|Pink Eye |
Question from Indiana
Approximately 2 weeks ago my son developed a pink eye condition. Not responding to medication from his family doctor he was sent to an ophthalmologist 3 days later. The ophthalmologist felt there was a bacterial infection. He took a culture and prescribed maxitrol. 3 days later the infection was much worse. The ophthalmologist added ocuflox. 2 days later the condition became worse. We were asked to come in for a re-evaluation. At that time the ophthalmologist found a pseudo-membrane, with severe conjunctivitis, and some abrasion of the first layer of the eye. Since the cultures were all negative, he felt an adendo-virus was at work. The Maxitrol was discontinued and we were asked to have re-evaluations every 48hrs. At our last visit, a second ophthalmologist in the office did an evaluation and stated this looked like an adendo virus 19. We were told very little can be done other than frequent visits, ocuflox, and allowing the immune system to fight the virus. We were told that there could be permanent damage. What can you tell me about this virus? Does it seem we are doing all that can be done? Can you give me some possible referrals for ophthalmologists in Central Indiana for an additional consultation? Thank you for your help and advice.
Unfortunately the most severe viral infections of the eye are often very difficult to treat. As you have been told, there is no good way to eradicate these viruses immediately and prevent the inflammation they cause. I hope that your son's situation has improved. If you are looking for additional consultation, I would recommend the Corneal Consultants of Indiana. I believe they have offices in your area, although they are basically in Indianapolis. Please contact us if you have further questions.
The description you give is most likely due to an ocular migraine. It is unlikely that your Plaquenil treatment would create such symptoms. Ocular migraines generally create a shimmering or zig-zag pattern in the peripheral vision that may last five to 30 minutes and then generally resolves completely. It is often accompanied by blurriness in the center of your vision, which may prevent you from reading or doing other visual tasks. However, when the episode resolves vision is entirely back to normal.
Ocular migraines essentially never cause any harm to the eye, but they can be very annoying. When they are only occasional no treatment is necessary. But when they are as frequent as you have described, you may wish to consider medical treatment. There are pills, which can be used on a preventative basis, but this should be done only in consultation with your own physician. I would recommend an evaluation by your rheumatologist and also your eye specialist, to determine whether this is indeed the cause of your symptoms and whether treatment would be appropriate in your case.
Question about Eye Twitching
Twitching in your eyelid is very annoying, but virtually never causes any harm to the lid or the eye. However, if this has persisted for over eight months it should be evaluated carefully by an ophthalmologist. The twitch results from a muscle spasm and many people may get this symptom periodically for a short period of time. However, if it is as long-standing as you described it may indeed just be nerves, but may require some further treatment. There are new treatments available for this condition, if it does not resolve on its own. I would recommend consultation with an ophthalmologist as soon as possible.
Twitching of the eye almost always occurs in the muscles of the eyelid. Because they press on the eye it may feel as though the eyeball itself is moving. Fortunately this is in no way a serious problem and does not reflect any abnormality in the eye or potential detrimental effect on the vision. In some cases it occurs because of irritation in the eye, which results in twitching of the eyelid. However, if the eye is comfortable it is more likely that it is a simple muscle spasm, which may be related to stress or fatigue or in, many cases happen spontaneously without any known cause. Usually it resolves over a period of several weeks, but if it does not it certainly is worth a comprehensive eye examination to ensure that no other problem is occurring in the eye.
Blepharospasm is the term for muscle spasms in the eyelid, a condition that most people think of as an eyelid twitch or tic. It is a common condition and usually is not reflective of any serious underlying problem. It may result from chronic irritation of the eye or impaired focusing, which can cause muscle spasms. It is also possible that stress, fatigue and other factors, unrelated to the eye, can bring on these muscle spasms. Fortunately, they usually disappear spontaneously and in some cases, simple measures like cold compresses or lubricating eyedrops can help.
