Ophthalmic Ailments

What is amblyopia?

Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. It is sometimes called 'lazy eye.” Newborn infants are able to see, but as they use their eyes during the first months of life, vision improves. During early childhood years, the visual system changes quickly and vision continues to develop. If a child cannot use his or her eyes normally, vision does not develop properly and may even decrease. After the first nine years of life, the visual system is normally fully developed and usually cannot be changed. The development of equal vision in both eyes is necessary for normal vision. When one eye develops good vision while the other does not, the eye with poorer vision is called amblyopic. Usually, only one eye is affected by amblyopia, but it is possible for both eyes to be 'lazy.' The condition is common, affecting approximately two or three out of every 100 people. The best time to correct amblyopia is during infancy or early childhood.

What causes amblyopia?

Amblyopia is caused by any condition that affects normal use of the eyes and visual development. In many cases, the conditions associated with amblyopia may be inherited. Amblyopia has three major causes:

• Strabismus (misaligned eyes) Amblyopia occurs most commonly with misaligned or crossed eyes. The crossed eye 'turns off' to avoid double vision, and the child uses only the better eye. The misaligned eye then fails to develop good vision.
• Unequal Focus / Refractive Error Refractive errors are eye conditions that are corrected by wearing glasses. Amblyopia occurs when one eye is out of focus because it is more nearsighted, farsighted or astigmatic than the other. The unfocused (blurred) eye 'turns off' and becomes amblyopic. The20eyes can look normal, but one eye has poor vision. This is the most difficult type of amblyopia to detect since the child appears to have normal vision when both eyes are open. Amblyopia also can occur in both eyes if both eyes are very blurred. This can happen when there is a high amount of nearsightedness, farsightedness or astigmatism. This is called bilateral refractive amblyopia.
• Cloudiness in the Normally Clear Eye Tissues An eye disease such as a cataract (a clouding of the eye's naturally clear lens) may lead to amblyopia. Any factor that prevents a clear image from being focused inside the eye can lead to the development of amblyopia in a child. This is often the most severe form of amblyopia.

How is amblyopia diagnosed?

It is not easy to recognize amblyopia. A child may not be aware of having one strong eye and one weak eye. Unless the child has a misaligned eye or other obvious abnormality, there is often no way for parents to tell that something is wrong. Amblyopia is detected by finding a difference in vision between the two eyes or poor vision in both eyes. Since it is difficult to measure vision in young children, your ophthalmologist often estimates visual acuity by watching how well a baby follows objects with one eye when the other eye is covered. Using a variety of tests, the ophthalmologist observes the reactions of the baby when one eye is covered. If one eye is amblyopic and the good eye is covered, the baby may attempt to look around the patch, try to pull it off, or cry.

Poor vision in one eye does not always mean that a child has amblyopia. Vision can often be improved by prescribing glasses for a child. Your ophthalmologist will also carefully examine the interior of the eye to see if other eye diseases may be causing decreased vision. These diseases include:

• Cataracts
• Inflammations
• Tumors
• Other disorders of the inner eye

How is amblyopia treated?

To correct amblyopia, a child must be made to use the weak eye. This is usually done by patching or covering the strong eye, often for weeks or months. Even after vision has been restored in the weak eye, part-time patching may be required over a period of years to maintain the improvement. Glasses may be prescribed to correct errors in focusing. If glasses alone do not improve vision, then patching is necessary. Amblyopia also may be treated by blurring the vision in the good eye with special eyedrops or lenses to force the child to use the amblyopic eye. Amblyopia is usually treated before surgery to correct misaligned eyes, and patching is often continued after surgery as well.

If your ophthalmologist finds a cataract or other abnormality, surgery may be required to correct the problem. An intraocular lens may be implanted. After surgery, glasses or contact lenses can be used to restore focusing while patching improves vision.

Amblyopia cannot usually be cured by treating the cause alone. The weaker eye must be made stronger in order to see normally. Prescribing glasses or performing surgery can correct the cause of amblyopia, but your ophthalmologist must also treat the amblyopia itself.

A common treatment for amblyopia is to patch the strong eye; the weak eye is strengthened because the child is forced to use it. If amblyopia is not treated, several problems may occur:

• The amblyopic eye may develop a serious and permanent visual defect
• Depth perception (seeing in three dimensions) may be lost
• If the good eye becomes diseased or injured, a lifetime of poor vision may be the result

Your ophthalmologist can give you instructions on how to treat amblyopia and can help you and your child to carry out this treatment. Children do not like to have their eyes patched. But as a parent, you must convince your child to do what is best for him or her. Your interest and involvement will be necessary for successful treatment.

Loss of Vision Is Preventable

Success in the treatment of amblyopia also depends upon how severe the amblyopia is; and How old the child is when treatment is begun. If the problem is detected and treated early, vision can improve for most children. Amblyopia caused by strabismus or unequal refractive errors may be treated successfully during the first nine years of age. After this time, amblyopia usually does not recur.

If amblyopia is not detected until after early childhood, treatment may not be successful. Amblyopia caused by cloudiness of the eye tissues needs to be detected and treated extremely early - within the first two months of life - in order to be treated successfully.

What is AMD?

Age related macular degeneration (AMD) is a common eye condition and a leading cause of vision loss among people age 50 and older. It causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead.

In some people, AMD advances so slowly that vision loss does not occur for a long time. In others, the disease progresses faster and may lead to a loss of vision in one or both eyes. As AMD progresses, a blurred area near the center of vision is a common symptom. Over time, the blurred area may grow larger or person may develop blank spots in the central vision. Objects also may not appear to be as bright as they used to be.

AMD by itself does not lead to complete blindness, with no ability to see. However, the loss of central vision in AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house.

The Macula

The macula is made up of millions of light-sensing cells that provide sharp, central vision. It is the most sensitive part of the retina, which is located at the back of the eye. The retina turns light into electrical signals and then sends these electrical signals through the optic nerve to the brain, where they are translated into the images we see. When the macula is damaged, the center of your field of view may appear blurry, distorted, or dark.

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.

Does lifestyle make a difference?

Researchers have found links between AMD and some lifestyle choices, such as smoking. You might be able to reduce your risk of AMD or slow its progression by making these healthy choices:

• Avoid smoking

• Exercise regularly

• Maintain normal blood pressure and cholesterol levels

• Eat a healthy diet rich in green, leafy vegetables and fish

• Protect eyes from harmful UV (ultraviolet) light with glasses or wide hat

How is AMD detected?

The early and intermediate stages of AMD usually start without symptoms. Only a comprehensive dilated eye exam can detect macular degeneration. The eye exam may include the following:

• Visual acuity test. This eye chart measures how well you see at distances.

• Dilated eye exam. Your eye care professional places drops in your eyes to widen or dilate the pupils. This provides a better view of the back of your eye. Using a special magnifying lens, he or she then looks at your retina and optic nerve for signs of AMD and other eye problems.

• Amsler grid. Your eye care professional also may ask you to look at an Amsler grid. Changes in your central vision may cause the lines in the grid to disappear or appear wavy, a sign of AMD.

• Fluorescein angiogram. In this test, which is performed by an ophthalmologist, a fluorescent dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your eye. This makes it possible to see leaking blood vessels, which occur in a severe, rapidly progressive type of AMD (see below). In rare cases, complications to the injection can arise, from nausea to more severe allergic reactions.

