Blog

Keratoconus

Eye allergies are overreactions of the body’s immune system when certain substances come in contact with the eyes of sensitive individuals.

These allergy-causing substances (called allergens) can include dust, pollen, mold and
animal dander. Certain ingredients in cosmetics and eye drops also can cause eye allergies in some individuals.

Eye allergy signs and symptoms

The most common signs and symptoms of eye allergies include red eyes, swollen eyelids,
itchy eyes and excessive tearing.

Eye allergy treatment

Avoidance.The best way to handle eye allergies is to
avoid exposure to known allergens that are causing your problems. For example, if animal dander appears to be the
problem, don’t allow your pet in your bedroom and avoid touching your eyes after handling your pet. Also, purchase a
high-quality furnace filter that traps airborne pet dander.

Medications.If you’re not sure what’s causing your
eye allergies, or you’re not having any luck avoiding known allergens that are causing problems, use
doctor-recommended medication to alleviate your eye allergy symptoms.

Over-the-counter and prescription medications each have their advantages; for example,
over-the-counter products often are less expensive, while prescription ones usually are stronger and might be more
effective.

Eye drops are available as simple eye washes, or they may have one or more active
ingredients such as antihistamines, decongestants or mast cell stabilizers to relieve allergy symptoms or reduce the
severity of allergic reactions. Antihistamines relieve many symptoms caused
by airborne allergens, such as itchy, watery eyes, runny nose and sneezing.

Decongestantsclear up redness. They contain
vasoconstrictors, which make the blood vessels in your eyes smaller, lessening the apparent redness. They treat the
symptom, not the cause.

In fact, with extended use, the blood vessels can become dependent on the vasoconstrictor
to stay small. When you discontinue the eye drops, the vessels might actually get bigger than they were in the first
place. This process is called rebound hyperemia, and the result is that your red eyes worsen over time.

Some products have ingredients called mast cell stabilizers,
which alleviate redness and swelling. Mast cell stabilizers are best taken prior to allergy symptoms to reduce your
sensitivity to problematic allergens and can provide long-lasting relief.

Other medications used for eye allergies include non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.,
In some cases, combinations of medications may be used.

Immunotherapy.You also might benefit from
immunotherapy, in which an allergy specialist injects you with small amounts of allergens to help your body
gradually build up immunity to them.

Eye allergies and contact lenses

Even if you are a successful contact lens wearer, allergy season can make your contacts
uncomfortable. Airborne allergens can get on your lenses, causing discomfort.

Allergens also can stimulate the excessive production of natural substances in your tears
that bind to your contacts, adding to your discomfort and allergy symptoms.

Ask your eye doctor about eye drops that can help relieve your symptoms and keep your
contact lenses clean. Certain drops can discolor or damage contact lenses, so ask your doctor first before trying
out a new brand.

Another alternative is daily disposable contact lenses, which are designed to be worn once,
and then discarded at the end of the day. Because you replace them daily, these lenses are unlikely to develop
irritating deposits that can build up over time and cause or heighten allergy-related discomfort.

Article ©2011 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use
is strictly prohibited.

Keratoconus

Dry eye syndrome (or “dry eye”) is the chronic lack of sufficient lubrication and moisture on the surface of the eye, causing discomfort, contact lens intolerance and increased risk of eye infections.

Dry eye is common, with some studies reporting that 10 to 20 million Americans experience some degree of dry eye syndrome.

Common risk factors for dry eye include increasing age, a dry environment and use of certain medications.

Signs and symptoms of dry eye

Signs and symptoms of dry eye syndrome include:

• Red, irritated eyes
• A burning or scratchy sensation
• Feeling something is “in” your eye (called a foreign body sensation)
• Fluctuating or blurred vision
• Eye pain
• Contact lens discomfort

It may seem odd, but another symptom of dry eye syndrome is a watery eye. This is because, as a reaction to dry eye irritation, the tear glands sometimes secrete very watery tears as a protective mechanism to prevent eye damage from a dry eye condition.

What causes dry eyes?

Dry eye is caused by the tear glands failing to secrete an adequate amount of tears or producing a tear film that, because of insufficient oiliness, evaporates too quickly.

These problems can be due to aging or a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines and birth control pills.

