Author: Boston Eye Physicians and Surgeons

If you have noticed a sore or opening on the clear outer covering of your eye(cornea), you may be experiencing a corneal ulcer.  Some ulcers may appear as a gray to white area on the normally transparent cornea. However, some corneal ulcers may be too small to see without adequate magnification and illumination. This can sometimes be caused by bacterial or viral infections or even overuse or misuse of contacts among other reasons.   Anyone with an irritated eye that does not improve quickly after removing a contact lens or after mild irrigation should contact an ophthalmologist immediately.

Here are some quick facts about corneal ulcers: how they form, their symptoms and treatments.

Possible Signs and Symptoms of a corneal ulcer –

• Redness, pain, a feeling that something is in the eye.
• Pus or thick discharge draining from the eye.
• Blurriness or pain when looking at bright lights.
• Swelling of the eyelid.

Causes – There are a wide variety of causes of corneal ulcers, including:

• Bacterial infections can cause corneal ulcers and are common in people who wear contact lenses.
• Viruses such as  herpes simplex virus (the virus that causes cold sores) and the Varicella virus may cause corneal ulcers.
• Fungal infections can cause corneal ulcers and may occur with improper care of contact lenses or overuse of eye drops that contain steroids.

Treatment Options –

• Anti-infective agents directed at the inciting microbial agent will be used in cases of corneal ulcer due to infection. (Drops, or possibly oral medications)
• In cases aggravated by dryness or corneal exposure, tear substitutes will be used, possibly accompanied by patching or a bandage contact lens.
• In corneal ulcers involving injury, the inciting agent must be removed from the eye- using a slit lamp microscope to to remove the particles causing the injury.
• In extreme cases surgery may be needed to debride the ulcer.

If you have ever had a small, painful lump along the edge of your eyelid then you have probably had a sty (also spelled stye). While styes are fairly common and are usually visible on the outer eyelid, they have formed deeper inside the eyelid in some cases as well.  Let’s look at the causes, types and treatments of styes to keep you informed in case you suspect that you may be suffering from one of these painful blockages.

What is a sty and what causes it?

A sty is an external bump on the eyelid that swells and then eventually bursts then heals.  The sty originally forms due to a blocked gland that needs to become cleared.  There are two main types of sty lumps.  These include: hordeolum and chalazion. Each has different causes and treatments.

Hordeolum

A hordeolum is a blockage of one of the sweat glands found in the skin of the lid and base of the eyelashes, or one of the small sebaceous glands found at the base of the eyelashes.

Chalazion

A chalazion is a blockage of a meibomian gland, which is a special sebaceous gland unique to the eyelids.

The sty can occur due to a gland becoming blocked with its own secretion or possibly from makeup, dust or other foreign substances.  It can also be caused by a sluggish gland that was infected or had some sort of trauma.

What are the treatments for a sty on the eyelid?

A non-infected hordeolum will resolve on its own. Warm compresses may help soften the material in the gland, easing the drainage of the gland’s contents. A non-infected chalazion similarly will resolve on its own, though over a much longer period of time. A small chalazion may resolve within weeks, while larger ones may resolve over the course of a year. The most conservative treatment is application of frequent warm compresses. Steroids can be injected into the lesion, often resulting in a speedier resolution. However this carries a small risk of bleeding/bruising, depigmentation/thinning of the skin, scar, pain, and in very rare cases, loss of vision. Finally, the chalazion can be incised and drained. This is the most invasive method and is reserved as a last resort by most eye doctors.

If you have ever woken up with itchy eyes accompanied by a thick, crusty discharge or green or yellow mucus coming from your eye then you may have the dreaded
“pink eye” or conjunctivitis.  Other symptoms that are experienced with conjunctivitis include:  redness in the whites of the eyes or the inner eyelid, blurriness, burning or even sensitivity to light.  If you are suffering from any of these symptoms then consult your primary care physician for a swab of the effected area.  While this disease is not a serious health risk it should be dealt with quickly through your doctors office.

What is conjunctivitis?

Conjunctivitis, also known as pinkeye, is an inflammation of the conjunctiva. The conjunctiva is the thin clear tissue that lies over the white part of the eye and lines the inside of the eyelid.

What causes pink eye?

This eye disease has several possible causes such as: a virus, a bacterial infection such as gonorrhea or chlamydia, irritants such as shampoos, dirt, smoke, and pool chlorine
or possibly allergies, like dust, pollen, or a special type of allergy that affects some contact lens wearers.

What treatments are available for pink eye?

The treatment proscribed by your doctor will depend mostly upon the cause of the disease.  If bacteria was the root cause then antibiotics, in the form of eye drops, ointments, or pills will be the treatment.  If a virus is the cause (such as the virus that causes the common cold) then it must run its course over the next 7-10 days.  Warm compresses can help with the discharge.  Throw away all contacts and makeup that you used during the period before being diagnosed.  If irritants or allergies are the cause of the discharge then washing out eyes and removing irritants from laundry, home or other areas that will affect your eyes.

