BLEPHARITIS
What is it?
Blepharitis is a swelling and build-up of oil and debris on the eyelids and lashes. This may cause itching, burning, crusting and stickiness of the lashes. Because of the closeness to the tear ducts, most people also experience dry eyes.

Who does it affect?
Many people of all ages get Blepharitis. Due to cosmetic use and hormones, it is more likely to show up in women - particularly those who wear contact lenses.

How is it treated?
We treat this by stressing good lid hygiene, scrubbing the eyelids and lashes. Eye drops and ointments soothe the symptoms. Occasionally, oral medication is also used.

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CATARACT
What is it?
A clouding or thickening of the normal lens in the eye. This clouding blocks light from entering the eye and causes vision to be blurry and colors to be faded. Many people with cataracts complain of problems with glare from lights.

Who does it affect?
Eventually, everyone will develop a cataract. It is a normal aging process in the lens of the eye. Family history, smoking and ultraviolet light exposure may make cataracts develop sooner.

How is it treated?
Cataracts can cause a change in prescription so glasses might help with early detection. Usually when activities are affected, cataract surgery is recommended to restore clear vision. Surgery is performed in a quick, painless manner; and often, without stitches or shots. Patients can resume normal activities the same day of surgery.

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CENTRAL RETINAL VEIN OCCLUSION
What is it?
A blockage or obstruction of blood leaving the eye through the main retinal vein. It results in internal bleeding and fluid buildup that can cause blurring or sudden loss of vision.

Who does it affect?
Vein obstructions can be due to a variety of causes. High blood pressure (treated and untreated), medication, anatomy or certain systemic conditions have all been identified as causes. Generally, this type of occlusion is more common in older patients.

How is it treated?
The first step is to try and identify the cause if one exists. We may suggest blood work, a physical or other testing if appropriate. Visual recovery depends on the level of loss, extent of damage and the ability of the eye to heal itself. healing generally takes months. Patients must be carefully monitored for secondary complications in the eye, arising from the obstruction. In some cases a yellow dye study or laser may prove helpful in the healing phase.

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CHALAZION
What is it?
Also called hordeolum, stye. One of the glands of the eyelids swells with infection.

Who does it affect?
A chalazion can happen in anyone, but it is more likely in patients who have blepharitis, meibomianitis or other reasons for tear glands to get blocked.

How is it treated?
Warm or hot compresses, eye drops and oral medications are used to open the gland and help it drain. In stubborn, resistant cases the bump may need to be injected with a steroid or drained by making a small incision on the underside of the eyelid.

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CONJUNCTIVITIS
What is it?
A swelling of the delicate tissue on the outer white part of the eye. Since this tissue has blood vessels, most people have redness, a watery or sticky discharge, burning or grittiness - and sometimes itching.

Who does it affect?
A few of the common causes are:

• Viral - The most common type. This is what some people call "pink eye". It is highly contagious
• Bacterial - This usually causes more crusting or stickiness and a white or yellow soupy discharge
• Allergic - A lot of itching is characteristic of this type. It may happen only during certain seasons. The discharge is usually watery or filled with mucus.

How is it treated?
It depends on the cause. A virus needs to run its course like the common cold. Antibiotics do not usually help viral conjunctivitis, but do help bacterial problems. In both viral and bacterial cases - good hygiene (separate towel - no hand to eye contact) is essential. In allergic types, blood vessel constrictors and other antihistamine drops are used to stop the itching. One of our doctors may also suggest anti-inflammatory drops in cases of severe swelling.

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DIABETIC RETINOPATHY
What is it?
Changes that occur in the retina due to elevated blood sugar.

Who does it affect?
Both insulin and non-insulin dependent diabetic patients are affected. There is a greater chance of retinal changes in patients who have had diabetes for a longer period of time.

How is it treated?
Regular dilated eye exams are the best defense against retinal complications from diabetes. In both types of diabetic retinopathy, early laser treatments have been found to decrease the chance of vision loss or other complications. In addition, the Diabetes Control and Complication Trial (DCCT) has proven that strict control of blood sugar can greatly reduce the potential for vision loss associated with diabetes. You need to work closely with your general physician to maintain a well-controlled blood sugar level.

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DRY EYES
What is it?
A condition caused by a decrease in the amount of tears necessary to bathe the front of the eye. When the cornea is exposed, dry areas develop which cause dry eye irritation.

Who does it affect?
Nearly everyone experiences dry eye problems once in awhile. The most common symptoms include burning, gritty or scratchy sensations. People who have a reduced volume or poor quality of tears are more likely to complain of dry eyes. Medications, hormonal changes; contact lens wear, general body (e.g., arthritis), eye or eyelid problems can make the symptoms worse.

