What is a cataract? A cataract is a clouding the normally clear lens of the eye. You can think of the eye as a camera. In a camera, there is a lens which focuses light onto the film. Similarly, in the eye there is a clear lens that focuses light onto the retina. In a camera if you were to take a smear the lens with grease and then take a picture, the picture would come out blurry. By the same token, if the normally crystal clear lens of the eye becomes cloudy, the "pictures" the eye sees will also be blurry.
What causes cataracts? A cataract is most often related to aging of the eye. A family history of cataract can be important. In addition, a history of diabetes, eye injury or use of certain medications (most notably steroids) can also play a role in the development of cataract. Frequent and extensive exposure to ultraviolet light has also been shown to hasten the development of cataracts. No specific evidence exists that links diet and the development of cataracts.
What are the symptoms? The most common symptom of cataracts is a painless, gradual blurring of the vision. Other symptoms include glare, double vision in one eye, poor night vision, fading or yellowing of colors, frequent eyeglass prescription changes, and need to use brighter light to read.
The rate at which a cataract grows is highly variable, even between the two eyes of the same individual. The typical age related cataract usually grows slowly, whereas the cataract associated with diabetes may grow more quickly. It is impossible to predict how fast a cataract will grow in any given person.
How is a cataract detected? In order to detect a cataract, a thorough medical examination by your ophthalmologist is recommended. This way, the ophthalmologist can tell if there are other reasons for the visual disturbance you may have.
If the cataract is causing only a mild blurring of your vision, a change in your glasses may be all that is needed to allow you to see better. If, however, the cataract is more advanced, correcting your vision fully may require removal of the cataract.
How is a cataract treated? The only way a cataract can be removed is through surgery. There are no medications, dietary supplements, exercises, or optical devices that have been shown to treat cataracts.
Cataract surgery is an elective procedure in most instances. This means that the time to remove the cataract is when it interferes with your visual needs. If you are still able to perform all of the daily tasks that you like and need to do, then you may not need to have the cataracts removed. If, however, your vision is preventing you from driving, cooking, sewing, reading, or doing anything you want to do, and if the reason for the decreased vision is your cataract, then surgery to remove the may be indicated. Based on your symptoms, you and your ophthalmologist should decide together when surgery is appropriate.
Cataract surgery is usually performed under local anesthesia on an out-patient basis. Your ophthalmologist uses a microscope and delicate instruments to remove the cataract. In most cases, the focusing power of the eye is restored by placing a permanent lens implant inside the eye. This plastic lens implant is held in place inside the eye by a natural membrane. In approximately 20% of people, this natural membrane will become cloudy causing a decrease in vision. When this occurs, a laser can be used to open this cloudy membrane and restore vision. Thus, the laser is used after the initial cataract surgery, and only when that membrane becomes cloudy. Lasers are not used to remove the cataract itself!
What can be expected from cataract surgery? Cataract surgery is highly successful. Improved vision occurs in over 90% of patients who have the surgery. Of course, no surgery is 100% successful, and it is imperative that you understand that complications can occur during or after the surgery. Some of these complications can be severe enough to limit vision. As with any surgery, a good result cannot be guaranteed. Make sure to discuss the surgery in detail with your doctor, and have all of your questions answered.
Below are Educational Animations to help explain about Cataracts and Cataract Surgery. To view in Spanish, select Spanish from the Languages drop down menu.
Diabetes and the Eye
Diabetes mellitus is a condition in which the body does not properly use and store sugar. The excess sugars that develop in the blood stream of a person with diabetes can lead to excessive urination and increased thirst. Over the long-term, the erratic blood sugar levels in a diabetic can different organs throughout the body. In the eye it can cause cataracts, glaucoma and even damage the blood vessels inside the eye.
During periods of uncontrolled diabetes, the diabetic's blood sugar level may become very high. When the blood sugar stays very high it may cause swelling of the lens of the eye. This will lead to a blurring of the vision. Fortunately, when the blood sugar returns to normal and stays normal, the lens swelling will subside and the vision will return to baseline. While this is not a very serious problem, diabetes can lead to permanent vision loss if not detected and treated early.
