Blepharitis / Ocular Rosacea

Blepharitis is an infection of the eyelids.  Some patients call it granulated eyelids. Almost everyone has some form of blepharitis.  It is caused by bacteria that is part of our normal makeup but then gets out of hand and concentrates on the eyelids and eye.  Blepharitis causes problems for some people but not for others. Fortunately, blepharitis is relatively easy to treat. However, it is a chronic condition and needs to be taken care of on an ongoing basis, like brushing or flossing your teeth. 

Types of blepharitis:

• Staphylococcus blepharitis is caused bacteria called Staphylococci, commonly known as "staph." It often begins in childhood and continues throughout adulthood. This form of the condition results in dandruff like debris and scales on the lashes along with crusting and chronic redness at the lid margin. If left untreated, loss of eyelashes can result along with red inflamed eyelids.  Eventually a blockage of the oil glands along the eyelid margins can lead to styes, also known as hordeolum or chalazia.  In severe cases, the cornea, the transparent covering of the front of the eyeball, may also become inflamed and vision affected.

• Seborrheic blepharitis is a common form of this condition as well. It is not an infection but is caused by improper function of the oil glands, which causes greasy, waxy scales to accumulate along the eyelid margins. Seborrhea may be a part of an overall skin disorder that affects other areas. Dandruff of the scalp, hormones, nutrition, general physical condition and stress are factors in seborrhea.

Ocular Rosacea is the term used to describe blepharitis in its most severe form. Once diagnosed with Ocular Rosacea, oral medications are often required in addition to the topical measures used to treat blepharitis.

Symptoms of blepharitis:

• Itchy, burning, watery eyes

• Matter in the corners of the eyes on awakening

• Redness of the eyelids

• Frequent sty formation

• Tiny pimples on the eyelid edges

• Scaly skin flakes along the eyelid margins

• Gritty sensation leading to irritated eyes and light sensitivity

• Blurred vision

• Eye dryness

Causes of blepharitis:

• Normal aging

• Poor eyelid hygiene

• Excess oil produced by the glands in the eyelid

• Bacterial infection (often staphylococcal)

• Allergic reaction

• Dietary factors in some individuals (caffeine, alcohol, spicy foods, tobacco)

Treating blepharitis

In addition to eliminating redness and soreness, treatment can prevent potential infection and scarring of the cornea. You doctor will perform a complete eye examination to determine the most effective treatment.

Warm soaks

Usually, blepharitis can be controlled by careful, daily cleaning of the eyelashes. Warm compresses (a wash cloth moistened with warm water) placed on the eyes several times a day is the best initial treatment for blepharitis. The wash cloth should be placed over both eyes until it begins to cool (five to ten minutes). This softens the accumulated oils and reduces the bacterial content of the eyelids. Artificial tears can be instilled into the eyes after each warm soak to increase the aqueous content of the tears and reduce the accumulation of the oil components of the tears on the eyelids.

If the warm soaks and artificial tears fail to control the blepharitis alone, the eyelid margins can be cleansed with lid scrubs. A few drops of baby shampoo in lukewarm water should be mixed in one's hand. Being careful to avoid getting shampoo in your eye, scrub back and forth along the eyelashes of all eyelids, either with a washcloth draped over your finger or a cotton swab (Q-tip). Rinse with plain tap water.

Once the redness and soreness are under control, this cleaning may be decreased from daily (usually at bedtime) to every other night. However, if the symptoms return, return to daily cleansing immediately.

It is important to understand that blepharitis is a chronic condition that usually requires continuous care. Therefore, it is important to continue the warm eyelid soaks and artificial tears from two to four times a day as part of one's normal hygienic routine to prevent a recurrence of eye irritation. If eye irritation reoccurs while performing the warm soaks and lid scrubs, it is important to call the doctors at North Hill Eye Associates to be evaluated for a possible more serious eye condition.

Medication

In some cases, your doctor may prescribe eye drops or ointment to be used along with the daily cleansing regimen. For ointments, use a clean fingertip to rub a small amount into the eyelashes. Be careful to follow recommended dosages; excess medication will cause temporary blurring of vision. And with any medication, there is a small possibility of allergy or other reaction. If you think this is happening, stop the medication and contact your doctor immediately.

For certain types of blepharitis or ocular rosacea, prescription medications taken by mouth are helpful. Most of these medications are antibiotics that also improve or alter the oil composition of the eyelid oil glands. When taken properly, they are safe. However, side effects may occur in some individuals, including skin rash, slight nausea and increased sensitivity to sun.

Although medications may help control the symptoms of blepharitis, they alone are not sufficient; keeping the eyelids clean is essential.

If you think you may have blepharitis, your eye doctor can determine the cause and recommend the right therapy specifically designed for you.

Cataracts

Over fifty percent of people over the age of 60 (and quite a few younger than that) develop cataracts. Almost everyone will eventually develop cataracts as they grow older. Cataract formation occurs at different rates in different people, and can affect one, or in most cases, both eyes.

A cataract is a progressive clouding of the eye's natural lens. It interferes with light passing through the eye to the back of the eye, the retina. Aging and other factors cause cells in the eye's lens to clump together, forming these cloudy areas. Early changes may not disturb vision, but over time cataracts typically result in blurred or fuzzy vision and sensitivity to light. People with advanced cataracts often say they feel as if they are looking through a waterfall or a piece of wax paper.

Symptoms of cataracts:

• Decreasing vision with age

• Blurred or double vision

• Seeing halos around bright lights

• Difficulty seeing at night

• Vision that worsens in sunlight

• Difficulty distinguishing colors

• Poor depth perception

• Frequent prescription changes for glasses

• Difficulty reading

• Headaches

Causes of cataracts:

• Age

• Eye injury

• Heredity

• Diabetes

• Some medications including long-term use of oral steroids

• Ultraviolet radiation

• Smoking

• Glaucoma/Retinal disorders 

• Certain metabolic conditions

Diagnosing cataracts

Your eye doctor can perform a variety of tests to determine how much your vision has been affected by a cataract. But typically, when decreased vision affects your everyday activities or hobbies, a cataract should be treated.

Treating cataracts

Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only one way to achieve clear vision again is through cataract surgery. 

Corneal Abrasions

The cornea is the clear, outer window of the eye. A corneal abrasion is simply a scratch in the epithelium (skin), or the thin, outer layer of the cornea. Abrasions usually heal in a short time period, sometimes within hours. Deeper or larger scratches may take up to a week. The cornea has a tremendous number of nerve endings, which makes any damage to the cornea very painful.

