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External Eye,
Cornea and Ocular Surface Diseases
Maurice Mosseri, MD of
Glaucoma Consultants of New York specialize in treating external eye,
cornea and ocular surface diseases and infections.
Maurice Mosseri, MD is a nationally recognized ophthalmologist
(eye doctor). With offices in Manhattan, Brooklyn, and Queens, New York. Board Certified Ophthalmologist, Maurice Mosseri, MD is consulted by
a wide variety of eye doctors for the treatment of corneal diseases and
other ocular surface eye diseases.
The most common external and
ocular surface diseases and infections that Board Certified
Ophthalmologist, Maurice Mosseri, MD treat
include:
Allergies
Allergies affecting the eye are fairly common. The most common allergies
are those related to pollen, particularly when the weather is warm and
dry. Symptoms can include redness, itching, tearing, burning, stinging,
and watery discharge, although they are not usually severe enough to
require medical attention.
An increasing number of eye allergy cases are related to medications and
contact lens wear. Also, animal hair and certain cosmetics, such as
mascara, face creams, and eyebrow pencil, can cause allergies that affect
the eye. Touching or rubbing eyes after handling nail polish, soaps, or
chemicals may cause an allergic reaction. Some people have sensitivity to
lip gloss and eye makeup. There are many different prescription eye drops
that can be used to treat eye allergies: if the symptoms are affecting the
eyes only, there is usually no need for allergy pills.
Blepheritis
Blepheritis refers to inflammation on the lashes of the eyelids. This
inflammation can cause crusting and redness of the lids, and eye redness
and irritation. Proper lid hygiene as well as judicious use of antibiotic
ointment usually controls the problem. Occasionally an antibiotic/steroid
ointment must be used to control the disease, in which case it is
important to monitor the eye for any medication side effects.
Conjunctivitis
(Pink Eye)
Conjunctivitis (Pink Eye) describes a group of diseases that cause
swelling, itching, burning, and redness of the conjunctiva, the protective
membrane that lines the eyelids and covers exposed areas of the sclera, or
white of the eye. Conjunctivitis can spread from one person to another and
affects millions of Americans at any given time. Conjunctivitis can be
caused by a bacterial or viral infection, allergy, environmental
irritants, a contact lens product, eye drops, or eye ointments.
At its onset, conjunctivitis is usually painless and does not adversely
affect vision. The infection will clear in most cases without requiring
medical care. But for some forms of conjunctivitis, treatment will be
needed. If treatment is delayed, the infection may worsen and cause
corneal inflammation and a loss of vision.
Corneal Infections
Sometimes the cornea is damaged after a foreign object has penetrated the
tissue, such as from a poke in the eye. At other times, bacteria or fungi
from a contaminated contact lens can pass into the cornea. Situations like
these can cause painful inflammation and corneal infections called
keratitis. These infections can reduce visual clarity, produce corneal
discharges, and perhaps erode the cornea. Corneal infections can also lead
to corneal scarring, which can impair vision and may require a corneal
transplant.
As a general rule, the deeper the corneal infection, the more severe the
symptoms and complications. It should be noted that corneal infections,
although relatively infrequent, are the most serious complication of
contact lens wear. Contact lens users must be extremely careful with any
red eye-this may represent a corneal infection that can cause permanent
loss of vision.
Minor corneal infections are commonly treated with anti-bacterial eye
drops. If the problem is severe, it may require more intensive antibiotic
or anti-fungal treatment to eliminate the infection, as well as steroid
eye drops to reduce inflammation. Frequent visits to an eye care
professional may be necessary for several months to eliminate the problem.
Dry Eye
The continuous production and drainage of tears is important to the
eye's health. Tears keep the eye moist, help wounds heal, and protect
against eye infection. In people with dry eye, the eye produces fewer or
less quality tears and is unable to keep its surface lubricated and
comfortable.
