Patient Education

Blepharitis

• What is blepharitis? Blepharitis is a chronic malfunction and inflammation of the oil-producing glands in the eyelids. There are three components to the tear film: oil, water and mucus. These three layers must be in balance to have normally functioning tears. Without the proper combination of secretions, the tear film breaks down and becomes unstable. This causes itching, burning, grittiness and occasionally a red eye. This unstable tear film can also cause intermittent blurring of vision. The eyes may feel dry or watery depending on the consistency of the tears. Sometimes the eyes may overflow with watery tears as the body tries to “flush” out this gritty sensation. Rarely, problems such as ulcers or scars in the cornea can be caused by blepharitis. Blepharitis produces crusting of eyelids, styes and rarely damage to the surface of the eyeball. There can often be an associated dry eye which will worsen symptoms. Blepharitis is not a true infection but it reduces the eye’s ability to fight bacteria. Severe bacterial overgrowth may occur in some cases.In general, blepharitis is a life-long condition that is never completely cured but is treatable.

• What are the symptoms of blepharitis?
  – Redness of eyelids and eyes
  – Tearing, itching, burning, gritty sensation
  – Intermittent blurry vision that improves with blinking or tear drops
  – Loss of eyelashes
  – Crusting and scales of lashes
  – Eyelid, white lid bumps, and styes

• What is a stye? Oily build-up at the lash margin can seal the opening of the ducts and cause little white lumps that look like a pimple. Hot compresses and gentle lid massage to “milk” the glands can restore flow through the pores. When the glands become completely blocked they swell, and they may rupture and leak fatty debris in the lid. These leakages are toxic and create redness, swelling, pain and pus. Styes will go away on their own if left completely alone but can last for over a year. Warm compresses are the first line of treatment. Incising and draining a stye may speed up the healing process.

Cataract & Cataract Surgery

• What is a cataract? When the normally clear lens inside your eye becomes discolored and cloudy, you have a cataract.

• What causes cataracts? For the majority of people, cataracts are a result of the natural aging process. People over 55 years old are at most risk of developing a cataract. Less frequently, cataracts can develop at an earlier age or more abruptly in people who have diabetes mellitus, who use medication containing steroid, or who have experienced trauma to their head or their eye. Unfortunately, there is no current proven method of preventing or reversing the development of cataracts.

• How do I know if I have cataracts? The main symptom of cataracts is worsening vision.  You may experience:
  – Blurred vision
  – Difficulty reading in dim light
  – Glare, most noticeable at night or when driving
  – Feeling like your glasses are always dirty
  – Seeing through a fog
  Because cataracts do not cause pain, you may not know you have cataracts until you see your doctor for your annual eye exam.

• What do I do if I have cataracts? If you feel your vision has worsened, you should schedule an eye exam with your ophthalmologist. In many cases, vision loss from cataracts can be corrected with a change in your glasses or contacts. However, if your cataracts are significant, the preferred way to rehabilitate your vision is to have intraocular cataract surgery with lens implantation. Currently, cataracts cannot be removed with medication or with a laser. Cataract surgery is the most common eye surgery performed in the United States. This “same-day” procedure, usually lasting 15 minutes, does not require you to stay in the hospital – you will have your surgery and leave the same day. During this microscopic, stitch-less surgery, the cataract is gently removed and is replaced with a clear artificial lens, usually made out of silicone or other synthetic material. This artificial lens, often referred to as an intraocular lens or IOL, is designed to permanently remain in your eye and it can correct your vision so that you no longer have to wear corrective lenses.After surgery, you will use several eye drops for 2-6 weeks to prevent infection and to expedite healing. You can usually return to normal activity within a few days of your surgery.

• Will I have to wear glasses after surgery? Traditionally after cataract surgery, most people need glasses only to read (presbyopia).  However, if you have astigmatism, you may have to wear glasses to optimize your distance vision, in addition to reading.Newer premium intraocular lenses now allow you to minimize your dependence on glasses both at distance and at close range.  Ask your ophthalmologist if a toric (astigmatism-correcting) or multifocal (presbyopia-correcting) lens is right for you.

