There are many causes of blurred vision. Sometimes, the eye doctor needs to update the power of the contact lens. At other times, there may be an eye disorder that requires diagnosis and treatment by an ophthalmologist. However, a smudged contact lens may be the problem. To find out, remove and inspect the contact lens for a smudge.
What are the causes of a smudge on the contact lens?
Many things may cause a smudge on the contact lens. A factory defect is rare and the contact lens specialist usually detects damaged lenses prior to dispensing. Makeup, creams, oils, or moisturizers on your fingers may cause the contact lens to be smudged. A moisturizer in your hand soap may cause blurred vision by smudging the lens.
What can be done to prevent smudges on the contact lens?
Proper contact lens maintenance and hygiene is important. Follow all instructions given by your contact lens provider to the letter. Make sure to wash your hands with hand detergent without moisturizers prior to inserting your contact lenses. This is very important to keep your lenses clear and free of germs that can cause serious infection.
How do you remove a smudge from a contact lens?
The management of a smudged contact lens depends, in part, on the type of contact lens you wear. If you use daily-wear contact lenses, it may be best to dispose of the smudged contact lens and replace it with a new lens. When wearing lenses made to wear for longer than a day, carefully clean them daily by following the manufacturer’s recommendations.
Rigid gas-permeable lenses are made for long-term use. If they become smudged, gently rinse them with conditioning solution or a cleaning solution. If this fails, an enzymatic cleaner may help. Follow all instructions on the contact lens product recommended by your doctor. Professional polishing is available by your contact lens provider.
Where do I go for urgent care?
If you have pain while wearing your contact, remove it immediately. If your eye remains blurred after you remove the contact lens, you may have a damaged cornea. Make a prompt appointment with your eye doctor. If you have pain or persistent foreign-body sensation (a feeling like sand in the eye), notify your eye doctor without delay. If you are unable to contact your eye doctor and there is significant pain and/or loss of vision, report to the hospital emergency department urgently.
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Choroidal macrovessel is the term currently used for a rare choroidal vascular abnormality that may present as a small choroidal mass with or without symptoms. It usually appears as a dilated, tortuous choroidal vessel beneath the temporal macula and may extend to the periphery. A dilation of the posterior ampulla may elevate the overlying retina (see OCT image below) and cause secondary changes in the retinal pigment epithelium, rarely with subretinal fluid. Choroidal macrovessel is usually diagnosed during adulthood with a female predilection. There is no known associated systemic vascular abnormality.
Another term that may be somewhat more specific for this condition is posterior aneurysmal choroidal varix. An aneurysmal varix is a markedly dilated and tortuous vessel, sometimes used to describe a dilated vascular channel due to a direct communication of an artery and a vein. In the example below, there appeared to be a direct communication between a short posterior choroidal artery and a choroidal vein (Haller vein) as seen on ICG angiography where there was early filling of the lesion in the arterial phase. On the color photo, the prominence of the lesion diminishes in appearance as the vessels track toward the vortex outflow. This is likely due to numerous collateral venous channels that are known to exist, which allows for a reduction in blood flow and intraluminal pressure. Thus, the peripheral choroidal venous channels appear unremarkable.
The most helpful diagnostic tests include optical coherence tomography (OCT) and indocyanine green angiography (ICGA). OCT shows a small hyporeflective choroidal mass temporal to the fovea. There may be disruption of the outer retinal bands and/or subretinal fluid. ICGA shows early filling of the prominently dilated and tortuous choroidal vessel.
As choroidal macrovessels are usually asymptomatic, no treatment is needed. Their importance is primarily to differentiate them from tumors. Rarely, they cause disruption of retinal pigment epithelium resulting in simulated “tracks”, which may be confused for ophthalmomyiasis (subretinal larva).
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
HTLV1 is a virus that causes HTLV1-associated uveitis. It is an abbreviation for human T-lymphotropic virus type 1. First isolated in 1980, HTLV1 belongs to the retrovirus group that also includes the virus that causes HIV/AIDS. Retroviruses are called “retro” because they use a pathway to reproduce that is the reverse of what most organisms use. The genetic map of retroviruses is RNA, which is converted inside host cells to DNA by a special enzyme (reverse transcriptase). The host cell is then directed to produce more virus particles. HTLV1 is called “lymphotropic” because it tends to infect lymphocytes, which are a type of white blood cell involved with immunity (see Legrand).
How and where do you get exposed to HTLV1?
Because most people with HTLV1 infection remain without symptoms, they carry the virus and spread it to others by sexual contact (semen), shared blood (e.g. IV drug-shared needles, organ transplantation), and by breast milk. HTLV1 is found in most frequently in people from Brazil, Japan, sub-Saharan Africa, Honduras, Iran and the Caribbean islands. However, due to international travel, HTLV1 may be found anywhere in the world.
