Corneal conditions

  Cataracts are caused by clouding of the crystalline lens due to aging. They initially cause symptoms with reduced night vision from glare and halos however eventually progress to reduce contrast sensitivity, color vision and overall reduction in visual acuity. To a certain point, updating your glasses prescription can compensate for the cataracts however surgery is the only way to get rid of cataracts. Feel free to look at the cataract surgery section of this website to learn more about how surgery works.

Corneal ulcer – this is a sight threatening condition where you have infection of the cornea which is the clear window of the eye. The most common risk factors are contact lens misuse and trauma. Corneal ulcers are often due to bacterial infections but can be viral, fungal or parasitic infections. Management of corneal ulcers includes taking cultures, and starting antibiotic eye drops. Depending on the severity, corneal ulcers can result in permanent blindness. 

Cancers of the conjunctiva such as squamous cell are often due to UV sun light damage, smoking and being immunosuppressed. Although slow growing, treatment consists of chemotherapy eye drops or surgical excision. 

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   A pterygium is a benign growth of the conjunctiva usually on the nasal or temporal side of the cornea. This is usually a result of UV light damage and may enlarge to cover the pupil and reduce vision or may get inflamed. Pterygium, often also referred to as surfer's eye are not dangerous although can cause permanent vision problems if they grow large. Medical treatment involves wearing sunglasses to protect the eyes form uv light damage, artificial tears, and occasionally steroid eye drops. Surgery is often a last resort and involves removing the pterygium and then suturing or gluing a conjunctival graft. 

 Keratoconus and pellucid marginal degeneration (also referred to as corneal ectasia) are conditions in which the cornea begins to change shape and cause blurred vision. The blurred vision is due to irregular astigmatism induced by the abnormal corneal shape.  The first signs of keratoconus can be a rapidly changing eye glass prescription or an inability for spectacles to clear your vision. Diagnosis often requires a topography which helps create a topographical map of your cornea. Treatment includes hard contact lens, cross linking and corneal transplants. 

 Dry eye syndrome is very common as you get older and results in symptoms of redness, foreign body sensation,  grittiness, dryness, tearing and fluctuating vision. Dry eye syndrome can be made worse by other medications you take such as water pills and allergy medications, as well as environmental factors. Treatment of dry eyes usually requires artificial tears but other options such as prescription medications, punctal plugs, serum tears, steroid eye drops, and special contact lens are also an option. Dry eyes can be difficult to manage and often times requires ruling out autoimmune conditions and vitamin deficiency. 

 Diabetes can affect the eyes in multiple ways including causing bleeding and swelling of the retina, and by causing cataracts to develop at an early age. Patients with diabetes can also develop abnormal fragile blood vessels that can leak to cause bleeding and swelling of the retina. Treatment includes laser therapy, injections, and routine eye exams. Rarely surgery may be necessary to treat diabetes damage. It is important that all diabetic patients get examined at least annually to detect these findings before permanent vision loss develops. 

 Age related Macular degeneration is a condition that results in buildup of metabolic waste in the retina resulting in permanent damage and the development of a blind spot. This is typically seen in patients older than 60. There are 2 types of macular degeneration and they are the wet and dry type. Whereas the dry type of AMD is benign in nature, wet AMD usually means abnormal bleeding and needs to be treated. Diagnosis requires a thorough dilated eye exam and a retinal scan to rule out any active bleeding at the leve of the retina. Treatment of AMD includes eye vitamins and injections of medications into the eye. 

Glaucoma is a condition in which the optic nerve gets damage usually due to elevated intraocular pressure. Glaucoma typically develops as you get older and often causes no symptoms. The optic nerve damage usually results in loss of peripheral vision. Risk factors for glaucoma a family history, thin corneal thickness, steroid use, ethinicity (hispanics and african americans are at increased risk), and age. Diagnosis usually requires a thorough examination with optic nerve scans and visual field testing as well as IOP checks. Treatment usually requires eye drops to reduce the pressure but in certain instances laser and incisional surgery can be done if severe. 

• Hydroxychloroquine: (HCQ) patients who use HCQ for autoimmune conditions require annual testing. A side effect of hCQ (albeit rare) involves development of scarring in the macula which can result in the development of a permanent blind spot. This rare side effect increases with the longer and more frequent you are on the medication. Another risk factor is reduced kidney function. There is no treatment for this retinal damage, and the blind spot can be permanent. Thus, routine monitoring with an eye exam, retinal scan, retinal photos, and visual field testing is crucial.
• Ethambutol: this is an antibiotic that is often used to treat pneumonia, and tuberculosis. this medication can cause damage to the optic nerve resulting in reduced vision and color vision
• Amiodarone: amiodarone is a medication often used for patients with heart disease and abnormal heart rhythm. This medication can result in damage to the optic nerve by causing swelling and eventually leading to damage. 

neurotrophic keratopathy refers to a condition where the nerve function to the cornea is decreased for multiple reasons including viral infections, medication toxicity, and after surgical nerve ablation procedures for trigeminal neuralgia and postherpetic neuralgia. As a result of the decreased nerve function, the cornea starts to break down, resulting in abrasion and thinning and eventually melting. Diagnosis and management is aimed at restoring the broken down surface of the cornea via medications, artificial tears, punctal plugs, amniotic membrane, contact lens, and even surgical procedures such as temporary tarsorraphy. Being aggressive is often recommended as once damage develops, permanent vision decrease results. 

Fuchs dystrophy is a genetic condition that results due to a reduction in the cellular pump layer of the inner cornea that maintain the clarity of the cornea and prevent swelling. Symptoms including foggy vision and blurred vision usually upon awakening. As we age, the condition tends to become more noticeable. Diagnosis includes examination of the eye, and measuring the cell density and thickness of the cornea. While asympomatic and mild for most patients treatment usually consists of salt water drops and ointments. Rarely surgery is recommended with a partial thickness transplant. Often times this surgery is done either after cataract surgery or rarely at the same time of surgery. Feel free to read more about transplants in the "corneal transplant" section of this website

Chemical burns can result when the ocular surface comes in contact with an abrasive chemical (bleach, lye, acids) resulting in permanent injury to the conjunctiva, eyelids, and cornea resulting in scarring, opacifications and decreased vision.

Corneal abrasions result from injury to the cornea which can result in severe pain, light sensitivity and decreased vision. Appropriate management is important to prevent infection, scarring and limit permanent visual sequalae. 

Penetrating injuries or open globe injuries are eye emergencies that usually require emergent surgery and depending on the extent of injury can result in permanent vision loss, need for additional surgery and/or blindness.