Glaucoma, Macular Degeneration, Bletharoplasty, Diabetic Retinopathy, Dry Eye,
Strabismus, Keratoconus, Ectropian and Entropian, Pinguecula and Pterygium

Glaucoma

Primary open angle glaucoma is the most common form of this eye disease. It causes pressure to build up within the eye, which may cause damage to the optic nerve. The optic nerve is essential for transmitting vision to and from the brain. If glaucoma is not kept under control it can lead to blindness.

Beginning at age 35, patients should be tested for glaucoma each year. The procedures that check for glaucoma include: a slit lamp exam, eye pressure check and a visual field test (which checks peripheral vision). To the right is a photograph of an eye pressure check.

Many patients retain central vision while losing peripheral vision long before they notice any loss of sight. Glaucoma is more common in older people, black people, diabetics and may be genetic. Life long attention must be maintained to keep glaucoma under control.

The most common treatment is the use of eye drops. If the eye drops fail to control the pressure within the eye, a laser procedure known as trabeculoplasty is recommended. Controlling the pressure within the eye is of utmost concern for maintaining good vision.    Top

Macular Degeneration

Macular degeneration forms in the central retina (back of eye) and causes loss of central vision of the macula. It is a complicated disease and is not always treatable. This disease is usually caused by the aging process, which changes the back of the eye through degeneration of the macula.

Testing for macular degeneration includes the use of an Amsler grid that the patient looks at to see if the lines appear straight and fluorescein angiography (injection of a dye into the arm) that checks for irregularities in the retina. An individual with macular degeneration might see the Amsler grid as shown on the left (rather than straight lines).

Macular degeneration can sometimes be treated with a laser procedure, the use of low vision aids and is helped, in some cases, with anitoxidant formula vitamins. In some cases, a new therapy called Rheo Therapy can improve some patients' vision.     Top

Blepharoplasty

There are a variety of conditions that can cause our eyelids to interfere with our vision. Most frequently the aging process is the culprit. Excess skin tissue and/or fat can cause our eyelids to droop or look puffy. Many times this drooping will actually hinder one's vision by causing interference with peripheral or side vision. Some people notice that they have to "raise their eyebrows" in order to see well. Most of the time this occurs bilaterally, or in both eyes. Individuals with this condition feel as though they always look tired.

There are also some injuries and diseases that affect the nerves that go to our eyelids causing them to not function correctly. This is frequently seen in just one eye and is referred to as ptosis (pronounced toe' sis). Sometimes the condition will correct itself as the disease process is aleviated, but in many cases theptosis will remain.

Through a surgical procedure known as a Blepharoplasty or Blepharoptosis Repair (blepharo means eyelid and ptosis refers to the drooping), this condition may be remedied. Under local anesthesia the patient has the excess skin and/or fat pads surgically removed. A fine incision is made in the upper eyelid which follows one of the natural creases. Stitches are put in which are removed in 1-2 weeks. Although everyone heals a little bit differently, patients usually experience very little discomfort, but they do notice temporary swelling and bruising around the eyelids. Again, this is just part of the healing process and these conditions will go away. In some situations the puffiness is just in the area beneath the eyes. This can also cause an unwanted tired or 'older' look to the individual. Again, through a minor surgical procedure under local anesthetic, the cause of the puffiness can be removed. This procedure is usually perfomed through a delicate incision that is made under the eyelid so there is no visible evidence on the skin.    Top

Diabetic Retinopathy

Diabetic Retinopathy causes the delicate blood vessels in the retina (back of eye) to weaken, enlarge and/or sometimes to burst, leaking blood into the eye. If this condition persists, loss of vision may occur. A laser is used to inhibit the growth of new abnormal blood vessels and reduce the size of the vessels already abnormally enlarged on the retina. It can also be used on leaking blood vessels to seal them off.

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Dry Eye

The aging process changes the effectiveness of tears in their ability to lubricate the eyes. Moisture helps eyes see and focus more clearly. Dry eye is a tear deficiency that makes sight appear as though looking through a dirty window. Sometimes, the eyes seem more watery, but those tears lack the true lubricant to keep eyes moist.

Treatments include using artificial tears, an ointment at bedtime, the use of glasses with side shields to protect from wind and sometimes inserting a small plug into the duct at the corner of the eye to keep natural tears from draining. If unchecked, dry eye can lead to more serious problems of the eye.   Top

Strabismus

Strabismus is caused by the misalignment of the extraocular muscles. This condition prohibits normal movement of the eyes. As a result, a patient may complain of double vision (diplopia). Strabismus may also result when one or more muscles lose their elasticity from scarring.

Surgical repair or tightening of the damaged muscles may restore alignment. Trauma or other disease processes may cause strabismus as the result of complete or partial paralysis (palsy) of muscle function due to nerve damage.

Treatment in this case is generally directed to the primary disease. Strabismus may also result from a congenital weakness of one or more extraocular muscles. In this case, the normal, stronger member of a pair of muscles will tend to pull the eye in a direction away from the weak muscle. The tendency of the eyes to deviate in some cases is prevented by the brain's effort to fuse the images. The eyes may also deviate in an upward, downward, or other direction, depending on which pairs of extraocular muscles are mismatched in strength.

Treatment of congenital strabismus generally consists of prescription eyeglasses, patching one eye, and surgically tightening the weak muscles. This is usually done at an early age because delays can risk permanent loss of binocular vision and three-dimensional visual perception. Therefore, it is important that diagnosis and treatment occurs by ages 7 to 8.  Top

Keratoconus

The condition known as keratoconus occurs when the curved, crystal clear cornea (the covering to our eye) takes on a bulging or cone-like shape. When this bulging occurs the cornea also gets thinner. These changes in the cornea seriously affect the vision by causing astigmatism (irregular curvature of the cornea) which results in very distorted vision. Although the cause is usually unknown, there seems to be a genetic connection. Most of the time this condition occurs bilaterally (or in both eyes), but one eye may be affected before the other one. Onset usually occurs between 20 and 29 years of age and will commonly worsen over a period of 15 to 20 years. Since keratoconus involves a thinning of the cornea (and therefore probably weakening it), any procedure that involves changes in the cornea will further intensify the degeneration of a cornea that is already compromised.

If diagnosed by your ophthalmologist early enough, the condition can often be treated with the use of contact lens. If in an advanced state, keratoconus may need to be treated by performing a cornea transplant to achieve better vision. This condition would prohibit laser vision correction.  Top

Ectropion and Entropion

Ectropion is a turning of the lid margin outward and away from the eye. Excessive drying of the cornea and exposed eye results, causing irritation and tearing. The condition is generally caused by abnormal muscle tone of the orbicularis oculi muscle or by scarring. Treatment is surgical and directed to the specific cause.

In entropion, the lid margins are turned inward causing the eyelashes to rub against the eyeball producing tearing, discomfort and possible scratching of the cornea. This condition may be caused by excessive action of the orbicularis oculi muscle or by scarring and is treated surgically.   Top

Pinguecula and Pterygium

A pinguecula is a small, benign, yellow-white mass of degenerated tissue. This mass may be located on either side of the cornea and may be present in both eyes. Pingeuculae do not threaten vision but can cause minor eye irration.

A pterygium (ter ij' ee um) is a wedge-shaped growth, probably the result of sun irritation. The abnormal tissue gradually grows over the cornea and may cause irritation, chronic redness, foreign-body sensation and sensitivity to light. The growth can be surgically removed but may recur. Both pingueculae and pterygia are caused by ultraviolet light damage.   Top