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Learn About Eye Diseases

Glaucoma

Glaucoma refers to a group of disorders that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain.

Alternative Names

Open-angle glaucoma; Chronic glaucoma; Closed-angle glaucoma; Congenital glaucoma

Causes

Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma:

  • Angle-closure (acute) glaucoma
  • Congenital glaucoma
  • Open-angle (chronic) glaucoma
  • Secondary glaucoma

All four types of glaucoma are characterized by increased pressure within the eyeball, and therefore all can cause progressive damage to the optic nerve. Open-angle (chronic) glaucoma is by far the most common type of glaucoma.

The front part of the eye is filled with a clear fluid called the aqueous humor. This fluid is constantly made in the back of the eye. It leaves the eye through channels in the front (anterior) chamber of the eye in an area called the anterior chamber angle, or simply the angle.

Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddently blocked. This causes a quick, severe, and painful rise in the pressure within the eye (intraocular pressure). Angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision.

If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment.

Dilating eye drops and certain systemic medications may trigger an acute glaucoma attack if you are at risk.

Congenital glaucoma often runs in families (hereditary). It is present at birth, and is the result of the abnormal development of the fluid outflow channels in the eye.

In open-angle glaucoma, the cause is essentially unknown. An increase in eye pressure pushes on the junction of the optic nerve and the retina at the back of the eye, reducing the blood supply to the optic nerve.

Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are at particularly high risk for this disease.

Secondary glaucoma is caused by:

  • Drugs such as corticosteroids
  • Eye diseases such as uveitis
  • Systemic diseases

Symptoms

OPEN-ANGLE

  • Gradual loss of peripheral (side) vision
  • Most people have no symptoms until they lose vision

ANGLE-CLOSURE

  • Decreased or cloudy vision
  • Nausea and vomiting
  • Pupil does not react to light
  • Red eye
  • Severe eye pain, facial pain
  • Swelling of the eye

CONGENITAL

  • Cloudiness of the front of the eye
  • Enlargement of one eye or both eyes
  • Red eye
  • Sensitivity to light
  • Tearing

Exams and Tests

An examination of the eye may be used to diagnose glaucoma. However, checking the intraocular pressure alone (tonometry) is not enough because eye pressure changes. The doctor will need to examine the inside of the eye by looking through the pupil, often while the pupil is dilated.

Usually the doctor will perform a complete examination of the eyes.

Tests may include:

  • Gonioscopy (use of a special lens to see the outflow channels of the angle)
  • Intraocular pressure measurement by tonometry
  • Optic nerve imaging (photographs of the interior of the eye)
  • Pupillary reflex response
  • Refraction
  • Retinal examination
  • Slit lamp examination
  • Visual acuity
  • Visual field measurement

Treatment

The objective of treatment is to reduce intraocular pressure. Depending on the type of glaucoma, this is achieved with medications or by surgery.

Open-angle glaucoma treatment:

Most people with glaucoma can be treated successfully with eye drops. In the past, eye drops for glaucoma caused blurring of vision, but most eye drops used today have few side effects. Your doctor will look at your medical history and determine the best drops for you. You may need more than one type of drop. Some patients may also be treated with pills to lower pressure in the eye. Newer drops and pills are being developed that directly protect the optic nerve from glaucoma damage.

Some patients will need other forms of treatment, such as a laser treatment, to help open the fluid outflow channels. This procedure is usually painless. Others may need traditional surgery to open a new outflow channel.

Angle-closure glaucoma treatment:

Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated. Drops, pills, and medicine given through a vein (by IV) are used to lower pressure. Some people also need an emergency operation, called an iridotomy. This procedure uses a laser to open a new channel in the iris. The new channel relieves pressure and prevents another attack.

Congenital glaucoma:

This form of glaucoma is almost always treated with surgery to open the outflow channels of the angle. This is done while the patient is asleep and feels no pain (with anesthesia).

Outlook (Prognosis)

Open-angle glaucoma:

You can manage open-angle glaucoma and almost always preserve your vision, but the condition cannot be cured. It's important to carefully follow up with your doctor. With good care, most patients with open-angle glaucoma will not lose vision.