How is it treated?
Artificial teardrops are helpful for most people. In more problematic cases, tear ointments are used. "Plugging" the tear drainage system is often very helpful and can be performed in the office without discomfort. Eliminating or reducing all of the contributing causes of dry eyes is very important.

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FLASHES AND FLOATERS
What is it? Flashing lights, floating spots, gnats, cobwebs, strings - all describe annoying objects that may suddenly appear in our vision. Though they appear in front of our sight, they usually come from the thick fluid inside the eye called the vitreous gel.

Who does it affect? Most everyone will see a floating spot sometime in life. It is more common to notice them as we age since the vitreous breaks down, moves around or separates from the retina. Nearsighted people are more likely to see these floaters.

How is it treated? A full examination including dilation is essential. Most of the time flashes and floaters are caused by movement or separation of the vitreous gel, and this may only need regular monitoring. With time, the floaters drop out of sight due to gravity and become less noticeable. This may take several weeks. Dilated exams are important since some flashes and floaters can be caused by retinal tears or detachments. Whether they are new or returning, any sudden increase in flashes or floaters should prompt you to call your Cool Springs Eye Doctor immediately.

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FOREIGN BODY
What is it?
Debris, metal or other material which has blown into the eye and remains lodged.

Who does it affect?
A foreign body can occur in anyone. Certain occupations, such as auto mechanics and metal workers are more likely to encounter eye problems from flying debris and foreign material.

How is it treated?
Prevention through the use of safety glasses is the best medicine. In mild cases, material may be irrigated out of the eye. Embedded foreign bodies on the surface of the eye are removed in the office with a minor surgical procedure. A foreign body inside the eye first requires extensive testing for the determination of location, and then may necessitate surgical removal.

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GLAUCOMA
What is it?
An eye problem that develops when the pressure in the eye is high over a long enough period of time to cause damage to the main nerve in the back of the eye. People with glaucoma usually lose side vision, but can also lose straight-ahead vision if glaucoma is left untreated.

Who does it affect?
Usually people are more at risk to develop glaucoma as they mature. African Americans and people with a family history of glaucoma are more at risk. Although glaucoma usually develops slowly over time and is painless, it can sometimes start suddenly with sharp pain and nausea.

How is it treated?
Glaucoma cannot be cured; however, in most cases, it is controllable. Our doctors use drops, lasers and occasionally surgery to control eye pressure and minimize or prevent damage from glaucoma.

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KERATOCONUS
What is it?
Keratoconus is an ocular disease in which progressive, degenerative thinning of the cornea results in a complex, irregular steepening of the corneal surface.

Who does it affect?
Keratoconus usually begins in adolescence and continues into middle age. Keratoconus is associated with Down's syndrome, atopic disease, and may be related to chronic eye rubbing.

How is it treated?
Vision is progressively reduced and is corrected with glasses only in mild cases.? The use of gas permeable contact lenses is?successful in most cases to?improve vision.? The unique design creates a regular optical surface in place of the irregular cornea.?Often rigid contact lenses can help correct the vision of the keratoconic eye and provide the required visual acuity to legally drive a car and perform many job related tasks.

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MACULAR DEGENERATION
What is it?
The macula is the part of the retina that allows us to see things straight ahead. As we mature, changes occur in this area, and the tissue becomes irregular, thus distorting our central vision.

Who does it affect?
Macular Degeneration is typically a disease of older adults. Family history plays a part in how severe a person's condition may develop. A lot of research is aimed at why some people lose vision from macular degeneration and others don't. High blood pressure, extended sun exposure and certain vitamin deficiencies may be related.

How is it treated?
Early detection and careful monitoring of a person's vision are the best methods to prevent vision changes from macular degeneration. Some severe types of macular degeneration may require laser treatment or surgery as soon as it is detected. Vitamins may be recommended, as many doctors believe they slow down changes in the macula.

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OPTIC NEURITIS
What is it?
An inflamed, swollen or irritated optic nerve. It is sometimes referred to as "papillitis" when the visible portion of the nerve is inflamed. It is called "retrobulbar neuritis" when the swollen portion of the nerve lies behind the eyeball.

Who does it affect? There are a number of causes for optic neuritis. Some are related to eye problems while others may be due to systemic problems that are just showing up in the eye. Often optic neuritis follows flu-like symptoms in some people.

How is it treated? Treatment depends upon first identifying the specific cause of the inflammation. Visual fields, X-rays, MRIs of the nerve and brain and laboratory tests are helpful in making the diagnosis. Often, the best treatment is to allow the eye to heal itself normally, and to be closely monitored by a Cool Springs Eye Doctor.

