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Common Eye Problems

Here is an outline to go along with the video presented by PECAA.

  • In a study, it was found that 47% of Americans wprry about losing their sight more than losing their memory or hearing. Yet many do not get the yearly examinations that they need. Here are some ocular conditions that can be found during an eye examination at Visualeyes Optometry.

  • Strabismus

    • Strabismus, also known as "crossed eyes," is an eye misalignment where the two eyes are not looking in the same direction. ​

    • It is caused by a muscle imbalance. 

    • The eye can be turned in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia). 

    • The degree that the eye is turned is measured in a unit called prism diopters. 

    • So, if a patient has 2RHT written in their charts, this signifies 2 prism diopters of right eye hypertropia. 

  • Amblyopia

    • Amblyopia is the loss of vision of an eye without any apparent disease of the eye. ​It is caused by a poor development of the communication between the eye and brain, usually because of either uncorrected strabismus as a child, a large uncorrected refractive error in one eye, or an uncorrected blockage of the eye as a child, such as a ptosis or congential cataract. 

    • This is usually treated with an intermittent patcing of the stronger eye to force the weaker eye to work. 

  • Cataracts

    • A cataract is a clouding of the normally clear crystalline lens. This causes the patient to see "cloudy, foggy, or hazy." ​

    • Causes usually include part of thr normal aging process, but they can also be due to oral steroid use, trauma, or diseases like diabetes. 

    • Early treatment includes prescribing stronger glasses, increasing light, anti-reflective treatments, and magnifying lenses. As the disease progresses, surgery is required with the implantation of an intraocular lens, or IOL. 

  • Glaucoma

    • Glaucoma is called the silent thief of sight, because there are no symptoms early on in the disease. It is only diagnosed at an eye examination. ​

    • As the disease progresses, the peripheral vision starts to deteriorate. Once the vision is lost, it cannot be returned. 

    • Those at more risk for glaucoma include the elderly, African-American population, and those that have a family history of glaucoma. 

    • Testing performed in the office includes 

      • Tonometry​

        • Measuring the intraocular pressure (IOP), which is normally 13-20mmHg​

      • Ophthalmoscopy

        • Assessing the shape and color of the optic nerve to determine if there is damage to it or the retinal nerve fiber layer, which can cause a change in visual fields. ​

      • Retinal Photography

        • Utilizing a fundus camera or the OCT to take pictures of the retina and optic nerve to determine if changes are taking place. ​

      • Perimetry

        • Measuring the patient's visual field​

      • Gonioscopy

        • Measurig the angle between the iris and cornea. If the angle is closed, the aqueous humor cannot drain, and the IOP can increase. ​

      • Pachymetry

        • Measuring the thickness of the cornea, which can affect the reading of the IOP. A thinner cornea can underestimate the IOP. A thicker cornea can overestimate it. ​

    • Treatment includes eye drops, lasers, and surgery

  •  Macular Degeneration

    • Macular degeneration usually onset in patients older than 60 years of age. It affects the macular region of the retina, which is responsible for central vision, so macular degeneration causes a reduced central vision in patients. ​

    • There are two types. 

      • Wet Macular Degeneration results in abnormal blood vessel growth under the macula, and blood and fluid can leak out resulting in decreased vision. Treatment includes lasers, injections, and photodynamic therapy to stop the progression. ​

      • Dry Macular Degeneration results from the retina's photoreceptors breaking down, causing a decreased central vision. When diagnosed early, treatment can involve special vitamins to slow the progression. 

    • Patients with macular degeneration may be given an Amsler grid to take home to monitor for any changes waviness of vision, or blind spots. 

  • Diabetes

    • Type 1 Diabetes is due to an autoimmune disease in which the patient's own body attacks the insulin producing Beta cells in the pancreas, so insulin is not produced. Treatment includes insulin injections. ​

    • Type 2 Diabetes is more common (90-95% of diabetics) and is associated with aging, obesity, family history, previous gestational diabetes, physical inactivity, and certain ethnicities. 

    • Gestational Diabetes usually occurs late in pregnancy. This type of diabetes usually goes away after birth, but there is a 40-60% chance of causing Type 2 Diabetes in 5-10 years. 

    • Diabetic Retinopathy

      • Diabetic retinopathy is the leading cause of blindness in the US adult population. ​

      • Changing blood sugars can cause changes in a patient's visual acuity. This can take up to 3 months to stabilize. It also causes an increased chance of cataracts and glaucoma.

      • Untreated diabetes can caused changes in retinal blood vessels, leading to retinopathy.

      • Stages of Diabetic Retinopathy

        • 1. Mild Non-Proliferative Retinopathy- indicated by small dot/blot hemerrhages and microaneurysms. 

        • 2. Moderate Non-Proliferative Retinopathy- Here the blood vessels are blocked. 

        • 3. Severe Non-Proliferative Retinopathy- The blocked blood vessels start to cause damage

        • 4. Proliferative Retinopathy - new, abnormally fragile blood vessels begin to form in the retina and heading to the vitreous. This can cause pulling and retinal detachments. 

        • Treatment includes lasers to try to shrink the blood vessels. 

  • Hypertensive Retinopathy

    • With high blood pressure, the retinal arteries narrow, causing cotton-wool spots and flame hemorrhages. ​

    • Some of these patients will have no symptoms until it gets too bad. 

