Red eyes & dry eyes
Your Natural Tears
Eyes are lubricated by tears produced by tear glands located behind your upper eyelids. Blinking spreads a film of tears over the surface of your eyes. The tears move to the inside region of the eye and through the tear drainage ducts into the nose and throat. Tears make your eyes feel cool, comfortable, refreshed and helps to prevent infection.
What causes Dry Eye Syndrome?
When the balance of tear production and tear loss is not maintained, dry spots appear on the eye’s surface and cause irritation.
Can Watery eyes be a symptom of Dry Eyes?
Ironically the tear production glands sometimes react to the dry, scratchy feeling by watering more than ever. These reflex tears do not relieve the dryness as they lack a natural component that is essential to lubricate the cornea properly.
Can Dry Eyes harm my eyes?
Yes. If left untreated severe Dry Eye Syndrome can damage tissue and possibly scar the cornea of the eye.
Common causes of Dry Eye Symptoms.
- Environment—The list is virtually endless! Sunny, windy, dry conditions, air conditioning, dry climates, smoke, air pollution are just a few.
- Contact lens wear—these could result in increased evaporation of tears which leads to irritation, increased protein deposits, inflammation and pain. Dry Eye Symptoms are the number one reason people stop wearing contact lenses.
- The aging process—tear production gradually decreases with age. At age 65 the tear glands produce about 40% of the lubricating tears they produced at age 18.
- Medications—tear production could be reduced if you take certain medications. These include decongestants, antihistamines and diuretics, beta blockers, sleeping pills, anti-depressants, pain relievers, Skin Rejuvenation treatment, alcohol, oral contraceptives and more.
- Computer users—Computer and television users may also have dry eyes as a result of staring for hours without blinking regularly.
- Diseases—these include Rheumatoid Arthritis, Diabetes, Thyroid abnormalities, Skin conditions, Asthma and Lupus.
- Menopause and pregnancy—women are more prone to develop dry eyes after menopause and during pregnancy.
Symptoms of Dry Eye Syndrome
- Burning and stinging.
- Gritty feeling when there is nothing in your eye.
- Sensitivity to bright light.
- Mucous secretions in the eye.
Can Dry Eye Syndrome be cured?
There is no cure although you can relieve the symptoms and reduce your chances of complications.
How is Dry Eye Syndrome treated?
Eyelid Hygiene attention – to remove buildup of debris among eyelashes, which can cause irritation and Blepharitis and Meibomian Gland Dysfunction. Meibomian Gland oil reduces Tearfilm evaporation and allows lubricated smooth eyelid movement.
Artificial tears—these provide temporary relief but while soothing the eyes initially, they can increase the possibility of infection by washing away the natural infection-fighting tear film of the eye.
Punctal occlusion-in cases of persistent Dry Eye Syndrome , semi-permanent or permanent closure of the tear duct, or punctal occlusion, may be the best solution. This long-term solution allows patients to retain their own natural tears to longer before evaporation.
What is a punctum plug?
This acts like a stopper in a sink! When the tear duct (punctal opening) is closed tears stay on the eye much longer. A small, soft silicone plug is non-surgically inserted into the natural punctum opening. The reversible procedure is performed in a few minutes in the doctors office.
Cataracts & Phaco & IOL
Is this your vision?
Over 50% of people over the age of 60, and quite a few even younger than that, suffer from cataracts. When a cataract forms, activities like reading, gardening, golfing or driving become difficult. Cataract sufferers are usually troubled by a bothersome glare, halos around lights, or even monocular double vision. As the cataract worsens eyeglass prescriptions may be needed more frequently although the prescriptions were stable for several years.
What are cataracts?
A cataract is the natural lens inside the eye that became cloudy or discoloured. The clarity of light passing through the eye’s lens to the retina is thus disturbed and the image sent to the brain is dull and blurred.
Although they can occur in young people, most cataracts are a normal part of aging.
As we mature, gradual changes occur to the focusing lens inside the eye.
Prior to young adulthood the lens is soft, flexible and clear. At about age 45 the lens begins to harden, change color and may turn cloudy, usually resulting in the need for reading glasses or bifocals.
As we continue to mature the lens continues to change. Blurring and glare can get worse, until stronger glasses no longer help and cataract surgery is required to provide clear vision again.
Symptoms of cataracts
* Blurred or distorted vision * Halos or glare around bright lights.
