PATIENT EDUCATION MATERIALS COPYAmblyopiaWhat is amblyopia?The brain and the eye work together to produce vision. Light enters the eye and is changed into nerve signals that travel along the optic nerve to the brain. Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called lazy eye.How common is amblyopia?Amblyopia is the most common cause of visual impairment in childhood. The condition affects approximately 2 to 3 out of every 100 children. Unless it is successfully treated in early childhood, amblyopia usually persists into adulthood, and is the most common cause of monocular (one eye) visual impairment among children and young and middle-aged adults.CauseWhat causes amblyopia?Amblyopia may be caused by any condition that affects normal visual development or use of the eyes. Amblyopia can be caused by strabismus, an imbalance in the positioning of the two eyes. Strabismus can cause the eyes to cross in (esotropia) or turn out (exotropia). Sometimes amblyopia is caused when one eye is more nearsighted, farsighted, or astigmatic than the other eye. Occasionally, amblyopia is caused by other eye conditions such as cataract.TreatmentHow is amblyopia treated in children?Treating amblyopia involves making the child use the eye with the reduced vision (weaker eye). Currently, there are two ways used to do this:AtropineA drop of a drug called atropine is placed in the stronger eye once a day to temporarily blur the vision so that the child will prefer to use the eye with amblyopia. Treatment with atropine also stimulates vision in the weaker eye and helps the part of the brain that manages vision develop more completely.PatchingAn opaque, adhesive patch is worn over the stronger eye for weeks to months. This therapy forces the child to use the eye with amblyopia. Patching stimulates vision in the weaker eye and helps the part of the brain that manages vision develop more completely.Previously, eye care professionals often thought that treating amblyopia in older children would be of little benefit. However, surprising results from a nationwide clinical trial show that many children age seven through 17 with amblyopia may benefit from treatments that are more commonly used on younger children. This study shows that age alone should not be used as a factor to decide whether or not to treat a child for amblyopia.Can amblyopia be treated in adults?Studies are very limited at this time and scientists dont know what the success rate might be for treating amblyopia in adults. During the first six to nine years of life, the visual system develops very rapidly. Complicated connections between the eye and the brain are created during that period of growth and development. Scientists are exploring whether treatment for amblyopia in adults can improve vision.

Blepharitis Blepharitis is inflammation of the eyelash follicles, along the edge of the eyelid. Blepharitis is a common condition that can be difficult to manage because it tends to recur.CausesBlepharitis is caused by an overgrowth of the bacteria that is normally found on the skin. It is usually due to seborrheic dermatitisor a bacterial infection. Both may occur at the same time.The cause is overgrowth of the bacteria that is normally found on the skin.Allergiesandlicethat affects the eyelashes may also cause blepharitis, although these causes are less common.People who have blepharitis have too much oil being produced by the glands near the eyelid. This allows bacteria normally found on the skin to overgrow.Blepharitis may be linked to repeatedstyesandchalazia. You are more likely to develop this condition if you have seborrheic dermatitis of the face or scalp,rosacea, lice, and allergies.SymptomsThe eyelids appear red and irritated, withscalesthat stick to the base of the eyelashes. The eyelids may be:CrustyReddenedSwollenItchingBurningYou may feel like you have sand or dust in your eye when you blink. Sometimes, the eyelashes may fall out.Exams and TestsAn examination of the eyelids during an eye examination is usually enough to diagnose blepharitis.TreatmentCareful daily cleansing of the edges of the eyelids helps remove the skin oils that cause the bacteria to overgrow. Your health care provider might recommend using baby shampoo or special cleansers. Antibiotic ointments may also be helpful.Outlook (Prognosis)The likely outcome is good with treatment. Continued attention to lid cleanliness may be required to prevent repeated problems. Continued treatment will typically make the eyes less red and more comfortable.Possible ComplicationsStyesChalaziaInjury to the eye tissue (corneal ulcer) from irritationInflammation of the surface of the eye (conjunctivitis)Loss of eyelashesScarring of the eyelidsWhen to Contact a Medical ProfessionalCall for an appointment with your health care provider if symptoms worsen or do not improve after careful cleansing of the eyelids for several days.PreventionCleaning eyelids carefully will help prevent blepharitis. If a specific skin condition is present, it should be treated.Alternative NamesEyelid inflammation

Frequently Asked Questions about BlepharitisWhat other conditions are associated with blepharitis?Complications from blepharitis include:Stye: 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.Problems with the tear film: Abnormal or decreased oil secretions that are part of the tear film can result in excess tearing or dry eye. Because tears are necessary to keep the cornea healthy, tear film problems can make people more at risk for corneal infections.CausesWhat causes blepharitis?Blepharitis occurs in two forms:Anterior blepharitisaffects the outside front of the eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are bacteria (Staphylococcus) and scalp dandruff.Posterior blepharitisaffects 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).SymptomsWhat are the symptoms of blepharitis?Symptoms of either form of blepharitis include a foreign body or burning sensation, excessive tearing, itching, sensitivity to light (photophobia), red and swollen eyelids, redness of the eye, blurred vision, frothy tears, dry eye, or crusting of the eyelashes on awakening.TreatmentHow is blepharitis treated?Treatment for both forms 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 light scrubbing of the eyelid with a cotton swab and a mixture of water and baby shampoo. Because blepharitis rarely goes away completely, most patients must maintain an eyelid hygiene routine for life. If the blepharitis is severe, an eye care professional may also prescribe antibiotics or steroid eyedrops.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.ChalazionA chalazion is a small bump in the eyelid caused by a blockage of a tiny oil gland.CausesA chalazion develops in the glands that produce the fluid that lubricates the eye. These are called Meibomian glands. The eyelid has approximately 100 of these glands, which are located near the eyelashes.A chalazion is caused by a blockage of the duct that drains one of these glands.SymptomsEyelid tendernessIncreased tearingPainful swelling on the eyelidSensitivity to lightExams and TestsAn exam of the eyelid confirms the diagnosis.Rarely, the Meibomian gland duct may be blocked by askin cancer. If this is suspected, you may need abiopsy.TreatmentA chalazion will often disappear without treatment in a month or so.The primary treatment is to apply warm compresses for 10-15 minutes at least four times a day. This may soften the hardened oils blocking the duct, and promote drainage and healing.If the chalazion continues to get bigger, it may need to be removed with surgery. This is usually done from underneath the eyelid to avoid a scar on the skin.Antibiotic eye drops are usually used several days before and after thecystis removed. However, they are not much use otherwise in treating a chalazion.Steroid injection is another treatment option.Outlook (Prognosis)Chalazia usually heal on their own. The outcome with treatment is usually excellent.Possible ComplicationsA large chalazion can causeastigmatismdue to pressure on the cornea. This will get better when the chalazion is treated.When to Contact a Medical ProfessionalApply warm compresses and call your health care provider if the swelling gets worse or continues for longer than 1 month.Call for an appointment with your health care provider if lumps on the eyelid continue to get bigger despite treatment, or you have an area of eyelash loss.PreventionProperly cleaning the eyelid may prevent the condition from returning in people who are prone to chalazia. Cleaning the eyelash area with baby shampoo will help reduce clogging of the ducts.Alternative NamesMeibomian gland lipogranulomaDry EyeWhen you blink, a film of tears spreads over the eye, making the surface of the eye smooth and clear. Without this tear film, good vision would not be possible. Sometimes people don't produce enough tears or the right quality of tears to keep their eyes healthy and comfortable. This condition is known as dry eye.The tear film consists of three layers:An oily layer;A watery layer;A layer of mucus.Each layer has its own purpose. The oily layer, produced by the meibomian glands, forms the outermost surface of the tear film. Its main purpose is to smooth the tear surface and reduce evaporation of tears.The middle watery layer makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal glands in the eyelids, cleanses the eye and washes away foreign particles or irritants.The inner layer consists of mucus produced by the conjunctiva. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain moist. Without mucus, tears would not stick to the eye.Normally, the eye constantly bathes itself in tears. By producing tears at a slow and steady rate, the eye stays moist and comfortable.The eye uses two different methods to produce tears. It can make tears at a slow, steady rate to maintain normal eye lubrication. It can also produce a lot of tears in response to eye irritation or emotion. When a foreign body or dryness irritates the eye, or when a person cries, excessive tearing occurs.It may not sound logical that dry eye would cause excess tearing, but think of it as the eye's response to discomfort. If the tears responsible for maintaining lubrication do not keep the eye wet enough, the eye becomes irritated. Eye irritation prompts the gland that makes tears (called the lacrimal gland) to release a large volume of tears, overwhelming the tear drainage system. These excess tears then overflow from your eye.Causes of Dry EyeHormonal changes are a main cause ofdry eye syndrome, causing changes in tear production. The hormonal changes associated with menopause are one of the main reasons why women are most often affected by dry eye.Conditions that affect the lacrimal gland or its ducts including autoimmune diseases like lupus and rheumatoid arthritis lead to decreased tear secretion and dry eye.