Diabetes and the Eye

• I have diabetes – can this affect my eyes? Diabetes is a frequent cause of blindness in the United States for patients aged 20-64 years. The chances of your eyes being affected by diabetes increases with the duration of your disease and your age.Your vision may fluctuate with your blood sugar levels. When your blood glucose is very high, you may experience transient blurriness. However, if your blood sugar remains uncontrolled, more permanent changes in your vision may occur.As you may know, the high levels of sugar in your blood can damage the small blood vessels in your body leading to kidney problems and peripheral neuropathy. It can also damage the blood vessels in your retina leading to diabetic retinopathy and vision loss.

• How do I know if I have diabetic retinopathy? The main symptom of diabetic retinopathy is worsening vision. Because diabetic retinopathy degeneration does not cause pain, you may not know you have a problem until you see your doctor for your annual eye exam.The American Diabetes Association recommends for people with diabetes (controlled or uncontrolled) to have a dilated eye exam at least every year.

• What do I do if I have diabetic retinopathy? If you have diabetes and feel your vision has worsened, you should schedule an eye exam with your ophthalmologist to see if you have diabetic retinopathy. If the retinopathy is mild, careful control of your blood sugar is the most appropriate treatment. When the retinopathy is more advanced, supplemental laser or intraocular medication may also be necessary.Most importantly, you should adhere to the medications and dietary recommendations that have been prescribed to you.

Dry Eye Syndrome

• What is dry eye syndrome? When your tear film is unable to properly lubricate your ocular surface, you may have dry eye syndrome. This inability may be from decreased tear production (aqueous tear deficiency or ATD) or from poorly functioning tears (evaporative dry eye syndrome or EDE). ATD most often is caused by chronic contact lens wear, environmental factors (wind, air conditioning, dry climate), systemic medications, menopause, and aging. Other causes may be:
  – Auto-immune diseases (e.g. Sjögrens Syndrome, rheumatoid arthritis, lupus)
  – Surgeries on the eyes or eyelids (e.g. blepharoplasty, LASIK, PRK)
  – Medication side effects
  – Other medical treatments EDE is most commonly caused by obstruction or malfunction of the eyelid oil glands (meibomian gland dysfunction or blepharitis). Because the glands do not work properly, your tears consequently do not work well even though you may produce enough.

• What are the symptoms of dry eye? The main symptom of eye dryness is burning and irritation of the eyes. You may also experience:
  – Foreign body sensation
  – Scratchy, gritty eyes
  – Fluctuating vision
  – Watery eyes
  – Sensitivity to light (photophobia)
  – Eye fatigue, particularly when reading, watching TV or using a computer
  – Contact lens discomfort or intolerance
  – Excessive mucus discharge
  – Caking of eyelids upon awakening
  – Eyelids feel “heavy”

• How can my eyes be dry if my eyes are watery all the time? Believe it or not, you are one of the lucky ones. Because your tear film is not working well on a regular basis leading to an unhealthy ocular surface, your reflexive tear system is being stimulated, similar to the tearing that occurs when you get something in your eye. Your eye then becomes very watery which can also interfere with your vision.While this can be a nuisance, your body is responding appropriately by reflexively producing more tears to protect your eye. To fix this problem, it is important to address the underlying cause.

• How can dry eye be treated? There are many different treatments for dry eye that are tailored to your specific symptoms and needs. For some, using a supplemental artificial tear drop is sufficient. For others, prescription medications or interventions may be appropriate. You should discuss what treatment is most appropriate for you with your ophthalmologist.

Flashes and Floaters

• What are floaters? If you sometimes see small black dots or cobwebs in your field of vision, you have floaters. You may notice them when you are looking at a plain space, such as a blank wall.Floaters are tiny clumps of cells within the vitreous, which is the natural gel-like fluid inside your eye.

