Common Problems

Strabismus

This is a misalignment of the eyes. The eyes may turn inward toward the nose (estropia/ET), outward away from the nose (exotropia, XT), vertically upward (hypertropia/HT), or some combination of these. Treatment may require glasses, medication, prisms, patching, exercises (orthoptics), or surgical intervention. Your thorough evaluation will determine the appropriate therapy(s) required for your problem. 

Amblyopia

This term means "dull" or reduced vision in an eye(s). It may be caused by a variety of problems such as: Strabismus (misalignment), unequal refractive error (Anisometripia), organic problems (cataracts), Opacification (corneal scars), or optic nerve and other retinal abnormalities.

Treatment will vary and may include:

  • Optical glasses, which will be used to correct the refractive errors.
  • Patching therapy to cover the stronger eye to make the weaker eye work harder.
  • Surgery to correct the misalignment.

Amblyopia can usually be improved dramatically or corrected, if it is detected early and treated appropriately.

Ptosis

This is the term describing a "droopy" eyelid. Ptosis can occur congenitally or develop later in life due to some acquired disease. It can be unilateral or bilateral. If it does not create a visual problem, it may not require treament. If treatment is requied, it is usaully surgical. The ophthalmologist will determine the cause, in addition the need for and timing of appropriate therapy.

Convergence Insufficenct Exotropia

This is a muscle imbalance in which the eyes do not function or cooperate together appropriately, particularly at near distances. This muscles imbalance often exists without any obvious outward deviation of the eyes and it may become symptomatic at any age. Many patients will complain that they have difficulty concentrating on near work (computer, reading, etc.) and that the written words will move around and become blurry after prolonged periods of reading. Patients may be noted to squint or close one when reading. Additional symptoms of convergence insufficiency include:

  • Tearing
  • Red Eyes
  • Headaches
  • Blurry Vision
  • Skipping words while reading
  • Eyestrain
  • Double Vision (diplopia) 

* All of these symptoms are increased with prolonged near work.

Anyone may develop a convergence insufficiency. A combination of factors such as nearsightedness, poor binocular control and excessive near work may cause this muscle imbalance to become symptomatic more rapidly. The general growth of the face, which causes the eyes to become farther apart with age, is also a contributing factor.  It can also be noted during school vision screening examinations. However it can be so intermittent as to be easily overlooked by even the most experienced obsever. If the symptoms are ignored and treatment not sought appropriately,  the deviation may progress further and decompensate to a constant deviation. At this point, symptoms may be present at distance, as well as near.

Treatment for convergence insufficiency is directed at teaching the patient to improve his/her convergence ability so that his/her eyes may function properly together.  Therapy may include glasses, patching or orthoptic/prism exercises.  The therapy consists of approximately 15 thirty-minute sessions at the physician’s office.  Orthoptic therapy is recommended by the physician as a medically necessary form of treatment in an attempt to eliminate/delay surgical correction of the exotropia. 

Each patient’s tolerance to this therapy is different and will determine the exact amount of time spent working with the exercises and prism therapy.  Once the patient has established improved convergence ability, periodic follow-up visits will be necessary to maintain the appropriate level of control.

Dry Eye Syndrome

Dry Eye Syndrome – Natural tears lubricate and nourish the eyes.They wash away foreign material, protect against infection and provide a smooth ocular surface allowing for clear, comfortable vision.

There are three crucial components that make up the tear film:

  • an outer oil layer
  • middle water layer
  • inner mucus layer

The outer oil layer is spread over the tears with every blink to coat and prevent evaporation of the middle layer of water.  The water layer makes up the largest percentage of the tear film and is adhered to the front surface of the eye by the mucus layer.  Adequate production of all three layers are important for a stable tear film.  Dry eye is a condition of poor tear quality or decreased production of tears. 

Symptoms of dry eye include:  blurry vision, excessive tearing, irritation or pain, light sensitivity, redness, itchiness, foreign body sensation, sticky eyelids, crusting of lashes and frequent blinking.

Due to the many different causes of dry eye, there are many ways to effectively treat the condition.  Treatments include over-the-counter artificial tear solutions, conserving the tears by blocking tear drainage, decreasing inflammation of the ocular surface and increasing the natural tear production with warm compresses, gentle massage, supplements and prescription ophthalmic drops. 

Most mild cases of dry eye are treated with over-the-counter artificial tears to supplement the natural tear production.  There are many different types of artificial tears created for specific inadequacies in the tear film.  With moderate and chronic dry eye, treatments aim to conserve and increase tear production.  Tiny silicone or gel-like plugs can be placed in the tear ducts to help keep the tears on the eyes longer.  Omega-3 fatty acid and fish oil supplements may help with natural oil production and warm compresses and massage of the lids can help express the natural oils as well.  Keeping lids clean decreases inflammation and can prevent dryness and irritation of the oil glands, thus allowing them to properly coat the tears.  In severe and chronic cases, ophthalmic medications can also be prescribed to increase tear production. 

To help prevent dry eye, remember to blink regularly and completely, take breaks from extended computer use, wear sunglasses when outdoors to prevent wind and debris from getting in eyes, avoid large amounts of salty food and drink plenty of water to avoid becoming dehydrated.