Tear secretion also may be reduced by certain conditions that decrease corneal sensation. Diseases such as diabetes and herpes zoster are associated with decreased corneal sensation. So is long-term contact lens wear and surgery that involves making incisions in or removing tissue from the cornea (such asLASIK).A wide variety of common medications, both prescription and over-the-counter, can cause dry eye by reducing tear secretion. Be sure to tell your ophthalmologist (Eye M.D.) the names of all the medications you are taking, especially if you are using:Diuretics for high blood pressure;Beta-blockers for heart or high blood pressure;Antihistamines for allergies;Sleeping pills;Anti-anxiety medications;Pain relievers.Since these medications are often necessary, the dry eye condition may have to be tolerated or treated with eyedrops called artificial tears.People with dry eye are often more likely to experience the side effects of eye medications, including artificial tears. For example, the preservatives in certain eye drops and artificial tear preparations can irritate the eye. These people may need special, preservative-free artificial tears.Another cause for dry eye is exposure to a dry, windy climate, as well as smoke and air conditioning, which can speed tear evaporation. Avoiding these irritants can offerdry eye relief.

Dry Eye SymptomsWhile it may sound strange, people with dry eye may find their eyes water quite a bit. This is because the eye is responding to the irritation of this condition. Dry-eye sufferers may find that they feel like they cannot keep their eyes open for very long. They may also find their eyes feel more uncomfortable after reading or watching television.Dry eye symptoms usually include: Stinging or burning eyes; Scratchiness; Stringy mucus in or around the eyes; Excessive eye irritation from smoke or wind; Excess tearing; Discomfort when wearing contact lenses.Anyone can experience dry eye, though it is more common among women, particularly after menopause. Women who experience other hormonal conditions, such as pregnancy and menstruation, may also have dry eye symptoms.People who have a condition called Sjgren's syndrome will usually have dry eye. So will others with similar systemic diseases like lupus, rheumatoid arthritis or some types of thyroid disease. Also, people who take certain over-the-counter and prescription medications can have dry eye due to reduced tear secretion.People who have hadLASIKor other refractive surgery, where their corneas have reduced sensation due to incisions or tissue removal, may also experience dry eye. Also, people who wearcontact lenseslong term are at risk for developing dry eye.People who are sensitive to certain climates (such as windy, dry air) or to environmental factors like cigarette smoke or air conditioning may develop dry eye when they are exposed to these conditions.Because people who work long hours at a computer are less likely to blink often, they are more susceptible to getting dry eye than people who don't spend a lot of time in front of a computer monitor.Dry Eye DiagnosisAn ophthalmologist is usually able to diagnose dry eye by examining the eyes.Sometimes tests that measure tear production are necessary. A test called the Schirmer tear test involves placing filter-paper strips under the lower eyelids to measure the rate of tear production under various conditions.Another way your Eye M.D. can diagnose dry eye is by putting special dye drops in the eye then studying how long it takes for dry spots to develop on the cornea. The dye test can also be used to look for certain staining patterns that show any damage to the surface of the cornea.Dry Eye TreatmentAdding tearsEyedrops called artificial tears are similar to your own tears. They lubricate the eyes and help maintain moisture. Artificial tears are available without a prescription. There are many brands on the market, so you may want to try several to find the one you like best.Preservative-free eyedrops are available for people who are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands may be better for you.You can use the artificial tears as often as necessary once or twice a day or as often as several times an hour.Conserving your tearsConserving your eyes' own tears is another approach to keeping the eyes moist. Tears drain out of the eye through a small channel into the nose (which is why your nose runs when you cry). Your ophthalmologist may close these channels either temporarily or permanently. This method conserves your own tears and makes artificial tears last longer.A temporary method of closing the channels may involve the use of punctal plugs. The plugs are inserted into the punctum (tear duct) and work much like a dam by blocking your eye's drainage system. Your Eye M.D. may also choose to permanently close your tear ducts by using heat to seal the puncta closed.Other methodsTears evaporate like any other liquid. You can take steps to prevent evaporation. In winter, when indoor heating is in use, a humidifier or a pan of water on the radiator adds moisture to dry air. Wraparound glasses may reduce the drying effect of the wind.A person with dry eye should avoid anything that may cause dryness, such as an overly warm room, hair dryers or wind. Smoking is especially bothersome.Some people may find dry-eye relief by supplementing their diet with omega-3 fatty acids, which are found naturally in foods like oily fish (salmon, sardines, anchovies) and flax seeds. Ask your Eye M.D. if you should take supplements of omega-3 fatty acids and, if so, in what form and dosage.If other methods do not give you adequate dry eye relief, your ophthalmologist may suggest that you use a prescription medication. One such medication, cyclosporine, works by stimulating tear production. Steroid eyedrops may also be used, but are generally not recommended for long-term treatment. Other treatment options may include ointments, gels and inserts.Dry eye due to lack of vitamin A in the diet is rare in the United States but is more common in poorer countries, especially among children. Ointments containing vitamin A can help dry eye if it is caused by unusual conditions such as Stevens-Johnson syndrome or pemphigoid. Vitamin A supplements do not seem to help people with ordinary dry eye.Dry Eye questionsWhat 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 is the cornea?The cornea is the clear, dome-shaped outer surface that covers the eye in front of the iris, the colored part of the eye. The cornea helps protect the rest of the eye from germs, dust, and other harmful matter. The cornea bends, or refracts, light entering the eye, and accounts for most of the eye's total focusing power. It also serves as a filter to screen out most of the damaging ultraviolet (UV) wavelengths in sunlight.The cornea is a highly organized, clear structure made up of a group of cells and proteins precisely arranged in layers, but it has no blood vessels to nourish or protect it against infection. Instead, it receives its nourishment from the tears and the watery fluid (aqueous humor) that fills the chamber behind it.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.