• What causes floaters? As you age, the vitreous gel inside your eye may start to change and form clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. This is a common cause of floaters.Posterior vitreous detachment is more common in people who are nearsighted or have had cataract surgery. The appearance of floaters may be alarming, especially if they develop very suddenly. You should contact your ophthalmologist right away if you develop new floaters, especially if you are over 45 years of age.

• Should I be worried if I have floaters? If you have recently experienced new floaters, you should visit your ophthalmologist for a full dilated exam. As the vitreous gel pulls away from the back wall of the eye, it can cause a tear in the retina putting you at risk for a retinal detachment.You should see your ophthalmologist as soon as possible if:
  – You suddenly experience a new floater
  – You see flashes of light
  However, if you have had chronic floaters without any recent change, you should not be alarmed. Once a floater has formed, it will not cause any future harm.

• Can floaters be removed? Floaters are essentially harmless to your eye and require no treatment. They generally become less apparent with time.However, if a retinal tear is found on exam, this must be treated to prevent a retinal detachment.

• What causes flashing lights? As the vitreous gel pulls away from the back wall of the eye, it can irritate the retina, the delicate membrane that lines the inside of your eye. This membrane is composed of nerves that are designed to sense light, just as the nerves in your finger are designed to sense pain. Therefore, when the nerves of your retina are irritated, you see light.If you experience sudden flashes of light, especially at the time of new floaters, you should contact your ophthalmologist immediately in case you have a tear in your retina.

Glaucoma

• What is Glaucoma? Glaucoma is an eye disease that can permanently damage your vision. Often, glaucoma has no symptoms and progressively reduces vision. However, some types of glaucoma can suddenly result in loss of vision. Without proper treatment, glaucoma can lead to blindness. Fortunately, with regular eye exams, early detection, and treatment, you can preserve your vision.

• Who can get Glaucoma? Anyone can get glaucoma. It affects people of all ages from babies to older adults. However, it is more common if you are over 60 years old, Hispanic, of African descent, or have a family member with glaucoma.

• Who should get their eyes checked for glaucoma? Everyone should get checked for glaucoma. Early detection with a complete eye exam (then regular follow-up every 1 to 2 years) is important in protecting your vision from damage caused by glaucoma.

• How does glaucoma cause damage? Essentially, when the eye’s internal drainage system becomes clogged, the intraocular fluid cannot drain. If this fluid builds up in the eye, it causes the pressure to build inside the eye. High pressure pushes on the optic nerve which results in loss of vision.

• What are the different types of glaucoma? There are several different types of glaucoma.  Open angle glaucoma is the most common type.  It develops slowly and usually without signs or symptoms. Many people with open angle glaucoma feel fine and have no visual complaints. Regular eye exams are very important to detect this type of glaucoma.Narrow or closed angle glaucoma is less common and develops quickly, resulting in a painful attack in the eye. The eye usually looks red, you will feel a headache, nauseous, and severe eye pain. This is an emergency and immediate medical attention is required.

• Why is my doctor doing so many diagnostic tests? Diagnosing glaucoma is not always easy. There are many technologies which help Dr. Terraciano and Dr. Ross diagnose and manage glaucoma correctly. The results of these tests help your doctor make important decisions about your treatment and follow-up appointment schedule.

• What is the treatment for glaucoma? There is no cure for glaucoma.  With early diagnosis and proper treatment with eye medications, laser or surgery, glaucoma can be controlled.  These treatments prevent future loss of vision but cannot restore previously damaged vision.

• What is glaucoma laser surgery? There are several types of laser surgery used for glaucoma. The type of laser used on your eye is dependent on the form and severity of your glaucoma.