What problems does HTLV1 cause?
Many people who are exposed to HTLV1 develop no symptoms. However, because HTLV1 affects white blood cells, it may cause autoimmune conditions, as well as blood cancer. For example, autoimmune conditions include seborrheic dermatitis (infective rash), paralysis (tropical spastic paresis), and uveitis (see Schierhout). Examples of blood cancer include T-cell lymphoma and leukemia.
What is Uveitis?
Uveitis (pronounced, “you-vee-EYE-tis”) is a general term used to describe inflammation inside the eye. The uvea is the name given to the layer of tissue in the eye that has a brown color (melanin pigment) and blood vessels, which serve to provide blood supply and protect the eye from excessive light. The uvea can be divided into separate parts, which perform different functions in the eye: the iris, the ciliary body, the pars plana, and the choroid (see anatomy of the eye). Therefore, in any one patient uveitis is usually given a more specific name depending on where most of the inflammation is located in the eye. Sometimes, uveitis affects tissues not considered a part of the uvea.
What type of uveitis is most common with HTLV1?
Intermediate uveitis is the most common type of uveitis caused by HTLV1. In intermediate uveitis the inflammation mainly centers in the vitreous gel (the clear gel that fills the eye). This type of uvetiis is called intermediate because it affects the middle or intermediate part of the eye. That is, the vitreous gel fills the eye and is located in an intermediate position between the front and the back of the eye. Vitritis and pars planitis are other names for intermediate uveitis.
Who is most likely to develop HTLV1-associated uveitis (HAU)?
The age group most likely to be affected by HAU is between 20-49 years; however, any age group may develop HAU (see Mochizuki). Female are affected by HAU twice as often as males (see Takahashi). It appears that the eye inflammation (uveitis) is caused by the effect of HTLV1 infection on the behavior of white blood cells (lymphocytes), rendering them more likely to mistakenly attack the eye (see Mochizuki). HAU may occur with or without other ocular inflammatory conditions, such as thyroid eye disease (see Nakao). Likewise, HAU may occur with or without non-ocular HTLV1-associated conditions, such as paralysis, rash, or blood cancer.
What are the symptoms of HTLV1-associated uveitis (HAU)?
The most common symptoms include tiny floating spots which move or “float” in the vision. They are usually numerous and may cause a veil-like appearance in the vision. Sometimes blind spots, blurred vision, distortion, or loss of side vision occurs. The eye may be painful, red, tearing, and light sensitive if other parts of the eye are also inflamed (5-10% of cases). Symptoms may be mild or they may be severe and disabling. Only one eye is affected in about half of all cases of HAU (see Takahshi).
How is HTLV1-associated uveitis (HAU) diagnosed?
Diagnosis can be difficult. Blood tests are performed to identify HTLV1 infection in patients with findings that suggest HAU. One FDA-approved test is produced by MP Biomedicals Diagnostics: HTLV blot 2.4 (EIA). Sometimes, accurate diagnosis requires multiple tests.
How is HTLV1-associated uveitis (HAU) managed?
There is no cure for HTLV1 infection. To limit the damage from inflammation, HAU is treated with anti-inflammatory medication in the form of eye drops, injections, or pills. When pills are used, the eye doctor may coordinate medical care with the expert assistance of a rheumatologist. Rarely, surgery is required to treat uveitis. Episodes of inflammation may last from weeks to many years. HAU is a serious eye problem and may result in loss of vision (see Takahashi). However, by seeing your eye doctor and taking the medications exactly as recommended, damage to your vision can be minimized. Most people with HAU keep good vision (See Nakao). In some cases, HAU may go away, but return at a future date in about 50% of cases (see Takahashi). Therefore, if you become aware of symptoms of uveitis in the future, do not hesitate to contact your doctor.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
How are genes and heredity involved in color vision?
You ask, “how is color blindness inherited?” But first we must separate color blindness into two groups: acquired and congenital. Acquired color blindness starts after birth and may worsen over time. Congenital color blindness is present from birth and does not worsen with time. This blog is about congenital color blindness and it is an inherited trait. It appears to have evolved to give a competitive advantage in the visual perception of the environment. For example, the ability to tell the difference between red and green allows a gatherer to find the red fruit among the green leaves of a plant more easily than a competitor who cannot see the color difference.
What are DNA, genes, and chromosomes?
Most cells in the body contain a nucleus that contain DNA, which codes for proteins. The DNA is organized into genes, which, in turn, are organized into large units called chromosomes. Each of us has 23 pairs of chromosomes (as in the Ancestry.com genetic test, “23 and me”). The pair consists of one set of chromosomes from the mother and one from the father. Collectively, they represent the genetic blueprint of the individual.