* Loss of color perception (especially blues) * Loss of depth perception
* Night blindness * Eye fatigue and headaches
* Monocular Double vision – in one or both eyes when the second eye is occluded.
How can a cataract be treated?
Up to a point, stronger eyeglass prescriptions can adjust for vision changes due to cataracts. Eventually the only effective treatment of a cataract is the surgical removal of the clouded lens.
The lens opacity cannot be cleared by eye drops, medication, eye exercises or laser treatment.
Modern cataract surgery is one of the most successful operations performed all around the world.
Cataract surgery is also the most common eye surgical procedure done in the world today.
Your cataract will be removed with an advanced technique called phacoemulcification, or small incision cataract surgery.
After applying a local anesthetic, a ‘stair-stepped’; incision of about 3-4 mm is made on the side of the front part of the eye. The cataract is then broken / emulsified into microscopic particles using high energy sound waves and gently suctioned from the eye.
To compensate for the removal of the eye’s natural lens, a calculated intra-ocular lens (IOL) is implanted into the eye. After using this special ‘stair-stepped’; incision, you may receive one, several or even no stitches. This type of incision is mostly self-sealing, stronger, heals faster and remains tightly sealed by the natural outward pressure within your eye.
Successful cataract surgery.
Everyone heals somewhat differently, but many cataract patients report improvement in their vision almost immediately after the procedure. Most patients return to their normal work and lifestyle within a day or two or even a week.
Many patients experience vision that is actually better than before they developed cataracts. Once the cataract is removed, however some patients may experience clouding again of a thin tissue called a capsule or ‘bag’ that holds the IOL. In most cases a laser is used to painlessly open the clouded capsule and restore clear vision again.
Advantages of Intra-ocular Lenses
Elimination of contact lenses or thick cataract glasses.
Requires no care after the immediate postoperative care
No restrictions on activities after recovery from the surgery
More normal appearance after surgery
Improved depth perception and ability to judge distances
No interference with side vision.
What is Glaucoma?
Primary open-angle glaucoma is the most common form of glaucoma:
· Glaucoma is a serious eye disease which can lead to vision loss and blindness if left untreated.
· Glaucoma is the second most common cause of legal blindness in the U.S.A. and the leading cause of blindness for African-Americans.
· Glaucoma is a chronic (ongoing) condition that requires lifelong monitoring and treatment. It is important for people with glaucoma to work with their Ophthalmologists / Eye M.D.s to find a treatment plan that is right for them.
· About 2 million Americans have glaucoma — but only half of them are aware of it.
· In glaucoma, the internal ocular fluid (different from tears) that normally flows through the front section of the eye cannot drain properly. This causes a buildup of pressure in the eye that can damage the optic nerve and lead to vision loss.
· Your ophthalmologist uses a series of painless tests and exams to check you for glaucoma. Other tests may be done if your ophthalmologist suspects you may have glaucoma related damage.
· Vision loss is usually preventable if glaucoma is detected early. There is no “cure” for glaucoma, but early detection and ongoing treatment can control the disease and usually preserve vision, or postpone the deterioration.
· Treatment for glaucoma can include medication and/or surgery. The best treatment for each person is determined by a number of factors, including type and severity of glaucoma, and the person’s medical history and lifestyle.
· Open Angle Glaucoma usually has no symptoms until vision loss has occurred
· Approximately 80,000 Americans are legally blind from glaucoma. The incidence is higher in certain other countries. Many more have visual impairment.
· Seniors, African-Americans and those with a family history of glaucoma are at higher risk for the primary disease and should have screening eye exams more often.
Medications for glaucoma — even eye drops — can affect the whole body and may interact with other medications. It is very important for all your doctors to be aware of any medication you take.
Secondary Glaucoma may result as a side effect from systemic Diseases, and from certain systemic Medications.
Symptoms of Glaucoma
Most people who have glaucoma don’t notice any symptoms until they begin to lose some vision.
As optic nerve fibers are damaged by glaucoma, small blind spots may begin to develop, usually in the side – or peripheral – vision. The top photo on the next page shows how a scene would be viewed by a person with normal vision. The bottom image shows the same scene as viewed by a person with glaucoma. Many people don’t notice the blind spots until significant optic nerve damage has already occurred. If the entire nerve is destroyed, blindness results.