The tear film consists of three layers--an outer, oily (lipid) layer that
keeps tears from evaporating too quickly and helps tears remain on the
eye; a middle (aqueous) layer that nourishes the cornea and conjunctiva;
and a bottom (mucin) layer that helps to spread the aqueous layer across
the eye to ensure that the eye remains wet. As we age, the eyes usually
produce fewer tears. Also, in some cases, the lipid and mucin layers
produced by the eye are of such poor quality that tears cannot remain in
the eye long enough to keep the eye sufficiently lubricated.
The main symptom of dry eye is usually a scratchy or sandy feeling, as if
something is in the eye. Other symptoms may include stinging or burning of
the eye; episodes of excess tearing that follow periods of very dry
sensation; a stringy discharge from the eye; and pain and redness of the
eye. Sometimes people with dry eye experience heaviness of the eyelids or
blurred, changing, or decreased vision, although loss of vision is
uncommon.
Dry eye is more common in women, especially after menopause. Surprisingly,
some people with dry eye may have tears that run down their cheeks. This
is because the eye may be producing less of the lipid and mucin layers of
the tear film, which help keep tears on the eye. When this happens, tears
do not stay on the eye long enough to thoroughly moisten it, the body
senses this dryness, and produces excess tears from the same gland that
creates tears when you cry-result: tears that run down your cheeks.
Dry eye can occur in climates with dry air, as well as with the use of
some drugs, including antihistamines, nasal decongestants, tranquilizers,
and anti-depressant drugs. People with dry eye should let their doctor
know all the medications they are taking, since some of them may intensify
dry eye symptoms.
People with connective tissue diseases, such as rheumatoid arthritis, can
also develop dry eye. It is important to note that dry eye is sometimes a
symptom of Sjögren's syndrome, a disease that attacks the body's
lubricating glands, such as the tear and salivary glands. A complete
physical examination may diagnose any underlying diseases.
Artificial tears, which lubricate the eye, are the principal treatment for
dry eye. Sterile ointments are sometimes used at night to help prevent the
eye from drying. Using humidifiers, wearing wrap-around glasses when
outside, and avoiding outside windy and dry conditions may bring relief.
Nutritional supplements are also helpful. A new prescription eye drop has
recently been approved to treat dry eye: it has proven to be particularly
effective in post-menopausal women with dry eye. For people with severe
cases of dry eye, temporary or permanent closure of the tear drain (small
openings at the inner corner of the eyelids where tears drain from the
eye) may be helpful. These punctual plugs are easy for a skilled
ophthalmologist to insert (it takes a few seconds) and can be very
effective in relieving dry eye symptoms.
Fuchs'
Dystrophy
Fuchs' dystrophy is a slowly
progressing disease that usually affects both eyes and is slightly more
common in women than in men. Although doctors can often see early signs of
Fuchs' dystrophy in people in their 30s and 40s, the disease rarely
affects vision until people reach their 50s and 60s.
Fuchs' dystrophy occurs when endothelial cells gradually deteriorate
without any apparent reason. As more endothelial cells are lost over the
years, the endothelium becomes less efficient at pumping water out of the
stroma. This causes the cornea to swell and distort vision. Eventually,
the epithelium also takes on water, resulting in pain and severe visual
impairment.
Epithelial swelling damages vision by changing the cornea's normal
curvature, and causing a sight-impairing haze to appear in the tissue.
Epithelial swelling will also produce tiny blisters on the corneal
surface. When these blisters burst, they are extremely painful.
At first, a person with Fuchs' dystrophy will awaken with blurred vision
that will gradually clear during the day. This occurs because the cornea
is normally thicker in the morning; it retains fluids during sleep that
evaporate in the tear film while we are awake. As the disease worsens,
this swelling will remain constant and reduce vision throughout the day.
When treating the disease, doctors will try first to reduce the swelling
with drops, ointments, or soft contact lenses.
When the disease interferes with daily activities, a person may need to
consider having a corneal transplant to restore sight.
Herpes Zoster
(Shingles)
Herpes Zoster (Shingles) infection is produced by the varicella-zoster
virus, the same virus that causes chickenpox. After an initial outbreak of
chickenpox (often during childhood), the virus remains inactive within the
nerve cells of the central nervous system. But in some people, the
varicella-zoster virus will reactivate at another time in their lives.
