What is catarcts ?

What is adult strabismus ?

What is glaucoma ?

What is amblyopia ?

What is trichiasis ?

What is astigmatism ?

What is vision ?

What is blepharitis ?

What is trauma ?

What is Bp causes ?

What is Bp symptoms ?

What is chalazion ?

What is corneal abrasion ?

What is detached retina ?

What is diabetes ?

What is entropion ?

What is flashes ?

What is herpes simplex ?

What is herpes zoster ?

What is hyperopia ?

What is macular degeneration ?

What is myopia ?

What is nasolacrimal duct obstruction ?

What is nystagmus ?

What is pterygium ?

What is ptosis ?

What is retinitis pigmentosa ?

What is trachoma ?

What is subconjuctival hemorrhage ?

What istwitching eyelids ?

viral conjunctivitis ?

 Cataracts

Cataracts occur as part of the normal aging process. Studies show that about 50% of all people will have some cataract formation before age 60 and close to 100% will develop them by age 70. Cataracts are the leading cause of vision loss in the world! They can severely impair your vision, but fortunately they can be treated. Today, modern surgical techniques, intraocular lens implantation and "same day surgery" make cataract surgery safe, fast and effective.
A cataract is a clouding of the normally clear lens in your eye that may cause blurred or hazy vision. As the cataract develops, the clouded lens reduces the amount of light that can enter your eye resulting in blurred or foggy vision. Currently, there is nothing you can do to prevent the formation of cataracts.
Treatment is indicated when decreased vision affects your everyday activities or hobbies. There are several techniques to remove the clouded lens. The most widely used technique is phacoemulsification. A very small incision is made and a tiny ultrasonic probe is used to break up the cataract and gently suction it away. A clear membrane is left in your eye where an intraocular lens is placed (IOL). This lens is necessary to replace the powerful lens that turned cloudy and has been removed. The IOL has almost eliminated the need for thick cataract glasses and contact lenses that were used years ago.
The benefits to this small incision surgery is the short period of time the procedure takes and the quick recovery time. Patients are able to eat a light snack and drink immediately after the surgery. The results of the surgery are almost immediate. Most people notice an improvement in their vision soon after surgery. You will still need glasses to read after the surgery. Your new prescription is given several weeks after the procedure.
No matter what your age, you want to enjoy an active and productive lifestyle. Improved vision will enhance your normal lifestyle and activities and add years of enjoyment to your life. 

Pediatric Cataracts .

Diagnosis and Evaluation The diagnosis of a congenital cataract can be made on the first day of life if a red reflex is not obtained in the newborn nursery. Early diagnosis and referral are important. Irreversible damage will occur if a congenital cataract is not treated in the first few months of life. 
Because of the association of cataracts with other ocular and systemic disorders, a thorough ocular and systemic evaluation should be performed in any child who presents with a cataract. A genetic evaluation may be indicated in some cases as well. 
Treatment If the cataract is determined to be visually significant, surgery is indicated to remove the involved lens. Once the visual axis is cleared, the child will require optical correction to allow visual rehabilitation. This may include the use of glasses, a contact lens or an intraocular lens implant. Because of the short diameter of the infant eye, a high power optical correction is necessary, which eliminates the use of glasses in an infant. Glasses may also be contraindicated in a child following unilateral cataract extraction because of their magnification effect and impediment to binocular vision. These contact lenses should not be thought of as a substitute for glasses as they may be in adult patients. They are an absolute necessity for infants with cataracts or an older child with a unilateral cataract. Although contact lenses have long been the gold standard in the rehabilitation of children with cataracts, many ophthalmologists now consider implanting an intraocular lens in the appropriate pediatric patient. Because of concerns regarding the immaturity and future growth of the infant eye, some surgeons prefer not to implant an intraocular lens in a very young child. 
Prognosis Children with bilateral cataracts tend to do better than those with unilateral cataracts. Amblyopia is a major obstacle to the development of good vision in these children. Amblyopia therapy is the single most important issue in the management of childhood cataracts. A good visual outcome is highly dependent on the compliance with amblyopia treatment. Other complications that can develop at any time following cataract surgery include retinal detachment and glaucoma. 

What is Pediatric Cataracts ?

A cataract is a clouding of a part of the eye known as the crystalline lens. The lens is a clear tissue located behind the pupil - the dark circular opening in the middle of the iris or colored part of the eye. The lens works with the transparent cornea, which covers the eye's surface, to focus light on the retina at the back of the eye. When the lens becomes cloudy, or cataractous, light cannot pass to the retina properly, and vision is blurred and decreased. 
Although cataracts result from many conditions, the most frequent cause is the natural aging process. Other causes may include injury, chronic eye disease, and other system-wide diseases such as diabetes. 
More than half the people over age 65 have some degree of cataract development. Cataracts can take from a few months to several years to develop. Sometimes, the cataract stops developing in its early stages, and vision is only slightly decreased. But if it continues to develop, vision is impaired, and treatment is necessary. 
Surgery to remove the diseased lens is the only effective treatment for cataract. Neither diet nor medications have not been shown to stop cataract formation. Cataract surgery is now a frequently performed operation in most parts of the world. More than one million cataract procedures are performed every year, and in the majority of those cases, the diseased tissue is replaced with an artificial device known as an intraocular lens implant. 

What happens in Cataract Surgery ?

In a cataract operation, the eye's natural lens is removed. Therefore, a new lens must replace the removed one for vision to be restored. This new lens can be in the form of special eyeglasses with thick lenses or contact lenses. Most commonly, it is in the form of an intraocular lens implant, which permanently replaces the old lens. 
The artificial lens is made of plastic and is usually inserted at the same time the cataract is removed. Depending on the individual case, the lens is placed directly behind or, less frequently, in front of the iris, the "colored" part of the eye. Not every case is appropriate for this type of procedure, and the method of implantation used depends on the individual patient. 
Once the surgeon has determined that intraocular lens replacement is appropriate, the patient undergoes a special preoperative evaluation. Like contact lenses and "prescription" eyeglasses, intraocular lenses differ in terms of refractive power, and the evaluation will determine the proper lens power of the implant. The length of the eye is measured and the curvature of the cornea is evaluated. Calculation of the implant power is based on this information and performed on a computer. 
The natural lens has the ability to accommodate, or change shape, so that it is possible to focus at varying distances. The intraocular lens, which cannot change shape, is usually calculated for a middle distance so that the patient can see well enough to move about without glasses. Normal eyeglasses must still be worn to see up close up and far away. In most cases, though, patients notice significant improvements in vision resulting from intraocular lens implantation. 
Generally speaking, cataract surgery lasts about an hour and is usually performed on an outpatient basis. After a brief rest after surgery, the patient generally returns home the same day. 
In some cases where there is a previously existing medical problem or when advised by the surgeon, hospitalization may be needed. 
Because of inflammation related to the surgery, initial vision may remain cloudy for a few days or weeks. Clear vision generally returns in about three months.

Glaucoma

About glaucoma . 

On this page, we address the four questions listed below. In each section, you are invited to find out more about the subject by means of a link to the online edition of Patient Guide, Doctor, I Have a Question. · What is glaucoma?· Who is at risk for glaucoma?· How do I find out if I have glaucoma?· How do I minimize the risk of getting glaucoma? Where can I find other online resources?

