Other Common
Conditions

Age related macular degeneration (AMD) is one of the most common causes of poor vision after age 60. Although the specific cause is unknown, AMD seems to be in part due to aging. While age is the most significant risk factor for developing AMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors. AMD accounts for 90 percent of new legal blindness in the US.

Symptoms

The visual symptoms of age-related macular degeneration involve a loss of central vision. While peripheral vision is unaffected, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and generally looking at detail. Imagine being able to see a clock on the wall but being unable to make out the time or unable to read because you could not see parts of words on the page.

Promising age-related macular degeneration research is being done on many fronts. In the meantime, high-intensity reading lamps, magnifiers and other low-vision aids help people with AMD make the most of remaining vision.

Risk Factors

• Aging. Approximately 10% of patients 66 to 74 years of age will have findings of macular degeneration. The prevalence increases to 30% in patients 75 to 85 years of age.
• Smoking. The only environmental exposure clearly associated with macular degeneration is tobacco smoking. Not only does smoking increase the risk of macular degeneration development, current or ex-smokers cannot take vitamin supplements that have beta carotene because the risk of lung cancer increases if they do so.
• Family history of macular degeneration. Macular degeneration appears to be hereditary in some families but not in others. Approximately one fourth of all late-stage macular degeneration appears to have a genetic basis. The lifetime risk of developing late-stage macular degeneration is 50% for people who have a relative with macular degeneration.

Other possible risk factors include:

• Exposure to sunlight, especially blue light
• Hypertension
• Cardiovascular conditions (high cholesterol, obesity)
• Female gender
• Non-Hispanic whites
• Hyperopia (Farsightedness)

Other forms of macular degeneration

There are also two other forms of macular degeneration: dry and wet. Nine out of 10 people who have AMD have the dry form, which results in thinning of the macula, the area of the retina responsible for central vision. Dry AMD takes many years to develop. The wet form of AMD occurs much less frequently (one out of 10 people) but is more serious.

Treatment Options

Oral antibiotics with warm compresses for 15-20 minutes are often the leading path of treatment. If the conditions continue to escalate or persistently trouble for weeks on end, then smaller lesions may be injected with a corticosteroid or larger ones may be surgically removed using local anesthesia. This is usually done from underneath the eyelid to avoid a scar on the skin.

The surgical removal of larger chalazia may result in visible hematoma around the lid, which will wear off within three or four days, whereas the swelling may persist for longer. Chalazion excision is an ambulant treatment and normally does not take longer than fifteen minutes.

High blood pressure can also affect vision by raising the intraocular pressure of the eye (an early symptom of glaucoma). If you have hypertension, it is important to have your eye pressure checked on a regular basis as irreversible vision loss can happen if not properly taken care of.

Hypertension is a major health problem, especially because it has no symptoms. Many people have hypertension without knowing it. In the United States, about 50 million people have high blood pressure. Hypertension is more common in men than women and in people over the age of 65 than in younger persons. More than half of all Americans over the age of 65 have hypertension.

What causes conjunctivitis?

Not all cases of conjunctivitis are caused by an infection. Allergies can cause conjunctivitis, too. Typically, people with allergic conjunctivitis have itchy eyes, especially in spring and fall. Allergic conjunctivitis may also be caused by intolerance to substances such as makeup, fragrance or certain medications. Eye drops are often used to treat allergic conjunctivitis. It is important to avoid medications that contain steroids unless prescribed by a professional.

To avoid spreading infection, remember these steps:

• Wash hands repeatedly
• Disinfect household surfaces, such as doorknobs and counters with diluted bleach solution
• Avoid swimming as water may spread symptoms
• Avoid touching the affected area and face
• Don’t share towels or washcloths
• Avoid unnecessary contact with others, (such as shaking hands)

Forms of blepharitis

Blepharitis, while invariably chronic, comes in three forms: Staphylococcal, Seborrheic, and Meibomian Gland Dysfunction (MGD). It is defined as the chronic inflammation of the eyelids, and is one of the most commonly diagnosed eye disorders today. It is a leading cause of redness, tearing and overall discomfort. The most common associated symptoms are chronic red eye, dry eye, marginal ulcers, and phlyctenules.

Staphylococcal blepharitis

Staphylococcal blepharitis is caused by the ‘Staph’ bacteria, and is most often characterized by dense crusts around a patient’s eyelashes. These formations may cause the patient discomfort when trying to open their eyes in the morning. With this form of Blepharitis, the patient can experience a loss of eyelashes, formation of a sty, or upon removal of the crusts a possibility for small ulcers. The traditional treatment for this form of blepharitis is antibiotic ointment, sometimes offset with warm compresses and enhanced care in regards to lid hygiene. In extreme cases, steroids may be used for marginal ulcers.