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STRABISMUS
What is it? A misalignment of the eye muscles causing a lack of coordination between both eyes. It may cause one of the eyes to turn in, out, up or down.

Who does it affect?
Many people are born with an eye muscle problem. Often it is inherited in some families. Strabismus can also be acquired through eye trauma or disease.

How is it treated?
The treatment depends on the cause and the symptoms of the patient. In patients born with Strabismus, the biggest risk is that the turned eye may become "lazy." The technical term for lazy eye is Amblyopia. Surgery or vision therapy may need to be performed to align the eyes and prevent amblyopia. In some cases, the eyes function well but patients may desire surgery to improve the cosmetic appearance.

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UVEITIS
What is it?
Swelling or inflammation of the inner layers of the eye. The swelling can be located in the front, middle, back or all segments of the eye. The symptoms each patient experiences may vary depending on the location affected.

Who does it affect? There is a long list of causes for Uveitis. Eye disorders, infections or abnormal conditions affecting other parts of the body can all lead to signs of swelling in the eye. In systemic conditions, blood disorders or arthritis-like syndromes are often related. In some cases, no cause is identified despite an eye doctor performing a thorough work-up and testing.

How is it treated?
The treatment depends on the site of swelling, underlying cause and severity of the disease. In some cases, no treatment is necessary. Most however, require oral or injectable medicine or eyedrops. Corticosteroids are the mainstay of therapy in Uveitis due to their ability to suppress inflammation. Many types of Uveitis take a long time to heal so it is essential to have follow up visits with your Cool Springs Eye Doctor even when symptoms improve.

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ARGON LASER TRABECULAPLASTY
What is it?
A trabeculoplasty is a procedure designed to improve the drainage of fluid from the inside of the eye.

Who Needs This Treatment?
Patients with glaucoma. The laser is used to better control eye pressure or minimize the side effects associated with daily drop therapy. The laser also helps many patients by reducing the cost of expensive medicines.

How is it treated?
After a numbing drop is instilled, the patient is placed at the microscope and the laser is aimed. Most patients report a bright flash of light during the brief five minute procedure. Eye pressure lowering usually takes place over two months. In some cases it may be necessary to have more than one laser treatment to control eye pressure. Follow-up care with your eye doctor is essential.

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FLUORESCEIN ANGIOGRAPHY
What is it?
Fluorescein is a yellow dye used to evaluate the blood vessels and other layers of the retina. This test is performed in the office using a small amount of dye injected into the hand or arm. Side effects are few but may include allergic reaction (itching, rash) or a queasy tummy. Since the eye is yellow, you might have a yellowish tinge to your skin and urine for one to two days. You can resume normal activities immediately after the test.

Who is a Candidate?
Patients who have reduced vision, vascular swelling or other retinal problems.

How is it Used?
The fluorescein angiogram is not a treatment, but rather a helpful test in determining a treatment plan for patients with retinal conditions. An eye doctor will evaluate the bright and dim spots of dye collection as well as the flow of the dye through the blood vessels.

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FOCAL/GRID LASER
What is it?
A finely focused beam of light used to treat fluid build-up on the retina (back of the eye).

Who Needs This Treatment?
Fluid build-up can arise from many causes. Most fluid is due to retinal blood vessel leakage or disease. Patients with diabetes or blocked veins are more likely to develop fluid build-up.

How is it treated?
After a numbing drop is given, the patient is placed at the microscope and the laser is aimed. During the treatment, most patients report a brief flash of light. The treatment is generally painless and may only last 5 to 20 minutes. It is important to have follow up care with your Cool Springs Eye Doctor after your laser procedure.

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GLAUCOMA MEDICATIONS
All medications have side effects. The following are the most common side effects associated with glaucoma drugs. Any major side effect should be reported to us immediately.

Alpha Agonist

• Allergy - redness and itchin
• Dry mouth

Beta Blocker

• Breathing problems
• Tired or fatigued feeling
• Depression
• Allergy - redness or itching
• Impotency (in males)

Cholinergic Agents

• Blurred or dim vision (especially at night)`
• Eye pain and/or brow ache

Carbonic Anhydrase Inhibitors

• Do not use if allergic to Sulfa drugs
• Stringing when instilled
• Bad taste in mouth

Epinephrine

• Allergy - redness and itching
• Rebound redness of eyes (if used for a long time)
• Brown discoloration of contact lenses

Prostaglandin Agents

• Eye redness and watering
• Aching in or around the eye
• Change in eye color

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HOW TO INSTILL EYE DROPS

Eye doctors prescribe eyedrops for a variety of ocular conditions. While they are beneficial, they are only effective if they are used regularly and instilled properly.