· What is glaucoma?Glaucoma is a specific pattern of optic nerve damage and visual field loss caused by a number of different eye diseases which can affect the eye. Most, but not all of these diseases, are characterized by elevated intraocular pressure, which is not the disease itself, but the most important risk factor for the development of glaucoma.The disease is called the `sneak thief of sight´ because it strikes without obvious symptoms. Therefore, the person with glaucoma is usually unaware of it until serious loss of vision has occurred. In fact, half of those suffering damage from glaucoma do not know it. Currently, damage from glaucoma cannot be reversed. Research funded by The Glaucoma Foundation seeks to find a cure.For further details, see Patient Guide, Doctor, I Have a Question.· Who is at risk for glaucoma?Everyone should be concerned about glaucoma and its effects. It is important for each of us, from infants to senior citizens, to have our eyes checked regularly, because early detection and treatment of glaucoma are the only ways to prevent vision impairment and blindness. There are a few conditions related to this disease which tend to put some people at greater risk. This may apply to you if:o you are over 45 and have not had your eyes examined regularly o someone in your family has a history of glaucoma o you have abnormally high intraocular pressure o you are of African descent o you have diabetes o myopia (nearsighted) o regular, long-term steroid/cortisone use o previous eye injury In angle-closure glaucoma, intraocular pressure (IOP) can increase suddenly, causing an angle-closure (acute glaucoma) attack. This attack can occur within a matter of hours and become very painful. Possible indications include:o intense pain, which may result in nausea and vomiting o red eye(s) o swollen or cloudy cornea(s) o halos around lights (rainbow-colored rings around lights) o recurrent blurry vision o morning headaches o pain around your eyes after watching TV or leaving a dark theater See also Patient Guide, Doctor, I Have a Question.Please consult the chart below to determine how often you should visit your eye doctor for a comprehensive glaucoma examination. This chart is based upon age and whether or not you have any characteristics (as listed above) that place you at greater risk of developing glaucoma.

Your eye doctor can perform a series of simple tests which will help to determine whether or not you have glaucoma or are especially likely to develop the disease -- even before you have any symptoms. The diagnostic tools available to your doctor are described in our Patient Guide, Doctor, I Have a Question

How do I minimize the risk of getting glaucoma?

The most important thing you can do to protect your vision from glaucoma is to have regular eye exams. If your eye doctor finds that you have the disease or that you are at risk for the disease, he or she can recommend treatment to minimize the risks or the effects of the disease

Types of Glaucoma .

Glaucoma is a leading cause of blindness in the United States, especially for older people. Loss of vision is preventable if treatment begins early enough.It is a disease of the optic nerve which carries images to the brain. The higher the pressure in the eye, the greater the opportunity to damage the optic nerve. High pressure can not be felt, but is measured with a special instrument called a tonometer which should be a part of every routine eye exam.
Glaucoma rarely has symptoms before it affects vision. This is the reason that routine eye exams are critical. Early detection are the keys to preventing vision loss or blindness from glaucoma.Chronic open-angle glaucoma is the most common type of glaucoma. It occurs as a result of aging and is a result of poor drainage of the clear liquid inside of the eye. This liquid is not part of the tears that we normally have in our eyes. Poor draining increases pressure which causes optic nerve damage. It is so gradual and painless that you are unaware there is a problem until the nerve is badly damaged. This damage is not reversible. Over 90% of adult glaucoma patients have this type of glaucoma.
Angle-closure glaucoma is when the drainage system is completely blocked. This occurs very quickly and has symptoms that include blurred vision, severe pain in the eye, headache, rainbows or haloes around lights and nausea and vomiting. Angle closure glaucoma is an emergency. If it is not treated immediately, blindness may result.
The risk factors for glaucoma include age, nearsightedness, family history of glaucoma, African ancestry, past injury to the eyes, and a history of severe anemia or shock.
Glaucoma is usually treated with eye drops that are taken several times a day. Laser surgery may be used for glaucoma and sometimes surgery is performed if the eye drops do not control the 

What is color vision ?

What causes Double Vision?

The human eye is quite amazing. Considering the eye's ability to discriminate miniscule differences in colors, we can see approximately 8,000 colors in nearly 8 million different shades and tints.
The "normal" eye is trichromatic. This means we can see three basic colors: red, green and blue. The brain blends these colors to obtain the large variety of colors we perceive.
The retina is composed of 10 layers with nearly 2 million nerve fibers. When stimulated by light, they transmit electrical impulses from our eyes to the brain where the signals are interpreted to give vision. The retina is the focus of our "color receptors".
Receptors, called rods, function well in dimly lit situations. Rods perceive only black, white and shades of grey. Cones are the second type of receptor. This type of receptor functions to provide daytime vision, but also are responsible for color vision. There are about 3 times more rods than cones.
There are 3 types of cones: red, green and blue which blend these colors to give all of the other colors we see. The fovea, a tiny pit in the retina, has the highest concentration of cones. The fovea gives us our finest central detailed vision.
The purpose of color vision testing is to identify color defects in your vision. Screening methods are commonly used color tests that test your gross perception of color. If necessary, other tests can be performed to analyze specific color vision defects. 

What causes Double Vision?

Diplopia, the medical term for double vision, can be caused by a number of disorders. Diplopia can be monocular or binocular.
Monocular diplopia does not go away when either eye is closed. This type of diplopia can be caused by defects in the front part of the eye, cataracts or the need for glasses.
Binocular diplopia does go away when either eye is closed. This is caused by a misalignment of the eyes which can be secondary to many disorders. A new onset of binocular diplopia should be brought to the attention of your doctor promptly.

What is trichiasis ?

Trichiasis is an uncomfortable condition in which the eyelashes are misdirected toward the eyeball and scratch its surface, the cornea. The position of the lower lid is normal, but the lashes point in the wrong direction. This may cause infection and scarring of the cornea.
The most common cause is chronic inflammation with scarring in the lower lid. Such scarring can occur from lid infections, skin diseases, or from trauma and poor healing of the lid tissues.
Treatment by removal of the lashes is frustrating, because within a few weeks the lashes return to irritate the eye. Removal does provide temporary relief, however. Permanent destruction of the lash follicle is the only sure way to prevent recurrences. This can be done by one of the following methods:
The first is electrolysis. Here an electric current is passed through the base of the lash in hopes of killing the cells that produce the hair. Recurrence rates are very high, and scarring can be a problem.
The second is a newer method called cryosurgery. Here a general area is frozen with an appropriate instrument, thus disturbing the micro circulation and thereby killing the hair follicles. Recurrence rates with cryosurgery are much lower than with electrolysis. Refreezing is only occasionally necessary. Ordinarily no local anesthetic is used. The lid does swell within a few minutes and sometimes forms a blister. Oozing is common for several days after the procedure. With time, the lid returns to an almost normal appearance without the offending lashes.
An even newer method is now being investigated, in which the offending lashes are treated with an Argon LASER to destroy the hair follicle. Early results are positive, but more work needs to be done to make sure this treatment is well tolerated and safe.

What is Trauma ?

Ocular Trauma 
Blunt Trauma 
Open eye trauma 
Orbital Trauma
ORBITAL PENETRATING INJURIES
ORBITAL BLOW-OUT FRACTURES
TRAUMATIC OPTIC NEUROPATHY

Ocular Trauma 

Ocular trauma is a common casualty referral. They can result from fight, fall, foreign body at work or road traffic accident. It is important for the referring doctor to differentiate blunt ocular trauma from perforating ocular injuries. The latter may leave the eye with an open wound which can lead rapidly to sight-threatening infection if not referred early. 
Ocular trauma often has medicolegal implication, it is important for the attending physician to keep a good record including the presenting visual acuity. 

Blunt Trauma 

This usually results from fist, sport injury (tennis or squash ball injury). Presentation: · Black eye is common due to skin ecchymosis · Painful eye results from corneal abrasion and rarely raised intraocular pressure · Reduced vision from hyphaema or retina contusion · Double vision may occur due to blow-out fracture or introrbital haemorrhage Examination: · Corneal abrasion is best seen by instillation of fluorescein dye and examine with a blue light · Hyphaema may show up as blood level in the anterior chamber · The pupil may be dilated due to traumatic mydriasis · Posterior segment examination with direct ophthalmoscope is usually difficult due to swollen lid, abrasion or hyphaema. Management: Refer the patient within 24 hours after seeing to exclude any serious ocular injury which may include:

* hyphaema 

* cataract

* retinal oedema

* retinal haemorrhage 

* globe perforation (rare)

* blow oud fracture.