Are there different degrees of severity?
Color perception is complex. There are many genes that have an impact of the ability to see color. Therefore, there is wide variation in the ability to perceive colors among individuals. There are a few, well-recognized causes of major color deficiency in humans and the most common is red-green color deficiency. These individuals have difficulty seeing the difference between red and green. Despite this limitation, they function well. They have no trouble with the blue-yellow spectrum.
What is the most common form of color blindness?
Red-green color deficiency is the most common form of color blindness. The genes for red-green color deficiency are located on the X chromosome. The X chromosome is one of the two sex (as in gender) genes, the other being the Y chromosome. Females possesses two X chromosomes and males possess an X and a Y chromosome. A child receives one sex chromosome from each parent. Thus, females inherit one X (either of the two maternal X chromosomes) from her mother and one X (the only paternal X chromosome) from her father. Males inherit one X (of her two X’s) from his mother and the (only) Y from his father. I emphasize the number of chromosomal options because it has an impact on heredity of genetic traits, as we will see later.
Is red-green color deficiency a recessive trait?
The red-green color deficiency trait is considered a recessive trait by genetic specialists. That is, the trait is only (prominently) apparent if the affected gene is not paired with a normal gene (remember that each gene on each chromosome is one of a pair…one from each parent). Recessive genes on the X chromosome (X-linked recessive genes) are inherited in a peculiar fashion because, in males, there is no X pair. Instead, males have only one X chromosome. Therefore, an X-linked recessive gene manifests itself with symptoms in males, but not in females (with a normal fellow X chromosome). This explains the difference in the prevalence in color deficiency between males and females. Overall, color deficiency is present in about 8% of males compared with 0.5% of females.
What does this mean for me and my family?
The practical translation from the genetic explanation is somewhat simpler. The father with red-green color deficiency will not give any of his sons the gene for color deficiency. This is because the gene is located on his X chromosome and he gave his sons his Y chromosome. However, the father will pass on the X-linked recessive gene to ALL of his daughters. Because the trait is recessive, the daughters will not be red-green deficient. This assumes that their fellow (paired) X chromosome from their mother is normal. The color vision deficiency, however, will appear in 50% of the daughters’ male children. Likewise, half of their daughters will carry the trait asymptomatically.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
A hypermetropic eye is a far-sighted eye. Without glasses the vision may be good at distance or blurred, but the vision is usually blurred or strained at near without glasses. Hypermetropia is different from presbyopia (aging eyes). Hypermetropia affects many people and is treated with glasses, contact lenses, and, rarely, laser surgery. It is a common underlying reason for the need to wear optical correction (glasses).
What causes hypermetropia?
Hypermetropia is an inherited condition that usually develops in childhood or early adulthood. The eye develops with either a flat cornea or a short eyeball length, or both. As a result, the image entering the eye is focused behind the plane of the retina. In this case, the eye tries to focus the lens to make the image projection sharp. Sometimes, the natural lens in the eye can compensate for the focusing of images, but often eyeglasses or contact lenses are needed. The outer appearance of the eye is not usually changed. It is not obvious that an eye is hypermetropic by inspecting the outside of the eye.
Why is it important to know about hypermetropia?
Although most people with hypermetropia do not develop complications, some far-sighted people are at increased risk of losing vision from narrow-angle glaucoma, central serous choroidopathy (also known as central serous retinopathy), and choroidal effusion.
Angle-Closure Glaucoma is a condition in which the pressure inside the eye damages nerve tissue that helps you see. High pressure is the result of closure of the internal drain in the eye. The pump inside the eye does not sense the closure of the drain; it continues to pump fluid into the eye. The drain cannot keep up with the pump, so the pressure inside the eye rises. This pressure may or may not cause pain or discomfort. Over time, the pressure slowly takes away the side vision. If undetected and untreated, it may cause total, irreversible blindness. The best way to diagnose glaucoma is to have regular eye exams each year with pressure measurements and gonioscopy. Treatment is effective in preventing vision loss. Laser is often used to open the drain. Sometimes operative surgery is required with or without removal of the lens in the eye (to make more room for the drain to stay open). Often, eye drops are needed long-term to keep the pressure under control.
Central Serous Chorioretinopathy is an uncommon cause of vision loss from hyperopia. The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. In hypermetropic eyes, the layer under the retina called the choroid becomes crowded and thickened. The outer coat of the eye known as the sclera may be thickened as well. As a result of thickened choroid and sclera, the flow of fluid inside the eye that normally drains out through these structures, is restricted. This fluid may then collect under the retina and cause the central vision to become blurred or distorted even with proper glasses. Distortion is when straight lines look wavy or crooked. Blood vessels under the macula may bleed causing sudden blurring, blind spot, or distortion. Any of these symptoms should be reported to the eye doctor without delay, as early treatment with laser may prevent further loss of vision.
