratoconus in some patients.
    • Patients with Down syndrome are more prone to develop keratoconus
    • The cause of acute corneal hydrops is due to splitting of the inner layers of cornea, which then allows fluid to get into cornea, leading to corneal swelling
  • Treatment
    • In mild cases, glasses or contact lenses (usually hard gas-permeable or scleral contact lenses) will be fitted to give patient optimal vision
    • In moderate to severe cases, corneal transplantation is performed to restore vision
    • Newer treatments
      • Inserting plastic rings (Intacs) into keratoconus cornea to give more physical support to the corneal architecture and decrease the amount of the distortion of corneal contour
      • Collagen cross-linking therapy is current under FDA study and is designed to strengthen the keratonus cornea and to decrease the amount of corneal distortion from keratoconus
    • For acute corneal hydrops
      • Pupil is dilated with eye drop to reduce light sensitivity
      • Muro-128 eye ointment to reduce corneal swelling
      • Typically resolves within two months
  • Condition
    • Macular degeneration is a leading cause of blindness in the United States, affecting almost exclusively the elderly population.
    • Macular degeneration comes in two types
      • Dry macular degeneration
      • Wet macular degeneration
      • The main difference between the two is that bleeding occurs in wet macular degeneration but not in the dry form.
  • Symptoms
    • Decreased central vision
      • Macula is the central part of retina
      • When healthy, Macula provides fine central vision that allows most of us to see 20/20
    • Distortion of vision (metamorphopsia)
      • Seeing bending or curving in what should be straight lines
  • Signs
    • Macular Drusen
      • Discrete yellow spots in the macula
      • Usually the first sign of macular degeneration
      • Macular drusen increase in size and number as macular degeneration progresses.
    • Macular atrophy
      • Loss of the natural pigmentation in macula
      • The hallmark of dry macular degeneration
    • Macular hemorrhage
      • Bleeding in the macula from formation of abnormal blood vessel beneath the retina
      • The hallmark of wet macular degeneration
      • Macular swelling usually occurs with macular hemorrhage
    • Macular scarring
      • In the late stage of macular degeneration, the macula either forms an atrophic scar (as in dry macular degeneration) or a thick (fibrotic) scar (as in wet macular degeneration).
  • Causes
    • Macular degeneration tends to run in family, and genetics plays a significant role in development of macular degeneration in many patients.
    • The main defect is probably located in the retinal pigment epithelium, a layer of cells lying beneath the retina and is vital to retinal metabolism and to maintain retinal health.
    • As the retinal pigment epithelium degenerates, macula forms drusen and atrophies, and abnormal vessel formation may develop, leading to impairment of central vision.
  • Treatment
    • Stop smoking, if patient is a smoker
      • Patients who smoke are more prone to develop macular degeneration
    • AREDS vitamins (such as Ocuvite Preservision and I-CAP) are prescribed to retard the progression of dry macular degeneration
      • This is only treatment available for dry macular degeneration.
      • Smokers or ex-smokers with macular degeneration should take AREDS vitamins without beta-carotene or vitamin A.
        • Specially formulated AREDS vitamins for smokers and ex-smokers are available from our office.
    • In wet macular degeneration, treatment modalities include:
      • Laser therapy
      • Intraocular injections
      • The goal of these treatments is to cause regression of abnormal vessel growth from wet macular degeneration
    • Low vision evaluation and rehabilitation is recommended to patients with severe visual loss from macular degeneration.
    • Patients with macular degeneration should monitor their central (macular) vision regularly (preferably once daily) with Amsler grid (which consists of straight perpendicular lines with a central dot; available from the Internet)
      • Patient should contact their ophthalmologist IMMEDIATELY if new distortions are seen on the Amsler grid.
      • New distortions on the Amsler grid could be a sign of progression or developing abnormal retinal blood vessels
  • Condition
    • As the name indicates, macular pucker is a condition in which macula is puckered or wrinkled.
    • When healthy, Macula provides fine central vision that allows us to see 20/20.