It is always wise to get a comprehensive eye examination to determine what cause may be present. In severe cases, local injections of a muscle relaxing agent may be helpful, but this generally is only used in cases that persist over a long period of time and do not respond to any other treatment.
A twitching eyelid is termed blepharospasm. Most cases of blepharospasm have no known cause, although it is always wise to check for any source of irritation of the eye or impaired vision, which could result in this chronic muscle spasm. Thus a comprehensive eye exam is always crucial in ruling out any treatable causes in the eye. When no cause is apparent on a complete eye examination it may be that stress, fatigue, or other non-ocular factors are involved. However, in the majority of patients no specific cause is ever found.
Fortunately most people with blepharospasm have short bouts which resolve spontaneously. It appears that your case has been much more severe and longstanding at most. It would be wise to consider consulting a neuro-ophthalmologist. In the most severe and persistent cases, injections of minute doses of botulinum toxin can help to relax the muscle. This can be done safely but is usually done only as a last resort.
Iritis can usually be treated without resulting in any permanent harm to the eye or loss of vision. However, the more frequent the attacks and the more severe the attacks, the greater chance that there could be some long term effect on the eye, if they are not treated promptly and successfully. The "lazy eye" you have should not have any bearing on your iritis, although it may mean that you will need to be particularly careful if you primarily use one eye to treat your iritis vigilantly. Your ophthalmologist should be able to give you additional information on the nature of your particular variety of iritis and any measures that might help to prevent long term consequences.
Most floaters are normal in that they do not signify any disease or damage in the eye, though they may be annoying. However, it sounds as though you have been treated for an eye disease creating your floaters. If this is a disease causing inflammation in your eye, which was treated with medication by a retinal specialist, it would be very helpful to know which particular disease was being treated. In some cases these sorts of inflammations can be treated with newer or different drugs to which you may not be allergic. Please let us know if you have further details about your condition.
It appears that your eyes have been thoroughly examined to determine whether any abnormal floaters exist. Usually when the tests you have had turn out to be normal, the floaters that you continue to experience would be classified as a normal part of your eye. Unfortunately, there is no known cure or treatment for these floaters, which are denser areas of the vitreous jelly within the eye. Many people find that they notice them less under certain conditions or that they tend to decrease in number with time, but this is not always a predictable pattern. Floaters are frustrating problems shared by millions of people, and it is fortunate that yours do not reflect any damage within your eyes. However, any ability to eliminate them awaits future developments in Ophthalmology.
Question about Floaters
At present there is no safe and effective surgical treatment for floaters. Floaters are extremely common, and floaters that have been present for a long time without any changes are usually not a cause for concern, though they can be very annoying.
However, any new floater or floaters, any change in the number or appearance of floaters, and any visual disturbance like light flashes or shadows that accompanies floaters should be checked by an eye doctor right away.
Question about Floaters
The visual image you describe could be an atypical floater, but its appearance might also indicate a process affecting the retina in that eye. In order to determine which of these areas are involved, or if any other eye problem could have created this sensation, an eye doctor, should perform a dilated retinal examination as soon as possible. While your symptoms could resolve spontaneously, it is important to determine whether any treatment is necessary at this point to help this condition.
Question about Floaters
When floaters and flashes of light occur suddenly in one eye, it is wise to have an ophthalmologist check your eye as soon as possible. Most often these symptoms are caused by shrinkage or condensation of the vitreous, the gelatinous material inside the eye. This usually requires no treatment, but in a small fraction of cases, these symptoms can indicate a problem in the retina which may require treatment to prevent it from worsening or causing more serious problems. Usually this condition occurs spontaneously and is unrelated to any activities the individual may or may not have done. However, specific information about a particular case can be given after an eye doctor has examined the eye.
The condition you describe is called amblyopia. This means that the eye, though structurally normal, cannot see as well as your other eye. This is due to lack of symmetrical input from the eye to the brain in childhood. During the time that the eye was not aligned with your other eye, the brain was concentrating on the image from your "good" eye.
