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AIDS and the Eye

Acquired Immunodeficiency Syndrome (AIDS), is caused by the human immunodeficiency virus (HIV), a retrovirus that infects human cells, debilitating the body's immune defense mechanisms.

Once HIV has entered the cells, it may remain dormant for many years. At any given time, the virus can become active, causing AIDS, or AIDS-related illnesses. AIDS is not considered contagious. It is passed through contact with infected blood, or semen, thus making homosexuals, bisexual men, intravenous drug users, hemophiliacs, and prostitutes, likely candidates for the acquisition and transmission of the disease.

The majority of AIDS patients develop eye problems, associated with the disease. The light-sensitive retina is most commonly affected. Retinal hemorrhages and cotton-wool spots are often detected during routine eye exams. A cotton-wool spot is a circulatory disturbance in an area of the retina that can cause small blood spots, or hemorrhages.

Cytomegalovirus (CMV) is a type of virus that infects people with damaged immune systems, as is the case with AIDS patients. This virus kills retinal cells, and can lead to blindness. Herpes virus, the fungus candida, and the parasite toxoplasma, are other retinal infections that are often found in AIDS patients. Kaposi's sarcoma, a rare form of cancer found in AIDS patients, affects the eyelids and conjunctiva. Retinal cotton-wool spots, or hemorrhage do not often affect vision, and require no treatment. Experimental drugs are being used for CMV, and radiation treatments are available to slow the progression of Kaposi's sarcoma.


Albinism

This inherited condition, results from the inability of pigment cells in the hair, eyes, or skin to produce normal amounts of pigment. Albinos are people with a total lack of pigment, having white skin and hair, and pink colored eyes. Others may only have pink colored eyes, with normal skin and hair. This is known as Ocular Albinism.

In the most severe cases of albinism, the macula, our eye's central vision area, does not develop correctly, resulting in poor vision.

Symptoms of albinism start at childhood, and may include poor vision, eye misalignment, light sensitivity, and involuntary eye jitters. Because albinism is a genetic condition, inherited from parents, treatment is limited. Eyeglasses can be used to improve vision. Surgery or optical measures can be used to treat eye misalignment.


Amblyopia

Also known as "lazy eye", amblyopia describes the uncorrectable vision loss in an eye that appears to be normal.

Causes of amblyopia include uncorrected nearsightedness, farsightedness, or astigmatism, congenital cataracts, drooping eyelids, strabismus, or a cloudy cornea. Some patients experience partial vision loss, while others see only motion in the affected eye. Depth perception is affected in all cases, because the patient no longer has stereo-vision, or the ability to blend images from each eye together.

Symptoms of amblyopia include poor vision in one or both eyes, the need to squint, or close one eye while reading, and a crossed or turned eye. Patients with amblyopia tend to turn or tilt their heads when focusing on objects.

Nearly one half of the children who have strabismus have amblyopia in the weaker of the two eyes. The brain recognizes the image of the better eye, and ignores the image of the weaker eye. Early detection of amblyopia is essential for good treatment results. With children this can be difficult, as they generally adapt to most vision impairments.

Treatment depends on the underlying problem associated with the amblyopia. Often the good eye is patched to strengthen the vision of the weaker eye. In some cases, glasses may be used to correct the vision. If the condition is associated with drooping eyelid or cataracts, surgery may be necessary. It is especially important that amblyopia in children be detected and treated early, before the child's brain learns to permanently ignore the affected eye.


Astigmatism

The normal cornea is curved equally in all directions. With astigmatism, the cornea is irregularly shaped, like the back of a spoon. Light rays have numerous focal points and focus on different areas of the retina, instead of one point.


Basal Cell Carcinoma

Basal cell carcinoma is the most common type of skin cancer in the US. Fair-skinned people, over the age of 50 are most commonly affected. It is usually found on the face and neck, and often near the nose or eyes. Large amounts of exposure to the sun's ultraviolet rays significantly increases you risk.
 

Symptoms of basal cell carcinoma include small raised growths on the eyelid, or near the eye. The tumor edges may appear "pearly". They do not cause discomfort, but will grow and invade surrounding tissue.

These tumors are diagnosed by microscopic examination of their cells. They are treated by using radiation, or surgical removal procedures. Successful treatment requires early detection.

You will greatly reduce your risk of basal cell carcinoma by avoiding overexposure to sunlight. This is particularly true for fair-skinned people. When you must be in the sunlight for extended periods of time, consider wearing sunglasses, protective clothing, sun screen, and a hat.


Blepharitis

Blepharitis is the inflammation of the eyelids, which commonly occurs in people with dry eyes, dandruff or oily skin.With this condition, bacteria thrive in the skin at the base of the eyelashes, near the edge of the lower and upper eyelids. The resulting irritation leads to dandruff-like particles forming along the eyelashes.

