Causes

There are diseases and conditions that can cause blepharitis. Depending on where it occurs, it may be linked to the following:

• Anterior Blepharitis – infections occur at the front part of the eyelid where the eyelashes are attached. It happens when there is too much bacteria on the skin or dandruff found on the scalp and eyebrows. Allergies or eyelash mites/lice on the eyelashes also increase risk for anterior Blepharitis.
• Posterior Blepharitis – this occurs at the inner edge of the eyelid where the oil glands are located. Bacteria are likely to grow when the eyelid glands do not produce enough oil. It may also be due to other conditions like rosacea and dandruff on the scalp.

Signs and symptoms

The signs and symptoms of blepharitis are usually worse in the morning. There may be crust on the eyelashes and eyelid edges, with difficulty opening the eyelids upon waking up, and there may also be yellow or green eye discharge. Other warning signs include:

• Eyelid redness
• Stinging or burning sensation in the eyelid
• A feeling like there is sand in your eye
• Itchy eyelids
• Eyelids that are stuck together
• Excessive tearing
• Oily eyelids
• Red, swollen eyelids
• Blurred vision
• Frequent blinking

Complications

Blepharitis can lead to other eye problems, such as:

• Excessive tearing or dry eyes
• Loss of eyelashes
• Stye or chalazion
• Eyelid scarring
• Chronic pink eye
• Corneal injury, infection

Treatment

It is important to treat what us causing or triggering it.  The following treatment options may be prescribed:

• Warm compress and lid hygiene (lid scrub with lid cleansing agents)
• Antibiotics (may be an ointment, eye drop, or oral)
• Lubricating eye drops / artificial tears
• Blephex – a quick and painless 10-minute outpatient procedure used to clean the eyelids, it makes use of a revolutionary handpiece that safely and effectively eliminates the bacterial film and oil on the eyelids. It will feel like having a massage on your eyelids, but it promotes relief and improvement from the eyelid symptoms.

It is also very important to do these tips to help control your Blepharitis:

• Keep your eyelids clean
• Use a warm and clean compress to soften the crust
• Avoid eye makeup, or remove it completely before bed time
• Replace eye makeup regularly
• Avoid touching or rubbing your eyes
• Wear eyeglasses instead of contact lenses until it heals

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Causes

Tears have three layers – oily layer, watery layer, and mucus layer. Each of these layers has a purpose. The oily layer prevents tears from evaporating or drying up too quickly; the water layer lubricates the eye and washes away the particles in the eyes; and the mucus layer spreads the watery layer over the surface of the eye evenly, helping the tears stick to the surface of the eyes. If there is a problem in any of these layers, such as not being able to produce enough water, oil or mucus, it can lead to dry eyes.

There are different reasons one can have dry eyes:

• Aging – while it can occur at any age, it becomes more common when you are over 50 years old.
• Computer use or any near work activity – when doing near work activities like using the computer or a gadget or reading a frequently, causing the tears to dry up more quickly
• Indoor environment – electric fans and air conditioning can decrease indoor humidity, which makes tears to hasten tear evaporation
• Outdoor environment – having dry climates or windy condition puts one at higher risk for dry eyes
• Smoking – it has been linked to several eye conditions like cataract, macular degeneration and even dry eyes
• Eyelid problems – eyelids that do not fully close when blinking or sleeping can lead to severe dry eyes
• Medications – certain prescription and non-prescription medicines like anti-histamines, beta blockers and birth control pills can increase one’s risk for dry eyes

Other potential causes include menopause, contact lens wear, LASIK and allergies.

Signs and symptoms

While it is not usually a serious eye condition, it may lead to discomfort. It usually affects both eyes and may cause:

• Burning or stinging sensation in the eyes
• Blurred vision
• Red, scratchy or itchy eyes
• Sensitivity to light
• Watery eyes/tearing

Treatment

The treatment for dry eyes depends on what is causing it. The goal is to relieve the symptoms and keep your eyes healthy:

• Lubricating eye drops – the most common treatment, these are also called artificial tears. It is the mainstay treatment for dry eye, aimed to help your eyes feel more comfortable
• Prescription eye drops – aside from lubricating the surface of the eyes, it helps your eyes make more tears, and reduce swelling
• Punctal plugs – used to keep the tears on the surface of the eye longer, a small, sterile device is inserted in the opening of the tear ducts. This device is removable.
• Surgery – certain eyelid conditions can lead to dry eyes. Consult with an oculoplastics/eye plastic surgeon to correct this eyelid problem.
• Lifestyle changes – what medicine are you taking? Do you smoke? How much water do you drink? Are you always exposed to smoke or air-conditioning? Do you sleep 7 to 8 hours a night? Consult with your doctor to know what is causing your dry eyes or making it worse. He/she will then recommend you to make adjustments to protect your eyes.
• Blephex – a quick and painless 10-minute outpatient procedure used to clean the eyelids, it makes use of a revolutionary handpiece that safely and effectively eliminates the bacterial film and oil on the eyelids. It will feel like having a massage on your eyelids, but it promotes relief and improvement from the dry eye symptoms.