Dry eye can also be caused by chronic exposure to a dry, dusty or windy climate with low humidity. Air conditioning and forced air heating systems at home and at work also can dry out your eyes.

Another cause is failing to blink your eyes normally to remoisten them. This frequently occurs during computer work.

Dry eye syndrome also is associated with certain systemic diseases such as lupus, rheumatoid arthritis, rosacea and Sjogren’s syndrome.

Long-term contact lens wear, incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.

Dry eye syndrome is more common in women, possibly due to hormone fluctuations. Recent research suggests that smoking, too, can increase your risk of dry eye syndrome.

Dry eye also has been associated with incomplete lid closure following blepharoplasty — a popular cosmetic surgery to eliminate droopy eyelids.

Treatment for dry eye

There are several treatments for dry eye, based on the severity of the condition.

For mild dry eye, your eye doctor might recommend artificial tears, which are lubricating eye drops that are designed to alleviate the dry, scratching feeling and foreign body sensation of dry eye. Prescription eye drops for dry eye go one step further: they help increase your tear production.

If you wear contact lenses, be aware that some artificial tears and lubricating eye drops cannot be used during contact lens wear. You may need to remove your lenses before using the drops and wait 15 minutes or longer (check the label) before reinserting them.

Use only the brand of artificial tears your eye doctor recommends. Avoid self-medicating a dry eye condition by choosing artificial tears randomly in a drug store. Some products might actually make your symptoms worse.

To reduce the effects of sun, wind and dust on dry eyes, wear sunglasses when outdoors. Close-fitting wraparound styles offer the best protection.

Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that’s too dry because of air conditioning or heating.

For more significant cases of dry eye, your eye doctor might recommend punctal plugs. These tiny devices are inserted in the tear drainage ducts in your eyelids to slow the drainage of tears away from your eyes, thereby keeping your eyes more moist.

Doctors sometimes recommend special nutritional supplements such as flaxseed oil or fish oil to decrease dry eye symptoms. Drinking more water also may relieve dryness symptoms.

If medications are the cause of dry eyes, switching to a different medication or a different medical treatment may resolve the problem. However, always consult with your doctor before switching or discontinuing any medication.

Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid drops, plus frequent eyelid scrubs with an antibacterial shampoo.

Article ©2011 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

Keratoconus

Amblyopia is reduced vision in an eye caused by abnormal visual development. Commonly called “lazy eye,” amblyopia usually occurs in just one eye, but both eyes can be affected.

Left untreated, amblyopia can cause legal blindness in the affected eye. About 2 to 3 percent of the American population has amblyopia.

What causes amblyopia?

The most common cause of amblyopia is strabismus, which is misalignment of the eyes. To avoid double vision caused by strabismus, the visual part of the brain suppresses visual information provided by one eye, causing that eye to be amblyopic.

Another cause of amblyopia is a significant difference in the refractive errors (nearsightedness, farsightedness and/or astigmatism) in the two eyes.

It’s important to correct amblyopia as early as possible to enable proper visual development and normal visual acuity in both eyes.

Amblyopia signs and symptoms

Amblyopia generally starts at birth or during early childhood. Because the vision in one eye usually remains normal, sometimes there are no symptoms of amblyopia until the “good” eye is covered.

If amblyopia is caused by strabismus, it is the misalignment of the eyes that often leads to the diagnosis of amblyopia after vision testing of each eye is performed.

Treatment of amblyopia

If amblyopia is caused only by unequal refractive error, sometimes full-time wear of glasses or contact lenses will be sufficient for vision to develop properly in the amblyopic eye. But in most cases, eye patching or some other technique to temporarily reduce the visual acuity of the “good” eye is needed to stimulate the visual development of the amblyopic eye.

Eye patching may be required for several hours each day or even all day long, and may continue for weeks or months. If you have a lot of trouble with your child taking the patch off, you might consider a prosthetic contact lens that is specially designed to block vision in one eye and is colored to closely match the other eye.

Another alternative to patching is the use of atropine eye drops in the non-amblyopic eye. The drops blur the vision of the good eye to force greater use of the amblyopic eye. Studies have shown use of atropine eye drops is comparable to eye patching for treating amblyopia and doesn’t require constant vigilance to make sure your child wears an eye patch.