Seborrheic blepharitis

Seborrheic blepharitis exhibits similar symptoms but appears differently on the patient’s eye. Where staph-based blepharitis is dry and crust-like, seborrheic blepharitis is greasy and akin to scales. Patients suffering from this form of blepharitis may also be diagnosed with seborrheic dermatitis. The standard treatment here is extra care in lid hygiene through use of lid scrubs and warm compresses.

Meibomian gland dysfunction

A working Meibomian Gland produces oily secretions which form an integral part of the tear film. When this gland fails to function properly, it can secrete abnormal oily substances. This causes an erratic tear film and can result in eye irritation, as well as chronic dry eye. The treatment for this form of blepharitis is lid scrubs, antibiotic ointment, and sometimes tetracycline, taken orally.

Symptoms and diagnosis

It is important to note that blepharitis is a chronic condition, and patients diagnosed with it must take extra care to keep their eyelids as clean as possible. At the Benjamin Eye Institute, we will be happy to give you the easiest, most convenient and effective ways to accomplish this.

Blepharitis hygiene

The key to controlling blepharitis is to keep the eyelids and eyelashes clean.

Directions for a warm soak of the eyelids:

1. Wash your hands thoroughly
2. Moisten a clean washcloth with warm water
3. Close your eyes and place a washcloth on your eyelids for about 5 minutes
4. Repeat several times daily

Directions for an eyelid scrub:

1. Wash your hands thoroughly
2. Mix warm water and a small amount of shampoo that does not irritate the eye (baby shampoo would be best) or use a commercially prepared lid scrub solution recommended by your eye doctor.
3. Close one eye and use a clean wash cloth (a different one for each eye) to rub the solution back and forth across the eyelashes and the edge of the eyelid.
4. Rinse with clear, cool water.
5. Repeat with the other eye.

Causes of amblyopia

Lazy eye can be caused by a number of common childhood eye conditions. If children are extremely nearsighted or farsighted, both eyes will be constantly blurred and may become lazy. Some children have one eye that is more nearsighted or farsighted than the other, and can develop amblyopia in just the one eye.

Another common childhood eye condition that can cause lazy eye is ocular misalignment, also called strabismus. This is a condition in which the two eyes are looking in different directions. This may look like crossed eyes if the misaligned eye points inward, or wall eyes if the misaligned eye points outward. In either case, only one eye at a time is looking where the child wants to look, and to avoid double vision, the brain ignores the vision coming through the misaligned eye. If this vision is ignored long enough, lazy eye can develop in the misaligned eye.

Some uncommon causes of lazy eye are conditions that block vision from entering the eye, such as a droopy eyelid or a cataract. Though these instances are rare in children, we do see them.

Treatment

A lazy eye can be treated to restore normal vision, but it has to be diagnosed promptly. If a lazy eye is not diagnosed and treated by the age of 9 or 10, the vision loss becomes permanent. All children should have their vision measured before starting school and at least once or twice while in elementary school to make sure that their eyesight is developing normally in both eyes. Any abnormal vision measurement, whether in one or both eyes, should be evaluated by an eye specialist to make sure amblyopia is not present.

Treating lazy eye depends in part on the cause of the amblyopia, and the first step is to fix the cause. Droopy eyelids can be tucked, and cataracts can be removed. For more common causes, your doctor can correct nearsightedness or farsightedness, and eye muscle surgery can re-align misaligned eyes.

Once the cause of amblyopia is fixed, then vision loss must be regained. This is often accomplished by patching the good eye for brief periods, or blurring the vision in the good eye with special eye drops. Patching or blurring the good eye forces the lazy eye to work harder, so it can catch up to the good eye. It is important to follow Dr. Benjamin’s instructions carefully when blurring the good eye with a patch or eye drops, because too much blurring of the good eye can make it become lazy.

Regular outward pressure within the eye causes the cornea to progressively swell into a cone-like shape. These changes cause irregularities in the corneal shape and can have a dramatic influence on one’s vision, causing distortion and glare. Many patients are initially unaware they have keratoconus and see their eye doctor because of increasing blur or continual changes in their eye glass prescription.

Treatment options

In most cases, eye glasses no longer provide suitable vision. Keratoconus patients usually require specialized contact lenses to improve vision. There are a variety of contact lens designs available from custom specialty soft and rigid lenses, to hybrid lenses, and Scleral lenses. Laser guided lens fittings performed at the Benjamin Eye Institute offers the most advanced way to fit patients in an effort to maintain corneal health and allow for the greatest relief and vision improvement.

Symptoms

Patients often notice the first signs of presbyopia when they are unable to read items closely. You may find that you are holding things further from your face to read them. Beginning to adjust for close vision is one of the first signs of presbyopia.

Treatment options

There are both non-surgical and surgical treatments available to correct presbyopia. Non-surgical options include reading glasses or “readers,” as well as contact lenses. Surgical options include LASIK, Conductive Keratoplasty and refractive lens exchange.