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Types of Eye Problems in Children

The most common eye problems that may affect children include:

REFRACTIVE ERRORS

The most common type of vision problem, these are caused by the inability to focus images on the retina (the back part of the eye), making it hard for children to see clearly. These can be caused by three (3) things – changes in the length of the eyeball, changes in the shape of the cornea (the clear surface layer of the eye), and aging of the lens.

Children may experience any of these types of refractive errors:

• Myopia – More commonly known as nearsightedness, this happens when the eyeball is slightly longer than normal or the refractive power of the eye is too strong. Because of this, children can see nearby objects clearly but things afar look blurry. It also often progresses as children grow older.
• Hyperopia – Babies are naturally farsighted. However, they see clearly at near because they have strong “autofocusing” abilities (accommodation), which allows them to overcome farsightedness.
• Astigmatism – This vision problem happens when the normally smooth cornea (clear surface layer of the eye) is curved or becomes oblong. This makes your child’s vision blurry, whether it is near, far or intermediate. Astigmatism may start in childhood and may happen in combination with nearsightedness or farsightedness.

Symptoms

Anyone can have refractive errors, but your child’s risk increases if one or both parents have any of the three (3) types. When it comes to signs and symptoms, it is important for parents to be observant of their children. Among the things that parents need to look out for are:

• frequent headaches
• frequent eye rubbing
• holding objects close to the eyes
• sitting too close to the TV
• squinting
• avoiding to read or do other close activities
• turning head to the side misaligned eyes

Treatment

Eyeglasses or contact lenses are often prescribed refractive errors. This allows children to have the clear vision they need for their learning and development. However, the device or eyewear they will use depends on their age, type of refractive error or needs.

Does wearing eyeglasses or contact lenses make your eyes or vision worse? Does it cause your child’s eye grade to increase? It does not. Your child’s eye grade may increase as they grow older, especially if nearsighted. All nearsighted children experience an increase in their eye grade. It is also not true that wearing eyeglasses or contact lenses will make them dependent on them. They are just getting used to seeing things more clearly, so they want to wear it more often.

At present, there are myopia control lenses and Ortho-K contact lenses. These are specially designed eyewear to slow the progression of nearsightedness in children. This is especially helpful as having high nearsightedness can lead to potentially blinding eye diseases, such as retinal detachment and glaucoma.

When they turn 18 and their eye grade has become stable, they may undergo LASIK screening to see if they are qualified for LASIK surgery. LASIK surgery [to link to LASIK service page] is a popular procedure that lets patients enjoy clear vision, without having to wear eyeglasses or contact lenses.

Amblyopia

Amblyopia or lazy eye is a condition where there is reduced vision in one or both eyes. Normally, the brain uses both eyes to see. If both eyes have poor vision (ie. refractive error), the vision center of the brain will not develop properly resulting in “lazy eyes”. One eye has poor vision, the brain will prefer the better eye and will ignore the weaker eye. When that happens, the weaker or “lazy” eye often wanders inward or outward. Lazy eye develops in childhood, usually when only one eye is used from birth until the child is 7 years old.

Symptoms

Some children are born with lazy eyes, but others may develop it if they have misaligned eyes (one eye turns in or out); a difference in the prescription of each eye; or an eye problem that obstructs vision in either eye (cataract, droopy eyelid). Lazy eye rarely affects both eyes, and you may also notice the following signs or symptoms:

• wandering eye
• eyes that seem to not work together
• squinting or shutting one eye
• tilting head to one side

Treatment

It is important to start the treatment for lazy eyes during childhood. It is during this critical time that complicated connections between the eye and the brain are forming. Treatment options will depend on the cause of the lazy eyes:

• patching – Sticky eye patches are worn on the better eye for two to six or more hours a day. This forces the brain to use the weaker eye to see, and helps this eye to be stronger.
• prescription eyewear – Full-time wear of eyeglasses or contact lenses can help correct refractive errors (nearsightedness, farsightedness or astigmatism) that result in lazy eye
• eye drops – Atropine eye drop is used to temporarily blur the better eye, which forces the brain to use the weaker eye.
• Bangerter filter – A special filter, it is placed on the eyeglass lenses and functions like an eye patch. The filter blurs the stronger eye to stimulate the weaker eye.
• Surgery – Children with cataracts or droopy eyelids might have to undergo surgery to remove what is blocking their vision. If your child has misaligned eyes, his/her doctor may recommend a surgical repair to improve the appearance of the eyes.
• Orthoptic exercises – The child will have to do certain activities like coloring, word games, Lego building while his/her better eye has a patch. Once the weaker eye has improved, the child may do other exercises like pencil push-ups.

Strabismus

Strabismus is a condition in which there is a misalignment of the eyes. This happens when both eyes are not working together when looking at an object. One eye may look straight ahead, while the other may turn inward (cross-eyed), outward (wall-eyed), upward (hypertropia) or downward (hypotropia). It may be permanent or intermittent.

Cause

Each eye has six (6) muscles that control its movements and alignment. These muscles are attached to the outside of the eye and are controlled by the brain. All these have to work and move together. If one or two muscles do not move well, strabismus happens. It can also happen, especially if he/she has:

• family history of strabismus – If a parent has strabismus, their child is likely to develop it.
• uncorrected refractive error – A child with a significant amount of uncorrected refractive error (nearsightedness, farsightedness or astigmatism) may develop this condition.
• medical condition – Risk for strabismus increases if a person is suffering from conditions like Down Syndrome, cerebral palsy, have suffered from stroke, brain tumor or head injury

Types of Strabismus

Strabismus can also develop in both children and adults. There are several types of strabismus, and the two most common forms are:

• Accommodative esotropia – occurs due to uncorrected farsightedness. A patient that is farsighted has to focus hard to see images clearly up close. This focusing effort is referred to as accommodation. The closer the object is, the more accommodation is needed, and this may cause crossed eyes. It typically starts in the first few years of life, and may cause double vision, squinting or covering one eye when looking at an object nearby or tilting the head to the side.
• Intermittent exotropia – occurs when the eyes cannot coordinate together. One eye may look straight at an object, while the other may look outward, or both eyes may turn outward. It can start at any age, and often causes headaches, eyestrain or difficulty reading. Some people do not experience any signs or symptoms.

Treatment

The earlier the strabismus is detected and managed, the higher the success rate of the treatments are likely to be. If not treated immediately, the patient may experience double vision, have problems with 3D vision or depth perception, or develop lazy eyes. There are different ways to treat or manage strabismus, depending on the cause and extent of the condition:

• prescription eyewear – if the person has an uncorrected refractive error, they may be prescribed with eyeglasses or contact lenses to correct their vision.
• prism lenses – these are special lenses that are thicker on one side than the other. The goal is to bend the light that enters the eye to reduce the amount of turning the eye when looking at objects.
• orthoptic exercises – structured visual activities will be prescribed to help problems with movement, focusing, teaming of the eyes. These will help improve the eye by training the eyes and the brain to work together more effectively.
  eye muscle surgery – to make the eyes appear straight or aligned, eye muscle surgery is done to change the position or length of the muscles around the eyes. However, this is usually combined with orthoptic exercises to prevent the eyes from getting misaligned again.

Infants and children may also develop serious eye conditions:

• Pediatric cataract – clouding of the normally clear lens of the eye, causing blurry vision. If left untreated, it can lead to blindness.
• Retinoblastoma – a rare form of eye cancer, retinoblastoma usually occurs in children younger than 5 years old and may be in one eye or both eyes.
• Retinopathy of prematurity (ROP) – a potentially blinding eye disease that usually affects premature babies. It is the development of abnormal blood vessels in the retina of the eye. These vessels are fragile, causing it to leak. Eventually, it will pull the retina from the inner surface of the retina, leading to retinal detachment.

Children are more responsive to treatment when diagnosed early. That is why comprehensive eye exams are important. It is best for infants to get their vision screen as soon as they are born. Formal vision tests can begin as early as 3 years old or before going to school. More frequent comprehensive eye exams are required for those who were born prematurely, have developmental delays or are cross-eyed.