Symptoms of corneal abrasions:

• History of recent eye trauma

• Watery eyes

• Acute pain

• Sensitivity to light

• Blurry vision

• The feeling that there is something in your eye

• Pain upon awakening in one's eye

Causes of corneal abrasions:

• Foreign object in the eye

• Contact lenses

• Chemicals

• Blow to the eye

• Scratched eye (fingernails, hairbrushes, tree branches, etc).

Diagnosing corneal abrasions

Only your eye doctor can identify corneal abrasions by examining your eyes with special instruments.  Your doctor will check your eye, including under your eyelid, to make sure there are no foreign materials present.

Treating corneal abrasions

Occasionally the eye will have to be patched, but modern day therapy for abrasions usually involves leaving the eye open and prescribing antibiotics to help prevent infection and pain medication for comfort. Sometimes a contact lens is placed in the eye as a temporary bandage to help the abrasion resolve more quickly.  It is important that you do not rub your eye, especially during the healing process.  Following specific doctor instructions is also critical, including keeping follow up appointments.

Care examination and close follow-up is essential to ensure a corneal abrasion does not develop into a corneal ulcer.

Corneal Disease

The cornea is the clear front window of the eye. It transmits light to the interior of the eye allowing us to see clearly. Corneal disease can cause clouding, distortion and eventually blindness. There are many types of corneal disease.

Symptoms of Corneal disease:

• Blurred vision

• Ghost images or halos around lights

• Sensitivity to bright lights especially outdoor sunlight

• Sensation of a foreign body or object in the eye

• Moderate to severe pain  

Causes of corneal disease:

• Infection: Bacterial, fungal and viral infections are common causes of corneal damage

• Herpes simplex in the eye

• Foreign material in the eye such as grass, debris, or metal

• Chemical injury, such as the wrong contact lens solution or household cleaners

• Hereditary corneal dystrophies like Anterior Basement Membrane, Granular or Lattice dystrophy 

• Contact lens overwear or poor cleaning techniques

• Eye trauma from a blunt blow to the eye

• Systemic diseases

Some other corneal conditions

Keratoconus is a weakening and thinning of the central cornea. The cornea develops a cone-shaped deformity. Progression can be rapid, gradual or intermittent. Keratoconus usually occurs in both eyes, but can occur in only one eye.

Fuchs' endothelial dystrophy is a hereditary abnormality of the inner cell layer of the cornea called the endothelium. The purpose of this layer is to pump fluids out of the cornea, keeping it thin and crystal clear. When the endothelium is not healthy, fluids are not pumped out and the cornea develops swelling, causing it to become cloudy and decrease vision.

Bullous keratopathy is a condition in which the cornea becomes permanently swollen. This occurs because the inner layer of the cornea, the endothelium, has been damaged and is no longer pumping fluids out of the tissue.

Diagnosing corneal disease

Your eye doctor can check for corneal disease and trauma by examining your eyes with magnifying instruments. Using a slit lamp and advanced diagnostic technology such as corneal topography, your doctor can detect early cataracts, corneal scars, and other problems associated with the front structures of the eye. After dilating your eyes, your doctor will also examine your retina for early signs of disease.

Treatment for corneal disease

As with any serious eye infection, corneal disease should be treated immediately. Foreign bodies can be removed in the office, and infections treated with new generation antibiotics, steroids, and antiviral agents. Rarely, corneal transplant may be necessary to restore vision when the cornea becomes clouded. 

Corneal Ulcers

The front of the eye is covered with a thin, transparent membrane called the cornea, which protects the interior of the eye. If there is a break or defect in the surface layer of the cornea, called the epithelium, and damage to the underlying stroma, a corneal ulcer results. The ulcer is usually caused by microorganisms, which gain access to the stroma through the break in the epithelium.

Corneal ulcers generally heal well if treated early and aggressively. However if neglected, corneal clouding and even perforation (a hole in the cornea) may develop, resulting in serious loss of vision and possibly loss of the eye. Corneal ulcers are a serious vision-threatening condition and require prompt medical attention. DO NOT WAIT to see your eye doctor if you experience any of the symptoms below. 

Symptoms of corneal ulcers:

• Watery eyes

• Acute pain

• Sensitivity to light

• Blurry vision

• The feeling that there is something in your eye

• Discharge from the eye

Causes of corneal ulcers:

• Infection

• Wearing contact lenses for excessive periods of time

• Inadequate contact lens sterilization

• Eye injury

• Lack of tear production

• Complications of herpes simplex keratitis, neurotrophic keratitis, chronic blepharitis, conjunctivitis

• Eyelid abnormalities

Diagnosing corneal ulcers

Corneal ulcers are a serious vision-threatening condition and require prompt medical attention. If left unattended, corneal ulcers may penetrate the cornea allowing infection to enter the eye, which can cause permanent loss of vision and possible loss of the eye. Your eye doctor can identify corneal ulcers by examining your eyes with magnifying instruments and if necessary by taking a culture to identify infection. Your doctor will check your eye, including under your eyelid, to make sure there are no foreign materials present. 

Treatment for corneal ulcers

If treated early, corneal ulcers are usually curable. They are typically treated with antibiotic eye drops, often several different types. Sometimes, topical steroids will also be used to decrease the risk of scarring and inflammation. Expect to be seen for frequent follow-up visits.

Diabetic Retinopathy

Diabetes is a disease that affects blood vessels throughout the body, particularly vessels in the kidneys and eyes. When the blood vessels in the eyes are affected, this is called diabetic retinopathy.

The retina is the thin layer that lines the back of the eye. It detects visual images and transmits them to the brain. Major blood vessels lie on the front portion of the retina. When these blood vessels are damaged due to diabetes, they may leak fluid or blood and grow scar tissue. This leakage affects the ability of the retina to detect and transmit images.

During the early stages of diabetic retinopathy, reading vision is typically not affected. However, when retinopathy becomes advanced, new blood vessels grow in the retina. These new vessels are the body's attempt to overcome and replace the vessels that have been damaged by diabetes. However, these new vessels are not normal. They may bleed and cause the vision to become hazy, occasionally resulting in a complete loss of vision. The growth of abnormal blood vessels on the iris of the eye can lead to glaucoma. Diabetic retinopathy can also cause your body to form cataracts more quickly.