Symptoms of blepharitis include eye irritation, itching, scales and debris along the eyelashes, and occasionally, a red eye.

Treatments include antibiotics and steroids. Although there is no specific cure, this condition can be managed through good hygiene, and medications.


Cataract
A cataract is a cloudy area of the normally clear lens. This cloudy area lets less light pass through the lens, to the retina. The results include blurred vision, glaring, distortion of objects, dull colors, double vision, and the need for more light for normal reading.

Cataract development is a normal part of aging that can occur as early as the mid-forties. More than 50 percent of people over the age of 60 will experience cataracts.

The lens, located behind the iris and pupil, contains three parts. The capsule is the outer protective membrane, surrounding the cortex, which itself surrounds the nucleus. Cataracts can affect any of these areas.

Cataract development is a normal part of aging that can occur as early as the mid-forties. More than 50 percent of people over the age of 60 will experience cataracts.

The lens, located behind the iris and pupil, contains three parts. The capsule is the outer protective membrane, surrounding the cortex, which itself surrounds the nucleus. Cataracts can affect any of these areas.

Cortical Cataract. This type of cataract develops slow, forming wedges in the cortex that extend towards the center of the lens, progressively impairing light transmission through the eye. The result is glaring, and loss of near and distance vision.

Nuclear Cataract. This type of cataracts occurs in the nucleus of the lens. Vision becomes blurred and dim. The patient can expect glaring, distorted vision, and temporary nearsightedness.

Cataracts are treated by surgical removal of the clouded natural lens. Once the lens is removed, an artificial lens is inserted in its place. The procedure involves making a very small incision, fragmenting the cataract into microscopic particles with high-energy sound waves, and then removing them. At the conclusion of this procedure, known as phacoemulsification, an intraocular lens is implanted. The vast majority of cataract patients experience significant improvement in vision.


Chalazion

A chalazion is a swelling in the upper or lower eyelid, caused by the inflammation of a small oil-producing gland. They are often confused with styes, which also produce a swelling on the eyelid.

Chalazions normally occur further from the eyelid than styes, tending to point towards the inside of the eyelid. They can occasionally cause the entire eyelid to swell.

Symptoms include a lump on the eyelid, and as the chalazion grows in size, blurring of vision in the associated eye. Treatment includes antibiotics, and/or steroids, warm compresses, expression of the secretion, and surgical incisions, or excisions.


Conjunctivitis

Conjunctivitis is a condition involving the inflammation of the conjunctiva. The conjunctiva is a thin membrane that covers the sclera, or white of the eye, producing mucus to lubricate the eye. When it becomes irritated, the very fine blood vessels within it become enlarged and the eye turns red.

Irritation can result from allergies, infections, bacteria, and viruses. Bacteria such as streptococcus, can cause a red eye, with large amounts of pus, requiring immediate attention. Some viruses produce red eyes, sore throat, and other symptoms associated with the common cold. Viral conjunctivitis produces a watery discharge, and may last as long as two weeks.

Infectious conjunctivitis is very contagious, and easily transmitted by physical contact. Because there are several eye diseases that result in red eyes, and can lead to blindness, it is important to have an ophthalmologist evaluate your condition.


Corneal Abrasion

The cornea is the transparent "window" of the eye, focusing light rays through the pupil, and onto the lens. The outermost layer is called the corneal epithelium.

A corneal abrasion refers to a scratch or injury of the corneal epithelium, generally caused by contact lenses, vigorous eye rubbing, tree limbs, fingernails, or other foreign objects in contact with the eye's surface.

Corneal abrasions are treated by patching the eye to allow the epithelium to heal. Antibiotics may be prescribed to prevent infection. Anesthetic drops can reduce pain and facilitate examination, but often keep the eye from healing properly after prolonged use. In most cases, corneal abrasions will heal completely, usually within a week. However, a bacterial infection or corneal ulcer can lead to serious complications, including vision loss.


Cystoid Macular Edema

Cystoid macular edema (CME) is a condition that causes retinal swelling, also known as edema. Multiple cyst-like formations appear in the area of the retina responsible for central vision. The causes of CME are not yet known, however it may accompany a number of diseases such as diabetes, retina vein occlusion, or uveitis. A small amount of people who have had cataract surgery will experience decreased vision due to CME. In most cases, they will eventually recover from the vision loss.

Symptoms of CME include decreased central or "straight-ahead" vision. This disorder is painless, and may exist even without vision loss. In this case, it may only be detected by your ophthalmologist.

