Dry Eye Syndrome

In people with dry eye, the eye produces fewer or less quality tears and is unable to keep its surface lubricated and comfortable. 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, a stringy discharge from the eye, and pain and redness. 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. Artificial tears, which lubricate the eye, are the principal treatment for dry eye. Using humidifiers, wearing wrap-around glasses when outside and avoiding windy and dry conditions may bring relief. For people with severe cases, temporary or permanent closure of the tear drain may be helpful.

Additionally, Restasis, a prescription strength eye drop is available to help your body secrete more of its own tears.  We actually participated in FDA trials that ultimately led to the approval of this medication in the United States.  In some cases we even use components of your own serum to help treat dry eye.  We are always pursuing new research opportunities in order to bring the latest technology to our patients.

Allergies

Allergies affecting the eye are fairly common. The most common allergies are those related to pollen, medications and contact lens wear. Symptoms can include redness, itching, burning and watery discharge. Antihistamine decongestant eye drops can effectively reduce these symptoms.

Fuchs' Endothelial Dystrophy

Fuchs' endothelial dystrophy is a corneal disease that is a cause of blindness in the United States.
This corneal eye disease is described by slow-moving changes in endothelium (the microscopic cells of the cornea) that leads to internal swelling of these delicate corneal cells. As endothelial cells die, the body cannot replace them. This loss of corneal cells leads to corneal cloudiness and decreased vision.

The disease most often begins with blurry vision in the morning and with worsening vision as the disease progresses. Fuchs’ is often inherited and found more often in women than men. Early signs of Fuchs' dystrophy can be detected in people in their 30s and 40s, but the disease rarely affects vision until people reach their 50s and 60s. Fuchs’ endothelial dystrophy is detected by a thorough eye examination of the cornea. This disease cannot be cured, but with the use of eye medication, a patient’s blurry vision can be minimized. If the vision is significantly affected, there may be a need to complete a corneal transplant.

Keratoconus

Keratoconus is the progressive thinning and steepening of the central cornea (clear part of your eye). Keratoconus occurs in about .15% to .6% of the general population. Onset of keratoconus most often occurs during the teenage years. The mean age of onset is age 16 years but onset has been reported to occur at ages as young as 6 years. In over 90% of the cases it is bilateral and rarely develops after age 30.

Patients often complain of distorted vision rather than blurry vision at both distance and near. Some patients report halos around lights and photophobia (light sensitivity). As the cornea steepens and thins, a patient experiences a decrease in vision which can be mild or severe depending on the amount of corneal tissue affected. Diagnosis of keratoconus is completed through a comprehensive eye exam and advanced corneal testing. Typically, vision loss can be corrected early by glasses; later, irregular astigmatism requires optical correction with firm contact lenses. Contact lenses provide a uniform refracting surface and therefore improve vision.

Ultimately cornea transplant may be necessary.  We are also involved in the development of new technology including the placement of Intacs, collagen crosslinking and Deep Anterior Lamellar Keratoplasty.

Treatments for Keratoconus

Contact Lenses – Soft and Rigid

Patients with very mild disease may initially be corrected with glasses or soft contact lenses. The vast majority of patients with keratoconus however need rigid contact lenses for adequate vision correction.

Many patients find their contact lenses uncomfortable and can only tolerate their contact lenses for only a short period of time. The main reason why this happens is that the cornea steepens and rubs against the lens causing an abrasion and light sensitivity.

Another reason this happens is that patients with keratoconus often have very dry eye and as the eye dries out there is no lubricating barrier between the lens and the cornea contributing to the patient being uncomfortable.

Intacs

Intacs are clear, arc-shaped plastic “stents” placed within the peripheral cornea. Originally FDA approved to correct low amounts of near sightedness, they are currently used to improve the cornea shape of patients with keratoconus or and irregular cornea shape due to LASIK complications. This indication gained FDA approval in 2004.

While some patients have experienced remarkable improvement in the shape of their cornea after this procedure, in general the majority of recipients experience an improvement in the tolerance of their contact lenses. The effects do appear to last some significant period of time.

Doctors at Cornea Consultants of Albany were the first in Northeastern New York to perform Intacs. We encourage you to personally discuss your candidacy with our doctors as well as your risks, benefits and alternatives to this procedure.

Collagen Crosslinking - Keratoconus

This is an experimental procedure that is currently being performed in which attempts are made to strengthen the cornea with riboflavin and UV light. This procedure is not presently approved by the FDA for use in the United States and is available under investigational protocol only.

This treatment appears to stabilize the cornea and effect some modest flattening of the steep keratoconic cornea. Progression of disease appears to be arrested for at least 2 years. Laboratory evidence performed to date by European investigators indicate that there is a resultant increase in collagen strength.

