Kirk Eye Center - Loveland, Colorado

Age-Related Macular Degeneration
What is age-related macular degeneration?
Age-related macular degeneration (AMD) is damage to the part of the eye called the macula. It is in the center of the retina. The retina is light-sensitive tissue at the back of the eye. Cells in the retina change light into impulses that are sent to the brain. The brain interprets them as images. If the macula is damaged, you can no longer see fine detail in the center of your vision. Usually your side (peripheral) vision is not affected. However, the loss of central vision can make it difficult to read, drive, or see straight ahead.

AMD is a common problem for many people, as they get older. It usually affects both eyes, but one eye may be affected before the other.

How does it occur?
There are two forms of AMD: wet and dry. The wet form occurs when new, fragile blood vessels grow beneath the retina and leak blood and fluid. The leaks can rapidly damage the macula. In the dry form, the light-sensitive cells in the macula gradually break down. In both cases, a blind spot forms in or near the center of vision. The dry form is more common and causes a slower and often less severe loss of vision.

The cause of these changes is not known. Smoking may contribute to the problem. You may also be at greater risk if you have family members with AMD.

What are the symptoms?
AMD does not cause pain. The first signs of the condition are usually problems with your vision. Symptoms may include:

Blurred vision
Wavy appearance to straight lines (for example, a telephone pole may appear to be bent)
A dark patch in the middle of words as you read
Worsening of your color vision.

If just one eye is affected, you may not notice the loss of vision when you are using both eyes.

How is it diagnosed?
Your health care provider will review your symptoms and examine your eyes with a lighted tool called an ophthalmoscope. You may need a special test called fluorescein angiography by a medical eye doctor. In this test dye is put into a vein in your arm. The dye travels to blood vessels in your retina. Then pictures are taken of your retina. The pictures will show where the leaking blood vessels are behind your retina.

How is it treated?
If the leaking vessels are not in the center of the macula, sealing the leaking vessels with a thermal laser can sometimes treat the wet form of AMD. This may prevent further damage to the retina, particularly if the condition is caught early. Sealing blood vessels may leave a small blind spot near the center of your vision.
The center of the macula is very important for good vision. If the leaking vessels were directly in the center of the macula, a thermal laser treatment would cause too much vision loss. In this case, a treatment called photodynamic therapy may be used. For this procedure, a laser-activated dye is injected into your bloodstream. When the dye reaches the retina, a “cold” (nonthermal) laser is used to activate the dye to close the leaking blood vessels. These blood vessels can grow back, so the procedure must be repeated 5 or 6 times in the next 2 years. However, in some cases of wet AMD, this treatment will reduce the amount of vision loss you will have compared to having no treatment

The risk of vision loss from dry AMD can sometimes be decreased with a vitamin and mineral supplement. Talk to your health care provider about the risks and benefits of this treatment.

If you have either form of AMD, low vision aids may help you with your daily activities. Low vision aids include such things as:

Magnifying glasses and telescopes
Closed-circuit TV
Clocks and phones with large numbers and reading material printed in large type

Ask your health care provider for help in finding which low vision aids may be helpful for you.

How can I take care of myself?

Tell your doctor if your vision changes in any way
Never ignore blurred vision, lines that appear wavy, blind spots, or loss of color vision.
Have a complete eye exam every 2 or 3years. If you have diabetes or a family history of eye disease, have your eyes checked at least once a year

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Age-Related Macular Degeneration (AMD) And Nutritional Supplements

Age-related macular degeneration (AMD) is a disease caused by damage or breakdown of the macula, the small part of the eye’s retina that is responsible for our central vision.

This condition affects both distance and close vision and can make some activities - like threading a needle or reading - very difficult or impossible. Macular degeneration is the leading cause of severe vision loss in people over the age of 50.

How can vitamins and minerals affect AMD?
Although the exact causes of AMD are not fully understood, a 2001 scientific study called AREDS (Age-Related Eye Disease Study) has shown that some antioxidant, vitamins and zinc may reduce the impact of AMD in some people.

The study found that people at higher risk for late-stage macular degeneration who followed a dietary supplement of vitamin C, E and beta-carotene, along with zinc, lowered the risk of the disease progressing to advanced stages by about 25%. The same treatment did not appear to achieve the same results among people without AMD, or within the first stages of the disease.

Deposits located beneath the retina, named drusen, are a common sign of AMD. By themselves, such deposits don’t cause loss of vision but, m increased numbers and size, they are an indication of being at risk to develop an advanced stage of AMD. People at risk of developing a late stage of AMD may have a significant amount of drusen, prominent dry AMD, or presence of abnormal blood vessels beneath the macula in one eye (wet AMD).

The nutritional supplements used by AREDS that proved to he beneficial contain vitamin C (500mg); vitamin E (40(IIU); beta-carotene (15mg); zinc oxide (80mg); and copper oxide (2mg, to prevent the loss of copper associated with zinc supplements).

The levels of antioxidants and zinc that were shown to be effective in slowing AMD’s progression cannot be consumed through your diet alone. These vitamins and minerals are recommended in specific daily amounts as supplements to a healthy, balanced diet, to benefit the health of people with minimal presence of AMD, or those without evidence of macular degeneration.

Some people may prefer not to take high dosage of antioxidants or zinc for medical reasons. The AREDS study did not reveal any evidence that the treatment may be toxic, however, beta-carotene may increase the risk of developing lung cancer among smokers, or those who have quit smoking recently.

Should I take antioxidant vitamins for macular degeneration?
It is very important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision you may have already lost from the disease. However, specific amounts of certain supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision. Talk to your ophthalmologist, Dr. Kirk, to determine if you are at risk for developing advanced AMD and to learn if supplements are recommended for you.

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Anti-VEGF Treatment For Age-Related Macular Degeneration

What is Anti-VEGF treatment?
Anti-VEGF treatment is a way to slow vision loss in people who have a condition called “wet” age-related macular degeneration.

What is age-related macular degeneration (AMD)?
Age-related macular degeneration (or AMD) is the leading cause of vision loss in people 50 years or older in the United States. It involves damage to the part of the eye called the macula. The macula is a small but extremely important area located at the center of the retina, the light-sensing tissue lining the back of the eye.

The macula is responsible for your ability to see fine details clearly. You rely on your macula whenever you read, drive or perform any other activity that requires seeing fine details such as threading a needle.

A person with AMD loses the ability to perceive fine detailed vision up close and at a distance. This loss of detailed vision affects only your central vision. The side, or peripheral, vision usually remains normal. For example, when people with AMD look at a clock, they can see the clock’s outline but cannot tell what time it is.

What is different about “WE” AMD?
There are two common types of AMD. Most people (about 90%) have a form of AMD called “atrophic” or “dry” AMD, which develops when the tissues of the inacula grow thin with age. Dry AMD usually causes a slow loss of vision. A second, smaller group of people (about 10%) have a more serious condition called “exudative” or “wet” AMD. Wet AMD occurs when abnormal blood vessels grow underneath the retina. These unhealthy vessels leak blood and fluid, which can scar the macula. For patients with wet AMD, vision loss may be rapid and severe.

How does Anti-VEGF treatment help slow vision loss in people with wet AMD?
Researchers who study wet AMD have found that a certain chemical in your body is critical in causing abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor, or VEGF. Recently, scientists have developed several new drugs (anti-VEGF) that can block the trouble-causing VEGF. Blocking VEGF reduces the growth of abnormal blood vessels, slows their leakage, and helps to slow vision loss.

What can you expect from Anti-VEGF treatment?
The anti-VEGF drug must be injected into your eye with a very fine needle. Your ophthalmologist will clean your eye to prevent infection and will administer an anesthetic to your eye to reduce pain. Usually, patients receive multiple anti-VEGF injections over the course of many months. As with any medical procedure, there is a small risk of complications following anti-VEGF treatment. Any complications that might occur usually result from the injection itself, including eye pain, subconjunctival hemorrhage (bloodshot eye), vitreous floaters, irregularity or swelling of the cornea, inflammation of the eye, and visual disturbances. For most people the benefit of the treatment outweighs the low risk of injection injury.

Is Anti-VEGF treatment right for you?
Your ophthalmologist will determine if the treatment is appropriate for you. Only patients with the wet form of AMD can benefit from it.

In some cases, your ophthalmologist may recommend combining anti-VEGF treatment with other therapies. For instance, some patients also receive photodynamic laser therapy. With this treatment, a special drug is injected into the veins in your arm, where it flows to your macula. Your ophthalmologist uses a special laser to activate this drug in order to close abnormal blood vessels in the macula.

The treatment that’s right for you will depend on the specific condition of your macular degeneration.

Anti-VEGF treatment is a step forward in the treatment of wet AMD because it targets the underlying cause of abnormal blood vessel growth. The treatment may offer new hope to thousands of people diagnosed with wet AMD.

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Amblyopia

What is amblyopia?
Amblyopia is reduced vision that occurs when an eye does not develop normal sight during early childhood. It is also called lazy eye.

How does it occur?
Normally, a newborn baby’s vision is blurred. It improves as the baby gets older and uses her eyes. Both eyes work together (called binocular vision) and send images to the brain. The brain blends the two images into a single, clear picture. If for some reason the images are different, the brain ignores the image from one eye to avoid double vision. This may mean that normal vision does not develop in that eye.

The images from the eyes may be different because of:

Strabismus, or “crossed eyes”. If your brain were to try to use the pictures coming from two eyes that were not aligned the same way, you would see a jumble of images. To make sense of the confusing images, the brain ignores the image coming from one eye.
Vision disorders. One eye may be more nearsighted, farsighted, or astigmatic than the other eye. These three vision problems keep the eye from focusing correctly. The brain uses the image from the stronger eye. The other eye may stop developing.
Diseases. Childhood cataracts and eyelid problems that prevent the eye from opening all the way can keep a young child’s eyes from developing normally.