Are you or a loved one suffering from the following symptoms- distortion or blurring of images at all distances, headaches, and fatigue or even squinting and eye discomfort or irritation? These symptoms may not necessarily mean a diagnosis of astigmatism, however, if you experience one or more of these symptoms, contact your ophthalmologist for a complete exam. Let’s look at the causes and treatment for astigmatism.

What Is Astigmatism?

Astigmatism is an imperfection in the curvature of your cornea — the clear, round dome covering the eye’s iris and pupil — or in the shape of the eye’s lens. Astigmatism is very common. In most cases, people with astigmatism are born with this condition. The reason why corneal shape differs from person to person is unknown, but the likelihood of developing astigmatism is inherited.

Treatment For Astigmatism

Depending upon the degree of astigmatism will determine the treatment needed. If the degree of astigmatism is slight and there are no other problems of refraction, such as nearsightedness or farsightedness, corrective lenses may not be needed.

If the degree of astigmatism is great enough to cause eye strain, headache, or distortion of vision, corrective lenses will be needed for clear and comfortable vision. Your ophthalmologist will perform precise tests during your exam to determine the ideal lens prescription. Refractive surgery also may be an option for correcting some forms of astigmatism.

Age Related Macular Degeneration (AMD) is a common eye condition and a leading cause of vision loss among people age 50 and older. The eye’s macula (small part of the retina) deteriorates and fine details in central vision become difficult to see. Many older people develop macular degeneration as part of the body’s natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration.

Symptoms of AMD – Blurriness, dark areas or distortion in your central vision, and perhaps permanent loss of your central vision. It usually does not affect your side, or peripheral vision.

Who is at risk?  Age is a major risk factor for AMD. The disease is most likely to occur after age 60, but it can occur earlier. Other risk factors for AMD include:

• Smoking. Research shows that smoking doubles the risk of AMD.
• Race. AMD is more common among Caucasians than among African-Americans or Hispanics/Latinos.
• Family history. People with a family history of AMD are at higher risk.

Causes of AMD – include the formation of deposits called drusen under the retina, and in some cases, the growth of abnormal blood vessels under the retina. With or without treatment, macular degeneration alone almost never causes total blindness. People with more advanced cases of macular degeneration continue to have useful vision using their side, or peripheral vision.

The early and intermediate stages of AMD usually start without symptoms. Only a comprehensive dilated eye exam can detect AMD. Consult with your eye doctor is you have any symptoms of macular degeneration.

Cataracts are the the most common cause of vision loss in people over age 40.  In fact, it effects 22 million Americans in that age range currently.  According to Prevent Blindness America (PBA), there are more cases of cataracts worldwide than there are of glaucoma, macular degeneration and diabetic retinopathy combined.  Therefore it is important to understand the signs and symptoms of cataracts so that you may seek medical help.

What Are Cataracts?

A cataract is a clouding of the eye’s natural lens. When first forming on the lens the cataract has little impact on vision.  As the cataract progresses however, a patient may notice blurriness.  A cataract may make light from the sun or a lamp seem too bright or glaring. Colors may not appear as bright as they once did.

What causes cataracts?

No one knows for sure why the proteins in the eye clump together to form cataracts but there are factors that researchers have identified as risk factors that can cause cataracts.

• Ultraviolet radiation from sunlight and other sources
• Diabetes
• Hypertension
• Obesity
• Smoking
• Prolonged use of corticosteroid medications
• Statin medicines used to reduce cholesterol
• Previous eye injury or inflammation
• Previous eye surgery
• Hormone replacement therapy
• Significant alcohol consumption
• High myopia
• Family history

What are the treatments for cataracts?

When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids. Cataracts surgery is also very successful once the cataract has progressed enough to impair vision.  More than 3 million Americans undergo cataract surgery each year, according to PBA. Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40.

Have you been suffering from any of the following eye symptoms: stinging or burning, a gritty feeling, pain and redness, a stringy discharge of the mucus,  fatigue or blurry vision? If you have dealt with any of these symptoms and they persist or recur you will want to get an accurate diagnosis from your eye care professional.  You may be experiencing chronic dry eye or dry eye disorder.  Let’s look at who is most at risk for this disorder, its symptoms and causes.

Who is at Risk?

While dry eye can affect anyone at any age,  the elderly frequently experience this chronic syndrome.  Nearly five million Americans 50 years of age and older are estimated to have dry eye. Of these, more than three million are women and more than one and a half million are men. Post menopausal women are also at a higher risk for dry eye.  Dry eyes are also associated with some medical conditions such as diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren’s syndrome, thyroid disorders and vitamin A deficiency. Certain antidepressants, high blood pressure medication, antihistamines and decongestants can also put a patient at risk for dry eye.