Helpful tips for instilling eye drops:

• Sit in a chair
• Shake eye dropper bottle
• Tilt head as far back as possible
• Position eye drop bottle one inch (1") and directly above the eye
• Pull down the lower lid with other hand
• Stare at the bottle
• Prior to squeezing bottle, immediately look up and away from bottle
• Squeeze eye drop bottle
• Goal is for drop to land between the lower eyelid and eye
• Close eyes and apply pressure with finger to lower, inner corner between eye and nose
• Keep finger there and close your eye for one minute
• Repeat process for other eye
• If using more than one eye medicine, wait three minutes before instilling the second eye drop

Additional tips:
Some people that have difficulty with eye drops have better success with the following:

• Lay down on bed to ensure head is back
• Pinch lower lid with thumb and pointing finger to make cup to receive drop
• Rest bottle on eyebrow over the eye to help with the aim

Remember:

• Never use expired drops
• Only use your prescribed eyedrop for the condition that it was prescribed
• All eye drops sting a little. This is not an indication of whether it is working however.
• Understand clearly from your doctor what the drops are for and what side effects you may notice. Many drops have no affect on vision and patients cannot tell if they are working

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HOW TO PERFORM LID SCRUBS
What is it?
A treatment for chronic staph lid disease that must be continued indefinitely, or the disease could return.

Who does it affect?
Anyone can get staff lid disease. It normally appears with the following symptoms: redness, burning, mild itching, tears and the sensation that you have something in your eye.

How is it treated?
Heat a washcloth with warm water and place on the lash line four to five times. Fill an 8 oz glass of water with three drops of baby shampoo. Then wrap the washcloth around your index finger and dip into the glass. Scrub both your upper and lower lids vigorously then rinse your eyelids. Repeat this procedure first thing in the morning and last thing in the evening every day for a month. Maintenance afterwards will be three times a week.

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PAN RETINAL PHOTOCOAGULATION (PRP)
What is it?
A finely focused beam of light used to eliminate abnormal new blood vessel growth on the retina (back of the eye).

Who Needs This Treatment? Abnormal blood vessels can develop when the amount of oxygen on the back of the eye is reduced. Patients with eye problems caused by diabetes or blocked retinal blood vessels are most likely to need PRP.

How is it treated?
After a numbing drop is given, the patient is placed at the microscope and the laser is aimed. Occasionally numbing medication is also used around the eye to improve comfort. Most patients do not experience pain with the laser. It is common to see bright flashes of light during the 15 to 45 minute PRP treatment. Close follow up with your eye doctor is essential after treatment.

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PERIPHERAL IRIDOTOMY (PI)
What is it?
A small opening made in the iris (colored part of the eye). Generally, this is performed with a laser. It can also be performed surgically at which time it is called a peripheral iridectomy.

Who does it affect?
The most common reason for a PI is to equalize or lower the pressure in the eye. Patients who have narrow angle glaucoma or are at risk due to the shape of their eye may require a PI.

How is it treated?
The patient is seated at a microscope and numbing drops are instilled. A small contact lens may be used in conjunction with this five-minute painless laser procedure. The risks are few but do include bleeding, eye pressure rise or scarring. If scarring occurs, the laser PI may need to be repeated at a later time.

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VISUAL FIELD
What is it?
The visual field is a test of your peripheral or side vision. It can be performed with large targets such as the hand of a doctor or a technician. When more sensitive information is needed, a visual field is typically performed with a special unit that is capable of testing sensitive areas with very small or dimly lit targets.

Who is a Candidate?
Visual field tests are useful in helping to make the diagnosis in patients that may have glaucoma, retinal or neurologic problems. In addition to making the diagnosis, a visual field is a very useful monitoring test to help the doctor decide whether a patient's eye condition is stable, getting better or getting worse.

How is it Used?
The visual field test itself is not a treatment. It is a test that helps your doctor make the decision as to what treatment would be best for your specific eye problem.

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YAG LASER CAPSULOTOMY
What is it?
A finely focused laser beam used to remove tissue from the lens capsule.

Who Needs This Treatment?
After cataract surgery, there is a thin transparent membrane left around the implant. The membrane or "capsule" may turn hazy. This results in poor vision, haziness, glare from lights or other problematic visual symptoms.

How is it treated?
The laser is used in a short procedure that does not require hospitalization. After a numbing drop is used, the patient is placed at the microscope and the laser is aimed. Most patients report a brief flash of light but feel no discomfort during the 3 to 5 minute procedure. Although the risks are few, it is important to see your eye doctor for follow up visits after a YAG laser procedure.

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