If this problem is detected and treated when the child is young, both eyes may develop normal vision and work together. After age 10 the visual system is usually fully developed. Treatment in children younger than 6 years old is more effective than in older children. Treatment should begin as soon as the condition is detected.

What are the symptoms?
Babies often do not show any symptoms of amblyopia. However, they may have trouble following an object with their eyes or may have crossed eyes. Toddlers may favor one eye. They may react strongly to having one eye covered but not the other. Older children may complain of eye pain, watery eyes, or headaches. If you suspect that there is anything abnormal about your child’s eyes at any age, see a doctor. Most of the time, amblyopia is detected during a vision exam at school or by a pediatrician.

In an older person, amblyopia is often suspected when no prescription of eyeglasses can correct reduced vision.

How is it diagnosed?
A pediatrician, primary care doctor, or preschool staff member may suggest that a child needs a complete eye exam. An eye doctor can diagnose amblyopia by watching how a baby or child follows objects with his eyes or by watching his movements when one eye is covered.

If an adult’s vision cannot be corrected to 20/20 with glasses and if a thorough exam reveals no other cause for impaired vision, he or she probably has amblyopia.

How is it treated?
Treatment in children usually begins by patching the stronger eye. Patching forces the brain to use the “lazy” eye. Some doctors prescribe eye drops to blur the “good” eye instead of putting a patch on it. The eye doctor also treats the problem that led to the amblyopia. Glasses can help correct nearsightedness, farsightedness, or astigmatism. Strabismus may require eye muscle surgery, glasses, or both.

Unfortunately, there is no treatment for amblyopia in adults.

If amblyopia is detected early and treated properly, a child can develop normal binocular vision. If treatment does not take place early, glasses may provide good vision. However, the vision in the lazy eye may never be as good as that in the stronger eye.

Most people can work and play well with one lazy eye. For example, Babe Ruth had amblyopia. However, airline pilots and interstate truck drivers, for example, are required by law to have good vision in both eyes.

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Argon Laser Trabeculoplasty

What is argon laser trabeculoplasty?
Argon laser trabeculoplasty is a common procedure used to treat glaucoma. Glaucoma is an eye disease in which the optic nerve is damaged, usually by high pressure inside the eye. Eye pressure can become too high if you have a problem with the drainage of fluid from your eye. Damage to the optic nerve can cause a loss of vision.

In this procedure, your doctor uses a laser to treat the drainage pathways (the trabecular meshwork) in your eye. The procedure can lower the pressure in your eye and help prevent more damage to the optic nerve and loss of vision.

Your eye doctor may recommend this procedure after you have tried treating high pressure in your eye with eye drops or pills. These medicines may not be reducing your eye pressure or they may be causing side effects.

What happens during the procedure?
This procedure is usually done in the doctor’s office. The eye doctor uses eye drops to numb your eye. A special contact lens is put on your eye to help direct the laser’s high-energy beam of light at the trabecular meshwork in your eye. The laser makes 50 to 100 evenly spaced bums. You will see a few brief flashes of light and feel little, if any, discomfort.

The procedure usually takes less than 10 minutes. You may be able to go home soon after it is done.

What happens after the procedure?
Your vision will probably be blurred for the rest of the day, but then it should clear. You will not need to wear an eye patch. If your vision does not clear within a day or if you feel any pain or discomfort, call your doctor.

This procedure is usually successful. Several days or weeks after the procedure, the flow of fluid from your eye should improve. Improved flow usually reduces the pressure inside the eye. Your doctor will want to check you regularly to see if the pressure inside your eye is in fact getting lower. It will take 3 to 6 weeks, and sometimes longer, to learn the results.

After the procedure you may no longer need to take medicine for glaucoma, but most people do still need to take some medicine.

The effects of this treatment may not last. After some time you may need to have the procedure again.

What are the risks?
Although there are some risks with the laser treatment, there are fewer risks than with other types of surgery. Problems may occur that could threaten your vision, but they are rare. If you have any questions about the risks of argon laser treatment, ask your doctor.

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Blepharitis
Blepharitis, often referred to as “granulated eyelids” because of their appearance, is simply an inflammation of the outer edges of the eyelids where the eyelashes originate (the eyelid margins). It is a common, chronic condition that will never totally go away, but can be controlled by treatment if it is bothersome.

Symptoms
Crusts form on the eyelid margins, and can cause a foreign body sensation in your eyes or make your eyes seem bloodshot. The edges of your eyelids may stay red much of the time, making it look as if you have been crying. Sometimes the lids itch, and you may want to pick at the crusts to relieve the itching.

What causes Blepharitis?
Blepharitis can be caused by a number of infectious organisms, though in most cases it is related to seborrhea, a common condition of the skin and hair known as “dandruff’. A rash forms at the eyelid margins. The rash creates a flaky, moist area for germs to grow. The increase in germs and the by-products they produce cause eye irritation and redness. Blepharitis itself does not affect your eyesight.

Examination
The outer and possibly inner surfaces of your eyelids will be examined under magnification with a slit lamp (clinical microscope). The condition is very common and the diagnosis is usually apparent from examining the lids.

Treatment
If you are bothered by your blepharitis, you will be given a prescription for an anti-infective/ anti-inflammatory ointment. To apply the ointment, pull down on your lower eyelid and squeeze a small amount (1/8 inch or a dab about the size of the head of a match) into the inside of the eyelid. (The medication will be ineffective if you simply rub the ointment onto your outer eyelids.) Repeat for the other eye. Use the ointment just before you go to bed, because it will cause your vision to be blurry and you will have difficulty reading or watching television. Continue to treat yourself with the medication every night for two to four weeks, depending on the doctor’s recommendation. You may have to repeat treatment every six to twelve months.

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Blepharoplasty

What is blepharoplasty?
Blepharoplasty is a surgical procedure in which excess skin and fat around the eyes are removed. Excess skin can develop because of:

Aging
A history of puffy eyelids because of allergies or water retention
An inherited tendency toward droopy eyelids

When is it used?
This procedure may be used when:

Your field of vision is partially blocked by excess skin
You have aches in your brow from trying to use your forehead muscles to lift drooping eyelids
You want to change your appearance

How do I prepare for this procedure?
You will need to arrange for someone to take you home after your surgery. Allow some time to rest at home.

Follow your doctor’s instructions. Do not wear eye makeup on the day of surgery. No special preparation is needed if you are to have local anesthesia. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight before the procedure. Do not even drink coffee, tea, or water.

If you take important medicines regularly, ask your doctor about taking them on the day of surgery. If you take aspirin, warfarin (Coumadin), or vitamin E ask your doctor if you should stop taking it before surgery.

What happens during the procedure?
The surgeon marks the skin that will be removed. He or she also finds any fat pads that need to be removed. The surgeon cuts away these tissues. If needed, the surgeon may modify muscles that control the eyelids to help them function better. Then the surgeon sews up the incisions with stitches.

What happens after the procedure?
You may have swelling or bruising (“black eyes”) for about a week. You may have mild pain or discomfort right after your surgery. Ask your doctor if you can take acetaminophen for pain.

You may want to rest quietly for a day or two with your head raised. Also, you may put cold compresses (a washcloth moistened with cold water) over your eyes to reduce swelling and bruising.

Right after the surgery, the incisions are red and visible. Since they are made in natural creases in your skin, they will not be visible when they heal.

If you wear contact lenses, wait about 4 days after your surgery before you put them in. If you wear glasses, you may wear them right away. Wait 2 weeks before using eye makeup.

What are the benefits of this procedure?
This procedure corrects vision problems caused by droopy eyelids. Also, you may look younger and less tired.

What are the risks of this procedure?
There are always risks associated with anesthesia. Ask your doctor about these risks. Other
Risks may include:

Bleeding
Infection
Rarely, double vision or loss of vision.

If your doctor removes too much skin, too much of the front of your eye may be exposed. This may lead to dry eye and problems with your cornea (the clear dome on the front of the eye).

When should I call my doctor?
Call your doctor immediately if you:

Have unusual pain
Have a sudden loss of vision
Have a lot of drainage from your eye
Develop a fever

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Branch Retinal Vein Occlusion (BRVO)

A branch retinal vein occlusion (BRVO) is a blockage of one of the small blood vessels that drains blood from the retina. The retina is the light-sensitive nerve tissue lining the back of the eye.

Like film in a camera, the retina continually “takes pictures” of everything you look at. When a retinal vein becomes blocked, part of the retinal blood flow slows or stops. Suddenly and usually without warning, a patch of retina loses some of its “picture-taking” function and you may become aware that part of your field of vision has darkened.

Why is vision lost?
Normally, the retina is nourished by oxygen-rich blood that is brought to it by arteries and drained away by veins. When a vein - drainage channel - is blocked, blood backs up, leading to bleeding and swelling (edema) in the retina and hampering its nourishment.

The extent of damage and the visual symptoms produced depend on the size of the blocked vein and its exact location. If the blockage occurs toward the peripheral part of the retina, you may hardly notice it. But if it occurs in or near the macula - the central zone of the retina that is critical for sharp vision - and causes it to swell, vision is likely to be reduced or distorted.

A more serious threat to vision can develop later from a complication called neovascularization (neo = new; vascular = blood vessels). A month or more after the BRVO, new blood vessels may begin to appear in the retina, as if they were trying to renourish it. These are not normal blood vessels, however; they are very fragile and bleed easily. They are dangerous to the eye because they can lead to still other problems that damage vision.

Neovascularization only occurs in about one in five BRVO patients. If it develops in your eye, it should be treated before causing harm. In most cases there are no warning symptoms; but occasionally there are, such as the sudden appearance of new floaters (translucent specks that move about in your field of vision) or a sudden decrease in vision.