Angle-closure glaucoma:

Rapid diagnosis and treatment of an attack is the key element to preserving vision. Seek emergency care if you have the symptoms of angle-closure attack.

Congenital glaucoma:

Early diagnosis and treatment is important. If surgery is done early enough, many patients will have no future problems.

When to Contact a Medical Professional

Call your health care provider if you have severe eye pain or a sudden loss of vision, especially loss of peripheral vision.

Call for an appointment with your health care provider if you have risk factors for glaucoma and have not been screened for the condition.

Prevention

There is no way to prevent open-angle glaucoma, but you can prevent vision loss from the condition. Early diagnosis and careful management are the keys to preventing vision loss.

Most people with open-angle glaucoma have no symptoms. Everyone over age 40 should have an eye examination at least once every 5 years, and more often if in a high-risk group. Those in high-risk groups include people with a family history of open-angle glaucoma and people of African heritage.

People at high risk for acute glaucoma may opt to undergo iridotomy before having an attack. Patients who have had an acute episode in the past may have the procedure to prevent a recurrence.

References

Burr JM, Mowatt G, Hernández R, Siddiqui MA, Cook J, Lourenco T, et al. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess. 2007 Oct;11(41):iii-iv, ix-x, 1-190.

Vass C, Hirn C, Sycha T, Findl O, Bauer P, Schmetterer L. Medical interventions for primary open angle glaucoma and ocular hypertension. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003167.

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Cloudy Cornea

A cloudy cornea is a loss of transparency of the cornea.

Alternative Names

Corneal opacification; Corneal edema

Causes

The cornea is normally a nearly invisible, clear structure covering the iris of the eye. Its two purposes are to transmit and focus the light entering the eye.

Causes of cloudy cornea include:

  • Chemical burns to the cornea
  • Herpetic keratoconjunctivitis (a form of conjunctivitis caused by herpes simplex)
  • Infectious diseases
  • Poor nutrition
  • River blindness (onchocerciasis -- an infection common in parts of Africa)
  • Several rare inherited diseases involving abnormal metabolism
  • Sjogren syndrome
  • Trachoma
  • Trauma
  • Vitamin A deficiency

Clouding leads to varying degrees of vision loss.

Home Care

Consult your health care provider. There is no appropriate home care.

When to Contact a Medical Professional

Contact your health care provider if:

  • The outer surface of the eye appears cloudy
  • You have trouble with your vision

Note: It is appropriate to see an ophthalmologist for vision or eye problems. However, your primary health care provider may also be involved if a whole-body (systemic) disease is suspected.

What to Expect at Your Office Visit

The doctor will take a medical history and examine your eyes.

Medical history questions may include:

  • Did the cornea become cloudy quickly, or did it develop slowly?
  • When did you first notice this?
  • Does it affect both eyes?
  • Is there any history of injury to the eye?
  • What other symptoms do you have?
  • Do you have any trouble with your vision?
  • If so, what type (blurring, reduced vision, or other) and how much?

Physical examination will include a thorough check of your eyes and vision.

Diagnostic tests may include:

  • Biopsy of lid tissue
  • Ophthalmoscopy
  • Special photographs to measure the cells of the cornea
  • Standard eye exam
  • Tests for suspected causes
  • Ultrasound to measure corneal thickness

After seeing your health care provider:

You may want to add a diagnosis related to cloudy cornea to your personal medical record.

References

Crouch JR ER, Crouch ER, Grant T. Ophthalmology. In: Rakel RE. Rakel: Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 53.

Brunette DD. Ophthalmology. In: Marx JA. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby; 2006: chap 70.

Newlin AC, Sugar J. Corneal and External Eye Manifestations of Systemic Disease. In: Yanoff M, Duker JS, Augsburger JJ, Azar DT. Yanoff: Opthalmology. 2nd ed. Philadelphia, Pa: Mosby; 2004: chap 66.

 

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Conjunctivitis

Conjunctivitis is an inflammation or infection of the membrane lining the eyelids (conjunctiva).