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 are 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 Sjgren's syndrome, lupus, and rheumatoid arthritis. Sjgren'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 Sjgren'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.

Eyelid bumpMost bumps on the eyelid are styes. A stye is an inflamed oil gland on the edge of your eyelid, where the lash meets the lid. It appears as a red, swollen bump that looks like a pimple. It is tender, especially to the touch.CausesA stye is caused by bacteria from the skin that get into the oil glands in the eyelids that provide lubrication to the tear film. Styes are similar to common acne pimples that occur elsewhere on the skin. You may have more than one stye at the same time.Styes usually develop over a few days and may drain and heal on their own. A stye can become achalazion-- this is when an inflamed oil gland becomes fully blocked. If a chalazion gets large enough, it can cause trouble with your vision.If you haveblepharitis(seeeye redness), you are more likely to get styes.Other possible eyelid bumps include:Xanthelasma-- raised yellow patches on your eyelids that can happen with age. These are harmless, although they are occasionally a sign of high cholesterol.Papillomas -- pink or skin-colored bumps. They are harmless, but can slowly grow, affect your vision, or bother you for cosmetic reasons. If so, they can be surgically removed.Cysts -- small fluid-filled sacs that can affect your vision.SymptomsIn addition to the red, swollen bump, other possible symptoms include:A gritty, scratchy sensation as if there is a foreign bodySensitivityto lightTearing of your eyeTenderness of the eyelidExams and TestsA doctor can diagnose a stye just by looking at it. Special tests are usually not necessary.TreatmentTo treat eyelid bumps:Styes and chalazions can be treated by applying warm compresses. Apply for 10 minutes. Do this four times a day.Do NOT attempt to squeeze a stye or any other type of eyelid bump. Let it drain on its own.Antibiotic creams may help recurrent or persistent styes. Some large styes need to be lanced to drain the infection.Outlook (Prognosis)Styes often get better on their own. However, they may recur. The outcome is generally excellent with simple treatment.Possible ComplicationsRecurrence of a styeSpread of infection to other eyelash folliclesSpread of infection to the tissue of the eyelid (eyelid cellulitis)When to Contact a Medical ProfessionalCall your doctor if:You have problems with your vision.The eyelid bump worsens or does not improve within a week or two of self-care.The eyelid bump or bumps become very large or painful.You have a blister on your eyelid.You have crusting or scaling of your eyelids.Your whole eyelid is red, or the eye itself is red.You are very sensitive to light or have excessive tears.A stye comes back soon after successful treatment of another one.Your eyelid bump bleeds.PreventionAlways wash your hands thoroughly before touching the skin around your eye. If you are susceptible to styes, it may help to carefully clean off excess oils from the edges of your lids.