Another type of glaucoma, Acute Angle-Closure Glaucoma, does produce noticeable symptoms. In angle-closure glaucoma, there is a rapid buildup of pressure in the eye (intra-ocular pressure, known as IOP), which may cause any of the following:
- blurred vision
- severe eye pain
- haloes (which may appear as rainbows) around lights
- nausea and vomiting
Angle-closure glaucoma is a rare, but serious, form of Glaucoma. If you have any of these symptoms, call your ophthalmologist immediately. Unless treated quickly, blindness can result.
Surgery For Glaucoma
For some people, surgery might be the best treatment for glaucoma. Your ophthalmologist may suggest surgery as a first treatment, or after trying medication to lower your IOP.
There are several different types of surgery for glaucoma. The kind of surgery you and your ophthalmologist decide is right for you depends on many factors, including the type and severity of your glaucoma, and other eye problems or health conditions.
Glaucoma surgery may be performed using a laser (a concentrated beam of light) or conventional surgical instruments.
Trabeculoplasty – SLT / ALT – is used most often to treat open-angle glaucoma. In trabeculoplasty, a laser is used to place “spot welds” in the drainage area of the eye– the trabecular meshwork — that allow the aqueous to drain more freely.
Iridotomy is another kind of laser surgery used in treating glaucoma. It is frequently used to treat Pigment Dispersion – and Angle-Closure Glaucoma. In this procedure, the surgeon uses the laser to make a small hole in the iris– the colored part of the eye — which allows the aqueous to flow more freely within the eye so the iris doesn’t plug up the trabecular meshwork.
In cyclophotocoagulation, a laser beam is used to treat selected areas of the ciliary body — the part of the eye that produces aqueous humor — to reduce the production of fluid. This procedure may be used to treat more advanced or aggressive cases of glaucoma.
Most laser surgeries for glaucoma can be performed in the ophthalmologist’s office or an outpatient surgical facility. Eye drops are used to numb the eye for the duration of the procedure. Because there is usually little discomfort during glaucoma surgery, this is often the only anesthesia needed.
Little recuperation is needed after laser eye surgery. Patients may experience some local eye irritation, but can usually resume their normal activities a day or two after surgery.
In some cases, laser surgery is not the preferred surgical treatment for glaucoma. Sometimes, when vision loss is rapid, or medication and/or laser surgery fails to lower IOP sufficiently, “conventional” incisional surgery is the best option.
Filtering surgery is usually done in a hospital or outpatient surgery center, with local anesthesia, and sometimes, sedation. The surgeon uses very delicate instruments to remove a tiny piece of the wall of the eye (the sclera), leaving a tiny hole. The aqueous can then drain through the hole, reducing the intraocular pressure, and be reabsorbed into the bloodstream.
In some cases, the surgeon may place a small tube or valve in the eye through a tiny incision in the sclera. The valve acts a regulator for the buildup of aqueous within the eye. When the intraocular pressure reaches a certain level, the valve opens, allowing the fluid to flow out of the eye’s interior, where it can be reabsorbed by the body. The procedure may take place in the ophthalmologist’s office or outpatient surgical center, and can be done under local anesthesia.
The recuperative period following incisional glaucoma surgery is usually short. You may need to wear an eye patch for a few days after surgery, and to avoid activities which expose the eye to water, such as showering or swimming. The ophthalmologist may recommend that you refrain from heavy exercise, straining or driving for a short time after surgery, to avoid complications.
As with all surgery, there are risks associated with glaucoma surgery. Complications are unusual, but can include:
· undesirable changes in intraocular pressure
· loss of vision
Sometimes, a single surgical procedure is not effective in halting the progress of an person’s glaucoma. In these cases, repeat surgery, and/or continued treatment with topical or oral medications may be necessary.
Your age, eye structure, type of glaucoma, and other medical conditions are all considerations when deciding how to treat your glaucoma.
The ophthalmologist, in partnership with the patient, is best able to make the appropriate treatment decisions.
Before your surgery: (TIPS)
1. Make sure you understand the risks and benefits of the surgery. Here are some questions you may want to ask your ophthalmologist:
- Why do you think surgery is the best treatment for my condition?
- What kind of surgery do you recommend for my condition, and why?
- Are there other treatment options I should consider?
- What do you think might happen if I don’t have the surgery?