What causes a vein occlusion?
Several factors combine to bring on an occlusion. The usual situation is that something causes the blood flow in a retinal vein to slow down so much that it permits a clot to form there. The clot prevents blood from flowing freely.

The most common reason for slowed venous blood flow is, surprisingly, a hardened artery (arteriosclerosis). If a stiff artery happens to lie across a vein and compresses it, it can slow the flow of blood in that vein in the same way that a log across a stream can obstruct the flow of water. Because arteriosclerosis occurs so often in people who have hypertension it is considered to be a risk factor for the development of BRVO.

Other conditions that can lead to a BRVO are venous inflammation (vasculitis), which can plug the vein, and some rare blood conditions that produce a greater-than-normal tendency for blood to clot. Even estrogen medication (as in oral contraceptives) can introduce a slight risk of blood clotting.

Examination
You will have a complete eye examination and vision test. Your pupils will be dilated (enlarged) with eye drops so the insides of both eyes can be studied. An ophthalmoscope and slit lamp (clinical microscope) are instruments used for looking inside the eyes; they are especially useful for studying the retina and its blood supply.

Retinal photographs may be taken to help determine the extent of the problem. An angiogram (photographs of blood vessels) may also be made. For this test, an orange-colored dye (fluorescent) is injected into a vein in your arm and immediately followed by a series of retinal photographs that track the dye and time its flow as it travels through the eye’s blood vessels. The angiogram helps identify the exact site of the vein’s blockage, the extent of damage to the capillaries (the smallest retinal blood vessels), and whether or not neovascularization has developed.

Because BRVO can be associated with medical conditions that affect the rest of the body (high blood pressure, for example, which also increases the risk of a heart attack or stroke), you may be referred to an internist or family physician for a complete check-up after your eye examination.

Treatment
Once a BRVO has occurred, there is no simple way to speed the healing process along. Eventually, over several months, the blocked vein may re-open on its own, or some nearby blood vessels (called collaterals) may develop and reroute the blood flow around the site of blockage. Either of these may help restore at least part of the lost retinal function.

If neovascularization develops, a type of laser surgery called panretinal photocoagulation (PRP) can help reduce or even eliminate the abnormal blood vessels. PRP is not intended to improve vision directly. It reduces the risk of further vision loss from internal bleeding or, possibly, from a retinal detachment.

PRP is preformed on an outpatient basis and is a painless treatment. It consists of making hundreds of tiny laser burns in and around the damaged part of the retina. If the neovascularization does not respond to this treatment by decreasing substantially within a month or so, additional laser PRY can be applied.

After a BRVO, the central retina (macula) sometimes remains swollen for months, reducing vision significantly. To help minimize the macular swelling, another type of laser treatment (called grid-pattern) can sometimes be used. Its risks and intended results, however, are distinctly different from the laser PRY technique used for treating neovascularization.

Prognosis
If you are under age 50 or so, a BRVO may not impair your vision much, if at all. Even if vision is reduced initially, it has some potential for returning, perhaps even to its previous level, over the next few months. If neovascularization occurs, it can be treated with laser PRP.

If you are older, good visual recovery is not as likely. But even if some reduced vision remains, the degree of impairment is not likely to be severe.

Regular follow-up examinations are important to protect your eyesight. Your eyes should be checked regularly for potential late complications, such as neovascularization or macular edema, and for the development of a second vascular occlusion in either eye.

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Blepharospasm

What is blepharospasm?
Blepharospasm is forceful, uncontrollable closing of the eyelids. Often it affects both eyes, but it can affect only one. As the condition worsens, the blinking or winking occurs more often. The eyelids can be closed for longer than a normal blinking reflex, which may cause vision problems.

Sometimes the condition is called essential blepharospasm. Essential means that the problem is not caused by any other disease.

Blepharospasm is quite different from the mild spasms of the lid that sometimes occur with stress, use of caffeine, or insufficient sleep and do not affect vision.

How does it occur?
The exact cause of blepharospasm is not known. Most experts believe that the basal ganglion in the brain does not work normally. The basal ganglion helps coordinate movement of the muscles. Also, the nerves in or near this area of the brain may not work normally. This problem may run in families.

Medicines, such as those used to treat Parkinson’s disease, may cause this problem. Other factors may play a part in this condition, including:

Stress or fatigue
Dry eyes (not enough normal moisture in your eyes).

In the past, blepharospasm was thought to be a psychiatric problem, but now we know that is not true.

What are the symptoms?
The symptoms are:

Winking, blinking, or squinting that you cannot control
Trouble keeping your eyes open
Sensitivity to light

How is it diagnosed?
Your doctor will ask about your symptoms and examine your eyes.

How is it treated?
The main forms of treatment are:

Injection of a medicine
Medicines taken by mouth surgery
Stress management.

Very small amounts of botulinum toxin A, made from the bacteria Clostridium botulinum, can be injected into the muscle that closes the eyelids. This stops the muscle spasms for several months. These injections will need to be repeated about every 3 months.

Medicines taken by mouth may help stop the muscle spasms. But often what works for one person may not work for another. Also, the benefits may not last very long. You will need to work closely with your doctor to find out what medicine and dosage work for you. Sometimes researchers find new medicines that may help. Or they find that medicines used for other diseases provide relief for some people. Ask your doctor about the latest research on medicines to treat blepharospasm.

Some medicines cause spasms. Stopping these medicines or reducing their dosage may stop the spasms.

If neither the injections nor the medicines taken by mouth stop the spasms, you may need surgery to remove some of the muscles that close the eyelids. This surgery (called myectomy) is generally safe and effective for many people.

Finally, stress management and coping techniques may help lessen the spasms and help you feel more comfortable in social situations. Bright light may make spasms worse, so wearing dark glasses may reduce some spasms. Also, dark glasses make the problem less noticeable to others. Support from support groups, family, and friends can be reassuring and may help you continue to be as active as you want.

How can it be prevented?
Usually blepharospasm cannot be prevented. If you have dry eyes, getting treatment for them may help prevent blepharospasm.

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Cataract

What is a cataract?
A cataract is a cloudy area in the lens of the eye. The lens helps focus light on the retina at the back of the eye. It is located behind the iris (the colored part of the eye). As a cataract grows larger over time, the cloudiness worsens and causes vision problems.

How does it occur?
Most cataracts occur naturally as people get older. What causes cataracts is not known, but many factors may contribute to their formation, such as:

Eye injury
Diabetes or other diseases
Exposure to radiation, especially x-rays
Long-term use of steroid medication
Exposure to toxic substances
An inflammatory disorder of the eye (iritis)
Prolonged exposure to sunlight.

A child may be born with cataracts or develop them at an early age. These cataracts, called congenital cataracts, may be caused by a genetic disorder (such as Down syndrome) or by a condition the mother had during pregnancy (such as German measles). They also may be inherited.

Cataracts don’t spread from one eye to the other, but many people have cataracts in both eyes.

What are the symptoms?
The symptoms of a cataract include:

Blurred vision
A need for frequent changes in your eyeglasses or contacts
Trouble driving at night
Sensitivity to bright light
Change in color vision (yellow, orange, and red appear brighter and blue appears dull)

Cataracts do not cause complete blindness. However, it is possible to lose enough vision to be declared legally blind.

How is it diagnosed?
The symptoms of a cataract develop slowly and are painless. The condition may go unnoticed and undiagnosed for a long time. It is often first diagnosed during a routine eye exam.

An eye doctor will thoroughly examine your eyes. He or she will evaluate your symptoms and determine the best course of treatment.

How is it treated?
If a cataract is not interfering with your lifestyle or work, your doctor may suggest changing your glasses or using brighter lights to help you read.

If the cataract is seriously affecting your vision and cannot be helped with glasses or contact lenses, a surgeon may need to remove the lens. This type of surgery is called cataract extraction surgery. The surgeon may first use sound waves (ultrasound) to break up the lens so the pieces can then be removed through a narrow hollow suction tube. This part of the procedure is called phacoemulsification. In some cases, the lens is removed in one piece through a larger incision (nuclear expression). After the lens is removed your surgeon may put a new plastic lens in your eye (intraocular lens implantation). If you do not have a new lens put in, you will need to wear contact lenses or cataract glasses. Lasers are not used to remove cataracts. However, they may be used to open a cloudy membrane that may develop after cataract surgery.

How long will the effects last?
Decreased vision from cataracts is reversible and will last until it is corrected with glasses, contact lenses, or surgery. Surgery to remove cataracts is at least 90% successful in restoring vision. Ask your doctor about his or her success rate.

How can I take care of myself?

Be sure to follow your doctor's instructions.
Call your eye doctor if your vision gets worse.
Be careful when you drive at night. A cataract can make lights such as oncoming headlights seem very bright, causing a glare that makes it hard to see

What can be done to help prevent cataracts?
You may reduce the risk of damaging your eyes and in turn reduce the risk of developing cataracts by wearing goggles or safety glasses at work or during recreation where your eyes could be injured. Wearing glasses with a UV coating that protects your eyes from sunlight might prevent or delay some types of cataracts, but this is not proven.

If you are a woman and plan to have a baby, make sure you have had a German measles(rubella) shot at least 3 months before you become pregnant. If you have German measles while you are pregnant, your baby's eyes should be checked by an eye care professional soon after birth. A baby can develop cataracts if you had German measles while you were pregnant.

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Central Retinal Vein Occlusion (CRVO)

The sudden blockage (occlusion) of the blood vessel called the central retinal vein is a type of small stroke in the retina. (The retina is the light-sensitive nerve tissue lining the back of the eye. It is like film in a camera, taking “moving pictures” of everything you see.) The abrupt disturbance in the retina’s blood circulation usually causes a rapid reduction in vision.

Why is vision lost?
Good vision requires a healthy, well-nourished retina, which depends on a steady stream of oxygen-rich blood - brought to it by arteries and carried away by veins. The central retinal vein (CRV) is the main blood vessel that drains “used” blood from the retina. When this vessel is blocked, the entire retinal bloodstream swells and backs up.