  • Symptoms
    • Asymptomatic in mild cases
    • Decreased and distorted central vision can occur in moderate and severe cases
  • Signs
    • Radiating or parallel lines of wrinkling in the macula
    • Fine layer of transparent to translucent scar tissue overlying the area of macular wrinkling
    • Swelling of macula can occur in advanced cases
    • Normally, the macular contour is smooth with a natural central depression (called fovea).
  • Causes
    • Macular pucker is caused by growth of fine layer of scar tissue on the surface of the macula
    • Macular pucker can rise from:
      • Age
        • With age, macular pucker is more prevalent
      • Eye Trauma
        • Trauma to the eye can contribute and accelerate the development of macular pucker
      • Previous eye disorders
        • Retina detachment
        • Occlusion of retinal veins
    • As the scar tissue on the macula contracts over time, it may lead to further wrinkling in the macula and distortion of vision.
  • Treatment
    • The treatment for macular degeneration is the surgical removal of the scar tissue lying on the macula.
    • Surgery is generally performed when there is significant loss of vision or significant macular swelling.
  • Condition
    • A common type of one-sided headache with visual symptoms
    • Tends to run in families
    • Usually starts in childhood or adolescence
  • Symptoms
    • Sudden onset of one-sided headache, frequently characterized as “boring” or “stabbing”
    • In many cases, visual disturbance (called aura) precedes the onset of headache.
      • The aura is characterized as shimmering lights, zigzag lines, kaleidoscopic colors, and distortion of vision.
      • Part of the peripheral or central vision becomes blurry and the area of visual distortion may expand during the attack.
      • Aura typically lasts about 20 to 30 minutes.
    • Some patients may develop nausea and vomiting once the headaches starts.
    • The headache becomes less prominent with age, but the aura becomes more predominant with age.
    • Light sensitivity may be prominent in some patients.
    • Sleeping or staying in a darkened room alleviates migraine headaches in some patient.
  • Signs
    • Reversible loss of peripheral or central vision
  • Causes (all of the following can trigger migraines)
    • Birth control pills
    • Hormonal supplements
    • Puberty
    • Menopause
    • Certain foods (aged cheeses, wines, chocolates, cashew nuts)
    • MSG (monosodium glutamate)
    • Bright and flashing lights
    • Alcohol
    • Emotional distress
    • Fatigue
  • Treatment
    • Avoid causative agents if identifiable.
    • Seek medical attention if symptoms are severe and unrelenting.
    • Neurological consultation in moderate to severe cases.
    • Medical therapy may be needed in moderate to severe cases.
  • Condition
    • Myasthenia gravis is a neurological condition, characterized by muscular weakness that worsens with repetitive muscular contractions.
  • Symptoms
    • Double vision and droopy upper eyelids, which worsen with fatigue, usually at the end of day.
    • Weakness of facial muscles
    • Weakness of muscles of the arms and legs, especially the limb muscles closer to the body
    • Difficulty with swallowing and breathing
  • Signs
    • Worsening of droopy upper eyelids when forced to look up for prolonged period of time
    • Worsening of double vision with repetitive eye movements
    • Cannot forcefully closed the eyelids
      • Upper eyelids can be easily lifted despite patient’s attempt to close eyes tightly.
    • Droopiness of upper eyelid improves dramatically after ice-pack is applied.
    • Myasthenis gravis can be associated with thyroid disease and thymoma, a benign tumor of the thymus.
    • In many patients, eye findings are the first sign of myasthenia gravis.
  • Causes
    • Production of abnormal antibodies (by patient’s immune system) that interfere with the transmission of signals from nerves to skeletal muscles
  • Treatment
    • Neurological consultation for evaluation and medical therapy
  • Removal of thymoma if present
  • Condition
    • Myopis is characterized by poorer (blurrier) vision in distance compared to vision at near
  • Symptoms
    • Squinting to see clearly in distance
  • Signs
    • In myopia, distance vision can be improved with minus lenses

  • Causes
    • Myopia that develops during childhood or adolescence is usually due to excessive lengthening of the eye. As result the images are blurry because they are focused in front of the retina, instead of on the retina as it normally occurs.