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Adults with strabismus may suffer from double vision or lower self-esteem because they do not like the appearance of their eyes. They may also experience:

• Difficulty in driving
• Headaches
• Eye strain

Unlike in children with strabismus, adults are not at risk of developing amblyopia or lazy eye. This is because the connection between the eye and the brain has already been formed. Amblyopia is decreased vision is one or both eyes due to the abnormal development of vision. If left untreated the brain “ignores” the images seen by the amblyopic eye.

Depending on the type and extent of the condition, patients may be prescribed with prism glasses or recommended to undergo surgery. These will help improve double vision and depth perception.

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Eyelid conditions:

• Ptosis – It refers to the drooping of one of both upper eyelids. Depending on the extent of the drooping, people with ptosis may experience difficulty seeing. Surgery is the best treatment for ptosis.
• Entropion – It occurs when the eyelid turns inwards, causing eyelashes to rub against the cornea.
• Ectropion – It occurs when the eyelid turns outward, leading to excessive tearing or eye dryness, eye irritation or sensitivity to light.
• Blepharospasm – Blepharospasm is the excessive uncontrolled blinking, causing patients to experience difficulty keeping the eyes open. They may also suffer from sensitivity to light, blurry vision and facial spasm.
• Lagophthalmos – The inability to fully close the eyelids, lagophthalmos may lead to increased tearing and foreign body sensation. There may also be pain due to dryness during sleep and blurry vision that results from excessive tearing.
• Trauma – It refers to the lacerations to complex multiple injuries to the eyelid.
• Tumors – Growths on the eye, whether benign or malignant, require excision and repair to restore normal eyelid function. These include chalazion, cyst, basal cell carcinoma, squamous cell carcinoma and sebaceous cell carcinoma.

Orbit conditions:

• Eye problems caused Graves Thyroid Eye Disease – swelling of the structures in the eye socket, particularly the muscles and fat due to the abnormality in the thyroid function, causing the eyeball to bulge forward.
• Pseudomotor Condition – It is the non-infectious painful swelling of structures within the eye.
• Cellulites or infection of the soft tissue within the eye socket – It is the infection of the soft tissue within the eye socket.
• Trauma – It refers to the fractures or breaks in the bony orbital walls. These may cause misalignment of the eyes or deformities of the face.
• Tumors – Benign or malignant tumors within the eye socket can cause displacement of the eyeball, limitation of eye movement and deterioration of vision.
• Acquired anophthalmia
  • Enucleation – It is the surgical removal of the eyeball. It includes orbital implant placement followed by fitting of an artificial eye.
  • Exenteration – It refers to the surgical removal of the content of the eye sockets.

Lacrimal system conditions:

• Infections – The infected tear sac and obstructed tear drainage can cause watering of the eyes with discharge.
• Blocked tear duct – Blocked tear drainage (may be congenital or acquired) can lead to excessive tearing.
• Trauma – This may include lacerations in the tear channels and fracture of the bone surrounding the tear duct.
• Tumors – Benign or malignant tumors of the tear sac or tear duct can result in bloody tear discharge.

Since the tissue and structure surrounding the eye play a significant role in the patient’s ability to see, it is important that an experienced plastic surgeon checks, recommends treatment or performs the surgery.

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Low vision may be caused by eye diseases, such as:

• Glaucoma – the patient develops tunnel vision that may eventually lead to blindness
• Diabetic retinopathy – the patient loses a portion of his vision that may eventually lead to blindness
• Macular degeneration – the patient loses central vision
• Retinitis pigmentosa – the patient may lose peripheral (side) vision that may eventually lead to blindness
• Brain tumors – the defect in the patient’s visual pathway will result in loss of visual field
• Amblyopia/Lazy eye – the patient, usually a child, has poorer vision in one eye than in the other

Patients with low vision are encouraged to make use if their remaining vision. They should also consult with a low vision specialist to evaluate the extent and type of vision loss. He will then provide a visual rehabilitation program that fits that needs, lifestyle and visual condition. The program may include use of special devices, such as magnifiers, tele-microscopes and electronic optical systems (CCTV, magni-cam and low vision imaging system or LVIS).

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Symptoms may occur suddenly and get worse quickly. There are cases when it slowly develops. Some signs and symptoms include:

• Redness of the eye
• Pain in the eye
• Light sensitivity
• Blurred or cloudy vision
• Glare
• Strings or cobwebs floating across field of vision (floaters)
• Whitish area inside the lower part of the iris

Treatment for uveitis depends on the type and severity of the condition. Patients may be recommended to take non-steroidal anti-inflammatory drugs (NSAIDs), antiviral medication, immunosuppressive medication, or undergo intravitreal injection or laser and surgical procedures.

