Dry Eye Syndrome: DES is caused by a chronic or sporadic lack of lubrication on the surface of the eye. For some individuals, dry eyes could be a result of either environmental or seasonal factors. However for others, systemic or physiological components can cause chronic ocular ir-ritation, resulting in blurry vision, pain and even decreased quality of life. Generally, dry eyes can be caused by excessive computer use (don’t forget to blink!), contact lens wear, medica-tions or lagophthalmos, the inability to fully close eyelids. In addition, diseases such as diabe-tes, thyroid disorders, rosacea, lupus, rheumatoid arthritis or Sjogren’s syndrome, will affect tear film production. Management for dry eyes include: artificial tears and gels, medication drops, serum tears, punctal plugs, stem cell therapy as well as laser treatments. Furthermore, treating underlying conditions like blepharitis or lid malpositioning, can alleviate these symp-toms.

Filaments over cornea in a patient with severe DES
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Blepharitis: Blepharitis is a chronic inflammation of the eyelids and commonly occurs when the oil glands located on lids are blocked. This causes the lids to become irritated and even ap-pear greasy. Individuals with blepharitis usually wake up with crusty eyelashes or with lids that are stuck together. Additionally, the surface of the eye can be affected due to abnormal oily se-cretions and debris from lashes. This irritation can lead to dryness, blurry vision, foreign body sensation and excessive tearing. Certain organisms called Demodex might also exacerbate the inflammation around the eyes. Therefore, it is essential to practice consistent lid hygiene and in-corporate hot compresses and lid wipes into daily regimen. Since ocular rosacea might also be another factor for chronic inflammation, Dr. Josephson might prescribe oral antibiotics (doxycycline) that will help promote healthy oil secretion and ultimately minimize inflamma-tion.

Crusting of the lid margin due to blepharitis
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Dilated blood vessels of the lid margin in a patient with rosacea
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Chalazion: Chalazia are benign bumps that arise on the upper or lower lids and are usually caused by clogged oil glands. These cyst-like nodules can sometimes drain on their own. How-ever, frequent use of hot compresses, gently massaging the surface, lid wipes and topical ster-oid ointments, can speed up the process. If these treatments are unsuccessful, Dr. Josephson can perform an incision and drainage to remove these growths. Although a chalazion is not visually threatening, if it grows big enough it can press on the cornea, induce astigmatism and cause distorted vision. Additionally, the frequency and amount of chalazia growth can be exac-erbated by conditions like blepharitis or ocular rosacea due to chronic eyelid inflammation. If you have these conditions, you can prophylactically use lid wipes, oral antibiotics and hot com-presses to halt further eyelid irritation.

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Pterygium: This is a pink or fleshy non-cancerous growth that starts from the white surface of the eye and can slowly extend to the cornea. Pterygiums are usually caused by significant ex-posure to ultraviolet light. Therefore, it’s most common in individuals who live near the equa-tor. Other irritants like dust and wind can also aggravate symptoms. Therefore, it is very im-portant to wear sunglasses with UV protection and use artificial tears frequently to minimize ir-ritation. Pterygiums can cause constant foreign body sensation, eye redness, dryness and irrita-tion. Additionally, if they grow on the cornea, they can change the shape and become visually distorting. In this case, Dr. Josephson will likely recommend a surgical intervention or will closely monitor for any increase in size.

A large pterygium that has extended onto the cornea
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Pinguecula: Pinguecula is a noncancerous yellowish bump presenting on the white part of the eye. This is usually caused by sun damage and wind exposure. Pingueculas can cause dryness, foreign body sensation, redness and irritation. Symptoms can sometimes be alleviated by fre-quent use of artificial tears and using sunglasses with UV light protection to avoid further dam-age. Since reoccurrence is possible after removal, patients should closely consider the risks, benefits and alternatives before pursuing a surgical intervention.

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Iritis: Iritis is the inflammation of the colored part of the eye, also known as the iris. Symptoms include: redness, pain, light sensitivity and sometimes decreased vision. This can be caused by injuries, infections, genetic factors or due to an autoimmune response. This is usually treated with topical steroid drops to help reduce the inflammation. Dilation drops can also aid in dimin-ishing pain by freezing the pupil in position and minimizing iris spasm. If this is reoccurring, your eye care provider will likely order an autoimmune workup since iritis can be an indication for underlying autoimmune conditions.

Synechia or iris detachment caused by inflammation Image courtesy of aao.org

 

Uveitis: Uveitis is an inflammation of the middle layer of the eye, known as the uvea. Howev-er, this disease can also extend to other parts such as the lens, the optic nerve as well as the ret-ina. Since there are different types of uveitis, which are mainly classified by the area of inflam-mation, an ophthalmologist will construct a treatment plan based on the symptoms the patient displays. Symptoms can include: pain, light sensitivity, eye redness, floaters, increased eye pressure and blurry vision. Although the cause might sometimes be ambiguous, uveitis can manifest due to systemic, inflammatory or autoimmune conditions. This disease can also be in-duced by eye infections or trauma. Finally, since uveitis can lead to permanent complications if left untreated, it’s crucial to be closely monitor by an eye care provider.

A hypopyon or a cluster of white blood cells in the anterior chamber, can be a sign of uveitis
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Scleritis: Scleritis is a condition when the white part of the eye, also known as the sclera, be-comes inflamed. Although this could be caused by infection or trauma to the eyes, autoimmune disorders are usually found to be the underlying issue. Individuals with rheumatoid arthritis, lupus, Sjögren’s syndrome, etc. can experience recurrent episodes of scleritis. Symptoms in-clude an inflamed or red sclera, deep aching pain that extends to the face, blurry vision and photophobia. Usually, NSAIDs like ibuprofen are recommended due to their pain relieving as well as anti-inflammatory properties. Your ophthalmologist might also order blood tests to rule out any autoimmune disorders. If indicated, it is important to establish care with a rheumatolo-gist and receive systemic treatment with oral steroids and biologic drugs .

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