• Optical coherence tomography. You have probably heard of ultrasound, which uses sound waves to capture images of living tissues. OCT is similar except that it uses light waves, and can achieve very high-resolution images of any tissues that can be penetrated by light—such as the eyes. After your eyes are dilated, you’ll be asked to place your head on a chin rest and hold still for several seconds while the images are obtained. The light beam is painless.

During the exam, your eye care professional will look for drusen, which are yellow deposits beneath the retina. Most people develop some very small drusen as a normal part of aging. The presence of medium-to-large drusen may indicate that you have AMD.

Another sign of AMD is the appearance of pigmentary changes under the retina. In addition to the pigmented cells in the iris (the colored part of the eye), there are pigmented cells beneath the retina. As these cells break down and release their pigment, your eye care professional may see dark clumps of released pigment and later, areas that are less pigmented.

What are the stages of AMD?

There are three stages of AMD defined in part by the size and number of drusen under the retina. It is possible to have AMD in one eye only, or to have one eye with a later stage of AMD than the other.

• Early AMD - Early AMD is diagnosed by the presence of medium-sized drusen, which are about the width of an average human hair. People with early AMD typically do not have vision loss.

• Intermediate AMD - People with intermediate AMD typically have large drusen, pigment changes in the retina, or both. Again, these changes can only be detected during an eye exam. Intermediate AMD may cause some vision loss, but most people will not experience any symptoms.

• Late AMD - In addition to drusen, people with late AMD have vision loss from damage to the macula. There are two types of late AMD:

•  In geographic atrophy (also called dry AMD), there is a gradual breakdown of the light-sensitive cells in the macula that convey visual information to the brain, and of the supporting tissue beneath the macula. These changes cause vision loss.

•  In neovascular AMD (also called wet AMD), abnormal blood vessels grow underneath the retina. ("Neovascular" literally means "new vessels.") These vessels can leak fluid and blood, which may lead to swelling and damage of the macula. The damage may be rapid and severe, unlike the more gradual course of geographic atrophy. It is possible to have both geographic atrophy and neovascular AMD in the same eye, and either condition can appear first.

AMD has few symptoms in the early stages, so it is important to have your eyes examined regularly. If you are at risk for AMD because of age, family history, lifestyle, or some combination of these factors, you should not wait to experience changes in vision before getting checked for AMD.

Not everyone with early AMD will develop late AMD. For people who have early AMD in one eye and no signs of AMD in the other eye, about five percent will develop advanced AMD after 10 years. For people who have early AMD in both eyes, about 14 percent will develop late AMD in at least one eye after 10 years. With prompt detection of AMD, there are steps you can take to further reduce your risk of vision loss from late AMD.

If you have late AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you may still be able to drive, read, and see fine details. However, having late AMD in one eye means you are at increased risk for late AMD in your other eye. If you notice distortion or blurred vision, even if it doesn’t have much effect on your daily life, consult an eye care professional.

How is AMD treated?

Early AMD

Currently, no treatment exists for early AMD, these patients typically do not have any visual symptoms. Your eye care professional may recommend that you get a comprehensive dilated eye exam at least once a year. The exam will help determine if your condition is advancing.

As for prevention, AMD occurs less often in people who exercise, avoid smoking, and eat nutritious foods including green leafy vegetables and fish. If you already have AMD, adopting some of these habits may help you keep your vision longer.

Intermediate and late AMD

Age-Related Eye Disease Studies (AREDS and AREDS2) found that daily intake of certain high-dose vitamins and minerals can slow progression of the disease in people who have intermediate AMD, and those who have late AMD in one eye.

Here are the clinically effective daily doses based AREDS and AREDS2 studies:

500 milligrams (mg) of vitamin C

400 international units of vitamin E

80 mg zinc as zinc oxide (25 mg in AREDS2)

2 mg copper as cupric oxide

10 mg lutein

2 mg zeaxanthin

Persons that have intermediate or late AMD, might benefit from taking such supplements. But first, be sure to review and compare the labels. Many of the supplements have different ingredients, or different doses, from those tested in the AREDS trials. Also, consult your doctor or eye care professional about which supplement, if any, is right for you. For example, if you smoke regularly, or used to, your doctor may recommend that you avoid supplements containing beta-carotene.

Even if you take a daily multivitamin, you should consider taking an AREDS supplement if you are at risk for late AMD. The formulations tested in the AREDS trials contain much higher doses of vitamins and minerals than what is found in multivitamins. Tell your doctor or eye care professional about any multivitamins you are taking when you are discussing possible AREDS formulations.

Finally, remember that the AREDS formulation is not a cure. It will not restore vision already lost from AMD, but it may delay the onset of late AMD. It also may help slow vision loss in people who already have late AMD.

Advanced neovascular AMD

In the past neovascular AMD typically resulted in severe vision loss. In recent years great progress has been achieved in treatment of wet macular degeneration.  Your ophthalmologist may use different therapies to stop further vision loss and in some patients improve vision. Therapies for wet macular degeneration are not a cure. The condition may progress even with treatment.  Treatment is more successful if done early before wet macular degeneration had a chance to progress.  Thus if you have been diagnosed with macular degeneration checking Amsler grid as directed and seeking help at first sign of distortion or blurriness of vision is essential.

Injections. One option to slow the progression of neovascular AMD is to inject drugs into the eye. With neovascular AMD, abnormally high levels of vascular endothelial growth factor (VEGF) are produced in the eye. VEGF is a protein that promotes the growth of new abnormal blood vessels. Anti-VEGF injection with drugs such as Lucentis or EYLEA blocks this growth. Patients receiving this treatment may need multiple or monthly injections. Injections are very well tolerated, but be sure to discus specifics and risks with you ophthalmologist. Before each injection, eye is numbed (very well!) and cleaned with antiseptics. To further reduce the risk of infection antibiotic drops may be prescribed. A few different anti-VEGF drugs are available. They vary in cost and in how often they need to be injected, so you may wish to discuss these issues with your eye care professional.

Photodynamic therapy was a common treatment for wet AMD prior development of Lucentis and EYLEA; this treatment has become less common and is currently used only for specific types of neovascular AMD.

Laser surgery. Ophthalmologists treat certain cases of neovascular AMD with laser surgery, though this is less common than other treatments. This laser surgery may help prevent more severe vision loss from occurring later.

Loss of Vision

Coping with AMD and vision loss can be a traumatic experience. This is especially true if you have just begun to lose your vision or have low vision. However, help is available. You may or may not be able to restore your vision, but low vision services can help you make the most of what is remaining. You can continue enjoying friends, family, hobbies, and other interests just as you always have. Please ask your eye care provider about available services.

What is astigmatism?

Astigmatism is a common type of refractive error. It is a condition in which the eye does not focus light evenly onto the retina, the light-sensitive tissue at the back of the eye.

How does astigmatism occur?

Astigmatism occurs when light is bent differently depending on where it strikes the cornea and passes through the eyeball. The cornea of a normal eye is curved like a basketball, with the same degree of roundness in all areas. An eye with astigmatism has a cornea that is curved more like a football, with some areas that are steeper or more rounded than others. This can cause images to appear blurry and stretched out.

Who is at risk for astigmatism?