ORBITAL BLOW-OUT FRACTURES

The eye is protected by a pear-shaped bony orbit. The bony floor of the orbit is particularly susceptible to a type of fracture called a "blow-out" fracture. The force of a non-penetrating object greater in size than the orbital entrance can result in a "blow-out fracture." Typically, these types of fractures are caused when the orbit is struck by a ball, fist, or a dashboard during a motor vehicle accident.You may notice bruising around the eye, double vision (diplopia), protrusion of the eye (proptosis) and/or numbness in the cheek and upper teeth areas. Your eye plastic surgeon will perform a complete ocular examination to assure that no damage has occurred to the eye. This exam may include a test where the eye is rotated to assess whether the eye muscles are involved in the fracture site. A radiological study, such as a CT scan, will be performed to assess the extent of the fracture. Your eye plastic surgeon may request that you limit pressure on the fractured site by avoiding blowing your nose and by limiting physical activity.Based upon this complete evaluation, your eye plastic surgeon may recommend surgical correction of the "blow-out" fracture either initially or within the next few weeks. Factors that will influence this decision include persistence of double vision, enophthalmos (eye appears shrunken in the orbit as swelling subsides), involvement of eye muscles and the size of the fracture. Your eye plastic surgeon will determine if surgery is necessary in your individual case to achieve satisfying cosmetic and functional results.

TRAUMATIC OPTIC NEUROPATHY

Craniofacial Trauma (head & face) may result in injury to the optic nerve, the nerve that connects the eye to the brain. This type of injury is present in less than 5% of closed head trauma cases. Injury can occur not only from fractures in the bony canal around the optic nerve, but also from swelling or damage to the blood vessels supplying the optic nerve.Visual loss usually occurs instantaneously, but delayed visual loss is possible. Your eye plastic surgeon will perform a complete ocular examiantion to assure that no damage has occurred to the eye. A radiological study, such as a CT scan or MRI scan, will be performed to assess the optic nerve and optic canal.Based on this information, your eye plastic surgeon will recommend one of the following treatments: (1) Intravenous steroids, or (2) Surgical intervention to correct fractures in the bony canal surrounding the optic nerve. Your eye plastic surgeon will monitor you closely in the hospital for your response to the selected treatment. Eye plastic surgeons around the country are currently participating in a collaborative study to determine the most appropriate treatment for patients with traumatic optic neuropathy.

Adult Strabismus

What is Adult Strabismus?

Strabismus is the medical term relating to a misalignment of the eyes. When strabismus occurs in an adult for the first time, it leads to double vision, or diplopia . 
Causes of Strabismus in an adult
The following are the most common causes of strabismus in adults:
1. Strabismus in an adult who had a history of strabismus as a child. Many children are successfully treated for strabismus only to redevelop strabismus later in life. This may be secondary to the inability of a person to use both eyes together (binocular vision) or other unknown causes. 
2. Poor vision in one eye. People who have one eye that does not see well when fully corrected with glasses will often develop strabismus with time. Most often, the poor seeing eyes drifts outward. 
3. Vascular insults to a nerve that controls the movement of one or more eye muscles can lead to strabismus. This is most often seen in older adults with a history of diabetes or high blood pressure. 
Treatment of Strabismus in Adults Treatment of strabismus in an adult depends on the cause of the strabismus. Small deviations that cause double vision can often be treated with prism glasses. These glasses do not "cure" the problem. They "compensate" for it by allowing the eye to deviate and adjust the rays of light that enter the eye to deviate in the correct direction in order to eliminate double vision. Only a relatively small strabismus can be treated as prism glasses may distort vision and can be very thick. 
Most strabismus caused by microvascular insults get better with time. Therefore, the treatment for this form of strabismus is often time. Patching one eye, or the use of prism glasses, may eliminate the bothersome double vision until time has allowed the problem to correct itself.
Patients with a history of strabismus, poor vision in one eye that has lead to the development of strabismus and a large angle strabismus may be helped with strabismus surgery.
Summary
Adult strabismus is very common and has a number of causes. Most adult patients can be helped with a variety of treatment modalities.

Amblyopia

About Amblyopia .
The immature brain of a child
Causes of amblyopia
Treatment of amblyopia

About Amblyopia .

Amblyopia is the medical term for poor vision in one, or sometimes both eyes. It is generally caused by lack of use of one eye when the brain "favors" one eye over the other. In most cases, the eye itself is normal but is different in some way to cause this preference. In essence, amblyopia is a disorder of the brain cells that control the vision in one eye, not a problem with the eye itself. The brain cells diminish in size when they are not used.

The immature brain of a child

The visual brain cells of a child are developing during their first decade of life. Any insult to the child's vision during this time period can lead to amblyopia. Likewise, amblyopia must be corrected during this time of development. Once the brain cells have matured, they can not be stimulated to develop if they have not been previously. 

Causes of amblyopia

The most common forms of amblyopia are strabismic and anisometropic. Strabismic amblyopia occurs when a strabismus is present and the eyes are not aligned. The brain favors one eye over the other and the non-preferred eye is not adequately stimulated and the visual brain cells do not mature normally. Anisometropia refers to the condition when the eyes have an unequal "refractive power". One eye may be nearsighted and the other is farsighted. Because the brain can not "balance" this difference, it picks the eye that is "easier" to use and develops a preference for this eye only. Other causes of amblyopia include: cataracts , ptosis and trauma.

Treatment of amblyopia

In most cases amblyopia is treatable. However, the success of treatment is dependent upon the initial level of vision, the amount of time the vision has been poor and the age of the child. The most important factor in treating amblyopia is compliance with the treatment protocol. Treatment requires "forcing" the brain to use the non-preferred eye. In most cases this means patching the normal eye for most or all of the day. Glasses may also be required to "balance" an unequal refractive power between the two eyes. If a cataract is present, this may need to be removed before amblyopia treatment can be started. The initial treatment period may be difficult for the child, as he/she is being made to use their "bad" eye. This usually lasts a short period of time, as their vision improves rapidly. It can not be overemphasized that the major reason for failure in the treatment of amblyopia is poor compliance with the treatment protocol. Remember, amblyopia can be treated only when a child is young. If it is delayed until the child is older and more understanding, it may be too late!

Astigmatism

Astigmatism may be one of the most misunderstood words in the English language! To illustrate what astigmatism really is, compare an egg to a ping-pong ball, or a football to a basketball. Because they are not perfectly round, the egg and the football have lots of astigmatism, whereas the ping-pong ball and the basketball have none.
Similarly, two round surfaces in the eye are responsible for focusing light: the clear outer window of the eye called the cornea and the lens, which resides just behind the colored part of the eye (the iris). If one or both of these surfaces are NOT perfectly spherical or round, we say that astigmatism is present.
The usual site of this irregularity in the eye is the cornea. It is a normal variant and, if present, may be considered one of nature's imperfections. Rarely astigmatism is caused by lid swellings such as chalazia, and corneal scars, or by keratoconus (a rare condition in which the cornea becomes misshapen and pointed rather than smooth and rounded).
Astigmatism may cause blurred vision, eye strain or even headaches. Small amounts of astigmatism can be ignored, but if any of its symptoms are present, astigmatism can be corrected by glasses or contact lenses. In most patients hard contact lenses do a better job of correcting for astigmatism than soft contact lenses. 

