Fouad Melamed, OD Los Angeles Eye Doctor

Glaucoma is not just one disease that affects the eye, but rather, a group of diseases. The one common factor is the damage to the optic nerve. It is this damage that leads to impaired vision or even blindness. Glaucoma is one of the leading causes of blindness.

In the early stages of glaucoma there are almost no warning signs. Glaucomatous damage first steals the far peripheral vision, thus explaining why most patients with the early disease have no symptoms. For roughly half the patients diagnosed with glaucoma the disease is discovered on a routine eye examination. Early diagnosis and treatment is essential to saving vision. An example of the view of the glaucoma patient is depicted on the right.

In the early days of glaucoma research, it was thought that the rising intraocular pressure caused the optic nerve damage. As treatments and research have progressed over the years it is understood that this is only part of the problem. Increased intraocular pressure a known risk factor, but there are other issues involved too.

Glaucoma that affects adults’ falls into two broad categories: open angle glaucoma and closed angle glaucoma. Open angle glaucoma is the most common form and also the easiest to treat. Angle closure glaucoma is a more devastating disease, because of its fast progression, but thankfully it only affects 5% of glaucoma cases in the U.S.

In glaucoma, the pressure of the inside of the eye is too high for that specific patient and causes damage to the optic never. So there is nothing for the patient to notice externally. This is a completely different mechanism than tears. Tears are actually produced outside of the eyeball. The process is gradual and most patients have no symptoms in the early stages when treatment is the most successful at vision retention.

The good news is because it is a gradual process; regular eye exams will detect the disease early. This form of glaucoma usually responds very well to medication. Optic nerve damage can be usually stopped as the intraocular pressure decreases. Patients will need to be diligent about using their glaucoma drops and having regular eye exams to ensure that the pressure in the eye remains normal.

Closed angle glaucoma is much less common than open angle glaucoma.  The iris of the eye is not as open as it should be and as it closes or bunches up at the edges the drainage system of the eye gets clogged. When this happens the intraocular pressure increases rapidly. Surgery will be done to increase the opening of the iris. This will allow the fluid to drain again. Although yearly exams are still needed to monitor the pressure, reoccurrence of increased pressure is rare.

Normal tension glaucoma is a bit of a mystery. This type of glaucoma causes nerve damage even though the pressure in the eye is normal. While the cause is poorly understood, treatment involves the use of eye drops to keep the pressures as low as possible. People that have a family history of normal tension glaucoma need to be diligent about yearly eye exams.

Risk factors for glaucoma include being over age 40.  African Americans are at the highest risk than the general population to develop glaucoma. Older Hispanic populations are also at an increased risk for developing glaucoma. Interestingly, patients with sleep apnea are also at higher risk. Researchers are recently coming out with results of nutritional supplements that can possible reduce the risks of glaucoma. Finals results have not yet been published.

Even if you are not in a high risk group, yearly eye examinations are essential. Early detection and early treatment is the cornerstone to preserving eye sight where this insidious disease is concerned. The tests are a painless part of a thorough yearly eye examination.

Hordeolum is the medical term for a stye (sometimes spelled sty- both are correct). Hordeolum treatment can be very simple or invasive depending upon the extent of the stye. Anyone who has had a stye will tell you for such a little bump, the pain can be intense.

Hordeolum (or hordeola if there is more than one) is caused by the Staphylococcus aureus bacteria in fully 90 per cent of cases. Unfortunately, MRSA or methicillin-resistant Staphylococcus aureus can also be the causative agent in some cases of styes. Hordeolum can be more than just a minor irritation so if there are any questions as to the severity of the stye call your eye care professional immediately.

Hordeolum generally occur in one of two places. Those that are along the eyelash line are called external hordeolum. Those that occur under the eyelid are referred to as internal hordeolum. Both are a result of an impacted oil gland which then gives the bacteria a place to grow.

The hordeolum will begin as a reddened and swollen area on the eye lid or below the eye. As the pressure builds from the bacteria and the growing accumulation of white cells a bump will appear. As it matures it will develop a whitish yellow spot called the point. This is where the stye will rupture allowing the purulent material or pus to escape.

If the point is on the inside of the eye lid, every time the eye is blinked it can cause a scratching sensation. As the stye grows, just the mass itself will cause discomfort. Plus as the hordeolum grows it looks painful and infected, which it is. The eye may also become sensitive to light and water frequently.

During an examination the optometrist or eye doctor can evaluate the status of the hordeolum and prescribe the necessary course of treatment. Most of the time, topical antibiotic drops will not enter the eyelid where the hordeolum presides. Therefore, at times, oral antibiotics are given to treat the infection with topical drops to prevent any secondary infection of the eyeball itself.  Be sure to finish all antibiotics as prescribed.