Unfortunately, when these nerve connections did not develop in childhood, there is no known way to improve the quality of eyesight in an eye with amblyopia. Even the many new developments in eye research have not changed this situation. Your eye will never suffer any decrease in vision, but there is no treatment that will improve its vision to the level of your other eye.
Question about Amblyopia
The condition you describe is called amblyopia, an inability of the eye to see clearly despite a normal structure. It is true that if any condition impairs the eye's ability to send nerve impulses to the brain in childhood, the quality of vision in that eye in adulthood will not be perfect. Unfortunately, it appears that if treatment is not undertaken by approximately age 8 or 9, no further treatment will change the condition in adulthood. The positive side of this situation is that the eye can never further deteriorate in adulthood either.
If the best glasses prescription available does not seem to help, it is unlikely that there is any other treatment that will bring noticeable improvement. However, there are some optometrists who specialize in visual exercises that may, in some cases, help eyes to work together better. This is one option to consider, although the results are variable and many patients may not notice any improvement.
If you have further question, please do not hesitate to contact us.
Blepharitis can be very difficult to eradicate and different people respond differently to certain kinds of treatment. Some other measures that can be helpful include hot compresses on the eye in an effort to decrease the clogging of the oil glands, antibiotic drops or ointment if there is evidence of excess microbial growth or infection, anti-inflammatory drops for flare-ups, and sometimes oral medications such as Tetracycline and others, which can help to decrease the inflammatory process. If your treatment, thus far, has not been successful, it would be wise to have your eye doctor re-evaluate the situation and consider whether other options would be appropriate.
Question about Blepharitis
Toxoplasmosis is an infectious disease, which can affect the eye as well as other parts of the body. When it occurs in the eye, it usually causes inflammation in the retina, which can create floaters, blurred vision and eventual scarring of the retina. Frequently the flare-ups will resolve by themselves, although in some cases, medication is necessary to help suppress the inflammation. Unfortunately, patients with toxoplasmosis frequently have reactivation of the disease with future episodes that resemble the previous ones. Most ophthalmologists believe that toxioplasmosis in the eye is most often acquired before the child is born but can remain dormant for long periods of time before it flares up. Once retinal damage has been done it is not possible to repair that area of the retina, but further treatment can prevent some of the scarring that would occur in subsequent flare-ups.
Cytomegalovirus is a different disease, which can affect the retina and cause severe retinal damage. It is less likely to behave in the manner you have described, with repeated flare-ups, except in patients with impaired immunity.
If you have any further questions, please feel free to contact us.
An ulcer is usually an area of inflammation, which reaches beneath the surface of a particular part of the body. In the eye an ulcer is most often seen in the cornea. Corneal ulcers can be very dangerous, depending on their cause. If a corneal ulcer is infected, it can produce scarring and damage to the eye leading to permanent loss of vision. Other ulcers may be less serious, but an ulcer should always be evaluated immediately by an eye doctor.
Double vision, diplopia, is usually caused by an eye that is not in alignment with the other eye. There are many causes of loss of alignment and they may include injuries, neurologic problems or abnormal blood flow.
Most cases of double vision occur when both eyes are open but disappear when one eye is covered. There are also other types of problems, which may occur with one eye alone that may resemble double vision including most images and poor focusing.
What you are describing sounds like it may be a variety of double vision because it occurs with both eyes but not with one eye alone. The new onset of double vision should always be investigated by an eye doctor and often by a neurologist and the patient's own physician. There are many causes of double vision including injuries, neurologic diseases and problems with the blood circulation. If your sister has blood vessel problems that may well be part of what is causing her eye difficulty. However, only a detailed eye examination in person would help to determine the source. If no definite answer has been received, further investigation by additional physicians would certainly be indicated.