Because different factors can lead to CME, your ophthalmologist may attempt several methods of treatment. Retinal swelling and inflammation are often treated with diuretics and anti-inflammatory medications. If the clear vitreous fluid in the eye is considered the problem, laser surgery may be recommended. If the vitreous is blood-filled, a procedure called a vitrectomy may be used to suction the fluid and replace it with clear solution.

On occasion, the swelling and inflammation associated with CME leads to glaucoma, a condition that often occurs due to increased pressure in the eye. The glaucoma must be treated with appropriate medications.


Cytomegalovirus (CMV)

Cytomegalovirus, or CMV, is a virus related to herpes and is present in most people. The body's immune system is usually able to fight this virus. However, in cases where the immune system is suppressed, such as patients with HIV, transplant recipients, and chemotherapy patients, CMV actively affects the body.

CMV causes retinitis in nearly 40% of the people with AIDS. CMV retinitis may affect one eye first, but generally progresses to both eyes, and progresses as the immune system weakens. Patients with CMV retinitis are at risk of retinal detachment, hemorrhages, retinal inflammation.

Patients with suppressed immune systems should look for floaters, blind spots, blurred and obstructed vision, and light flashes.

This virus is sight threatening and usually requires the care of a vitreo-retinal surgeon, who can diagnose this condition by examining retina and retinal circulation. In the photo below, CMV retinitis is easily distinguishable with its "pizza pie" appearance of intraretinal hemorrhages.

Anti-viral medications are used to manage CMV retinitis and slow its progression. Additionally, the doctor may need to treat other related eye conditions.


Dry Eye

The outer layer of the eye contains a tear film that lubricates the eye. With age, the tear film diminishes, leaving the eye more exposed to drying. This drying is not due to a lack of tear production. In fact, the eye often produces more tears, trying to replace the tear film.

Symptoms of dry eye include burning, itching, tearing, or light sensitivity. Wind, dust, dry weather, extreme temperatures, smoke, and fumes aggravate dry eye symptoms. Activities where natural blinking is reduced, such as reading, or computer work, aggravate this condition.

Because this condition cannot be cured, treatment is an ongoing process. In most cases artificial tears and ointments provide temporary relief. Avoiding conditions that aggravate dry eye also greatly reduces the discomfort associated with this condition.


Entropion

Entropion is a condition where the eyelid turns inward. This condition most commonly affects the lower lid. It is usually caused by muscle spasms, but may also be caused by scarring from trauma, or inflammation associated with other diseases involving the eyelid. Because the eyelid turns inward, the eyelashes rub against the eye, causing irritation.

Symptoms include tearing, irritation, burning, a "gritty" feeling, and redness in the eye.

Entropion can be detected during your routine eye exam. Artificial tears may be used to relieve the irritation. In most cases surgery is necessary.


Eyelid Spasms

The three common types of eyelid spasms are the twitch, hemifacial spasm, and essential blepharospasm. Minor spasms of upper, lower, or both eyelids is common. They require no treatment, and generally resolve spontaneously. In most cases, using warm soaks, reducing stress and fatigue, or correction of any refractive error can help.

Essential blepharospasm is an involuntary closing of the eyelid caused by abnormal nerve impulses. These muscle spasms usually involve both eyes, and can affect the eyebrows and mouth muscles as well. Essential blepharospasm results in a temporary inability to see. Treatments for essential blepharospasm include medications, injection of botulinum, and surgery. Medications are usually only effective in the mildest cases. Botulinum injections are the most common and successful treatment. In the cases of surgery, the surgeon removes either the nerve or muscle causing the spasm.

Hemifacial spasm is a condition caused by an artery pressing on the nerves of facial muscles. This condition involves the eyelid muscles, and usually the muscles around the mouth, on only one side of the face. Treatments include botulinum injections, and neurosurgical procedures.


Floater & Flashers

The retina is a multi-layered tissue of nerve cells that lines the back of the eye. These nerve cells sense light and create impulses that are sent to the brain via the optic nerve. The large central cavity of the eye contains a jelly-like fluid called vitreous humor. This fluid is composed primarily of water, but also contains some fibrous elements.

During normal aging, the gel portion of the vitreous becomes separated from the fibrous part, becoming more liquid. This causes the fibrous elements to contract, pulling the vitreous away from the retina. This contraction, known as Posterior Vitreous Detachment, causes the characteristic sudden "flashes" that retinal detachment patients experience. When the fibrous elements change positions, the patient experiences "floaters". Floaters also occur when pieces of the retina are dislodged as the vitreous contracts. Both flashes and floaters can be associated with nearsightedness and eye injuries, as well.

