Blepharitis is an extremely common inflammatory condition of the eyelid margins and plugging of the oil-producing eyelid glands. It most commonly causes chronic irritation, redness, burning, and tearing symptoms.
It can be related to chronic skin conditions such as rosacea or seborrheic dermatitis and may also be caused by overgrowth of common bacteria along the eyelid margins. It can also cause “styes” of the eyelid glands which can be acutely painful.
While often not visually threatening, long term treatment is frequently required to control the symptoms.
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Cataract
A cataract is an opacity of the lens of the eye. Clouding of the lens may develop from age-related change, drug-induced toxicity, ocular inflammation, trauma, diabetes, or hereditary factors. As the lens becomes increasingly cloudy patients may experience blurred vision, glare, difficulty with night driving, or an altered color perception.
Cataract is the most common cause of blindness worldwide affecting 20 million people. Cataract is treatable with cataract surgery.
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Chemical Injuries
Ocular exposure to alkali and acidic compounds can cause severe disruption of the normal ocular surface resulting in long term dysfunction of the normal conjunctival and corneal epithelium.
Often times complex reconstructive procedures are necessary to restore vision which may include the use of amniotic membrange grafting, limbal stem cell transplantation, or corneal transplantation.
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Conjunctivitis
Conjunctivitis is a non-specific term signifiying inflammation of the mucous membrane overlying the eye (conjunctiva). Conjunctivitis can occur from bacterial and viral infections, as well as allergic, toxic, immune, mechanical, neoplastic, and inflammatory causes. Typically, patients notice redness, discharge, and a foreign body sensation. Specific treatment depends on identifying the underlying cause.
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Dry Eye
Dry eye is a common condition that is often related to a decrease in the production of tears from the lacrimal glands. Severe forms can be associated with autoimmune processes such as Sjogrens disease, rheumatoid arthritis, or following herpes zoster (shingles) infections. Dry eye can be exacerbated by the use of some medicines, hormone levels, and other eye conditions such as blepharitis. Symptoms may include burning, irritation, foreign body sensation, paradoxical reflex tearing, eye redness, blurry vision, or eye fatigue. There are many treatment options available for chronic dry eye sufferers.
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FUCHS’ Corneal Dystrophy
A corneal dystrophy is a bilateral (both eyes) abnormality occasionally present at birth but more frequently appearing later in life. Any of the five layers of the cornea can be involved. Of the many known dystrophies, the one most commonly encountered in clinical practice is Fuchs' Corneal Dystrophy.
Fuchs’ is a hereditary disorder of the endothelial cells (inner layer of the cornea) that can cause corneal swelling later in life. Progressive swelling (edema) and thickening of the cornea may lead to blurred vision, painful erosions, and difficulty recovering from cataract surgery. Patients often notice blurred vision in the morning hours with gradual improvement in the vision as the day progresses.
Corneal transplantation is occasionally necessary in advanced cases of Fuchs’ dystrophy to improve vision and maintain comfort. The newer technique of DSEK (Descemet’s stripping endothelial keratoplasty) in which only the inner endothelial cell layer of the cornea is replaced by transplantation (leaving the other 95% of the cornea intact) may be applicable and may lead to quicker visual recovery following corneal transplantation.
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Herpetic Eye Disease
The herpes simplex virus (HSV) is a common virus that causes ocular problems in over half a million people in the United States. It also frequently causes facial “cold sores”. Corneal involvement with HSV may lead to blurry vision, light sensitivity, and discomfort by causing keratitis (inflammation of the cornea). The virus can remain dormant within ocular nerves for many years and reactivate during periods of stress, ultraviolet light exposure, or times of sickness. Frequent reactivation of the herpes virus can eventually cause progressive corneal scarring. The goal of treatment is to limit the frequency and duration of keratitis episodes. Treatment includes the use of antiviral medications and/or steroid medications to limit inflammation. Rarely, corneal transplantation is necessary when corneal involvement is severe.
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Iritis
is a form of anterior Uveitis and refers to the inflammation of the iris of the eye. There are two main types of Iritis: acute and chronic. Acute Iritis is a type of Iritis that can heal independently within a few weeks. If treatment is provided, Acute Iritis can improve quickly. Chronic Iritis can exist for months or years before recovery occurs. Chronic Iritis does not respond to treatment as well as Acute Iritis, and is also accompanied by a higher risk of serious visual impairment.
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Keratitis
Keratitis is a condition in which the cornea, the clear watch crystal part of the eye, becomes inflamed. The condition has many different causes and can be associated with minimal symptoms or intense pain.
Superficial Keratitis involves the outer layer of the cornea. This form of keratitis does not result in any permanent visual difficulties.
Deep Keratitis involving the deeper layers of the cornea may leave a scar upon healing that impairs vision if the Keratitis involves the cornea on or near the visual axis.
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Keratoconus
Keratoconus is a disorder which causes a thinning of the cornea. As the disease progresses the curvature of the cornea becomes distorted by abnormal thinning and forward bulging of the central portion of the cornea (this is known as ectasia). This condition is usually bilateral although one eye is often worse than the other. Onset is usually at the time of puberty. Keratoconus typically progresses slowly over many years, although it may become stationary at any time. The main symptom is blurred and distorted vision, often not correctable by glasses alone. Fortunately, most patients can obtain clear vision with contact lenses.
For those that are unable to wear contact lenses or obtain good vision with contact lenses, surgery is often necessary to rehabilitate the vision. Corneal transplant surgery is often necessary in advanced cases. For intermediate cases, Intacs prescription inserts are an exciting new intermediate option between contacts and a corneal transplant that may improve vision and improve tolerance of glasses or contact lenses by reshaping the cornea. Refractive surgery such as LASIK is not helpful and can potentially worsen this condition.
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Pterygium
A pterygium is a wing-shaped fibrovascular connective tissue that grows from conjunctiva (a clear membrane that covers the white of the eye and the inner eyelids) over the cornea. It is typically associated with exposure to ultraviolet light and wind and is frequently found in individuals who spend significant time outdoors or who grew up in sunny or low latitude areas.
Growth of the pterygium can cause ongoing irritation and can often affect the vision by causing astigmatism. If the vision is affected or symptoms are significant, the tissue can be surgically removed.
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Recurrent Corneal Erosions
Recurrent corneal erosions refer to recurrent painful scratches on the surface of the eye, often when patients awake in the morning. Recurrent erosions are typically related to dysfunction of the surface layer of the cornea (epithelium) with faulty attachment of the surface cells to the deeper layers of the cornea. This can be related to prior trauma or to an underlying Anterior Basement Membrane Dystrophy which is typically inherited and bilateral. Recurrent erosions are associated with frequent episodes of pain, poor healing of minor injuries, and may cause blurred vision from an irregular corneal surface.
There are several medical and surgical treatment options available which range from the use of eye drops, to superficial keratectomy, to laser resurfacing of the eye with the excimer laser.
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Uveitis
Uveitis specifically refers to inflammation of the middle layers of the eye termed the “Uvea”. Iritis is the most common form of Uveitis. This process primarily involves the Iris.
Anywhere from two-thirds to 90% of uveitis cases are anterior in location (anterior uveitis), frequently termed iritis – or inflammation of the iris demonstrated by inflammation in the anterior chamber. This condition can occur as a single episode and subside with proper treatment or may take on a recurrent or chronic nature. Symptoms include a red eye, aching pain, decreased vision, and light sensitivity.
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