Eyelid droopingEyelid drooping is excessive sagging of the upper eyelid.ConsiderationsA drooping eyelid can stay constant, worsen over time (progressive), or come and go (intermittent). It can be one-sided or on both sides. When drooping is one-sided (unilateral), it is easy to detect by comparing the two eyelids. Drooping is more difficult to detect when it occurs on both sides, or if there is only a slight problem.A furrowed forehead or a chin-up head position may indicate that someone is trying to see under their drooping lids. Eyelid drooping can make someone appear sleepy or tired.Drooping lids are either present at birth (congenital) or develop later in life. A drooping eyelid is not a reason to panic, but you should report it to your doctor.CausesDrooping eyelids may be due to a variety of conditions include aging, diabetes, stroke, Horner syndrome, myasthenia gravis, or a brain tumor or other cancer that affects nerve or muscle reactions. Below are some common causes.Both eyelids drooping:Medical problem, such asmyasthenia gravisMigraine headachesNormal aging processNormal variation of the eyelidsOne eyelid drooping:Growth in the eyelid, such as a styeMedical problemNerve injuryNormal aging processNormal variationHome CareBelow is a list of recommendations based on the various causes of eye drooping:Caused by aging -- no treatment is necessary, unless it affects your vision.Caused by anallergic reaction-- consult your doctor about antihistamine or steroid treatment.Caused by nerve injury -- consult your doctor about surgical correction.For all other causes -- follow your health care provider's recommendations.When to Contact a Medical ProfessionalContact your health care provider if:Eyelid drooping is affecting your appearance or visionOne eyelid suddenly droops or closesIt is associated with other symptoms, such as double visionInterventions:Surgery may be necessary to correct problems with the muscles that open the eyelid (levator muscle dysfunction).Eyelid liftEyelid lift surgery, also called blepharoplasty, is done to repair sagging or drooping upper eyelids (ptosis).DescriptionSagging ordrooping eyelidsoccur naturally with increasing age. However, some people are born with droopy eyelids or develop diseases (such asmyasthenia gravis) that cause eyelid drooping.An eyelid lift is usually done while you are awake. You will be given medicine to relieve anxiety. The surgeon will inject numbing medicine around the eye so you do not feel pain during the surgery.The surgeon will make tiny cuts into the natural creases or folds of the eyelids, and then remove any loose skin and extra fat tissue. After tightening the eyelid muscles, the surgeon places stitches in the area.Eyelid repair surgery rarely requires a hospital stay. The surgery is done in a surgeon's office or as outpatient surgery in a medical center.Why the Procedure is performedAn eyelid lift is needed for those who have excessive eyelid drooping that interferes with vision.Some people have an eyelid lift to improve their appearance. This is called cosmetic or elective surgery. The eyelid lift may be done alone or with other facial surgery such as a browlift orfacelift.Eyelid surgery will not remove wrinkles around the eyes, lift sagging eyebrows, or eliminate dark circles under the eyes.RisksRisks of an eyelid lift may include:Damage to eye or loss of vision (rare)Difficulty closing the eyes while sleeping (rarely permanent)Double orblurred visionTemporary swelling of the eyelidsTiny whiteheads after stitches are removedSlow healingUneven healing or scarringMedical conditions that make blepharoplasty more risky are:DiabetesDry eye or not enough tear productionHeart diseaseor disorders of the blood vesselsHigh blood pressure or other circulatory disordersThyroid problems such ashypothyroidismandGraves' diseaseThe risks for any anesthesia include:Breathing problemsReactions to medicationsThe risks for any surgery include:BleedingInfectionAfter the ProcedureScars may remain slightly pink for 6 months or more after surgery. They will fade eventually to a thin, nearly invisible white line. The more alert and youthful look usually lasts for years. These results are permanent for many people.Outlook (Prognosis)You can usually go home the day of surgery. Before you leave, a doctor or nurse will cover your eyes and eyelids with ointment and a bandage. Your eyelids may feel tight and sore as the numbing medicine wears off. However, the discomfort is easily controlled with pain medication.Keep your head raised up as much as possible for several days. Place cold packs over the area to reduce swelling and bruising.Your doctor may recommend eyedrops to reduce burning or itching.You should be able to see well after 2 to 3 days. Do not wear contact lenses for at least 2 weeks. Keep activities to a minimum for 3 to 5 days, and avoid strenuous activities that raise the blood pressure for about 3 weeks. This includes lifting, bending, and rigorous sports.Your doctor will remove the stitches 2 to 7 days after surgery. You will have some bruising, which may last 2 to 4 weeks. You may notice increased tears, increasedsensitivity to lightand wind, and temporary vision changes (such as blurring or double vision) for the first few weeks.Alternative NamesBlepharoplastyEctropionEctropion is the turning out of the eyelid (usually the lower eyelid) so that the inner surface is exposed.CausesEctropion is usually caused by the aging process and the weakening of the connective tissue of the eyelid, which causes the lid to turn out. It can also be caused by:A defect that occurs before birth (for example, in children with Down syndrome)Facial palsyScar tissue from burnsSymptomsDry, painful eyesExcesstearing of the eye(epiphora)Eyelid turns outwardLong-term (chronic)conjunctivitisKeratitisRedness of the lid and white part of the eyeExams and TestsA physical examination of the eyes and eyelids confirms the diagnosis. Special tests are usually not necessary.TreatmentArtificial tears (a lubricant) may relieve dryness and keep the cornea lubricated. Surgery to tighten the muscles that hold the eyelids in place is usually effective. It may be performed as outpatient surgery with local anesthesia.Outlook (Prognosis)The outcome is expected to be good with treatment.Possible ComplicationsCorneal dryness and irritation may lead to:Corneal abrasionsCorneal ulcersEye infectionsCorneal ulcers can threaten vision.When to Contact a Medical ProfessionalCall for an appointment with your health care provider if you develop symptoms of ectropion.If you have ectropion, get medical attention if you experience the following emergency symptoms:Decreasing visionPainLight sensitivityRapidly increasing rednessPreventionMost cases are not preventable. Using artificial tears or lubricating ointments may prevent corneal complications.EntropionEntropion is the turning in of the edges of the eyelid (usually the lower eyelid) so that the lashes rub against the eye surface.CausesEntropion can be present at birth (congenital).In babies, it rarely causes problems because the lashes are very soft and do not easily damage the cornea. In older people, the condition is usually caused by a spasm or weakening of the muscles surrounding the lower part of the eye. This causes the lid to turn inward.Although rare in North America and Europe,trachomainfection can cause scarring of the inner side of the lid, which may cause entropion. Trachoma scarring is one of the three leading causes of blindness in the world.Risk factors for entropion are:AgingChemical burnInfection with trachomaSymptomsDecreased vision if the cornea is damagedExcessive tearingEye discomfortor painEye irritationRednessExams and TestsA physical examination of the eyes and eyelids confirms the diagnosis. Special tests are usually not necessary.TreatmentArtificial tears (a lubricant) may provide relief from dryness and keep the cornea lubricated. Surgery to correct the position of the eyelids is usually effective.Severe cases may need surgery to protect the eye.Outlook (Prognosis)The outlook is usually good if the condition is treated before cornea damage occurs.Possible ComplicationsCorneal dryness and irritation may increase the risk of:Corneal abrasionsCorneal ulcersEye infectionsWhen to Contact a Medical ProfessionalCall for an appointment with your health care provider if:Your eyelids turn inwardYou constantly feel as though there is aforeign body in the eyeIf you have entropion, the following should be considered an emergency:Decreasing visionLight sensitivityPainEye redness that increases rapidlyPreventionMost cases are not preventable. Treatment reduces the risk of complications.People who have recently traveled to an area where there is trachoma (North Africa, South Asia) should seek treatment if they have red eyes.

Glaucoma What is Glaucoma?Glaucoma is a group of diseases that damage the eyes optic nerve and can result in vision loss and blindness. However, with early detection and treatment, you can often protect your eyes against serious vision loss.The optic nerve

The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina to the brain. (See diagram above.) The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision.How does the optic nerve get damaged by open-angle glaucoma?Several large studies have shown that eye pressure is a major risk factor for optic nerve damage. In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. (See diagram below.) When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.In open-angle glaucoma, even though the drainage angle is "open", the fluid passes too slowly through the meshwork drain. Since the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma-and vision lossmay result. Thats why controlling pressure inside the eye is important.Another risk factor for optic nerve damage relates to blood pressure. Thus, it is important to also make sure that your blood pressure is at a proper level for your body by working with your medical doctor.

Fluid pathway is shown in teal.Can I develop glaucoma if I have increased eye pressure?Not necessarily. Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher levels of eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another.Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. Thats why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.Can I develop glaucoma without an increase in my eye pressure?Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is a type of open-angle glaucoma.Who is at risk for open-angle glaucoma?Anyone can develop glaucoma. Some people, listed below, are at higher risk than others:African Americans over age 40Everyone over age 60, especially Mexican AmericansPeople with a family history of glaucomaA comprehensive dilated eye exam can reveal more risk factors, such as high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy. In some people with certain combinations of these high-risk factors, medicines in the form of eyedrops reduce the risk of developing glaucoma by about half.Glaucoma SymptomsAt first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes.Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. They seem to be looking through a tunnel. Over time, straight-ahead (central) vision may decrease until no vision remains.

Normal Vision.

