Common Eye Conditions

Approximately 22 million people in the US suffer from seasonal itchy, swollen, red eyes. Airborne allergens, such as house dust, animal dander and mold constantly bombard the eyes and can cause ocular allergies at any time. But when spring rolls around and the plant pollen starts flying, it seems like everyone starts crying.

Seasonal allergic conjunctivitis, or hay fever, is the most common allergic eye problem. Various antihistamine and decongestant drops and sprays can soothe irritated eyes and the nose.

Make every effort to avoid allergens. An allergist can help determine what you are allergic to so you can stay away from it. Staying away from outdoor pollen may be impossible, but remaining indoors in the morning when the outdoor pollen levels are highest man help control symptoms. If you are allergic to house dust, open the windows and keep household filters clean.

Cool compresses decrease swelling and itching. Artifical tears dilute the allergens and form a protective barrier over the surface of the eye. Avoid rubbing the eyes. It makes the symptoms worse.

If seasonal allergic conjunctivitis is a problem, see an ophthalmologist. There are several new safe and effective anti-allergy drops that can be prescribed. An ophthalmologist can also make sure symptoms are not caused by a more serious problem.

Blepharitis is a common inflammatory condition that affects the eyelids, causing burning, itching and irritation.

Blepharitis is caused by an overgrowth of bacteria on the eyelid margins. Symptoms of blepharitis include foreign body sensation, sensitivity to light, red or swollen eyelids, blurred vision, inability to tolerate contact lenses, recurrent eye infections, dry eyes and crusting or flakes on the lids and lashes.

Blepharitis occurs in two forms. Anterior blepharitis which affects the outside of the eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are bacteria (Staphylococcus) 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. Two skin disorders can cause this form of blepharitis: acne rosacea, which leads to red and inflamed skin, and scalp dandruff ( seborrheic dermatitis). Its important to treat blepharitis because if left unchecked it can lead to styes, chalazions, loss of lashes, and decreased oil secretions that are necessary to keep the cornea healthy.

Treatment for both types of blepharitis involves keeping the lids clean and free of crusts. Warm compresses should be applied to the lid to loosen the crusts, followed by a scrubbing of the eyelid with a cotton swab and a mixture of water and baby shampoo. There are also prepared commercial products available to scrub the lids and lashes. Because blepharitis rarely goes away completely, most patients must maintain a routine eyelid hygiene for life. If the blepharitis is severe, Dr. Adler will prescribe antibiotic or steroid eye drops. Dr. Adler routinely prescribes an antibiotic steroid ointment to be applied to the lashes and lid margin before bedtime. 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.

Pink eye, the common name for conjunctivitis, is an inflammation or infection of the conjunctiva, the outer, normally clear covering of the sclera, the white part of the eye. The eye appears pink in conjunctivitis because the blood vessels are dilated. Pink eye is often accompanied by a discharge, but vision is usually normal, and discomfort is mild.

Either a bacterial or a viral infection may cause conjunctivitis. Viruses, which are more common and last several weeks, may cause an upper respiratory infection (or cold) at the same time. Unlike viruses, bacterial conjunctivitis is treated with a variety of antibiotic eye drops or ointments, which usually cure the infection in a day or two.

Conjunctivitis can be very contagious. People who have it should not share towels or pillowcases and should wash their hands frequently. They may need to stay home from school or work and should stay out of swimming pools.

Not everyone with conjunctivitis has an infection. Allergies can cause conjunctivitis too. Typically, people with allergic conjunctivitis have itchy eyes, especially in spring and fall. Eyedrops to control itching are used to treat allergic conjunctivitis. It is important not to use medications that contain steroids (they usually end in “one” or”dex”) unless prescribed by an eye doctor.

Finally, not everyone with pink eye has conjunctivitis. Sometimes more serious diseases, such as infections, damage to the cornea, very severe glaucoma, or inflammation on the inside of the eye cause the conjunctiva to become inflamed and pink. Vision is usually normal if the pink eye is really conjunctivitis. If vision is affected, or if the problem does not get better in a few days, see your eye doctor.

Giant papillary conjunctivitis is an inflammation of the inner surface of the eyelids most frequently associated with contact lens wear. It can develop in people who wear either soft or rigid gas permeable contacts and can occur at any time, even if an individual has successfully worn contacts for a number of years. Although not vision threatening, GPC can be inconvenient and may require one to stop wearing contacts temporarily or even permanently.

The typical symptoms of GPC include red, irritated eyes, often with itching and mucous discharge. Blurred vision and light sensitivity can also occur. GPC is not an infection, but a hypersensitivity of the membrane covering the inner lids and the whites of the eyes. The inner lining of the eyelid becomes roughened and inflamed by constant blinking over a contact lens or other foreign body such as an artifical eye. Hard, flat elevations in a cobblestone pattern develop on the undersurface of the upper eyelid. Eventually the entire eye becomes irritated.