When that happens:

Fresh blood cannot enter the retina. And without the oxygen that is normally brought by the blood, the retina slowly starves and some retinal cells die.
Hemorrhages (bleeding) occur in the retina.
The reduced blood supply sets the stage for the possibility of even more damage to the retina. Months later, the starved retina sometimes starts to grow new blood vessels. The process is called neovascularization (neo = new; vascular blood vessels). Though you might think that new blood vessels are just what the retina needs, these vessels are not normal. They are extremely fragile, bleed easily, and can lead to scarring of the clear tissues inside the eye. Any of these complications can further obscure the remaining vision.

What caused the vein occlusion?
The most usual cause is a blood clot that forms in the vein. That can happen whenever something slows down the normal flow of blood; for example, pressure on the vein from an overlying hardened artery (arteriosclerosis) can slow the flow of blood in the same way a fallen log tends to obstruct a stream. Increased fluid pressure within the eye (glaucoma) or an inflammation in the vein wall (vasculitis) can also slow blood flow. Or there may simply be an increased tendency for blood to clot (this is a rare complication in some women taking oral contraceptives and in certain medical conditions).

Most causes of CRVO are related to aging changes and are more likely to occur in patients who have atherosclerosis, hypertension, diabetes or glaucoma.

Examination
A complete eye examination will be performed, including a test of your vision. The pressure inside your eyes will be checked with a painless test called tonometry. Depending on the type of tonometer used, you may be given anesthetic eye drops.

Your pupils will be dilated (enlarged) with eye drops so the insides of both eyes can be studied. An ophthalmoscope and a slit lamp (clinical microscope) are instruments used for looking inside the eyes, and are especially useful for studying the retina and its blood supply.

Retinal photographs may be taken to determine the extent of the problem. An angiogram (photographs of blood vessels) may be made. For this test, a greenish-orange dye (fluorescent) is injected into a vein in your arm and immediately followed by a series of retinal photographs that track the dye and time its flow as it travels through the eye’s blood vessels. The angiogram also helps identify the site of the vein’s blockage, the extent of damage to the capillaries (the smallest retinal blood vessels), and the presence of neovascularization.

Because CRVO can be associated with several medical conditions that affect the rest of the body, you may be referred to an internist or family physician for a complete physical check-up after your eye examination.

Treatment

If the occlusion has existed for only a few hours, it may be possible to slow or even reverse some of the retinal damage with eye drops or other medications. The purpose is to lower the pressure inside the eye and lessen the tendency for further blood clotting.

But if you have had the occlusion for more than a day or so, there is usually little that can be done to stop the damage or to speed normal healing. Eventually, the blocked vein may re-open on its own or nearby blood vessels (collaterals) may expand and redirect the flow of blood around the blockage site, but the vision that has been lost is not likely to return to normal.

If neovascularization develops later, a type of laser surgery called pan-retinal photocoagulation (PRP) can help reduce the number and severity of the abnormal blood vessels. In the procedure, many hundreds of tiny laser burns are made in the retina during a 15- to 30-minute operation. The treatment is generally painless and can be done on an outpatient basis. If the neovascularization does not subside sufficiently within a few weeks, additional laser treatments can be given.

PRP is not likely to improve vision directly. It is designed to reduce the risks created by neovascularization, such as damage from internal bleeding or the development of hemmmorhagic glaucoma, a much more serious condition than the common type of glaucoma that is sometimes a cause of CRVO. Occasionally the laser cannot be used at all, especially when there are opacities (dense blood or cataract) within the eye that block the laser beam from reaching the retina.

Prognosis
After a CRVO in an older patient, vision will seldom get very much better. Many eyes remain legally blind. Younger patients (under age 50) are more likely to recover some vision, even without treatment; but it may take many months, and even at best their eyesight will not be as good as it was before the occlusion occurred.

Routine eye exams are important after a CRVO. What is being watched for are the development of potential late complications, especially neovascularization and glaucoma, or even a pending problem in the other eye.

An immediate eye exam is important if you should notice any brief episodes (a minute or so) of vision loss in your other eye. Permanent loss may be prevented by quick action.

Fortunately, complications of retinal vein occlusions are not common, and a CRVO is very unlikely to occur in your other eye.

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Central Retinal Artery Occlusion (CRAO)

An occlusion (blockage) in the central retinal artery may be thought of as a “small stoke” within the eye. It occurs suddenly, usually causing the loss of part or even nearly all of the sight in one eye. It is a frightening experience. Once it has happened, your vision may not get any better, but it should not get any worse unless you have another occlusion, which is unlikely.

Why is vision lost?
The central retinal artery is the main blood vessel that supplies blood and oxygen to the retina. The retina is the light-sensitive membrane at the back of the eye that is primarily responsible for “seeing” what you are looking at. If the retina stops receiving oxygen from the central retinal artery, it loses cell life quickly, within minutes. Since the retinal cells are a vital part of the visual system, vision will be destroyed.

Whether the entire retina or just a part of it is affected depends on where the blockage occurs. If the main segment is blocked, you can lose most or all vision in that eye. If only one of the side branches is blocked, only part of the field of vision in that eye will be lost.

What causes the occlusion?
The central retinal artery can become clogged by a blood clot or by pieces of hardened material that have broken off from the wall of some other artery in the body. There are a number of possible problems that can result in small fragments (emboli) getting loose in the circulation. Most are related to atherosclerosis, hypertension, heart valve abnormalities, or clotting problems. Inflammatory vascular conditions (arteritis) may also cause blood vessel blockages.

You did not cause the occlusion by using that eye, nor will you ever harm the other “good” eye by using it.

Examination
Your pupil will be dilated (enlarged) with eye drops, so that the retina and its blood vessels at the back of the eye can be examined and evaluated. If fat or calcium deposits are found in the retinal arteries, it could indicate similar problems in other blood vessels (for example, reduced circulation in the brain might indicate an increased risk of stroke). Because of this possibility, you may be referred to a neurologist or neurosurgeon for further tests and evaluation.

Treatment and Prognosis
If the occlusion can be diagnosed and treated in the first hour or so, some emergency treatment may be tried in an attempt to soften the eye. Treatment may include medication, massage of the eye. or a tiny needle puncture into the eye to drain away some fluid. The hope is to increase the chance that normal blood flow will push the block out of the way and lessen the damage.

A very few patients recover some vision without treatment when, for example, a blockage that has been present for only a short time becomes unblocked. The clot or fragment may shrink or simply move out of the way, renewing the circulation.

If any visual improvement is going to happen, it will take place within the first hours after the attack.

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Chalazion

What is a chalazion?
A chalazion is a small lump in the eyelid. It is similar to a stye, which is an infection of the edge of the eyelid caused by bacteria. However, a chalazion is away from the edge and is usually not caused by bacteria.

How does it occur?
A chalazion occurs when one of the small oil-producing glands in the eyelid becomes blocked. Oil secretions may become trapped and cause the lid to swell. The site of the lump may become infected by bacteria.

What are the symptoms?
Symptoms may include:

A red lump in your eyelid
Pain near the lump
Swelling of part or all of the eyelid
Rarely, blurred vision.

How is it diagnosed?
Your doctor will examine your eye. He or she may send a sample of the tissue or fluid from around the lump to a lab to determine if bacteria are present or if the lump occurs for other reasons, such as cancer. Be sure that you tell your doctor if you have any changes in your vision.

How is it treated?
Sometimes a chalazion will go away without treatment.

Usually, you will need to apply hot compresses to the closed eyelid. A compress is a clean washcloth moistened with hot water. You may need to apply hot compresses for at least 10 to 15 minutes at a time, 3 to 4 times a day, for several days. The moist heat helps to reduce inflammation and may help remove the plug that is blocking the oil gland.

If compresses do not relieve your symptoms, your doctor may prescribe steroids in the form of eye drops or shots into the lump. Other treatment may include antibiotics in the form of eye drops, ointment, pills, or shots.

If the chalazion is still present after 6 weeks, an ophthalmologist (a medical eye doctor) may need to remove the lump during minor surgery. The surgery is generally safe and effective.

How long will the effects last?
Usually the symptoms are gone in 6 weeks. Some people have chalazions frequently and may need to take medicine all the time.

How can it be prevented?
You may be able to help prevent chalazions from recurring by using warm compresses and, in severe cases, medicines such as doxycycline.

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Corneal Abrasions

What is a corneal abrasion?
A corneal abrasion is a scratch on the outer layer of the cornea. The cornea is the clear outer layer on the front of the eye. Corneal abrasions can be very painful.

How does it occur?
Corneal abrasions can be caused by:

A sports injury. This can happen in sports such as basketball or football when a player
gets poked in the eye, or in tennis or racquetball when a player gets hit in the eye with the ball.
A tiny object that gets in your eye. The object may come out in your tears, or your health care provider may need to remove it.
An object that scratches your eye. You may scratch your eye with something such as a fingernail, branch, piece of paper, or comb.
Problems with contact lenses. Gas permeable contacts may become chipped or cracked and scratch your eye. Wearing contact lenses too long can also cause an abrasion. Soft contacts can cause eye infections if they are not kept sterile, and eye infections can cause corneal abrasion.

What are the symptoms?
Symptoms may include:

Redness
Tearing
Feeling like you have something in your eye
Pain
A scratchy feeling
Sensitivity to light
Blurry vision

How is it diagnosed?
Your health care provider will ask about your symptoms and ask if you know how your eye was scratched. (If you don’t know, the cause may be a disease rather than an object in your eye.) Using special eye drops and a light that makes an abrasion easier to see, your provider will look at your eye. The drops are a painless dye that will make your vision yellow for a few minutes.

