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Common Eye Problems
A variety of problems could indicate the need for an outpatient screening at our center. Read more about each
of these common eye problems.
Macular Degeneration
Macular degeneration, or age-related macular degeneration (AMD), is a leading cause of vision loss in Americans 60
and older. It destroys a person's sharp, central vision, which is needed to see objects clearly and to do things like reading
and driving.
There are two kinds of AMD: dry or wet. For dry AMD, the most common early sign is blurred vision. As fewer cells
in the macula are able to function, people will see details, like words in a book, less clearly in front of them. Often this
blurred vision will go away in brighter light. People may also see a small but growing blind spot in their field of vision.
For wet AMD, the classic early symptom is that straight lines appear crooked. This results when fluid from the leaking
blood vessels gathers and lifts the macula, distorting vision. A small blind spot may also appear in wet AMD, resulting
in the loss of one's central vision.
There is currently no cure for AMD, just treatment options that stop the progress of the condition. For wet AMD,
treatment options include thermal laser, phytodynamic therapy and anti-VEFG drugs. Very few treatments exist
to treat dry AMD.
The cause of AMD is not known, however, several factors appear to increase a person's risk. There are several risk
factors that people can't control, such as age, having light-colored eyes and a family history of the disease. However,
there are several risk factors people can control: not smoking, reducing exposure to sunlight by wearing UVA/UVB
protective eyewear and wide-brimmed hats and eating a healthy diet.
Currently, there are no treatment options available that restore lost vision, and for most AMD patients, there are not
even treatments that prevent further vision loss. Rehabilitation is simply learning to live with restricted vision.
Droopy Eyelids (Ocular Plastics)
There are many reasons someone would need to have ocular plastic procedures done, including a condition called ptosis,
or droopy eyelid. Blepharoplasty, or revision of the upper or lower eyelid, is a common procedure performed to treat
this condition. The surgery may also be performed to treat a medical condition called ptosis, or drooping eyelid, which
is caused by poor muscle tone or nerve damage. Ptosis causes the eyelids to hang very low and block vision.
Drooping eyelid is caused by weakness of the muscle responsible for raising the eyelid, damage to the nerves that control
those muscles or looseness of the skin of the upper eyelids. Symptoms include increased tearing, drooping of one or both
eyelids and, in severe cases, an interference in vision.
Blepharoplasty, or revision of the upper or lower eyelid, is a common procedure performed to treat droopy eyelid.
Most cases of droopy eyelid are associated with aging, so there is really no prevention available. After a revision of the
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upper or lower eyelid, the doctor will cover the patient's eyes and eyelids with ointment and a bandage. The eyelids may
feel tight and sore as the numbing medicine wears off but is easily controlled with pain medication. Patients will need
to keep their head raised up as much as possible for several days, with cold packs placed over the area to reduce swelling
and bruising. Eye drops will reduce burning or itching. Vision should be fine after a couple of days, but patients should
not wear contact lenses for at least two weeks. Activities should be kept to a minimum for three to five days, and
strenuous activities may resume after three weeks.
Conjunctivitis
Conjuctivitis, or pink eye, is an inflammation or infection of the transparent membrane (conjunctiva) that lines the
eyelid and part of the eyeball. Inflammation causes small blood vessels in the conjunctiva to become more prominent,
which is what causes the pink or red cast to the whites of the eyes. Conjunctivitis can spread from one person to another
and affects millions of Americans at any given time.
The most common conjunctivitis symptoms are redness and itchiness in one or both eyes, a gritty feeling in the eyes,
tearing and a discharge that forms a crust during sleep.
Conjunctivitis usually does not affect vision and, typically, doesn't require extensive or emergency treatment. But because
pink eye can be highly contagious for as long as two weeks after signs and symptoms begin, it is important to seek
diagnosis and treatment early. If the infection is bacterial, the doctor may prescribe antibiotic eye drops or ointment, and
it should clear up in several days. Viral conjunctivitis must run its course since it does not respond to drops or ointment
and may take up to three weeks before it goes away. Although pink eye often gets better without treatment, it can be
accompanied by an inflammation of the cornea, which can affect vision. Extreme cases may require a corneal transplant.
Practicing good hygiene is the best way to control pink eye once it has been diagnosed. Wash hands often, avoid
touching the eye, change towels and washcloths daily, change pillowcases often and discard all used/dated eye cosmetics.
