Listed below are some of the common eye conditions we treat in our group. Please read through this and if you have any questions, our trained medical consultants can further explain them. Call to schedule an appointment if you feel you have one of these conditions.
Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. This condition, sometimes referred to as"lazy eye," can run in families. The main causes of amblyopia are strabismus, refractive errors, or cloudiness of the eye tissues.
Amblyopia affects about three out of every 100 people. The best time to correct it is during infancy or early childhood, because after the first nine years of life, the visual system is normally fully developed and usually cannot be changed. It is recommended that children have their eyes and vision monitored by their primary care physician at their well-child visits. If there is a family history of amblyopia, children should be screened by an ophthalmologist (Eye M.D.).
Strabismus, or misaligned eyes, is the most common cause of amblyopia. The eye that is misaligned is ignored by the brain and"turns off." A refractive error (meaning an eye is nearsighted, farsighted, or has astigmatism) is another cause of amblyopia. If one eye has a very different refractive error from the other eye, or if both eyes have a very strong refractive error, amblyopia can develop in the eye or eyes that are out of focus. The most severe form of amblyopia occurs when cloudiness of the eye tissues prevents any clear image from being processed. This can happen in conditions such as infantile or developmental cataracts.
Amblyopia is detected by finding a difference in vision between the two eyes or poor vision in both eyes. The ophthalmologist will also carefully examine the eyes to see if other eye conditions are causing decreased vision.
Amblyopia is treated by forcing the brain to use the affected eye or eyes. If refractive errors are present, they are corrected with eyeglasses or, less commonly, with contact lenses or refractive surgery. If a cataract or other cloudiness is present, surgery may be necessary to clear the line of sight. Strabismus may require surgery before, during, or after the amblyopia treatment. Patching or blurring the sound eye is then used to improve the vision by forcing the brain to recognize and process information from the affected eye or eyes. Once maximum vision has been obtained, treatment often needs to be continued at least part time for months to years to maintain the recovered vision. The earlier the treatment is begun, the more successful it will be.
Color blindness (color vision deficiency) is a condition in which certain colors cannot be detected. There are two types of color vision difficulties: congenital (inherited) problems that you have at birth, and problems that develop later in life.
People born with color vision problems are unaware that what they see is different from what others see unless it is pointed out to them. People with acquired color vision problems are aware that something has gone wrong with their color perception.
Congenital color vision defects usually pass from mother to son. These defects are due to partial or complete lack of the light-sensitive photoreceptors (cones) in the retina, the layer of light-sensitive nerve cells lining the back of the eye. Cones distinguish the colors red, green, and blue through visual pigment present in the normal human eye. Problems with color vision occur when the amount of pigment per cone is reduced, or one or more of the three cone systems are absent. This limits the ability to distinguish between greens and reds, and occasionally blues. It involves both eyes equally and remains stable throughout life.
There are different degrees of color blindness. Some people with mild color deficiencies can see colors normally in good light but have difficulty in dim light. Others cannot distinguish certain colors in any light. In the most severe form of color blindness, everything is seen in shades of gray.
Except in the most severe form, color blindness does not affect the sharpness of vision at all. It does not correlate with low intelligence or learning disabilities.
Most color vision problems that occur later in life are a result of disease, trauma, toxic effects from drugs, metabolic disease, or vascular disease. Color vision defects from disease are less understood than congenital color vision problems. There is often uneven involvement of the eyes and the color vision defect will usually be progressive. Acquired color vision loss can be the result of damage to the retina or optic nerve.
There is no treatment for color blindness. It usually does not cause any significant disability. However, it can prevent employment in an increasing number of occupations.
Change in color vision can signify a more serious condition. Anyone who experiences a significant change in color perception should see an ophthalmologist (Eye M.D.).
"Pink eye," the common name for conjunctivitis, is an inflammation or infection of the conjunctiva. The conjunctiva is the outer, normally clear covering of the sclera (the white part of the eye). The eye appears pink when you have conjunctivitis because the blood vessels of the conjunctiva are dilated. Pink eye is often accompanied by a discharge, but vision is usually normal and discomfort is mild.