Diagnosis?

Once you have decided that the symptoms mentioned above are ones that you are experiencing you will want an accurate diagnosis.  Dry eyes can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on the evaluation of the quantity and quality of tears produced by the eyes, may include: taking the patient’s history, external examination of the eye, eyelid, and cornea, and measurement of the quantity and quality of tears. Your doctor will then recommend a course of treatment appropriate for your specific case of dry eye.

Do you have difficulty driving at night, seeing clearly in low light or have trouble transitioning from bright light to dim light?  You may be suffering from Night Blindness, also known as nyctalopia.  Night Blindness is a misnomer- in that people with this affliction are NOT blind but rather have vision impairment in low light environments.  Let’s look at some of the symptoms, causes and possible treatments of Night Blindness.

• Symptoms: The main symptom of night blindness is difficulty seeing in the dark. In fact most people notice that they have trouble seeing while driving at night.  Another symptom includes an inability to transition from light to dark situations. Seniors are more likely to suffer from night blindness than children or young adults.
• Causes: A number of eye conditions can cause night blindness, including:
  • nearsightedness: blurred vision when looking at faraway objects
  • cataracts: a clouding of the eye’s lens
  • retinitis pigmentosa: when dark pigment collects in your retina, creating tunnel vision
  • Usher syndrome: a genetic condition that affects both hearing and vision
  • Vitamin A deficiency: Vitamin A, also called retinol, plays a role in transforming nerve impulses into images in the retina. The retina is a light-sensitive area in the back of your eye.
  • Diabetes: Patients who have high blood glucose (sugar) levels or diabetes also have a higher risk of developing eye diseases, such as cataracts.
• Treatments: Seek an eye exam from your doctor in order to diagnose night blindness. You may also be asked to give a blood sample. Blood testing can measure your vitamin A and glucose levels. Night blindness caused by nearsightedness, cataracts, or vitamin A deficiency is treatable. Corrective lenses, such as eyeglasses or contacts, can improve nearsighted vision both during the day and at night. Let your doctor know if you still have trouble seeing in dim light even with corrective lenses.

Having vision problems such as blurry vision and headaches?

Let’s look at one of the group of eye diseases known as glaucoma.

Glaucoma is a complicated disease in which damage to the optic nerve results in vision loss.

While there are several forms of glaucoma there are two main forms that doctors see most frequently – open-angle glaucoma (POAG) and angle-closure glaucoma (ACG). Despite being grouped together under the disorder glaucoma, these two disorders have completely different symptoms. 

Symptoms of Glaucoma 

There are many signs and symptoms of glaucoma you can look out for. If you’re looking more into the symptoms, check out these two types of glaucoma and see if your symptoms match.

Primary Open-Angle Glaucoma

Signs and symptoms of Primary open-angle glaucoma include: gradual loss of peripheral vision, usually in both eyes and tunnel vision in the advanced stages. Unfortunately, there are typically no early warning signs or symptoms of open-angle glaucoma. It develops slowly and sometimes without noticeable sight loss for many years. By the time a patient is aware of vision loss, the disease is usually quite advanced. This makes regular eye doctor appointments critical to diagnosing glaucoma.

Acute Angle-Closure Glaucoma

Signs and symptoms of acute angle-closure glaucoma include: Eye pain, Nausea and vomiting (accompanying the severe eye pain), Sudden onset of visual disturbance, often in low light, Blurred vision, Halos around lights, and Reddening of the eye. In contrast with open-angle glaucoma, symptoms of acute angle-closure glaucoma are very noticeable and damage occurs quickly. If you experience any of these symptoms, seek immediate care from an ophthalmologist.

If your doctor diagnosed you or a family member with glaucoma, it is important to set a regular schedule of examinations in order to monitor your condition and make sure that your prescribed treatment is effectively maintaining a safe eye pressure. If you have questions about your eye health or your current symptoms, reach out to our office and schedule an appointment.

Years ago, Beth Israel was the first area hospital to start computer based medical record keeping and continues in that fine tradition. Today, also since early this year, customized preop medication orders from outside clinicians like me are generated without paper, reducing risk of errors.

How likely are errors? With so many fields of medicine, such as ours, ophthalmology, each with unique medicine formulations, the error rate elsewhere can be high.

How nice it is having the comfort at BIDMC, that eye drops are selected in a failsafe pharmacy environment.

The glaucoma and cataract surgeries I performed today seemed to fly by as the skilled team of circulating and scrub nurse specialists – Flor, Alma, Richie – and others, flawlessly made each patient’s surgery a serious and focused undertaking of personal importance.

As soon as the patch is removed In the morning, these patients will have good vision – no longer suffering lost eyesight from those diseases. Happily surgery is painless for nearly everybody. And the eyesight reward is without measure.