The retina is a nerve layer in the back of the eye that senses light and helps send images to the brain. Diabetes can damage the blood vessels in the retina causing them to leak blood or fluid. This can blur the vision especially if it affects the macula, that part of the retina that serves our most sensitive vision. If detected early enough, such swelling can often be treated with laser photocoagulation. A powerful beam of laser light is used to painlessly seal these leaking vessels.
Diabetes can also cause the blood vessels in the retina to grow fragile brush-like branches that can bleed. Severe bleeding in the eye can seriously diminish vision. Diabetics who develop such brush-like vessels can also develop scar tissue on the retina that can tug at the retina putting the patient at risk for retinal detachments. If these fragile vessels are detected before they bleed or cause scar tissue, their growth can be reduced and often halted by laser treatments. More advanced cases in which there is sever bleeding and/or retinal detachments require actual eye surgery to correct.
These abnormal blood vessels can also grow on the iris (e.g., the colored part of the eye around the pupil). When this happens the patient can develop a sever form of glaucoma as the pressure in the eye rises. Laser treatments can also be helpful in controlling the glaucoma if caught early enough.
Diabetes is the leading cause of new blindness among adults. The longer a person has diabetes, the more risk there is of developing diabetic eye disease. Fortunately today, with improved methods of diagnosis and treatment, only a small percentage of people with diabetes develop severe vision problems.
Early detection is the key to treatment in diabetic eye disease. Since the patient may not experience symptoms until the damage is advanced, it is important for each diabetic to have regular eye exams every year. In addition, pregnancy and high blood pressure can aggravate diabetic eye disease. Any diabetic who becomes pregnant should have their eyes examined in the first trimester even if they had a normal eye exam shortly before becoming pregnant. A diabetic whose blood pressure is not controlled should also have their eyes examined more frequently.
Despite the potentially severe affects of diabetes in the eye, a diabetic can maintain excellent ocular health. The best protection for a diabetic's eyes is to have regular medical eye examinations by an ophthalmologist (medical eye doctor). In addition, blood sugar control, attention to one's diet, avoiding smoking and watching blood pressure can aid a diabetic from losing the precious gift of sight.
Below are Educational Animations to help explain about Diabetes and the Eye. To view in Spanish, select Spanish from the Languages drop down menu.
EyeCommitted
Help prevent unnecessary vision loss from diabetes. Show your support for the importance of an annual diabetic eye exam. Get EyeCommitted today!
Floaters are a common visual occurrence. They are often described as small specks, cob-webs, or dots floating in the vision. They appear to move with the vision.
The back of the eye is filled with a gel called the vitreous. When we are young the vitreous is a firm gel, like a bowl of hardened Jell-O. As we get older, this firm gel normally begins to liquefy, just like a bowl of Jell-O does if it is left sitting out. As the vitreous gel liquefies we may begin to see the material that comprise it. These clumps of gel we see are the floaters.
Often the liquefaction of the vitreous is a gradual process. The floaters may come and go and are few in number. Occasionally, however, the vitreous may liquefy suddenly, pulling away briskly from the retina. When this happens, the vitreous may tug sharply on the retina. This pulling on the retina will stimulate the retinal cells and cause a flash of light to be perceived by the person.
If the pull of the vitreous on the retina is great enough, it can tear a hole in the retinal wall. This may lead to the release of hundreds of retinal cells or even blood. This can lead to a shower of spots. This shower of spots is much more serious than the occasional floater described above. A tear in the retina can lead to a retinal detachment, a potentially blinding condition.
Therefore, it is important to let your ophthalmologist know about floating spots. If you ever develop a sudden onset of floaters, if you ever have a dramatic increase in the number of floaters you see, or if you ever see flashes of light, CALL YOUR OPHTHALMOLOGIST IMMEDIATELY! A retinal hole or detachment is treatable if caught early, but disastrous if not treated.