Patients experiencing flashes or floaters should be examined by their ophthalmologist immediately. In most cases they are not associated with a serious problem. However, in about 10% of patients with Posterior Vitreous Detachment, a retinal tear is found. An untreated tear will likely lead to full retinal detachment, which seriously threatens sight, and requires a major surgical procedure.


Fuchs' Dystrophy

Fuchs' dystrophy is a condition that affects the endothelium, or inner layer, of the cornea. The endothelium functions as a pumping mechanism, constantly removing fluids from the cornea, to maintain its clarity. As this condition progresses the patient loses these endothelial cells, which will not grow back, diminishing the effectiveness of the pumping mechanism. The cornea ultimately becomes cloudy, reducing vision.

This inherited condition begins between the ages of 30 and 40, and gradually progresses. Symptoms include hazy vision, which is most pronounced in the morning, as the inner layers of the cornea retain more moisture during sleep. Once the eyes are open for prolonged periods, moisture evaporates and vision becomes sharper. Patients can therefore expect fluctuations in vision. Light sensitivity, glaring, and a "gritty" sensation are also common.

Although Fuchs' can not be cured, medications can be used to control this condition. Moisture can be removed from the cornea with salt solutions and ointments to reduce the swelling that causes blurred vision. In the event vision becomes significantly impaired, corneal transplant may be necessary.


Glaucoma
Glaucoma is a group of diseases that involves damage to the eye's optic nerve, and may result in blindness.

The optic nerve, located at the back of the eye, carries visual information from the eye to the visual centers of the brain, where we perceive the image of what our eyes see. Fluid pressure within the inner eye is related to the damage of the optic nerve. The eye contains a clear fluid, or gel, called aqueous humor, which provides nourishment for the cornea and lens, and keeps the eyeball round and firm. This fluid is constantly being produced by the ciliary body, and drained through the trabecular meshwork. A block in the drainage will cause an increase in inner eye pressure that ultimately damages the fibers of the optic nerve.Glaucoma surgical procedures concentrate on relieving this pressure by opening the drainage, or reducing the production of fluid.

Damaged nerve fibers cause blind spots to develop. People seldom notice that this damage is occurring, until there is considerable nerve damage to the optic nerve, which ultimately leads to blindness. Early detection and treatment by your ophthalmologist is essential in preventing nerve damage and potential blindness associated with glaucoma.

Closed-Angle Glaucoma. Closed-angle glaucoma results from poor access to the drainage system. As the angle between the iris and the cornea begins to close, the trabecular meshwork is obstructed, thus obstructing the drainage of aqueous fluid.

Open-Angle Glaucoma. Open-angle glaucoma results from problems within the drainage system. The angle between the iris and cornea remains open, however, fluid drainage is impaired.


Herpes Simplex Virus

Herpes simplex virus (HSV) is a virus that infects the skin, mucous membranes and nerves. There are two types of HSV.

Type I is the more common virus, responsible for herpes simplex eye disease, cold sores, and fever blisters. Type II is responsible for sexually transmitted herpes.

Most people are infected with HSV type I during childhood or adolescence. The infection comes from close contact with an infected person, and generally leads to a mild sore mouth or throat. After the original infection, the virus goes into a dormant state, living in the nerve cells of the skin or eye, until it occasionally reactivates, causing a cold sore or fever blister. HSV type I is responsible for herpes simplex eye disease, which generally occurs in one eye, rarely spreading to the other eye. The most common herpes simplex eye disease caused by type I is the infection of the cornea, the clear front window of the eye.

The disease begins on the surface of the cornea, with the eye turning red, and becoming sensitive to light. While this is the only episode for some people, others experience a recurrence of corneal infection within two years. The infection may go deeper into the cornea causing inflammation, chronic ulcers, and permanent scarring.

The treatment for herpes simplex eye disease depends on the extent of the disease. Antiviral eyedrops, eye patches, cornea scrapping, or a variety of medications may be required. In severe cases a cornea transplant may be necessary. It is imperative that you contact your ophthalmologist prior to beginning treatments, as some medications make the condition worse.


Herpes Zoster

Herpes zoster (shingles), is a viral disease caused by the same virus that causes chicken pox. It tends to lay dormant for long periods of time, then reactivate in older people, and those with weakened immune systems.

The virus attacks the nerves around the eye, particularly the nerve that supplies the upper eyelid, and forehead. When the virus affects the nerves entering the eyeball, it can cause inflammation, corneal ulcers, and glaucoma. The lingering pain associates with nerve injury may result in oversensitive nerves for years to come.

The first indication of the disease is usually itching or burning and throbbing pain, and the appearance of blisters. The small fluid-filled blisters form scabs, and can leave permanent scars. The rash usually lasts three to six weeks, but some people experience pain associated with herpes zoster for much longer.