• How do you do glaucoma laser surgery? The laser is done at a laser center in a room just like in Dr. Terraciano and Dr. Ross’s office.  Twenty minutes before the surgery you will receive some drops to prepare your eye for the laser. You will sit in a comfortable chair with your chin in the slit lamp machine (which is the same machine Dr. Terraciano and Dr. Ross uses to examine you).  A bright laser light is focused into your eye for several minutes. You typically will feel nothing, but some people occasionally feel an irritation in the eye.  After the procedure, your doctor will check the pressure in your eye to make sure that it is normal.  You will then go home on drops to diminish any inflammation in the eyes.

Age-Related Macular Degeneration (AMD)

• What is macular degeneration? AMD is a chronic condition caused by damage to the center of the retina, called the macula, leading to a permanent loss of vision.  It is one of the leading causes of severe vision loss in people over the age of 50 years old in the United States. AMD is classified into two types: dry (non-exudative) and wet (exudative).  Most people have the dry type, which is slowly progressive. The wet type tends to be more aggressive, leading to profound vision loss.

• What causes AMD? There is no known cause for macular degeneration. Studies have identified risk factors for the disease, some of which are modifiable, meaning that you can minimize your exposure to these factors. These modifiable risk factors include cigarette smoking, high blood pressure and high cholesterol. Other risk factors include a family member with the disease, hyperopia, light iris color and the female gender.

• How do I know if I have AMD? The main symptom of macular degeneration is worsening vision.  You may experience:
  – Blurred or loss of vision
  – Visual distortions (ie straight lines look curved or wavy)
  Because macular degeneration does not cause pain, you may not know you have a problem until you see your doctor for your annual eye exam.

• What do I do if I have AMD? If you feel your vision has worsened, you should schedule an eye exam with your ophthalmologist to see if you have macular degeneration. Depending on the type with which you are diagnosed, your doctor may choose to just observe you. This is appropriate in most cases of early macular degeneration. In more advanced stages, certain vitamins may be recommended to help retard the progression of your disease.Unfortunately, there is no “cure” for macular degeneration. Recently, an injectable medication has proven to improve vision in cases of wet degeneration.  The best treatment at this time is prevention. You should continue to eat a healthy balanced diet high in antioxidants and leafy green vegetables, exercise regularly, stop smoking, protect your eyes from UV light, and see your ophthalmologist regularly.

Narrow Angles and Narrow Angle Glaucoma

• What are Narrow Angles and Closed (Narrow) Angle Glaucoma (NAG)? This is the second most common form of glaucoma. Patients often have acute attacks of eye pain due to sudden increases in eye pressure. Between attacks the eye pressure is normal.

• Why do attacks happen? A watery fluid is generated inside the normal eye. It circulates through the eye and drains out of the eye in the “angle” between the cornea (the clear window of the eye) and the iris (the colored part of the eye). Some people are born with narrow, slit-like draining angles.  In such people, anything that further narrows the angle prevents adequate drainage and causes the pressure to build up.  The patient then experiences an acute attack of Narrow or Closed Angle Glaucoma.

• What are the symptoms of NAG? Between attacks the eye pressure is normal and there are no symptoms.  During the attack there are often eye pain, nausea and sometimes vomiting.  The eye may be red, vision may be blurry and patients may see halos around lights.

• How dangerous is an acute attack of NAG? An attack of this type of glaucoma is an emergency. Untreated, it may cause blindness in a day or two.

• What medicines should patients with Narrow Angle Glaucoma avoid? Patients with Narrow Angle Glaucoma should avoid cold remedies which contain Pseudoephedrine, Phenylephrine or Neo-Synephrine, anti-histamines (Chlorpheniramine,  Diphenhydramine, or Benadryl) and overactive bladder remedies such as Detrol. These remedies often carry a warning telling you not to use them if you have glaucoma. If your Narrow Angle Glaucoma has been treated with laser, these medicines become safe for you to use. The above medicines generally do not cause problems to patients who have open angle glaucoma.

• How is an acute attack of NAG treated? Narrow Angle Glaucoma is treated with a laser. In this office procedure a small drain hole is created in the iris, the colored part of the eye.  The hole is of microscopic size. The procedure is painless. In addition to laser treatment, eye drops are administered to lower pressure.