Choroidal Effusion is a separation of the choroid from the sclera, the wall of the eye. This is different from retinal detachment. When the choroid detaches, it is no longer in proper position inside the eye. As a result, symptoms of a dark curtain or shadow slowly starts off to the side and takes away the vision as the choroid detaches. Pain is not common. The diagnosis is made by a retinal specialist; it is critical to identify and differentiate choroidal detachment from retinal detachment and tumors. Treatment of choroidal effusion is typically started with medications. Sometimes, however, surgery is needed.
Will refractive surgery help prevent these complications of hypermetropia?
Although refractive surgery (laser correction) is effective at changing the shape of the cornea to help eliminate the need for corrective lenses (glasses and contacts lenses), it does not restore the natural shape of the eye. Therefore, it is still necessary to be aware of the warning signs of possible complications from hypermetropia.
What should a hypermetropic patient do?
Using your eyes to read or work at a computer will not weaken them. Remember to have your eyes examined once a year with special attention to the opening of the drainage apparatus (the corneoscleral angle). Not all eye doctors are proficient with determining the risk of angle-closure glaucoma; therefore, consider seeing a fellowship-trained glaucoma specialist if needed. In Tampa there are several choices including doctors Levitt, Gamell, Richards, King, and Fridman. Apart from an annual exam, report the following symptoms to your eye doctor without delay:
Sudden-onset pain in the eye (sometimes, associated with nausea)
Sudden-onset redness (especially, if associated with pain and blurred vision)
Loss of side-vision (possibly, a very late sign of glaucoma)
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Vuity is a new eye drop to improve near vision in mature adults and is available with a prescription. It became available with FDA approval in 2021. The generic name for Vuity is pilocarpine, a drug used for years to treat some types of glaucoma.
How does Vuity work?
Vuity works by causing the pupil to constrict. The pupil is the small black opening in the center of the iris (the colored part of the eye, usually blue or brown). When the pupil constricts it provides a greater depth of field just like a camera with a small aperture. Vuity also constricts the ciliary muscle inside the eye. This is the muscle that normally focuses the eye from distance to near.
What did the studies of Vuity show?
Gemini I and II were studies to prove the benefit of Vuity. Between the two studies a total of 375 patients were treated. One hour after instilling Vuity, about 26% more patients on Vuity had an improvement in near vision (three lines on the eye chart) compared with patients given a placebo. This suggests that a majority of patients may experience less of an effect. Vuity likely provides a modest short-term effect with minimal risk to most people making it of marginal value (cost/benefit ratio).
How do you use Vuity?
Apply a drop of Vuity to each eye in the morning. The drop takes affect within an hour and slowly loses its effect over 6-10 hours. If Vuity is used more than once a day, it is more likely to cause side effects.
What are the adverse effects of Vuity?
Vuity should not be used by anyone with an allergy to pilocarpine. It should also be avoided in people prone to iritis. Some patients notice poor vision at night while using Vuity; this is especially true if it is used after noon or in eyes with cataract. Therefore, caution may be needed while driving at night. Sometimes, patients experience accommodative spasm in which they have trouble focusing from near to distance. A brow ache may occur when the drop is started, but usually subsides over time with continued use of Vuity. Little is known about the safety of Vuity in pregnancy and during breast feeding. If you use soft contact lenses, they should be removed before instilling Vuity. They may be placed back in the eye after 10 minutes. Use Vuity at least 5 minutes apart from other eye drops you use for other conditions. Very rare adverse effects from Vuity may include acute angle-closure glaucoma and retinal detachment. Therefore, the following symptoms should be reported promptly: new flashes and/or floaters, any loss of vision (including loss of side vision), pain, or significant redness.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Tea tree oil is an essential oil extracted from the leaves of the Australian tea tree, Melaleuca alternifolia. Tea tree oil has important anti-inflammatory and anti-microbial properties. It is effective against many different micro-organisms that can infect the eye (see reference).
How does tea tree oil improve the health of the eyelid?
Tea tree oil appears to help prevent the overgrowth of germs on the eyelid, which leads to blepharitis. Blepharitis is a common eyelid condition that causes symptoms of redness, irritation, itching, burning, and dry-eye symptoms. There are many ways to treat blepharitis and tea tree oil is becoming an important tool to reduce inflammation and infection by bacteria, fungi, and mites.
What evidence is there that tea tree oil works? Tea tree oil has been studied in the treatment of blepharitis with very positive reports. However, high-level scientific evidence is lacking (see reference). I suspect the reason for this lack of evidence is the high cost of the studies rather than the effectiveness of tea tree oil. It takes large sums of money to complete the scientific trials required by the FDA and there is no corporate financial incentive to fund a large, randomized trial. In the meantime, low-cost tea tree oil is available for use without a prescription.
