HARTFORD EYE PHYSICIANS

EYE DISORDERS

GLAUCOMA

Glaucoma has been called the “sneak thief of sight” because most people with glaucoma have no symptoms. At first your vision appears normal and there is no pain. As the glaucoma progresses, however, you may notice your side vision is failing. In other words, objects in front of you may be seen clearly but those on the side may be missed. It may seem as though you are looking through a tunnel. As the disease progresses, the field of vision narrows and blindness may result. To prevent vision loss and blindness, you need to have your eyes examined on a regular basis by a qualified eye-care provider.

Glaucoma is the leading cause of irreversible blindness in African Americans and in all Americans over the age of 40. Approximately 3 million Americans have glaucoma, and more than half do not know it. Often it is not discovered until permanent damage and vision loss have occurred. Medical and surgical treatments for glaucoma are very effective at preventing blindness.

What Is Glaucoma?

"Glaucoma" is the term for a diverse group of eye diseases, all of which involve progressive damage to the optic nerve. Glaucoma is usually, but not always, accompanied by high intraocular (inside the eye) fluid pressure. Optic nerve damage produces certain characteristic defects in the individual’s peripheral (side) vision, or visual field.

There are many types of glaucoma. The most common are open-angle glaucoma and closed-angle glaucoma. Those rare individuals with symptoms may experience blurred vision, need for new glasses, loss of side vision and blank spots in your vision. If you have any of these symptoms, please contact us as soon as possible. The treatment for glaucoma is to lower the pressure in the eyes. This treatment may include medications, laser, or surgery.

Previously, it was believed that increased intraocular pressure (IOP), the pressure within the eye, was the only cause of damage to the optic nerve. However, now it is known that at least one third of people with glaucoma have eye pressure readings in the normal range. People may also develop glaucoma as a complication of surgery, as a result of medication usage, or as a result of other medical problems. As a chronic disease, glaucoma currently has no cure, and often it must be treated for as long as you live.

How Can I Reduce My Risk Factors?

Here are two ways you might be able to reduce your risk factors:

If you or a family member or friend is at risk for developing glaucoma, arrange to be screened for glaucoma. Every 2 years have an eye examination performed by one of professionals. Your eye examination may include: a family history, a measurement of intra-ocular pressure, an examination of the retina and optic nerve, and one or more field tests.

If you have been diagnosed with glaucoma, be sure to take your medication daily, as directed, and continue to see your eye-care provider regularly.

What Are the Treatments?

Glaucoma treatments include both medication and surgery. Topical medications are the most common early treatment for glaucoma. Some may cause your eye to make less fluid while others lower pressure by helping fluid drain from the eye. Topical medications may need to be taken several times a day in order to be effective. In addition to topical medication, laser treatment is now widely used to control intra-ocular pressure.

When is Surgery Recommended?

When medication and laser surgery fail to control progression of glaucoma, a surgical procedure known as a filtering operation is recommended to create an artificial outlet for fluid to drain from the eye, thus lowering intra-ocular pressure. In conclusion, the most helpful advice concerning glaucoma is to keep in mind the importance of early detection through routine eye examination, faithful use of prescribed medications, and close monitoring by an eye doctor of the optic nerve, visual fields and intra-ocular pressure.

Additional Information (external articles)

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CATARACTS

A cataract is the clouding of your eye's natural lens. A cataract scatters or blocks the light that passes into the eye and causes images to appear blurry. Cataracts are a natural part of aging and everyone gets them at some point. A clear lens inside the eye helps focus light. This lens allows images to be seen sharply. As a person ages, the lens slowly grows cloudy and turns yellow. It can happen so slowly that years may pass before you notice reduced vision. But as time passes, your vision may grow fuzzy. Colors may not appear as vivid. Glare may bother you both in bright sunlight and at night. Another scenario is that it may seem as if your glasses are always dirty. The good news is that your doctor can remove cataracts.

Small-Incision Cataract Surgery

Cataracts cannot be treated with lasers or medication. Surgery is still the only treatment option. During surgery the cloudy lens is removed and replaced with a clear, manmade intra-ocular lens (IOL). Cataract surgery is one of the most common and reliable operations. Each year, more than a million people have their vision improved through cataract surgery. Now the small-incision technique makes the procedure safer than it used to be and makes recovery quicker.

Small-Incision Surgery Benefits

The small-incision technique offers many benefits that can help you quickly get back to your normal activities. With small-incision cataract surgery:

You spend less time in the operating room
Your incision heals faster
You'll be back to your usual activities in days rather than weeks

Preparation for Small-Incision Cataracts Surgery

Hartford Eye Physicians will review your health history in detail and perform a thorough eye exam. During this exam, we will use devices that measure the length and curve of your eye. These measurements allow us to select the proper intra-ocular lens (IOL) for you. The night before your surgery do not eat or drink anything after midnight, except you may take your regular medications with water the morning of surgery. On the day of the surgery, have someone you know drive you to and from Constitution Eye Surgery facility. Plan to be at this facility for approximately 3 hours. Just before your surgery, medication will be given that will relax you and avoid any discomfort.

