Corneal neovascularization is a condition of the eyes, involving excessive growth of blood vessels in the cornea. This occurs as a compensatory mechanism of the body to deal with the lack of sufficient oxygen supply to the eyes. The new blood vessels originate from the limbal vascular plexus, and grow into the cornea. It most commonly occurs in contact lens wearers, which is why those who wear contact lenses, are strongly suggested to get their eyes checked annually, for early diagnosis of the disease. If it goes undetected, corneal neovascularization can result in severe vision impairment. The condition can either be superficial, as in contact lens wearers, or deep, when caused by an inflammatory condition.

Causes:

• Wearing contact lenses improperly or for a period longer than prescribed by the optometrist.
• Underlying intraocular medical condition, like glaucoma, pthisis bulbi, blepharitis, conjunctivitis, keratitis, trachoma and phlyctenulosis, uveitis, etc.
• Exposure of the eye to a caustic chemical, resulting in severe burns
• Immunological disorders
• Graft rejection
• Trauma to the eyes
• Infection in the eyes

Symptoms:

• Redness
• Irritation
• Eye pain
• Tearing
• Photophobia
• Intolerance of contact lenses after a few hours of wear
• Blurred vision even while wearing contact lenses
• Actively engorged vessels (around 12 mm long) in the ‘white of the eye’

Treatment:

• The treatment of the disease begins with identifying its cause, and working on the elimination of that cause.
• Topical corticosteroids can be administered to manage gross vascularization.
• Surgical treatment of the condition involves corneal laser photocoagulation and diathermy of the engorged vessels.
•  In case of severe chemical injuries, procedures like limbal grafting are performed. 
• The instillation of topical triamcinolone and doxycycline as a way to manage neovascularization is currently under trial, and has been proved effective in rats.
• The base curve of contact lenses should be altered in soft contact lens wearers to facilitate movement of the lenses.
• The patients might also be suggested to switch to silicone hydrogel lens materials, which are more permeable to oxygen due to their high Dk/t. These lenses are FDA approved either for 30 days extended wear or continuous wear up to 6 nights and 7 days.
• Patients should be educated on the importance of adequate corneal lubrication via proper blinking and use of lubricants, and should be advised to get annual follow-ups after the treatment is complete.

To know more about Corneal Neovascularization and its treatment, visit us at Killeen Eyecare Center located at 416, North Gray Street, Killeen, TX 76541, Downtown Killeen or call us at 254-634-7805.

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Photokeratitis is a condition of the eyes, which involves the inflammation of the outermost layers of the eyes- the cornea and conjunctiva, on exposure to natural or artificial ultraviolet rays (most commonly UVB rays). The disorder can be compared to sunburn of the skin, the only difference being that it affects the eyes. Symptoms usually appear after several hours of unprotected exposure to the UV rays.

The term photokeratitis is often used interchangeably with other terms like snow blindness, welder’s flash, arc eye, flash burns, etc. It can be prevented by using protective eye-gear like welding goggles, welding helmet, sunglasses certified to provide UV protection, and snow goggles.

All eye-gear used for protection should have side shields and large lenses, to avoid accidental exposure, and should be worn even when the sky is overcast, since UV rays penetrate clouds. Ancient Egyptians blackened the skin beneath the eyes to avoid reflection of UV rays. This method is recommended in the SAS survival guide.

Causes:

• Welding without protection (Arc eye)
• Exposure to sunlight reflected from ice or snow (Snow blindness)- Fresh snow reflects 80% of the UV radiations.
• Exposure to sunlight reflected from sea or sand- Sand reflects 15% of the UV radiations, while sea foam reflects 25%.
• Exposure to sunlight at elevated levels- The intensity of UV rays increases by 4% for every thousand feet above sea level.
• Looking directly at a solar eclipse
• Exposure to artificial sources of UV light, like carbon arcs, lighting, photographic flood lamps, halogen desk lamps, sun tanning beds etc.

Symptoms:

• Pain
• Swelling
• Feeling of sand particles in the eyes, which persists even after repeated washing
• Tearing
• Blurred vision
• Redness
• Itching
• Temporary vision loss
• Seeing halos around the eyes
• Headache
• Constricted pupils
• Twitching of the eyelids
• Discomfort in bright light
• While most of these symbols resolve on their own in around 36 hours, some symptoms, like constriction of the pupils can last for as long as 128 hours.

Treatment:

• Anesthetic eye drops can be administered for temporary relief of pain, but these should be avoided, as they interfere with the natural healing process, and can lead to corneal ulceration as well as vision loss.
• Cold compresses and artificial tears can be used to relieve symptoms.
• NSAID (Non Steroidal Anti-Inflammatory Drug) eye drops are useful in reducing pain and inflammation.
• Oral pain relievers can be used in case of severe pain.
• The source of exposure should be immediately removed, and the patient should preferably be isolated in a dark room, or should wear sun glasses.
• Contact lenses must be removed, and rubbing of eyes should be avoided.