Occasionally, surgical intervention will need to take place. This will be done under a local anesthetic unless the patient is a young child who will need sedation for the procedure. The area will be anesthetized and a very small stab wound will be made to allow the purulent material to be released.

If the stye is along the lashes care will be taken to not interrupt eye lash growth. Internal hordeolum stab wounds will be made inside the lid if possible for the best cosmetic affect. Usually, external stab wounds can be made in naturally occurring skin folds to provide for excellent cosmesis.

The cause of hordeolum is not well understood but there are a few precautions that can help reduce risks. Never share eye makeup with anyone. Any eye care products that are suspected of contamination should be discarded. Eye make-up and eye care solutions have a shelf life once opened. Do not keep these products indefinitely. Always wash hands thoroughly before working with the eyes. A diet full omega-3s, such as fish oil or flax oil will also help. Patients with recurrent styes can be put on prescription omega-3 dosage to prevent future outbreaks.

Diabetics are more prone to stye formation, as are people that have chronic inflammation of the eye lids. Stress also seems to be a causative factor in some patients. High blood lipids also seem to predispose some people to stye development.

Contact lenses should generally not be worn while there is a hordeolum present, unless ok’ed by your eye doctor. If the patient wears contacts and a stye develops, remove the contact lens, and call your eye care professional immediately for instructions. Never pinch or squeeze a stye to speed the rupture process. This can damage the delicate tissue around the eye.

Complications from a hordeolum are rare but they do occur. A chalazion is the most common complication. This is a cyst that forms in the oil gland where the stye occurred. Hordeolums seem very small and simple, but should be checked out by an optometrist for treatment, whether it is warm compresses, oral antiobiotics and/or topical antiobiotics drops. They can help you with symptomatic relief and complication prevention. You can find out more at http://melamedeyecare.com

Fouad Melamed, O.D.

Kerataconous is the thinning and the subsequent development of a dome shaped cornea. The cornea is the clear lens that covers the pupil and iris of the eye. For reasons that are not fully understood this gently curved surface can become dome shaped.

The purpose of the cornea is to focus light on the retina that is located in the back of the eyeball. As the cornea becomes dome shaped, the area of focus on the retina changes. Vision then becomes blurred and images are no longer distinct.

Kerataconous is usually diagnosed during puberty until the late teenaged years. The dome will usually increase in size for about 10 years and then stop growing. Nothing can be done to stop the progression of kerataconous. Kerataconous will decrease visual acuity dramatically as the cornea becomes more misshaped.

Initially the condition may be helped by glasses or soft contact lenses. However, as the dome shape a progress, the best vision acuity is obtained when the patient is fit with rigid gas permeable (RPG) lenses. Both eyes may be affected but not always to the same degree. Severe cases of kerataconous may require surgery.

If you are diagnosed with kerataconous, it is important to go to an eye care professional that has experience with treating this condition. This is a progressive condition that will require a change from soft contacts or glasses to rigid gas permeable lenses over time. Your eye care professional will need to be ever vigilant to your changing cornea shape to make the appropriate changes.

Generally patients with kerataconous will not see optimally with glasses or soft contact lenses because of the irregular corneal shape. In most cases, RGP lenses, or rigid gas permeable contact lenses, will give the best vision. It takes a skilled practitioner to get the right fit of the RGP lens over the cone shaped cornea. You will need to expect to make a couple of trips back to your eye care professional to have the initial fit checked and the prescription fine tuned. Regular eye exams will need to become part of your routine for the rest of your life. But that really isn’t any different from anyone who doesn’t have kerataconous.

The symptoms of kerataconous can be easily dismissed at first, which is why yearly eye exams are so important. Headaches that are caused by eye strain, blurry or distorted vision, and increased sensitivity to bright lights are a few of the common symptoms. Patients can also have real issues with glare from lights.

Some patients find out they have kerataconous when they are being examined for LASIK surgery because their glasses or soft contact lens have become ineffective. Unfortunately, at this time LASIK surgery is not advised for patients that have kerataconous.

The cause of kerataconous is not known. Patients that frequently, vigorously rub their eyes are more prone to develop the condition. It has also been occasionally known to run in families, although generally someone will develop kerataconous without any family history.

Catching kerataconous early and then following up with the treatment plan is absolutely essential. If left untreated, kerataconous can cause scar tissue to form at the point of the cone. This scar tissue will have a devastating effect on visual acuity. The only reliable treatment at that point is surgical corneal transplantation.

Kerataconous is a manageable eye condition. If left untreated vision can become very poor. If treated early by an eye care professional that is experienced with kerataconous, visual acuity can be optimized. Early treatment is key is maintaining excellent vision. Your eye care professional will also keep you abreast of any new treatment options that may become available.

Fouad Melamed, O.D.