How is it treated?
If something is still in your eye, your health care provider will flush it out with water or remove it with a swab or needle (after numbing your eye with a drop of anesthetic).

Your health care provider may:

Give you antibiotic drops or ointment to use for several days.
Give you another medicine that dilates your eyes, helps relieve pain, and promotes healing.
Want you to wear an eye patch. The patch keeps your eyelid shut, helps the cornea heal, and helps relieve pain.
Place a contact lens over your cornea to act as a bandage. The contact helps to speed up healing and reduce eye pain.
Want to see you daily until your eye is healed

How long will the effects last?
Most corneal abrasions heal in a day or two. If your symptoms last longer than that, see your health care provider again because you may have a more serious problem.

How can I help prevent a corneal abrasion?

Always wear goggles, safety glasses, or eye shields at work or when playing sports where your eyes could be injured.
Follow your eye care provider’s instructions for wearing and caring for contact lenses. Do not wear them longer than recommended.

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Conjunctivitis – Viral Or Bacterial

What is conjunctivitis?
Conjunctivitis is inflammation of the conjunctiva. The conjunctiva is the clear membrane that lines the eyelids and covers the white of the eye. Conjunctivitis is sometimes called pink eye.

How does it occur?
Conjunctivitis can be caused by many things, including infection by viruses or bacteria. Viruses that cause colds may lead to conjunctivitis. Some bacteria that cause conjunctivitis are Chlamydia, staphylococci, and streptococci. Severe conjunctivitis, such as that caused by gonococci, can cause blindness.

Viral and bacterial forms of conjunctivitis can be spread easily from person to person. They can be spread by coughing or sneezing. Bacteria or viruses can get in your eyes through contact with contaminated objects, including:

Hands washcloths or towels
Cosmetics
False eyelashes
Soft contact lenses.

What are the symptoms?
Symptoms may include:

Itchy or scratchy eyes
Redness
Sensitivity to light
Swelling of eyelids
Watery discharge
Discharge of pus

How is it diagnosed?
Your health care provider will ask about your medical history and if you have been near someone who has conjunctivitis. Your provider will examine your eyes. He or she will also check for enlarged lymph nodes near your ear and jaw. If the conjunctivitis appears to be caused by bacteria, your provider may get lab tests of a sample of the pus to see what type of bacteria are present.

How is it treated?
Like a cold, viral conjunctivitis will usually go away on its own, even without treatment. However, your health care provider may prescribe eye drops to help control your symptoms. Antihistamine pills may also relieve the itching and redness.

If you have bacterial conjunctivitis, your health care provider will prescribe antibiotic eye drops. You can also help your eyes get better by washing them gently to remove any pus or crusts. Then dry them gently with a clean towel.

For very severe forms of conjunctivitis, antibiotics may need to be given with a shot or an IV (intravenous).

If you wear contact lenses, you will need to stop wearing them until your eyes are healed. The combination of contacts and conjunctivitis may damage your cornea (the clear outer layer on the front of your eye) and cause severe vision problems.

How long will the effects last?
Viral conjunctivitis usually gets worse 5 to 7 days after the first symptoms. It can improve in 10 days to 1 month. If only one eye is affected at first, it may take up to 2 weeks for the other eye to be affected. Usually, if both eyes are affected, the first eye has worse conjunctivitis than the second.

Bacterial conjunctivitis should improve within 2 days after you begin using antibiotics. If your eyes are not better after 3 days of antibiotics, call your health care provider.

How can I prevent conjunctivitis?
To keep from getting conjunctivitis from someone who has it, or to keep from spreading it to others, follow these guidelines:

Wash your hands frequently. Do not touch or rub your eyes.
Never share eye makeup or cosmetics with anyone. Also, if lab results show that you have conjunctivitis, throw out eye makeup you have been using.
Never use eye medicine that has been prescribed for someone else.
Do not share towels, washcloths, or sheets with anyone. If one of your eyes is affected but not the other, use a separate towel for each eye.
Avoid swimming in swimming pools if you have conjunctivitis.

Avoid close contact with people until you have used the antibiotics for 24 hours and if your eye does not have a lot of pus. Children can return to school or day care after they have had 24 hours of antibiotic treatment.

When should I call my health care provider?
Call your health care provider if:
•    You have any severe eye pain.
•    Your symptoms do not improve after you have used your medicine for 3 days.
•    Your eyes become very sensitive to light, even up to a few weeks after the redness is gone.

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Corneal Transplant

What is a corneal transplant?
A corneal transplant is procedure in which a cloudy or injured cornea is removed. It is then replaced with a clear one. The cornea is the clear dome on the front of the eye.

What are some causes of corneal clouding or injury?
Causes of corneal clouding or injury include:

cuts, burns, explosions, or chemical splashes that can leave a dense white scar on the cornea
infections of the cornea caused by bacteria, fungi, or viruses (such as the herpes virus) that can lead to scarring of the cornea
keratinous, which occurs when the cornea grows abnormally and scars form on the
center of the cornea
age-related degeneration of the cornea or inherited diseases of the cornea
cataract surgery or other eye surgery

Where does corneal transplant tissue come from?
Corneas for transplant come from donors. An eye bank examines, protects, and stores the donated corneas. Before a donated cornea is used, it is tested for clarity and diseases. Only clear, healthy corneas are used.

How do I prepare for the procedure?
Arrange for someone to take you home when your surgery is over. You may be asked to skip breakfast on the day of your surgery.

What happens during the procedure?
You will be given a local anesthetic so you will not feel any pain.

The surgery takes about 1 hour. During surgery the center of the cloudy or damaged cornea is removed. Then the clear center of a donated cornea is sewn into its place. If your eye has a cataract, it can be removed at the same time.

Your eye doctor will put a patch over your eye. You can go home right after the procedure.

What happens after the procedure?
Your doctor will examine your eye the next day. There is usually very little discomfort after surgery. You may feel like you have something in your eye for a few days to a week. You can resume most of your normal activities very soon. However, avoid heavy lifting and exercise for at least 2 weeks.

Wear glasses or a shield at all times to protect your eye. You will use eye drops several times a day for several weeks. They help prevent infection and also rejection of the new cornea.

As the eye heals, some of the tiny stitches used to sew the transplant in place may be removed. This is done easily and painlessly in your doctor’s office. The stitches may be removed as early as a month after surgery or up to a year later. Sometimes the stitches are left in place permanently.

It takes time for good vision to return after this surgery. You will probably get new glasses or contact lenses 4 to 6 months after surgery.

Sometimes your eye has some astigmatism after surgery. This means your cornea is uneven. Astigmatism can caused blurred vision, but glasses or contact lenses usually can correct it. In the few cases where there is too much astigmatism to correct with glasses or contacts, more surgery may help.

What are the benefits of this procedure?
Your vision is clearer than it was when you had a cloudy or injured cornea.

What are the risks of surgery?
A possible complication is rejection of the transplanted tissue. Rejection can occur at any time, but usually it occurs between 4 months and 2 years after surgery. Pain, redness, and decreasing vision can be signs of rejection. They require immediate attention. Use of eye drops can sometimes reverse rejection if it is detected early. If rejection cannot be reversed, the transplanted cornea becomes cloudy and your vision blurred. Repeat transplants can be attempted.

While there are other complications, they are rare and most are treatable. But there is always the small risk that vision could be permanently damaged or lost. Complications may include:

Bleeding
Infection scarring
Glaucoma
Swelling or detachment of the retina (the light-sensitive tissue at the back of the eye)
Cataract
Swelling within the donated cornea.

Problems caused by the anesthetic can also occur.

Success in corneal transplant surgery depends on what caused the corneal clouding. For example, transplants for the abnormally shaped cornea of keratinous or for corneal clouding after cataract surgery are highly successful. But transplants for corneas scarred by chemical bums or infection (including herpes) have a lower success rate.

Overall, the outlook for success is excellent. In fact, corneal transplant surgery is the most successful of all tissue transplant operations.

When should I call the doctor?
Call the doctor immediately if you:

Have unusual pain.
Have a sudden loss of vision.
Have a lot of drainage from your eye.
Develop a fever

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Color Blindness

What is color blindness?
Color blindness is a vision problem that makes it hard to tell the difference between certain colors. If you are color blind, it usually does not mean you see everything in black and white or shades of gray. Full color blindness is very rare. Most color-blind people have trouble with just 1 or 2 colors. The colors they have the most difficulty telling the difference between are red and green. Shades of red and green might look brownish to a color-blind person.

How does it occur?
You see in color because the retina at the back of the eye has special cells called cones. There are 3 types of cones: cones for red light, cones for green light, and cones for blue light. These 3 types of cones mix the colors together to create all of the colors people see. In a color-blind person, the red and green cones are very similar to each other and try to see both colors of light. This causes an abnormal mix of color and color confusion.

Color blindness is usually an inherited and lifelong condition. It is most commonly passed from mother to son. A woman can be a “carrier” of the gene but will usually not be colorblind herself. Men cannot be just carriers of the gene. If a man has the color blindness gene then he is colorblind. For that reason, men are more commonly color blind than women.

Rarely an eye disease can cause you to become colorblind later in life. Usually color blindness is not caused by a disease.

How is it diagnosed?
Your eye doctor can do a very simple test for color blindness. You look at a special test book that has a pattern of small colored circles. Some of the circles on the page are a different color and form a number. A color blind person will not be able to see the number because it will appear as the same color as the other circles on the page. The test book has about a dozen of these patterns in it to make sure of the diagnosis and to judge the severity of the color blindness. This test is usually easy enough that it is possible to get good results even with young children.

How is it treated?
Usually there is no need to treat color blindness. People with color blindness learn to tell the differences between colors. For example, green might look brighter than red. If a person is severely color blind, occasionally a red tinted contact lens is prescribed for just one eye. This may help the person see colors a little better.