- Do you think I am likely to need further treatment after the surgery (i.e. medication or further surgery)?
- What change should I expect in my condition after surgery?
- What kind of anesthesia will you use for my surgery?
- Where will my surgery take place?
- Approximately how long will my surgery take?
- Should I discontinue any of my medications prior to surgery? If so, how long before my surgery should I stop taking them?
- Can I eat prior to my surgery?
You might find it helpful to write your questions down prior to your office visit, or to take notes during your appointment. This can help ensure you understand everything your ophthalmologist discusses with you.
2. If you have medical insurance, you should find out if your policy will cover your surgery, and how much – if anything – you should expect to pay out of pocket.
3. Most importantly, don’t be afraid to ask your ophthalmologist questions. If you have any concerns, now is the time to discuss them with your doctor.
The day of your surgery:
- If you’ve been told not to eat before surgery, it is very important that you follow that instruction. It can be dangerous to eat prior to undergoing some kinds of anesthesia.
- Most hospitals and outpatient facilities recommend you leave valuables, such as money or jewelry at home. You may not be allowed to take those items into the procedure room.
- If you are having your procedure in a hospital or outpatient surgery facility, make sure you get there in time to fill out any registration forms that may be required.
What will happen the day of surgery?
After you have registered or checked in, you may go to a waiting room or area prior to your surgery. You may be asked to change into a patient gown for your surgery. Depending on the kind of anesthesia you and your doctor selected for your procedure, an anesthesiologist may spend a few minutes talking with you to make sure it is the safest kind for you.
In the procedure room, you may be asked to sit in a special chair or lie on a table, depending on what kind of surgery you are having. In either case, special equipment will be used to make sure your head doesn’t move during your procedure.
Your ophthalmologist or an assistant will probably put drops in your eyes to numb them. This is the only anesthesia necessary for many patients having glaucoma surgery. He or she may also give you one or more injections near your eye to help numb the whole area. This usually involves a minimum of discomfort.
If you and your ophthalmologist decide you need sedation – medication to make you less anxious – you may be given an injection or have an intravenous line (i.v.) placed in your arm. (This means a small needle will be placed in your arm and connected to some tubing and a bag of sterile solution and medication.) This usually doesn’t hurt any more than getting a shot or giving blood.
If your surgery is a laser procedure, you will be seated in a special chair while the surgeon uses a beam of light to carry out the procedure. You will not be able to feel it, or to see it with the eye that is having the surgery.
If your surgery is an incisional procedure, the ophthalmologist or the assistant will place sterile cloth around your eye. You won’t be able to feel the surgery, or see it with the eye having the surgery, but you may hear the tiny instruments while the ophthalmologist works.
Most glaucoma surgeries don’t take very long – about an hour for most – but the time depends on many factors, such as your eye structure, the kind of surgery you’re having and the difficulty of the procedure.
After your glaucoma surgery…
After your surgery, the ophthalmologist or assistant may put more drops in your eyes. You may be given medication for discomfort. You might need to wear an eye patch to protect the eye.
You will probably have to wait for a period after your surgery to make sure it’s safe for you to return home. You may have to stay a little longer if you’ve had sedation.
1. Prior to leaving, you should be given instructions about:
- medications -when you should start taking them, and how often
- what to expect in the next few hours or days — i.e. how much discomfort or swelling you may have
- what signs to look out for that might indicate infection or another problem
- what activities you must refrain from, and for how long
- when you should return to the ophthalmologist for follow up
2. If you have any questions or concerns, ask your ophthalmologist or his/her assistant or nurse before you leave.
3. Make sure you have a friend or family member to drive you home after your procedure. You may have an eye patch, or feel slightly groggy after your surgery.
4. Make sure you understand your ophthalmologist’s instructions and follow them carefully. This will help ensure a speedy recovery and good outcome.
5. Keep your follow-up appointment(s), even if you have no sutures (stitches) to remove and are experiencing no complications.
6. Above all, take care of yourself and your eyes. Maintain a healthy diet – this is particularly important if you have a medical condition such as diabetes or hypertension (high blood pressure) – and get regular exercise. Wear sunglasses with adequate UV protection when you’re in the sun, and make sure your eyes are protected when you play sports or use heavy machinery.
What is Conjunctivitis?
Conjunctivitis is an inflammation of the conjunctiva in anyone with symptoms of conjunctivitis such as red eye or eye discharge.
