More Eye Education

Suncoast Eye Surgery Institute of Citrus River, Florida


WHAT IS GLAUCOMA?

The symptoms of glaucoma vary depending on the specific type of glaucoma:
There are several different types of glaucoma, but all types are caused by increased pressure within the eye that can destroy the optic nerve if not treated promptly.A constant level of liquid called the aqueous humor is maintained in the inner chamber of the eye. Fluid flows into the eye at a spongy outlet located at the angle where the cornea and sclera meet. If the outlet is clogged or if the drainage system is overwhelmed by too much liquid production, a buildup of fluid occurs and causes a pressure increase inside the eyeball.
This places pressure on the optic nerve and its blood supply that can cause serious irreversible damage.A blockage in the drainage system (and the resulting increase in pressure) can be caused by eye injury, tumor, hemorrhage, or infection.

WHAT ARE THE SYMPTOMS OF GLAUCOMA?

CHRONIC OPEN-ANGLE GLAUCOMA

Chronic open-angle glaucoma, is the most common type of glaucoma. This type of glaucoma primarily occurs in those persons over age forty and is symptomless a “quiet” disease that often causes irreversible damage before it is discovered.
Chronic open-angle glaucoma may develop as a result of gradual aging, causing a decreased drainage capacity. When drainage is reduced, pressure within the eye slowly mounts, harming the optic nerve.

CONGENITAL GLAUCOMA

Congenital Glaucoma is present at birth or shortly after birth. It is usually caused by a defect in the drainage system. Any infant who has symptoms of increased sensitivity to light or eyes that fill up with tears easily should be evaluated immediately to determine the nature of the problem and to prevent permanent damage to the sight.

ACUTE ANGLE-CLOSURE GLAUCOMA

Acute angle-closure glaucoma, also known as narrow-angle or acute glaucoma, results fro an immediate, complete blockage of the drainage area. The iris may press against the drain area causing sudden obstruction. Without drainage, fluid backs up and eye pressure increases rapidly. Rainbow like halos or circles around lights, severe pain in the eyes or forehead, nausea, and blurred vision may occur. This type of glaucoma can occur suddenly at any age and is a true medical emergency; immediate professional care is needed to preserve sight. Blindness can result quickly in a day or two without treatment.

SECONDARY GLAUCOMA

Secondary glaucoma occurs as the result of some other health problem of the entire body or of the eye. It may develop rapidly or slowly. If closure of the drainage system occurs rapidly, the symptoms will be similar to those described for acute-angle closure glaucoma. Immediate attention by an eyecare professional is needed.

HOW IS GLAUCOMA DIAGNOSED?

Prevention involves early detection through a comprehensive eye health examination, especially after age 35. Sometimes the level of pressure may be above normal, yet there are no symptoms, so an eye examination is the only way to discover the problem.
During a comprehensive eye health examination an instrument called a tonometer is used check the level of pressure in the eye. It is a simple painless test that takes a fraction of a second to perform.
As part of your eye examination, your eyecare professional can also determine the health of the optic nerve by examining the inside of the eye.
In addition, visual fields are performed to determine the presence of blind spots or shrinkage in the peripheral field of vision.

WHO DEVELOPS GLAUCOMA?

People with a family history of glaucoma are more likely to develop the problem, as are those who are nearsighted.
Some diseases that impact the entire body, such as diabetes, anemia, or hardening of the arteries, increase the risk of the condition. Persons who do not actually have diabetes, but have a strong family history of the problem, should have their eyes checked frequently for early development of the disease.African-Americans tend to develop glaucoma more frequently than other racial groups.

HOW IS GLAUCOMA TREATED?

Damage to optic nerve fibers cannot be reversed. For that reason, sight can only be protected through early detection of the problem. Since glaucoma may grow worse without symptoms, periodic eye examinations for those over age 35 are imperative.
The goal of glaucoma treatment is to prevent further damage and to preserve the highest possible level of vision. Glaucoma is treated by reducing the pressure within the eye. Medications, both pills or eye drops, are used to lower pressure either by causing better drainage of liquid or by decreasing liquid production. Medication usually must continue for life and must be taken regularly to effectively reduce eye pressure.
If medication does not reduce pressure, surgery may be recommended to correct drainage problems. The goal of surgery may be either to form a new drainage channel or open the old channel.

PREVENTION OF GLAUCOMA

Since glaucoma cannot be prevented, the next best measure to protect sight is early detection and treatment before optic nerve fibers have been destroyed. This can be accomplished only through regular comprehensive eye health examinations, because glaucoma often is symptomless.

Everyone over the age of 35 should be tested for glaucoma every 1-2 years or whenever problems arise.

WHAT IS MACULAR DEGENERATION?