We encourage you to personally discuss your candidacy with our study coordinator and doctors.

Deep Anterior Lamellar Keratoplasty (DALK)

DALK is an additional newer method of corneal transplantation. It replaces only the superficial layers of the cornea. Candidates typically have keratoconus or other disease of the superficial layers of the cornea only. Success rates are approximately 50% due to the highly technical nature of this procedure. Fortunately, if the cornea does not divide optimally at the time of the procedure, a full-thickness keratoplasty remains an excellent option to rehabilitate vision. Potential advantages to DALK include greater structural integrity of the eye and decreased chance of rejection.

Please personally discuss the risks, benefits and alternatives of any corneal surgery with our doctors at Cornea Consultants of Albany.

Basement Membrane Dystrophy

Basement Membrane Dystrophy is a corneal disease that affects the epithelium's (outer layer of the cornea) ability to attach to the lower layers of the cornea. There are five layers of the cornea. This inability to stay connected forces the outer layer of the cornea to grow unevenly or become disconnected.

Some patients have this disease and have no visual effects while others; especially dry eye patients can experience painful corneal erosions. The epithelium is layered with more sensory nerves than tooth pulp. Treatment is always completed in a stepped approach based off of a patient symptoms. Early steps include lubrication of the cornea through artificial tears and eye medications. This may proceed to a gently scraping the outer layer of the cornea manually or by laser with the goal of having healthy cornea cells regenerate. Basement Membrane Dystrophy generally occurs in adults over the age of 40 and is diagnosed through a comprehensive eye exam.

Conjunctivitis (Pink Eye)

This term 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. It can be caused by a bacterial or viral infection, allergy, environmental irritants, a contact lens product or eye drops. The infection will clear in most cases without requiring medical care but for some forms of conjunctivitis, treatment will be needed.

Herpes Infection

Herpes simplex is a common virus which can infect your eye. Herpes eye infections usually affect a patient’s cornea (the outer clear part of the eye). Patients complain about redness, sensitivity and pain coming from an area on their cornea. Your eye physician may detect an ulcer (an open sore) on the cornea or conjunctiva (tissue around the cornea). When an ulcer is detected, eye medications are prescribed to treat the ulcer and make the patient comfortable. Fortunately, most herpes simplex infections resolve quickly through treatment.

There are two types of herpes simplex viruses; herpes simplex type 1 and type 2. The most common is a herpes simplex type 1 infection. This is the same virus that causes cold sores on your lips. In some people, herpes eye infection is caused by herpes simplex type 2. This virus more commonly causes genital herpes. A herpes simplex infection is diagnosed through a comprehensive eye exam and through special testing. Herpetic eye infections are most often seen in children.

Bacterial Infection

A bacterial eye infection may be the result of trauma, eye surgery, contact lens wear, immune deficiencies, or other diseases resulting in bacterial growth. The two most common bacterial infections of the eye are conjunctivitis, commonly known as pink eye and blepharitis, a chronic inflammation of the eyelids. With bacterial conjunctivitis, the eye is red, burns and gives off a yellow discharge(pus). With blepharitis, the eye is irritated, red and tearing. Eye infections can occur in any age group of patients, and if not treated, benign infections can develop into serious conditions. People who have undergone eye surgery or experienced trauma to the eye are at higher risk for infection.
A bacterial infection is diagnosed through a comprehensive eye exam. Based of the severity of the infection, a sample of the bacteria may be sent to pathology for identification. Treatment is usually the use of topical anti-infective solutions. With any infection, it is important not to rub your eyes; this will contaminate your hands and could spread the infection to others. Hand washing is always recommended throughout the day.

Pterygium

A pterygium is a pinkish, triangular-shaped benign tissue growth on the cornea. Drs. Schultze and Eden are able to surgically remove this growth.

Pterygia are most often found in 20-40 year old patients from sunny climates. A pterygium is visible and many people want to have it removed for cosmetic reasons. Surgery to remove a pterygium is usually not recommended unless it affects vision. If a pterygium is surgically removed, it may grow back, particularly if the patient is less than 40 years of age.

Eye Tumors

An eye tumor is an abnormal growth of any eye tissue. Any part of the eye or eye socket may be affected. If you notice a raised bump, bulging eyeball, skin color change, sudden visual loss, double vision, or eye pain, contact our office. A tumor can be either benign or malignant. Benign tumors often remain localized, while malignant tumors often spread into surrounding structures.

A tumor can affect the eye eyelid, socket, eyeball, eye muscles, optic nerve, fat, and other tissues. Diagnosis is completed through a comprehensive eye exam and a biopsy of the tumor. Fortunately, malignant tumors are rare, but any growth should be immediately evaluated.