What preparations are available?
Tea tree is available as moist lid wipes, drops, and cleansing washes (see tables below). Follow the directions on each formulation. To keep the tea tree oil fresh, effective, and safe, store it in a cool, dark place (drawer or cupboard) with the lid securely attached.
What side-effects may occur?
Sometimes, a sensitivity reaction may occur with tea tree oil. Stop using tea tree oil, if your skin or eyes develop pain, redness, and/or itching. See an ophthalmologist as soon as possible for evaluation. Sensitivity reactions may occur more commonly with older, out-of-date tea tree oil, as well as with products with higher-concentrations of tea tree oil.
What brands are available?
The tables below serve as a reference list primarily for cost comparison. The various products have not been compared in a clinical study. Some contain ingredients in addition to tree tea oil. Review the product information, especially if you have known sensitivities. If you wear lash extensions, the oil in some of these products (including tea tree oil itself) may loosen the attachment of the extensions. Lash extensions are not recommended for patients with significant blepharitis.
Tea Tree Oil Products for Blepharitis
(Listed in order of least to most expensive per unit application)
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For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Neovascular glaucoma (NVG) is a severe type of glaucoma. Glaucoma is a condition in which the pressure inside the eye damages the cells of the optic nerve. The normal range of pressure in the eye is between 8-21 units of measurement. There is a tissue inside the eye called the ciliary body that pumps a clear fluid (aqueous) into the eye keeping the eye from collapsing. Another tissue called the trabecular meshwork drains the aqueous from the eye preventing the pressure from building up too high. The pump and the drain are not connected and do not communicate with each other. However, there is a normal balance between the pump and drain so that the eye pressure remains normal and healthy for the eye. In neovascular glaucoma (NVG) abnormal blood vessels grow inside the eye where they block the drain resulting in high pressure. High pressure inside the eye damages the cells of the optic nerve. The optic nerve transmits information from the eye to the brain to provide vision. Therefore, NVG can cause pain, loss of vision, and blindness if left untreated.
What causes neovascular glaucoma (NVG)?
The abnormal blood vessels in NVG grow inside the eye as a result of poor retinal blood supply. There are many conditions that cause abnormal blood supply to the retina. They include diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, ocular ischemic syndrome, retinal detachment, and inflammation. In these conditions the blood supply to the retina is impaired, so the retina sends out chemical messages that it needs more blood supply. As a result, new blood vessels begin to grow inside the eye. Unfortunately, these new blood vessels may grow into the drain (trabecular meshwork) where they cause harm.
What are the symptoms of neovascular glaucoma (NVG)?
In the early stages of NVG, there may be no symptoms. However, as the pressure inside the eye rises, symptoms include pain, redness, and loss of vision. Sometimes, the pain is so severe that it causes nausea and vomiting. If left untreated, NVG frequently results in a blind eye.
How is neovascular glaucoma (NVG) diagnosed?
The most common test for glaucoma in an eye examination is tonometry. Tonometry measures the pressure inside the eye. Most people are first suspected to have glaucoma because high pressure is found on an eye exam. In NVG the ophthalmologist then detects abnormal blood vessels growing in the drain (called NVA) by an office exam called gonioscopy. The presence of high pressure in an eye with NVA makes the diagnosis of neovascular glaucoma.
What treatment is available?
The key to treating NVG is addressing the underlying cause of poor blood supply to the retina. Examination and testing usually provides the retinal diagnosis and treatment is directed toward treating that condition. Frequently, medication injections (Avastin, Lucentis, and Eylea) initially help control the growth of abnormal blood vessels until laser or cryopexy can provide a more permanent effect.
If the drain (trabecular meshwork) has not been permanently damaged by scar tissue induced by the abnormal blood vessels, the pressure inside the eye may return to normal. However, if permanent damage has occurred, eye drops and/or surgery may be needed to control the pressure. The first line of treatment in most cases includes prescription eye drops. There are a number of very effective eye drops that work by either opening the drain or by slowing down the pump to lower the pressure. These drops are powerful medicines that should be used exactly as prescribed to prevent blindness from glaucoma and minimize side effects from the eye drops. Side effects are not common, but may include burning, itching, redness, dry mouth, and worsening of bronchitis or asthma. It is very important to take the eye drops exactly as prescribed to prevent blindness. If eye drops fail to control the pressure, surgery may help. Surgery, performed in the operating room (trabeculectomy or glaucoma drainage device), creates an artificial drain to lower the pressure. After trabeculectomy patients are warned to notify the doctor urgently if the eye becomes red or appears to be infected, because infection may enter the eye after glaucoma surgery and result in severe damage or blindness. In general, patients with glaucoma may require regular examinations every three to four months to preserve vision.