Most people recover from herpes zoster without complications, while some experience permanent visual damage, and pain, even with medications.

Treatments include controlling pain, and preventing further skin infection with soaks, scrubs, antiviral drugs, eye drops, steroids, and other medications.


Hyperopia (Farsightedness)

Normally, light passes through the cornea and lens, focusing on the retina. In the far sighted eye, the eye is shorter, thus the light is focused behind the retina, resulting in poor near vision.


Intraocular Lens

An intraocular lens, also known as an IOL is a clear artificial lens that is used to replace the cloudy natural lens of cataract patients. When a cataract forms, the natural lens becomes cloudy and light can no longer pass through it freely. The only way to remove a cataract is to remove the lens, and replace it with an IOL.

While cataract glasses magnify images, IOL lenses produce normally-sized and shaped images on the retina. They replace the focusing power of the natural lens more closely than either cataract glasses or contact lenses. An IOL cannot, however, adjust the focus of both near and far vision like the natural lens does. While distance vision is usually very good, reading glasses are often still necessary for close work.

IOLs are made of a variety of compounds including PMMA, silicon, and acrylic. They are very small and light weight. IOLs are usually placed either in front of or behind the iris.


Ischemic Optic Neuropathy

Ischemic Optic Neuropathy (ION) is the condition of losing your central or side vision because the optic nerve receives inadequate blood flow.

Symptoms include loss of central or side vision, or both. In most cases, vision loss is at its worse when first noticed, and is usually permanent. In some cases, vision improves or worsens within a few days or weeks. The more common ION usually occurs in people over 40 years of age, and is usually not associated with other illnesses.

The less common ION is associated with temporal arteritis and occurs in people over 60. This disease involves the inflammation of certain arteries, including those of the eye. People with temporal arteritis experience headaches and tenderness in the temples.

ION is diagnosed with a complete eye examination, pupil dilation, and a side vision test by your ophthalmologist. Your ophthalmologist may also recommend a blood pressure check, diabetes check, or a biopsy of a temporal artery.

Treatment does not exist for ION. There is a 50% chance that the disease will affect the other eye. This is particularly true with ION caused by temporal arteritis. In this case steroids are necessary to prevent the ION from affecting the other eye. The steroids will not improve vision loss in the first eye.


Keratoconus

Keratoconus is a developmental abnormality in which the cornea progressively becomes thinned, and bulges forward in a cone shape. It is an inherited condition that usually affects both eyes.

The patients vision is usually not correctable to its best acuity with glasses. In some cases, a gas permeable contact lens is helpful for mild to moderate keratoconus, as it will simulate a smooth, regular corneal surface.

If the patient is unable to tolerate contact lenses, a corneal transplant may be necessary, to obain functional vision.


Macular Degeneration

The very small central part of the retina is called the macula. It is responsible for our fine detail vision, and for color perception. Damage to this area of the eye occurs most often in people over fifty years of age, usually affecting both eyes, but often occurring in one eye first.

Juvenile macular degeneration occasionally occurs in infants and young children. There are three types of hereditary macular degeneration. 

  • Early onset macular degeneration occurs between birth and age seven, and is dominantly inherited, meaning that parents and their children can be affected.
  • Middle onset macular degeneration occurs between the ages five and twenty, and is usually recessively inherited, meaning that it may appear when few or no family members are affected.
  • Late onset macular degeneration occurs between the thirties and forties. This type of macular degeneration may be dominant or recessive.

A comprehensive eye exam by your ophthalmologist is the first step to diagnosing juvenile macular degeneration. Glasses and low vision aids help improve vision for patients with the disease.

Many patients are not aware of early macular degeneration in one eye, because the other eye compensates for the weaker one. Common symptoms include dimness of vision, difficulty reading or seeing near objects, and distortion of lines.

There is no cure for macular degeneration, however, current research suggests that some vitamins play a role in slowing the progress of the disease. In some cases, Laser surgery can be used to slow the disease, as it begins to advance. Early detection and treatment by your ophthalmologist is essential. If you are over the age of fifty, you should have regular eye exams.


Myopia (Nearsightedness)

Normally, light passes through the cornea and lens, focusing on the retina. In the near sighted eye, the eye is longer, thus the light is focused in front of the retina, resulting in poor distance vision.


Nevus

A nevus is flat, pigmented area that usually appears inside the eye. Nevi are usually found on the choroid layer just behind the retina, on the iris, or on the conjunctiva. Much like freckles, they are normally benign, and do not normally change or grow.

Symptoms include a brownish, freckle-like flat spot.