Astigmatism can affect both children and adults. Some patients with slight astigmatism will not notice much change in their vision. It is important to have eye examinations at regular intervals in order to detect any astigmatism early on for children.

What are the signs and symptoms of astigmatism?

• Signs and symptoms include:
• Headaches
• Eyestrain
• Squinting
• Distorted or blurred vision at all distances
• Difficulty driving at night

If you experience any of these symptoms, visit your eye care professional. If you wear glasses or contact lenses and still have these issues, a new prescription might be needed.

How is astigmatism diagnosed?

Astigmatism is usually found during a comprehensive dilated eye exam. Being aware of any changes in your vision is important. It can help in detecting any common vision problems. If you notice any changes in your vision, visit your eye care professional for a comprehensive eye dilated examination.

Importantly in small percent of patients astigmatism can be progressive and lead to corneal problems such as keratoconus. In this condition cornea can change shape over time and become thinner.  Special tests such as corneal topography may be needed to diagnose keratoconus.

Can you have astigmatism and not know it?

It is possible to have astigmatism and not know about it. This is especially true for children, who are not aware of their vision being other than normal. Some adults may also have mild astigmatism without any symptoms. It's important to have comprehensive dilated eye exams to make sure you are seeing your best.

How is astigmatism corrected?

Astigmatism can be corrected with eyeglasses, contact lenses, or surgery. Individual lifestyles affect the way astigmatism is treated.

Eyeglasses are the simplest and safest way to correct astigmatism. Your eye care professional will prescribe appropriate lenses to help you see as clearly as possible.

Contact Lenses work by becoming the first refractive surface for light rays entering the eye, causing a more precise refraction or focus. In many cases, contact lenses provide clearer vision, a wider field of vision, and greater comfort. They are a safe and effective option if fitted and used properly. However, contact lenses are not right for everyone. Discuss this with your eye care professional.

Refractive Surgery aims to change the shape of the cornea permanently. This change in eye shape restores the focusing power of the eye by allowing the light rays to focus precisely on the retina for improved vision. There are many types of refractive surgeries. Your eye care professional can help you decide if surgery is an option for you.

What is blepharitis?

Blepharitis is a common condition that causes inflammation of the eyelids. The condition can be difficult to manage because it tends to be chronic or recurrent.

What are the symptoms of blepharitis?

Symptoms of either form of blepharitis include a foreign body or burning sensation, excessive tearing, itching, sensitivity to light, red and swollen eyelids, redness of the eye, blurred vision, frothy tears, dry eye, or crusting of the eyelashes on awakening.

What causes blepharitis?

Blepharitis occurs in two forms:

Anterior blepharitis affects the outside front of the eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are bacteria (Staphylococcus), demodex mites and scalp dandruff.

Posterior blepharitis affects the inner eyelid (the moist part that makes contact with the eye) and is caused by problems with the oil (meibomian) glands in this part of the eyelid. In this form of blepharitis oil glands produce thick oil that can clog the pore and result in low level of oil in tear film, discomfort from clogged pores or Styes and Chalazia.  Two skin disorders are linked with this form of blepharitis: acne rosacea, which leads to red and inflamed skin, and scalp dandruff (seborrheic dermatitis).

Many people have both anterior and posterior blepharitis at the same time.

What other conditions are associated with blepharitis?

Complications from blepharitis include:

Stye (hordeolum): A red tender bump on the eyelid that is caused by an acute infection of the oil glands of the eyelid. 

Chalazion: This condition can follow the development of a stye. It is a usually painless firm lump caused by inflammation of the oil glands of the eyelid. Chalazion can be painful and red if there is also an infection. Treatment of Stye and Chalazion should include warm compresses but may also require antibiotics steroids or surgery.

Tear problems: Abnormal or decreased oil secretions that are part of the tear film can result in excess tearing or dry eye. Normal tears are essential for the health of the eye and clear vision.  Tear film consists of three layers: mucus, liquid tears and oil on surface. Oil cuts down on evaporation and is essential for healthy tear film.  Blepharitis is a common cause of tear film problems.

How to diagnose blepharitis?

A close examination of your eyelids and eyelashes by an eye doctor is usually all that is needed to diagnose blepharitis. However to rule out other problems your ophthalmologist will usually perform comprehensive eye exam upon initial presentation.

How is blepharitis treated?

Treatment for both forms of blepharitis involves keeping the lids clean and free of crusts. Eyelids and lashes needs to be cleaned twice a day in order to remove build up of crusts, dust and particles and wash off bacteria that are present on eyelids.

Warm compresses : If eyelids are red, warm (but not burning hot) compresses for 5 minutes with a wet clean washcloth or towel prior to eyelid washing will help to loosen crusts and melt the clogged oils.

Lid scrubs: To properly clean eyelids wash your hands with soap and water, then with your eyes closed wash eyelids and lashes by rubbing with your cotton swab, special toweled or fingertips along the base of eyelashes back and force for 5-10 times.  Diluted soap like Johnson and Johnson baby shampoo or special eyelid cleanser (Sterilid, Ocusoft) that does not sting the eye should be used daily. Taking a shower does not clean eyelids adequately.  In the shower we instinctively try to avoid getting water in the eye and do not wash eyelids enough.

When scalp dandruff is present, a dandruff shampoo for the hair is recommended as well. In addition to the warm compresses, patients with posterior blepharitis will need to massage their eyelids to clean the oil accumulated in the glands. Patients who also have acne rosacea should have that condition treated at the same time.

Because blepharitis rarely goes away completely, most patients must maintain an eyelid hygiene routine for life. If the blepharitis is severe, your ophthalmologist may also prescribe antibiotics or steroid eye drops.

Nutritional therapy:  In recent years importance of dietary intake of omega three fatty acids in treatment of blepharitis has been recognized. Ask your ophthalmologist about a proper diet and nutritional supplements to help treat this imbalance.

Cataracts are very common for older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. Inside everyone's eye is a lens. Just like the camera, the lens of your eye helps you to focus on things whether they are nearby or far away. To work well, the lens must be clear. As you age, the lens of your eye gradually becomes cloudy. We call a cloudy lens a cataract. The word cataract comes from an old Latin word for waterfall. Waterfalls produce heavy mist that can blur your vision. Cataracts have the same affect as they can also cause blurry vision. Looking through a cloudy lens is like looking through a dirty window and everything is blurred.

Everyone who lives into their 60's develops at least mild cataracts. Early on, the cataract process not only makes your lens cloudy, it also makes your lens swell a little bit. When your lens swell and get bigger, you will become a little more near-sighted. Typically in the early stages of the cataract, you can simply change your glasses prescription and this will usually restore your sight.

As you continue to get older, your vision will become more and more cloudy to the point that a change in your glasses prescription will not improve your sight. At that point, the only way to restore your vision is to remove the cataract. Surgery is the most common surgical procedure performed on adults in the United States. The procedure is performed on an outpatient basis and generally takes a half-hour or less.  The recovery time for cataract surgery is usually only a few days.

The surgery is a two-step procedure.  The surgeon removes your cloudy lens and then inserts a new lens implant is into your eye. The cloudy lens is removed with a tiny instrument that enters your eye through a small incision; usually one-eighth of an inch or smaller.  This instrument gently breaks the cataract into tiny pieces that are then removed from the eye with a miniature vacuum cleaner.  Once the cataract is out, you will need a new lens in order to focus after the surgery. Artificial lens implants made of plastic like materials are used to restore your ability to focus after surgery. These implants come in many different strengths similar to prescription glasses.  Before your cataract operation, your doctor will perform several measurements to determine the appropriate lens implant strength for your eye.

