Vitreous Degeneration

The vitreous is a transparent gel that fills two-thirds to three-fourths of the volume of the adult eye. The vitreous is two to four times as viscous as water. It is thought of as a shock absorber for the delicate retina that lines the back of the eye.

In a young eye the vitreous is attached firmly to the retina. A partial vitreous-retinal detachment, as a result of vitreous degeneration, is a common age-related event in half of all adults over age 50. Frequency generally increases with age. Typically, vitreous degeneration is a benign event and 85% of the time there is no significant consequence. More frequent testing is recommended, which may include pupil dilation and/or retinal visual field examination.

Age-related vitreous degeneration is the most common cause for the sudden onset of a single large floater. Floaters of this type will typically move out of sight with the passage of time. Flashes of light may also occur as the changing vitreous tugs on the sensitive retina.

Some degree of vitreous degeneration is natural and expected. If, however, vitreous degeneration increases significantly, there is possible risk of retinal damage or retinal detachment. If your vision changes suddenly, if you experience a noticeable change in visual floaters, a distortion in vision or a sudden increase in the frequency or duration of light flashes, call our office without delay. Always pay close attention to your symptoms.

Seborrheic Dermatitis

Dermatitis identifies an inflammatory condition of the skin. Sudden or persistent swelling and redness are characteristic, along with some degree of itching or burning. In the extreme, there can be blisters, oozing, scaling and crusting. Dermatitis has many forms and many causes.

Seborrheic dermatitis is characterized as a chronic inflammation of the tissues surrounding the eye. It typically involves the scalp, brows, face, and eyelid margin. The cause is unknown, however, it’s thought that hormone imbalances, infection, nutritional factors, and emotional stress may play some role. This annoying condition usually begins around puberty and persists into old age. Light skinned persons are more commonly involved.

Treatment generally involves the same form of treatment associated with dandruff-like conditions. When necessary, therapeutic treatments are very effective in reducing symptoms.

Scleritis

The sclera is the white portion of the eye. Scleritis is an inflammation of this white portion of the eye. This condition can be extremely destructive disease leading to vision loss. Occasionally, scleritis can be severe enough to cause pain and actual perforation of the globe of the eye. Once the globe is perforated, the possibilities for loss of the eye as well as the other eye are much greater.

As a general rule, scleritis is not a primary inflammation or infection but is secondary to some systemic disorder already present. Patients who suffer with Lupus, Rheumatoid Arthritis and other connective tissue disorders are more susceptible to scleritis than others. Scleritis may tend to be chronic in nature. It is not uncommon to see episodes of inflammation and then clearing. Whenever you feel as though you may be experiencing another episode of scleritis or that the inflammation present is increasing rather than decreasing in its intensity, contact our office as soon as possible for additional instructions regarding care.

Recurrent Corneal Erosion

Recurrent corneal erosions describe a disruption of the outermost surface of the cornea, which recurs in the same area of the cornea on a repeated basis. Although this clear tissue is typically very tough and resilient to damage, there are corneal dystrophies or degenerative diseases that may challenge the cornea’s integrity and ability to heal completely. If this disease or condition is chronic in nature, it can cause the cornea to suffer from recurrent erosion, a periodic loss of the outermost layer of the corneal tissue.

This loss of tissue generally results from a separation of this outer layer from the deeper layers of corneal tissue. When these corneal erosions occur, they leave nerve endings exposed, which can be very painful as well as cause a significant loss of vision. The recurrent nature of this condition relates to early (partial), yet structurally incomplete, healing of new outer layer of cells to the deeper layers. Corneal erosions may occur after traumatic injury to the cornea or they may form secondarily as a result of corneal disease.

The diagnosis of recurrent corneal erosion is aided by the patient supplying as much history as possible. Patients are also urged to track the frequency of erosion episodes and report any previous treatments. These measures will aid in better treating this chronic condition. Treatment may range from initial patching and use of medicated drops or ointments to office-based surgical procedures to aid tissue attachment and stability.

Pain and visual disturbances may occur needlessly if early warning signs are ignored. The sooner treatment can be started the better the chance we have of limiting the potentially damaging effects of this condition.

Pterygium

The conjunctiva is a clear, thin layer of tissue that covers the white part of the eye. Pterygia are a direct result of degeneration of this conjunctival tissue. A pterygium is a fleshy triangular shaped tissue located on the horizontal meridian of the white part of the eye. As this conjunctival degeneration progresses, its growth slowly extends onto the front clear surface of the eye, the cornea.

The cause for ptergia is not completely understood. However, there seems to be a relationship between those who have ptergia and the environments in which they live or work. Common causes are thought to be environment that are dirty, dusty, smoky, windy and environments that expose people to large amounts of sunlight or ultraviolet light. All spectacle eyewear corrections should contain an ultraviolet coating to help prevent further irritation.