Any sudden development of double vision in a child your son's age should be evaluated immediately both by an ophthalmologist and a physician well versed in neurological disorders such as a neurologist. While eye muscle strain or changes in the behavior of the eye muscles can cause this condition, it is also possible that another disease such as a neurologic problem may be involved. It would be wise to consider an evaluation by his own general physician or perhaps a neurology specialist as soon as possible, particularly if this condition has not completely resolved with the use of reading glasses or spontaneously. Please contact us if you have any further questions.
Surgery for crossed eyes almost always involves some combination of loosening and tightening the eye muscles in order to change their position. In order to get to the location of the eye muscles, the membrane covering the white of the eye must be opened and partially peeled back. The eye muscle itself is either detached from the eye and moved to a new location so it will be pulling in a different place or shortened so that it is tightened at its current location and is pulled relatively harder. This can be thought of as somewhat analogous to adjusting the reins on a horse so that one side is looser and the other side is tighter. Fortunately, re-adjustments of the eye muscles in this fashion tend to be very successful at moving the eye to a new position, although sometimes further surgery is necessary to fine-tune its position or if the eye subsequently changes position after the initial surgery. After the surgery the membrane is replaced and generally healing proceeds very successfully. Please feel free to contact us if you have any further questions.
Questions about Retinitis Pigmentosa
Retinitis Pigmentosa is a degeneration of the light receptor cells in the retina which causes impaired night vision, peripheral vision, and sometimes blindness. Excellent and detailed information can be found through the Retinitis Pigmentosa Foundation Fighting Blindness. Their web address is www.blindness.org, go to "what we study" on the navigational bar and you will find Retinitis Pigmentosa. They will also send you information by mail. Some forms of retinitis pigmentosa may start later in life or progress more slowly, so that complete blindness does not occur.
A sty can often be treated with hot compresses of the eyelid. The heat helps to drain the clogged oil gland, which creates a sty. This can be done for five to ten minutes, two to four times a day. When hot compresses on the eyelid are ineffective, usually medical treatment such as eyedrops or ointment is necessary and at that point it is wise to have a doctor look at the sty. Fortunately it is extremely rare for a sty to progressively worsen, even though it can be uncomfortable. However, if it does appear to enlarge or the swelling or redness spreads it should be evaluated by a doctor immediately.
If you develop redness in your eyes, particularly in the morning, but do not have itching or watering, your symptoms are not those of a typical allergy. Redness that occurs primarily in the morning can be due to inflammation of the eyelids, a condition called, Blepharitis. There is also a type of inflammation that some contact lens wearers get if their contact lenses are old or do not fit well. This also could be a possible source of your symptoms. It is unlikely that an active infection would create redness without other symptoms as well. If your current treatment is not successful you may wish to have your eye doctor investigate other possible causes or even consider rechecking or changing your contact lenses. It is usually not necessary to discontinue contact lens wear as a result of the type of symptoms you described.
Central Serous Retinopathy
Central serous retinopathy is a relatively uncommon condition that generally affects young healthy people but at present has no known cause. Researchers have studied this but as yet, there is no conclusive information on why certain people develop this condition and why flare-ups occur at a particular time in one eye or the other, although there has been much theorizing in that regard. As you may have heard in certain situations, laser treatment can be beneficial when leakage occurs although it is not always advisable and in some cases it may not, eliminate visual symptoms all together or may even be unsuccessful at improving the visual distortion experienced. Active research in this area, as well as other disorders of retinal leakage is occurring and it may be that new treatments or information will be available in the future.
What you describe is most likely the thickening of the white of the eye called a pinguecula. This tends to occur in the area between the eyelids on both sides of the iris. Usually it is caused by mild irritation of the eye, such as dryness, dust, wind and the like. However, some people develop these areas without any known irritation.
Fortunately these never cause damage to the eye or vision problems. If you are noticing some increased blurriness, it is most likely to be from another source and should be evaluated by an eye doctor. Please contact us if you have any further questions.