Below are Educational Animations to help explain about Floaters and Flashes. To view in Spanish, select Spanish from the Languages drop down menu.
Glaucoma is not one disease. There are many types of glaucoma, but in all of them, the optic nerve behind the eye is damaged. This damage results in a very characteristic loss of peripheral, or side, vision. If left untreated, eventually the vision is lost completely leading to complete blindness. This can happen in one eye or both eyes. Glaucoma is one of the main causes of blindness in the US. It affects millions of people. Unfortunately, many people don't know that they have glaucoma.
Glaucoma is not one disease. There are many types of glaucoma, but in all of them, the optic nerve behind the eye is damaged. This damage results in a very characteristic loss of peripheral, or side, vision. If left untreated, eventually the vision is lost completely leading to complete blindness. This can happen in one eye or both eyes. Glaucoma is one of the main causes of blindness in the US. It affects millions of people. Unfortunately, many people don't know that they have glaucoma.
In glaucoma, usually the pressure inside the eye is too high. The eye is filled with fluid called aqueous humor. This fluid must drain out of the eye to prevent this pressure build-up. If there is a problem with the drainage inside the eye, the pressure inside the eye will increase. In most patients this pressure increase is gradual, and will generally produce no early symptoms. This is called chronic glaucoma. But if the pressure increase is sudden, it can produce severe pain and rapid loss of vision. This is called acute glaucoma.
The optic nerve, like the brain, does not grow back. Therefore, damage to the optic nerve from glaucoma is not reversible. Once vision is lost from glaucoma, nothing can be done to bring it back. This is why it is so important to catch and begin glaucoma treatment as soon as possible, before it causes any damage, or at least when the damage is minimal. The goal of treatment is to prevent glaucoma from getting worse. To make sure glaucoma is not getting worse, our glaucoma specialists at MEA check the eye pressure at every office visit. Other tests, such as the visual field tests and optic nerve imaging tests, are performed on a regular basis as well. MEA has the latest equipment to help monitor for glaucoma progression.
The only treatment proven to stop glaucoma is lowering the pressure inside the eye. There are different ways to lower the eye pressure, and treatment options vary depending on the severity and type of glaucoma. Our glaucoma specialists at MEA will determine the most appropriate treatment for you. Treatments may include eyedrops, pills, laser procedures, and surgery. Eye drops must be used daily, often long-term, to maintain the eye pressure at a low level. Laser procedures are performed in our offices and are generally painless, quick, and are low-risk. Surgery for glaucoma is performed in the operating room. Surgery is the most effective treatment to lower eye pressure, but it also has more risk. The "gold standard" surgical procedure for glaucoma is called trabeculectomy and it is the most commonly performed glaucoma operation. Our glaucoma specialists at MEA were trained at some of the most prestigious academic centers to perform glaucoma surgery using the latest techniques available.
In most patients, glaucoma is a treatable condition. The key to glaucoma treatment, as with many other diseases, is early detection and faithful adherence to the treatments prescribed by your doctor at MEA.
Increased eye pressure is the greatest risk factor for the development of glaucoma. There are other significant risk factors. If a family member has glaucoma, make certain your eyes are checked regularly. Also, African-Americans have a 4 times greater risk for glaucoma than whites. Age is a risk factor, especially if you are over 40. Nearsightedness, or myopia, is another risk factor. If you have poorly controlled diabetes, you are also at higher risk for glaucoma.
Below are a group of Educational Animations that help explain Glaucoma. To view in Spanish, select Spanish from the Languages drop down menu.
The back of the eye is lined with a layer of cells called the retina. The retina is responsible for changing the light that enters our eye into an electrical signal that then goes to the brain where it is processed into vision. Within the retina is a small area where the cells are very, very sensitive. This area of the retina is responsible for our finest, central vision. It is called the macula.