    • Myopia that develops or worsens later in life could indicate development of cataracts
    • Intermittent myopia could be a sign of elevated blood glucose level and possibly diabetes mellitus
  • Treatment
    • Glasses
    • Contact lenses
    • Laser vision correction (LASIK, see Laser Vision Center) if patient desires to be spectacle-free and is a suitable candidate
    • Cataract surgery in cases where vision cannot be corrected adequately with glasses
    • Medical evaluation if elevated blood glucose level or diabetes mellitus is suspected.
  • Condition
    • Nystagmus is a disorder, characterized by abnormal, wiggly eye movements.
    • Can involve either one eye or both eyes.
  • Symptoms
    • None if onset is in early childhood
    • ‘Shaky’ vision if nystagmus develops later in life
  • Signs
    • Repetitive back-and-forth eye movements
    • May be vertical, horizontal, or rotational
  • Causes
    • Albnism
    • Aniridia (congenital absence of iris)
    • Prolonged visual loss or visual loss since birth or during early childhood
      • Cataracts
      • Congenital retinal disorders
      • Congenital optic nerve disorders
    • Drugs
      • Alcohol poisoning
      • Aspirin overdose
    • Brain disorders
      • Tumor
      • Stroke
      • Head trauma
      • Brain Hemorrhage
    • Spasms of eye muscles
    • Multiple sclerosis
  • Treatment
    • The evaluation and treatment of nystagmus depends on underling condition
    • Imaging studies (CT and MRI scans) are performed if neurological or brain disorders are suspected
    • Consultation with neurologist or neuro-ophthalmologist may be necessary in some cases
  • Condition
    • Optic neuritis is the Inflammation of the optic nerve.
    • Normally, optic nerve connects the eye to the brain and transmits nerve impulses from eye to brain.
  • Symptoms
    • Acute onset of visual loss that occurs usually in days
    • Usually unilateral
    • Pain with eye movement
    • Vision appears dim or darkened
    • Colors look washed-out
  • Signs
    • Abnormal color vision
    • Loss of central visual field
    • Abnormal pupil reaction in the affected eye
    • The optic nerve may appear swollen
  • Causes
    • Inflammation of the optic nerve causing deterioration of the myelin sheath (the protective covering of the optic nerve fibers), which is vital for the normal transmission of neural impulses from the eye to the brain
    • Optic neuritis can be associated with multiple sclerosis
  • Treatment
    • Seek medical attention IMMEDIATELY.
    • In cases of significant visual loss, intravenous steroids are given in a four-day course, which may be followed by a course of oral steroids.
    • Neurological evaluation and imaging studies of the brain if multiple sclerosis is suspected.
  • Condition
    • As the name implies, presbyopia comes with age and is characterized by the loss of the ability to focus at near
    • Occurs usually in 40’s to 50’s of age

  • Symptoms
    • Blurry vision at near
    • Eye tires easily with near task (prolonged reading or computer work)
  • Signs
    • Near vision can be improved with plus lenses
    • Pushing reading material away to clear near vision
  • Causes
    • With age, the natural lens of eye loses elasticity. As result, the eye’s range of focus decreases with time
  • Treatment
    • Reading or bifocal glasses
    • In patients who can wear contact lenses, monovision is another option. With monovision,
      • The contact lens in the dominant eye is usually set for distance vision, and
      • The contact lens in the non-dominant is usually set for near vision.
    • Presbyopia correction is an option for patients who do not want to rely on glasses or contact lenses.
      • With presbyopia correction, the natural lens of the eye is removed and a special lens implant is placed in the eye, allowing patient to see far and near most of the time without glasses or contact lenses
  • Condition
    • Pterygium is corneal scar extending from the conjunctiva.
    • Usually involves the nasal side of the cornea.