Nevi found on the iris or conjunctiva are detected with a slit lamp microscope. For nevi inside the eye, an ophthalmoscope is used. While they are generally harmless, nevi should be monitored for changes, and may occasionally require a biopsy. Your ophthalmologist can do this with photos or ultrasound, documenting the size, shape, and degree of elevation.


Nystagmus

Nystagmus is a condition that involves unintentional jittering of one or both eyes.

It is often associated with reduced vision, the brain's control over eye movement, extreme nearsightedness or farsightedness, and with retina or optic nerve scars. Medications, such as those used for seizure control, and excessive alcohol use may cause nystagmus as well. On rare occasions, nystagmus can result from brain tumors, or other neurological disorders.

In many cases, nystagmus is permanent, although the reduced vision may be improved with glasses or low vision aids. Glasses with prisms may be used if the eyes are more stable looking in a certain direction. Eye muscle surgery may improve head position and allow better vision.

The most common forms of nystagmus include motor nystagmus, and sensory nystagmus.

Motor nystagmus usually occurs in early infancy, between six and twelve weeks of age, and usually involves horizontal jittering of the eyes. While vision may be reduced at a distance, close vision is almost normal.

Sensory nystagmus is associated with reduced vision of any cause. This condition usually begins between six and eight weeks of age. The eyes appear to rove, fast or slow, and often rotate upward. As the infant becomes older, he may wave his hand in front of his eyes, or poke at his eyes. In babies who are born with cataracts, the reduced vision is treatable. Other conditions leading to nystagmus may not be treatable.


Ocular Migraines

Migraines are commonly thought of as severe headaches. Ocular migraines can occur with or without a headache. In younger people with common migraines, ocular migraines usually occur as well. However, as we age, it is often more common to experience an ocular migraine without the symptoms of a headache.

Ocular migraines involve visual distortions, where images often look gray, or appear to be wavy. If visual distortion is present, it generally occurs in central vision, and moves off to one side. Loss of vision, particularly in one eye, and increased sensitivity to light, are also common symptoms.

Generally, there are no serious complications caused by ocular migraines. In most cases, treatment is not necessary, unless the ocular migraine is linked to a common migraine.


Ocular Migraines

Migraines are commonly thought of as severe headaches. Ocular migraines can occur with or without a headache. In younger people with common migraines, ocular migraines usually occur as well. However, as we age, it is often more common to experience an ocular migraine without the symptoms of a headache.

Ocular migraines involve visual distortions, where images often look gray, or appear to be wavy. If visual distortion is present, it generally occurs in central vision, and moves off to one side. Loss of vision, particularly in one eye, and increased sensitivity to light, are also common symptoms.

Generally, there are no serious complications caused by ocular migraines. In most cases, treatment is not necessary, unless the ocular migraine is linked to a common migraine.


Optic Neuritis

Optic neuritis is a condition where the optic nerve fibers become inflamed, by any number of diseases or conditions. The extent of nerve fiber damage dictates the extent of vision impairment associated with the condition.

Children often develop optic neuritis following a viral illness, such as a cold, the measles, or the mumps. Some may develop it in association with other neurological diseases, such as multiple sclerosis. Most often, the cause of optic neuritis is unknown.

The onset of optic neuritis is sudden, with the patient noticing blurred vision in one or both eyes, which generally becomes dim, with washed out colors. Pain around the eye socket is common, and vision usually becomes progressively worse over the next week. If the inflammation of the optic nerve fibers occurs inside the eye, your eye doctor can readily detect it. However, if the inflammation occurs behind the eye, the doctor may not be able to detect the swollen nerve tissue. It is therefore very important that you, as the patient, clearly describe the symptoms you are experiencing.

Medical diagnosis of optic neuritis often requires an ultrasound or CT scan, among a series of other tests.

There is no good treatment for optic neuritis. Steroids are often prescribed, but in most cases, ineffectively. Some patients improve without treatment, returning to normal vision. Others do not return to normal vision, especially those with special conditions.


Presbyopia

Presbyopia, commonly called "old man's eye", is a common condition in adults by their mid-forties. The lens of a young person is soft and flexible, easily changing shape to focus on near or distant objects. As we age, the lens becomes harder and less flexible, making it difficult to focus. Nearby objects become difficult to bring into focus.

Symptoms include difficulty reading, or the tendency to push objects further away to bring them into focus.

This condition is a normal part of aging and is corrected by wearing reading glasses, or for some patients, bifocals.


Pterygium

A pterygium is a triangular wedge-shaped thickening of the conjunctiva. It is usually found on the nasal side of the eye, invading the cornea. Pterygia are most common in people who live in tropical climates, and those who spend a great deal of time in the sun.

Symptoms include redness, irritation, and tearing. In some cases the pterygium remains dormant. Others experience growth over the central cornea that eventually encroaches on the visual axis, causing vision loss.