In cases when the amblyopia is caused by a large eye turn, strabismus surgery is usually required to straighten the eyes. The surgery corrects the muscle problem that causes strabismus so the eyes can focus together and see properly.

In many cases, a program of active vision therapy also is recommended to speed the development of normal vision and visual skills in an eye with amblyopia. Vision therapy exercises the eyes and helps both eyes work as a team. Vision therapy for someone with amblyopia forces the brain to use the amblyopic eye, thus restoring vision.

Amblyopia does not go away on its own, and untreated amblyopia can lead to permanent visual problems and poor depth perception. If your child has amblyopia and his or her “good” eye develops disease or is injured later in life, this could cause a permanent disability.

For best results, amblyopia should be treated as soon as possible during childhood. If amblyopia is detected and aggressively treated before the age of 8 or 9, in many cases normal 20/20 vision can be achieved.

Article ©2011 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

Keratoconus

Keratoconus is a progressive eye disease in which degenerative changes occur in the clear
front surface of the eye (cornea), causing it to bulge outward in an irregular, cone-like shape, causing distorted
vision that cannot be corrected with glasses or soft contact lenses. It can occur in one or both eyes. Keratoconus
is relatively rare. Most studies indicate it occurs in less than 0.6 percent of the U.S. population. Onset of the
disease usually occurs in people in their teens or early twenties.

What causes keratoconus?

Research suggests the weakening of the corneal tissue that leads to keratoconus may be due
to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidation from
compounds called free radicals, which causes it to weaken and bulge forward. Risk factors for oxidative damage and
weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one
member of the same family. Keratoconus also is associated with overexposure to ultraviolet rays from the sun,
excessive eye rubbing, a history of poorly fit contact lenses and chronic eye irritation.

Signs and symptoms of keratoconus

Keratoconus usually appears in a person’s late teens or early twenties, and its onset can
be slow and gradual or relatively rapid. As the cornea becomes more irregular in shape, it causes a progressive
increase in nearsightedness and irregular astigmatism, creating problems with distorted and blurred vision. Other
symptoms include glare and light sensitivity and frequent eyeglass prescription changes.

Keratoconus treatment

In very early and mild keratoconus, vision with eyeglasses or soft contact lenses may
remain acceptable. But as the disease progresses and the cornea thins and becomes increasingly more irregular in
shape, glasses or soft contacts no longer provide adequate vision correction. Treatments for moderate and advanced
keratoconus include:

Gas permeable contact lenses: Because they are
rigid, gas permeable (GP) contacts replace the irregular shape of the central cornea of a keratoconic eye with a
smooth, uniform refracting surface for better vision correction. In some cases, large-diameter GP lenses called
scleral contact lenses may be used to vault over the entire corneal surface to correct vision problems caused by
keratoconus.

“Piggybacking” contact lenses: Because fitting a gas
permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for the individual with keratoconus,
some eye care practitioners advocate fitting the eye with a soft contact lens, and then fitting a GP contact lens
over the soft lens. With this “piggybacking” technique, the underlying soft lens acts as a cushion between the GP
lens and the corneal surface for greater comfort.

Hybrid contact lenses: Hybrid contact lenses are
premium contacts that have a GP optical center, surrounded by a “skirt” of soft lens material. These lenses are
designed to provide the optical clarity of a gas permeable contact lens, combined with wearing comfort comparable to
soft contact lenses. Special hybrid lens designs are available for the correction of keratoconus.

Intacs: These tiny plastic inserts are surgically
placed just under the eye’s surface in the periphery of the cornea, and help re-shape the cornea for clearer vision.
Intacs may be needed when keratoconus patients no longer can obtain functional vision with contact lenses or
eyeglasses.

CXL: Corneal collagen cross-linking (CXL) is a
relatively new procedure that strengthens bonds between connective tissue (collagen) fibers within the cornea to
halt the progression of keratoconus. The surface layer of the cornea (epithelium) is gently removed and the
underlying corneal tissue is treated with eye drops of riboflavin (vitamin B2) and then exposed to ultraviolet light
for several minutes. Within a few days of the brief in-office treatment, the epithelial layer grows back. Early
results of CXL research show the procedure can successfully stop the progression of keratoconus, and some patients
experience reversal of the condition and vision improvement.