  • Symptoms
    • Eye irritation
    • Dry eye
    • Blurry vision
    • Intermittent red eye with congested blood vessels in the pterygium
  • Signs
    • Whitish scar extending from the conjunctiva (clear mucus membrane that covers sclera, the white part of eye)
    • Vessels present in pterygium
    • Dryness of corneal surface, particularly areas next to the pterygium
  • Causes
    • Due to chronic exposure of ultraviolet light from the sun
    • Ultraviolet light from the sun causes breakdown of collagen fibers of the conjunctiva, which then progresses to pterygium.
  • Treatment
    • Artificial tears for dry eye or eye irritation
    • Short course of steroid eye drop for acute inflammation of the pterygium
      • Steroid eye drops should be taken only under medical supervision.
    • Surgical removal of pterygium, if
      • Pterygium enlarges and grows further onto the cornea.
      • Visual loss due to distortion of corneal surface from pterygium.
      • Poor appearance
    • Ultra-violet light blocking sunglasses are recommended in patient with a history of pterygium
  • Condition
    • Ptosis is an eye disorder characterized by drooping of upper eyelid.
  • Symptoms
    • Drooping of upper eyelid
    • Difficulty with near tasks (such as reading)
  • Signs
    • Drooping of upper eyelid
    • Contraction of forehead muscles in attempt to lift droopy upper eyelid
    • Loss of superior visual field from the droopy upper eyelid covering part of the peripheral vision
    • Brow ptosis (drooping of eyebrows) may also be present with age-related eyelid ptosis
  • Causes
    • Due to abnormalities in the levator muscle
      • Normally, the levator muscle pulls on upper eyelid against gravity and keeps it in proper position.
    • In congenital ptosis, the levator muscle is abnormally formed.
    • In age-related ptosis, the levator muscle is stretched out over time, with loss of elasticity.
    • In myasthenia gravis, the levator muscle cannot function properly due to impaired transmission of nerve impulses to the levator muscle.
      • In myasthenia gravis, the amount of ptosis varies from time to time and worsens with fatigue
    • Nerve controlling the levator muscle can be affected or injured in stroke, diabetes mellitus, hypertension, brain aneurysm, or brain tumor, leading to drooping of the upper eyelid
  • Treatment
    • The treatment depends on underlying cause
    • Surgury to repair eyelid ptosis is usually performed,
      • If ptosis are congenital in origin or age-related.
      • If brow ptosis is present with age-related eyelid ptosis, both might have to be repaired surgically.
      • If the drooping of the upper eyelid is affecting the peripheral vision or is cosmetically displeasing.
    • Imaging studies of the brain (CT and MRI) is performed in cases suspicious for stroke, brain aneurysm, or brain tumor.
    • Medical testing might be necessary in cases, where hypertension or diabetes mellitus is suspected.
    • Neurological evaluation and testing should be performed in cases suspicious for myasthenia gravis.
  • Condition
    • Retinal detachment is an eye disorder, characterized by the separation of retina from the back wall of the eye.
    • Normally, retina is adherent to the back wall of the eye, similar to wall paper is glued to a wall
  • Symptoms
    • Intermittent flashes
      • Usually lasting few seconds
      • More prominent in dark and in the peripheral vision
      • Can be induced with rapid eye movement
    • Floators
    • Loss of peripheral vision (like a curtain or shadow covering part of vision)
  • Signs
    • Separation (detachment) of the retina from the back wall of the eye
    • Accumulation of fluid beneath the detached retina
    • Hole or tear in retina, usually in the outer portion of retina
    • Visual field defect
    • Separation of vitreous (the jelly of the eye) from the retina
    • Floators and blood in vitreous
  • Causes
    • The most common cause of retinal detachment is posterior vitreous detachment, the separation of vitreous from the retina (also called posterior vitreous detachment), that comes with age, usually in the  60’s and 70’s
      • Posterior vitreous detachment causes the vitreous to pull on the retina and, in some patients, can lead to retinal tear or hole.
      • Retinal tear or hole leads to accumulation of fluid under the retina, resulting in retinal detachment.
    • Nearsighted (myopic) eyes are more prone to develop retinal detachment.
    • Eyes with peripheral retinal thinning or changes (such as lattice retinal degeneration) are also prone to develop retinal detachment.