Alternative Names

Inflammation - conjunctiva; Pink eye

Causes

The conjunctiva is exposed to bacteria and other irritants. Tears help protect the conjunctiva by washing away bacteria. Tears also contain enzymes and antibodies that kill bacteria.

There are many causes of conjunctivitis. Viruses are the most common cause. Other causes include bacteria, Chlamydia, fungi, and rarely, parasites.

"Pink eye" refers to a viral infection of the conjunctiva. These infections are especially contagious among children.

Bacteria are an uncommon cause of conjunctivitis. Conjunctivitis is also caused by allergies (allergic conjunctivitis), chemical exposure, and certain systemic (throughout the body) diseases.

Newborns can be infected by bacteria in the birth canal. This condition is called ophthalmia neonatorum, and it must be treated immediately to preserve eyesight. Use of contact lenses, particularly extended-wear lenses, can cause conjunctivitis.

See also:

  • Allergic conjunctivitis
  • Keratoconjunctivitis sicca
  • Neonatal conjunctivitis
  • Trachoma
  • Vernal conjunctivitis

Symptoms

  • Blurred vision
  • Crusts that form on the eyelid overnight
  • Eye pain
  • Gritty feeling in the eyes
  • Increased tearing
  • Itching of the eye
  • Redness in the eyes
  • Sensitivity to light

Exams and Tests

  • Examination of the eyes
  • Swab of conjunctiva for analysis

Treatment

Treatment of conjunctivitis depends on the cause.

Allergic conjunctivitis may respond to treatment for the underlying allergies, or it may disappear on its own when the allergen that caused it is removed. Cool compresses may be soothing for allergic conjunctivitis.

Antibiotic medication, usually eye drops, is effective for bacterial conjunctivitis. Viral conjunctivitis will disappear on its own. Many doctors give a mild antibiotic eyedrop for pink eye to prevent bacterial conjunctivitis.

You can soothe the discomfort of viral or bacterial conjunctivitis by applying warm compresses (a clean cloth soaked in warm water) to your closed eyes.

Outlook (Prognosis)

The outcome is usually good with treatment.

Possible Complications

Reinfection within a household or school may occur if you don't follow preventive measures.

When to Contact a Medical Professional

Call for an appointment with your health care provider if your symptoms last longer than 3 or 4 days.

Prevention

Good hygiene can help prevent the spread of conjunctivitis:

  • Change pillowcases frequently.
  • Do not share eye cosmetics.
  • Do not share towels or handkerchiefs.
  • Handle and clean contact lenses properly.
  • Keep hands away from the eye.
  • Replace eye cosmetics regularly.
  • Wash your hands often.

Review Date: 11/13/2007
Reviewed By: Manju Subramanian, M.D., Assistant Professor in Ophthalmology, Vitreoretinal Disease and Surgery, Boston University Eye Associates, Boston, MA. Review provided by VeriMed Healthcare Network.

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Cataracts

A cataract is a cloudy or opaque area (an area you cannot see through) in the lens of the eye.

The lens of the eye is normally clear. If the lens becomes cloudy, the condition is known as a cataract. Rarely, cataracts may be present at or shortly after birth. These are called congenital cataracts.

Adult cataracts usually develop with advancing age and may run in families. Cataracts develop more quickly in the presence of some environmental factors, such as smoking or exposure to other toxic substances. They may develop at any time after an eye injury. Metabolic diseases such as diabetes also greatly increase the risk for cataracts. Certain medications, such as cortisone, can also accelerate cataract formation.

Congenital cataracts may be inherited. The gene for such cataracts is dominant (autosomal dominant inheritance), which means that the defective gene will cause the condition even if only one parent passes it along. I families where one parent carries the gene, there is a 50% chance in every pregnancy that the child will be affected.

Congenital cataracts can also be caused by infections affecting the mother during pregnancy, such as rubella. They are also associated with metabolic disorders such as galactosemia. Risk factors include inherited metabolic diseases, a family history of cataracts, and maternal viral infection during pregnancy.

Adult cataracts are generally associated with aging. They develop slowly and painlessly, and vision in the affected eye or eyes slowly gets worse.