Corneal transplant: In advanced cases of keratoconus
that cannot be successfully treated by other means, the last remedy is a cornea transplant, also called a
penetrating keratoplasty (PK or PKP). Even after a successful cornea transplant, most keratoconic patients still
need glasses or contact lenses for clear vision.

Article ©2011 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use
is strictly prohibited.

“Pink eye”, or conjunctivitis, is condition that has likely impacted us all at one point or another but still holds a level of mystery for many. What are its causes and treatments? First, let’s understand what is meant by the words “pink eye”. In case you haven’t yet experienced it, when you have pink eye, your eye becomes pink or red because it’s irritated or inflamed. We all have a thin membrane that covers the inside of our eyelids and the whites of our eyes – it’s called the conjunctiva. When it becomes inflamed or irritated, we have a case of conjunctivitis.

There are a lot of non-infectious agents that can be irritating and cause our eye to get pink. If we’re allergic to pollen or pet dander, that can give us a type of pink eye. Sometimes the chlorine in pools will do the same. We can also pick up a bacterial or viral infection that results in pink eye and is infectious, easily spreading person to person.

Viral conjunctivitis is by far the most common, especially in adults. This form of pink eye is highly contagious, can accompany a flu or upper respiratory infection, and has typical symptoms of tearing and discomfort. It usually infects one eye first and then spreads to the other. There are no standard treatments for viral pink eye other than letting the virus take its course. Artificial tears may help your eyes feel more comfortable but do nothing to speed the recovery.

Bacterial conjunctivitis is typically seen in children, although the exact rates of incidence are difficult measure. This form of pink eye involves a lot of mucous-like discharge and is also contagious. This is the only form of pink eye that will respond to antibiotic drop treatment, thus shortening the course of infection. However, even if left untreated, the condition will resolve on its own in about a week.

Allergic conjunctivitis is easier to diagnose as people are generally aware of environmental allergies they may have, be it seasonal, animals, or otherwise. Because the offending cause is in the air, this form will affect both eyes simultaneously. Itching, tearing, swelling of the lids are typical symptoms of allergic pink eye. Treatment is based on the severity of the eyes’ reaction. Avoidance of the affecting agent is the easiest treatment but in a time where that is not practical there a number of very effective allergy eye drops available to reduce or eliminate the symptoms involved.

There are of course exceptions to any rule but the best way to tell which cause is the culprit is to have your eye care specialist inspect your eyes. Also, other serious eye conditions can mimic conjunctivitis, so anyone who complains of severe pain, changes in eyesight, swelling around the eyes, or sensitivity to light should be examined. If the pink eye does not improve after 2 to 3 days of treatment, or after a week when left untreated, call your doctor. If your child has pink eye and starts to develop increased swelling, redness, and tenderness in the eyelids and around the eye, along with a fever, call your eye care specialist. Those symptoms may mean the infection has started to spread beyond the conjunctiva and will require additional treatment.

Pink eye has very real social and economic impacts as well. While there are no universal guidelines regarding school exclusion for conjunctivitis, many schools will not allow children to return to school until they have been on antibiotics for some period of time, most typically 24 hours, or their infection has cleared. The American Academy of Pediatrics states that children with viral or bacterial conjunctivitis should be allowed to remain in school once any indicated therapy is started unless limiting contact with other children is not possible. Therefore, young children, whose play behavior inherently requires touching and sharing toys, should be excluded from school per this recommendation. For parents, the advantage of initiating antibiotic drops is that the child may then return to school; however, the danger here is that, if it is a viral illness, the antibiotics are not actually doing any good and it can continue to spread.

To simplify: if you’re an adult, it’s probably viral and there is no specific treatment; if you’re a child it is also likely viral but can also be due to a bacteria in some cases with the difference typically lying in the primary symptom (tearing=viral and mucous discharge=bacterial); and if your eyes itch more than anything it is likely allergic. One of the best methods of disease prevention (and not just pink eye) is to keep your hands clean and to limit touching your nose, eyes, or mouth. Also, remember not to share any items that have been near an infected person’s eye, such as pillowcases, towels, or makeup. Regardless of the cause of pink eye, knowing what to do and what to expect can lessen the impact of this condition. And if you are yet to experience it, those days are numbered.

J. Mark Snyder, O.D.