The macula is located in the center of the retina, it is the micro-thin membrane that lines the back inside of the eye. The retina has millions of light-sensitive nerve cells that capture images focused on the retina. These captured images are transmitted to the brain by the optic nerve.The retina performs two separate vision functions: central and peripheral. Central vision originates in the macula and is needed for highly-focused, straight-on tasks, such as reading, driving a car, or operating a computer. The rest of the retina's nerve cells handle peripheral vision.
Any damage to the macula will result in some or even total loss of central vision. Since peripheral vision is not affected, people with macular degeneration can adapt to the loss of central vision by learning to use their remaining peripheral vision. To focus on a particular object, the person must turn his head to the angle required to bring peripheral vision into play.
Most cases of macular degeneration develop after age 50. For this reason, the disease is often referred to as age-related macular degeneration or ARMD. There are two types of macular degeneration: The Dry Form and The Wet Form.

DRY FORM OF MACULAR DEGENERATON

About 90 percent of those who have ARMD experience this simple form of deterioration of the macula. Usually, the process happens over a period of months or years and may affect only one eye. Because the “good” eye gradually takes over the central vision functions of the “bad” eye, the victim is usually not aware of the loss of central vision in the affected eye until there are symptoms. The person may notice more difficulty seeing with one eye than the other, distortion of straight lines, or small dark spots appearing in the field of vision.
At this time, effective medical treatments are limited. Along with certain low-vision aids and devices, the best treatment is learning to use the remaining peripheral vision to compensate for loss of central vision.

WET FORM OF MACULAR DEGENERATION

Although only about 10 percent of all age-related macular degeneration victims are diagnosed with the wet form of the disease, it accounts for 90 percent of the most serious loss of vision cases. In the dry form, the loss of central vision tends to be gradual. In the wet form, the deterioration of central vision can be serious and rapid. This occurs when tiny blood vessels in the micro-thin layer of tissue beneath the retina begin to degenerate with age causing tiny leaks. This can cause swellings and breaks or lesions in the retina, damaging the retina's light-sensitive nerve cells.
Lasers have been used in treating this form of ARMD, but usually the best result is a slowing down of the deterioration process. The laser is used to cauterize the leaking blood vessels and/or “tack” the detached retina back into place. A diagnostic procedure used to determine the best course of treatment allows the doctor to tell if there is hemorrhaging in the retina. It is known as a fluorescein angiogram. Both procedures are virtually painless.

As with all eye disorders, early detection leads to more effective treatment. A thorough annual eye exam is the best protection for your vision.

WHAT IS DIABETIC RETINOPATHY?

As the name implies, diabetic retinopathy is a potentially serious disorder that affects the retina, the micro-thin membrane that contains millions of light-sensitive nerve cells and covers the back three-quarters of the eyeball. The retina receives images that are focused on its surface by the cornea and inner lens. These images are transmitted to the brain via the optic nerve, thereby creating the miracle of sight. Any damage to the retina will result in diminished vision capabilities, or in the most severe cases, the loss of central vision or even total blindness.
There are two types of diabetic retinopathy: background diabetic retinopathy and proliferative diabetic retinopathy. The proliferative type is the advanced stage of the disease and fortunately affects only about 5 percent of all diabetics, mostly those who have had diabetes for 25 years or more.

One of the complications of diabetes is the weakening of tiny blood vessels that nourish the retina. When this happens, some of the blood vessels begin to leak fluid (serum) and blood, thereby reducing the nourishment provided to the retina. Some may also hemorrhage or leak fatty or protein deposits. When this occurs in the peripheral areas of the retina, the loss of vision is usually gradual and treatable. In the early stages, the individual may be unaware of the presence of the disease until a regular eye examination has been performed. However, if the macula is affected, serious vision problems can develop. Although it is only about one-forth inch in diameter, the macula is responsible for all of the eye's central vision functions. The rest of the retina performs peripheral vision requirements. With proliferative diabetic retinopathy, blood vessels may leak into the vitreous humor, the clear, jelly-like fluid that fills the inner cavity of the eye. This leak can cause a cloudiness of vision. Another problem is created when connective scar tissue forms from damaged blood vessels. Over time, this tissue can shrink and exert a pulling effect on the retina. This can result in a retinal detachment, another serious side effect of proliferative diabetic retinopathy.

WHAT IS THE TREATMENT FOR DIABETIC RETINOPATHY?