The new vessels also may damage the retina by forming scar tissue and pulling the retina away from its proper location. This is called a retinal detachment and can lead to blindness if left untreated.

Symptoms of diabetic retinopathy:

There are usually no symptoms in the early stages of diabetic retinopathy
Blurry or hazy vision
Floaters
Difficulty reading or doing close work
Double vision 

Causes of diabetic retinopathy:

Diabetes: Everyone who has diabetes is at risk for developing diabetic retinopathy, but not everyone develops it. Changes in blood sugar levels increase the risk.
 

You Can Reduce Your Risk of Developing Diabetic Retinopathy By:

• keeping your blood sugar under control and seeing your medical doctor routinely 

• monitoring your blood pressure

• maintaining a healthy diet

• exercising regularly

• getting an eye exam at least once a year

Diagnosing diabetic retinopathy:

There are usually no symptoms in the early stages of diabetic retinopathy. Vision may not change until the disease becomes severe. An exam is often the only way to diagnose changes in the vessels of your eyes. This is why yearly examinations with an ophthalmologist are extremely important for anyone with diabetes. If your vision changes and you feel you are not seeing clearly, get in to see your eye doctor immediately.

If any hemorrhages are detected on your eye examination, a test called fluorescein angiography will often be performed. During the test, a harmless yellow dye called fluorescein will be injected into a vein in your arm. The dye will travel through your body to the blood vessels in your retina. A special camera with a green filter will be used to take multiple photographs. The pictures will be analyzed to identify leaky blood vessels, damage to the lining of the retina or the formation of new blood vessels. Swelling from leaking blood vessels can also be evaluated by an non-invasive imaging test called OCT.

Treatment for diabetic retinopathy:

It is occasionally necessary to treat the retinal swelling produced by diabetic retinopathy with a laser treatment. Additionally, injection of medication into the vitreous of the eye is sometimes indicated. If proliferative retinopathy occurs (when abnormal new blood vessels bleed into the eye), pan-retinal photocoagulation is performed. During this procedure, a laser is used to destroy all of the dead areas of the retina where blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to decrease or disappear.

If diabetic retinopathy has caused your body to form cataracts, they can be corrected with cataract surgery.

Dry Eye

The term "dry eye" can be a little confusing since one of the most common symptoms is excessive watering or tearing! It makes more sense, though, when you learn that the eye makes two different types of tears.

The first type, called lubricating tears, is produced slowly and steadily throughout the day. Lubricating tears contain a precise balance of mucous, water, oil, nutrient proteins, and antibodies that nourish and protect the front surface of the eye.

The second type of tear, called a reflex tear, does not have much lubricating value. Reflex tears serve as a kind of emergency response to flood the eye when it is suddenly irritated or injured. Reflex tears might occur when you get something in your eye, when you are cutting onions, when you cry, or when you accidentally scratch your eye. The reflex tears gush out in such large quantities that the tear drainage system cannot handle them all and they spill out onto your cheek. Still another cause of reflex tearing is irritation of the eye from lack of lubricating tears. If your eye is not producing enough lubricating tears, you have dry eye syndrome.

Symptoms of dry eye:

• Watery eyes

• The feeling that there is sand or grit in your eyes

• Burning sensation, worse in heated rooms or air conditioning

• Vision that becomes blurred after periods of reading, watching TV, or using a computer

Causes of dry eye:

• Aging can result in less oil production in the glands of the eyelids. Oil keeps tears from evaporating off the eye. Reduced oil production allows tears to evaporate too quickly, leaving the eye dry.

• Diseases including Connective Tissue Disorders (Rheumatoid Arthritis, Systemic Lupus Erythematosus, Sjogren's Syndrome), Parkinson's and Diabetes

• Hormonal changes, especially after menopause

• Prescription medications: These include some high blood pressure medications, antihistamines, diuretics, antidepressants, anti-anxiety pills, sleeping pills and pain medications. Over-the-counter medications including some cold and allergy products, motion sickness remedies, and sleep aids can also cause dry eyes.

• Hot dry or windy conditions: High altitude, air-conditioning and smoke can also cause dry eyes.

• Reading, using a computer or watching TV

• Eye surgery: Some types of eye surgery, including LASIK can aggravate dry eye.

Diagnosing dry eye

Your eye doctor can check for dry eye by examining your eyes with a bio-microscope, measuring your rate of tear production, and checking the amount of time it takes for tears to evaporate between blinks. The doctor can also check for pinpoint scratches on the front surface of the eye caused by dryness using special diagnostic dyes such as fluorescein or Rose Bengal.

Treatments for dry eye

The most common treatment is the use of artificial teardrops, which help make up for the lack of natural lubricating tears. Artificial tear products come in liquid form, longer lasting gelform, and long-lasting ointment form. Many different brands of artificial tears are available over-the-counter. Some contain preservatives and some do not. Unpreserved tears may be recommended for people whose eyes are sensitive to preservatives. Artificial tears can generally be used as often as needed, from a few times per day to every few minutes. You should follow the regimen your doctor recommends. Ask for samples of several different brands of tears so you can determine which helps you the most.

When infection, inflammation of the eyelids, or clogged oil glands contributes to dry eye, special lid cleaning techniques or antibiotics may be recommended (see section on Blepharitis). It may also help to avoid hot, dry or windy environments or to humidify the air in your home or office.

Anti-inflammatory medications such as Restasis have been shown to be effective.  See our section on Restasis for more information.  Research on nutrients called fatty acids as a treatment for dry eye is ongoing.

Punctal occlusion is a medical treatment for dry eye that may enable your eyes to make better and longer use of the few lubricating tears they do produce.

Farsightedness

Hyperopia, unlike normal vision, occurs when the cornea is too flat in relation to the length of the eye. This causes light to focus at a point beyond the retina, resulting in blurry close vision and occasionally blurred distance vision as well. Usually this condition is undetected until later in life because the young eye is able to compensate for the hyperopia by focusing the internal lens of the eye.

Symptoms of hyperopia:

• Blurry close vision

• Occasional distance blur

Causes of hyperopia

• Hereditary

Diagnosing hyperopia

Many people are not diagnosed with hyperopia without a complete eye exam. This is especially critical in children.   School screenings typically do not detect this condition because they test only for distance vision. It is important that any child experiencing difficulty with their vision, learning, or deviation of their eye alignment, to have an evaluation with an ophthalmologist.