To know more about Photokeratitis and its treatment, visit us at Killeen Eyecare Center located at 416, North Gray Street, Killeen, TX 76541, Downtown Killeen or call us at 254-634-7805.

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Ocular hypotony is a condition of the eyes, in which the intraocular pressure (IOP), i.e. the fluid pressure inside the eye, drops to a level of 5 mm Hg or less. It is usually an indication of an underlying eye disorder. The two most common causes of this condition are fluid leakage and eyeball deflation.

Apart from the discomfort associated with hypotony, it can also lead to various other pathophysiological complications, which become more pronounced as the IOP approaches 0 mm Hg. These include maculopathy, corneal decompensation (accumulation of fluid in the cornea), and cataract formation. 

Causes:

The underlying cause of ocular hypotony is either the decreased formation, or the increased outflow of aqueous humor, which is the gelatinous fluid contained in the space between the lens and the cornea, and is responsible for maintaining IOP. The causes for decreased IOP include:

• Conditions causing increased outflow- wound leak, cyclodialysis cleft, overfiltering belb, etc.
• Conditions causing impaired ciliary body function- hypoperfusion,  iridocyclitis, tractional ciliary body detachment etc. These conditions result in the decreased production of aqueous humor.
• Retinal detachment
• Altered osmotic state, causing greater outflow- This can be caused by the use of hyperosmotic agents e.g. glycerol, mannitol, urea, isosorbide etc.
• Inflammation, resulting in increased permeability of blood-aqueous barrier, and hence decreased aqueous humor production.
• Dehydration
• Uncontrolled diabetes
• Uremia (High level of nitrogen waste in the body)
• Rupture of the sclera with a needle, suture or trauma
• Aqueous humor suppression by certain drugs- e.g., topical beta-blockers or carbonic anhydrase inhibitors.

Symptoms:

Patients might report symptoms like blurred vision and deep pain in the eyes, or might be completely asymptomatic. Others might develop symptoms related to retinal detachment like floaters in the field of vision, “sparks of light” visible on moving the eyes, darkness in a particular region in the field of vision, etc. 

Treatment:

The primary focus in the treatment of hypotony is usually focused on the underlying disorder that causes it. However, the following lines of treatment are followed to offer temporary relief:

• Inflation of the anterior chamber with gas or viscoelastic.
• Administration of steroids to enhance aqueous humor production.
• Increased fluid intake
• Patients who have had a recent inflammatory condition, or those who have undergone surgery or trauma are administered with topical prednisolone acetate, which helps in wound-healing.
• Atropine and other cycloplegics can be administered to restore lens anatomy.
• Most of the underlying disorders that cause hypotony might need surgical correction.

To know more about Ocular Hypotony and its treatment, visit us at Killeen Eyecare Center 416, North Gray Street, Killeen, TX 76541, and Downtown Killeen or call us at 254-634-7805.

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Keratoconus is a disorder of the eye in which the cornea, which is the outer transparent layer of the eye, gets damaged, leading to a distortion in its structure. The cornea loses its normal round shape, and becomes thin and conical. The disorder is usually diagnosed in the adolescent years of the patient, and it is believed to have a one-in-a-thousand prevalence, even though these figures might be inaccurate due to the differential diagnosis of the disease. In severe cases, it might affect the patient’s ability to carry out everyday tasks like driving and reading.

Causes: Keratoconus is believed to arise from a disorder in collagen, which is the connective tissue that constitutes the cornea. Even though its exact cause is not known, the following are possible causes of the disorder:

• Some patients might have a genetic predisposition to the disease. Patients with Down’s syndrome have an increased risk of developing keratoconus.
• It can result due to untreated allergy
• Rubbing the eyes aggravates the disorder
• It is associated with other disorders like asthma and eczema
• LASIK surgery has been found to cause iatrogenic keratoconus

Symptoms:

• Blurring of vision, which remains uncorrected with the use of glasses. This is the earliest symptom of the disease.
• Rapid deterioration in eyesight as the disease progresses.
• Trouble in viewing distant as well as close objects
• The symptoms might affect only one eye, but commonly affect both eyes nearly equally.
• Itching in the eyes
• Photophobia (Finding bright light unbearable)
• Perceiving distortion and streaking around light sources
• Viewing ghostly images against a contrasting background
• Eye strain while reading or concentrating on close objects, resulting in the need to squint.

Treatment:

• The most common treatment for keratoconus is the use of contact lenses for visual correction. Soft contact lenses can correct mild astigmatism, while rigid contact lenses are needed at later stages of the disorder.
• In the most severe cases, corneal transplantation surgery might be required. The results of the surgery are mostly good, even though the recovery period might be long. Patients will still need to use contact lenses after surgery.
• The latest developments in the treatment of the disorder include intracorneal ring segments, which are high-frequency corneal implants used to correct the shape of the cornea; and corneal cross-linking, in which the cornea will be hardened, to prevent further damage.

To know more about Keratoconus and its treatment, visit us at Killeen Eyecare Center located at 416, North Gray Street, Killeen, TX 76541, Downtown Killeen or call us at 254-634-7805.

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