In addition, certain tasks decrease the normal blink rate of the eye, e.g., computer use. A decrease in the blink rate increases evaporation of the tears from the surface of the eye, causing decreased lubrication. Decreased lubrication causes mechanical irritation of the eye, which is thought to be a contributory cause of this type of degeneration.

Ptergia are typically not dangerous. They are characterized by a whiteish or yellowish appearance.

Symptoms include a gritty or a sandy sensation upon blinking. Since they contain numerous blood

vessels, the eye will look much redder than normal. Treatment may involve the use of ocular

decongestants or in some cases, mild topical steroids. If the ptergium continues to grow towards the center of the cornea, threatening vision, or if it presents a cosmetic problem, it may require surgical intervention and removal. This condition should be monitored on a regular basis so that measurements can be taken to evaluate any change in growth or change in position.

Pseudoepiphora

Pseudoepiphora exists when tears spill from the eye as a result of initial eye dryness.  Rather than an initial excess of tears causing tear spillage, pseudoepiphora results from initial irritation of the eye.  Proper lubrication of the eye requires two types of tears, an oily component produced in the eyelids and a watery component produced in the tear glad.  The initial dryness is usually caused by inadequate production of the oily component of the tears.  To compensate, this causes a natural reflex to flood the eye with an excessive amount of watery tear fluid; however, this flood of incomplete watery tears may do little to improve the underlying surface irritation.

Myokymia

Myokymia is a sudden, involuntary intermittent twitching of the muscles that surround the eye. This annoying twitching typically results from stress, anxiety, fatigue, lack of sleep and occasionally excessive use of alcohol or smoking. In some cases, it may result from increased caffeine consumption or from superficial irritation of the eye. Aside from uncorrected refractive errors, eye-related factors are rarely the cause of myokymia.

Occasionally, topically applied (drops placed in the eye) decongestants containing antihistamines may reduce the annoying symptoms of this condition by relaxing the eyelid muscles. Do not use any eye drops without direct permission from this office. Although these muscles spasms are often annoying, they typically are of no medical concern and require no treatment other than eliminating the cause.

Posterior Blepharitis – Meibomitis

The meibomian (mi-bo’-me-an) glands, named for the German anatomist Heinrich Meibom, are positioned in a row along the posterior (back) edge of the upper and lower eyelid margins. These important glands lie very close to the eye. Meibomian glands supply the oily compenent of the normal tearfilm and are in large part responsible for ocular comfort.

When these glands become blocked, inflammation or infection may follow causing “meibomitis.” Depending upon the severity of the lid-margin disease, it may be necessary to release eyelid secretions by manually expressing them at the examining microscope. Further treatment will certainly require careful lid hygiene, including periodic warm lid-scrubs. Heat is helpful to open the glands and to soften the blocked glandular secretions.

I some cases, it may become helpful to undergo a course of oral antibiotics. There is no reliable permanent cure for this disease and this condition may recur from time to time. It is important to bear in mind that this is an eyelid abnormality which may, in large part, be controlled by the patient. Your comfort can generally be maintained by ongoing care and treatment.

HOT COMPRESSES

Soak a clean face cloth in tap water that is as hot as possible without burning. Wring out the excess water and place the hot face cloth over the affected are. The warmth and moisture of the hot compresses will tend to decrease tenderness, increase comfort and increase blood circulation in the affected area, which is needed for healing. Repeat this procedure often in the early stages of treatment and gradually reduce frequency as your symptoms decrease.

Map Dot Dystrophy

Epithelial basement membrane dystrophy or map dot dystrophy is a relatively rare, inherited disorder that affects the cornea of both eyes. The cornea is the clear outer surface or window of the eye. Cells within the surface layers of the cornea form finger-like projections which appear as “maps” when examining the cornea with a microscope. These projections trap debris and cells which appear as “dots.” As these cysts migrate to the surface, they cause symptoms which can include visual fluctuations, sudden pain on awakening, feeling of something in the eye and light sensitivity. One eye may advance more quickly than the other, but both usually stabilize by 30 years of age.

Treatment is aimed at relieving the symptoms by using ointments or eye drops. Bandage contact lenses may be used in cases of severe discomfort.

Lagophthalmos

Lagophthalmos is a condition in which the eyelids do not close together to completely cover the globe of the eye. This inadequate closure of the lids often causes the front surface of the eye to be improperly or inadequately lubricated. As a result, the front surface of the eye dries and generally is uncomfortable.

A second type of lagophthalmos is called nocturnal lagophthalmos, in which the eyelids do not completely close and cover the globe of the eye while sleeping. This causes discomfort, especially in the early morning.

All types of lagophthalmos commonly cause a sandy, gritty feeling accompanied by increased watering (tearing) of the eyes. Treatment may include artificial tears, lubricating ointment and occasionally taping the eyelid or patching at bedtime. If medical therapy fails, surgical procedures may be beneficial.