Look at the diagram below. Stare directly at the words "Fine Vision". As you do this, you should be able to appreciate that there are words "Side Vision" to either side of "Fine Vision". However, the words "Side Vision" will not be in sharp focus. The reason for this is that when we look at something directly we are using the macula, that area of the retina that serves our finest vision. At the same time, the remainder of the retina is still helping to perceive our world, and is providing us with our side, or peripheral, vision.
The macula, possibly because its cells work very hard to serve our central vision, can deteriorate as part of the body's natural aging process. When this occurs, a person's fine, or central vision becomes affected. Although macular degeneration reduces vision in the center, it does not affect the side vision. So a person with macular degeneration may not be able to see the words fine vision above, but would be able to tell that there were the words side vision. Likewise, patients could see the outline of a clock, but not be able to tell what time it is. Macular degeneration alone does not result in total blindness. People continue to have side vision.
This usually allows them to take care of themselves.
The cause of macular degeneration is not known. We know that it occurs as part of the aging process in some people, although there are also "juvenile" forms of the condition that develop in people at much younger ages. We do know that macular degeneration can run in families. It has also been linked to smoking. In addition, it tends to be more common in women, fair skinned people and light eye colored individuals. The absence of these risk factors, however, does not mean macular degeneration cannot occur.
There are two common types of macular degeneration: "dry", or atrophic, macular degeneration, and "wet", or exudative, macular degeneration.
Dry Macular Degeneration: Most people (90%) who have macular degeneration have this form of the condition. In dry macular degeneration the deterioration of the macula leads to thinning of the macular tissue. This thinning of the tissue leads to progressive loss of vision. It tends to be slow in progression. There, unfortunately, are no treatment for this type of degeneration.
Wet Macular Degeneration: Wet, or exudative, macular degeneration account for about 10% of all cases of the condition. The wet form occurs when abnormal blood vessels form in the deteriorating macula. These abnormal blood vessels will leak fluid or blood and cause a dramatic loss of central, or fine vision. This leads to a severe and rapid loss of vision. If the wet form is caught early enough, laser treatment can be used to try and halt the bleeding of these vessels.
The symptoms are wide and varied. In some people, the early form of the degeneration may be hardly noticeable. Sometimes the condition affects only one eye while the other eye continues to see well, so that symptoms are minimized.
When both eyes are affected, the symptoms will be noticed as a disturbance in central, or fine vision. Words on a page may become blurred, straight lines (especially vertical edges of door frames, etc.) may become crooked, and dark or empty areas may appear in the center of one's vision.
A complete eye exam by an ophthalmologist (medical doctor who specializes in the eye) is needed to determine if a person has macular degeneration. Simple in office tests combined with the doctor dilating your pupils and looking at your macula under magnification will allow him or her to tell if you suffer from macular degeneration.
Despite ongoing medical research, there is no treatment or cure for the dry form of the condition. Some doctors believe that nutritional supplements may slow the deterioration, although this has not been proven. Treatment now focuses on helping people find ways to cope with the visual impairment.
The wet form of the degeneration can be treated with laser if caught early. This laser treatment will not bring the vision back to normal, but is done to prevent the person from losing all of their central vision.
Despite advanced medical treatment, people with macular degeneration still experience vision loss. Matossian Eye is proud to offer the services of a low vision specialist who can help select optical and non-optical devices to aid a person in their activities of daily living. While the vision loss cannot be reversed, the goal of our low vision service is to help people maintain a satisfying lifestyle.
Below are a group of Educational Animations that help describe Macular conditions described here on our website. To view in Spanish, select Spanish from the Languages drop down menu.
You can check your vision daily by using an Amsler grid like the one pictured below. You may find changes in your vision you would not notice otherwise. Putting the grid on the refrigerator door is a good way to remember to look at it each day.
To use the grid:
wear your reading glasses and look at the grid from a distance of
12 - 15 inches in good light.
cover one eye.
look at the center dot with the uncovered eye.
While looking at the center dot, note whether all of the lines are straight or if any areas are distorted, blurred or dark.
repeat this procedure with the other eye.
if any area of the grid looks wavy, blurred or dark, contact your ophthalmologist immediately.