Once the blurry cataract is out and your implant is in, the operation is over. Most people see better within a day or two after cataract surgery however it is not abnormal or worrisome if your vision seems blurry for a few weeks after surgery as your eye heals. Your doctor will prescribe some eye drops for the healing period after surgery and if you need new glasses after surgery, these will be prescribed for you once your eye is completely healed.  This is usually about a month after surgery.

Cataracts cannot grow back, but sometimes a thin cloudy membrane grows behind the lens implant, making your vision blurry like the cataract did. This is not uncommon as it happens to roughly 40 percent of patients having cataract surgery. If it happens to you, a quick and simple laser treatment can be performed to make a hole in the membrane for you to see through.

Albany Eye Associates is an Accredited Dry Eye Center

What is dry eye?

Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly.

In addition, inflammation of the surface of the eye may occur along with dry eye. If left untreated, this condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision. However, permanent loss of vision from dry eye is uncommon.

Dry eye can make it more difficult to perform some activities, such as using a computer or reading for an extended period of time, and it can decrease tolerance for dry environments, such as the air inside an airplane.

Other names for dry eye include dry eye syndrome, keratoconjunctivitis sicca (KCS), dysfunctional tear syndrome, lacrimal keratoconjunctivitis, evaporative tear deficiency, aqueous tear deficiency, and LASIK-induced neurotrophic epitheliopathy (LNE).

What are the types of dry eye?

1. Aqueous tear-deficient dry eye is a disorder in which the lacrimal glands fail to produce enough of the watery component of tears to maintain a healthy eye surface.
2. Evaporative dry eye may result from inflammation of the meibomian glands, also located in the eyelids. These glands make the lipid or oily part of tears that slows evaporation and keeps the tears stable.

Dry eye can be associated with:

• inflammation of the surface of the eye, the lacrimal gland, or the conjunctiva;
• any disease process that alters the components of the tears;
• an increase in the surface of the eye, as in thyroid disease when the eye protrudes forward;
• cosmetic surgery, if the eyelids are opened too widely.

What are tears, and how do they relate to dry eye?

Tears, made by the lacrimal gland, are necessary for overall eye health and clear vision. Tears bathe the surface of the eye, keeping it moist, and wash away dust and debris. They also help protect the eye from bacterial and other types of infections.

Tears are composed of three major components: a) outer, oily, lipid layer produced by the meibomian glands; b) middle, watery, lacrimal layer produced by the lacrimal glands; and c) inner, mucous or mucin layer produced by goblet cells located within a thin transparent layer over the white part of the eye and covering the inner surface of the eyelids. Tears are made of proteins (including growth factors), electrolytes, and vitamins that are critical to maintain the health of the eye surface and to prevent infection.

Tears are constantly produced to bathe, nourish, and protect the eye surface. They are also produced in response to emergencies, such as a particle of dust in the eye, an infection or irritation of the eye, or an onset of strong emotions. When the lacrimal glands fail to produce sufficient tears, dry eye can result.

Any disease process that alters the components of tears can make them unhealthy and result in dry eye.

What are the symptoms of dry eye?

Dry eye symptoms may include any of the following:

• stinging or burning of the eye;
• a sandy or gritty feeling as if something is in the eye;
• episodes of excess tears following very dry eye periods;
• a stringy discharge from the eye;
• pain and redness of the eye;
• episodes of blurred vision;
• heavy eyelids;
• inability to cry when emotionally stressed;
• uncomfortable contact lenses;
• decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention;
• eye fatigue.

NOTE: If symptoms of dry eye persist, consult an eye care professional to get an accurate diagnosis of the condition and begin treatment to avoid permanent damage.

What are the causes of dry eye?

Dry eye can be a temporary or chronic condition:

• Dry eye can be a side effect of some medications, including antihistamines, nasal decongestants, tranquilizers, certain blood pressure medicines, Parkinson's medications, birth control pills and anti-depressants.
• Skin disease on or around the eyelids can result in dry eye.
• Diseases of the glands in the eyelids, such as meibomian gland dysfunction, can cause dry eye.
• Dry eye can occur in women who are pregnant.
• Women who are on hormone replacement therapy may experience dry eye symptoms. Women taking only estrogen is 70 percent more likely to experience dry eye, whereas those taking estrogen and progesterone have a 30 percent increased risk of developing dry eye.
• Dry eye can also develop after the refractive surgery known as LASIK. These symptoms generally last three to six months, but may last longer in some cases.
• Dry eye can result from chemical and thermal burns that scar the membrane lining the eyelids and covering the eye.
• Allergies can be associated with dry eye.
• Infrequent blinking associated with staring at computer or video screens, may also lead to dry eye symptoms.
• Both excessive and insufficient dosages of vitamins can contribute to dry eye.
• Homeopathic remedies may have an adverse impact on a dry eye condition.
• Loss of sensation in the cornea from long-term contact lens wear can lead to dry eye.
• Dry eye can be associated with immune system disorders such as Sjögren's syndrome, lupus, and rheumatoid arthritis. Sjögren's leads to inflammation and dryness of the mouth, eyes, and other mucous membranes. It can also affect other organs, including the kidneys, lungs and blood vessels.
• Dry eye can be a symptom of chronic inflammation of the conjunctiva, the membrane lining the eyelid and covering the front part of the eye, or the lacrimal gland. Chronic conjunctivitis can be caused by certain eye diseases, infection, exposure to irritants such as chemical fumes and tobacco smoke, or drafts from air conditioning or heating.
• If the surface area of the eye is increased, as in thyroid disease when the eye protrudes forward or after cosmetic surgery if the eyelids are opened too widely, dry eye can result.
• Dry eye may occur from exposure keratitis, in which the eyelids do not close completely during sleep.

Who is likely to develop dry eye?

Elderly people frequently experience dryness of the eyes, but dry eye can occur at any age. 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. Tens of millions more have less severe symptoms. Dry eye is more common after menopause. Women who experience menopause prematurely are more likely to have eye surface damage from dry eye.

How is dry eye treated?

Depending on the causes of dry eye, your doctor may use various approaches to relieve the symptoms.

Dry eye can be managed as an ongoing condition. The first priority is to determine if a disease is the underlying cause of the dry eye (such as Sjögren's syndrome or lacrimal and meibomian gland dysfunction). If it is, then the underlying disease needs to be treated.

Cyclosporine, an anti-inflammatory medication, is the only prescription drug available to treat dry eye. It decreases corneal damage, increases basic tear production, and reduces symptoms of dry eye. It may take three to six months of twice-a-day dosages for the medication to work. In some cases of severe dry eye, short term use of corticosteroid eye drops that decrease inflammation is required.

If dry eye results from taking a medication, your doctor may recommend switching to a medication that does not cause the dry eye side effect.

If contact lens wear is the problem, your eye care practitioner may recommend another type of lens or reducing the number of hours you wear your lenses. In the case of severe dry eye, your eye care professional may advise you not to wear contact lenses at all.