The goal of treatment is to protect the vision and relieve pain. If there is no usable vision, the pressure only needs to be controlled enough to prevent pain. In severe cases surgery is performed to remove the eye (enucleation or evisceration) to relieve pain in a blind, painful eye. An artificial eye is made to appear cosmetically acceptable.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Giant cell arteritis (also called cranial arteritis or temporal arteritis) is an inflammatory condition affecting medium to larger arteries in people over the age of 50 years. GCA may cause headache, neck stiffness, tenderness of the temple, and/or cramping of the tongue or jaw while eating or talking. It may also cause fever, fatigue, weight loss, depression, night sweats and general feeling of illness or feeling unwell.
What causes giant cell arteritis (GCA)?
The cause of GCA is not very well understood. The inflammation from GCA is not due to infection. In GCA, it appears the body’s immune system attacks itself, in some ways similar to rheumatoid arthritis.
How is giant cell arteritis (GCA) diagnosed?
The diagnosis is first suspected by typical symptoms in an older patient. Blood tests may include complete blood count (CBC), sedimentation rate (ESR), and C-reactive protein (CRP). Biopsy of the temporal artery is necessary in most cases to confirm to diagnosis. Firmly establishing the diagnosis is critical, because treatment needs to be started quickly and continued for a long time in GCA.
How does giant cell arteritis (GCA) affect the eyes?
Giant cell arteritis (GCA) causes loss of vision due to retinal artery occlusion or ischemic optic neuropathy. Early diagnosis is critical to begin treatment and limit the damage from blood vessel inflammation, which includes complications of brain stroke.
How is giant cell arteritis (GCA) treated?
Prompt steroid treatment is important to stop inflammation from causing further damage with loss of vision and brain stroke. Prednisone is continued at a low dose for a year or more to prevent the inflammation from returning. In an effort to avoid or manage side-effects of steroids, methotrexate is sometimes used. Tocilizumab was approved in 2017 for use in GCA. It avoids the use of steroids, but is very expensive.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
There are several ways in which a tattoo may threaten loss of vision. The most obvious situation is a scleral tattoo. This is a tattoo applied to the outer eye wall, the white sclera. The tattoo ink may have direct toxic effects on the eye and there is a risk of serious infection. However, even a skin tattoo applied far from the eyes may risk loss of vision. This is due to an autoimmune condition called tattoo granuloma with uveitis (TAGU). Autoimmune conditions occur when your own immune system attacks your body.
What are the symptoms of TAGU?
Various symptoms may be experienced depending on where the eye is most inflamed. Symptoms may be mild or they may be severe and disabling. The eye may be painful, red, tearing, and light sensitive. Tiny floating spots which move or “float” may be seen. Sometimes blind spots, blurred vision, distortion, or loss of side vision occurs. The visual symptoms are frequently associated with inflammation of the tattoo (elevation, redness, warmth, itching, tenderness and/or swollen lymph nodes).
Who is at greatest risk of TAGU?
Fortunately, TAGU appears to be a rare condition. However, risk factors that may increase the chance of TAGU include the size of the tattoo. The larger the tattoo, the greater the risk of TAGU. Also, a personal history or family history of other autoimmune conditions may increase the risk of TAGU. Other autoimmune conditions include sarcoidosis, rheumatoid arthritis, lupus, and Harada’s disease.
How is TAGU diagnosed?
The diagnosis of TAGU is first considered in anyone with inflammation of the eye (uveitis) in a person who has had a tattoo. A skin biopsy may be needed to demonstrate a typical form of inflammation of the tattoo. In addition, other tests may be needed to be sure the uveitis is not due to a problem unrelated to the tattoo (see uveitis questionnaire).
Take some time to carefully review and report to your doctor any unusual or unexplained symptoms such as rashes, back and joint problems. Tell your doctor if you travel abroad, spend time in rural settings, or may be exposed to animals or infections. Heredity may also play a role. Also, review and report your ancestry (for example, Asian, Mediterranean, or American Indian ancestry). When the doctor diagnoses uveitis, laboratory tests may be ordered to help determine its cause.
How is TAGU managed?
To limit the damage from inflammation, TAGU is treated with anti-inflammatory medication in the form of eye drops, injections (next to the eye or into the eye), or pills. When pills are used, the eye doctor frequently coordinates medical care with the expert assistance of a rheumatologist. Rarely, surgery is required to treat TAGU. In some cases, uveitis may be long-lasting. In these cases, years of therapy are needed to preserve vision. TAGU is a serious eye problem and may result in loss of vision or blindness. However, by seeing your eye doctor and taking the medications exactly as recommended, damage to your vision can be minimized.