A healthy and stable tear film is essential for someone to enjoy good quality vision. When the over all balance and stability of the tear film is disrupted either by a decrease in production of the watery portion to our tears or an increase in evaporation of our tears patients can develop dry eyes. This can lead to discomfort and difficulties in performing certain activities such as computer use and extended periods of reading. Treatments are directed at improving the tear film balance to maintain good quality vision and minimize symptoms.
Who is likely to develop dry eye?
Elderly people frequently experience dryness of the eyes, but dry eye can occur at any age. Nearly five million Americans 50 years of age and older are estimated to have dry eye. Of these, more than three million are women and more than one and a half million are men.
What are the signs and symptoms of dry eye?
Signs and symptoms of dry eyes, which usually affect both eyes, may include any of the following:
stinging, burning or scratchy sensation in your eyes
sandy or gritty feeling as if something is in the eye
a stringy discharge from the eye
episodes of excess tears following very dry eye periods
pain and redness of the eye
heavy eyelids
inability to cry when emotionally stressed
increased eye irritation from smoke or wind
episodes of blurred vision
decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention
sensitivity to light
difficulty wearing contact lenses
eye fatigue
What are the causes of dry eye?
Our tears are formed by the delicate balance of three main components:
an oily portion- which is produced by the meibomian glands (located behind the eyelashes) and prevents premature evaporation of the watery portion
a watery portion- which is produced by the tear glands (lacrimal) and promotes cleansing and removal of foreign particles and irritants
a mucous portion- which is produced by the goblet cells and allows the tears to spread evenly over the eye
A disruption in any one of these components can lead to dry eyes. Dry eye can be a temporary or a chronic condition that can have multiple causes. Patients typically fall in two categories: those who have excessive tear evaporation and those who do not produce enough tears.
There are a number of factors that can cause excessive tear evaporation including environmental, certain sustained visual tasks and inflammatory conditions of the eyelids. The environmental factors include being exposed to forced hot air heat at home or at work, dry climates, air travel, reduced blinking from contact lens wear, air pollution or even just blowing your hair dry. Visual tasks that can lead to excessive tear evaporation from reduced blinking include extended periods of reading and computer use. Your tears may also evaporate too quickly if you suffer from a particular eyelid inflammation known as meibomian gland dysfunction or posterior blepharitis. The meibomian glands are the oil producing glands of the eyelids. Rosacea, a skin disorder, can be seen quite commonly in association with this posterior blepharitis.
Inadequate tear production is probably the biggest and most common cause of dry eye especially after the age of 40. As we age tear production normally decreases which affects the largest component to our tear film, the watery portion. Although this can occur in men and women, it affects women more often especially after menopause because of the hormonal changes. Other causes include damage to the lacrimal glands from inflammation and radiation, systemic diseases such as diabetes, rheumatoid arthritis, lupus, scleroderma and Sjogren's syndrome, refractive eye procedures such as LASIK and medications.
The most common medications both prescription and over-the-counter (OTC) that decrease tear production are:
Diuretics, Angiotensin-converting enzyme (ACE) and Beta-blockers drugs commonly used to treat high blood pressure
Antihistamines and decongestants
Sleeping pills
Birth control pills
Certain antidepressants
Isotretinoin-type drugs for treatment of acne
Opiate-based pain relievers, such as morphine
Another cause for dry eyes that is not as common is poor lid function. This may be due to a number of factors including:
Improper or incomplete closure of your eyes during sleep
Eye “bulging” conditions that may be related to thyroid problems
Loss of tone or shape of the eyelids so that they turn in or turn out, called entropion and ectropion.
How do you diagnosis dry eye?
The proper diagnosis of dry eyes requires a thorough dry eye examination. At Matossian Eye Associates, we will take time to carefully review your medical history, eye history and eye conditions including any medications that you are taking. Please be sure to tell us about all of the medications you take or have taken recently, including not only the ones prescribed, but also those that you may have purchased over the counter at the pharmacy.