Another option is to plug the drainage holes, small circular openings at the inner corners of the eyelids where tears drain from the eye into the nose. Lacrimal plugs, also called punctal plugs, can be inserted painlessly by an eye care professional. The patient usually does not feel them. These plugs are made of silicone or collagen, are reversible, and are a temporary measure. In severe cases, permanent plugs may be considered.

In some cases, a simple surgery, called punctal cautery, is recommended to permanently close the drainage holes. The procedure helps keep the limited volume of tears on the eye for a longer period of time.

In some patients with dry eye, supplements or dietary sources (such as tuna fish) of omega-3 fatty acids (especially DHA and EPA) may decrease symptoms of irritation. The use and dosage of nutritional supplements and vitamins should be discussed with your primary medical doctor.

What can I do to help myself?

• Use artificial tears, gels, gel inserts, and ointments - available over the counter - as the first line of therapy. They offer temporary relief and provide an important replacement of naturally produced tears in patients with aqueous tear deficiency. Avoid artificial tears with preservatives if you need to apply them more than four times a day or preparations with chemicals that cause blood vessels to constrict.
• Wearing glasses or sunglasses that fit close to the face (wrap around shades) or that have side shields can help slow tear evaporation from the eye surfaces. Indoors, an air cleaner to filter dust and other particles helps prevent dry eyes. A humidifier also may help by adding moisture to the air.
• Avoid dry conditions and allow your eyes to rest when performing activities that require you to use your eyes for long periods of time. Instill lubricating eye drops while performing these tasks.

To learn more about Dry Eye Treatment contact Albany Eye Associates at 518-434-1042 to schedule an appointment with one of our Board Certified Doctors.

What is ectropion?

Ectropion occurs when eyelid, usually lower lid turns outward and does not normally oppose the eye globe.  This may result in discomfort, unsightly appearance, tearing but more importantly may lead to excessive eye drying out and result in corneal damage.

What causes ectropion?

Ectropion most commonly caused by age related degenerative changes in eyelid, when eyelid tissue loses elasticity and stretches out.  However ectropion may be also caused by lack of nerve supply to the eyelid muscles (such as in patient with history of stroke), eyelid scar/mass or skin cancer.

How is ectropion treated?

Treatment of ectropion is usually surgical.  Procedure is done on an outpatient basis and exact procedure depends on severity and the underlying cause. Usually the tendon and the muscle are tighten causing the lid to lay properly on the eye.

In mild ectropion using artificial tears or gel to lubricate the eye may help symptoms and improve corneal health.  Particularly it is important to use gel or thicker eye drops at bed time.  Importantly excessive eyelid rubbing may contribute to ectropion development.  This one must wipe eyes carefully up and towards the nose and avoid rubbing the eyes.

What is entropion?

Ectropion occurs when eyelid, usually lower lid turns in and results in eye lashes rubbing the eye.  Patients may report irritation, tearing but more importantly eyelashes rubbing the eye may damage cornea and result in corneal scar and decreased vision.

What causes entropion?

Entropion may be congenital (since birth) but more commonly is caused by age related degenerative changes in eyelid, when eyelid tissue loses elasticity and stretches, but eyelid muscle turns loose eyelid in.  Other less common causes of entropion may be chemical damage or eye infections such as trachoma.

How is entropion treated?

Treatment of entropion is usually surgical.  The tendon is tightened and sutures are used to turn eyelid out causing the lid to lie properly on the eye.

Prior to surgery, using artificial tears or gel to lubricate the eye may help symptoms and improve corneal health.  It is important to use gel or thicker eye drops at bed time.  Avoid rubbing the eyes, however pulling down and out can at times result in lid turning temporarily back to a normal position.

What are floaters?

Floaters are little "cobwebs" or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like spots, thread-like strands, or squiggly lines. They move as your eyes move and seem to dart away when you try to look at them directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.

Most people have floaters and learn to ignore them; they are usually not noticed until they become numerous or more prominent. Floaters can become apparent when looking at something bright, such as white paper or a blue sky.

Floaters and Retinal Detachment

Sometimes a section of the vitreous pulls the fine fibers away from the retina all at once, rather than gradually, causing many new floaters to appear suddenly. This is called a vitreous detachment, which in most cases is not sight-threatening and requires no treatment.

However, a sudden increase in floaters, possibly accompanied by light flashes or peripheral (side) vision loss, could indicate a retinal detachment. A retinal detachment occurs when any part of the retina, the eye's light-sensitive tissue, is lifted or pulled from its normal position at the back wall of the eye.

A retinal detachment is a serious condition and should always be considered an emergency. If left untreated, it can lead to permanent visual impairment within two or three days or even result in blindness in the affected eye.

Persons who experience a sudden increase in floaters, flashes of light in peripheral vision, or a loss of peripheral vision should have an eye care professional examine their eyes as soon as possible.

What causes floaters?

Floaters occur when the vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape, slowly shrinks.

As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina. These are floaters.

In most cases, floaters are part of the natural aging process and simply an annoyance. They can be distracting at first, but eventually tend to "settle" at the bottom of the eye, becoming less bothersome. They usually settle below the line of sight and do not go away completely.

However, there are other, more serious causes of floaters, including infection, inflammation (uveitis), hemorrhaging, retinal tears, and injury to the eye.

Who is at risk for floaters?

Floaters are more likely to develop as we age and are more common in people who are very nearsighted, have diabetes, or who have had a cataract operation.

Symptoms and Detection

Floaters are little "cobwebs" or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like spots, thread-like strands, or squiggly lines. They move as your eyes move and seem to dart away when you try to look at them directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.

How are floaters treated?

The most important step is to have a comprehensive dilated eye exam to rule out retinal tear, detachment or other problem. This needs to be done urgently.

Floaters tend to be less bothersome over time.  For people who have floaters that are simply annoying, no treatment is recommended.

On rare occasions, floaters can be so dense and numerous that they significantly affect vision. In these cases, a vitrectomy, a surgical procedure that removes floaters from the vitreous, may be needed.

A vitrectomy removes the vitreous gel, along with its floating debris, from the eye. The vitreous is replaced with a salt solution. Because the vitreous is mostly water, you will not notice any change between the salt solution and the original vitreous.

This operation carries significant risks to sight because of possible complications, which include retinal detachment, retinal tears, and cataract. Most eye surgeons are reluctant to recommend this surgery unless the floaters seriously interfere with vision.

What is Glaucoma?

Glaucoma is a group of eye diseases that damage the optic nerve. Damage to the optic nerve is usually a result of increased intraocular pressure (IOP). Increased eye pressure develops when the fluids in the eye improperly drain. Over time, an increase in IOP may damages the optic nerve and cause vision loss and blindness.

Symptoms

Glaucoma is often referred to as the “sneak thief of sight” because it produces no symptoms until later stages. Glaucoma is diagnosed through regular, routine eye examinations, which can help to catch glaucoma before it progresses.

Visual loss from glaucoma is irreversible.  This is why early detection and treatment is very important: they allow measures to prevent progression and preserve remaining vision or slow down the progression of vision loss.

Most Common Types

Acute Closed-Angle Glaucoma

Closed-angle glaucoma occurs when the iris prevents proper intraocular fluid draining. This may result in an acute glaucoma attack when eye pressure may increase rapidly, producing severe headache, eye pain, nausea, and halos and result in significant vision loss in hours.