Visual problems may include the following changes:

  • Difficulty seeing at night
  • Seeing halos around lights
  • Being sensitive to glare

Vision problems associated with cataracts generally move towards decreased vision, even in daylight.

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Trachoma

Trachoma is a bacterial infection of the eye.

Alternative Names

Granular conjunctivitis; Egyptian ophthalmia; Conjunctivitis - granular

Causes

Trachoma is caused by infection with the bacteria Chlamydia trachomatis.

The condition occurs worldwide, mostly in rural settings in developing countries. It frequently affects children, although the effects of scarring may not be seen until later in life. While trachoma is rare in the United States, certain populations marked by poverty, crowded living conditions, or poor hygiene are at higher risk for this illness.

Trachoma is spread through direct contact with infected eye, nose, or throat secretions or by contact with contaminated objects, such as towels or clothes. Certain flies can also spread the bacteria.

Symptoms

Symptoms begin 5 to 12 days after being exposed to the bacteria. The condition begins slowly as inflammation of the tissue lining the eyelids (conjunctivitis, or "pink eye"), which if untreated may lead to scarring.

Symptoms may include:

  • Cloudy cornea
  • Discharge from the eye
  • Swelling of lymph nodes just in front of the ears
  • Swollen eyelids
  • Turned-in eyelashes

Exams and Tests

An eye exam may reveal scarring on the inside of the upper eye lid, redness of the white part of the eyes, and new blood vessel growth into the cornea.

Laboratory tests are needed to accurately identify and detect the bacteria and diagnose trachoma.

Treatment

Antibiotics can prevent long-term complications if used early in the infection. Antibiotics include erythromycin and doxycycline. In certain cases, eyelid surgery may be needed to prevent long-term scarring, which can lead to blindness if not corrected.

Outlook (Prognosis)

Early treatment before the development of scarring and lid deformities has an excellent prognosis.

Possible Complications

If the eyelids are severely irritated, the eyelashes may turn in and rub against the cornea. This can cause eye ulcers, additional scars, vision loss, and possibly, blindness.

When to Contact a Medical Professional

Call your health care provider if you or your child recently visited an area of the world where trachoma is common and there are symptoms of conjunctivitis.

Prevention

Improved sanitation and not sharing items such as towels are important measures for limiting the spread of trachoma.

References

Diseases Caused By Chlamydiae. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 339.

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Vision Problems

Vision changes and problems can be caused by many different conditions:

  • Presbyopia -- difficulty focusing on objects that are close. Common in the elderly.
  • Cataracts -- cloudiness over the eye's lens, causing poor nighttime vision, halos around lights, and sensitivity to glare. Daytime vision is eventually affected. Common in the elderly.
  • Glaucoma -- increased pressure in the eye, causing poor night vision, blind spots, and loss of vision to either side. A major cause of blindness. Glaucoma can happen gradually or suddenly -- if sudden, it's a medical emergency.
  • Diabetic retinopathy -- this complication of diabetes can lead to bleeding into the retina. Another common cause of blindness.
  • Macular degeneration -- loss of central vision, blurred vision (especially while reading), distorted vision (like seeing wavy lines), and colors appearing faded. The most common cause of blindness in people over age 60.
  • Eye infection, inflammation, or injury.
  • Floaters -- tiny particles drifting across the eye. Although often brief and harmless, they may be a sign of retinal detachment.
  • Retinal detachment -- symptoms include floaters, flashes of light across your visual field, or a sensation of a shade or curtain hanging on one side of your visual field.
  • Optic neuritis -- inflammation of the optic nerve from infection or multiple sclerosis. You may have pain when you move your eye or touch it through the eyelid.
  • Stroke or TIA.
  • Brain tumor.
  • Bleeding into the eye.
  • Temporal arteritis -- inflammation of an artery in the brain that supplies blood to the optic nerve.
  • Migraine headaches -- spots of light, halos, or zigzag patterns are common symptoms prior to the start of the headache. An ophthalmic migraine is when you have only visual symptoms without a headache.


Other potential causes of vision problems include fatigue, overexposure to the outdoors (temporary and reversible blurring of vision), and many medications.

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