  • Treatment
    • Seek medical attention IMMEDIATELY.
    • If left untreated, retinal detachment may lead to total loss of vision.
    • Only surgery can resolve retinal detachment. Sooner the surgery the better.
    • Surgery is usually performed urgently especially if the macula (the central part of retina that provides sharp central vision) is still attached.
  • Condition
    • Retinopathy of prematurity is an eye disorder of the retina related to premature birth and is characterized by abnormal retinal vascular growth.
  • Symptoms
    • Usually none
    • Poor eye fixation
  • Signs
    • Absence of blood vessels in the outer portion of immature retina
    • Growth of abnormal retinal blood vessels
    • Engorgement of retinal blood vessels
    • Retinal detachment
    • Cataract
  • Causes
    • Normally, in neonates born full-term, the retinal vascular growth is usually completed shortly before birth
      • If born preterm, the baby may have retinas which are not completely covered with blood vessels.
      • After birth, retinal blood vessels may develop abnormally, if the retinal development has be completed in an environment outside of womb
    • Risk factors associated with retinopathy of prematurity
      • Premature birth
        • Less than 32 weeks of pregnancy
      • Low birth weight
        • Less than three pounds and five ounces
        • Especially high risk if less than two pounds and 12 ounces
      • Oxygen therapy, lack of oxygen, carbon dioxide retention, and other concurrent illnesses
  • Treatment
    • Regularly scheduled eye examination is a must in detecting retinopathy of prematuriity in infants at risk.
    • Retinal laser treatment is performed when the abnormal retinal growth reaches a threshold stage.
    • Surgery may be indicated if there is cataract, retinal detachment, or vitreous hemorrhage.
    • Infants with retinopathy of prematurity will need periodic eye examination for the rest of their lives. Later in life, these children are more prone to develop:
      • Nearsightedness (myopia)
      • Amblopia (lazy eye)
      • Strabismus (misalignment of the eyes)
      • Retinal detachment
  • Condition
    • Retinitis pigmentosa is a progressive degenerative disorder of retina, which is genetic in origin.
  • Symptoms
    • Progressively worsening night blindness
    • Loss of peripheral vision
  • Signs
    • Diffuse pigment clumping of the retina
    • Cells in the vitreous (the jelly of the eye)
    • Narrowing of the retinal arteries
    • Atrophy of optic nerve
    • Loss of peripheral visual field
    • Abnormal results on electrophysiologic testing of the retina
      • Like the heart, the retina naturally generates electrical activities, which are decreased in retinitis pigmentosa
      • Electrophysiologic testing (electroretinogram, ERG). measures the electrical output of the retinal under different light conditions. ERG is abnormally decreased in retinitis pigmentosa.
  • Causes
    • Genetic in origin
    • Inheritance patterns include:
      • Autosomal dominant:
        • One affected parent with half of the offspring affected, on average
        • No predilection for either sex
      • Autosomal recessive
        • None of the parents are affected with a quarter of the offspring affected, on average
        • No predilection for either sex
      • X-linked recessive
        • Mother is the carrier with half of the sons affected, on average, and half of the daughters are carriers, on average
        • Most of the patients are male, although sometimes female carriers may develop retinitis pigmentosa
      • Sporadic
        • No discernible hereditary patterns
    • Onset can be early to late in life.
  • Treatment
    • Generally speaking, in most cases, retinitis pigmentosa is not treatable
    • However treatment is available for a few types of retinitis pigmentosa
      • Refsum disease: requires diet low in phytol and phytanic acid.
      • Abetalipoproteinemia: requires vitamin (A, E, K) supplementation.
      • Kearns-Sayre syndrome: requires cardiac evaluation for check for heart block.
    • Genetic counseling is recommended for patients with retinitis pigmentosa and their family members.
    • Low vision evaluation and rehabilitation is useful in assisting patients with retinitis pigmentosa to lead productive lives.