Next, we will evaluate your tear production by using a specialized microscopic technique to observe the height of the tear film and may also use a clinical test called a Schirmer test that allows us to actually measure the rate at which you produce natural tears. We may also use specially formulated dyes such as Fluorescein, Lissamine Green and Rose Bengal to help investigate the functioning of the various layers of the tear film as well as the underlying surface of the eye. This is not uncomfortable and will not interfere with your vision.
From this information, we will be able to make a proper diagnosis as to the particular cause of your dry eye syndrome and prescribe the necessary treatment.
How is dry eye treated?
Depending on the cause and severity of your dry eyes our Doctors at Matossian Eye Associates may recommend a number of different treatment options.
If you have mild to moderate dry eyes associated with inadequate tear production then typically the first line of treatment is the use of preserved artificial tears. If patients do not respond to this treatment or present with moderate to severe dry eyes then unpreserved tears with the addition of an artificial tear ointment and maybe a medicated drop by the name of Restasis® may offered. Restasis® works on the inflammatory component of dry eyes and can help you produce more of your natural tears.
How to put eye drops into your eyes:
Six Steps for One Drop
Tip your head back or lie on a couch and look straight up at the ceiling.
Hold the bottle perpendicular to the floor and look up at the bottle tip, which should be a few inches above your eye.
Pull the lower lid down with one hand.
Steady your hands by resting the wrist of the hand holding the bottle onto the hand holding the eyelid.
Apply a drop.
Keep the bottle from touching the eye or it can become contaminated. And do not attempt to look in a mirror during instillation; this practically guarantees drops will fall to the floor.
In instances where these approaches do not adequately relieve your dry eye symptoms then we may suggest conserving your eye’s own tears. This can be accomplished by inserting punctal plugs in the holes (puncta) located on the upper and lower eyelids toward your nose. Here is where your tears drain into your nose and then into the back of your throat. These plugs are made of silicone plastic and are easily and comfortably inserted in the office.
Even with the above treatment options, there are some patients that may not respond as well as we would like because of some underlying inflammatory condition such as meibomian gland dysfunction (posterior eyelid inflammation). In addition to lid hygiene these patients may require a topical medication by the name of Azasite® or an oral antibiotic as last resort.
Recently some studies have shown that omega 3 fatty acids (O3FAs) may be of benefit in patients with dry eye. O3FAs are a natural anti-inflammatory that can help a multitude of inflammatory conditions that affect the body including dry eyes. Patients can obtain their source of O3FAs by increasing their diets in foods rich in O3FAs such as fish (salmon, sardines and anchovies.) However, because of the concerns with the mercury and other impurities in fish O3FA supplements have become quite popular. We here at Matossian Eye Associates are pleased to be able to offer a high quality O3FA supplement for the treatment of dry eyes. Dry Eye Omega Benefits® which is produced by PRN (Physician Recommended Nutriceuticals) is custom formulated with a high concentration of the anti-inflammatory Omega-3, EPA (eicosapentaenoic acid) in its natural TG form for natural relief of dry eyes and support of proper tear function.
Other steps in addition to the above mentioned treatments that can be utilized to help with minimizing environmental factors that can cause and exacerbate dry eyes include:
Avoid air blowing in your eyes. Don't direct hair dryers, car heaters, air conditioners or fans toward your eyes.
Wear glasses on windy days and goggles while swimming. The wraparound style of glasses may help reduce the effects of the wind.
Add moisture to the air. In winter, a humidifier can add moisture to dry indoor air. Some people use specially designed glasses that form a moisture chamber around the eye, creating additional humidity. These glasses can be worn at night, and may be especially helpful for people that sleep with their eyes partially open. They can also be worn during the day to relieve dry eye symptoms.
Avoid rubbing your eyes. You can irritate your eyes further by rubbing them.
Take preventive steps. Use eye drops before, rather than after, your eyes become irritated as a result of visually demanding activities. Try to avoid activities that might worsen the problem.