When this occurs, the virus travels down long nerve fibers and infects
some part of the body, producing a blistering rash (shingles), fever,
painful inflammations of the affected nerve fibers, and a general feeling
of sluggishness.
Varicella-zoster virus may travel to the head and neck, perhaps involving
an eye, part of the nose, cheek, and forehead. In about 40 percent of
those with shingles in these areas, the virus infects the cornea. Doctors
will often prescribe oral anti-viral treatment to reduce the risk of the
virus infecting cells deep within the tissue, which could inflame and scar
the cornea. The disease may also cause decreased corneal sensitivity,
meaning that foreign matter, such as eyelashes, in the eye are not felt as
keenly. For many, this decreased sensitivity will be permanent.
Although shingles can occur in anyone exposed to the varicella-zoster
virus, research has established two general risk factors for the disease:
(1) Advanced age; and (2) A weakened immune system. Studies show that
people over age 80 have a five times greater chance of having shingles
than adults between the ages of 20 and 40. Unlike herpes simplex I, the
varicella-zoster virus does not usually flare up more than once in adults
with normally functioning immune systems.
Be aware that corneal problems may arise months after the shingles are
gone. For this reason, it is important that people who have had facial
shingles schedule follow-up eye examinations.
Iridocorneal
Endothelial Syndrome
More common in women and usually diagnosed between ages 30-50,
iridocorneal endothelial (ICE) syndrome has three main features: (1)
Visible changes in the iris, the colored part of the eye that regulates
the amount of light entering the eye; (2) Swelling of the cornea; and (3)
The development of glaucoma, a disease that can cause severe vision loss
when normal fluid inside the eye cannot drain properly. ICE is usually
present in only one eye.
ICE syndrome is actually a grouping of three closely linked conditions:
iris nevus (or Cogan-Reese) syndrome; Chandler's syndrome; and essential
(progressive) iris atrophy (hence the acronym ICE). The most common
feature of this group of diseases is the movement of endothelial cells off
the cornea onto the iris. This loss of cells from the cornea often leads
to corneal swelling, distortion of the iris, and variable degrees of
distortion of the pupil, the adjustable opening at the center of the iris
that allows varying amounts of light to enter the eye. This cell movement
also plugs the fluid outflow channels of the eye, causing glaucoma.
The cause of this disease is unknown. While we do not yet know how to keep
ICE syndrome from progressing, the glaucoma associated with the disease
can be treated with medication, and a corneal transplant can treat the
corneal swelling.
Keratoconus
Keratoconus disorder is a
progressive thinning of the cornea--is the most common corneal dystrophy
in the U.S., affecting one in every 2000 Americans. It is more prevalent
in teenagers and adults in their 20s. Keratoconus arises when the middle
of the cornea thins and gradually bulges outward, forming a rounded cone
shape. This abnormal curvature changes the cornea's refractive power,
producing moderate to severe distortion (astigmatism) and blurriness
(nearsightedness) of vision. Keratoconus may also cause swelling and a
sight-impairing scarring of the tissue.
Studies indicate that keratoconus stems from one of several possible
causes:
An inherited corneal abnormality. About seven percent of those with the
condition have a family history of keratoconus.
An eye injury, i.e., excessive eye rubbing or wearing hard contact lenses
for many years.
Certain eye diseases, such as retinitis pigmentosa, retinopathy of
prematurity, and vernal keratoconjunctivitis.
Systemic diseases, such as Leber's congenital amaurosis, Ehlers-Danlos
syndrome, Down syndrome, and osteogenesis imperfecta.
Keratoconus usually affects both eyes. At first, people can correct their
vision with eyeglasses. But as the astigmatism worsens, they must rely on
specially fitted contact lenses to reduce the distortion and provide
better vision. Although finding a comfortable contact lens can be an
extremely frustrating and difficult process, it is crucial because a
poorly fitting lens could further damage the cornea and make wearing a
contact lens intolerable.
In most cases, the cornea will stabilize after a few years without ever
causing severe vision problems. But in about 10 to 20 percent of people
with keratoconus, the cornea will eventually become too scarred or will
not tolerate a contact lens. If either of these problems occur, a corneal
transplant may be needed. This operation is successful in more than 90
percent of those with advanced keratoconus. Several studies have also
reported that 80 percent or more of these patients have 20/40 vision or
better after the operation.