In most cases, treatment of GPC involves discontinuing the use of contact lenses to allow the eye to rest. Eyedrops are frequently prescribed to control inflammation. Many people find their symptoms are relieved when contact lens wear is discontinued. Unfortunately, the symptoms can return when lens wear is resumed.

Once GPC is under control, it may be helpful to consider changing to new contacts or disposable contacts. Changing lens care systems and cleaning solutions can also be helpful. After an episode of GPC, limit the amount of time lenses are worn, and increase the time slowly.

Once it develops, GPC can be an ongoing problem. Prolonged GPC may be more difficult to treat.

Do you suffer from dry eyes? If you answered “yes”, you are not alone. It is estimated that between 5-40 million Americans suffer from this condition. What causes dry eye?

1. AGING – Decreases the production of tears. This is especially true of women after menopause.

2. CONTACT LENS WEAR – Can increase tear evaporation causing irritation and discomfort.

3. ENVIRONMENTAL CONDITIONS – Such as wind, dry air, dust, smoke, air pollution and pollen can cause dry eye symptoms.

4. MEDICATIONS – Such as antihistamines, diuretics, antidepressants and birth control pills can cause decreased tear production.

5. COMPUTER USE – Causes decreased blink frequency- about 7 times per minute verses a normal rate of 20 times, leading to tear evaporation.

6. LASER EYE SURGERY – This is something we always tell our LASIK surgery patients. LASIK can cause the nerve endings of the central cornea to be severed, causing less corneal sensitivity and decreased blink reflex; tear film evaporation increases and tear production is reduced.

7. CERTAIN SYSTEMIC CONDITIONS – Such as rheumatoid arthritis, lupus, rosacea, Sjogren’s syndrome, and menopause.

8. LID DEFECTS – Such as lid paralysis, ectropion, and lagophthalmos can lead to defective tear circulation.

To better understand dry eye, it may be helpful to learn about the anatomy of the tear film. The tear film has three complex layers.

1. The very thin outer layer contains lipids and is produced by tiny glands in the eyelid called meibomian glands. This outer layer functions to reduce tear evaporation.

2. The lacrimal glands produce the middle, watery layer of tears and are located at the upper outer region of the bony orbit above the eyeball. This gland keeps the salinity (level of salt and water) and acidity of the tears at proper levels. This layer also carries antibodies and other immune defense agents to defend the eye against infection.

3. The inner mucin layer helps the tear film to “stick” to the cornea and stay intact. Deficient production of the mucin layer interferes with the even distribution of tears.

While dry eye cannot be cured, it can certainly be managed. Many patients find relief from their symptoms by using artificial tears. Some artificial tear products are thin and alleviate the symptoms temporarily; others are thicker, adhere to the eye, and may last several hours, but also have the potential to blur your vision. Preservative-free tears are recommended because they are soothing and have fewer additives that can irritate an already compromised cornea. Find an artificial tear that is truly preservative-free and provides antioxidants for protection from free radicals. Also, for dry eye avoid products that whiten the eyes-they make the problem worse.

If a patients’ symptoms do not improve with over the counter preservative-free artificial tears the next recommendation would be RESTASIS Ophthalmic Emulsion. RESTASIS is packaged in single usage disposable droppers. The approved treatment is one drop in the morning and one drop at night in each eye, everyday. RESTASIS helps increase your natural ability to produce tears. RESTASIS is primarily effective in people whose dry eye condition is caused by an underlying autoimmune disorder (e.g. Rheumatoid Arthritis, Sjogren’s Syndrome ect.). Many patients report a noticeable increase in tear production with continued use. Its important to note that RESTASIS may take several months to produce the desired results.

The next step is temporary punctal occlusion. Sometimes it is necessary to close the ducts that drain tears out of the eye. This is done via a painless procedure where a plug that will dissolve quickly is inserted into the tear drain of the lower eyelid. This is a temporary procedure, done to determine whether permanent plugs can provide an adequate supply of tears. If temporary plugging of the tear drains works well, than permanent plugs may be used. The plugs will hold tears around the eyes as long as they are in place. They can also be removed (depending on the type used). Rarely, the plugs will come out spontaneously or migrate down the tear drain. Many patients find that the plugs improve comfort and reduce the need for artifical tears. If needed, the ducts that drain tears into the nose can be permanently closed to allow more tears to remain around the eye. This is done with local anesthetic on an outpatient basis. There are no limitations in activity after having this surgery.

Treating dry eye syndrome symptoms is important for your short-term comfort and the long-term health of your cornea. For more information or to have your eyes evaluated for dry eye syndrome call the Adler Eye Institute at 941-753-0220.