In the early stages of background diabetic retinopathy there may be no need for immediate treatment, but the disease should be carefully monitored by regular eye examinations in accordance with your doctor's advice. If the condition becomes more serious, a laser may be used to seal leaking blood vessels and thereby slow down their development into the more serious form, proliferative diabetic retinopathy, which is subject to the same type of treatment. As with macular degeneration, use of heat-sealing lasers to cauterize leaking blood vessels in the macular area of the retina must be done with great caution in order to prevent additional damage to the macula.
With all serious eye disorders, early detection by regular eye examinations results in more effective treatment, especially for a disease that is progressive in nature, such as diabetic retinopathy. If you have diabetes mellitus, you should have a thorough eye examination at least once a year. It is important to note that such factors as pregnancy, high blood pressure, smoking and diets rich in fats increase the chances of developing diabetic retinopathy. When you come in for your examination, we will be happy to answer any questions you may have and provide more information on this relatively common eye problem that can become serious in nature as the years progress.

WHAT ARE EYELID SKIN CANCERS?

The outer layer of skin is called the epidermis. Skin cancers are abnormal growths of any of the different cell types that make up the outer layer. These cell types include flat squamous cells, round basal cells, and pigment producing melanocytes. The deep layer of skin that contains the hair follicles, sweat glands, and blood vessels make up the dermis. Cancers can form from any of these skin cells. A biopsy is needed to confirm a diagnosis of skin cancer. Much like the rest of your body, the skin of your eyelids, are susceptible to developing skin cancer.

WHAT CAUSES EYELID SKIN CANCER?

Excessive exposure to the sun is the single most important factor in relation to skin cancers of the face, eyelids, and arms. As a preventative measure, it is recommended that sun protection such as sunscreen, hats, and/or sunglasses be used. Skin pigmentation is also a risk factor, as fair-skinned individuals are at a higher risk level for developing skin cancer than their counterparts with darker skin. Genetic causes and smoking are also considered risk factors. 

WHAT ARE THE TYPES OF SKIN CANCER OF THE EYELIDS?

Depending upon the cell type growing within the tumor, the types of skin cancer include basal cell carcinoma, squamous cell carcinoma, melanoma, and sebaceous cell carcinoma. 

ARE SKIN CANCERS ON THE EYELIDS OR AROUND THE EYE SERIOUS?

All skin cancer is considered serious as these growths can invade surrounding areas, and in some forms of cancers, even spread (metastasize) to other areas of the body if left untreated. When detected early, there is a greater chance of removing the tumor and minimizing the amount of tissue, that as a result, needs to be removed.

HOW ARE EYELID SKIN CANCERS TREATED?

A surgical excision is the most effective treatment of skin cancers of the eyelid. Our board certified ophthalmologist, Dr. Jay Older has over 30 years of experience in the highly specialized field of ophthalmic plastic and reconstructive surgery. Dr. Older will examine the tissue to make a conclusion as to the type of skin cancer that is present and determine if all of it was removed. Skin cancers of the eyelid can appear as a bump, freckle, or persistent inflammation of the eyelid. If you are noticing anything suspicious on your eyelids, please call Dr. Older's appointment line at 813-971-3846 and schedule a visit with him at Suncoast Eye Center.
DRY EYE SYNDROME
Dry eye syndrome- also called dry eye disease (DED) is also referred to, in medical terms: Keratitis Sicca or ocular surface disease. This chronic condition is caused by either decreased tear production in the lacrimal glands or increased tear film evaporation in the meibomian glands. An adequate and consistent production and drainage of tears is important to maintaining the health of your eyes. Tears moisturize your eyes, protect against eye infection, and assist in wound healing. Dry eye syndrome is frequently under-diagnosed due to the complex nature and its tendency to mimic the symptoms of other problems associated with ocular allergies.
SYMPTOMS
If you are experiencing symptoms of dry eye, you may be feeling that grit, or some other object or material is in your eye (foreign body sensation), burning, aching or stinging sensations, itchy eyes, and episodes of excess tearing. Dry eye may even cause the vision to become blurred. These symptoms might be more noticeable while reading, watching television, or using the computer. 
CAUSES
A normal tear film consists of three important components: an oily (lipid) component, a watery (aqueous) component, and a mucous-like (mucin) component. There are different types of dry eye, depending on which component is affected. Two primary types are evaporative or oil-deficient dry eye and aqueous or water-deficient dry eye. Each component, of the tear film, serve a critical purpose, and each tear component is produced by different glands. A problem with any of these sources of tear film components can result in tear instability and dry eyes.

Dry eye is common in women, especially after menopause, as hormone fluctuations are known to cause a worsening of dry eye. Other causes can occur due to environmental factors to include but not limited to low humidity or air conditioner ventilation. Some medications may intensify dry eyes such as antihistamines, sedatives and anti-depressant drugs. Systemic disease may also cause dry eye, such as rheumatoid arthritis, thyroid conditions, lupus, among others. Anatomy of the eyelids causing incomplete function or closure may also play a role in dry eyes. 
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