Remember to blink. Consciously blinking repeatedly helps spread your own tears more evenly. When performing tasks that require intense visual concentration, take occasional breaks — adding up to about five minutes each hour — and rest your eyes by closing your lids for several seconds. Follow this by consciously increasing your blink rate. Be especially careful to follow these suggestions if you have had LASIK or a similar procedure.
Avoid smoke. Smoke, whether yours or someone else's, can contribute to dry eyes.
As you can see the diagnosis and treatment of dry eyes is complex and requires patience and persistence on the part of the eye doctor and the patient. Through careful evaluation and systematic therapeutic approach dry patients can experience significant improvement. If you have any questions about dry eye or feel you may be suffering from dry eye please call to schedule an appointment with one of our Doctors.
Dry Eye Questionnaire
Do you think you may have Dry Eye Syndrome? Be proactive by answering this questionnaire about your daily activities and symptoms. Share your answers with your eye care physician on your next visit to Matossian Eye Associates. A complete examination is necessary to diagnose Dry Eye Syndrome.
A chalazion, also referred to as a stye, is caused by a blockage of one of the oil glands along the lid margin. When one of these oil glands becomes plugged, its contents back up causing swelling. The swelling causes pressure which is why a stye tends to be very sensitive. Blocked oil is released into the surrounding tissues causing the inflammation and redness associated with a stye. Chalazion can affect any age group from small children to older individuals.
While chalazion are often unsightly and uncomfortable, they generally go away spontaneously. In fact, 90% of styes will resolve on their own within 3 to 4 weeks of their appearance.
To aid in the resolution of your chalazion, we suggest you use a warm compress on the eye at least 4 times a day, more if possible, until either the stye resolves or a month passes.
Warm Compresses
use water from the tap that is hot but not so hot as to burn!
wet a wash cloth with the water.
wring out the cloth so that it is warm and moist.
place over closed eye.
repeat the dipping in warm water whenever the cloth becomes cool.
continue for a total of 15 minutes each time and repeat at least 4 times a day.
If the stye is still large and firm after a month, it is unlikely that it will go away completely on its own. In that case various options exist: you may elect to do nothing or we can incise and drain it in the office. Steroid injections into the stye have been used in the past, but recent evidence shows that their success rate is poor and they can lead to complications. We generally do not recommend steroid injections into the styes.
Your doctor will discuss these treatment options with you in more detail. As always, if you have any questions, please do not hesitate to ask us!
Tears are very beneficial for our eyes. They help keep the eyes moist, can aid in flushing out foreign substances, and even help to express your deepest emotions. But sometimes people tear for reasons that are not normal or beneficial. Oftentimes such tearing is a real hindrance to normal activities.
Excess tearing can produce many symptoms. Some people actually have tears overflow onto their cheeks, while in others the tears produce a moist appearance to the eye. Some people complain that they constantly have to blot their eyes dry and are never without a tissue for this reason. Whatever the symptom, the excess tears can cause blurry vision, redness of the lids, and may even lead to eye infections.
In order to understand tearing problems, it is helpful to know a little bit about the anatomy of tear production and drainage. Tears are produced by glands in the eyelids. There are two types of tears; baseline tears, which are present constantly and serve to keep the eye moist, and reflex tears which are produced in response to some stimulation, such as foreign body or emotion. The tears are then drained from the eye via small opening in the inner aspect of each eyelid. From these openings, the tears drain through a duct into the nose (see figure). This explain why our nose runs when we cry. Excess tearing in adults can occur because of a number of problems ranging from tear production to drainage.
Many conditions cause excess tearing. Surprisingly, people with dry eye may complain of tearing. This is because the dryness causes the eye to become irritated, and this, in turn, stimulates the lacrimal gland to work overtime. Excess tears are then formed which may role down the face. The treatment in dry eye, therefore, is aimed at the reducing the dryness which causes the irritation either through artificial tears or tiny plugs that block the drainage holes for the tears.
