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Dry Eye

Dry eye is a condition in which there are insufficient tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing clear vision. People with dry eyes either do not produce enough tears or have a poor quality of tears.

Dry eye is a common and often chronic problem, particularly in older adults.
With each blink of the eyelids, tears are spread across the front surface of the eye, known as the cornea. Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye, and keep the surface of the eyes smooth and clear. Excess tears in the eyes flow into small drainage ducts, in the inner corners of the eyelids, which drain in the back of the nose.

Dry eyes can result from an improper balance of tear production and drainage.

Inadequate amount of tears – Tears are produced by several glands in and around the eyelids. Tear production tends to diminish with age, with various medical conditions, or as a side effect of certain medicines. Environmental conditions such as wind and dry climates can also affect tear volume by increasing tear evaporation. When the normal amount of tear production decreases or tears evaporate too quickly from the eyes, symptoms of dry eye can develop.
Poor quality of tears – Tears are made up of three layers: oil, water, and mucus. Each component serves a function in protecting and nourishing the front surface of the eye. A smooth oil layer helps to prevent evaporation of the water layer, while the mucin layer functions in spreading the tears evenly over the surface of the eye. If the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers, dry eye symptoms can develop.

The most common form of dry eyes is due to an inadequate amount of the water layer of tears. This condition, called keratoconjunctivitis sicca (KCS), is also referred to as dry eye syndrome.

People with dry eyes may experience symptoms of irritated, gritty, scratchy, or burning eyes, a feeling of something in their eyes, excess watering, and blurred vision. Advanced dry eyes may damage the front surface of the eye and impair vision.

Treatments for dry eyes aim to restore or maintain the normal amount of tears in the eye to minimize dryness and related discomfort and to maintain eye health.

Conjunctivitis

The cause of conjunctivitis varies depending on the offending agent. There are three main categories of conjunctivitis: allergic, infectious and chemical:

Allergic Conjunctivitis

Allergic Conjunctivitis occurs more commonly among people who already have seasonal allergies. At some point they come into contact with a substance that triggers an allergic reaction in their eyes.
Giant Papillary Conjunctivitis is a type of allergic conjunctivitis caused by the chronic presence of a foreign body in the eye. This condition occurs predominantly with people who wear hard or rigid contact lenses, wear soft contact lenses that are not replaced frequently, have an exposed suture on the surface or the eye, or have a glass eye.

Infectious Conjunctivitis

Bacterial Conjunctivitis is an infection most often caused by staphylococcal or streptococcal bacteria from your own skin or respiratory system. Infection can also occur by transmittal from insects, physical contact with other people, poor hygiene (touching the eye with unclean hands), or by use of contaminated eye makeup and facial lotions.
Viral Conjunctivitis is most commonly caused by contagious viruses associated with the common cold. The primary means of contracting this is through exposure to coughing or sneezing by persons with upper respiratory tract infections. It can also occur as the virus spreads along the body’s own mucous membranes connecting lungs, throat, nose, tear ducts, and conjunctiva.
Ophthalmia Neonatorum is a severe form of bacterial conjunctivitis that occurs in newborn babies. This is a serious condition that could lead to permanent eye damage unless it is treated immediately. Ophthalmia neonatorum occurs when an infant is exposed to Chlamydia or gonorrhea while passing through the birth canal.

Chemical Conjunctivitis
Chemical Conjunctivitis can be caused by irritants like air pollution, chlorine in swimming pools, and exposure to noxious chemicals.

How is conjunctivitis diagnosed?
Conjunctivitis can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on evaluation of the conjunctiva and surrounding tissues, may include:

Patient history to determine the symptoms the patient is experiencing, when the symptoms began, and the presence of any general health or environmental conditions that may be contributing to the problem.
Visual acuity measurements to determine the extent to which vision may be affected.
Evaluation of the conjunctiva and external eye tissue using bright light and magnification.
Evaluation of the inner structures of the eye to ensure that no other tissues are affected by the condition.
Supplemental testing may include taking cultures or smears of conjunctival tissue, particularly in cases of chronic conjunctivitis or when the condition is not responding to treatment.

Using the information obtained from these tests, your optometrist can determine if you have conjunctivitis and advise you on treatment options.

How is conjunctivitis treated?
Treatment of conjunctivitis is directed at three main goals:

To increase patient comfort.
To reduce or lessen the course of the infection or inflammation.
To prevent the spread of the infection in contagious forms of conjunctivitis.

The appropriate treatment for conjunctivitis depends on its cause:

Allergic conjunctivitis – The first step should be to remove or avoid the irritant, if possible. Cool compresses and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Cases of persistent allergic conjunctivitis may also require topical steroid eye drops.
Bacterial conjunctivitis – This type of conjunctivitis is usually treated with antibiotic eye drops or ointments. Improvement can occur after three or four days of treatment, but the entire course of antibiotics needs to be used to prevent recurrence.
Viral Conjunctivitis – There are no available drops or ointments to eradicate the virus for this type of conjunctivitis. Antibiotics will not cure a viral infection. Like a common cold, the virus just has to run its course, which may take up to two or three weeks in some cases. The symptoms can often be relieved with cool compresses and artificial tear solutions. For the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation, but do not shorten the course of the infection. Some doctors may perform an ophthalmic iodine eye wash in the office in hopes of shortening the course of the infection. This newer treatment has not been well studied yet, therefore no conclusive evidence of the success exists.
Chemical Conjunctivitis – Treatment for chemical conjunctivitis requires careful flushing of the eyes with saline and may require topical steroids. The more acute chemical injuries are medical emergencies, particularly alkali burns, which can lead to severe scarring, intraocular damage or even loss of the eye.

Cataracts

A cataract is a cloudy or opaque area in the normally clear lens of the eye. Depending upon its size and location, it can interfere with normal vision. Most cataracts develop in people over age 55, but they occasionally occur in infants and young children. Usually cataracts develop in both eyes, but one may be worse than the other.

The lens is located inside the eye behind the iris, the colored part of the eye. The lens focuses light on the back of the eye, the retina. The lens is made of mostly proteins and water. Clouding of the lens occurs due to changes in the proteins and lens fibers.

The lens is composed of layers like an onion. The outermost is the capsule. The layer inside the capsule is the cortex, and the innermost layer is the nucleus. A cataract may develop in any of these areas and is described based on its location in the lens:

A nuclear cataract is located in the center of the lens. The nucleus tends to darken changing from clear to yellow and sometimes brown.
A cortical cataract affects the layer of the lens surrounding the nucleus. It is identified by its unique wedge or spoke appearance.
A posterior capsular cataract is found in the back outer layer of the lens. This type often develops more rapidly.