Your eye doctor can conduct a refractive evaluation to determine whether the eyes focus light rays exactly on the retina at distance and at near. A visual acuity test will determine ability to see sharply and clearly at all distances. Your eye doctor will also check eye coordination and muscle control, as well as the eyes' ability to change focus. All of these are important factors in how the eyes see.

Treatment of hyperopia

Glasses and contact lenses are the standard treatment for hyperopia. Other types of refractive errors include: nearsightedness and presbyopia.

Refractive Surgery (LASIK, PRK, refractive lensectomy) can be performed to correct hyperopia.

Flashes & Floaters

Flashes and floaters can be alarming. Usually, however, an eye examination will confirm that they are harmless and do not require any treatment.

Symptoms of flashes and vitreous floaters;

• Seeing small, floating spots

• Seeing bright flashes of light

Causes of flashes and floaters

Aging of the eye: Most flashes and floaters are caused by age-related changes in the gel-like material, called vitreous, that fills the back of the eye.

When you are born, the vitreous is firmly attached to the retina. In the very young, the vitreous is rather thick, like firm gelatin. Within the vitreous, there may be clumps of gel or tiny strands of tissue debris left over from the eye's early development. These clumps or strands are firmly embedded in the thick, young vitreous and cannot move around much.

As you get older, the vitreous gradually becomes thinner or more watery. By the time you are in your twenties or thirties, the vitreous may be watery enough to allow some of the clumps and strands to move around inside the eye. This material floating inside the eye can cast shadows on the retina, which you see as small floating spots.

With time and aging, you may experience the onset of larger, more bothersome floaters or flashes of light. This is because with aging the vitreous gel becomes more watery. It jiggles around quite a bit when you move your eye, making flashes and floaters much more common.

Eventually, the aging vitreous can pull away from the retina and shrink into a dense mass of gel in the middle of the eyeball. Shadows cast onto the retina by the detached vitreous can cause you to see large floaters. This is a gradual process, but the symptoms are often noticed suddenly.  It can be very alarming to the person experiencing it.

Who is at risk?

Flashes and floaters are very common. Almost everyone experiences them at one time or another. They become more frequent as we age. In rare cases, a doctor's exam may reveal a more serious problem called a retinal tear or retinal hole. Therefore, it is important to call North Hill Eye Associates to be examined with the onset of any change in floaters or onset of flashes.

Diagnosing Flashes and Floaters

Your eyes will be dilated to allow a better view of the retina.  Using special instruments to look into your eyes, your doctor can distinguish between harmless floaters and flashes and more serious retinal problems such as holes, tears or a retinal detachment.  The usual symptoms of these more serious problems include seeing hundreds of small floating spots, persistent flashing lights, or a veil-like blockage of a portion of the vision. If you experience any of these, you should contact your doctor immediately.

Treatment for Flashes and Floaters

With time, floaters become less noticeable as the brain adjusts to its presence and can "tune out" the floaters. Some floaters may always be somewhat observable and present, particularly if one eye is covered and the patient looks at a light-colored background. The presence of floaters alone is not an indication for surgery.

Anyone with flashes or the sudden onset of a new floater should be examined promptly by an ophthalmologist. If a tear is present in the retina, it is important to find this prior to the development of a retinal detachment. A retinal tear can be closed by the doctors at North Hills Eye Associates by an in-office laser procedure. If a tear has progressed to a retinal detachment, surgery becomes necessary.

Glaucoma: Open Angle

It is estimated that over two million Americans have some type of glaucoma and half of them do not know it. Ninety percent of glaucoma patients have open-angle glaucoma. Although it cannot be cured, it can usually be controlled. Vision loss may be minimized with early treatment. The eye receives its nourishment from a clear fluid that circulates inside the eye.

This fluid must be constantly returned to the bloodstream through the eye's drainage canal, called the trabecular meshwork. In the case of open-angle glaucoma, something has gone wrong with the drainage canal. When the fluid cannot drain fast enough, pressure inside the eye begins to build.

This excess fluid pressure pushes against the delicate optic nerve that connects the eye to the brain. If the pressure remains too high for too long, irreversible vision loss can occur.

Symptoms of open-angle glaucoma:

• In the early stages, there are no symptoms of blurred vision or pain 

• Gradual loss of peripheral vision (the top, sides and bottom areas of vision) that is not perceptible to most people until the disease is in the advanced stages

Who is at risk:

Glaucoma can occur in people of all races at any age. However, the likelihood of developing glaucoma increases if you:

• are African American

• have a family history of glaucoma

• are diabetic

• are very nearsighted

• are over 40 years of age

Diagnosing Open-Angle Glaucoma:

Everyone should be checked for glaucoma at around age 35 and especially at age 40 and over. Those considered to be at higher risk, including those over the age of 60 should have their pressure checked every year or two.  Ideally, you should have an eye exam every two years no matter what age you are.

Your doctor will use tonometry to check your eye pressure. After applying numbing drops, the tonometer is gently pressed against the eye and its resistance is measured and recorded.

Eye pressure is not directly related to blood pressure. The "normal" pressure ranges from 10 to 21.  However, it is important to know that many people with eye pressure in the normal range have glaucoma, and many with pressure above the normal range do not.  There are many other factors that determine glaucoma, including:

The Optic Nerve: This is the structure in the eye that suffers damage from eye pressure that is too high for an individual eye to tolerate.   An ophthalmoscope can be used to examine the shape and color of your optic nerve. The ophthalmoscope magnifies and lights up the inside of the eye. Cupping or atrophy of the optic nerve will be carefully evaluated.  If the optic nerve appears to be cupped or is not a healthy pink color, additional tests will be run. At North Hill Eye Associates, all patients that are suspicious for glaucoma or diagnosed with glaucoma have the health of their optic nerves documented with digital retinal imaging. Imaging is repeated if any progressive damage to a patient's optic nerve is evident.

Optic Nerve Scanning is performed at North Hill Eye Associates using a Heidelberg Retinal Tomograph (HRT). This scanning laser measures the nerve tissue present in the optic nerve of each eye. Repeat measurements by the HRT can be obtained to document progressive optic nerve damage before they may be evident on examination. This technology assists the doctors at North Hill Eye Associates in diagnosing glaucoma at the earliest stages and ensures that each glaucoma patient's disease is being adequately treated.