  • Condition
    • Subconjunctival hemorrhage is bleeding underneath the conjunctiva (clear membrane that covers the sclera, the white part of eye)
  • Symptoms
    • Usually asymptomatic
    • Bleeding is frequently discovered incidentally by the patient (looking oneself in the mirror) or noted by others
  • Signs
    • Patches of blood under the conjunctiva, blocking the view of underling sclera
  • Causes
    • Eye or head trauma
    • Straining
      • Coughing
      • Sneezing
      • Constipation
      • Heavy lifting
    • High blood pressure
    • Bleeding disorder
    • Medications that interferes with blood clotting
      • Aspirin
      • Ibuprofen
      • Coumadin
      • Plavix
  • Treatment
    • None in most cases, if it is mild to moderate
    • Medical evaluation and testing if subconjunctival hemorrhage is recurrent, or the hemorrhage also involves the eyelids and the eye sockets
  • Condition
    • Skin eruptions and eye inflammation caused by reactivation of Herpes zoster virus.
  • Symptoms
    • Pain and abnormal sensation in the skin
    • Eye pain with light sensitivity if eye is involved by Herpes zoster.
  • Signs
    • Shingles is almost always one-sided.
    • Skin rash and blisters that cover a patch of skin, and they later progress to scabs and then scars.
    • The skin lesions do not cross midline of the body.
    • If the forehead develops shingles, the eye could be at risk of also being involved.
    • Almost every part of the eye can become inflamed from Herpes zoster virus, leading to
      • Keratitis: corneal inflammation
      • Iritis: inflammation in the anterior part of eye
      • Glaucoma; elevation of eye pressure due to inflammation inside the eye
      • Retinitis: inflammation of the retina due to Herpes zoster virus involving the retina and may progress to retinal tear and detachment
  • Causes
    • Initial exposure to Herpes zoster virus causes chickenpox, a common childhood viral infection
      • Herpes zoster becomes dormant inside of human nerve system
    • Herpes zoster virus leads to shingles when it is reactivated later in life
      • The Herpes zoster virus uses the nerves to reach various parts of skin and other organs
  • Treatment
    • Oral antiviral medications
      • Acycylovir
      • Famvir
      • Valtrex
    • Steroid eye drop to control eye inflammation from shingles
    • Glaucoma eye drop to treat elevated eye pressure
    • Oral steroid may be necessary in cases of severe inflammation from Herpes zoster
    • Pain management
      • Oral pain medications
      • Capsaicin cream applied to affect skin areas
        • Do not get Capsaicin in the eye. It can lead eye irritation.
  • Condition
    • Sjogren’s syndrome is a combination of dry eye and dry mouth
    • Primary Sjogren’s syndrome
      • Not associated with any underling associated illnesses
    • Secondary Sjogren’s syndrome
      • Associated with systemic illnesses such as:
        • Rheumaoid arthritis (most common)
        • Lupus erythematosus
        • Scleroderma
        • Sarcoidosis
  • Symptoms
    • See section on dry eye
    • Dry mouth
    • Difficulty with swallowing
  • Signs
    • See section on dry eye
    • Dental disorders and gum disease due to lack of saliva
  • Causes
    • Decreased in tear and saliva production due to inflammation involving lacrimal (tear) and salivary glands
  • Treatment
    • See section dry eye
    • Treat underlying illness if present
    • Regular dental care
  • Condition
    • Normally, the both eyes move in perfect synchrony. Strabismus is a condition in which the eyes are misaligned.
  • Symptoms
    • May be asymptomatic
      • Especially when strabismus was present since childhood.
    • Some patients may experience diplopia (double vision)
      • Usually in patients who develop strabismus later in life.
    • Decreased vision may be present in eye that is misaligned.
  • Signs
    • Misalignment of the eyes, which may be present in all gazes or occur only in certain gaze
    • The misaligned eye could be turned-in, turned-out, too high or too low.
    • In some cases, the amount of ocular misalignment may vary and may not be present at all times.
    • In some cases, ocular misalignment worsens with fatigue or inattention.
    • Amblyopia (lazy eye) may be present in the misaligned eye. This is frequently seen in both pediatric and adult strabismus patients.
