The cornea, the clear front window of the eye, is comprised of 5 layers of complex tissue: Epithelium, Bowman’s Layer, Stroma, Descemet’s Membrane, and Endothelium. The following section highlights conditions, injuries, and surgical treatments that affect this structure of the eye.
- Pinguecula & Pterygium
A pinguecula is a yellowish patch or bump on the white part of the eye, most often on the side closest to the nose. It is not a tumor, but an alteration of normal tissue resulting in a deposit of protein and fat. Unlike a pterygium, a pinguecula does not actually grow onto the cornea. A pinguecula may be a response to chronic eye irritation or sunlight.A pterygium is ﬂeshy tissue that grows over the cornea (the clear dome in the front of the eye). It may remain small or may grow large enough to interfere with vision. A pterygium most commonly occurs on the inner corner of the eye, but can appear on the outer corner as well. The exact cause is not well understood, but pterygia occur more often in people who spend a great deal of time outdoors, especially in sunny climates. In areas of the world in which the population are predominantly ﬁshermen or farmers, pterygia are extremely common. Long-term exposure to sunlight, especially ultraviolet (UV) rays, and chronic eye irritation from dry, dusty conditions seem to play an important causal role. A dry eye may contribute to pterygium. Sunglass wear with UV protection and the use of artiﬁcial tears might reduce the incidence and growth rate of pterygia.
When a pterigium becomes red and irritated, eye drops or ointments may be used to help reduce the inﬂammation. If the pterygium is large enough to threaten sight or grows rapidly, it should be removed surgically. Despite proper surgical removal, the pterygium may return.
The diagnosis of pinguecula or pterygium should be made by your eye doctor. Although rare, certain eye cancers mimic the appearance of a pinguecula or pterygium. A thorough eye exam by an eye professional will determine the appropriate treatment.
- Dry Eye
What is dry eye syndrome?
The eye depends on the flow of tears to provide constant moisture and lubrication to maintain vision and comfort. Tears are a combination of water (for moisture), oils (for lubrication), mucus (for even spreading), and antibiotics and special proteins (for resistance to infection). These components are secreted by special glands located around the eye. When there is an imbalance in this tear system, a person may experience the symptoms of dry eye syndrome.
What are the symptoms of dry eye syndrome?
When tears do not adequately lubricate the eye, a person may experience:
- Light sensitivity
- A gritty sensation
- A feeling of a foreign body or sand in the eye
- Blurred vision
- Watering or tearing
Paradoxically, a person with dry eye syndrome will have excess tears running down their cheeks. This “reflex tearing” actually occurs when the eye is not receiving sufficient lubrication. The eye sends a distress signal through the nervous system for more lubrication and, in response, the eye is flooded with reflex tears to try to compensate for the underlying dryness. These tears, however, are composed mostly of water and do not have the lubricating qualities or the rich composition of normal tears. They will wash away debris, but they will not coat the eye surface properly.
What causes dry eye syndrome?
In addition to a decrease in the production of lubricating tears by the tear glands, dry eye syndrome can be caused by the drying out of the tear film. This can be due to air conditioning, heat, or other environmental conditions. Other conditions that may cause dry eye syndrome are:
- The natural aging process
- Side effects of certain medications such as antihistamines and medications that treat high blood pressure and elevated cholesterol
- Diseases that affect the ability to make tears, such as rheumatoid arthritis and collagen vascular diseases
- Structural problems that prevent the eyes from closing properly
- Blocked meibomian glands that secrete the natural oils needed for proper lubrication in the tear film
How common is dry eye syndrome?
“Dry eye” is an extremely common eye condition, with incidences and symptoms that increase with age. In the United States, approximately six million women and three million men experience moderate or severe dry eye symptoms, and scientists estimate that an additional 20 to 30 million people in this country have mild cases of dry eye. Diabetes is the number one systemic disease implicated in dry eye.
How is dry eye syndrome treated?
Although dry eye syndrome cannot be cured, there are a number of steps that can be taken to treat it. We specialize in treating dry eye syndrome and will discuss your options with you to individualize your dry eye therapy.
Treatment options include the following:
Artificial tear drops and ointments
The use of over-the-counter artificial tear eye drops is the primary treatment for dry eye syndrome. We offer many samples of artificial tears for you to try, because no one brand works for everyone and you might have to try more than one to find the drop that works best for you. Some artificial tear brands contain more preservatives than others, and an individual may find these preservatives irritating. Preservative-free artificial tears are available and may be less irritating. If you have chronic dry eye, it is important to use the drops even when your eyes feel fine, to keep them lubricated. If your eyes dry out while you sleep, you can use a thicker lubricant, such as an ointment or gel, at bedtime.
Temporary tear savers
Tear savers are small plugs placed in the ducts that drain tears out of the eye. They help to “save” or “conserve” the eye’s natural tears to maintain lubrication, so tears do not drain too quickly. Temporary collagen tear savers are easily placed in the tear ducts via a painless procedure. The various type of tear savers available can last from one week to several months. Your doctor may place these temporary plugs to determine whether permanent plugs can provide an adequate supply of tears.