Treatments include steroid drops to treat the inflammation. Artificial tears are often helpful to decrease the irritation. If the pterygium invades the central cornea, surgical removal is necessary.

The best defense against this condition is to avoid prolonged sun exposure, wind, and dust. Wearing protective eyewear greatly reduces your risk.


Ptosis

Ptosis is a condition where the upper eyelid droops to an abnormal level, covering part of the eye. It may be associated with birth, aging, injury, or nerve disorder.

Aging is the most common cause of ptosis, as muscles that normally hold the upper eyelid in position, lose strength. Trauma, such as a car accident, can damage muscle tissue as well. When this condition is noticed at birth, it generally occurs in one eye alone, and is associated with an abnormality in the development of eye muscles. In rare cases ptosis is associated with a nerve disorder. When a neurological disorder is present, symptoms include difficulty reading, driving, and headaches, especially after raising the eyebrows with the muscles of the forehead.

The most common treatment for ptosis is surgery, to tighten the muscles that control the position of the drooping eyelid.


Refractive Errors

In order to see clearly, light rays must be bent or "refracted" to focus on the retina, in the back of the eye. Along the retina, the rods and cones sense the light, and create impulses, that travel to the brain and are interpreted as images. When you have a "refractive error", the shape of your eye doesn't properly refract the light so the image is blurred rather than clear.

Myopia, hyperopia, astigmatism, and presbyopia are refractive errors that lead to blurred vision.

Normally, light passes through the cornea and lens, focusing on the retina. In the near sighted eye, the eye is longer, thus the light is focused in front of the retina, resulting in poor distance vision.

Normally, light passes through the cornea and lens, focusing on the retina. In the far sighted eye, the eye is shorter, thus the light is focused behind the retina, resulting in poor near vision, and in some cases, distance vision.
ASTIGMATISM

The normal cornea is curved equally in all directions. With astigmatism the cornea is irregularly shaped, like a spoon's back. Light rays have numerous focal points and focus on different areas of the retina, instead of one point, causing "ghost like" double images.

PRESBYOPIA
The lens of a young person is soft and flexible, easily changing shape to focus on near or distant objects. As we age, the lens becomes harder and less flexible, making it difficult to focus on near objects. This condition is normal and usually occurs near the age of 40.


Retinal Detachment

The retina is a multi-layered tissue of nerve cells that lines the back of the eye. These nerve cells sense light and create impulses that are sent to the brain via the optic nerve. A retinal detachment is the separation of the retinal tissue from the back, inside wall of the eye, resulting in vision loss. Any area of the retina that becomes detached is an area where vision is lost.

Most retinal detachments involve tears at the sides of the retina, resulting in peripheral vision loss in the early stages. The patient usually experiences an apparent covering or curtain from the sides, above, or below. Many patients experience flashing lights, or floaters. Eventually, the fluid in the vitreous cavity collects under the retina, separating it from the back of the eye. As this process continues, the patient will eventually experience total vision loss in the affected eye.

Retinal detachments or tears may be caused by head trauma, or even occur spontaneously. They are more common in patients with a high degree of nearsightedness, a family history of retinal detachment, or patients with degenerative retina diseases.

Patients experiencing the symptoms associated with retinal detachment should consult an ophthalmologist immediately. In cases where the retina has a tear, treatment is accomplished with a laser to seal the tear. When the retina is fully detached, surgery is necessary to reposition the retina.


Retinal Vein Occlusion

Retinal vein occlusion is a condition where retinal vein circulation becomes obstructed. An adjacent blood vessel obstructs a retinal vein, causing hemorrhages. Swelling of the retina, and reduced oxygen are common complications. Conditions that cause it include diabetes, hypertension, glaucoma, and cardiovascular disease.

Symptoms can vary, and are dependant on whether the central retinal vein or a branch retinal vein is involved. Patients with a branch vein occlusion tend to have blurred or missing areas of vision, and often notice a gradual improvement as the hemorrhage resolves. Patients with central vein occlusion experience severe loss of vision. Because a central vein occlusion affects the entire retina, recovery is much less likely.

Primary treatment for retinal vein occlusion involves treating the secondary complications. In cases where the retina is being deprived of oxygen, a laser may be used to prevent growth of delicate vessels that could break, bleed or result in glaucoma.


Retinitis Pigmentosa

Retinitis pigmentosa refers to a group of hereditary diseases that result in progressive vision loss, caused by the gradual destruction of nervous sensors in the retina.

Generally, the first symptoms occur in children or young adults, although symptoms can be first seen at any age. The symptoms include night blindness where the visual system adjusts much more slowly, if at all, to darkness. Peripheral (side vision) vision loss, is also common with retinitis pigmentosa.