In some cases, TAGU can resolve with treatment, but return at a future date. Therefore, if you become aware of symptoms of uveitis in the future, do not hesitate to contact your doctor.
What are other risks of tattoos?
Apart from eye inflammation, there are a host of health risks associated with tattoo. They include infection of the skin or blood (sepsis), hepatitis, HIV/AIDS, heart valve infection (endocarditis), scleroderma, scarring (keloid formation), and hypersensitivity reactions. Remember that the FDA does not regulate the contents of the ink that is injected into the skin. Also, government regulation is variable as it relates to training, sanitation, and infection control. Current regulations may not be adequate to protect you against harm.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Polymyalgia rheumatica is an inflammatory condition affecting the hips and shoulders of people over the age of 50 years. PMR may cause sudden shoulder and/or hip pain, especially after or during rest from activity. It usually affects both sides of the body. It may also cause fever, fatigue, weight loss, depression, and night sweats.
What causes polymyalgia rheumatica (PMR)?
The cause of PMR is not very well understood. The inflammation from PMR is not due to infection, though various infections may need to be excluded before a diagnosis of PMR is made. In PMR, it appears the body’s immune system attacks itself, in some ways similar to rheumatoid arthritis.
How is polymyalgia rheumatica (PMR) diagnosed?
The diagnosis is first suspected by typical symptoms in an older patient. Blood tests may include complete blood count (CBC), sedimentation rate (ESR), and C-reactive protein. If needed, ultrasound may detect bursitis in the shoulder. PET/CT scan is also very sensitive and specific for PMR.
How does polymyalgia rheumatica (PMR) affect the eyes?
When PMR is associated with inflammation of the blood vessels, the eye can become affected. This closely-related blood vessel inflammation is called giant cell arteritis (also called cranial arteritis or temporal arteritis). Giant cell arteritis (GCA) causes symptoms similar to PMR with the addition of headache, neck stiffness, tenderness of the scalp, and cramping of the tongue or jaw when speaking or chewing. These symptoms indicate inflammation of the blood vessels of the head. Loss of vision may occur due to retinal artery occlusion or ischemic optic neuropathy. Early diagnosis is critical to begin treatment and limit the damage from blood vessel inflammation, which includes complications of brain stroke.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
The eye is a specialized organ to provide sight. The various parts of the eye work to assist in this process. There are two eyes per human (many more if you are a spider or a scallop). The paired human eyes allow for improved depth perception. It takes two eyes for a human to best determine how far an object lies in front of him or her. Each eye has a slightly different view and the difference between the two images is used by the brain to make a three-dimensional (3-D) image. Test: you can see the difference in depth perception by trying to thread a needle or perform a similar fine task with one eye compared with two eyes. If the two eyes are not lined up straight, a person sees two images (double vision).
Shape of the eye
The shape of the eye is fairly round like a ball. This design helps the eye determine what direction light is coming from (see video: evolution of the eye). In near-sighted eyes, the eye becomes somewhat elongated (like an egg). This appears to be due to an adaptive response of the eye to aid in focusing at near. However, the elongation of the eye causes the tissues to stretch and this predisposes the eye to retinal detachment.
The Tear Film
This is an often-overlooked part of the eye. The tears form a smooth surface over the front of the cornea and help avoid scattering of light as it enters the eye. The tear film also provides nutrition, protection (antibacterial), and cleansing of the surface of the eye. The tear film is composed of three parts/layers: the aqueous (water), mucin, and lipid layers. The aqueous component is produced by lacrimal glands that rest in the eye socket behind a bone under the eye brow. The mucin layer is produced by specialized cells (goblet cells) in the conjunctiva. The mucin mixes with the aqueous layer and adds structure to the tears helping them to remain on the eye surface. The lipid layer (outer surface) produced by meibomian glands along the edge of the eye lids. The lipid helps protect against evaporation of the tears from the surface of the eye. Various conditions and diseases interfere with one or more layers of the tear film leading to dry eyes and reduced vision.
The Conjunctiva
The conjunctiva (not labelled on image) is a smooth moveable outer “skin” overlying the white sclera (see below). The conjunctiva acts as a physical barrier against entry of infectious organisms, and contains many blood vessels which dilate and become inflamed if infection or foreign objects threaten to damage the eye. The smooth surface of the conjunctiva and loose attachment to the underlying sclera helps the eye turn smoothly.
The Sclera
The sclera is the tough outer coat of the eye. It provides structural support and protection of the sensitive tissues (like the retina) inside the eye. The sclera does allow for the outflow of water that is produced by the ciliary body. It also allows medications to pass into the eye. Nerves and blood vessels penetrate the sclera to reach the inside of the eye.