    • Most of these will resolve when the blood pressure normalizes. 

  • Floaters

    • These are floating specs and spots in the vitreous, seen in the vision. ​

    • It is caused by condensations in the vitreous, either due to the normal aging process or because of a pathology. 

    • Most of the floaters will fade with time. 

  • Vitreous Detachment

    • With age, the vitreous shrinks, pulls on the retina, and causes flashes of light and floaters. The vitreous can fully break away from the retina, which is a good thing.. ​

    • Because flashes of light and floaters can also signify a retinal detachment, a dilated eye examination needs to be performed. 

  • Retinal Detachment

    • This is a very serious matter, which can cause blindness if not treated quickly. ​

    • Most of these are caused by retinal breaks, holes, or tears, in which liquid can get under the retina and zause it to detach. 

    • Symptoms include flashes of light, floaters, or a curtain blocking the vision. 

  • Conjunctivitis

    • This condition, in which the conjuctiva is inflammed, is usually called a "pink eye." ​

    • It can be caused by bacteria, viruses, chemicals, or allergies. 

    • Bacterial conjunctivitis is common, especially in children and presents as an eye with a discharge. This can be very contagious. 

    • Allergic conjunctivitis usually presents with other symptoms of allergies as well. 

  • Blepharitis

    • Blepharitis is an inflammation of the eyelids. ​

    • It is caused by bacteria, dandruff, or oil gland production. 

    • Symptoms include burning, a foreign body sensation, tearing, itching, light sensitivity, flaking, crusting, and red, swollen lids. 

    • Treatment includes cleaning the lids and warm compresses. 

  • Pinguecula/ Pterygium

    • These are both conjunctival growths. ​

    • A pinguecula is a ywllosh area on the conjunctiva at 3 or 9 oclock near the limbus. It is usually seen more in tropical climates due to increased UV expoosure. Many times there are no treatments unless the pinguecula is inflammed. 

    • A pterygium is a wedge-shaped growth of the conjunctiva onto the cornea, usually due to UV, low hunidity, and dust. When it grows past the limbus, it can affect the patient's visual acuity, so surgery may be indicated. 

  • Eyelid Bumps

    • Styes are infected hair follicles. It causes swollen, tender lids which can be treated with warm compresses. ​

    • A chalazia is a blocked meibomian gland. It is treated with warm compresses, and possibly a surgery. 

  • Basal Cell Carcinoma

    • This is the most common cancerous lesion seen on the eyelid. It is usually caused by UV. ​

    • It is not life threatening, but it can spread and disfigure the lid if not treated promptly. They need to be removed. 

  • Squamous Cell Carcinoma

    • This is a more dangerous cancer lesion. It may metstasize to other locations in the body. ​

    • These are seen as red, scaly skin that leads to an open sore. 

    • Surgery is required. 

  • Dry Eye

    • This is either caused by a decreased tear production or a poor tear quality. It is a chronic condition. 

    • This can be caused by age, gender (women more than men due to fluctuating hormones), medications (like antihistamines, decongestants, those for hypertension, and antidepresants), medical conditions (like rhematoid arthiritis, diabetes, and thyroid disorders), environmental factors (like smoking, windy, and dry environments), contact lens use, previous refractive surgery, and decreased blinking, especially when using increased technology. 

    • Treatments can include OTC artificial tears, tear conservation like punctal plugs, prescription tears, and omega 3 supplements. 

Test Your Knowledge

1. Which word describes an eye that turns inward

     a. Exotropia

     b. Esotropia

     c. Hypertropia

     d. Hypotropia

2. Which word describes an eye that turns downward

     a. Exotropia

     b. Esotropia

     c. Hypertropia

     d. Hypotropia

3. Which of the followig is caused by stress, steroid use, or trauma

     a. Amblyopia

     b. AMD

     c. Cataracts

     d. Hyertropia

4. Amblyopia and Strabismus are the same thing

     a. True

     b. False

5. Which instrument(s) may be used to monitor the progression of glaucoma? 

     a. Tonometer

     b. OCT

     c. Visual Field Analyzer

     d. All of the Above

6. What is the third stage of diabetic retinopathy?

     a. Proliferative 

     b. Severe

     c. Advanced

     d. None of the Above

7. Floaters are most commonly caused by 

     a. Deposits or condensation of the vitreous

     b. High blood pressure

     c. Cataracts

     d. Glaucoma

8. A person with macular degeneration would have the most difficulty seeing

     a. Close up

     b. Far away

     c. Centrally

     d. Peripherally 

9. The correct name for "pink eye" is

     a. Glaucoma

     b. Strabismus

     c. Conjunctivitis

     d. None of the Above

10. Blepharitis affects which part of the eye?

     a. Retina 

     b. Pupil

     c. Cornea

     d. Eyelids

11. Which of the following could be considered a risk factor for dry eye? 

     a. Age

     b. Medication

     c. Gender

     d. All of the Above

12. Which of the following are symptoms of dry eye? 

     a. Excessive tearing

     b. Itching eye

     c. Both a and b

13. Which eyelid lesion woulc be considered the most dangerous? 

     a. Basal cell lesion

     b. Squamous cell lesion

     c. Chalazion

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