COMMON EYE CONDITIONS, DISORDERS AND DISEASES

Amblyopia

Amblyopia is poor sight in an eye that failed to develop normal vision in early childhood.  The visual system in infants develops rapidly, with visual development completed by age 8-9 years.  Most pediatricians and family doctors will formally test vision at a child’s four-year exam. An eye that is misaligned (strabismus), or is out of focus because of a need for strong glasses, or has a congenital cloudiness may fail to develop normal vision (i.e. “20/20” vision).  Amblyopia will affect 2% of the population.  Ophthalmologists are trained to detect this condition, even in neonates, and the sooner therapy is started the quicker the vision will recover.  Treatment usually consists of an occlusive patch worn over the strong normal eye to stimulate visual development in the “lazy eye”.

Cataract

Cataract is a common cause of poor vision, particularly in the elderly, but the condition is treatable.  An ophthalmologist can determine whether a cataract or some other problem is the cause of poor vision.  Cataract is a clouding of the lens of the eye.  It causes a blurring or dimming of vision.  Cataract is often associated with aging and usually develops slowly.  It is diagnosed during an examination by an ophthalmologist. Cataracts may be treated surgically when changes of glasses no longer provide the vision that the patient needs.  Over 1.4 million people have cataract surgery each year in the United States.  The surgery is usually done under local anesthesia as an outpatient procedure.  In most cases the focusing power of the natural lens of the eye is restored by replacing it with a permanent intraocular lens.  Cataract surgery is successful and uncomplicated in over 95% of people.

Diabetic Retinopathy

Dry Eye Syndrome

Some people do not produce enough tears to keep the eye comfortable with each blink.  This is known as dry eye.  Tears that lubricate the eye are constantly produced by a healthy eye.  Frequently, as we age, not enough baseline tears are produced or sometimes the tears are not held on the surface of the eye properly.  Symptoms usually include stinging or burning, scratchiness, stringy mucus, irritation from smoke or wind, and excess tearing.  Dry eye particularly affects women after menopause.  Also, many medications associated with the treatment of high blood pressure, sleeping pills, medications for nerves, pain pills, and even pills to treat a cold can add to a dry eye syndrome.  An ophthalmologist is usually able to diagnosis dry eye by examining the eyes and sometimes performing special tests regarding tear production.  Frequently dry eye can be easily treated by just adding lubricating drops.  In some cases, your ophthalmologist may be able to put in a “lacrimal plug” to help hold the tears onto the eyes.  Your options can be discussed with your ophthalmologist at your regular examination.

Macular Degeneration

Macular degeneration is damage or swelling of the small area of the retina (the nerve layer at the back of the eye) that allows us to see fine details clearly.  When the macula doesn’t function correctly, we experience blurriness or darkness in the center of our vision for both distance and close vision.  Many older people develop macular degeneration as part of the body’s natural aging process.  The two most common types are dry and wet.  Most people have dry macular degeneration.  It is caused by aging and scarring of the macula portion of the retina.  Visual loss is usually gradual and generally treatment is not effective.  Wet macular degeneration accounts for about 10% of all cases.  It is caused by abnormal blood vessel growth at the back of the eye.  There are several new and exciting treatments for management of this type of macular degeneration; however, vision loss can sometimes be rapid and severe.  Macular degeneration alone does not result in total blindness.  People continue to have some useful vision and are frequently able to take care of themselves.  Early detection can many times prevent the severe visual loss of wet macular degeneration.  Regular and frequent exams with your ophthalmologist are important in preventing severe visual loss.

Glaucoma

Glaucoma is a leading cause of blindness, especially in older people.  It is a disorder caused by damage to the optic nerve, most often due to increased pressure of the fluids inside the eye. There are several types of glaucoma.  The more common ones are a) open angle: the pressure inside the eye increases because of aging of the structures in the eye.  This pressure damages the optic nerve.  The effects usually occur gradually and painlessly so that the patient is unaware of the disease until the nerve is severely damaged.  Regular examinations by an ophthalmologist can detect elevated pressure and thereby prevent loss of sight if detected and treated early enough; b) angle closure glaucoma (also called acute glaucoma): a disorder in which there is a sudden increase in the pressure within the eye due to an abnormality in the anatomy of the eye.  Often the patient experiences symptoms that may include blurred vision, severe eye pain, headache, halos around lights, nausea and vomiting.  Acute angle closure glaucoma is an emergency which must be treated by an ophthalmologist immediately or severe loss of vision can result.

Treatment of Glaucoma:  Open angle glaucoma is most often treated with eye drops.  Laser treatment is often successful in reducing the pressure.  In some cases surgery becomes necessary.

Angle closure glaucoma is usually treated with laser but surgery may become necessary in a few cases. 

Pink Eye

The term “pink eye” is a general term that describes inflammation of the conjunctiva.  The conjunctiva is a clear skin that overlies the white wall of the eyeball.  Technically, “conjunctivitis” is the medical term for “pink eye”. 

The common conjunctivitis of childhood is usually viral in origin and transmission is similar to a common cold.  Like a cold, there is no pill or drop that will kill this virus, but cool compresses, antihistamines and antibiotic drops or ointment are usually prescribed.  Children are often quarantined from school.  A more serious type of pink eye, which is usually one-sided, is caused by a bacterial infection.  There is a very thick green or tan discharge gluing the eyelids together.  Antibiotics are necessary to treat this.  Conjunctivitis can be allergic in nature due to seasonal allergies and there is intense itching.  A variety of prescription drops called antihistamines and/or “mast cell stabilizers” are very helpful. 

All “pink eye” in contact lens wearers should be considered an ophthalmic emergency.  Corneal ulcers can form, and the contact lenses must be immediately removed and strong antibiotics started.  Less commonly, conjunctivitis can be related to various skin conditions like chicken pox, shingles, contact dermatitis or chemical burns.

 Strabismus

Strabismus is a misalignment of the two eyes that can be constant or intermittent.  Six muscles control the horizontal and vertical eye movements in a carefully balanced manner.  This balance enables the two eyes to focus on a single target.  If the balance is disrupted, single binocular vision will not develop, and it will result in failure on depth perception tests.

 Strabismus affects 3-4% of children. The earlier it is detected and treated, the higher the likelihood is of the child developing normal binocular vision.  A common congenital crossing towards the nose is “congenital esotropia”.  An ophthalmologist should surgically correct this during infancy.  Any misaligned eye in a child could signal a cataract, an intraocular tumor (retinoblastoma) or a neurological condition.  Another type of inward turning, “accommodative esotropia” occurs in many children ages two to five years.  These children need to wear farsighted corrective glasses, sometimes bifocals, to straighten the eyes.  Eyes that turn outward more commonly occur in older children and adults.  It is rare for eye exercises to cure any of these problems, and surgical options should always be discussed with an ophthalmologist.

 Strabismus in an adult usually creates “double vision” and is considered an ophthalmic emergency when it occurs.  Treatment options include prisms in glasses, Botulinum injections and surgical realignment.