The same scene as viewed by a person with glaucoma.How is glaucoma detected?Glaucoma is detected through a comprehensive dilated eye exam that includes the following:Visual acuity test. This eye chart test measures how well you see at various distances.Visual field test. This test measures your peripheral (side vision). It helps your eye care professional tell if you have lost peripheral vision, a sign of glaucoma.Dilated eye exam. In this exam, drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.Tonometryis the measurement of pressure inside the eye by using an instrumentcalled a tonometer. Numbing drops may be applied to your eye for this test. A tonometer measures pressure inside the eye to detect glaucoma.Pachymetryis the measurement of the thickness of your cornea. Your eye care professional applies a numbing drop to your eye and uses an ultrasonic wave instrument to measure the thickness of your cornea.Can glaucoma be cured?No. There is no cure for glaucoma. Vision lost from the disease cannot be restored.Glaucoma TreatmentsImmediate treatment for early-stage, open-angle glaucoma can delay progression of the disease. Thats why early diagnosis is very important.Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.Medicines. Medicines, in the form of eyedrops or pills, are the most common early treatment for glaucoma. Taken regularly, these eyedrops lower eye pressure. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.Before you begin glaucoma treatment, tell your eye care professional about other medicines and supplements that you are taking. Sometimes the drops can interfere with the way other medicines work.Glaucoma medicines need to be taken regularly as directed by your eye care professional. Most people have no problems. However, some medicines can cause headaches or other side effects. For example, drops may cause stinging, burning, and redness in the eyes.Many medicines are available to treat glaucoma. If you have problems with one medicine, tell your eye care professional. Treatment with a different dose or a new medicine may be possible.Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important.Make sure your eye care professional shows you how to put the drops into your eye. For tips on using your glaucoma eyedrops, see the inside back cover of this booklet.Laser trabeculoplasty. Laser trabeculoplasty helps fluid drain out of the eye. Your doctor may suggest this step at any time. In many cases, you will need to keep taking glaucoma medicines after this procedure.Laser trabeculoplasty is performed in your doctors office or eye clinic. Before the surgery, numbing drops are applied to your eye. As you sit facing the laser machine, your doctor holds a special lens to your eye. A high-intensity beam of light is aimed through the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This allows the fluid to drain better.Like any surgery, laser surgery can cause side effects, such as inflammation. Your doctor may give you some drops to take home for any soreness or inflammation inside the eye. You will need to make several follow-up visits to have your eye pressure and eye monitored.If you have glaucoma in both eyes, usually only one eye will be treated at a time. Laser treatments for each eye will be scheduled several days to several weeks apart.Studies show that laser surgery can be very good at reducing the pressure in some patients. However, its effects can wear off over time. Your doctor may suggest further treatment.Conventional surgery. Conventional surgery makes a new opening for the fluid to leave the eye. (See diagram on the next page.) Your doctor may suggest this treatment at any time. Conventional surgery often is done after medicines and laser surgery have failed to control pressure.Conventional surgery, called trabeculectomy, is performed in an operating room. Before the surgery, you are given medicine to help you relax. Your doctor makes small injections around the eye to numb it. A small piece of tissue is removed to create a new channel for the fluid to drain from the eye. This fluid will drain between the eye tissue layers and create a blister-like "filtration bleb."For several weeks after the surgery, you must put drops in the eye to fight infection and inflammation. These drops will be different from those you may have been using before surgery.Conventional surgery is performed on one eye at a time. Usually the operations are four to six weeks apart.Conventional surgery is about 60 to 80 percent effective at lowering eye pressure. If the new drainage opening narrows, a second operation may be needed. Conventional surgery works best if you have not had previous eye surgery, such as a cataract operation.Sometimes after conventional surgery, your vision may not be as good as it was before conventional surgery. Conventional surgery can cause side effects, including cataract, problems with the cornea, inflammation, infection inside the eye, or low eye pressure problems. If you have any of these problems, tell your doctor so a treatment plan can be developed.What are some other forms of glaucoma and how are they treated?Open-angle glaucoma is the most common form. Some people have other types of the disease.Inlow-tensionornormal-tension glaucoma, optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsen in others despite low pressures.A comprehensive medical history is important to identify other potential risk factors, such as low blood pressure, that contribute to low-tension glaucoma. If no risk factors are identified, the treatment options for low-tension glaucoma are the same as for open-angle glaucoma.Inangle-closure glaucoma, the fluid at the front of the eye cannot drain through the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma may have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well2 as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately.This is a medical emergency.If your doctor is unavailable, go to the nearest hospital or clinic. Without treatment to restore the flow of fluid, the eye can become blind. Usually, prompt laser surgery and medicines can clear the blockage, lower eye pressure, and protect vision.Incongenital glaucoma, children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery typically is the suggested treatment, because medicines are not effective and can cause more serious side effects in infants and be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.