Conjunctivitis occurs worldwide and affect all ages, social strata, and both genders and is one of the most frequent causes of self-referral to a comprehensive ophthalmologist.
Conjunctivitis rarely causes permanent visual loss or structural damage, but the economic impact of the disease in terms of lost work time is considerable.
The CONJUNCTIVA is a wet mucous membrane, similar to mucous membranes elsewhere in the body. Conjunctiva is the “LINING” of the inner surface of the eyelids and the eyeball beside the clear Cornea
Conjunctivitis can be classified as INFECTIOUS or NON-INFECTIOUS and as acute, chronic, or recurrent.
The causes of INFECTIOUS conjunctivitis include * Viruses, * Bacteria, * Chlamydia an *Acanthamoeba.
The causes of NON-INFECTIOUS conjunctivitis include the following:
- Allergy / immunity (e.g. hay fever / atopy, vernal allergy, contact hypersensitivity, contact lens solution reaction/medication allergy, ocular cicatricial pemphigoid (a rare autoimmune disease characterized by recurrent sub epithelial blisters of the skin and mucous membranes), and Stevens-Johnson syndrome.
- Mechanical causes / irritants (e.g. eyelashes, contact lenses, foreign bodies, self-inflicted irritation and floppy eyelid syndrome)
- Chemicals / toxins (e.g. medicaments and personal care products.)
- Neoplasia—continuous, unregulated increase in cells growth in a tissue.
Clinical evaluation of conjunctivitis:
The four main clinical features which should be considered in the diagnosis of conjunctivitis are:
- Type of discharge
- Type of conjunctival reaction
- Presence of pseudomembranes or true membranes
- Presence or absence of lymphadenopathy (enlarged lymphnodes).
Early detection of conjunctivitis is important because conjunctivitis can signify serious systemic disease. For example, some types of neonatal conjunctivitis are associated with pneumonia, otitis media or Kawasaki’s disease. In adults, conjunctivitis caused by pemphigoid, gonococcus, and Chlamydia is important to detect early because it is necessary to treat the concomitant systemic disorder. Early detection of conjunctivitis associated with local or systemic neoplasms may be lifesaving.
Counseling is imperative for all contagious varieties of conjunctivitis to minimize and prevent the spread of the disease in the community. Modes of transmission include sexual contact, eye-hand contact, instillation of contaminated droplets, and exposure to airborne pathogens.
Diabetes and Eyes:
More than 16 million Americans have diabetes and half of these are at risk of vision loss because they are unaware that they are diabetic. More than one third of those diagnosed with diabetes don’t get recommended vision care and may be more at risk for blindness.
Diabetic retinopathy blinds more than 8000 Americans each year and is the leading cause of blindness among working age Americans.
Early diagnosis of diabetes and the effective control of blood sugar levels and hypertension through diet and exercise can help control eye diseases associated with diabetes.
Diabetic retinopathy is a potentially vision threatening condition in which the blood vessels inside the retina become damaged by high blood sugar levels.
Diabetes can also affect your vision by causing cataracts at a younger age and your chances of developing glaucoma are doubled.
Because early stages of diabetic retinopathy often have no symptoms, the vision may not be affected until the disease becomes severe. You should see your Ophthalmologist soon after your Diabetes is diagnosed, and then promptly if you experience visual changes that:
- Affect only one eye.
- Lasts for more than a few days.
- Are not associated with a change in blood sugar.
Once diagnosed with diabetes, schedule a complete dilated eye examination with your Ophthalmologist at least once a year.
Important things to remember:
People with diabetes can protect their vision by having a dilated eye exam every year – this can lead to early detection of eye disease.
Your risk of developing diabetic retinopathy increases with the number of years you have had diabetes. After 15 years with the disease almost 80% of people with type I diabetes have some form of diabetic eye disease.
Early detection and treatment of diabetic retinopathy can usually prevent permanent vision loss.
Pregnant women with diabetes should have an eye exam in the first trimester because diabetic eye disease can progress rapidly during pregnancy.
Rapid changes in blood sugar can cause temporary changes in vision even if diabetic eye disease isn’t present.
It is especially important to keep blood sugar in good control for a few days before being examined for glasses because your blood sugar levels can affect your vision and you may end up with corrected lenses that don’t work for you later. Good control of your blood sugar can help ensure you get the right prescription.