Perimetry, or visual field testing, is a test that maps the field of vision. Looking straight ahead into a white, bowl-shaped area, you will indicate when you are able to detect lights as they are brought into your field of vision. This map allows your doctor to see any pattern of side or peripheral vision changes caused by the early stages of glaucoma.  This is a somewhat tedious test for the patient, but with modern instruments can be done in 15 minutes or less.  The results are extremely important in diagnosing and managing glaucoma.

Gonioscopy is used to check whether the angle where the iris meets the cornea is open or closed. This helps your doctor determine if they are dealing with open-angle glaucoma or narrow-angle glaucoma.  Narrow angle glaucoma (please refer to the section on this condition) is a fairly uncommon condition.  Most people with glaucoma have the open angle variety.  Gonioscopy is the procedure that helps determine which type of glaucoma you have. Gonioscopy also helps determine how appropriate laser treatment (SLT) may be in a patient with glaucoma.

Treatments for open-angle glaucoma:

To control glaucoma, treatment has been traditionally started with medication. This typically requires the daily instillation of eye drops for life. With advancements made in laser treatment, initial treatment of open angle glaucoma can now be performed with a laser (SLT) in the office.

Glaucoma medicines come in eye drop form and medications to be taken by mouth. Oral medications (tablets and capsules) are rarely used anymore due to side effects, but are still an option. Drops work by either slowing the production of fluid within the eye or by improving the flow through the drainage meshwork. To be effective, most glaucoma medications must be taken once or twice every day, without fail. Some of these medications have some undesirable side effects, so your doctor will work with you to find a medication that controls your pressure with the least amount of side effects. Medicines should never be stopped without consulting your doctor, and you should notify all of your other doctors about the eye medications you are taking.

Selective Laser Trabeculoplasty (SLT) is an in-office laser procedure designed to open the drainage canal of the eye, resulting in a reduction of the pressure of the eye. Patients can typically drive home after having this laser procedure performed in the offices of North Hill Eye Associates. Requiring only numbing eye drops, the laser beam is applied to the trabecular meshwork resulting in an improved rate of drainage. When laser surgery is successful, it may reduce or eliminate the need for daily medications. For reasons of convenience, side-effects, and expense, many patients now choose this laser procedure (SLT) over the life-long daily requirement of eyedrops which was once necessary for the treatment of open angle glaucoma. The doctors of North Hill Eye Associates discuss this option with all patients diagnosed with open angle glaucoma.

Endoscopic CycloPhotocoagulation (ECP) is another type of laser procedure. Instead of treating the drainage canal, it treats the ciliary body. Treating the ciliary body reduces the amount of fluid production thereby reducing the intraocular pressure. ECP is most often performed along with cataract surgery, but can be done on an outpatient basis when in the best interest of the patient. The majority of patients having ECP reduce or eliminate their need to take glaucoma medications. 

Filtration surgery is performed when medicines and/or laser surgery are unsuccessful in controlling eye pressure. During this microscopic procedure, a new drainage channel is created to allow fluid to drain from the eye.

Procedures:

• Selective Laser Trabeculoplasty (SLT)

• Filtration Surgery (Trabeculectomy)

Glaucoma: Narrow Angle

Narrow-angle glaucoma is very different from open-angle glaucoma in that eye pressure usually goes up very fast. This happens when the drainage canals get blocked or covered over. The iris gets pushed against the lens of the eye, shutting off the drainage angle. Sometimes the lens and the iris stick to each other. This results in pressure increasing suddenly, usually in one eye. There may be a feeling of fullness in the eye along with reddening, swelling and blurred vision.

Symptoms of narrow-angle glaucoma:

The onset of acute narrow-angle glaucoma is typically rapid, constituting an emergency. If not treated promptly, this glaucoma may produce blindness in the affected eye within hours to days. Symptoms may include:

• Inflammation and pain

• Pressure over the eye or extreme headache

• Moderate pupil dilation that is non-reactive to light

• Blurring and decreased visual acuity

• Extreme sensitivity to light

• Seeing halos around lights

• Nausea and/or vomiting

Causes of Narrow-Angle Glaucoma

• Farsightedness

• Cataracts

• Anything that causes the pupil to dilate -- dim lighting, dilation drops

• Certain oral medications like cold medications, anti-histamines, incontinence medications, or abdominal medications

• Diabetes-related growth of abnormal blood vessels

Diagnosing Narrow-angle glaucoma

Everyone should be checked for glaucoma at around age 35 and again at age 40. Those considered at higher risk for narrow-angle glaucoma, including those who are Asian, farsighted or over the age of 60, should have their pressure checked every year or two.

Because of the rapid, potentially devastating results of narrow-angle glaucoma, you should consult your eye doctor immediately if you experience any of the above symptoms.

During eye exams, your doctor will use tonometry to check your eye pressure. After applying numbing drops, the tonometer is gently pressed against the eye and its resistance is measured and recorded.

A microscope is used to assess the angle structure of the eye, to determine if you are at risk for developing narrow-angle glaucoma.  This is important because there is preventative treatment before the acute problem strikes.

An ophthalmoscope can be used to examine the shape and color of your optic nerve. The ophthalmoscope magnifies and lights up the inside of the eye. If the optic nerve appears to be damaged, or is not a healthy pink color, additional tests will be performed.

Treatment for narrow angle glaucoma

The management of narrow-angle glaucoma is strictly surgical, unlike the more common open angle glaucoma that is managed in most cases with eye drops.  If you have a narrow-angle attack or are at risk for angle closure, a laser procedure called a laser iridotomy is required.

Laser iridotomy is a common treatment for narrow-angle glaucoma. During this procedure, a laser is used to create a small hole in the iris, restoring the flow of fluid to the front of the eye. This procedure is performed in the office. Patients are typically able to drive home after the procedure is performed.

Filtration surgery is performed when medicines and/or laser surgery are unsuccessful in controlling eye pressure. During this microscopic procedure, a new drainage channel is created to allow fluid to drain from the eye.

Procedures

• Laser Iridotomy

• Filtration Surgery (Trabeculectomy)

Headaches

Headaches can be caused by many diverse medical conditions. Headaches often involve some degree of eye discomfort. Ophthalmic pathology or disturbances of vision can both cause headaches. Discomfort associated with less than optimal vision is referred to as astenopia ("eye strain"). Many patients with headaches are referred to North Hill Eye Associates by their primary care physician or neurologist to evaluate for an ophthalmic component contributing to their headaches.