Either a bacterial or a viral infection may cause conjunctivitis. Viral conjunctivitis is much more common. It may last several weeks and is frequently accompanied by a respiratory infection (or cold). Antibiotic drops or ointments usually do not help, but symptomatic treatment such as cool compresses or over-the-counter decongestant eyedrops can be used while the infection runs it course. Unlike viral conjunctivitis, bacterial conjunctivitis can be treated with a variety of antibiotic eyedrops or ointments, which usually cure the infection in a day or two.
Conjunctivitis can be very contagious. People who have it should not share towels or pillowcases and should wash their hands frequently. They may need to stay home from school or work, and they should stay out of swimming pools.
Not all cases of conjunctivitis are caused by an infection. Allergies can cause conjunctivitis, too. Typically, people with allergic conjunctivitis have itchy eyes, especially in spring and fall. Eyedrops to control itching are used to treat allergic conjunctivitis. It is important not to use medications that contain steroids (names of steroids usually end in"-one" or"-dex") unless prescribed by an ophthalmologist (Eye M.D.).
Finally, not all cases of pink eye are caused by conjunctivitis. Sometimes more serious conditions, such as infections, damage to the cornea, very severe glaucoma, or inflammation inside the eye will cause the conjunctiva to become inflamed and pink. Vision is usually normal when pink eye is caused by conjunctivitis. If your vision is affected or you experience eye pain, it is recommended that you see an ophthalmologist.
Glaucoma is a disease of the optic nerve, which transmits the images you see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable with its numerous wires). Glaucoma damages nerve fibers, which can cause blind spots and vision loss.
Glaucoma has to do with the pressure inside the eye, known as intraocular pressure (IOP). When the aqueous humor (a clear liquid that normally flows in and out of the eye) cannot drain properly, pressure builds up in the eye. The resulting increase in IOP can damage the optic nerve and lead to vision loss.
The most common form of glaucoma is primary open-angle glaucoma, in which the aqueous fluid is blocked from flowing back out of the eye at a normal rate through a tiny drainage system. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.
Ocular hypertension is often a forerunner to actual open-angle glaucoma. When ocular pressure is above normal, the risk of developing glaucoma increases. Several risk factors will affect whether you will develop glaucoma, including the level of IOP, family history, and corneal thickness. If your risk is high, your ophthalmologist (Eye M.D.) may recommend treatment to lower your IOP to prevent future damage.
In angle-closure glaucoma, the iris (the colored part of the eye) may drop over and completely close off the drainage angle, abruptly blocking the flow of aqueous fluid and leading to increased IOP or optic nerve damage. In acute angle-closure glaucoma there is a sudden increase in IOP due to the buildup of aqueous fluid. This condition is considered an emergency because optic nerve damage and vision loss can occur within hours of the problem. Symptoms can include nausea, vomiting, seeing halos around lights, and eye pain.
Even some people with"normal" IOP can experience vision loss from glaucoma. This condition is called normal-tension glaucoma. In this type of glaucoma, the optic nerve is damaged even though the IOP is considered normal. Normal-tension glaucoma is not well understood, but lowering IOP has been shown to slow progression of this form of glaucoma.
Childhood glaucoma, which starts in infancy, childhood, or adolescence, is rare. Like primary open-angle glaucoma, there are few, if any, symptoms in the early stage. Blindness can result if it is left untreated. Like most types of glaucoma, childhood glaucoma may run in families. Signs of this disease include:
clouding of the cornea (the clear front part of the eye);
tearing; and
an enlarged eye.
Your ophthalmologist may tell you that you are at risk for glaucoma if you have one or more risk factors, including having an elevated IOP, a family history of glaucoma, certain optic nerve conditions, are of a particular ethnic background, or are of advanced age. Regular examinations with your ophthalmologist are important if you are at risk for this condition.
The goal of glaucoma treatment is to lower your eye pressure to prevent or slow further vision loss. Your ophthalmologist will recommend treatment if the risk of vision loss is high. Treatment often consists of eyedrops but can include laser treatment or surgery to create a new drain in the eye. Glaucoma is a chronic disease that can be controlled but not cured. Ongoing monitoring (every three to six months) is needed to watch for changes. Ask your ophthalmologist if you have any questions about glaucoma or your treatment.
Age-related macular degeneration (AMD) is one of the most common causes of poor vision after age 60. AMD is a deterioration or breakdown of the macula. The macula is a small area at the center of the retina in the back of the eye that allows us to see fine details clearly and perform activities such as reading and driving.