  • Causes
    • Congenital
      • Misalignment of the eyes present since birth or shortly after.
    • Trauma
      • Head trauma may cause damage to nerves that control eye movements.
      • Head trauma may cause direct injury to the eye muscles.
      • Fracture of orbital (eye socket) walls may entrap eye muscles and lead to strabismus.
    • Thyroid eye disease (see section on Thyroid eye disease)
      • Ocular misalignment from inflammation of eye muscles
    • Poor vision in one eye
      • Misalignment occurs frequently in patients with significant difference in the glasses prescription (refractive error) between the eyes.
      • Significantly poorer vision in one eye for long time can also lead to misalignment of that eye. Causes include:
        • Old dense Cataracts
        • Longstanding corneal scars
        • Chronic retinal detachment
    • Myasthenia gravis
      • In Myasthenia gravis, amount strabismus varies and worsens with fatigue.
      • Strabismus may be the first sign of myasthenia gravis.
    • Orbital (eye socket) mass
      • Mass in the eye socket may interfere with the eye movements and lead to misalignment of the eyes.
    • Brain tumor or aneurysm
      • Brain tumor or aneurysm may injure nerves that control eye movements
  • Treatment
    • Treat underlying amblyopia (lazy eye) if present.
    • Prescription glasses with prism is prescribed for some patients.
    • Medical evaluation if thyroid disease or myasthenia gravis is suspected.
    • Imaging studies (MRI scan, CT scan, and angiogram) may be performed to check for any anatomical abnormalities in the brain and the orbit (eye socket).
    • In some patients, eye muscle surgery is performed to re-establish proper ocular alignment and depth perception.
    • Eye muscle surgery may also be done for appearance.
  • Condition
    • Stye (chalazion) is an inflammation of the oily glands of the eye lid.
  • Symptoms
    • Lumpy swelling of the eyelids
    • Pressure sensation in the eyelid with tenderness to touch during acute stage
  • Signs
    • Redness on the eye lid margin
    • Swelling of eyelid with palpable nodules or cysts
      • They are tender to touch during the acute phase
    • Thickened secretion from the oily glands at the eyelid margin
    • Openings to the oily glands may be closed (occluded) at the location of chalazion.
  • Causes
    • Blepharitis, or chronic inflammation at the eye lid margin, may cause the openings of the eyelid glands to close, leading to inflammation of the glands.
    • Acne rosacea; a skin disorder characterized by adult acne, ruddy face, rosy cheeks and chin.
      • Patients with acne rosacea frequently have blepharitis.
  • Treatment
    • In mild cases, warm compresses applied to the affect eyelid (with eyes closed) three to four times
    • Topical antibiotic eye drop or ointment may be prescribed to keep the eyelids clean
    • Topical steroid may be prescribed if there is excessive inflammation of the eyelid margin
    • In moderate to severe cases, oral antibiotic (such as doxycycline) may be prescribed.
    • Surgical removal of chalazion is performed, when chalazion becomes persistent and is no longer unresponsive to medical therapy.
    • Oral antibiotics may be prescribed as a preventive measure in patients with history of recurrent chalazia.
  • Condition
    • Thyroid eye disease is Inflammation of the eye muscles that is related to concurrent thyroid disease.
  • Symptoms
    • Redness with congested blood vessels
    • Dry eye
      • Worsens with near tasks (reading and computer work)
    • Chronic eye irritation
    • Double vision
    • ‘Bug-eyed’ appearance (white of eye showing 360 degrees)
    • Eyelid swelling
    • Pressure sensation behind the eyes
  • Signs
    • Protruding eyeballs
    • Upper eyelid retracted showing the sclera (the white part of eye)
    • Dilated blood vessels on the surface of the eye
    • Restricted eye movements
    • Poor tear film
    • Breakdown of ocular surface due to poor blinking or closure of eyelids
    • Strabismus (ocular misalignment)
    • Decreased vision and impaired color vision
    • Concurrent thyroid disease (usually hyperthyroidism)
  • Causes
    • Normally, six muscles in the orbit (eye socket) control the eye movements.