Patients with headaches can expect to undergo a complete dilated evaluation with refraction to evaluate for any ophthalmic pathology or visual disturbance. Headaches associated with visual flashes, nausea, or vomiting are often associated with migraines.

Treatment of Headaches:

Treatment of headaches requires cooperation and communication between the physicians of North Hill Eye Associates and the patient's other heath care providers.

Headaches or visual discomfort (astenopia) associated with visual disturbances may require treatment ranging from eyeglasses to cataract surgery.

Headaches associated with migraines are often treated jointly by the physicians at North Hill Eye Associates and a patient's primary care physician or neurologist.

Keratoconus

Keratoconus is an eye condition that causes the cornea to become progressively thinner. A normal cornea is round or spherical in shape, but with keratoconus the cornea bulges forward, assuming more of a cone shape. As light enters the cone shaped cornea it is bent and distorted. Therefore, the light is unable to come to a point of clear focus on the light-sensitive retina.

Keratoconus usually affects both eyes, but the two eyes often progress at different rates. This disease typically begins during teenage years. In most patients, it progresses for several years before stabilizing in the third to fourth decade of life. In severe cases it can continue to worsen. In these cases the cornea continues to thin and bulge outward. This can result in further blurring of vision. Scarring of the cornea can also develop.

Symptoms of keratoconus:

• bulging, cone-shaped cornea

• nearsightedness

• astigmatism

• glare and light sensitivity

• the need for frequent prescription changes

Who is at risk:

Researchers believe that approximately 3 million people worldwide have keratoconus. It affects males and females of all races throughout the world. The causes are still being researched, but the likelihood of developing keratoconus is greater if you:

• have a relative with keratoconus

• have had excessive laser eye surgery

• have hay fever, eczema, asthma or food allergies

Treatments for Keratoconus

In mild cases, glasses and soft contacts can be effective, but in more advanced cases, these no longer work well and custom contact lenses or surgery must be considered.

• Gas Permeable (GP) contact lenses:  This is the primary treatment for keratoconus. To counteract the distortion of the cornea, most keratoconus patients require special hard lenses that help mold the corneal surface so that light can be focused clearly. Because the pattern of distortion in keratoconus is as unique as a fingerprint, the GP lenses are custom prescribed and manufactured. A proper contact lens fitting is crucial to ensure optimal vision, comfort, and eye health. Poor fitting lenses can lead to corneal abrasions, scarring, and infection. 

• Surgery: Many keratoconus patients will never require surgery, but it is an option in severe and advanced cases. Treatment is the performance of corneal transplantation.   In this procedure, the scarred tissue is replaced with a section of donated cornea that is clear. About 10 to 20% of keratoconus patients will eventually require a corneal transplantation. However, corneal transplantation is not a cure in and of itself. Following a successful corneal transplant, most patients still need glasses, soft contacts, or GP lenses for adequate vision.

Precautions

Patients with keratoconus must not have LASIK or PRK laser eye surgery due to an unacceptable risk of a poor outcome. The cornea in keratoconus is unusually thin and weak. For patients with keratoconus, LASIK surgery thins and weakens their corneas further. This can irreversibly destabilize the cornea and accelerate its distortion. Rubbing the eyes may also increase the progression of keratoconus.

Macular Degeneration

Macular degeneration is a disease of the macula, an area of the retina at the back of the eye that is responsible for fine detail vision. Vision loss usually occurs gradually and typically affects both eyes at different rates. Even with a loss of central vision, however, color vision and peripheral vision may remain clear.

There are two forms of age-related macular degeneration, wet and dry.

• Wet Macular Degeneration: Wet macular degeneration occurs when abnormal or leaking blood vessels grow underneath the retina in the area of the macula. These changes can lead to distorted or blurred vision and, in some cases, a rapid and severe loss of straight ahead vision.

• Dry Macular Degeneration: The vast majority of cases of macular degeneration are the dry type, in which there is thinning or deterioration of the tissues of the macula or the formation of abnormal yellow deposits called drusen. Progression of dry macular degeneration occurs very slowly and does not always affect both eyes in the same way.

Symptoms of Macular Degeneration:

• Early macular degeneration may cause little, if any noticeable change in vision

• Difficulty reading without extra light and magnification

• Seeing objects as distorted or blurred, or abnormal in shape, size or color

• The perception that objects "jump" when you try to look right at them

• Difficulty seeing to read or drive

• Inability to see details

• Blind spot in center of vision

• Any Amsler Grid changes

Causes of or contributing factors to macular degeneration:

The root causes of macular degeneration are still unknown. Women are at a slightly higher risk than men. Caucasians are more likely to develop macular degeneration than African Americans. Risk factors include:

• Age: Macular degeneration is the leading cause of decreased vision in people over 65 years of age.

• Heredity: Macular degeneration appears to be hereditary in some families but not in others

• Long-term sun exposure

• Smoking

• High cholesterol

• Hypertension

• Nutritional deficiencies

• Diabetes

Diagnosing Macular Degeneration

Your eye doctor can identify changes of the macula by looking into your eyes with various instruments. A chart known as an Amsler Grid can be used to pick up subtle changes in vision.

Digital Angiography is the most widely used macular degeneration diagnostic test. During the test, a harmless orange-red dye called Fluorescein will be injected into a vein in the arm. The dye travels through the body to the blood vessels in the retina. A special camera takes multiple photographs. The pictures are then analyzed to identify damage to the lining of the retina or atypical new blood vessels. The formation of new blood vessels from blood vessels in and under the macula is often the first physical sign that macular degeneration may develop.

Optical Coherence Tomography (OCT) uses light waves to create a contour map of the retina and can show areas of thickening or fluid accumulation.

Treatment for Macular Degeneration

In the early stages of macular degeneration, treatment is accomplished by:

• scheduled eye examinations (usually every six months)

• attention to diet

• smoking cessation

• in-home monitoring of vision with an Amsler Grid

• nutritional supplements (multivitamins)

Diet and Nutritional Supplements: There has been active research on the use of vitamins and nutritional supplements called antioxidants to try to prevent or slow macular degeneration. Antioxidants are thought to protect against the damaging effects of oxygen-charged molecules called free radicals. A potentially important group of antioxidants are called carotenoids. These are the pigments that give fruits and vegetables their color. Two carotenoids that occur naturally in the macula are lutein and zeaxanthin. Some research studies suggest that people who have diets high in lutein and zeaxanthin may have a lower risk of developing macular degeneration. Kale, raw spinach, and collard greens are vegetables with the highest amount of lutein and zeaxanthin. You can also buy nutritional supplements (multivitamins) that are high in these and other antioxidants.