Blepharitis

Blepharitis is a common, chronic infection and inflammation of the eyelids. Chronic means that once present, it will always be present - but its severity will fluctuate. Symptoms include redness, swelling, and itching of the eyelids. Symptoms may disappear for months or even years and then recur.
The most important factor in controlling blepharitis is keeping your lashes meticulously clean. This can be accomplished by daily cleaning with a mild baby shampoo solution (a few drops of baby shampoo in a cup of warm water).
Once the symptoms are under control, this cleaning may be decreased from daily to twice weekly. However, if the symptoms return, daily cleansing should be resumed immediately. Medication is of secondary importance in the treatment. In some cases eye drops or ointment will be prescribed to be used along with the daily cleansing.
However, medication alone is not sufficient; keeping the eyelids clean is essential. Warm, moist compresses can also help relieve the symptoms of blepharitis when used in conjunction with regular eyelid cleansing.
There are two main causes of blepharitis: staphylococcus bacteria and seborrhea. Staphylococcus bacteria commonly begins in childhood and continues throughout adulthood. Common symptoms include collar scales on lashes, crusting, and chronic redness at the lid margin. Also seen are dilated blood vessels, loss of lashes, sties, and chalazia. If left untreated, infection and scarring of the cornea and conjunctiva can occur.
Seborrhea is secondary to overactive glands causing greasy, waxy scales to accumulate along the eyelid margins. Seborrhea may be a part of an overall skin disorder that affects other areas. Hormones, nutrition, general physical condition and stress are factors in seborrhea. 

CAUSES of Bell's Palsy

OTHER VIRAL LINKS
RAMSEY HUNT SYNDROME
Symptoms
HIV / AIDS
BACTERIAL TRIGGERS.
BILATERAL
MELKERSSON-ROSENTHAL SYNDROME

HERPES SIMPLEX 1

  far back as 1970, Herpes Simplex 1 was suggested as a cause of Bell's palsy (Dr. Kedar Adour). Some Bells palsy must still be designated as idiopathic, but a 1995 study (Dr. Shingo Murakami and others) points compellingly to the herpes simplex virus (HSV-1) as the most frequent cause of Bell's palsy, possibly accounting for 60 - 70% of cases. Additional research since this study was published has been reinforcing the conclusion.
Exposure to HSV-1 is common; a vast majority of the population has been exposed to it. Most people are exposed during childhood (sharing towels, utensils, etc.). The active virus is commonly associated with cold sores, but the virus often runs its course without causing any blisters - blisters actually appear only 15% of the time. This results in a large population of HSV-1 carriers who do not know they've been exposed to the virus.
HSV-1 is only infectious for a short time following the incubation period. It then enters a dormant state, residing on nerve tissue. For most people, the virus remains dormant forever. However, there are triggers that can cause the dormant virus to reactivate. When this occurs the immune system begins to produce antibodies, causing an inflammation. This is a normal function, and is part of the process that eliminates harmful foreign bodies sV-1 the inflammation can be at the 7th nerve, and in the area (described above) that the nerve is in a tight, bony canal with no room for swelling. The resulting inflammation exerts pressure on the nerve, compressing it. Compression of the nerve is the injury that stops transmission of signals to muscles. Unabluch as viruses and bacteria so that we can recover from illness and injury. With reactivated HSe to recieve signals to contract and relax, the muscles become temporarily weakened or paralysed. 
The triggers for reactivation of the virus have not been proven conclusively. Impaired immunity, whether temporary (stress, lack of sleep, minor illness, upper respiratory infection, etc.) or long-term (autoimmune syndromes, chronic disease, etc.) is strongly targeted as the most likely trigger.

OTHER VIRAL LINKS

There has been research implicating other viruses, including cytomegalovirus, Epstein-Barr, rubella and mumps, in the etiology of Bell's palsy. As with the herpes virus, potential triggers appear to be related to conditions that affect the immune system. The internal process that would cause the nerve to become compressed and result in Bells palsy is currently thought to be the same as described above for the Herpes virus.

RAMSEY HUNT SYNDROME

Ramsey Hunt syndrome is similar to Bell's palsy. Unlike Bells palsy, the virus that causes Ramsey-Hunt syndrome has been conclusively identified. It is varicella zoster virus (VSV), which is the virus that causes chicken pox, and is a strain of the Herpes virus. Like HSV-1, it remains in the body, residing on nerve tissue in a dormant state on nerve ganglia after the initial infectious stage has passed.
Ramsey-Hunt syndrome results in symptoms that are in many respects identical to Bell's palsy. The symptoms are so alike that a diagnosis of Ramsey Hunt syndrome can easily be missed.
When the VSV virus is reactivated the resulting eruptions (blisters) are known as shingles. The first symptom is usually severe pain. There may also be a fever, headache, and localized tenderness. Blisters typically begin to emerge 1.5 to 3 days after the onset of these symptoms, although they may emerge with no prior symptoms.

Symptoms

In addition to the "classic" symptoms of Bells palsy, Ramsey Hunt syndrome is associated with some additional symptoms that help differentiate it. Knowledge of these symptoms is key to an early diagnosis, and should be brought to a doctor's attention during the first visit, or when any of these symptoms become apparent.

1. Pain: Bell's palsy patients may complain of pain (often in or behind the ear) which can be acute. However, it will tend to fade within a week or two. The pain associated with Ramsey Hunt syndrome is often more severe, and more likely to be felt inside the ear. It may start before muscle weakness is apparent, and may last for weeks or months; sometimes longer. Medications such as Neurontin can ease the post-herpatic pain of Ramsey Hunt syndrome.

2. Vertigo: Dizziness is occasionally reported by Bells palsy patients, but is often associated with Ramsey Hunt syndrome. It can be more severe, and longer lasting.
3. Hearing loss: Unlike Bell's palsy, Ramsey Hunt syndrome can also affect the auditory nerve (CN-VIII), resulting in hearing deficit. This should not occur with Bells palsy, and is an important clue to the diagnosing physician. In some cases hearing loss will continue after facial muscle function returns.
4. Blisters: The primary symptom that makes a diagnosis of Ramsey Hunt syndrome likely is the appearance of blisters (known as shingles, or herpes zoster) in the ear. The blisters can appear prior to, concurrent to, or after the onset of facial paralysis. They can be expected to last 2 - 5 weeks, and can be quite painful. The pain can continue after the blisters have disappeared. Blisters are often the only clearly visible symptom that identifies Ramsay Hunt. Unfortunately, they may not be evident during the diagnostic examination. They can be present, but too deep within the ear to be visible. Or they can be too small to be seen. In some cases they may not appear until a week or more after the onset of muscle weakness. At times they do not appear in the ear at all, but may be present in the mouth or throat. It is also possible for the virus to reactivate without blisters at all.
5. Swollen and tender lymph nodes near the affected area.
Unlike reactivated HSV-1, shingles is contagious. Contact with an open blister by someone who has never had chickenpox can result in transmission of the virus. The result will be chickenpox, not shingles or facial paralysis.

HIV / AIDS

HIV can cause facial paralysis and increases the chance of developing Ramsey Hunt syndrome, as well as Bell's palsy. In the early stage of HIV, paralysis can be directly due to the viral infection. In later stages paralysis is more likely to be associated with the opportunistic infections or tumors associated with severe immune deficiency. Herpes zoster has been confirmed to be associated with suppressed immune systems.

BACTERIAL TRIGGERS...

Lyme disease can cause facial paralysis and the same symptoms as Bells palsy. Bacteria enter the body through the skin at the site of the tick bite. Typical early symptoms of Lyme disease are a red ring around the site of the bite and flu-like symptoms. Unfortunately these symptoms do not always appear. The early symptoms will pass, but administration of an antibiotic as early as possible is important to avoid serious problems later. Without an antibiotic the bacteria can spread throughout the body, causing arthritis, heart disease, and nervous system disorders such as facial paralysis.
Otitis Media - Bacteria from some acute or chronic middle ear infections can invade the canal around the nerve through small portals. As with viruses, the presence of bacteria can evoke an inflammatory response, and compress the nerve.