Conventional surgery makes a new opening for the fluid to leave the eye.Secondary glaucomascan develop as complications of other medical conditions. For example, a severe form of glaucoma is calledneovascular glaucoma, and can be a result from poorly controlled diabetes or high blood pressure. Other types of glaucoma sometimes occur with cataract, certain eye tumors, or when the eye is inflamed or irritated by a condition called uveitis. Sometimes glaucoma develops after other eye surgeries or serious eye injuries. Steroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. There are two eye conditions known to cause secondary forms of glaucoma.Pigmentary glaucomaoccurs when pigment from the iris sheds off and blocks the meshwork, slowing fluid drainage.Pseudoexfoliation glaucomaoccurs when extra material is produced and shed off internal eye structures and blocks the meshwork, again slowing fluid drainage.Depending on the cause of these secondary glaucomas, treatment includes medicines, laser surgery, or conventional or other glaucoma surgery.What You Can DoIf you are being treated for glaucoma, be sure to take your glaucoma medicine every day. See your eye care professional regularly.You also can help protect the vision of family members and friends who may be at high risk for glaucoma-African Americans over age 40; everyone over age 60, especially Mexican Americans; and people with a family history of the disease. Encourage them to have a comprehensive dilated eye exam at least once every two years. Remember that lowering eye pressure in the early stages of glaucoma slows progression of the disease and helps save vision.Medicare covers an annual comprehensive dilated eye exam for some people at high risk for glaucoma. These people include those with diabetes, those with a family history of glaucoma, and African Americans age 50 and older.Loss of VisionIf you have lost some sight from glaucoma, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments.How should I use my glaucoma eyedrops?If eyedrops have been prescribed for treating your glaucoma, you need to use them properly, as instructed by your eye care professional. Proper use of your glaucoma medication can improve the medicines effectiveness and reduce your risk of side effects.To properly apply your eyedrops, follow these steps:Wash your hands.Hold the bottle upside down.Tilt your head back.Hold the bottle in one hand and place it as close as possible to the eye.With the other hand, pull down your lower eyelid. This forms a pocket.Place the prescribed number of drops into the lower eyelid pocket. If you are using more than one eyedrop, be sure to wait at least 5 minutes before applying the second eyedrop.Close your eye OR press the lower lid lightly with your finger for at least 1 minute. Either of these steps keeps the drops in the eye and helps prevent the drops from draining into the tear duct, which can increase your risk of side effects.Histoplasmosis What is histoplasmosis?Histoplasmosis is a disease caused when airborne spores of the fungusHistoplasma capsulatumare inhaled into the lungs, the primary infection site. This microscopic fungus, which is found throughout the world in river valleys and soil where bird or bat droppings accumulate, is released into the air when soil is disturbed by plowing fields, sweeping chicken coops, or digging holes.Histoplasmosis is often so mild that it produces no apparent symptoms. Any symptoms that might occur are often similar to those from a common cold. In fact, if you had histoplasmosis symptoms, you might dismiss them as those from a cold or flu, since the body's immune system normally overcomes the infection in a few days without treatment.However, histoplasmosis, even mild cases, can later cause a serious eye disease called ocular histoplasmosis syndrome (OHS), a leading cause of vision loss in Americans ages 20 to 40.Cause and Risk FactorsHow does histoplasmosis cause ocular histoplasmosis syndrome?Scientists believe thatHistoplasma capsulatum(histo) spores spread from the lungs to the eye, lodging in thechoroid, a layer of blood vessels that provides blood and nutrients to the retina. The retina is the light-sensitive layer of tissue that lines the back of the eye. Scientists have not yet been able to detect any trace of the histo fungus in the eyes of patients with ocular histoplasmosis syndrome. Nevertheless, there is good reason to suspect the histo organism as the cause of OHS.How does OHS develop?OHS develops when fragile, abnormal blood vessels grow underneath the retina. These abnormal blood vessels form a lesion known as choroidal neovascularization (CNV). If left untreated, the CNV lesion can turn into scar tissue and replace the normal retinal tissue in themacula. The macula is the central part of the retina that provides the sharp, central vision that allows us to read a newspaper or drive a car. When this scar tissue forms, visual messages from the retina to the brain are affected, and vision loss results.Vision is also impaired when these abnormal blood vessels leak fluid and blood into the macula. If these abnormal blood vessels grow toward the center of the macula, they may affect a tiny depression called thefovea. The fovea is the region of the retina with the highest concentration of special retinal nerve cells, calledcones, that produce sharp, daytime vision. Damage to the fovea and the cones can severely impair, and even destroy, this straight-ahead vision. Early treatment of OHS is essential; if the abnormal blood vessels have affected the fovea, controlling the disease will be more difficult. Since OHS rarely affects side, or peripheral vision, the disease does not cause total blindness.Who is at risk for OHS?Although only a tiny fraction of the people infected with the histo fungus ever develops OHS, any person who has had histoplasmosis should be alert for any changes in vision similar to those described above. Studies have shown the OHS patients usually test positive for previous exposure to histoplasmosis.In the United States, the highest incidence of histoplasmosis occurs in a region often referred to as the "Histo Belt," where up to 90 percent of the adult population has been infected by histoplasmosis. This region includes all of Arkansas, Kentucky, Missouri, Tennessee, and West Virginia as well as large portions of Alabama, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Mississippi, Nebraska, Ohio, Oklahoma, Texas, and Virginia. Since most cases of histoplasmosis are undiagnosed, anyone who has ever lived in an area known to have a high rate of histoplasmosis should consider having their eyes examined for histo spots.Symptoms and DetectionWhat are the symptoms of OHS?OHS usually has no symptoms in its early stages; the initial OHS infection usually subsides without the need for treatment. This is true for other histo infections; in fact, often the only evidence that the inflammation ever occurred are tiny scars called "histo spots," which remain at the infection sites. Histo spots do not generally affect vision, but for reasons that are still not well understood, they can result in complications years--sometimes even decades--after the original eye infection. Histo spots have been associated with the growth of the abnormal blood vessels underneath the retina.In later stages, OHS symptoms may appear if the abnormal blood vessels cause changes in vision. For example, straight lines may appear crooked or wavy, or a blind spot may appear in the field of vision. Because these symptoms indicate that OHS has already progressed enough to affect vision, anyone who has been exposed to histoplasmosis and perceives even slight changes in vision should consult an eye care professional.How is OHS diagnosed?An eye care professional will usually diagnose OHS if a careful eye examination reveals two conditions: (1) The presence of histo spots, which indicate previous exposure to the histo fungus spores; and (2) Swelling of the retina, which signals the growth of new, abnormal blood vessels. To confirm the diagnosis, a dilated eye examination must be performed. This means that the pupils are enlarged temporarily with special drops, allowing the eye care professional to better examine the retina.If fluid, blood, or abnormal blood vessels are present, an eye care professional may want to perform a diagnostic procedure calledfluorescein angiography. In this procedure, a dye, injected into the patient's arm, travels to the blood vessels of the retina. The dye allows a better view of the CNV lesion, and photographs can document the location and extent to which it has spread. Particular attention is paid to how close the abnormal blood vessels are to the fovea.TreatmentHow is OHS treated?The only proven treatment for OHS is a form oflaser surgerycalledphotocoagulation. A small, powerful beam of light destroys the fragile, abnormal blood vessels, as well as a small amount of the overlying retinal tissue. Although the destruction of retinal tissue during the procedure can itself cause some loss of vision, this is done in the hope of protecting the fovea and preserving the finely-tuned vision it provides.How effective is laser surgery?Controlled clinical trials, sponsored by the National Eye Institute, have shown that photocoagulation can reduce future vision loss from OHS by more than half. The treatment is most effective when:The CNV has not grown into the center of the fovea, where it can affect vision.The eye care professional is able to identify and destroy the entire area of CNV.Does laser surgery restore lost vision?Laser photocoagulation usually does not restore lost vision. However, it does reduce the chance of further CNV growth and any resulting vision loss.Does laser surgery cure OHS?No. OHS cannot be cured. Once contracted, OHS remains a threat to a person's sight for their lifetime.People with OHS who experience one bout of abnormal blood vessel growth may have recurrent CNV. Each recurrence can damage vision and may require additional laser therapy. It is crucial to detect and treat OHS as early as possible before it causes significant visual impairment.Is there a simple way to check for signs of OHS damage to the macula?Yes. A person can check for signs of damage to the macula by looking at a printed pattern called an Amsler grid. If the macula has been damaged, the vertical and horizontal lines of the grid may appear curved, or a blank spot may seem to appear.Many eye care professionals advise patients who have received treatment for OHS, as well as those with histo spots, to check their vision daily with theAmsler gridone eye at a time. Patients with OHS in one eye are likely to develop it in the other.What help is available for people who have already lost significant vision from OHS?Scientists and engineers have developed many useful devices to help people with severe visual impairment in both eyes. These devices, calledlow vision aids, use special lenses or electronics to create enlarged visual images. An eye care professional can suggest sources that provide information on counseling, training, and special services for people with low vision. Many organizations for people who are blind also serve those with low vision.