Low Vision Aids: In patients that experience significant progression of their macular degeneration, low vision aids may be of benefit. Low vision aids range from hand-held magnifying glasses to sophisticated systems that use video cameras to enlarge a printed page. Lifestyle aids such as large print books, tape-recorded books or magazines, large print playing cards, talking clocks and scales and many other devices are available. 

The doctors at North Hill Eye Associates refer patients to specialists which work with patients to maximize their available vision (low vision specialists), when appropriate.

In some cases of wet macular degeneration, laser treatment may be recommended. This involves the use of painless laser light to destroy abnormal, leaking blood vessels under the retina. This form of treatment is only possible when the abnormal blood vessels are far enough away from the macula that the laser will not produce further damage. Only rare cases of wet macular degeneration meet these criteria. When laser treatment is possible, it may slow or stop the progression of the disease. However, it is generally not expected to recover any of the vision that has already been lost.

A relatively new form of treatment for some cases of wet macular degeneration is called photodynamic therapy or PDT. In those cases where PDT is appropriate, slowing of the loss of vision and sometimes, even improvement in vision are possible.

Anti-VEGF Therapies (Lucentis of Avastin) are medications that can regress the abnormal bleeding and swelling caused by wet macular degeneration. When indicated, these medications can be injected into or around the eye to help stabilize or even improve the vision of a patient with macular degeneration.

To have any chance of the newer treatments for macular degeneration providing any benefit, it is important that patients contact the doctors of North Hill Eye Associates immediately if they notice any change in their vision or Amsler Grid changes.

Procedures

• Anti-VEGF Therapy (Lucentis/Avastin)

• Fluorescein Angiography

Monovision

During childhood, people with normal vision have the ability to focus on objects as close as their nose and also on objects very far away. They can rapidly, without conscious thought, switch focus from near to far vision. This process of focusing at different distances is called accommodation. As each year passes, that ability to focus and to switch focus decreases. By the time most people reach their forties, they need an aid, such as reading glasses or bifocals, to focus on objects close up. This condition is called presbyopia.

Monovision is a technique where one eye (usually the dominant eye) is corrected for clear distance vision, and the other eye is corrected for comfortable near vision. Monovision allows a person to see close objects clearly with one eye and distance objects clearly with the other eye. The vision part of the brain tends to filter out the image from the eye that is not in clear focus, so those who have monovision eventually do not pay attention to the eye that is not as clearly focused. Those who have monovision are often able to see well enough both at distance and near to do things at any age without corrective lenses.

Monovision can be achieved with contact lenses, cataract surgery, or laser vision correction (LASIK or PRK). If you are considering a vision correction procedure, your doctor can trial monovision with you through the use of contact lenses prior to undergoing a permanent laser vision correction procedure.

For those undergoing cataract surgery who are considering the intraocular lens for monovision, an in depth discussion with your surgeon is necessary to be sure that this is the correct decision for you.

Procedures

• Cataract Surgery

• LASIK

• Refractive Lensectomy

Nearsightedness (Myopia)

Myopia, unlike normal vision, occurs when the cornea is too curved or the eye is too long. This causes light to focus in front of the retina, resulting in blurry distance vision.

Myopia is a very common condition that affects a large portion of the U.S. population. It normally starts to appear between the ages of eight and twelve, and almost always before the age of twenty. As the body grows, the condition often worsens. It typically stabilizes in adulthood.

Symptoms of myopia:

• Blurry distance vision

Causes of myopia:

• Heredity

• Cataracts

Diagnosing Myopia

Light focuses in front of the retina causing blurry distance vision
In young people, myopia is diagnosed during school screenings. Sometimes parents notice that their children are having difficulty seeing street signs or the television. A visual acuity test will determine your ability to see sharply and clearly at all distances.

Treatments for myopia

Glasses and contact lenses are used by many for the correction of myopia. There are also a number of surgical procedures available for reducing or eliminating myopia.

Refractive surgery (LASIK, PRK, or Clear Lens Extraction) is appropriate for patients that wish to reduce or eliminate their dependence on eyeglasses or contact lenses.

Other types of refractive errors include: farsightedness and presbyopia.

Procedures:

• LASIK/PRK

• Refractive Lensectomy

Normal Vision

The human eye gives us the sense of sight, allowing us to learn more about the surrounding world than any of the other five senses. The eye allows us to see and interpret the shapes, colors and dimensions of objects by processing the light they reflect or give off.

The cornea (the clear window on the front of the eye) and the lens of the eye (the transparent structure inside the eye) are both critical to normal vision. The goal of these two lenses is to focus light onto a layer on the back of the eye known as the retina. As light enters into the eye it is focused by the cornea and the lens so that images appear clearly on the retina. The retina then transmits these images to the brain where they are processed. If the images focus perfectly on the retina, the result is 20/20 vision; focusing in front or behind the retina results in nearsightedness or farsightedness. If the cornea is shaped like a football instead of a sphere, this is called astigmatism. When any of these conditions occur, images are perceived by the brain as being blurry. This is due to "refractive error" which means the eyeball is not the right size or the cornea does not have the right curve. Presbyopia is a vision condition in which the lens loses its flexibility, making it difficult to focus on close objects.  Your ophthalmologist is the physician qualified to check and correct your vision, and perform regular eye health examinations.

Pink Eye (Conjunctivitis)

Conjunctivitis is an infection or inflammation of the conjunctiva, the thin, transparent membrane covering the surface of the inner eyelid and the front of the eye. The conjunctiva has many small blood vessels. It lubricates and protects the eye. When the conjunctiva becomes inflamed, this is called conjunctivitis. There are many causes of conjunctivitis.  The most common forms are bacterial and viral.

Bacterial conjunctivitis typically causes swelling of the eyelid and a yellowish discharge. Sometimes it causes itching and/or matting of the eyelids. It can be accompanied by a sty.

Viral conjunctivitis, also known as EKC or epidemic kerato-conjunctivitis, is very contagious and can be easily transmitted by rubbing the eye and then infecting household items such as towels or handkerchiefs. It is common for entire families to become infected.