The visual symptoms of AMD involve loss of central vision. While peripheral (side) vision is unaffected, with AMD, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and looking at detail.
Although the specific cause is unknown, AMD seems to be part of aging. While age is the most significant risk factor for developing AMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors. AMD accounts for 90% of new cases of legal blindness in the United States.
Nine out of 10 people who have AMD have atrophic or" dry" AMD, which results in thinning of the macula. Dry AMD takes many years to develop. A specific vitamin regimen has been shown to slow progression of dry AMD.
Exudative or" wet" AMD is less common (occurring in one out of 10 people with AMD) but is more serious. In the wet form of AMD, abnormal blood vessels may grow in a layer beneath the retina, leaking fluid and blood and creating distortion or a large blind spot in the center of your vision. If the blood vessels are not growing directly beneath the macula, laser surgery is usually the treatment of choice. The procedure usually does not improve vision but tries to prevent further loss of vision. For those patients with wet AMD whose blood vessels are growing directly under the center of the macula, a procedure called photodynamic therapy (PDT), which causes fewer visual side effects, is sometimes used. Intravitreal injections of certain medications can also be used in these cases.
Promising AMD research is being done on many fronts. In the meantime, high-intensity reading lamps, magnifiers, and other low vision aids help people with AMD make the most of their remaining vision.
A retinal detachment is a very serious problem that usually causes blindness unless treated. The appearance of flashing lights, floating objects, or a gray curtain moving across the field of vision are all indications of a retinal detachment. If any of these occur, see an ophthalmologist (Eye M.D.) right away.
As one gets older, the vitreous (the clear, gel-like substance that fills the inside of the eye) tends to shrink slightly and take on a more watery consistency. Sometimes as the vitreous shrinks, it exerts enough force on the retina to make it tear.
Retinal tears can lead to a retinal detachment. Fluid vitreous, passing through the tear, lifts the retina off the back of the eye like wallpaper peeling off a wall. Laser surgery or cryotherapy (freezing) are often used to seal retinal tears and prevent detachment.
If the retina is detached, it must be reattached before sealing the retinal tear. There are three ways to repair retinal detachments. Pneumatic retinopexy involves injecting a special gas bubble into the eye that pushes on the retina to seal the tear. The scleral buckle procedure requires the fluid to be drained from under the retina before a flexible piece of silicone is sewn on the outer eye wall to give support to the tear while it heals. Vitrectomy surgery removes the vitreous gel from the eye, replacing it with a gas bubble, which is slowly replaced by the body's fluids.
Your eyes constantly produce tears at a slow and steady rate so that they stay moist and comfortable. Some people are not able to produce enough tears or the appropriate quality of tears to keep their eyes healthy or comfortable. This condition is known as dry eye.
Symptoms of dry eye include scratchiness, stinging, stringy mucus in or around the eyes, and blurry vision.
Sometimes people with dry eye will experience excess tearing. This is the eye's response to the discomfort from dry eye. When the eyes get irritated, the gland that makes tears releases a larger than usual volume of tears, which overwhelm the tear drainage system. These excess tears then overflow from your eyes.
Dry eye often increases with age as tear production slows. For women, this is especially true after menopause. Dry eye can be associated with other problems like Sjogren's syndrome, which can cause dry eyes along with dry mouth and arthritis.
Your ophthalmologist (Eye M.D.) can usually diagnose dry eye by examining your eyes. Sometimes tests that measure tear production are necessary. The Schirmer tear test measures tear production by placing filter-paper strips between your eyeball and your lower lid. Your ophthalmologist might also test you for dry eye using diagnostic drops to check for patterns of dryness on the eye's surface.
Treatments for dry eye include eyedrops called artificial tears to lubricate the eyes and help maintain moisture. Your ophthalmologist may conserve your tears by closing the channels through which your tears drain. You can also try to prevent tears from evaporating by avoiding wind and dry air from overheated rooms and hair dryers. Smoking irritates dry eyes and should be avoided.
In less developed countries, dry eye due to a lack of vitamin A in the diet is not uncommon. Ointments with vitamin A can help dry eye caused by unusual conditions like Stevens-Johnson syndrome or pemphigoid.