Likewise, allergies can produce tearing by causing eye irritation. The eye reacts to allergies much like it reacts to a foreign body, it wants to 'tear' the offending agent out of the eye. Unlike a foreign body, however, allergies cannot be washed away and the tearing may become chronic. Allergies can usually be treated with drops.
Abnormalities of the lid may also lead to excess tears. A lash that turns inwards can irritate the eye leading to tearing. This is easily treated by removing the offending lash. In addition, a lid that droops or otherwise does not sit in a normal position may cause tearing by not properly pumping the tears out of the eye. Returning the eyelid to its normal position thorough some simple surgical procedures generally takes care of the problem.
The tears drain from the eye through a small opening in each eyelid. From this opening, a canal drains the tears into the nose. This explains why we have a runny nose when we cry. Blockage of the canal that drains the tears is very common, especially as one gets older. In situations where the canal is blocked, surgery can usually take care of the problem.
In short, in almost every case of tearing there is a treatment plan that can help. Deciding on a proper course of treatment, however, begins with a thorough history into the nature of the tearing, and then a proper examination of your eyes and tear ducts.
While there are many causes of tearing in children, the majority in the first year of life are related to congenital obstruction of the nasolacrimal duct (NLD).
The following statistics are of interest:
6% of all newborns have a persistent congenital NLD obstruction
Of these, the majority will clear spontaneously.
of the children tearing at 3 months of age, 80% may spontaneously resolve by 12 months of age.
of those tearing at 6 months of age, 70% may resolve by 12 months.
of those tearing at 9 months of age, 50% may resolve by 12 months.
The following treatment options exist:
Medical management/massage/topical antibiotics
Surgical management:
probing only
probing and irrigation
infracture of the inferior turbinate
silastic intubation
dacryocystorhinostomy (DCR)
conjunctivo-DCR
Probing can be done either in the office or in the operating room under general anesthesia. In-office probing is limited to children under 6 months of age. Since most of these resolve on their own, in-office probing may be excessive treatment. In addition, in-office probing is uncomfortable and cannot provide a diagnostic probe. We generally reserve in-office probing only for those rare instances where a child was born with a swollen, infected tear sac.
Probing under general anesthesia allows for a complete evaluation and offers us the ability to do additional procedures at the time if required. The success of one probe and irrigation decreases the older the child is:
If the child was initially probed when less than 13 months, approximately 95% will be cured with the first probing.
If the child was initially probed between the ages of 13 and 18 months, 75% will be cured with the first probe.
If initially probed when older than 24 months, only 33% will be cured with one probe.
Any decision regarding the treatment of your child requires the active participation of YOU, the parent. We are here to answer any and all questions you may have; do not hesitate to ask!
Cataract surgery is usually performed under local anesthesia on an out-patient basis. Your ophthalmologist uses a microscope and delicate instruments to remove the cataract. In most cases, the focusing power of the eye is restored by placing a permanent lens implant inside the eye. This plastic lens implant is held in place inside the eye by a natural membrane. In approximately 20% of people, this natural membrane will become cloudy causing a decrease in vision. When this occurs, a laser can be used to open this cloudy membrane and restore vision. Thus, the laser is used after the initial cataract surgery, and only when that membrane becomes cloudy. Lasers are not used to remove the cataract itself! 
Diabetes mellitus is a condition in which the body does not properly use and store sugar. The excess sugars that develop in the blood stream of a person with diabetes can lead to excessive urination and increased thirst. Over the long-term, the erratic blood sugar levels in a diabetic can different organs throughout the body. In the eye it can cause cataracts, glaucoma and even damage the blood vessels inside the eye. 
Early detection is the key to treatment in diabetic eye disease. Since the patient may not experience symptoms until the damage is advanced, it is important for each diabetic to have regular eye exams every year. In addition, pregnancy and high blood pressure can aggravate diabetic eye disease. Any diabetic who becomes pregnant should have their eyes examined in the first trimester even if they had a normal eye exam shortly before becoming pregnant. A diabetic whose blood pressure is not controlled should also have their eyes examined more frequently. 