BILATERAL ...

Bell's palsy and Ramsey Hunt syndrome can be bilateral, but it's extremely rare. Mononucleosis, the flu, Guillain - Barre Syndrome, leukemia, lyme disease, sarcoidosis and Heerdfort's Syndrome are among the potential triggers of bilateral palsy.

MELKERSSON-ROSENTHAL SYNDROME

Melkersson-Rosenthal syndrome can result in unilateral or bilateral palsy. The palsy will tend to be recurrent, to such an extent that it's sometimes described as intermittant or bilateral. Recurrences don't follow any pattern - each recurrence can be on the same side, alternating side, or bilateral.
Diagnosis of this syndrome can easily be missed, as the obvious symptoms may look like Bells palsy. However, unlike Melkersson-Rosenthal syndrome Bell's palsy recurrences tend to be separated by wide timespans.
Another symptom that can help differentiate it from Bell's palsy is swelling of one or both lips. Facial edema (swelling) and/or swollen eyelids may also be evident, and the tongue can also appear to have fissures. Signs of this disorder usually begin in early adulthood, but it can occur at any age. The syndrome is rare, and the cause in not known.
OTHER CAUSES ...
Facial and surgical wounds, trauma due to a blunt force, temporal bone fractures, brain stem injuries, acoustic neuromas, cysts and tumors can result in facial palsy. Lupus, Sjogrens syndrome and congenital defects can, infrequently, cause facial paralysis.

SYMPTOMS of Bell's Palsy

The onset of paralysis is sudden with Bells palsy and Ramsey Hunt syndrome, although symptoms can worsen during the early days. Bell's palsy symptoms typically peak within a few days, although it can take as long as 2 weeks. Ramsey Hunt syndrome symptoms will peak within 3 weeks. If paralysis develops slowly, tests for other causes of the palsy must be done. Patients with recurrences, particularly if within close time frames, should also be re-evaluated as a precautionary measure.
Psychologically, facial paralysis can be devastating, particularly in cases that extend for a long period, or where residuals are significant. Friends, family and doctors often have no true concept of how deeply the patient's sense of self and self-esteem is affected. You will also find that they have little or no understanding of your physical discomfort, difficulty and frustration as you struggle to do seemingly simple things that they take for granted.
There are many physical symptoms associated with facial paralysis, but the effects will differ between individuals. They can vary in accordance with the degree of nerve damage, and the location of the damage.

Chalazion

Along the upper and lower lids are located a number of glands that manufacture part of the tear film that protects and lubricates the eyeball. If one of these glands becomes blocked, a small lump forms. This is called a chalazion (chalazia, plural).
Chalazia may vary in size from small, almost invisible lumps, to rather large masses as big as a little fingernail. Sometimes tender in their early stages, they are later painless and frequently will form a firm swelling in the lid. This lump can distort the eyeball, causing blurred vision if left untreated.
Chalazia are NOT caused by infection. They may become a site for infection once they have become established, however.
Their exact CAUSE remains unknown. Several conditions are associated with chalazia: seborrhea, chronic lid inflammation, dry eyes, and acne. Once a chalazion has formed, the chances of getting another one in the next two years are very high.
Most chalazia will disappear in a few weeks without any special therapy. To help them go away, frequent hot packs throughout the day and drops are helpful, especially in the early stages. In some cases, oral medications can help prevent recurrences.
If a chalazion persists, a simple in-office surgical procedure can be performed to remove it. The chalazion is drained from the inside or the outside of the lid after a small injection of a local anesthetic. The eye is often patched overnight to insure proper healing. Healing tends to be uncomplicated with minor pain only, but chalazia can recur and excision cannot guarantee complete resolution.

Corneal Abrasion

One of the most common injuries to the eye is an abrasion. In this condition the surface layer of the eye (epithelium) is removed by such dangerous intruders as baby's fingernails, tree limbs, bushes and the like.
Abrasions are very painful. They also cause excessive tearing, redness, blurred vision and light sensitivity. These usually heal in a short period of time. A good night's sleep is the cure is most instances. Treatment consists of a tight patch to keep the lids from moving and pain relievers as needed for comfort.
Often an antibiotic is instilled into the eye because an abrasion invites infection. Abrasions covering small areas heal rapidly; those covering more than one-third of the cornea may take an extra day or two to completely cover over again.
In the office a local anesthetic is instilled into the eye for temporary relief and for ease in making a reasonable examination of the injury. (Repeated use of anesthetic can harm the eye and is therefore NOT used in the treatment of abrasions.) Permanent loss of vision is very rare with superficial abrasions. It may take several weeks for all the blurriness to resolve, however.
It is important to NOT rub the eyes during the healing phase. The new cells have poor connections to the underlying tissue and can easily be rubbed off. When this occurs, the pain returns and repatching is necessary.
Occasionally, long after an abrasion has healed it recurs spontaneously, often upon awakening in the morning. This is called a recurrent erosion and represents an area of the epithelium that is not "glued" down well to the deeper parts of the cornea.
The treatment is similar to that for the abrasion. Sometimes the surface of the cornea is treated with a special instrument in order to help form better connections between the corneal layers. Extended use of bedtime ointments or lubricants may also help in preventing recurrent erosions. 

Detached Retina

The retina lines the inside of your eye and is responsible for sending images to your brain. This is similar to the film inside of a camera. When the retina pulls away from the eye, one has a retinal detachment.
The symptoms may include flashing lights, a "curtain" over the vision, or many floaters. Sometimes these symptoms are present without a retinal detachment. An immediate exam is necessary if you experience these symptoms.
If a retinal tear is diagnosed, treatment is done with a laser or freezing technique (cryotherapy) that seals the tear. This will usually prevent a retinal tear. If the retina is detached, surgery is performed to place the retina back into position.

Diabetes

If you have diabetes mellitus, your vision can be affected by cataracts, glaucoma and damage to the blood vessels in the eye. This is called diabetic retinopathy.
The retina lines the inside of your eye and is responsible for sending images to your brain. When the blood vessels are damaged, they may leak fluid or blood and grow scar tissue. This affects the quality of image sent to your brain and therefore your vision.
Diabetic Retinopathy is the leading cause of new blindness among adults in the United States. If untreated, there is a risk of becoming blind. The longer one has diabetes, the higher the incidence of developing diabetic retinopathy. Approximately 80% of people who have diabetes for 15 years have some damage to their retina. With today's treatment only a small percentage of people have serious vision problems.
There are two types of diabetic retinopathy. Background retinopathy is the early stage. Usually vision is not affected, but it can advance and cause vision problems. There usually are no symptoms with background diabetic retinopathy. An exam is the only way to diagnose changes in your eyes.
Proliferative retinopathy causes new and abnormal blood vessels to grow on the retina. These vessels may bleed which causes the vision to become hazy and sometimes causing a total loss of vision. There is no pain but this stage requires immediate medical attention. New vessels may also form scar tissue and pull the retina away from the back of the eye. Treatment is necessary to prevent severe loss of vision. If you are diabetic, regular eye exams are crucial. The disease can improve with treatment.