Neuro-ophthalmology is an ophthalmic subspecialty that addresses the relationship between the eye and the brain, specifically disorders of the optic nerve, orbit, and brain, associated with visual symptoms. Today, neuro-ophthalmologists provide comprehensive clinical care to a broad spectrum of patients with visual disturbance from optic nerve diseases, central nervous system disorders, ocular motility dysfunction, and pupillary abnormalities.
Headaches are one of the most common health complaints. They are caused by a variety of factors and can be divided into the following groups:
Tension-type headaches
This is the most common type of headache. The pain may be felt in the forehead, temples, neck, or around the eyes. Doctors are uncertain about the cause of this type of headache but believe they are due to stress, sleeping or working in unusual positions, clenching jaws, grinding teeth, or chewing gum. These kinds of headaches are usually temporary and can be relieved by an over-the-counter pain reliever.
Migraine headaches
This kind of headache is also common. Migraine pain is related to activity in the brain that swells blood vessels of the scalp, causing throbbing pain, nausea, sensitivity to light, sounds, or odors, and pain that increases with movement. The exact cause of migraines is still unknown. About one in 10 people suffer from migraines, and they affect more women than men. Migraines can run in families and can affect young children as well.
Cluster headaches
Cluster headaches are less common than migraines and affect more men than women. They are called cluster headaches because they come in daily bouts of 30 minutes to two hours and continue for one to two months. These bouts can occur several times a year. The pain is felt on one side of the head, is very severe, and can be accompanied by tearing or red eye on the affected side, sweating, and stuffy nose.
Bell's palsy is a disorder of the facial nerve, the seventh cranial nerve. This condition causes partial paralysis on one side of the face, affecting the muscles of facial expression. Bell's palsy usually occurs in adults and develops suddenly.
Symptoms of Bell's palsy include the inability to smile on one side or close one eyelid completely, decreased tear production and sense of taste, blurry vision, and distorted hearing.
The causes of Bell's palsy are varied. In most cases, the cause is never identified, but it is believed that Bell's palsy often develops secondary to a viral inflammation. Other causes include activation of the body's immune system and changes in blood flow. Bell's palsy is more common in patients with diabetes and in pregnant women.
Most of the time, Bell's palsy disappears on its own after a few months. Eye lubricants may be used to prevent complications. In some cases, corticosteroid or antiviral drugs may be used to help in the treatment of this condition.
Diplopia is double vision caused by a problem with the muscles that control the eye or the nerves that stimulate those muscles.
Many conditions can cause diplopia. Double vision is usually a symptom of strabismus (misalignment of the eyes), due to the improper movement of one or more eye muscles. Strabismus is most often found in children, but it can develop later in life. A growth in the eyelid pressing on the front of the eyeball can also cause temporary double vision. Rarely, double vision arises because of an abnormality within the eye, such as a dislocation of the eye's natural lens.
The onset of double vision in adulthood should be brought to the attention of your ophthalmologist (Eye M.D) immediately to exclude the possibility of a tumor, aneurysm, or neurological problem. Two of the primary neurological conditions that could cause diplopia are microvascular cranial nerve palsy (MCNP) and myasthenia gravis (MG).
Microvascular cranial nerve palsy, or"diabetic palsy," is one of the most common causes of double vision in older people. It occurs more often in patients with diabetes and high blood pressure, when blood flow is blocked to one or more of the six eye muscles that control eye movement. Although there is no known treatment for MCNP, the double vision may be treated by patching either eye. If the double vision persists, prism eyeglasses or eye muscle surgery may be prescribed.
Myastheniagravis is a disorder characterized by muscle weakness, caused by a communication breakdown between the nerves and the muscles due to an autoimmune condition. It is most common in the muscles of the face, eyes, arms, and legs, and in the muscles used for chewing, swallowing, and talking. Double vision is one of the common indicators of myasthenia gravis. Though there is no known cure for myasthenia gravis, there are a number of treatment options to manage the condition, including medication, surgery, and other procedures. If you have MG, physical therapy can help, and you can learn specific coping skills for improving your daily life. Early detection and treatment of MG is crucial to managing the condition and preventing serious problems with breathing or swallowing, which require emergency care.
Dr. Solomon see's all of our neuro-oph patients. He keeps times available every day to accommodate the needs of our patients needing immediate care.