Open-Angle Glaucoma

Open-angle glaucoma does not present any symptoms unless it progresses to its later stages. However, patients eventually lose vision; most often peripheral vision is lost first but central vision may also be affected or lost. Open-angle glaucoma can lead to total, permanent vision loss.

Normal-Tension Glaucoma

Also known as low-tension glaucoma, normal-tension glaucoma is a condition in which vision loss and optic nerve damage occur despite what is usually considered to be normal intraocular pressure levels. This type of glaucoma may also result in peripheral vision loss.

These are more common types, however many other types of glaucoma exist.

Testing

What is hyperopia?

Hyperopia, also known as farsightedness, is a common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience hyperopia differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant hyperopia, vision can be blurry for objects at any distance, near or far.

A color illustration of hyperopia highlighting the cornea, pupil and lens, and the way an image focuses behind the retina.

What are refractive errors?

In refractive errors, the shape of the eye prevents light from focusing on the retina. The length of the eyeball (longer or shorter), changes in the shape of the cornea, or aging of the lens can cause refractive errors.

How does hyperopia develop?

Hyperopia develops in eyes that focus images behind the retina instead of on the retina, which can result in blurred vision. This occurs when the eyeball is too short, which prevents incoming light from focusing directly on the retina. It may also be caused by an abnormal shape of the cornea or lens.

Who is at risk for hyperopia?

Hyperopia can affect both children and adults. It affects about 5 to 10 percent of Americans. People whose parents have hyperopia may also be more likely to get the condition.

What are the signs and symptoms of hyperopia?

The symptoms of hyperopia vary from person to person. Your eye care professional can help you understand how the condition affects you.

Common signs and symptoms of hyperopia include:

• Headaches
• Eyestrain
• Squinting
• Blurry vision, especially for close objects

How is hyperopia diagnosed?

An eye care professional can diagnose hyperopia and other refractive errors during a comprehensive dilated eye examination. People with this condition often visit their eye care professional with complaints of visual discomfort or blurred vision.

Importantly children with hyperopia may not complain about poor vision (this is the vision they are used to).  Some children with untreated hyperopia may develop amblyopia or strabismus.

How is hyperopia corrected?

Hyperopia can be corrected with eyeglasses, contact lenses, or surgery.

Eyeglasses are the simplest and safest way to correct hyperopia. Your eye care professional can prescribe lenses that will help correct the problem and help you see your best.

Contact Lenses work by becoming the first refractive surface for light rays entering the eye, causing a more precise refraction or focus. In many cases, contact lenses provide clearer vision, a wider field of vision, and greater comfort. They are a safe and effective option if fitted and used properly. However, contact lenses are not right for everyone. Discuss this with your eye care professional.

Refractive Surgery aims to permanently change the shape of the cornea which will improve refractive vision. Surgery can decrease or eliminate dependency on wearing eyeglasses and contact lenses. There are many types of refractive surgeries and surgical options should be discussed with an eye care professional.

What is myopia?

Myopia, also known as nearsightedness, is a common type of refractive error where close objects appear clearly, but distant objects appear blurry.

A color illustration of myopia highlighting the cornea, pupil and lens, and the way an image focuses in front of the retina.

What is high myopia?

High myopia is a severe form of the condition. In high myopia, the eyeball stretches and becomes too long. This can lead to holes or tears in the retina and can also cause retinal detachment. Abnormal blood vessels may grow under the retina and cause changes in vision. People with high myopia need comprehensive dilated eye exams more often. Early detection and timely treatment can help prevent vision loss.

What are refractive errors?

In refractive errors, the shape of the eye prevents light from focusing on the retina. The length of the eyeball (longer or shorter), changes in the shape of the cornea, or aging of the lens can cause refractive errors.

How does myopia develop?

Myopia develops when images is focused in front of the retina instead of on the retina.  This occurs when the eyeball becomes too long and prevents incoming light from focusing directly on the retina. It may also be caused by an abnormal shape of the cornea or lens.

Who is at risk for myopia?

Myopia can affect both children and adults. The condition affects about 25 percent of Americans. Myopia is often diagnosed in children between 8 and 12 years of age and may worsen during the teen years. Myopic changes stabilize in most patients between ages 20 to 40, but in some people it may keep progressing. People whose parents have myopia are more likely to get this condition.

What are the signs and symptoms of myopia?

Some of the signs and symptoms of myopia include:

• Headaches
• Eyestrain
• Squinting
• Difficulty seeing distant objects, such as highway signs

How is myopia diagnosed?

An eye care professional can diagnose myopia and other refractive errors during a comprehensive dilated eye examination. People with this condition often visit their eye care professional with complaints of visual discomfort or blurred vision.

How is myopia corrected?

Myopia can be corrected with eyeglasses, contact lenses, or surgery.

Eyeglasses are the simplest and safest way to correct myopia. Your eye care professional can prescribe lenses that will correct the problem and help you to see your best.

Contact Lenses work by becoming the first refractive surface for light rays entering the eye, causing a more precise refraction or focus. In many cases, contact lenses provide clearer vision, a wider field of vision, and greater comfort. They are a safe and effective option if fitted and used properly. However, contact lenses are not right for everyone. Discuss this with your eye care professional.

Refractive Surgery aims to permanently change the shape of the cornea which will improve vision. Surgery can decrease or eliminate dependency on wearing eyeglasses and contact lenses. There are many types of refractive surgeries and surgical options should be discussed with an eye care professional.

What is presbyopia?

Presbyopia is a common type of vision disorder that occurs as you age. It is often referred to as the aging eye condition. Presbyopia results in the inability to focus up close, a problem associated with refraction in the eye.

A color illustration of presbyopia highlighting the cornea, pupil and lens, and the way an image focuses behind the retina.

Can I have presbyopia and another type of refractive error at the same time?

Yes. It is common to have presbyopia and another type of refractive error at the same time. There are several other types of refractive errors: myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

An individual may have one type of refractive error in one eye and a different type of refractive error in the other.

How does presbyopia occur?

Presbyopia happens naturally in people as they age. When you are younger, the lens of the eye is soft and flexible, allowing the tiny muscles inside the eye to easily reshape the lens and focus on close and distant objects.   As we age lens slowly gets harder, unable to change shape as easily.  This harder lens causes light to focus behind the retina, causing poor vision for objects that are up close.

Who is at risk for presbyopia?

Anyone over the age of 35 is at risk for developing presbyopia. Everyone experiences some loss of focusing power for near objects as they age, but some will notice this more than others.

What are the signs and symptoms of presbyopia?

Some of the signs and symptoms of presbyopia include:

• Hard time reading small print
• Having to hold reading material farther than arm's distance
• Problems seeing objects that are close to you
• Headaches
• Eyestrain

If you experience any of these symptoms you may want to visit an eye care professional for a comprehensive dilated eye examination. If you wear glasses or contact lenses and still have these issues, a new prescription might be needed.

How is presbyopia diagnosed?

Presbyopia can be found during a comprehensive dilated eye exam. If you notice any changes in your vision, you should visit an eye care professional. Exams are recommended more often after the age 40 to check for age-related conditions.

How is presbyopia corrected?

Eyeglasses are the simplest and safest means of correcting presbyopia. Eyeglasses for presbyopia have higher focusing power in the lower portion of the lens. This allows you to read through the lower portion of the lens and see properly at distant through the upper portion of the lens. It is also possible to purchase reading eyeglasses. These types of glasses do not require a prescription and often can help with reading vision. 