Uveitis can recur anytime, so patients are recommended to undergo annual eye exams.

The post Uveitis appeared first on Asian Eye Institute.

• Conjunctivitis – commonly referred as pink eye, it involves the inflammation of the conjunctiva. Symptoms include itching or burning sensation, excessive tearing, discharge from one or both eyes, sensitivity to light, swollen eyelids or eye redness. Treatment depends on the cause of conjunctivitis – allergy, bacteria or virus. The key is to identify the cause of the disease and avoid self-medication by using over-the-counter eye drops or medicine.
• Pterygium – also known as surfer’s eye or pugita. It is a triangular shaped tissue that grows onto the cornea. It is usually caused by too much exposure to the sun’s ultraviolet (UV) rays, dust and wind. It may be accompanied by eye redness, tearing, foreign body sensation and dry and itchy eyes. Lubricants are prescribed to reduce swelling and redness of small pterygium. Surgery may be required if its growth is large enough that it obstructs vision and causes discomfort.
• Dry eye – occurs when tears do not provide sufficient moisture for the eyes. It is usually due to poor tear quality, decreased tear production, eyelid problems and some medications. When tears do not provide sufficient moisture for the eyes, the eyes try to compensate for it by producing excessive tears. A person with dry eyes may also experience, red, gritty or scratchy eyes, burning sensation in the eyes or eye redness. Instilling artificial tears and taking vision breaks are recommended to ease the symptoms. However, it is best to know the factor that is causing it.
• Keratoconus – occurs when the cornea bulges outward like a cone. Having a cone-shaped cornea causes blurry vision and may cause sensitivity to light and glare. It can affect people age 10 to 25. In its early stages, it can be corrected by wearing glasses or soft contact lenses. As it advances, rigid gas permeable contact lenses or other type of lenses may be fitted. Corneal transplant may also be recommended.
• Eye injuries – Eye injuries can occur in the workplace, at home, when playing sports or due to accidents. It can range from minor injuries, such as getting soap in the eye, to major ones like foreign bodies or chemical burns. These injuries can cause your cornea to be swollen or scarred, distorting your vision. Thus, it is best to avoid touching, rubbing or applying pressure to the eye and see an ophthalmologist immediately.
  • Burns to the eye – Some substances like soap or shampoo can make your eyes burn but will not cause serious eye problems. However, chemicals like acids and alkali, hot fumes can damage the eye.
  • Penetrating eye injuries – Penetrating eye injuries, such as lacerations or open wounds, usually involve tiny projectiles piercing through the different layers of the eye. Some wounds cause foreign bodies to lodge within the eye.
  • Contusion injuries – A direct blow to the eye by a blunt object like champagne cork or clenched fist can cause contusion injuries. Injuries may range from a superficial hemorrhage to more serious conditions like lens dislocation, iris tears, retinal swelling or edema.
  • Other injuries – Corneal abrasion and corneal foreign body are some of the common but less serious eye trauma. Corneal abrasions are the superficial defect in the outer surface of the eye. They may be accompanied by intense pain, tearing and foreign body sensation in the eye. Contact lens wearers usually experience corneal abrasions. Corneal foreign body, on the other hand, is a fragment of an object that can stick to the eye.

Corneal Transplants

Asian Eye is one the few eye centers in the Philippines that performs corneal transplants – Descemet Endothelial Keratoplasty (DSEK) and Deep Anterior Lamellar Keratoplasty (DALK). Aimed at improving vision, these surgeries remove only the unhealthy or diseased layers of the cornea and replace them with healthy ones from a donor.

• DSEK – the damaged endothelial layer (inner lining of the cornea) is selectively replaced with harvested donor cornea without the need for cuts or sutures
• DALK – The diseased front layers of the cornea called stroma and epithelium are removed. The donor cornea is then sutured. DALK is ideal for people suffering from corneal scars, chemical or thermal burns, and keratoconus.

DSEK and DALK lower the risk of cornea rejection of infections. Thus, patients do not have to undergo long-term steroid medications to prevent rejection of the cornea. Long-term use of steroids is a risk factor for blind-causing diseases like cataract and glaucoma. It also promotes shorter visual recovery, better visual outcome, less astigmatism (for DSEK), reduced discomfort and improvement in physical function.

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