Macular Pucker What is a macular pucker?A macular pucker is scar tissue that has formed on the eye's macula, located in the center of the eye's light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. A macular pucker can cause blurred and distorted central vision.Macular pucker is also known as epiretinal membrane, preretinal membrane, cellophane maculopathy, retina wrinkle, surface wrinkling retinopathy, premacular fibrosis, and internal limiting membrane disease.Frequently Asked Questions about Macular PuckerIs a macular pucker the same as age-related macular degeneration?No. A macular pucker and age-related macular degeneration are two separate and distinct conditions, although the symptoms for each are similar. An eye care professional will know the difference.Can macular pucker get worse?For most people, vision remains stable and does not get progressively worse. Usually macular pucker affects one eye, although it may affect the other eye later.Is a macular pucker similar to a macular hole?A macular pucker and a macular hole are different conditions, although they both result from the same reason: The pulling on the retina from a shrinking vitreous. When the "pulling" causes microscopic damage, the retina can heal itself; scar tissue, or a macular pucker, can be the result. If the shrinking vitreous pulls too hard, it can tear the retina, creating a macular hole, which is more serious. Both conditions have similar symptoms - distorted and blurred vision. Also, a macular pucker will not "develop" into a macular hole. An eye care professional will know the difference.CauseWhat causes a macular pucker?Most of the eye's interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. This is called a vitreous detachment, and is normal. In most cases, there are no adverse effects, except for a small increase in floaters, which are little "cobwebs" or specks that seem to float about in your field of vision.However, sometimes when the vitreous pulls away from the retina, there is microscopic damage to the retina's surface (Note: This is not a macular hole). When this happens, the retina begins a healing process to the damaged area and forms scar tissue, or an epiretinal membrane, on the surface of the retina. This scar tissue is firmly attached to the retina surface. When the scar tissue contracts, it causes the retina to wrinkle, or pucker, usually without any effect on central vision. However, if the scar tissue has formed over the macula, our sharp, central vision becomes blurred and distorted.SymptomsWhat are the symptoms of a macular pucker?Vision loss from a macular pucker can vary from no loss to severe loss, although severe vision loss is uncommon. People with a macular pucker may notice that their vision is blurry or mildly distorted, and straight lines can appear wavy. They may have difficulty in seeing fine detail and reading small print. There may be a gray area in the center of your vision, or perhaps even a blind spot.TreatmentHow is a macular pucker treated?A macular pucker usually requires no treatment. In many cases, the symptoms of vision distortion and blurriness are mild, and no treatment is necessary. People usually adjust to the mild visual distortion, since it does not affect activities of daily life, such as reading and driving. Neither eye drops, medications, nor nutritional supplements will improve vision distorted from macular pucker. Sometimes the scar tissue--which causes a macular pucker--separates from the retina, and the macular pucker clears up.Rarely, vision deteriorates to the point where it affects daily routine activities. However, when this happens, surgery may be recommended. This procedure is called a vitrectomy, in which the vitreous gel is removed to prevent it from pulling on the retina and replaced with a salt solution (Because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous). Also, the scar tissue which causes the wrinkling is removed. A vitrectomy is usually performed under local anesthesia.After the operation, you will need to wear an eye patch for a few days or weeks to protect the eye. You will also need to use medicated eye drops to protect against infection.How successful is this surgery?Surgery to repair a macular pucker is very delicate, and while vision improves in most cases, it does not usually return to normal. On average, about half of the vision lost from a macular pucker is restored; some people have significantly more vision restored, some less. In most cases, vision distortion is significantly reduced. Recovery of vision can take up to three months. Patients should talk with their eye care professional about whether treatment is appropriate.What are the risks of surgery?The most common complication of a vitrectomy is an increase in the rate of cataract development. Cataract surgery may be needed within a few years after the vitrectomy. Other, less common complications are retinal detachment either during or after surgery, and infection after surgery. Also, the macular pucker may grow back, but this is rare.

Floaters 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.Frequently Asked Questions about FloatersFloaters and Retinal DetachmentSometimes 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 blindness in the eye.Those 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.Causes and Risk FactorsWhat 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 DetectionFloaters 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.TreatmentHow are floaters treated?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.Vitreous Detachment What is vitreous detachment?Most of the eye's interior is filled with vitreous, a gel-like substance that helps the eye maintain a round shape. There are millions of fine fibers intertwined within the vitreous that are attached to the surface of the retina, the eye's light-sensitive tissue. As we age, the vitreous slowly shrinks, and these fine fibers pull on the retinal surface. Usually the fibers break, allowing the vitreous to separate and shrink from the retina. This is a vitreous detachment.In most cases, a vitreous detachment, also known as a posterior vitreous detachment, is not sight-threatening and requires no treatment.Risk FactorsWho is at risk for vitreous detachment?A vitreous detachment is a common condition that usually affects people over age 50, and is very common after age 80. People who are nearsighted are also at increased risk. Those who have a vitreous detachment in one eye are likely to have one in the other, although it may not happen until years later.Symptoms and DetectionWhat are the symptoms of vitreous detachment?As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina that you may notice asfloaters, which appear as little "cobwebs" or specks that seem to float about in your field of vision. If you try to look at these shadows they appear to quickly dart out of the way.One symptom of a vitreous detachment is a small but sudden increase in the number of new floaters. This increase in floaters may be accompanied by flashes of light (lightning streaks) in your peripheral, or side, vision. In most cases, either you will not notice a vitreous detachment, or you will find it merely annoying because of the increase in floaters.How is vitreous detachment detected?The only way to diagnose the cause of the problem is by a comprehensive dilated eye examination. If the vitreous detachment has led to a macular hole or detached retina, early treatment can help prevent loss of vision.TreatmentHow does vitreous detachment affect vision?Although a vitreous detachment does not threaten sight, once in a while some of the vitreous fibers pull so hard on the retina that they create amacular holeto or lead to aretinal detachment. Both of these conditions are sight-threatening and should be treated immediately.If left untreated, a macular hole or detached retina can lead to permanent vision loss in the affected eye. Those who experience a sudden increase in floaters or an increase in flashes of light in peripheral vision should have an eye care professional examine their eyes as soon as possible.

Retinal Detachment What is retinal detachment?The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages 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 detachmentcan 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.Frequently Asked Questions about Retinal DetachmentWhat are the different types of retinal detachment?There are three different types of retinal detachment:Rhegmatogenous[reg-ma-TAH-jenous] -- A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.Tractional-- In this type of detachment, scar tissue on the retina's surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.Exudative-- Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.Causes and Risk FactorsWho is at risk for retinal detachment?A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women, and Whites more than African Americans.A retinal detachment is also more likely to occur in people who:Are extremely nearsightedHave had a retinal detachment in the other eyeHave a family history of retinal detachmentHave had cataract surgeryHave other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degenerationHave had an eye injurySymptoms and DetectionWhat are the symptoms of retinal detachment?Symptoms include a sudden or gradual increase in either the number of floaters, which are little "cobwebs" or specks that float about in your field of vision, and/or light flashes in the eye. Another symptom is the appearance of a curtain over the field of vision.A retinal detachment is a medical emergency.Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.TreatmentHow is retinal detachment treated?Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to "weld" the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. Gas is often injected to into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye. With all of these procedures, either laser or cryopexy is used to "weld" the retina back in place.With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.