Never use someone else's eye cosmetics, and follow the doctor's instructions on proper contact lens care.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects the
new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery may take
up to a year.
Ocular Herpes
Ocular herpes is a recurrent viral infection caused by the herpes simplex virus. In fact, it is the most common infectious
cause of corneal blindness in the country. Studies show that once patients develop ocular herpes, they have up to a 50
percent chance of having a recurrence. This second flare-up could come weeks or even years after the initial occurrence.
Ocular herpes can produce a painful sore on the eyelid or eye surface, causing inflammation of the cornea. Other
symptoms include swelling, tearing, irritation, recurrent infections, discharge, redness, soreness and light sensitivity.
Prompt treatment with anti-viral drugs helps to stop the herpes virus from multiplying. However, the infection may
spread deeper into the cornea and develop into a more severe infection called stromal keratitis, which causes the body's
immune system to attack and destroy stromal, or connective tissue, cells. Stromal keratitis is more difficult to treat than
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less severe ocular herpes infections. Recurrent episodes of stromal keratitis can cause scarring of the cornea, which can
lead to loss of vision and possibly blindness. In this case, a corneal transplant may be required.
Ocular herpes is transmitted through contact with someone who is having an outbreak, such as a cold sore. Once the
initial outbreak occurs, ocular herpes has about a 50 percent chance of recurring. Outbreaks are caused by stress-related
factors such as fever, sunburn, major dental or surgical procedures, and trauma.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects the
new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery may take
up to a year.
Corneal Infections
A corneal infection occurs when the cornea is damaged by a foreign object, or from bacteria or fungi from a contaminated contact lens. This can cause painful inflammation and can lead to corneal scarring.
The deeper the infection, the more severe the symptoms will be. A corneal infection can reduce visual clarity, produce a
discharge, erode the cornea and cause scarring that can impair vision.
Minor infections are usually treated with anti-bacterial drops. More severe infections need stronger antibiotics or
anti-fungal treatment to clear up infections, as well as steroid drops for inflammation. If cornea scarring occurs, it can
lead to loss of vision and, possibly, blindness. In this case, a corneal transplant may be required.
Corneal infection is a complication for many contact lens wearers, so proper maintenance of contacts is necessary to
help prevent infection. People should also take proper care to avoid eye injury, such as wearing protective eyewear during
activities that could throw particles or other foreign bodies into the eye accidentally.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects the
new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery may take
up to a year.
Dry Eye
Dry eye is caused by a lack of tears, which are necessary for the normal lubrication of eyes and to wash away particles
and foreign bodies. Some people just don't produce enough tears for healthy eyes, resulting in dry eye.
Symptoms of dry eye include burning, stinging, scratchiness, excessive irritation from the elements, discomfort from
contacts and watering eyes. If the tears responsible for maintaining lubrication do not keep the eye moistenough, the eye
becomes irritated. Eye irritation prompts the gland that makes tears to release a large volume of tears, overwhelming the
tear drainage system.
There are a few ways to treat dry eye. Artificial tears, or eye drops, help lubricate and are available without prescription.
Also, patients may choose to have the small channel in their nose closed to conserve tears and prevent them from
draining off. If dry eye is caused by an underlying disease, a corneal transplant may be required.
55 St. George Road • Springfield, MA 01104 • Phone: (413) 736-7463
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Patients can prevent their tears from evaporating by using a humidifier and avoiding overly dry, warm rooms, hair dryers,
smoke and wind.
There is no rehabilitation from dry eye. Patients learn to live with the condition and find the right treatment options
for them. If dry eye is caused by an underlying disease, a corneal transplant may be required. If so, the patient must wear
an eye patch for a certain period of time, which protects the new cornea from injury. Eye drops are required to prevent
rejection of the transplant, and full vision recovery may take up to a year.
Fuch's Dystrophy
Fuch's Dystrophy is a degenerative, slowly progressing disease that usually affects both eyes. It happens when the
endothelial cells, which are essential in keeping the cornea clear, gradually deteriorate for no reason. The endothelium,
the thin innermost layer of the cornea, becomes less efficient at pumping out water, and this causes the cornea to swell
and vision to distort. Vision can become extremely impaired.