How can I take care of myself?
Usually nothing needs to be done. You many find that some tasks are frustrating such as:

Judging traffic lights
Reading test strips or identifying other chemical reactions
Coloring with markers or crayons
Matching clothes
Reading color-coded maps or weather charts
Knowing if fruits are ripe or if meat is rare or well done

In some cases, a colorblind person may need to avoid careers that require excellent color vision. However, there are many colorblind electricians who can easily work with multi-colored wires. Most of the time you can learn to adjust by using other cues such as looking for the position of the light on a traffic signal rather than the color or looking for subtle color differences (red may appear darker than green). Parents may need to give their colorblind child more assistance picking out clothes until the child can learn how to match colors.

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Diabetic Retinopathy
What is diabetic retinopathy?
Diabetic retinopathy is an eye problem caused by diabetes mellitus. It affects the retina, which is light-sensitive tissue at the back of the eye. Retinopathy occurs when diabetes damages the tiny blood vessels in the retina. This damage can lead to problems with your vision, including blindness. However, you may be able to prevent severe vision problems if:

You keep your diabetes and blood pressure under control
You have regular eye exams
You get early treatment for retinopathy

How does it occur?
High blood sugar levels damage small blood vessels. The weakened blood vessels may break and leak fluid and blood. Also, new abnormal blood vessels may grow. These new blood vessels can bleed, cause cloudy vision, and destroy the retina.

The longer you have had diabetes, the more likely you are to have retinopathy.

What are the symptoms?
Diabetic retinopathy begins before you have any symptoms. As the problem gets worse, you may have:

Blurred vision
Floaters, which are black spots or cobweb-like shapes
Temporary or permanent blindness.

How is it diagnosed?
Your eye doctor will examine your eyes using an ophthalmoscope (an instrument for seeing inside the eye). You may need a test called fluorescein angiography. In this test, a dye is inserted into a vein in your arm. Photos are then taken as the dye travels through the blood vessels in the retina.

How is it treated?
Early treatment before the retina has been badly damaged is the most successful in reducing vision loss from this disease.

Your eye surgeon may use a laser to seal leaking blood vessels. The surgeon may also use a laser to destroy abnormal blood vessels.

If you have had bleeding into the clear gel (vitreous) that fills the inside of the eye, the eye surgeon may remove the gel. The gel will be replaced with a clear fluid. This procedure is called a vitrectomy.

How long will the effects last?
You may need to be treated more than once for retinopathy. Have your eyes checked regularly to make sure you get treatment when you need it.

Retinopathy can cause the retina to become detached. This means the retina is pulled away from the back of the eye. If this happens, you need to see your doctor for urgent treatment to reduce the chance of permanent vision loss. Call your doctor right away if you start seeing dark spots, floaters, or light flashes or your vision is blocked, blurred, or distorted.

How can I take care of myself?
Follow your doctor’s recommendations and these guidelines:

Make sure you have eye exams regularly. Ask your doctor how often your eyes should be checked
Immediately tell your doctor if you have any change in your vision.

What can be done to help prevent diabetic retinopathy?
To help prevent diabetic retinopathy, follow these guidelines:

Control your blood sugar
Control your blood pressure
Stop smoking. (Smoking may speed up the development of retinopathy.)
Follow your diet and health care plan for your diabetes so you have fewer complications.

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Dry Eye Syndrome
Dry eye syndrome is perhaps the most common eye problem that I see in my practice. Symptoms may include redness and burning, a gritty or sandy feeling, intermittent blurring which clears with a blink and, surprisingly, tearing. It is usually most worst at the end of the day and is most bothersome when reading or m the wind. Dry eye can also make contact lens wear uncomfortable.

Dry eye syndrome becomes more common with age and is especially prevalent among women. Many people who have arthritis or other associated medical conditions will also have dry eye and/or dry mouth problems.

The problem
The surface of the eyes is kept moist by the tear film, a biochemically complicated, three-layered film with a definite structure. In dry eye patients, the tear film dries out briefly many times (e.g., 20-30 times) during an average day. Each drying episode causes only slight irritation, so it may not become noticeable until the 15-2Oth episodes. When concentrating on reading material or when using a computer terminal, it is normal to blink less frequently and it may aggravate the problem. Wind also worsens the problem by causing more rapid evaporation of the tear film.

Treatment
Since the only way to reverse the irritation is to allow the eye to heal (overnight while eyes are closed), the key to managing the problem is to prevent drying episodes by adding moisture to the eyes throughout the day, not just after they start burning. Artificial tears are eye drops designed to add to the tear film. Visine, prescription antibiotic drops, or water are not helpful, because they simply wash away the protective tear film and cause the drying problem to worsen.

Eyes have two “speeds” for tear production. Normal speed may not be enough lo keep the eyes moist in a dry climate like ours. High-speed tearing occurs for brief periods in response to irritation, such as a foreign body. High-speed tearing also occurs in response to irritation from other causes, including repeat episodes of drying. This is why many patients with dry eye syndrome will complain of tearing but may never consider dryness to be the cause.

If you think you may have dry eye syndrome, the easiest way to find out is to try artificial tears. I usually recommend using them religiously four times a day for one week If your eyes feel significantly better after that time, dryness is probably the problem and you can decide for yourself how frequently you need to use them. If you do not notice any improvement, dryness is probably not the problem and you should seek professional advice. Remember, There is no true cure for dryness and treatment requires the use of artificial tears for life. Avoiding dry conditions, such as heating or air conditioning vents, may help. For those with more serious dry eye problems, artificial tears alone may not be adequate. Other medicines and treatments are available.

Artificial tears are available under many different brand names and can be purchased at a grocery store or pharmacy without a prescription. There is no “best” brand, so experiment with different brands and choose the one which feels best in your eyes.

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Eyestrain

What is eyestrain?
Eyestrain is a term used to describe sore or tired eyes. Eyestrain is a common problem among people who do a lot of reading or computer work.

How does it occur?
Your eyestrain could be caused by one or more of the following:

You have a vision problem (for example, you are farsighted or your eyes do not line up properly making it hard for your eyes to work together).
You do one task for a long time without a break (such as reading, computer work, or even a long drive). The muscles that move and focus your eyes get tired of staying in one place.
Your workstation is not set up correctly. Poor lighting or glare off a computer screen or window is often a problem.

What are the symptoms?
Symptoms of eyestrain may include:

Sore eyes
Tired eyes
Blurred vision
Headache near your eyes or at the back of your neck
Squinting your eyes.

You may have just one or any combination of these symptoms.

How is it diagnosed?
You will have an eye exam. Your eye doctor will ask about your symptoms. Your doctor will ask how long your eyes have been hurting, what you are doing when your eyes hurt, and how often it happens. Your doctor will then carefully test your distance and close-up vision. Tests of your eyes’ ability to focus and work together will also be done. Your doctor will check the health of your eyes to make sure that the symptoms are not caused by a more serious medical condition.

How is it treated?
If your eyestrain is caused by a vision problem, your doctor will probably give you a new prescription for eyeglasses or contact lenses.

If you are over 40, you are probably developing presbyopia, the natural loss of ability to focus on close objects. When this happens, your doctor will prescribe either reading glasses or a type of bifocal lens.
If your eyes do not work together very well, glasses can help here, too. You will need glasses that can help direct your eyes where they should be looking. Some eye doctors may also prescribe eye exercises called vision therapy.

If doing one task for a long time is causing your eyestrain, you should take short breaks to let your eyes rest. At least every 20 minutes look at least 20 feet away for 20 seconds.

If your eyestrain is caused by your computer workstation, you will want to make some adjustments.

First, put your monitor 22 to 28 inches from your eyes. Then, make sure the top of the screen is no higher than eye-level.
If you need to look back and forth between your paper and your computer screen, use a paper holder that holds your paper next to the computer screen (at the same height and distance as your computer monitor).
Try to keep the room lighting at about the same brightness as the computer screen. Avoid having a bright window in front of you or behind you. This really helps cut glare and reflections.

How can I take care of myself?
The best way to take care of yourself is to have your eyes examined every year. Many people think it is normal for their eyes to hurt after a long day, but it is not. If you have symptoms of eyestrain, see your eye doctor. Don't wait until your yearly eye exam.

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First Aid: Something In Your Eye

Most of the time when you get something in your eye you can carefully remove it. In some cases, an object in your eye can scratch your cornea. A scratched cornea takes a couple of days to heal and may require treatment from your health care provider. If you get a chemical in your eye or something is imbedded in your eye, you need immediate medical treatment. Follow the instructions below for treating your eye.

How do I remove a particle in my eye?
If something is imbedded in your eye (such as a glass fragment), do not try to remove it. Cover both eyes with a wet washcloth and have someone take you to an eye doctor or emergency room.

To remove a loose eyelash, dirt particle, or other object in your eye:
1. Wash your hands before touching your eyes.
2. Look in a mirror and try to find the object in your eye.
3. Try the following methods to remove the object:

Try to blink to allow your tears to wash it out. Do not rub your eye.
If the particle is behind your upper eyelid, pull the upper lid out and over the lower lid and roll your eye upward. This can help get the particle come off the upper lid and flush out of the eye.
If the object is in the corner of your eye or under your lower eyelid, remove it with a wet cotton swab or the corner of a clean cloth while holding the lower lid open.
Fill an eyecup or small juice glass with lukewarm water. Put your eye over the cup of water and open your eye to rinse your eye and flush the object out.
You can pour lukewarm water into your eye or hold your eye under a faucet to flush out your eye.

What should I do if I get a chemical in my eye?
Chemical burns to the eyes are a medical emergency. Follow these steps if you get a chemical in your eyes.
1.   Immediately flush the eye with water by holding your head under the faucet or by pouring water into your eye from a clean container. Keep your eye open while flushing with water.
2.   Continue flushing out your eye for 15 to 30 minutes.
3.   After you flush your eye out, call your health care provider or have someone take you to the emergency department or urgent care center.
4.   If possible, take the container the chemical was in with you to the health care provider.