Lattice
Dystrophy
Lattice dystrophy gets its name
from an accumulation of amyloid deposits, or abnormal protein fibers,
throughout the middle and anterior stroma. During an eye examination, the
doctor sees these deposits in the stroma as clear, comma-shaped
overlapping dots and branching filaments, creating a lattice effect. Over
time, the lattice lines will grow opaque and involve more of the stroma.
They will also gradually converge, giving the cornea a cloudiness that may
also reduce vision.
In some people, these abnormal protein fibers can accumulate under the
cornea's outer layer--the epithelium. This can cause erosion of the
epithelium. This condition is known as recurrent epithelial erosion. These
erosions: (1) Alter the cornea's normal curvature, resulting in temporary
vision problems; and (2) Expose the nerves that line the cornea, causing
severe pain. Even the involuntary act of blinking can be painful.
To ease this pain, a doctor may prescribe eye drops and ointments to
reduce the friction on the eroded cornea. In some cases, an eye patch may
be used to immobilize the eyelids. With effective care, these erosions
usually heal within three days, although occasional sensations of pain may
occur for the next six-to-eight weeks.
By about age 40, some people with lattice dystrophy will have scarring
under the epithelium, resulting in a haze on the cornea that can greatly
obscure vision. In this case, a corneal transplant may be needed. Although
people with lattice dystrophy have an excellent chance for a successful
transplant, the disease may also arise in the donor cornea in as little as
three years. In one study, about half of the transplant patients with
lattice dystrophy had a recurrence of the disease from between two to 26
years after the operation. Of these, 15 percent required a second corneal
transplant. Early lattice and recurrent lattice arising in the donor
cornea responds well to treatment with the excimer laser.
Although lattice dystrophy can occur at any time in life, the condition
usually arises in children between the ages of two and seven.
Map-Dot-Fingerprint
Dystrophy
This dystrophy occurs when the
epithelium's basement membrane develops abnormally (the basement membrane
serves as the foundation on which the epithelial cells, which absorb
nutrients from tears, anchor and organize themselves). When the basement
membrane develops abnormally, the epithelial cells cannot properly adhere
to it. This, in turn, causes recurrent epithelial erosions, in which the
epithelium's outermost layer rises slightly, exposing a small gap between
the outermost layer and the rest of the cornea.
Epithelial erosions can be a chronic problem. They may alter the cornea's
normal curvature, causing periodic blurred vision. They may also expose
the nerve endings that line the tissue, resulting in moderate to severe
pain lasting as long as several days. Generally, the pain will be worse on
awakening in the morning. Other symptoms include sensitivity to light,
excessive tearing, and foreign body sensation in the eye.
Map-dot-fingerprint dystrophy, which tends to occur in both eyes, usually
affects adults between the ages of 40 and 70, although it can develop
earlier in life. Also known as epithelial basement membrane dystrophy,
map-dot-fingerprint dystrophy gets its name from the unusual appearance of
the cornea during an eye examination. Most often, the affected epithelium
will have a map-like appearance, i.e., large, slightly gray outlines that
look like a continent on a map. There may also be clusters of opaque dots
underneath or close to the map-like patches. Less frequently, the
irregular basement membrane will form concentric lines in the central
cornea that resemble small fingerprints.
Typically, map-dot-fingerprint dystrophy will flare up occasionally for a
few years and then go away on its own, with no lasting loss of vision.
Most people never know that they have map-dot-fingerprint dystrophy, since
they do not have any pain or vision loss. However, if treatment is needed,
doctors will try to control the pain associated with the epithelial
erosions. They may patch the eye to immobilize it, or prescribe
lubricating eye drops and ointments. With treatment, these erosions
usually heal within three days, although periodic flashes of pain may
occur for several weeks thereafter. Other treatments include anterior
corneal punctures to allow better adherence of cells; corneal scraping to
remove eroded areas of the cornea and allow regeneration of healthy
epithelial tissue; and use of the excimer laser to remove surface
irregularities.