Entropion

Entropion is an inward turning of the lower eyelid margin against the eyeball. Patients complain of the lashes rubbing against the eye, which can cause damage to the cornea by ulceration and infection. The basic causes are:
1. AGE.
The eye lid is held in good position by two sets of muscles. One pulls the eyelid AWAY from the eyeball, while the other turns the lid TOWARDS the eye, and ENTROPION results. This imbalance is a natural consequence of the aging process.
2. SCARRING.
This may result from many different diseases or injuries again causing the characteristic imbalance in the muscles controlling the lower lid.
3. CONGENITAL.
An entropion from birth is very rare.
4. SPASTICITY.
Here the eyes are vigorously closed because of inflammation, eye surgery or injury. The lower lid may turn on itself due to this strenuous attempt at closure.
Treatment is surgical in most cases - except for the temporary spastic entropion, which will clear up when the inciting agent is removed. The purpose of surgery is to strengthen the muscles that draw the lid away from the eye. Sometimes a better approach is to tighten up the whole lid to put it in better position. Each patient is different, and many factors are taken into consideration in planning the correct surgical procedure.
Entropion repair is done with a local anesthetic and takes only a few minutes to perform. Potential problems with this surgery include:
(1) overcorrection with consequent eversion of the lower lid (this usually corrects itself within a few weeks), (2) infection, and (3) recurrence.
Recurrence rates have improved dramatically with better understanding of the abnormal muscles involved and better surgical techniques. 

Flashes & Floaters

Flashes and floaters most often indicate a Posterior Vitreous Detachment (PVD) which is a rather dramatic event in the normal aging process of the human eye. The vitreous is the jelly-like material that fills the large central cavity of the eye. It is 98% water & 2% proteins, which give the vitreous a stiff consistency similar to double-strength gelatin. The vitreous has normal connections to the retina, the light sensitive layer in the back of the eye.
As we age, the watery elements in the vitreous separate from the fibrous components. With this comes a contraction of the fibrous elements away from the retina--a Posterior Vitreous Detachment. This contraction on the retina is responsible for the characteristic "flashes" that often accompany PVD's. The "floaters" frequently reported are from the reorganization of the fibrous elements as well as from some fragments of retina that may have been dragged into the vitreous cavity by this separation. Besides age, other contributing factors include nearsightedness and injuries to the eye. Both may speed up the normal aging process.
All patients who experience a recent onset of flashes and floaters should be examined carefully by an ophthalmologist. Most of the time nothing unusual is found, and simple reassurance is all that is needed. The flashes eventually go away, and the floaters diminish and become less bothersome with time.
However, a tear in the retina is found in about 10% of eyes with a PVD. If left untreated, these tears may lead to a retinal detachment, a very serious sight threatening condition requiring a major surgical procedure to repair. Even in the best of hands, the results of this procedure can be very unpredictable. When symptoms appear, it is important to examine the eye within a day of their onset. Changes can occur rapidly, and time can be of the essence if a retinal detachment is present.
Even if all is normal in the first eye, patients cannot assume that all will be well with the second one. It also should be carefully examined and treated if necessary. If retinal tears are found, treatment is simple and very effective. They should be sealed to prevent a retinal detachment. This is done either by spot welding several circles of burns around the tear with a LASER or by sealing it with a freezing unit. Both accomplish the same purpose with good results and low complication rates. The procedure is done in an outpatient setting under a local anesthetic. 

Herpes Simplex 

WHAT IS HERPES SIMPLEX?

Herpes simplex is a virus that infects the skin, mucous membranes and nerves. There are two major types of herpes simple virus (HSV). Type I is the most common and is responsible for herpes simplex eye disease and the familiar "cold sore" or "fever blister". Type II is responsible for sexually transmitted herpes and rarely causes infection above the waist.
An original infection with herpes simplex type I (HSV type I) occurs in 90% of the population, usually during childhood or adolescence. The infection, sometimes only a mild sore mouth or throat, comes from close personal contact with an infected person and usually passes without notice. After the original infection, the virus goes into a quiet or dormant period, living in nerve cells that supply the skin or eye. Occasionally, the virus reactivates and causes a recurrent "cold sore" or "fever blister".
WHAT IS HERPES SIMPLEX EYE DISEASE?
The most common herpes simplex eye disease caused by HSV type I is a recurrent eye infection of the cornea -- the clear front window of the eye -- which can potentially threaten sight. The infection varies in duration, severity and response to treatment, depending in part on which of several different strains of HSV type I caused the original infection. It can be considered a "cold sore" or "fever blister" of the eye.
The disease usually begins on the surface of the cornea. The eye turns red, is uncomfortable and sensitive to light. For most people this will be the only episode. Unfortunately, one of four people who have a corneal infection is likely to have a recurrence within two years. The process may go deeper into the cornea and cause permanent scarring or inflammation inside the eye. Chronic ulcers, which are sometimes very difficult to heal, may also develop on the cornea.
HERPES SIMPLEX EYE DISEASE
Herpes simplex eye disease usually occurs in only one eye and rarely spreads to the other eye. Spreading the infection to another person is unlikely. In people with poor immunity, the herpes simplex virus may infect other parts of the eye or body, such as the retina or brain, but this occurs infrequently. It is important to remember that herpes simplex eye disease is not usually caused by HSV type II, the sexually transmitted herpes. While possible, sexual transmission of herpes eye disease is extremely rare.
HOW IS HERPES SIMPLEX EYE DISEASE TREATED?
Treatment depends on the extent of the disease. Antiviral eye medications are commonly used and may need to be applied as frequently as one drop per hour. At times it may be necessary to scrape the surface of the cornea, to patch the eye, or to use a variety of medications. In cases of severe scarring and vision loss, a corneal transplant may be required.
It is very important to consult an ophthalmologist before beginning any treatment since some medications may actually make the disease worse.
WHY ARE REGULAR MEDICAL EYE EXAMINATIONS IMPORTANT FOR EVERYONE?
Eye disease can occur at any age. Many eye diseases do not cause symptoms until the disease has done damage. Since most blindness is preventable if diagnosed and treated early, regular medical examinations are very important.

Herpes Zoster (Shingles)

WHAT IS HERPES ZOSTER?

Herpes zoster, commonly known as "shingles", is a viral disease that causes a characteristic skin rash of small fluid-filled blisters (vesicles) which form scabs and can leave permanent scars. The first symptom is often severe pain or itching, followed by redness of the skin, and finally, the appearance of a few or many of the characteristic blisters. 
The distribution of the blisters follows the route of the infected nerve. Pain is often severe, accompanied by burning, throbbing and extreme skin sensitivity. The rash lasts three to six weeks but some people experience pain months or years later. This extended involvement is called "post-herpetic neuralgia".

WHAT CAUSES HERPES ZOSTER?

Varicella-zoster, the same virus that causes chicken pox, is responsible for herpes zoster. After years of dormancy, the virus reactivates, usually attacking older people or those with reduced immunity.

HOW DOES HERPES ZOSTER AFFECT THE EYE?

Herpes zoster commonly attacks the nerves around the eye, especially the nerve that supplies the upper eyelid and forehead. If the virus affects the nerves that go directly to the eyeball, it can cause serious eye problems, including corneal ulcers, inflammation and glaucoma. These problems may appear at the same time as the skin rash or weeks after the vesicles have disappeared. Lingering pain is the result of injured sensory nerves, which may remain overly sensitive for years after the attack.

WHAT IS THE TREATMENT FOR HERPES ZOSTER?

The usual procedure is to control pain and prevent further skin infection with soaks, scrubs and other treatments. Antiviral drugs, steroids taken by mouth or other medicines may be helpful in some circumstances. If the eyeball is affected, eyedrops, eye ointments or oral medication may be necessary. Most people recover without complications. Unfortunately, despite all available medicines, some people have permanent visual damage and continue to have pain even after the skin rash has gone away.

Hyperopia (Far sightedness)

Farsightedness (Hyperopia) occurs when light rays focus behind the retina, instead of on the retina. The reason for this is that the eye is too short or the cornea is too flat. This is often inherited.
A person with hyperopia is unable to see objects clearly up close like books or newspapers. Many people are not diagnosed with hyperopia until they have a complete eye exam. School screenings do not discover this because they test for vision in the distance.
Treatment includes Laser Vision Correction, LTK, contact lenses or glasses for near work such as reading. Corrective lenses do not need to be used for distance vision.