Initially a patient will wake up with blurry vision that clears up gradually throughout the day. As the disease progresses,
small blisters may form in the endothelium. The blisters get bigger and may eventually break, which is very painful.
Fuch's Dystrophy can also cause the shape of the cornea to change, causing further vision problems. Symptoms include
eye pain, sensitivity, blurred vision and seeing halos around lights.
Doctors will initially try to treat the disease with drops, ointments or soft contact lenses that create flaps over the sores
to help reduce pain. Sometimes doctors will instruct a patient to dry out the eyes two to three times a day with a blow
dryer held at arm's length. Once the disease interferes with a person's daily activities, a corneal transplant is recommended, which is the only cure.
Fuch's Dystrophy is usually an inherited condition that rarely affects people before their 50s. There are no known
preventive measures.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects the
new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery may take
up to a year.
Shingles
Shingles is a disease caused by the same virus that causes chickenpox. Once a patient has chickenpox, the virus stays
in the body, and, as some people age, it may reappear as shingles. Shingles is not contagious - you can't “catch it.”
In about 40 percent of people with shingles, the cornea will be affected.
Early signs of shingles include burning or shooting pain and tingling or itching, usually on one side of the body or face.
The pain can be mild to severe. Blisters soon form and last from one to 14 days. If shingles appear on the face, it can
affect vision or hearing. The pain of shingles may last for weeks, months or even years after the blisters have healed.
There is no cure for shingles, but early treatment with medicines that fight the virus may help. In some cases a corneal
transplant may be required.
55 St. George Road • Springfield, MA 01104 • Phone: (413) 736-7463
www.surgerycenterofnewengland.com
Iridcorneal Endothelial Syndrome
Iridocorneal Endothelial Syndrome (ICE) is a grouping of three closely linked conditions: Iris Nevus (or Cogan-Reese
Syndrome), Chandler's Syndrome and Essential Progressive Iris Syndrome. There are three main features of ICE:
visible changes of the iris, swelling of the cornea, and the development of glaucoma, which can cause severe vision loss.
ICE causes corneal swelling, distortion of the iris and variable degrees of distortion of the pupil, the adjustable
opening at the center of the iris that allows varying amounts of light to enter the eye. This cell movement also plugs
the fluid outflow channels of the eye, causing glaucoma.
While it is not yet known how to keep ICE syndrome from progressing, the glaucoma associated with the disease
can be treated with medication, and a corneal transplant can treat the corneal swelling.
The cause and prevention of this disease is unknown.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects
the new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery
may take up to a year.
Keratoconus
Keratoconus is a progressive thinning of the cornea and is the most common cornea dystrophy in the United States,
according to the National Eye Institute. In fact, it affects one in every 200 Americans. It happens when the middle
of the cornea thins and bulges outward, gradually forming a rounded cone shape. This changes the cornea's refractive
power producing astigmatism, or distortion, and nearsightedness, or blurriness.
The earliest symptom is a subtle blurring of vision that is not correctable with glasses and it usually affects both eyes.
As the astigmatism worsens, patients must rely on specially fitted contact lenses to reduce the distortion and provide
better vision. It is crucial for the lens to fit because a poorly fitting lens could further damage the cornea and make
wearing a contact lens intolerable
In most cases, the cornea will stabilize after a few years without ever causing severe vision problems. But in about 10
to 20 percent of people with keratoconus, the cornea will eventually become too scarred or will not tolerate a contact
lens. If either of these problems occur, a corneal transplant may be needed.
The cause of keratoconus is unknown, so there are no preventive measures.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects
the new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery
may take up to a year.
55 St. George Road • Springfield, MA 01104 • Phone: (413) 736-7463
www.surgerycenterofnewengland.com
Lattice Dystrophy
Lattice dystrophy gets its name from an accumulation of abnormal protein fibers throughout the middle and anterior
stroma, which makes up 90 percent of the cornea's thickness. A doctor will see these deposits in the stroma as clear,
comma-shaped overlapping dots and branching filaments, creating a lattice effect. Over time, the lattice lines will grow
opaque and involve more of the stroma. Gradually they will cause the cornea to cloud and reduce vision.
Lattice Dystrophy alters the cornea's normal curvature, causing temporary vision problems. It also exposes the nerves
that line the cornea, causing severe pain, even when blinking.