When should I call my health care provider?
Call if:

You have severe or deep eye pain.
You still have eye pain or irritation 30 minutes after you have removed an object.
You have glass or a chemical in your eye.
You have questions or concerns.

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Flashes and Floaters
What are flashes and floaters?
Flashes and floaters are specks, squiggles, or bright spots in your field of vision. Usually they come and go quickly. They are quite common and usually harmless.

Floaters can look like little bugs, stars, threads, or cobwebs. They move when you try to look at them and are most noticeable in bright light.

Flashes look like flashing lights or streaks of lightning. You may not be able to tell in which eye the flashes occurred. Flashes and floaters can occur at any age.

How do they occur?
Flashes and floaters result from changes in the vitreous. The vitreous is the gel that fills most of the eyeball. Clumps may form in the vitreous. These clumps appear as floaters across your vision.

As you get older, you may suddenly see a large floater. As a normal part of aging, the vitreous gets more watery and begins to separate from the back of the eye (the retina). After separating, the vitreous sometimes moves forward and floats in the middle of the eyeball. Then you see a large floater. This process is called vitreous detachment. It is most common after age 55.

Sometimes flashes may occur in your peripheral (side) vision. They occur when part of the retina is tugged or torn by the separating vitreous. If a tear forms, it can lead to a retinal detachment. Retinal detachment can lead to severe loss of vision.

What are the symptoms?

You see spots that look like little bugs, threads, or cobwebs
The spots usually shift away from your focus when you try to look at them and are most noticeable in bright light
Sometimes you also see flashing lights.

How are they diagnosed?
Your eye doctor will put eye drops in your eyes to dilate them. Then he or she will examine the inside of your eyes using a lighted tool called an ophthalmoscope.

How are they treated?
Most floaters do not require treatment. However, sometimes floaters are a symptom of a tear in the retina. Retinal tears can be serious. Without treatment, fluid can leak through the tear and cause the retina to detach. Retinal detachment may require surgery.

The waning signs of a retinal tear or detachment include:

Suddenly seeing many new flashes of light or many new floaters
Loss of peripheral vision
Blurred or distorted vision, which occurs as the detachment gets worse.

If you have these symptoms, call your doctor right away.

How long do the effects last?
Flashes and floaters not caused by a retinal tear or detachment are harmless. They may never go away completely, but they tend to become much less noticeable with time. However, if retinal tears or detachment causes the floaters or flashes, you could lose your vision if you don’t get treatment.

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Fluorescent Angiography

What is Fluorescent Angiography?
Fluorescent Angiography is a diagnostic procedure which uses a special camera to take a series of photographs of the retina, the light sensitive tissue in the back of the eye.

A special water-soluble dye (fluorescent) is injected into a vein in the arm. The due travels through the veins and into the arteries which circulate throughout the body. (This procedure is often confused with a X-ray angiogram where an iodine dye is injected into a vessel.)

As the dye passes through the blood vessels of the retina, a special camera flashes a blue light into the eye and takes multiple photographs of the retina.

If the blood vessels are abnormal, the dye may leak into the retina or stain the blood vessels. Damage to the lining underneath the retina or the appearance of the abnormal new blood vessels growing beneath the retina may also be revealed. The precise location of these abnormalities can be determined by a careful interpretation of the fluorescent angiogram by your ophthalmologist.

Why is Fluorescent Angiography Done?
If after examining your eyes your ophthalmologist suspects abnormalities in the back of the eye, he or she may recommend fluorescent angiography. It is often done to follow the course of disease and monitor treatment results.

What Are the Risks of Fluorescent Angiography?
After the fluorescent dye is injected, your skin may turn yellowish for several hours. This color disappears as the dye is filtered out of the body by the kidneys. Because the dye is removed by the kidneys, your urine will turn dark orange for up to 24 hours following the test.

Some individuals may experience slight nausea during the procedure, but this usually passes within a few seconds. If the dye leaks out of a fragile vein during the injection, some localized burning and yellow staining of the skin may occur. This burning usually lasts only a few minutes and the staining will go away in a few days.

Allergic reactions to fluorescent dye are rare. If they occur, they may cause a skin rash and itching. This is usually treated with oral or injectable antihistamines, depending on the severity of the symptoms. Even more rarely, severe allergic reactions (anaphylaxis) can occur and be life threatening.

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Glaucoma
What is glaucoma?
Glaucoma is an eye disease in which the optic nerve is damaged. Usually, high pressure inside the eye causes the damage. The damage can lead to a loss of vision. However, early treatment can prevent blindness.

How does it occur?
A clear, watery fluid called the aqueous humor normally circulates in your eye. When the flow of this fluid out of the eye becomes blocked, the pressure increases inside the eye. The increased pressure can damage the optic nerve.

There are two main types of glaucoma, depending on how the flow of fluid is blocked:

Open-angle glaucoma is caused by a gradual blockage in the area that drains fluid from the eyes into the drainage channels. It is the more common type of glaucoma in the US and Europe. It usually affects both eyes
Closed-angle glaucoma is a blockage caused by a change in the position of the iris (the colored part of the eye). The change in position causes the iris to block the drainage channels. This type of glaucoma usually happens in one eye at a time. If you get glaucoma in one eye, you are at risk for having the same problem in the other eye. When this type of glaucoma happens suddenly, it is called acute closed-angle glaucoma and is a medical emergency.

Glaucoma tends to run in families. It occurs most often after age 35, but sometimes children have it. Glaucoma is a common eye problem in people over age 60. It is more common among black people than white people.

What are the symptoms?
Open-angle and other chronic forms of glaucoma often have no symptoms in the early stages. In later stages, you will begin to notice a loss of vision. Side vision is affected first.

Symptoms of acute closed-angle glaucoma include:

Severe eye pain
Seeing halos around lights
Nausea and vomiting
Headache
Loss of vision.

How is it diagnosed?
Your health care provider may screen you for vision problems during your routine checkups. If you have vision problems, your provider will refer you to an eye doctor.

The eye doctor may use the following tests to diagnose glaucoma:

Tonometry, a painless procedure used to measure the pressure in your eyes
Ophthalmoscopy, in which the doctor uses an instrument to look at the optic nerve inside your eye visual field testing, which can show early changes in your side vision caused by damage to the optic nerve
Gonioscopy, which is a method of examining the drainage channels.

How is it treated?
The goal in the treatment of glaucoma is to reduce the pressure in your eyes. This may be done with eye drops, oral medication, laser surgery, or other types of surgery. Some eye drops reduce the amount of fluid made by your eye. Others increase the amount of fluid that flows out. Surgery relieves pressure inside the eye by opening up the drainage channel or by making another opening through which the fluid can dram.

Make sure your health care provider tells you about possible side effects of any medication you are taking. If you have concerns, call your provider.

How long will the effects last?
Loss of vision caused by glaucoma is permanent. This is why glaucoma needs to be diagnosed and treated early to stop further damage to the optic nerve.

If your health care provider prescribes medication to control the pressure, you may need to take it for the rest of your life.

How can I take care of myself?

Take your medication as prescribed.
Carefully follow your health care provider’s recommendations for follow-up visits and pressure measurements.
Call your health care provider if you have any side effects from your medication.

How can I help prevent glaucoma?
Glaucoma cannot be prevented. However, blindness can be prevented if glaucoma is treated before pressure in the eye has damaged the optic nerve too much.

You may be able to help prevent glaucoma from becoming severe if you:

Have a regular eye exam. How often you need to see the eye doctor will depend on how severely your optic nerve was damaged
At your eye exam, make sure the pressure in your eye is measured and that your optic nerve is examined
Learn about your family history. Chronic open-angle glaucoma often runs in families
See your health care provider at once if you see halos around lights or notice any changes in your vision

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Herpes Simplex Eye Infections

What is herpes simplex?
Herpes simplex is a disease caused by the herpes simplex virus (HSV). Type 1 HSV often produces painful, fluid-filled blisters on the skin or other tissues. Cold sores and fever blisters are caused by this form of HSV.

Another herpes simplex virus, type 2 HSV, affects mainly the genital area. It is usually spread during sexual contact. All of the following information is about type 1 HSV.

How do herpes simplex eye infections occur?
HSV is very common. About 90% of adults have had the infection. HSV is spread through contact with fluid from a person’s mouth. Most people have their first infection during childhood or early adolescence.

Attacks of HSV that affect your skin or eyes can be triggered by:

Too much exposure to sunlight physical or emotional stress
A fever
A reaction to certain foods or medicines eye injury.

Sometimes the cause of attacks is unknown.

In some people, HSV eye infections recur often. If not treated, repeated infections can cause serious damage to the cornea (the clear dome on the front of the eye).

What are the symptoms?
The symptoms of HSV eye infections are:

Blisters on or near the eyelid
Redness
Irritation
Tearing
Sensitivity to light
Blurred vision.

HSV often affects only one eye.

How are they diagnosed?
Herpes simplex eye infections can be difficult to diagnose. They may cause the same symptoms as allergies, other viruses, and reactions to some medicines.

Your doctor will examine your skin and eyes and ask about your medical history. Your doctor may send some of the fluid from the blisters to a lab for analysis.

How are they treated?
Sometimes herpes simplex eye infections go away without any treatment. Other times your doctor will prescribe medicines in the form of eye drops or ointments to kill the virus. To help speed up healing, your eye doctor may scrape the blisters away with a cotton swab. If your eyes do not get better with these treatments, you may need to take medicine in pill form.

One type of herpes simplex destroys cells in the eyes. For this condition your eye doctor may recommend that you take an additional medicine (corticosteroids) to help prevent serious problems. However, corticosteroids should not be taken for other forms of HSV. Be sure that your eye doctor knows about all your symptoms.