Ocular Herpes
Herpes of the eye, or ocular
herpes, is a recurrent viral infection that is caused by the herpes
simplex virus and is the most common infectious cause of corneal blindness
in the U.S. Previous studies show that once people develop ocular herpes,
they have up to a 50 percent chance of having a recurrence. This second
flare-up could come weeks or even years after the initial occurrence.
Ocular herpes can produce a painful sore on the eyelid or surface of the
eye and cause inflammation of the cornea. Prompt treatment with anti-viral
drugs helps to stop the herpes virus from multiplying and destroying
epithelial cells. However, the infection may spread deeper into the cornea
and develop into a more severe infection called stromal keratitis, which
causes the body's immune system to attack and destroy stromal cells.
Stromal keratitis is more difficult to treat than less severe ocular
herpes infections. Recurrent episodes of stromal keratitis can cause
scarring of the cornea, which can lead to loss of vision and possibly
blindness.
Like other herpetic infections, herpes of the eye can be controlled. An
estimated 400,000 Americans have had some form of ocular herpes. Each
year, nearly 50,000 new and recurring cases are diagnosed in the United
States, with the more serious stromal keratitis accounting for about 25
percent. In one large study, researchers found that recurrence rate of
ocular herpes was 10 percent within one year, 23 percent within two years,
and 63 percent within 20 years. Some factors believed to be associated
with recurrence include fever, stress, sunlight, and eye injury. Because
there are many variables in this complex disease and severe complications
can occur, it is critically important that you see a skilled
ophthalmologist for proper diagnosis and treatment.
Pterygium
A pterygium is a pinkish, triangular-shaped tissue growth on the cornea.
Some pterygia grow slowly throughout a person's life, while others stop
growing after a certain point. Rarely, a pterygium grows so large that it
begins to cover the pupil of the eye.
Pterygia are more common in sunny climates and in the 20-40 age group.
Scientists do not know what causes pterygia to develop. However, since
people who have pterygia usually have spent a significant time outdoors,
many doctors believe ultraviolet (UV) light from the sun may be a factor.
In areas where sunlight is strong, wearing protective eyeglasses,
sunglasses, and/or hats with brims are suggested. While some studies
report a higher prevalence of pterygia in men than in women, this may
reflect different rates of exposure to UV light.
Because a pterygium is visible, many people want to have it removed for
cosmetic reasons. It is usually not too noticeable unless it becomes red
and swollen from dust or air pollutants. If a pterygium is surgically
removed, it may grow back. Special surgical techniques can be used to
decrease the chance of recurrence.
Stevens-Johnson
Syndrome
Stevens-Johnson Syndrome (SJS),
also called erythema multiforme major, is a disorder of the skin that can
also affect the eyes. SJS is characterized by painful, blistery lesions on
the skin and the mucous membranes (the thin, moist tissues that line body
cavities) of the mouth, throat, genital region, and eyelids. SJS can cause
serious eye problems, such as severe conjunctivitis; iritis, an
inflammation inside the eye; corneal blisters and erosions; and corneal
holes. In some cases, the ocular complications from SJS can be disabling
and lead to severe vision loss.
Scientists are not certain why SJS develops. The most commonly cited cause
of SJS is an adverse allergic drug reaction. Almost any drug--but most
particularly sulfa drugs--can cause SJS. The allergic reaction to the drug
may not occur until 7-14 days after first using it. SJS can also be
preceded by a viral infection, such as herpes or the mumps, and its
accompanying fever, sore throat, and sluggishness. Treatment for the eye
may include artificial tears, antibiotics, or corticosteroids. About
one-third of all patients diagnosed with SJS have recurrences of the
disease.
SJS occurs twice as often in men as women, and most cases appear in
children and young adults under 30, although it can develop in people at
any age.
To schedule an appointment for testing or
treatment of your corneal disease, or if you have
any surgical or nonsurgical questions pertaining to your eyes,
please feel free to contact the doctor, Board Certified Ophthalmologist, Maurice Mosseri, MD at any of his New York offices or send an email to
info@drmosseri.com.
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