StrabismusStrabismus is a disorder in which the two eyes do not line up in the same direction, and therefore do not look at the same object at the same time. The condition is more commonly known as "crossed eyes."CausesSix different muscles surround the eyes and work "as a team" so that both eyes can focus on the same object.In someone with strabismus, these muscles do not work together. As a result, one eye looks at one object, while the other eye turns in a different direction and is focused on another object.When this occurs, two different images are sent to the brain -- one from each eye. This confuses the brain, and the brain may learn to ignore the image from the weaker eye.If the strabismus is not treated, the eye that the brain ignores will never see well. This loss of vision is called amblyopia. Another name for amblyopia is "lazy eye." Sometimes amblyopia is present first, and it causes strabismus.In most children with strabismus, the cause is unknown. In more than half of these cases, the problem is present at or shortly after birth (congenital strabismus).Most of the time, the problem has to do with muscle control, and not with muscle strength.Less often, problems with one of the nerves or muscles, orGraves' diseaserestriction may cause strabismus.Other disorders associated with strabismus include:Brain and nerve disorders, such as traumatic brain injury, stroke,cerebral palsy, orGuillain-Barre syndromeDiabetes (causes a condition known as acquired paralytic strabismus)Damage to the retinain children who are born prematureHemangiomanear the eye during infancyInjuries to the eyeTumor in the brain or eyeVision loss from any eye disease or injuryA family history of strabismus is a risk factor.Farsightednessmay be a contributing factor, especially in children. Any other disease that causes vision loss may also cause strabismus.SymptomsSymptoms of strabismus may be present all the time, or only when you are tired or sick.The eyes do not move together and may appear crossed at times.The other eye will appear turned out, up, or down from wherever the first eye is focused.Someone with strabismus may also have:Depth perception lossDouble visionVision lossExams and TestsAphysical examinationwill include a detailed examination of the eyes. Tests will be done to determine how much the eyes are out of alignment.Eye tests include:Corneal light reflexCover/uncover testRetinal examStandard ophthalmic examVisual acuityA brain and nervous system (neurological) examination will also be performed.TreatmentThe first step in treating strabismus is to prescribe glasses, if needed.Amblyopia or lazy eye must be treated first. A patch is placed over the better eye. This forces the weaker eye to work harder.Your child may not like wearing a patch or eyeglasses. A patch forces the child to see through the weaker eye at first. However, it is very important to use the patch or eyeglasses as directed.If the eyes still do not move correctly,eye muscle surgerymay be needed. Different muscles in the eye will be made stronger or weaker.Eye muscle repair surgery does not fix the poor vision of a lazy eye. A child may have to wear glasses after surgery. In general, the younger a child is when the surgery is done, the better the result.Adults with mild strabismus that comes and goes may do well with glasses and eye muscle exercises to help keep the eyes straight. More severe forms of adult strabismus will need surgery to straighten the eyes. If strabismus has occurred because of vision loss, the vision loss will need to be corrected before strabismus surgery can be successful.Outlook (Prognosis)After surgery, the eyes may look straight but vision problems can remain.The child may still have reading problems in school, and for adults driving may be more difficult. Vision may affect the ability to play sports.With early diagnosis and treatment, the problem can usually be corrected. Delayed treatment may lead to permanentvision lossin one eye. About one-third of children with strabismus will develop amblyopia.Because many children will get strabismus or amblyopia again, they need to be monitored closely.When to Contact a Medical ProfessionalStrabismus requires prompt medical evaluation. Call for an appointment with your health care provider or eye doctor if your child:Appears to be cross-eyedComplains of double visionHas difficulty seeingNote: Learning difficulties or problems at school can sometimes be due to a child's inability to see the blackboard or reading material.Alternative NamesCrossed eyes; Esotropia; Exotropia; Hypotropia; Hypertropia; Squint; Walleye; Misalignment of the eyes; Comitant strabismus; Noncomitant strabismus

Bottom of FormWhat Is Strabismus?

Strabismus is a visual problem in which the eyes are not aligned properly and point in different directions. One eye may look straight ahead, while the other eye turns inward, outward, upward, or downward. The eye turn may be consistent, or it may come and go. Which eye is straight (and which is misaligned) may switch or alternate.Strabismus is a common condition among children. About 4 percent of all children in the United States have strabismus. It can also occur later in life. It may run in families; however, many people with strabismus have no relatives with the problem.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.Accommodative esotropiais 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.Exotropia. Notice the outward-turning eye.

Exotropia, or an outward-turning eye, is another common type of strabismus. This occurs most often when a child is focusing on distant objects. The exotropia may occur only from time to time, particularly when a child is daydreaming, ill or tired. Parents often notice that the child squints one eye in bright sunlight.

Strabismus Causes

Six eye muscles, controlling eye movement, are attached to the outside of each eye. In each eye, one muscle moves in the eye to the right, and one muscle moves the eye to the left. The other four muscles move it up or down and at an angle.To line up and focus both eyes on a single target, all of the muscles in each eye must be balanced and working together. In order for the eyes to move together, the muscles in both eyes must be coordinated. The brain controls these muscles.With normal vision, both eyes aim at the same spot. 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 pictures 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.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 turned eye. A child generally does not see double.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.Strabismic amblyopiaGood 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.Strabismus Symptoms

The main sign of strabismus is an eye that is not straight. Sometimes children will squint one eye in bright sunlight or tilt their head to use their eyes together.PseudostrabismusThe eyes of infants often appear to be crossed, though actually they are not. This condition is called pseudostrabismus. Young children often have a wide, flat nose and a fold of skin at the inner eyelid that can make eyes appear crossed. This appearance of pseudostrabismus may improve as the child grows. A child will not outgrow true strabismus.An ophthalmologist can distinguish true strabismus and pseudostrabismusUnlike true strabismus, note here the symmetrical light reflection of pseudostrabismus.

.Strabismus Diagnosis

Strabismus can be diagnosed during an eye exam. It is recommended that all children between 3 and 3 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.Treatment for strabismus works to straighten the eyes and restore binocular (two-eyed) vision. In some cases of strabismus, eyeglasses can be prescribed for your child to straighten the eyes. Other treatments may involve surgery to correct the unbalanced eye muscles or to remove a cataract. Patching or blurring the strong eye to improve amblyopia is often necessary.Very young children with esotropia usually require surgery to realign the eyes.For accommodative esotropia, glasses reduce the focusing effort and often straighten the eyes. Sometimes bifocals are needed for close