    • Inflammation of the muscles that control eye movements
      • Leading to congestion in the orbit, which pushes the eyeball out.
      • Chronic inflammation may lead to scarring of eye muscles and restricted eye movements.
    • Due to abnormal immunologic regulation, leading to both thyroid disease and inflammation of eye muscles
  • Treatment
    • For dry eye, lubrication with artificial tears eye drop or ointment
    • Medical evaluation for thyroid disease
    • Oral steroid to reduce orbital congestion and inflammation of eye muscles
    • If there is loss of vision and impairment of color vision, surgery is preformed to decompress the orbit and to preserve the optic nerve by reducing the pressure on the optic nerve from orbital congestion.
    • Radiation therapy to the orbit (eye socket) is done sometimes to reduce acute inflammation.
    • Strabismus surgery is performed to correct ocular misalignment.
    • Eyelid surgery to reduce retraction of upper eyelid and place the upper eyelids in normal position
    • Stop smoking if patient is a smoker. Smoking exacerbates thyroid eye disease.
  • Condition
    • Uveitis is consisted of a group of eye disorders characterized by inflammation.
    • In uveitis, every part of the eye may be affected.
    • Course of uveitis can be acute or chronic.
  • Symptoms
    • Redness with congested blood vessels
    • Light sensitivity
    • Eye pain
    • Decreased central vision
    • Loss of peripheral vision
    • Floators
  • Signs
    • Presence of white bloods cells in the eye, and they could be seen:
      • On the inner surface of cornea
      • In the fluid of the anterior chamber, the space between the cornea and lens
      • In the vitreous, the jelly of the eye
    • Dilated blood vessels on ocular surface
    • Inflammation and thinning of cornea
    • Inflammation and thinning of the sclera (white part of the eye)
    • Cataract
    • Iris scarring
    • Retinal detachment
    • Macular swelling
  • Causes
    • Idiopathic (no identifiable underlying disorder)
    • Infectious
      • Toxoplasmosis
        • Causes inflammation and scarring of the retina and the optic nerve.
      • Toxocariasis
        • Causes inflammation and scarring of the retina.
      • Tuberculosis
        • May cause inflammation in any part of the eye.
      • Syphilis
        • May cause inflammation in any part of the eye.
      • Lyme disease
        • May cause inflammation of the optic nerve, vitreous, retina, cornea, sclera, and conjunctiva.
      • Viral
        • Herpe zoster virus (see section on Shingles)
        • Herpes simplex virus (see section on Herpes simplex eye disease)
        • Cytomegaliovirus
          • Causes inflammation of the retina.
          • May be associated with HIV infection.
    • Immunologic
      • Ankylosing spondylitis
        • Causes acute inflammation of iris.
      • Ulcerative colitis
        • Causes acute inflammation of the iris and the cornea.
      • Crohn’s disease
        • Causes acute inflammation of the iris and the cornea.
      • Rheumatoid arthritis (adult-onset)
        • Causes inflammation of the cornea and the sclera.
      • Juvenile rheumatoid arthritis
        • Causes chronic inflammation of the iris.
    • Trauma
      • Trauma may lead to inflammation of any part of the eye.
    • Sarcoidosis
      • Chronic inflammation of the iris and the retina
  • Treatment
    • Treatment has to be tailored to the severity of inflammation, the underlying disorder, and patient’s general medical condition.
    • Medical evaluation and testing for any underlying disorders if suspected.
    • Treat underlying the infection with appropriate antibiotics or anti-viral medications
    • Steroid is used to reduce inflammation and can be given
      • Topically (as eye drops)
      • Orally
      • Intravenously
      • As intraocular injections
    • Chemotherapeutic drugs are used when inflammation cannot be controlled with steroid.
    • Surgery is performed for
      • Removal of cataract
      • Repair of retinal detachment
      • Removal of inflammatory debris from the vitreous (the jelly inside the eye)

Reference:

The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 5th edition. Lippincott Williams & Wilkins: 2008.

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