To ease the pain of blinking, a doctor may prescribe eye drops and ointments to reduce the friction on the eroded
cornea. In some cases, an eye patch may be used to immobilize the eyelids. With effective care, these erosions usually
heal within three days, although occasional sensations of pain may occur for the next six to eight weeks. Some people
with Lattice Dystrophy will have scarring, resulting in a haze on the cornea that can greatly obscure vision. In this case,
a corneal transplant may be needed.
There are no preventive measures for Lattice Dystrophy.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects the
new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery may take
up to a year.
Map-Dot-Fingerprint Dystrophy
This dystrophy occurs when the cornea's outermost layer's basement membrane develops abnormally, which serves
as the foundation on which the epithelial cells, which absorb nutrients from tears, anchor and organize themselves.
This causes recurrent epithelial erosions, in which the cornea's outermost layer rises slightly, exposing a small gap
between the outermost layer and the rest of the cornea.
The chronic epithelial erosions can alter the cornea's curvature, causing periodic blurred vision. It can also expose the
nerve endings that line the tissue, resulting in moderate to severe pain lasting as long as several days. Generally, the pain
will be worse on awakening in the morning. Other symptoms include sensitivity to light, excessive tearing and foreign
body sensation in the eye.
Typically, patients will experience a flare up for a few years, and then it will go away on its own, with no lasting loss
of vision. Most people never know they have Map-Dot-Fingerprint dystrophy, since they do not have any pain or vision
loss. If treatment is needed, doctors will try to control the pain associated with the erosions. They may patch the eye to
immobilize it, or prescribe lubricating eye drops and ointments. With treatment, these erosions usually heal within days,
although periodic flashes of pain may occur for several weeks thereafter. Sometimes a corneal transplant is needed.
There are no known preventive measures for Map-Dot-Fingerprint Dystrophy.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects the
new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery may take
up to a year.
55 St. George Road • Springfield, MA 01104 • Phone: (413) 736-7463
www.surgerycenterofnewengland.com
Pterygium
A pterygium is a non-cancerous growth of the clear, thin tissue over the white part of the eye. Some grow slowly
throughout a person's life, while others stop growing after a certain point.
The primary symptom of a pterygium is a painless area of elevated white tissue, with blood vessels on the inner or outer
edge of the cornea. Other symptoms include redness or inflammation, blurred vision, dryness, irritation, burning or
having a gritty feeling.
In many cases, no treatment is needed. When a pterygium becomes red and irritated, eye drops or ointments may be
used to help reduce inflammation. If the growths become large enough to threaten sight or cause persistent discomfort,
a corneal transplant may be needed.
The cause is unclear, but it is more common in people with excess exposure outdoors to sunlight and wind. People with
exposure to sunny, dusty, sandy or windblown areas are at higher risk. Farmers, fishermen and people living near the
equator are often affected. People should wear protective glasses and a hat with a brim to prevent the condition from
returning after it is removed.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects the
new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery may take
up to a year.
Stevens-Johnson Syndrome
Stevens-Johnson Syndrome (SJS) is a rare, serious disorder of the skin and mucous membranes. SJS can cause
serious eye problems, such as severe conjunctivitis; iritis, an inflammation inside the eye; corneal blisters and erosions;
and corneal holes. In some cases it can lead to severe vision loss.
Often, SJS begins with several days of flu-like symptoms, followed by inflammation of the mucous membranes
and painful, blistery lesions on the skin and the mucous membranes of the mouth, throat, genital region and eyelids.
Treatment for the eye may include artificial tears, antibiotics or corticosteroids. In some cases, the ocular complications
from SJS can be disabling and lead to severe vision loss, and a corneal transplant may be needed.
It is not certain why SJS develops, so it is difficult to prevent an attack. It could be an adverse allergic drug reaction,
which may not occur until seven to14 days after first using the drug. SJS can also be preceded by a viral infection,
such as herpes or the mumps, and their accompanying fever, sore throat and sluggishness.
If a corneal transplant is required, the patient must wear an eye patch for a certain period of time, which protects
the new cornea from injury. Eye drops are required to prevent rejection of the transplant, and full vision recovery
may take up to a year.
55 St. George Road • Springfield, MA 01104 • Phone: (413) 736-7463
www.surgerycenterofnewengland.com