Macular Degeneration

Macular degeneration affects the portion of the retina that is responsible for our fine, close up vision and color perception. It usually affects both eyes but often begins in one eye.
Often people are unaware that they are having problems until the second eye has symptoms because the other eye compensates for the weak one. Macular Degeneration does not lead to total blindness but affects only the central vision. Your ability to read, see fine detail and drive are all affected.
The most common symptoms include difficulty reading, seeing up close or distorted lines. It is found most often in people over fifty years of age. If you notice these symptoms, it is important to see a retinal specialist as soon as possible. There is no cure for macular degeneration, but early laser treatment may help to slow the progress of the disease.
If you are over fifty, have your eyes examined regularly. If you have symptoms, report them to your eye doctor immediately before the disease progresses too far. 

Myopia (Near sightedness)

Nearsightedness (Myopia) occurs when the light rays focus in front of the retina instead of on the retina. This is caused because the eye is too long or the cornea is too steep.
Myopia occurs usually between eight and twelve years of age and almost always before twenty years of age. As the body grows, the myopia often increases and levels as an adult. Changes in glasses or contact lens prescriptions are necessary during growth periods.
The symptoms include an inability to see objects in the distance such as street signs, chalk boards and television. Most often this is diagnosed during the screenings at school.
The treatment for nearsightedness is a lens that allows the light rays to focus on the retina. This is accomplished through a contact lens, glasses or laservision correction. Once the vision has stabilized in life, laser vision correction is an option for many.

Nasolacrimal Duct Obstruction General

Nasolacrimal Duct Obstruction (NLDO) is very common in infants. 6% of all children are born before their tear ducts are open. 95% of these children will resolve on their own before their first birthday.
Symptoms
The most common symptoms are excess tearing and mucous discharge. This may lead to recurrent red eyes and infections. The excessive tearing can produce secondary skin changes on the lower eye lids as well.
Medical Management
Nasolacrimal sac massage has been shown to help increase the resolution rate in children with NLDO. Antibiotics for recurrent infections may be used when necessary.
Surgical treatment
Probing of the nasolacrimal duct is the surgical management of this disorder. Some controversy exists about the best time to surgical intervene in children with NLDO. The controversy revolves around early or late probing. 
Advocates of early (3-6 months) probing state that it can be done in the office and avoids the cost of hospitalization and the risk of anesthesia.
Advocates of later (12 months) probing claim that many children who would have been probed in the office would have gotten better before their first birthday anyway. Furthermore, the procedure is painful and anesthesia is safe should be used. 

What is nystagmus ?

Nystagmus means the eyes make involuntary repetitive, rhythmic oscillations. It is considered to be a fault in the mechanisms that hold the eyes or fixation steady, meaning the neural systems involved in nystagmus include the cerebellovestibular, optokinetic, and pursuit systems (which makes it real a challenge to research).
We have manifest, latent, and manifest-latent nystagmus for you. Manifest means it's there all the time, latent means it's not there unless you occlude one eye, and manifest-latent is an oxymoronic expression meaning it's there all the time but much worse when one eye is occluded.
Latent and Manifest-Latent Nystagmus
These two occur commonly in essential infantile esotropia, and are something else entirely than manifest congenital nystgamus. Latent nystagmus appears only when one eye is covered, then both eyes develop nystagmus with the slow phase toward the occluded eye and the fast phase in the other direction (you don't see anything during a fast phase. Slow phases give you some time to actually process the images flashing over your foveas).
Anywhere between a 10 and 52% percent incidence of (latent and manifest-latent) nystagmus in those with congenital esotropia syndrome has been reported. Many turn their face such that the preferred eye is turned inward a bit; in that position the nystagmus is absent or much less. Latent nystagmus is a real bother during a standard visual acuity test - that always involves the covering of one eye, and looking straight ahead too. That way, you'll may never get any further than the big E on the Snellen chart, despite the fact that you might very well see 20/20 when viewing binocularly.
Latent nystagmus is also a problem when using occlusion therapy (for the prevention of amblyopia) in children; covering one eye results in nystagmus, and thus in decreased vision, and an uncooperative child. Patching for a few hours each day is less effective than patching for a long time, in those cases. If patching is continued for some time, the nystagmus decreases. 
Manifest nystagmus
Manifest nystagmus occurs equally commonly with congenital esotropia syndrome as latent and manifest-latent nystagmus, as detemined with eye movement recordings. Based on clinical examination alone, CN with a latent shift is likely to be classified as manifest-latent nystagmus (which may be the reason some sources report that latent-manifest nystagmus is more commonly found with congenital esotropia syndrome, than is congenital nystagmus).
Often nystagmus is made less by converging the eyes or looking to one side; utilizing a "null zone", positioning the eyes such the nystagmus is less. Nystgamus blockage is when someone assumes an esotropic gaze posture while viewing at distance. It is suspected to perhaps cause esotropia in those cases.
Manifest nystagmus can be caused by a vision impairment present at birth, like cataracts.
As the name implies, congenital nystagmus is present at birth; there is no known cause for it.
Most patients with congenital nystagmus have a relatively quiet or "null" zone that can be eccentric to the primary position, and they will adjust a head turn to keep this eccentric position straight ahead.
Some surgical techniques for nystagmus are based on this; shifting the positions of the extra-ocular muscles such that the null zone is more or less straight ahead. Another method is recessing all horizontal rectus muscles a whole lot (up to 10 mm) which dampens the oscillations. Reportedly it doesn't have much effect on eye movements. Yet another technique that only works if the nystagmus is dampened by convergence, is the "artificial divergence" procedure, such that you have to 'converge' even when looking straight ahead. Obviously, it is no use if there is no fusion present.
Biofeedback and acupuncture have also been tried.
A crude method to stabilize the image on the retina is using a high plus contact lens on the eye and a high minus spectacle lens, but that probably has a bad effect on the quality of the image.
Stimulating the 5th cranial nerve (trigeminal nerve; it handles facial sensation) by simply massaging the forehead seems to decrease nystagmus, but it's not very practical. This stimulation can also be provided by wearing a contact lens, in some cases it seems to help a bit.
Experiments with several drugs and alcohol have been carried out too.
Nystagmus is increased by anxiety or "effort to see"; the more you try, the worse it gets. So even if alcohol doesn't work to decrease nystagmus by influencing neurochemistry, maybe a good glass of wine may help to relax. (Note: This last remark is not intended to get y'all drinking like crazy!).

Pterygium

A PTERYGIUM, pronounced with a silent "P", and pinguecula are quite similar to each other. They both are relatively easy to see since they grow on the front surface of the eye. The cause of each is also similar. Pterygia and pinguecula are frequently found in patients who are exposed to frequent sun, wind, or dust. Usually patients whose occupation or recreation requires them to be outdoors are more prone.
Gender is also a determining factor. Males develop pterygia or pinguecula approximately three times more often than females. Although pterygia and pinguecula share these similarities their appearance is quite different. A pterygium is a growth on the transparent outer layer of the eye, the conjunctiva. A pinguecula is actually degenerated tissue, and usually appears as a yellowish-brown mass.
Both conditions are generally found near the corners of the eye (canthus). However, a pterygium may progress and grow onto the cornea posing a visual threat. A pterygium may also cause "tension" on the cornea inducing astigmatism. For either condition and also cosmetic reasons, surgical excision of a pterygium may be indicated.
Symptoms from pterygia or pinguecula may range from mild to severe. During growth, a pterygium may appear red and/or inflamed. Symptoms can include blurred vision, irritation, dryness, itching, and burning. The most common symptoms are irritation and a dry, gritty feeling.
Prevention measures are by far the best methods of treatment. Prevention includes wearing hats and sunglasses when outdoors on windy or sunny days. But, if treatment is necessary, drops relieve dryness, redness, irritation and inflammation. Often, surgery is not necessary.
Pterygia often recur after removal. A combination of drops and preventative measures are critical post-operatively to prevent recurrence. Corneal transplants are almost never an option with recurrent pterygia. But a conjunctiva transplant may be at the time of excision. Despite adequate excision and proper post-operative care, dryness and irritation may persist. 