One’s first encounter with the herpes zoster virus is usually childhood chicken pox. Later in life, the virus may reactivate, causing a characteristic rash of small blisters, frequently on the chest or forehead, which crust over and may leave scars. This second encounter is known as shingles. Unlike chicken pox, this condition is usually quite painful. Although this disease often occurs in normal, healthy people, it occurs more frequently in elderly or immune-compromised individuals.

It is important to see an ophthalmologist when herpes zoster occurs on the face because the virus may invade the eye. An ophthalmologist looks for elevated pressure in the eye, inflammation, and herpes zoster lesions on the surface of the eye. All these problems can be treated but they are sometimes difficult to manage. Therefore, careful treatment and follow-up are required. New oral antiviral medications are providing sufferers with a quicker, more complete recovery.

A tumor is an abnormal growth of any tissue or structure and can be either benign or malignant. A tumor can affect any part of the eye, such as the eye socket, eyeball, eye muscles, optic nerve, fat and tissues. Sometimes tumors grow into the eye area, or tumors from other parts of the body travel to the eye. Most tumors of the eye are benign.

Basal cell carcinomas are the most frequent type of maliganat tumor to affect the eyelid (85-95% of all malignant eyelid tumors). The most frequent location is the inner portion of the lower eyelid, particularly in elderly fair-skinned people. Prolonged exposure to sunlight seems to be a risk factor for developing this form of tumor.

There are many different types of basal cell carcinomas but the nodular variety is one of the most common. It appears as a raised, firm, pearly nodule with tiny dilated blood vessels. If the nodule is in the eyelash area, some lashes may be missing.

The nodule may have some superficial ulceration and crusting and look like a chalazion or stye. While these tumors are malignant, they rarely spread elsewhere in the body. For most of these tumors, surgery is the most effective treatment. In severe cases when the tumor has been neglected for a long time, it can spread into the eyesocket, which may ultimately require removal of the eye and adjacent tissue.

Squamous cell carcinoma is the next most frequent malignant eyelid tumor (occuring in approximately 5% of malignant eyelid tumors.) As with basal cell carcinoma, the most common location is the lower eyelid, particularly in elderly, fair-skinned people. This tumor also appears as a raised nodule that can lead to loss of eyelashes in the involved area. When detected and treated early, the outcome for this type of tumor is excellent. However, if the tumor is neglected, it can spread to the lymph nodes in the neck. Surgery is the most effective treatment.

Sebaceous cell carcinoma originates in glands of the eyelid in elderly individuals. It is relatively rare but still accounts for 1 to 5% of malignant eyelid tumors. These are highly malignant tumors that may recur, invade the eyesocket, or spread to lymph nodes. The tumor may look like a chalazion or stye, making it difficult to diagnose. Surgery is usually necessary for this type of tumor.

Malignant melanoma makes up almost 1% of all malignant eyelid tumors but accounts for many of the deaths from malignant eyelid tumors. As with any other type of malignant melanoma, these tumors on the eyelid can arise from a pre-existing nevus or mole, or may arise with no other pre-existing cause. Again, these tumors tend to occur in sun exposed areas of elderly fair-skinned people. Any pigmented area should be examined, especially if it is growing or changing color. Surgical removal is usually the recommended treatment.

Tobacco smoking is directly linked to many adverse health effects, including high blood pressure, heart disease and cancer. Smoking is also linked to specific eye disease.

How does smoking affect the eyes? People who smoke cigarettes are at increased risk for developing cataracts, a clouding of the naturally clear lens of the eye. Cataracts cause a variety of vision problems, including blurry distance vision, sensitivity to glare, loss of contrast and difficulty seeing colors. When glasses or magnifiers are no longer helpful for someone with cataracts, or when cataracts develop in both eyes, surgery is the only option.

Tobacco smoking is also one of the preventable risk factors for age-related macular degeneration (ARMD). Studies have shown that current smokers and ex-smokers are more likely to develop ARMD than people who have never smoked.

In people with high blood-sugar levels, some studies suggest that smoking may be linked to diabetic retinopathy, or damage to the blood vessels in the retina. The optic nerve is also susceptible to damage from smoking. People with poor diets who smoke heavily and drink excessive amounts of alcohol run the risk of developing optic nerve-related vision loss (called tobacco-alcohol amblyopia). In some patients with thyroid disease (called Graves’ disease) who also have eye involvement, smoking can cause the eyes to become worse, with vision loss possible.

People who do not produce enough tears to keep their eyes comfortably lubricated have a condition called dry eye. For these people, smoking is a significant irritant, worsening the symptoms of scratchiness, stinging or burning of the eyes, and excess tearing from irritation.