Risks & Complications

Cataract surgery is one of the most successful and reliable types of surgery. However, as with most operations, cataract surgery has risks including:

Your doctor may have to shift from a small incision to a larger incision
There is a small chance of bleeding, infection, or corneal swelling

When to Call Your Doctor

After the surgery, your eye may be initially bruised or bloodshot. Fortunately, these symptoms will not last long. In most instances, patients are able to resume normal activities the day after the operation. Call your doctor right away if you have any of the following symptoms:

Your pain is not relieved by over-the-counter medicine
You experience nausea and/or vomiting
Your vision suddenly becomes worse

Additional Information (external articles)

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OCULAR PLASTIC SURGERY

The delicate skin of your eyelids and the area around your eyes are susceptible to several disorders that can obstruct your vision. For example, impairment of the field of vision from baggy upper eyelids is a common problem. In short, sagging eyelids or excess skin around your eyes can restrict your ability to see, which can interfere with daily activities such as reading and driving.

For total eye health, your eyelids need to be healthy (as well as your eyes). Excess eyelid skin, droopy eyelids, or eyelids that curl inward or outward can cause eye discomfort, and even limit vision. Commonly treated conditions are:

Ptosis (upper eyelid drooping)
Sun-related skin cancers of the lids
Excess eyelid skin
Ectropion (outward turning of the lower eyelid)
Entropion (inward turning of the lower eyelid)

Fortunately, such eyelid conditions are correctable by plastic surgery. Hartford Eye Physicians is pleased to offer ocular plastic surgery to correct this problem. Dr. Scott L. Dolin is our specialist for these procedures and is available for consultation if you wish to know whether a procedure is appropriate for you.

Ocular plastic surgery (eyelid surgery) is performed using local anesthesia on an out-patient basis. Before surgery, Dr. Dolin will perform an eye examination and make recommendations. Photographs and visual field testing are often required by insurance companies before surgery.

If you are planning to have ocular plastic surgery, be sure to tell us if you are taking aspirin or aspirin-containing drugs, blood thinners, or if you have a bleeding problem. This surgery is generally safe; however, as with any surgery, there are certain risks. Dr.Dolin will review the risks of surgery and the phases of healing with you during your appointment. Generally, ocular plastic surgery has a short recovery (a few days). With years of experience treating these conditions, Hartford Eye Physicians is ready to assist you. We regularly witness that the improvement in vision, comfort, and appearance for our patients is often very gratifying for them.

Additional Information (external articles)

Acquired Ptosis - "Upper Eyelid Drooping"

Blepharoplasty - "Cosmetic Eyelid Surgery"

TEARING DISORDER

What is Tearing?

Small glands, located in the surface tissue on the white of the eye and lining the eyelids, constantly produce small quantities of tears to keep the eye healthy and lubricated. The lacrimal gland, a larger gland located in the upper eyelid, responds to emotion or eye irritation by producing larger quantities of tears. In some people, tears well up in the eye because too many tears are produced or, because the tears are not draining properly. Excess tears give the eye a moist appearance, and can collect along the border of the lower lid and overflow onto the cheek.

How do Tears Drain?

After bathing the eye's surface, tears enter a small opening in each lid (the punctum), and drain through a small canal (canaliculus) into the lacrimal sac and down the nasal lacrimal duct into the nose. This process explains why we have a runny nose when we cry, since excess tears reach the nose through the normal tear drainage system.

How Is Excessive Tearing Diagnosed?

A thorough examination by a qualified ophthalmologist is necessary to determine the cause of excessive tearing. The physician may attempt to irrigate fluid through the tear drainage system to locate a blockage. Although there are a variety of methods now used to test tear production, the most common involves the Schirmer Tear Test Strip. The Schirmer test measures reflex and basic tear secrection. The sterile strips are placed just inside the lower lid margin of each eye, and remain there for 5 minutes. During that time, the strip will absorb the tears that are produced by the eye. The strips contain a printed measuring line (in mm). The tear production is then measured by observing where the tear absorption line ended after 5 minutes. The test is painless, and causes no adverse side-effects.

If the lacrimal gland is producing tears properly and the "duct" that drains the tears from the eye into the nose becomes non-functioning, the tears will back up and spill over the eyelid and cause tears to run down the face. If one has a plugged up "tear duct," not only will tears spill over the eyelids and run down the face, but the stagnant tears within the system can become infected. An infection within the "tear duct" causes a painful swelling in the inner corner of the eyelids.

How Is Excessive Tearing Treated?

Treatment depends on the exact cause. If excess tears are caused by an in-turned eyelash, the offending eyelash is removed. Abnormalities of the eyelid may require surgery. If the tear drainage system is blocked, surgery to open or bypass the blockage may be necessary. Improper tear drainage is caused by:

Mal-positioned eyelid or punctum, or faulty blinking
Orbital injury (fractures, cuts)
Birth defects
Infections
Complications of burns or radiation therapy

The type of surgery depends on the location of the blockage. For example, it may be necessary to make an additional opening from the lacrimal sac into the nose, a procedure known as a dacryocystorhinostomy or DCR.

What Causes Excess Tearing?

Excessive tearing does not always mean an excess of tears or blockage of the drainage system. Patients with a dry eye often complain of tearing. When the amount of lubricating tears secreted is too low to maintain necessary moisture for the eye, the large lacrimal gland often reacts by producing additional tears which cause episodes of overflow tearing, even though the underlying problem is too few lubricating tears or dry eyes. Eye infections, lid problems, an in-turned eyelash, wind exposure, yawning, glaucoma, certain drugs, eyestrain or even dry eye can also cause excessive tearing.

Additional Information (external articles)

The Wet Eye - "Excessive Tearing"

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