Symptoms of Conjunctivitis:

• Red, watery eyes

• Inflamed eye lids

• Blurred vision and a sandy or scratchy feeling in the eyes

• Pus-like or watery discharge around the eyelids

• Matting of the eyelids

• Possible swollen gland in front of the ear

How Can Conjunctivitis Be Prevented?

Certain precautions can be taken to avoid the disease and stop its spread. Careful washing of the hands, cutting hair so it does not contact the eyes, and avoiding contagious individuals are all helpful. Children frequently get conjunctivitis because of their their close contact with other children while in school.

If you or someone in your household has contracted conjunctivitis, follow these steps to prevent the spread of the infection:

• Do not touch the infected eye.

• If you do touch your eyes or face, including when using medicine in your eye(s), wash your hands thoroughly.

• Wash any clothing touched by infected eyes including clothes, towels and pillowcases.

• Do not share make-up or eye drops. If the infection is caused by bacteria or a virus, you must throw away your used make-up or contact lens solution and buy new make-up or solution.

Diagnosing conjunctivitis

The doctors at North Hill Eye Associates can diagnose the type of conjunctivitis with a careful case history and eye exam.  A medical history will also be taken because some conjunctivitis is caused by underlying disease conditions like herpes or the flu.

Treatment for conjunctivitis

Antibiotic drops and compresses can ease discomfort and clear up most bacterial infections, normally within just a few days. Sometimes, the inflammation does not respond well to the initial treatment with eye drops. In those cases, additional medication may be prescribed.  Keep all follow-up visits with your doctor. If left untreated, conjunctivitis can create serious complications such as infections in the cornea, eyelids and tear ducts.

There are no effective treatments for some forms of conjunctivitis like viral EKC mentioned above.  In this case your doctor will prescribe a regimen to make you more comfortable, but the viral condition will need time to resolve on its own.

Presbyopia

Presbyopia is a visual condition in which the lens loses its flexibility. This results in difficulty focusing on close objects. During the early and middle years of life, the crystalline lens of the eye has the ability to focus both near and distant images by getting thicker for near objects and thinner for distant objects. When this ability is lost, presbyopia results.

Symptoms of Presbyopia:

• Blurry close vision that starts after age 40

• Difficulty adjusting focus when switching from near to distance vision

• Eye fatigue along with headaches when doing close work

Diagnosing Presbyopia

A comprehensive examination will include testing for presbyopia. Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and at near. A visual acuity test will determine your ability to see sharply and clearly at all distances.
 

Treatment of presbyopia

Reading glasses and contact lenses are used by many for the treatment of presbyopia.  Some presbyopic patients like monovision, which allows them to see distance clearly in one eye and close-up clearly with the other eye.

Laser vision correction (LASIK or PRK) can be performed to provide monovision in patients that desire to reduce their dependence on reading glasses or contact lenses.

Patients undergoing cataract surgery or refractive lensectomy have the option of obtaining multifocal or accommodative intraocular lenses, which can reduce dependence on reading glasses. The surgeons of North Hill Eye Associates discuss these options with all of our surgical patients.

Presbyopia can be present in combination with other types of refractive errors such as nearsightedness, farsightedness and astigmatism.

Procedures:

• Deluxe IOLs

• LASIK/PRK

• Refractive Lensectomy

Pterygium

A pterygium is a fleshy triangular area of tissue, usually on the inner corner of the eye, which can also grow onto the cornea. Sometimes, it extends toward the center of the cornea so that it interferes with vision. As the pterygium develops, it may warp the cornea, causing astigmatism.

Symptoms of Pterygium:

• Visible tissue growing over the eye

• Irritation of the eye

• Redness localized in the corner

• Possible blurred vision

Causes of pterygium:

The causes of a pterygium are multifactorial. Associated factors include:

• Long-term exposure to sunlight 

• Dry, dusty conditions

• Age: Pterygia are typically found in adults over the age of 30.

Diagnosing a Pterygium

Chances are, you will notice a pterygium when you look in the mirror. It will look something like the photograph above.  Your eye doctor can also diagnose it during a routine eye exam. 

Treatment of a pterygium:

Eye drops or ointment can be used to reduce the irritation caused by a pterygium. If the pterygium grows toward the central cornea, it often needs to be removed surgically. Outpatient surgery is very successful but there is a chance that the growth will recur.

Retinal Detachment

Retinal detachment occurs when the retina is lifted or pulled from the wall of the eye. If not treated immediately, a retinal detachment can cause permanent vision loss. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should call the offices of North Hill Eye Associates immediately.
 

Symptoms of retinal detachment:

• The appearance of a curtain over the field of vision

• Seeing light flashes or sparks

• Wavy or watery vision

• A sudden decrease in vision

• A sudden increase in the number of floaters or cobwebs in the field of vision

Who is most at risk for retinal detachment?

• Those who are very nearsighted (myopic)

• People with a family history of retinal detachment

• Patients with a history of eye injury or surgery

• Patients with diabetes or other eye disorders

• Patients with a previous history of a retinal tear or detachment

Treatments for retinal detachment

Retinal detachments are treated with surgery that may require a hospital stay. In some cases, a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed. Vitrectomy is a procedure in which the vitreous humor is removed and replaced with a gas or silicone oil that pushes the retina back onto the wall of the eye. Over time the eye produces fluid that replaces the gas. In both of these procedures either a laser or a cryopexy (a freezing device) is used to “weld” the retina back in place. Visual recovery depends on how long the retina has been detached and the particular circumstances related to the detachment.  Regardless, the doctors at North Hill Eye Associates should be contacted without delay if the signs of a retinal tear or retinal detachment are evident.

Transient Visual Loss

Temporary loss of vision in one eye (transient monocular blindness) is termed amaurosis fugax. This condition can be very serious and a precursor to permanent visual loss or stroke.

If you experience sudden loss of your central (reading or straight-ahead) vision, or a blurry or missing area of vision, call your family doctor or the offices of North Hill Eye Associates at once.

Symptoms of Transient Visual loss:

• Sudden, painless loss of vision

• Sudden increase in floating spots or cobwebs

• Blurred or missing area of vision  

Causes of transient visual loss:

• High blood pressure

• High cholesterol

• Obesity

• Smoking

• Glaucoma, diabetes and other conditions

Treatment for transient visual loss

The type of treatment depends on the cause. Further evaluation with tests including evaluation of heart rhythm, cerebral blood flow, or blood coagulation may be indicated. Therapy with anti-coagulant medication may be necessary in some patients.