• How can you prevent glaucoma attacks? An easy and painless way to prevent attacks is to create a microscopic drain hole with the laser. This is called a peripheral laser iridotomy (PLI). This preventive treatment can be done at any time. We recommend this approach to anyone prone to acute attacks (people born with narrow angles). When such people are traveling they may not have access to prompt treatment. If they have an attack serious damage may occur in a matter of hours, long before they reach a treatment center. Also, people may delay treatment until it’s too late because they do not recognize that they are having a glaucoma attack. They often think that they are just having a headache, or a migraine. Because they do not suspect glaucoma they fail to seek treatment and damage to the nerve takes place.  Once the nerve fibers are dead, the damage cannot be reversed.

• Can laser-made openings close? Yes, rarely.  Then new attacks may occur. If the pain comes back while you are taking medicines known to cause glaucoma attacks, do not take any more and call us immediately.  Explain to the receptionist your situation. Tell her that you might be having an acute glaucoma attack and you feel it is an emergency.

• How do you do the Peripheral Laser Iridotomy Surgery? The laser is done at a laser center in a room just like the one you are being examined in today. Twenty minutes before the surgery you will receive some drops to prepare your eye for the laser. You will sit in a comfortable chair with your chin in the slit lamp machine (which is the exact same machine your doctor used today to examine you).  A lens will be placed over your eye and the laser is hooked onto the slit lamp machine and used to create the channel in your iris. This will take 10-15 minutes to complete. You typically will feel nothing, but some people occasionally feel a “burn” in their eye when the channel is created.  After the surgery, your doctor will check the pressure in your eye to make sure that it is normal.  You will then go home on drops to diminish any inflammation in the eyes. You will be seen one week later.

• What are the risks with the Peripheral Laser Iridotomy Surgery? The greatest risk of laser iridotomy is an increase in intraocular pressure.  Usually, the pressure spike is transient and eye drops are given at the time of surgery to help prevent this problem.The second greatest risk of this procedure is anterior uveitis, or inflammation in the eye.  Usually the inflammation subsides within several days but can persist for up to 30 days. Thus, follow-up care for laser iridotomy includes the application of topical corticosteroids. Some other risks of this procedure include the following: damage to the cornea, bleeding of the iris, glare and double vision, and macular edema. Blurred vision may occur as well, but usually disappears 30 minutes after surgery.

Refractive Eye Surgery

• Nearsightedness (myopia) usually occurs when the eye is too long, so that light focuses in front of the retina rather than directly on the retina. Near objects are seen clearly, but objects in the distance appear blurry. LASIK reshapes the cornea to allow the light to focus on the retina.

• Farsightedness (hyperopia) usually occurs when the eye is too short, so that light focuses behind the retina. LASIK reshapes the cornea to allow the light to focus on the retina.

• Astigmatism occurs when the cornea is shaped more like a football, so that light focuses at more than one point on the retina. LASIK makes the cornea more spherical or even by removing more tissue in one direction and less in others.

• Presbyopia is blurred vision at near points, such as when reading or working on a computer. It usually occurs as we get older (usually after the age of 40 years).  Presbyopia happens to everyone when they age, even those individuals who have never had a prior vision problem.

• How do you treat refractive errors? Refractive errors are fixed with glasses, contact lenses, refractive laser surgery, and lens extraction.

• What is refractive laser eye surgery? LASIK (Laser Assisted in Situ Keratomileusis) and PRK (Photorefractive Keratectomy) use a precise laser light to reshape the cornea, the clear tissue at the front of the eye, so that light rays can more precisely focus on the retina in the back of the eye.  There are many different modifications of these procedures including LASEK, Custom Laser, Femtosecond or Intralase (no blade LASIK), and the use of intraoperative mitomycin-C all of which will be considered by Dr. Terraciano and Dr. Ross if necessary.