Contact lenses can also be used to correct presbyopia.  This may be accomplished by different means such as bifocal contact lenses or monovision contact lenses but may not work for everyone.   Refractive surgery is constantly evolving and new laser therapies for presbyopia are being developed.   Ask your eye doctor what options may be appropriate for you.

What is ptosis?

Ptosis occurs when the muscles that normally raise eyelid cannot do so properly.  

What causes ptosis?

Ptosis can be caused by muscle weakness, improper development, loss or nerve supply, inflammation or muscle slipping from correct insertion site.  In children ptosis can be caused by improper development of muscle opening the eye, trauma, damage to nerves that open the eye or control pupil.  In middle-aged or elderly patients most common cause of droopy eyelid is excessive skin weighing down eyelid or age-related process results in muscle slipping from its initial insertion site.  This process may affect one or both eyes. 

How is ptosis diagnosed?

External eye exam is sufficient to diagnose ptosis, however since ptosis can be associated with other potentially dangerous medical or ocular conditions, comprehensive examination is needed to rule out such causes.

'What conditions are associated with ptosis?

Ptosis can be also caused by potentially life threatening conditions such as Myasthenia gravis, cerebral aneurism, Horner’s syndrome and others.

How is ptosis treated?

Ptosis treatment may require treatment of underlying medical problem or surgical correction.  Sometimes in mild ptosis eye drops may be used.  Surgery may be performed if droopy eyelid interferes with vision.  Exact surgical technique depends of severity and cause of ptosis.

What is retinal detachment?

Retina is the light-sensitive layer of tissue that lines the inside of the eye, senses visual messages and sends them through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.

What are the different types of retinal detachment?

There are three different types of retinal detachment:

Rhegmatogenous

What is strabismus?

Strabismus is a condition in which the eyes are not aligned properly and point in different directions. One eye may look straight ahead, while the other eye may turn inward, outward, upward, or downward. The eye turn may be constant, or it may come and go.

Strabismus is a common condition, about 2 percent of people have strabismus. It commonly presents in early childhood but can also occur later in life. It may run in families; however, many people with strabismus have no relatives with the problem.

What causes strabismus?

Movement of the eye is controlled by six eye muscles. For eyes to look straight all muscles in each eye must be balanced and work together. Importantly in strabismus eye muscles are usually normal, what is impaired is brain ability to coordinate these muscles.

Strabismus is especially common among children with disorders that may affect the brain, such as:

• Cerebral palsy;

• Down syndrome;

• Hydrocephalus;

• Brain tumors;

• Prematurity.

A cataract or eye injury that affects vision can also cause strabismus. The vast majority of children with strabismus, however, have none of these problems. Many do have a family history of strabismus.

Normally when both eyes aim at the same spot, the brain receives two images from two eyes. The brain then combines the two pictures into a single, three-dimensional image. This three-dimensional image gives us depth perception.

When one eye is out of alignment, two different images are sent to the brain. In a young child, the brain learns to ignore the image of the misaligned eye and sees only the image from the straight or better-seeing eye. The child then loses depth perception and may develop amblyopia. 

Adults who develop strabismus often have double vision because their brains have already learned to receive images from both eyes and cannot ignore the image from the misaligned eye. Children usually do not see double.

Strabismic amblyopia

Good vision develops during childhood when both eyes have normal alignment. Strabismus may cause reduced vision, or amblyopia, in the misaligned eye.

The brain will pay attention to the image of the straight eye and ignore the image of the crossed eye. If the same eye is consistently ignored during early childhood, this misaligned eye may fail to develop good vision, or may even lose vision. Strabismic amblyopia occurs in approximately half of the children who have strabismus.

Amblyopia can be treated by patching or blurring the stronger eye to strengthen and improve vision in the weaker eye. If amblyopia is detected in the first few years of life, treatment is usually successful. If treatment is delayed, amblyopia may become permanent. As a rule, the earlier amblyopia is treated, the better the result for vision.

What are the common types of Strabismus?

• Esotropia is an in-turning eye.
• Infantile esotropia, where the eye turns inward, is the most common type of strabismus in infants. Young children with esotropia cannot use their eyes together and surgery is usually recommended for this type of srabismus.
• Accommodative esotropia is a common form of esotropia that occurs in children usually 2 years or older. In this type of strabismus, when the child focuses the eyes to see clearly, the eyes turn inward. This crossing may occur when focusing at a distance, up close or both. This form of strabismus is often treated with glasses.
• Exotropia, or an outward-turning eye, is another common type of strabismus. The exotropia may occur only from time to time, particularly when a child is daydreaming, ill or tired. Parents may notice that the child squints one eye in bright sunlight.

How is strabismus diagnosed?

Strabismus can be diagnosed during an eye exam. It is recommended that all children between 3 and 3½ years of age have their vision checked by their pediatrician, family practitioner or an individual trained in vision assessment of preschool children. Any child who fails this vision screening should then have a complete eye exam by an ophthalmologist (Eye M.D.). If there is a family history of strabismus or amblyopia, or a family history of wearing thick eyeglasses, an ophthalmologist should check vision even earlier than age 3. After a complete eye examination, an ophthalmologist can recommend appropriate treatment.

How is strabismus treated?

Goals of strabismus treatment is to identify and treat amblyopia, straighten the eyes and restore binocular (two-eyed) vision. Depending on underlying cause of strabismus these goals may be achieved to varying degree. In children patching or blurring the strong eye to improve amblyopia is often necessary.

In some cases of strabismus (especially accommodative esotropia), eyeglasses can be prescribed for your child to straighten the eyes. Sometimes bifocal glasses are used to improve alignment.

Small angle of misalignment is often corrected with prism glasses.  Eye exercises are beneficial in patients with convergence insufficiency type of strabismus. 

Many forms of strabismus are treated with surgery to correct the unbalanced eye muscles or to remove a cataract.  Ophthalmologist will guide you as to timing of strabismus surgery.  In some cases it is advisable to do surgery soon upon diagnosis to improve the chance of restoring or promoting normal binocular vision; in other situations waiting until child reaches a certain age is desirable. 

How is strabismus surgery done?

The ophthalmologist makes a small incision in the tissue covering the eye to reach the eye muscles and reposition them to make them weaker or stronger.  Often surgery is done on both eyes to achieve good balance.  Patients are usually able to resume their normal activities within a few days after surgery.

After surgery, glasses or prisms may still be required. In some cases, more than one surgery may be needed to straighten the eyes. In some instances surgery may not be advisable at all.

In adults eye muscle surgery can restore normal appearance, improve binocular vision and minimize double vision. Eye contact is hugely important in human communication. Eye muscle surgery is considered restorative and is usually covered by medical insurances. 

Preoperative tests for strabismus surgery  

Before surgery, a specialized examination called a sensori-motor examination will be performed by ophthalmologist to assess the alignment of the eyes to determine which muscles are contributing to misalignment of the eyes. Prisms are used to measure the degree of the strabismus. These preoperative tests help guide the surgeon in determining the surgical plan. Often both eyes require surgery, even if only one is misaligned. Sometimes the exact surgical plan is determined based on findings at the time of the surgery, especially in reoperations. 