Because this disease is inherited, any information relating to the affects of this disease on other relatives will help predict how the disease can affect you.

No specific treatment is available for the disease. Research suggests that some types of vitamin therapy may be beneficial, but studies are not yet conclusive. Patients with this disease may develop other treatable eye diseases such as glaucoma or cataracts.


Strabismus

Strabismus in Children

Strabismus is a visual defect in which the eyes may be crossed or turned out. It is commonly found in children with refractive errors or a family history of strabismus, but also can be seen in children with brain disorders such as brain tumors, cerebral palsy, Down Syndrome, and hydrocephalus. Most noticeably, one of the child's eyes will be out of alignment. Some children squint in bright light, or tilt their heads, in an attempt to use both eyes together.

Normally, both eyes aim at the same image, and the brain fuses the two images into a single three-dimensional image, giving us depth perception. When the eyes are misaligned, two different images are sent to the brain. The brain ignores the image of the misaligned eye, and the child loses depth perception.

When this occurs in adults, it usually results in double vision, as the adult brain is trained to receive and process two images. Nearly one half of the children who have strabismus have amblyopia, or reduced vision, in the weaker of the two eyes. The brain recognizes the image of the better eye, and ignores the image of the weaker eye. Early detection of amblyopia is essential for good treatment results. The good eye is patched to strengthen the vision of the weaker eye.

Treatments for strabismus include eyeglasses, or surgery to reposition certain eye muscles.

Strabismus in Adults

Strabismus is a visual defect in which the eyes are crossed. Normally, both eyes aim at the same image, and the brain fuses the two images into a single three-dimensional image, giving us depth perception. When the eyes are misaligned, two different images are sent to the brain. In the case of children the brain ignores the image of the misaligned eye, and the child loses depth perception. However, in adults, it usually results in double vision, as the adult brain is trained to receive and process two images. Strabismus found in adults has usually been there since childhood and will not result in double vision. In the event an adult's strabismus is not associated with childhood eye misalignment, the patient should be considered for other medical or neurological causes. This disorder can be associated with brain tumors, diabetes, thyroid disorders, strokes, or other neurological disorders.

Symptoms of adult strabismus include headaches, double vision, eyestrain and fatigue, and the repositioning of the head in an attempt to use the eyes together.

Treatments for strabismus include glasses with prisms, eye muscle surgery, and eye exercises. Strabismus can also be associated with cataracts or eye injuries


Tearing

As we age, our tearing system changes as well. Tears ducts, that normally allow the tears to drain out of the eyes, become narrow or blocked causing excessive tearing, and repeated eye infections.

Excessive tears can actually be caused by a condition known as "dry eye syndrome". As aging decreases the amount of tears, and the consistency of the tear film, the eye becomes irritated and responds by producing more tears. These tears, however, do not have the right ingredients to properly lubricate the eye.

Tearing can be aggravated by constant exposure to eye irritants, or a foreign body in the eye. Wind, dust, dry weather, extreme temperatures, smoke, and fumes can aggravate it as well.

Treatments include removing any foreign matter the doctor finds. If the problem is a blocked duct, the doctor may treat it with antibiotic eye drops, then irrigate the tear ducts. Another procedure involves surgically forming a new channel through which the tears can drain inside your nose.


Thyroid Eye Disorders

The thyroid gland, located in your neck, produces hormones that aid in regulating the bodies metabolism. Insufficient production of thyroid hormone is known as hypothyroidism, while an over production of the hormone is called hyperthyroidism..

Symptoms of hypothyroidism include a slow heart rate, fatigue, weight gain, and constipation. Symptoms of hyperthyroidism include a fast heart rate, weight loss, fatigue, heat intolerance, and diarrhea.

Symptoms of hyperthyroidism, as it relates to the eye, include dry eyes and a staring appearance. The eyelids and the tissue of the eye socket begin swelling (edema), pushing the eyeball forward, to the point of obvious protrusion. Swelling of the muscles in the eye causes double vision for some patients. In some cases the cornea may become ulcerated, or the optic nerve may become damaged, leading to permanent vision loss.

Patients with symptoms of a thyroid eye disorder generally have abnormal blood levels of thyroid hormone. However, thyroid eye disease can occur even in patients with normal thyroid hormone tests.

Treatment of a thyroid gland disorder initially involves the evaluation of the thyroid's activity. While an overactive thyroid gland may be stabilized, the associated eye disease may continue to progress. The first priority is to treat the active eye disease, which can require several years, and regular monitoring. This may include artificial tears and ointments, steroids, or even orbital surgery. Other considerations include surgical correction of double vision, or eyeball protrusion.