Blepharitis/Meibomitis (Lid Margin Disease)
These conditions are caused by persistent inflammation of the eyelids. Symptoms include irritation, itching, and occasional red eye(s). It occurs commonly in people who have a tendency towards oily skin, dandruff, or dry eyes. Acne, rosacea, and eczema are frequently associated with some form of lid margin disease.
Bacteria normally resides on everyone’s skin, but in some people it thrives in the skin at the base of the eyelashes. Nearby oily glands may be overactive, causing dandruff-like scales and particles to form along the lashes and the eyelid margins, resulting in redness, stinging, or burning. The dryness that results from these entities might also result in discomfort and, occasionally, blurred vision.
Lid margin disease may not be cured, but it can be controlled with a few simple daily hygienic measures:
- At least twice a day, place a warm, wet washcloth over the closed eyelids for about 5 minutes. Rewet it as it cools, two or three times. This will soften and loosen scales and debris. More importantly, it helps liquefy the oily secretions from the eyelids’ oil glands that help prevent the development of a chalazion (stye), an inflamed lump in the eyelid oil gland.
- With your finger or a cotton swab or commercial lint-free pad, gently scrub the base of the lashes about 15 seconds per lid using warm water and diluted Baby Shampoo.
When medications are necessary, they may include:
- Artificial tears to relieve symptoms of dry eye. (These are eye drops which are available without a prescription)
- Antibiotics (ointments or drops) to decrease bacteria on the eyelids. Occasionally, even oral antibiotics are employed in this task.
- Steroids (ointment or drops) to decrease inflammation.
However, medications alone are not sufficient in the treatment of these conditions. The application of warmth and careful cleansing of the lashes daily is key to controlling lid margin disease.
Keratoconus is a disorder that is characterized by a progressive steepening of the cornea, typically just below the center. This results in a more pointed, cone-shaped center and blurred vision. Rarely, a medical condition can be associated with keratoconus, but the most common link to this disorder is that of allergic eye disease. Research has shown that eye rubbing, perhaps in response to itchy eyes, can worsen or even cause keratoconus. Eye-rubbing is never advocated by your eye physician and itchy eyes can be treated more effectively with drops or systemic allergy medications when necessary.
The treatment for the blurred vision which results from keratoconus is spectacles followed by hard contact lenses when spectacle correction becomes ineffective. Over time, the progressive corneal thinning may lead to breaks in the cornea and subsequent scarring or discomfort. When this occurs, or the vision cannot be corrected effectively with contacts or glasses, a corneal transplant can be performed.
Any scratch, or scrape on the surface of the cornea—the outermost clear, dome-shaped tissue of the eye–is called a corneal abrasion. Typically, these injuries are caused by direct contact with things like a fingernail, tree branch, or makeup brush. You may experience pain as the injury occurs, or later you may feel pain and a foreign body sensation.
Corneal abrasions can also be caused when airborne particles such as dust, wood, or metal shavings make contact with the eye. Even contact lenses and conditions such as dry eye can cause abrasions.
Common Symptoms include:
- Eye Redness
- Sensitivity To Light
- Blurred Vision
If you experience a corneal abrasion is it important that you visit your eye doctor within 24 hours of experiencing pain or discomfort. If left untreated, a corneal abrasion can lead to a secondary infection that can threaten vision in the absence of immediate medical attention.
A cornea transplant removes the central portion of the diseased cornea which is replaced with a healthy donor cornea.
Causes of Cornea Damage:
- Previous Eye Surgery
If damage is severe and all other options have been explored, a cornea transplant may be necessary. Common complications of a transplant include rejection of the donor cornea.
Ocular Herpes is a common recurrent viral infection that affects the eyes. It can cause scarring and inflammation of the cornea. One type of Ocular Herpes is known as Herpes Simplex Keratitis, or HSVK. It is typically transmitted through contact with another person who is having an outbreak.
If you have been under extreme amounts of stress and/or feeling tired ill or generally worn down this opportunistic infection can develop.
Signs & Symptoms:
- Ocular Pain
- Sensitivity to Light
- Corneal clouding which can result in blurry vision
In mild cases vison can become blurred, and, in some cases, vision may never return to its original state.
Seasonal Allergic Conjunctivitis
Many people in the US suffer from seasonal itchy, swollen, red eyes. Airborne allergens such as house dust, animal dander, and mold constantly bombard the eyes and can cause ocular allergies at anytime. But when spring rolls around and the plant pollen starts flying, it seems like everyone starts crying. Seasonal allergic conjunctivitis, or hay fever, is the most common allergic eye problem. Various antihistamine and decongestant drops and sprays can soothe irritated eyes and nose.
Make every effort to avoid allergens. An allergist can help determine what you are allergic to so you can stay away. Avoiding outdoor pollen may be impossible, but remaining indoors in the morning when the outdoor pollen levels are highest may help control symptoms. If you are allergic to house dust, open windows and keep household filters clean.
Cool compresses decrease swelling and itching. Artificial tears dilute the allergens and form a protective barrier over the surface of the eye. Rubbing the eyes makes symptoms worse and should be avoided. If seasonal allergic conjunctivitis is a problem, make an appointment with one of our doctors – there are several new, safe, and effective anti-allergy drops that can be prescribed. Also, a doctor can ensure symptoms are not being caused by a more serious problem.