Severe cases may require surgery. Some doctors recommend keratoplasty (a cornea transplant) if the cornea has been severely scarred. They may prescribe pills to reduce the chance of HSV in the transplant.

How long do the effects last?
After the first infection, HSV may not cause any problems for months or years. Then sores may reappear when your immune system is weakened by disease or stress. Sometimes HSV is active but you do not have any blisters.

The effects of HSV vary greatly from person to person. Your symptoms may go away in a few days or weeks. You may have only one attack after your initial infection in childhood. However, you may have a recurrence whenever your immune system is weakened or for unknown reasons.

What can I do to prevent herpes simplex eye infections?
Because type 1 herpes simplex virus is so common, you probably cannot prevent your first infection. Many cases are so mild that you may not know you have been exposed to HSV. Later in life, you may be able to prevent attacks by maintaining general good health and keeping stress in your life at a moderate level.

Sometimes attacks occur for no known reason and probably cannot be prevented.

Are herpes simplex eye infections contagious?
Herpes simplex usually doesn’t spread to the other eye, and spreading the virus to another person is unlikely. If you have an extremely weak immune system, the virus may spread to other parts of your body such as the retina or the brain, but not to another person.

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Herpes Zoster (Shingles) Eye Infections

What is herpes zoster?
Herpes zoster, also called shingles, is a disease caused by the varicella-zoster virus. This is the virus that causes chickenpox. Sometimes, many years after you have had chickenpox, the varicella-zoster virus becomes active again and causes shingles.

Shingles is an infection that produces fluid-filled blisters on the skin, often near certain nerves. It may spread to the eyes.

What are herpes zoster eye infections?
If the varicella-zoster virus spreads to nerves in your head, your face, eyes, and nose may be affected. The virus can cause several problems, including:

Blisters on or inside your eyelids
Damage to your cornea (the clear dome on the front of the eye)
Uveitis (inflammation to eye tissues behind the cornea)
Glaucoma (increased pressure inside the eye)
Cataracts.

How do they occur?
The first time you are exposed to the varicella-zoster virus, you usually develop chickenpox. After you recover, the virus stays in your body in a weak form. Usually your body’s immune system is strong enough to keep the virus from causing any problems. However, if your body’s immune system becomes weak, the virus may cause blisters on your skin and problems in your eyes.

Your body’s immune system may be weakened by:

Diseases such as AIDS or Hodgkin’s disease
Physical or emotional stress
Fatigue
Poor nutrition
Chemotherapy or radiation
Certain medicines.

Sometimes problems from herpes zoster occur for no known reason.

What are the symptoms?
Symptoms of herpes zoster eye infections include:

Fluid-filled blisters on or inside your eyelids or elsewhere on your face swollen eyelids
Eye pain
Watery eyes
Red eyes
Sensitivity to light
Blurred vision.

Often blisters are present on only one side of the face.

How is it diagnosed?
Your doctor will ask about your medical history and symptoms. Your doctor will also examine your skin and eyes. The blisters usually occur in a certain pattern near affected nerves. If necessary, scrapings from the blisters can be tested in a lab to determine if the virus is present.

How is it treated?
Several medicines are helpful in treating herpes zoster eye infections.

Acyclovir is an antiviral medicine that greatly limits the effects of the virus and helps reduce complications. This medicine is most effective when started as soon as the first symptoms appear.
Steroids can sometimes be used to reduce eye inflammation.
Antibiotics prevent infection from other organisms that may get in your eyes while you have herpes zoster.
Painkillers (such as acetaminophen) and lubricating eye drops may lessen your pain.
Medicines for glaucoma help keep the pressure in your eye at normal levels.

How long will the effects last?
Blisters dry up and form scabs about 5 days after they appear. You may develop permanent scars and longstanding pain, numbness, or skin discoloration. If your cornea is affected, it can become permanently scarred. Early treatment with acyclovir lessens the effects of the varicella-zoster virus and can sometimes prevent serious complications.

Shingles can be recurring problem.

Are herpes zoster eye infections contagious?
A person with shingles can transmit chickenpox to a person who has never been exposed to the varicella-zoster virus. The virus is spread by contact with the blister fluid. You are no longer contagious after the blisters dry up and form scabs, which is about 5 days after they first appear.

What can I do to help prevent herpes zoster eye infections?
If you have had chickenpox, you have the inactive varicella-zoster virus in your body. To keep it from becoming active, maintain general good health to keep your immune system strong.

Sometimes attacks of shingles occur for no apparent reason and cannot be prevented.

Early diagnosis and treatment can help greatly in reducing serious complications from herpes zoster eye infections.

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Hemifacial Spasms

What are hemifacial spasms?
Hemifacial spasms are twitching or spasms on one side of your face. The spasms are usually painless. They are chronic, which means they do not go away without treatment. The muscles may twitch even during sleep. Often the muscles around the eyes are affected.

How do they occur?
Hemifacial spasms occur when a blood vessel puts pressure on the facial nerve. This pressure causes the nerve to work abnormally. Rarely the pressure is caused by a tumor or other growth. Or it may follow Bell’s palsy, in which part of the face suddenly becomes paralyzed.

What are the symptoms?
The symptoms are:

Spasms of muscles in one side of the face only
Excessive tearing
The mouth clamping shut, which may cause problems eating, swallowing, and speaking.

Usually the spasms start around the eyes and go down the face. Less often they start around the mouth and go up to the forehead.

How are they diagnosed?
Your doctor will ask about your symptoms and examine you. Your doctor may want you to have an MRI scan to check for tumors or blood vessel problems.

How are they treated?
Medicines may help stop the muscle spasms. But often what works for one person may not work for another. Also, the benefits may not last very long. You will need to work closely with your doctor to find out what medicine and dosage work for you. Sometimes researchers find new medicines that may help. Or they find that medicines used for other diseases provide relief for some people. Ask your doctor about the latest research on medicines to treat hemifacial spasms.

Very small amounts of a medicine called botulinum toxin A can be injected into the muscles near the facial nerve. These injections stop the muscle spasms for several months for some people. The injections usually need to be repeated.

Sometimes surgery is necessary to stop the spasms. The surgeon moves the blood vessel off of the facial nerve. This stops or reduces the spasms in many cases. The surgery is most successful for people who have had symptoms for a short time.

How can they be prevented?
There is nothing you can do to prevent hemifacial spasms.

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Hyperthyroidism

What is hyperthyroidism?
Hyperthyroidism is over activity of the thyroid gland. This means the gland makes too much thyroid hormone. Too much hormone speeds up chemical reactions in the body. This causes mental and physical changes.

The thyroid gland is a small gland at the lower front of the neck. This gland takes iodine from the food you eat to make hormones called thyroxine (T4) and triiodothyronine (T3). The hormones control your metabolism (the process of turning the food you eat into energy). The thyroid gland is critical for maintaining body temperature and controlling heart rate, appetite, and digestive tract function.

The most common form of hyperthyroidism is called Graves’ disease. It occurs more in women than men, especially women in the childbearing years between 20 and 40.

How does it occur?
Possible causes are:

Your immune system is not working properly.
Your body may be producing a substance that causes the thyroid gland to make more hormone than your body needs.
You have a growth that makes the thyroid gland produce too much hormone. Some thyroid gland problems may be inherited.

What are the symptoms?
Symptoms include:

Anxiety, tiredness, or sleeplessness
Feeling shaky, having tremors
Feeling sweaty and hot, even though others around you are comfortable
Shortness of breath
Trouble focusing your eyes
A bulging of one or both of your eyes
Weight loss
Faster heart rate
Enlarged thyroid gland (goiter)
Increased appetite
Diarrhea

How is it diagnosed?
Your health care provider will ask about your symptoms and examine you. You will have blood tests. These tests measure hormone levels and check thyroid gland function. Your provider may order special x-ray tests, such as a thyroid scan, or an ultrasound to see how well the thyroid gland is working and to check for growths.

How is it treated?
The options for treatment are medicine, radiation, or surgery. These treatments lower the amount of thyroid hormone in your body.

Antithyroid drugs reduce the amount of thyroid hormone made by the gland. They usually control hyperthyroidism in several weeks. Propylthiouracil (PTU), propranolol, and methimazole (Tapazole) are 3 commonly used drugs. You may need to keep taking these drugs for a year or longer.

A pill containing radioactive iodine is commonly used to treat some types of hyperthyroidism, especially if you have had hyperthyroidism more than once. The radiation destroys the cells that are making too much hormone. The main risk of this treatment is that your thyroid levels will become too low. A low level of thyroid hormone can be dangerous if it is not recognized, but it is easily treated with thyroid hormone medicine.

Surgery can be done to remove part or all of the overactive thyroid gland or to remove a just a growth in the gland. Surgery cures the disease 90% of the time. However, surgery has certain risks. The most common risk is that you will have low thyroid hormone levels after the surgery. You will then most likely need to take thyroid hormone medicine the rest of your life. Nerve damage is an uncommon risk of surgery. When it occurs, the nerve that is damaged is usually the one that goes to the voice box. The nerve damage may cause a soft or raspy voice.

Sometimes steroid medicine (prednisone) is used to treat eye problems caused by hyperthyroidism. For reasons that are not understood, nonsmokers get better results from treatments for eye problems than smokers. The eyes need to be kept moist, so your health care provider may recommend that you use eye drops.

How long will the effects last?
The effects of hyperthyroidism usually last as long as thyroid hormone levels are too high. Sometimes the disease improves without treatment. However, it can cause heart failure and death if it is not treated.

Eye problems related to hyperthyroidism may continue even after the thyroid problem is treated.

How can I help prevent hyperthyroidism?
There is no known way to prevent this condition.

How can I take care of myself?

Follow the full treatment prescribed by your health care provider.
Do not stop or change your thyroid medicine without first asking your health care provider.
Have regular checkups according to your health care provider’s re