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.
Typically amblyopia is discovered when vision in each eye is tested separately such as in eye examination or in eye screening.
Decreased vision that cannot be corrected completely with glasses or contact lenses
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
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.
Margin of lower eyelid not in apposition to the ocular surface
Red eye with congested vessels
Especially prominent in the lower part of the eye
Scratchiness in the eye
Outward turning of the lower eyelid margin away from the eye
Rough corneal surface, especially prominent in the lower part of the ocular surface
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.
Scarring of the lower eyelid can pull the eyelid margin away from the eye.
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.
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)
The margin of the lower eyelid rolls into the eye and causes irritation of the ocular surface.
Scratchiness in the eye
Red eye with congested blooded vessels
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
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.
Scarring of the lower eyelid may cause the eyelid margin to roll in.
Forceful closure of the eyelids may cause the lower eyelid margin to roll in.
Could be associated with eye irritation from trauma or allergy.
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
Excessive looseness and laxity of upper eyelid leading to easy eversion (tuning inside out) of the upper eyelid
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
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
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.
Apply lubricating eye ointment prior to sleep
Tape the eye closed or covering the eye with a shield prior to sleep.
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:
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
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
Early stages: none
Late stages: loss of side (peripheral) vision, followed by loss of central vision
Family history positive for open-angle glaucoma
High eye pressure
Thinning of the optic nerve
Loss of peripheral vision
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.
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.
High eye pressure due to closure of the angle of the eye
Usually acute onset
Eye Pain, usually severe and boring in nature
Halos around lights
Headaches, usually severe
Nausea and vomiting
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
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.
Antihistamines and Topomax may induce angle-closure glaucoma in patients with narrow angles.
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.
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.
Hyphema usually occurs after trauma to the eye.
Spontaneous hyphema is rare
Sensitivity to light
Red eye with congested vessels
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.
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
Diabetes eye disease
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.
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.
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
Discrete yellow spots in the macula
Usually the first sign of macular degeneration
Macular drusen increase in size and number as macular degeneration progresses.
Loss of the natural pigmentation in macula
The hallmark of dry macular degeneration
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
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).
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.
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:
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
Myopis is characterized by poorer (blurrier) vision in distance compared to vision at near
Squinting to see clearly in distance
In myopia, distance vision can be improved with minus lenses
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
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.
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.
Acute onset of visual loss that occurs usually in days
Pain with eye movement
Vision appears dim or darkened
Colors look washed-out
Abnormal color vision
Loss of central visual field
Abnormal pupil reaction in the affected eye
The optic nerve may appear swollen
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
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.
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
Blurry vision at near
Eye tires easily with near task (prolonged reading or computer work)
Near vision can be improved with plus lenses
Pushing reading material away to clear near vision
With age, the natural lens of eye loses elasticity. As result, the eye’s range of focus decreases with time
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
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
Usually lasting few seconds
More prominent in dark and in the peripheral vision
Can be induced with rapid eye movement
Loss of peripheral vision (like a curtain or shadow covering part of vision)
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
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.
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.
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
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.
The material contained on this site is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Always seek the advice of your physician or other qualified health care provider.