Adjustable sutures  

In strabismus surgery, the muscle is weakened, strengthened or moved and a permanent knot is placed. In adults, there is the added advantage that an adjustable suture can be used. Instead of a permanent knot, a temporary knot is placed. After the surgery, with the patient awake, alignment can be reassessed, and if necessary, adjustments can be made before a permanent knot is placed to minimize the chance of an over-correction or under-correction.

Potential risks of strabismus surgery  

The chance of any serious complication from strabismus surgery that could affect the sight or well-being of the eye is exceedingly rare. However, there are risks with any surgery, including:

• Sore eyes;

• Redness;

• Residual misalignment;

• Double vision;

• Infection;

• Bleeding;

• Corneal abrasion;

• Decreased vision;

• Retinal detachment;

• Anesthesia-related complications;

• Need for more surgery.

How successful is strabismus surgery?

Strabismus surgery is a common procedure and most patients will see a large improvement in the alignment of their eyes after surgery.  However in month and years following surgery eyes may drift again and repeat surgery may be needed in some patients.

What is Uveitis?

Uveitis is a group of inflammatory diseases of the eye that produces swelling and destroys eye tissues. These diseases can slightly reduce vision or lead to severe vision loss.

The term "uveitis" is used because the diseases often affect a part of the eye called the uvea. Nevertheless, uveitis is not limited to the uvea. These diseases can also affect the lens, retina, optic nerve, and vitreous, producing reduced vision or blindness. 

Uveitis may be caused by problems or diseases occurring in the eye or it can be part of an inflammatory disease affecting other parts of the body. 

It can happen at all ages and primarily affects people between 20 – 60 years old.

Uveitis can last for a short (acute) or a long (chronic) time. The severest forms of uveitis reoccur many times. 

Eye care professionals may describe the disease more specifically as:

• Anterior uveitis
• Intermediate uveitis
• Posterior uveitis
• Panuveitis uveitis 

Eye care professionals may also describe the disease as infectious or noninfectious uveitis.

What is the Uvea and What Parts of the Eye are Most Affected by Uveitis?

The uvea is the middle layer of the eye, which contains much of the eye's blood vessels. Located between the sclera, the eye's white outer coat, and the inner layer of the eye, called the retina, the uvea consists of the iris, ciliary body, and choroid:

Iris - The colored circle at the front of the eye. It defines eye color, secretes nutrients to keep the lens healthy, and controls the amount of light that enters the eye by adjusting the size of the pupil. 

Ciliary Body - It is located between the iris and the choroid. It helps the eye focus by controlling the shape of the lens and it provides nutrients to keep the lens healthy.

Choroid - A thin, spongy network of blood vessels, which primarily provides nutrients to the retina.

Uveitis disrupts vision by primarily causing problems with the lens, retina, optic nerve, and vitreous

What Causes Uveitis? 

Uveitis is caused by inflammatory responses inside the eye. Inflammation is the body's natural response to tissue damage, germs, or toxins. It produces swelling, redness, heat, and destroys tissues as certain white blood cells rush to the affected part of the body to contain or eliminate the insult.

Uveitis may be caused by:

• An attack from the body's own immune system (autoimmunity).
• Infections or tumors occurring within the eye or in other parts of the body.
• Injury to the eye.
• Toxins that may penetrate the eye.

The disease will cause symptoms, such as decreased vision, pain, light sensitivity, and increased floaters. In many cases the cause of uveitis is unknown. Uveitis is usually classified by where it occurs in the eye.

What is Anterior Uveitis?

Anterior uveitis occurs in the front of the eye. It is the most common form of uveitis, predominantly occurring in young and middle-aged people. Many cases occur in healthy people and may only affect one eye but some are associated with rheumatologic, skin, gastrointestinal, lung and infectious diseases.

What is Intermediate Uveitis?

Intermediate uveitis is commonly seen in young adults. The center of the inflammation often appears in the vitreous. It has been linked to several disorders including, sarcoidosis and multiple sclerosis.

What is Posterior Uveitis?

Posterior uveitis is the least common form of uveitis. It primarily occurs in the back of the eye, often involving both the retina and the choroid. It is often called choroditis or chorioretinitis. There are many infectious and non-infectious causes to posterior uveitis.

What is Pan-Uveitis?

Pan-uveitis is a term used when all three major parts of the eye are affected by inflammation. Intermediate, posterior, and pan-uveitis are the most severe and highly recurrent forms of uveitis. They often cause blindness if left untreated.

Diseases Associated with Uveitis

Uveitis can be associated with many diseases including:

• AIDS
• Ankylosing spondylitis
• Behcet's syndrome
• CMV retinitis
• Herpes zoster infection
• Histoplasmosis
• Juvenile Idiopathic Arthritis
• Kawasaki disease
• Multiple sclerosis
• Psoriasis
• Reactive arthritis
• Rheumatoid arthritis
• Sarcoidosis
• Syphilis
• Toxoplasmosis
• Tuberculosis
• Ulcerative colitis
• Vogt Koyanagi Harada's disease

What are the Symptoms of Uveitis?

Uveitis can affect one or both eyes. Symptoms may develop rapidly and can include:

• Blurred vision
• Dark, floating spots in the vision (floaters)
• Eye pain
• Redness of the eye
• Sensitivity to light (photophobia)

Anyone suffering eye pain, severe light sensitivity, and any change in vision should immediately be examined by an ophthalmologist. 

The signs and symptoms of uveitis depend on the type of inflammation. 

Acute anterior uveitis may occur in one or both eyes and in adults is characterized by eye pain, blurred vision, sensitivity to light, a small pupil, and redness.

Intermediate uveitis causes blurred vision and floaters. Usually it is not associated with pain.

Posterior uveitis can produce vision loss. This type of uveitis can only be detected during an eye examination.

Some forms of uveitis such as uveitis in children with Juvenile Idiopathic arthritis may be initially asymptomatic until a lot of damage is done to the eye.

How is uveitis detected?

Diagnosis of uveitis includes a thorough examination and the recording of the patient's complete medical history. Laboratory tests may be done to rule out an infection or an autoimmune disorder.

The eye exams used, include:

An Eye Chart or Visual Acuity Test: This test measures whether a patient's vision has decreased.

A Funduscopic Exam: The pupil is widened (dilated) with eye drops and then a light is shown through with an instrument called an ophthalmoscope to noninvasively inspect the back, inside part of the eye.

Ocular Pressure: An instrument, such as a tonometer or a tonopen, measures the pressure inside the eye. Drops and nontoxic die that numb the eye may be used for this test.

A Slit Lamp Exam - A slit lamp noninvasively inspects much of the eye. It can inspect the front and back parts of the eye and allow measuring eye pressure.

Fundus photography and fluorescein angiography, which makes blood vessels easier to see, may help diagnosis and guide treatment.

How is Uveitis Treated?

Uveitis treatments primarily try to eliminate inflammation, alleviate pain, prevent further tissue damage, and restore any loss of vision. Depending on uveitis type and severity treatment may range from several weeks to many years. It may include streroid or non-steroidal anti-inflammatory eye drops or pills.  In difficult to control cases injection may be used or systemic immunomodulatory therapy could be initiated usually in conjunction with rheumatologist or uveitis specialist.

Uveitis may result in glaucoma, cataracts and retina damage.