Ptosis

Ptosis is the medical term for noticeable droopiness of the upper lid. It has many possible causes:
1. AGE.
This is the most common cause of ptosis. The muscles that elevate the eye stretch and become thinned as we age, resulting in a loss of muscle tone and inability to raise the upper lid well. Ptosis affects both eyes, but often one eye appears worse than the other. Eye surgery, such as cataract removal, may aggravate this condition.
2. CONGENITAL.
Noticed at birth or shortly thereafter, congenital ptosis is produced by a developmental abnormality in the muscles that elevate the upper lid. Three-quarters of the time it affects only one eye.
3. INJURY.
Automobile accidents often damage the delicate structures around and in the eye. Lacerations, burns, and chemical injuries may also cause this droopiness.
4. NEUROLOGICAL DISEASES.
These are rare but must be diagnosed properly to avoid unnecessary surgery until the timing is right. Symptoms are functional as well as cosmetic. Difficulty reading and driving are common complaints. Raising the entire brow with the muscles of the forehead and scalp may cause headaches and eyestrain as well. In newborns, this problem must be addressed and treated properly to insure normal maturation of the visual system and the avoidance of amblyopia (lazy eye).
Treatment is surgical, and there are a number of possible approaches. The goal is to elevate the lid to match the other side with a minimum of scars and side effects. The most discussed complication is "overdoing it" with resultant inability to close the eye completely after surgery. This creates a dry eye situation that may be difficult to manage.
In the age-related form, almost invariably the unoperated eye will appear lower after a successful repair of the first eye. This is a bilateral condition, and this drooping in the unoperated eye is to be expected. It also may require surgery.

Retinitis Pigmentosa

Retinitis pigmentosa (RP) refers to a group of related diseases which tend to run in families and cause slow but progressive loss of vision. The retina is the tissue which lines the inside of the eye and sends visual images to the brain. In retinitis pigmentosa there is gradual destruction of some of the nervous sensors in the retina along with abnormal pigment clumping.
The first symptoms usually occur in youth or young adulthood although it may be first seen at any age. Night blindness and loss of side vision are the most common symptoms in retinitis pigmentosa. People with normal vision adjust to the dark after a short period of time and are able to distinguish forms. People with night blindness adjust to darkness very slowly, if at all. Loss of side vision (peripheral vision) is a hindrance to those with retinitis pigmentosa, as mobility becomes more difficult.
Most forms of retinitis pigmentosa are inherited. Different patterns of heredity are associated with different degrees of progression and so an attempt to know more about the family line will help predict how an affected person might ultimately be afflicted, though variability exists within each family. This knowledge is also helpful in making decisions about such things as marriage, family and occupation.
In general, there is no specific treatment, although one rare form might benefit from proper vitamin therapy. Much research is directed toward solving this problem. Until there is a cure, it is important that patients with this disease not be deceived by those who claim a "secret cure" or "miracle drug." Periodic examinations by an ophthalmologist are advised.
The ophthalmologist will also keep the patient informed of legitimate scientific discoveries which may develop. Patients with retinitis pigmentosa may develop other treatable disease, such as glaucoma or cataract. Low vision aids may be prescribed. In some cases, retinitis pigmentosa may be associated with other disease processes which might need evaluation by other medical specialists.
Despite visual impairment, patients with retinitis pigmentosa can live meaningful and rewarding lives with the many rehabilitative services that are available today. 

Trachoma

Definition 

An eye infection caused by Chlamydia trachomatis, which may result in chronic scarring and blindness if left untreated. 
Alternative names 
Granular conjunctivitis; Egyptian ophthalmia 
Causes, incidences, and risk factors 
Trachoma is caused by infection with the bacteria Chlamydia trachomatis. It has an incubation period of 5 to 12 days and begins slowly as conjunctivitis (irritation near the eye, "pink eye") which if untreated may become chronic and lead to scarring. If the eyelids become inflamed, the eyelashes may turn in and rub against the cornea and lead to ulcers, further scarring, visual loss and even blindness.Trachoma occurs worldwide -- primarily in rural settings among developing countries. It frequently affects children, although the consequences of scarring may not be evident until later in life. While trachoma is rare in the United States, certain populations marked by poverty, crowded living conditions and/or poor hygiene are at higher risk for this illness. Trachoma is acquired through direct contact with eye or nose-throat secretions from affected individuals and inanimate objects which may have been in contact with these secretions, such as towels or clothes can also spread the disease. In addition, certain flies which have fed on these secretions can transmit trachoma.
Prevention 
Trachoma is spread by direct contact with eye, nose and throat secretions from affected individuals or by contact with objects that may have been in contact with these secretions. Improved sanitation and avoidance in the use of common toilet articles (e.g., towels) are important measures that will limit the spread/acquisition of trachoma. 
Symptoms 
· conjunctivitis · discharge from the eye · swollen eyelids · turned-in eyelashes · swelling of lymph nodes just in front of the ears · cloudy cornea
Signs and tests 
Trachoma is definitely diagnosed by detection of the organism or antigen in conjunctival scrapings or by isolation of the bacteria in culture.

Twitching Eyelids

Most of us have noticed a "twitching" in our eyelids at one time or another. This can be annoying and sometimes embarrassing but the good news is it is not serious.
The most common causes of a "twitching" lid is stress or from being tired. Most people find the nerve twitching will disappear when stress is relieved or after catching up on sleep. 

Viral Conjunctivitis (Pink Eye)

Probably the most common infection seen in the eye doctor's office is a viral infection of the conjunctiva. The conjunctiva is the clear lining that covers the surface of the white part of the eye. Sometimes this infection is described as a "cold" in the eye.
Dozens of viruses can cause this type of infection. Sometimes only the eye is infected; at other times the eye condition is part of a more generalized problem, such as the "flu" or a cold. Both eyes are usually involved, although perhaps not at the same time. Usually symptoms are mild and not serious. Infrequently, however, the eye complaints are incapacitating and extremely bothersome.
Symptoms of VIRAL CONJUNCTIVITIS include a wide spectrum of complaints. Tearing, redness, swelling of the conjunctiva, and a clear discharge are characteristic. Light sensitivity can also be a prominent symptom. Sometimes a lymph node on the cheek in front of the ear swells in response to the virus, (an important clue that the patient has viral, not bacterial conjunctivitis).
If there is involvement in the cornea (the clear front window of the eye) blurred vision may result. Fortunately, this blurriness resolves over a few days to weeks and rarely leaves permanent scars. Occasionally the lids become swollen and the patient experiences serious ocular pain, and very rarely there is bleeding into the lids.
Treatment is aimed at making the patient comfortable during the first few days. Cool compresses soothe the eyes and lids, pain relievers help with discomfort, and occasionally eye drops will help; but the real treatment is time and rest. If the blurred vision is significant, driving and work activities should be done only with great caution and care.
Cortisone eye drops are sometimes of great assistance in controlling the symptoms of this infection. Since this disease is very contagious, prevention of spread is very important. The incubation period for viral conjunctivitis is only one or two days, making rapid spread very easy.
Hand washing is critical to avoid spreading the germ. Direct contact with the infected eye should be avoided. Indirect contact through hand towels, wash cloths, and clothing should be carefully eliminated. Just as with a cold, patients may be miserable for a few days, but with time our defense systems overcome the infection. Complete resolution is expected in almost all patients. Only rarely do symptoms persist causing scarring and blurred vision.