The Cornea
The cornea is the clear window at the front of the eyeball that allows light to enter the eye. It is continuous with the sclera. Most of the focusing of light happens at the corneal surface/tear film. As this outer layer of the eye is so critical for sight, there are many nerve endings in the cornea making it the most sensitive part of the eye to touch. The outer-most layer is the epithelium: a smooth surface to transmit light with tightly layered cells difficult for infections to penetrate. The epithelium acts as a barrier to keep the water-filled tears from entering the cornea as this would make the cornea lose its clarity. The middle layer of the cornea is called the stroma. It occupies most of the cornea with orderly layers of protein fibers to transmit light and minimize scattering. There is very little water in the stroma because the inner-most layer of the cornea (the endothelium) pumps out water from the cornea into the eye. When the cornea becomes hazy or opaque, a corneal transplant may be performed.
The Iris and Pupil
The iris is responsible for the color of the eye as seen from the outside. A circular opening in the iris is called the pupil, which is seen as a black spot in the center of the iris. Iris muscles expand and contract to change the size of the pupil and alters the amount of light entering the eye. In bright light, the pupil constricts so as to prevent too much light from entering the eye. There is no specific function of iris color and iridology is not a true science. However, lighter-colored irises (irides) may not block as much light as dark irides. From a medical perspective, eyes with lighter color eyes may be at higher risk of developing macular degeneration. Darker eyes are seen among people who evolved nearer the equator. In birds, iris color appears to play a role in the mating ritual.
The lens
The lens inside the eye is made of specialized crystalline protein fibers that help to focus light and allow for flexibility of the lens in order to focus light from different distances from the eye. With age the eye loses its ability to focus light; therefore, reading glasses are needed by most people around the age of 40 years. When the clear lens turns foggy, the lens is called a cataract. Surgery may be performed to remove a cataract and replace it with a clear plastic lens implant.
The ciliary body (SILL-ee-air-ee)
The ciliary body has two functions inside the eye. It contains muscles to focus the lens (the ciliary muscles are attached to the lens by fine fibers called zonules). The ciliary body also has a pump that produces aqueous (water). The aqueous pump works to keep the eye inflated. The aqueous also provides nutrition to the structures inside the eye. There is a constant flow of aqueous into the eye via the ciliary body and out of the eye through the sclera (i.e. the trabeculum). If the trabecular drain becomes blocked, the pressure in the eye goes up and damage may occur to the optic nerve. This condition is called glaucoma.
The Vitreous
The vitreous is a clear gel that fills most of the eye. There are no blood vessels and very few cells in the vitreous. The clarity of the vitreous is important in order to allow light to pass from the lens to reach the retina. The vitreous is mainly composed of water, but there are fine protein fibers and a gel (hyaluronin) providing a unique structure. If the eye becomes cut from an accidental trauma, the vitreous gel may plug the hole in the sclera keeping the eye from deflating. The vitreous also appears to protect the lens; there are anti-oxidants in the vitreous gel that help keep the lens clear.
With age, the vitreous loses its gel-like quality and the protein fibers begin to clump together. When this happens, fiber-like floaters may appear in the vision. These floaters occur earlier in life in near-sighted eyes and in eyes following inflammation or trauma. Occasionally, the vitreous fibers will pull on the retina causing brief, streak-like flashes of light in the vision. The pulling may cause a retinal break (retinal tear), which may lead to retinal detachment. In other situations, the vitreous fibers may pull on the macula resulting in distortion of vision from vitreo-macular traction syndrome, epiretinal membrane, or macular hole.
The Retina
The retina is a light-sensitive layer of nerve tissue that lines the inside of the eye wall. It acts like the film in a camera. The central portion of the retina is called the macula. The macula is designed for central vision. When you read or see fine details, you move your eye so that light focuses on the macula. The rest of the retina is used for peripheral vision (side-vision). The peripheral vision is essential for walking around a room without bumping into things. The peripheral retina is also sensitive to detect movement in the environment. The blood supply to the inner retinal layers (ten layers in all) comes from retinal blood vessels that enter and exit the eye through the optic nerve. The outer retinal layers are supplies by blood vessels in the choroid (see below). Blockage of the blood supply (retinal artery occlusion or retinal vein occlusion) causes a blind spot in the vision or blurred vision. If the retina becomes detached from the eye wall, it does not function well, and surgery is required to recover vision. Aging may result in macular degeneration.
The Choroid
The choroid is a layer of tissue under the retina filled with blood vessels. This important blood vessel layer provides oxygen and nutrition to the retina. It also evacuates waste materials from the outer retina and acts as a heat sump, keeping the retina from overheating. The choroid may be affected by a number of problems including inflammation, blood vessel blockage, and central serous retinopathy.
The Optic Nerve
The optic nerve connects the nerve tissue of the retina to the nerve tissue in the brain, like wire in an electric circuit. The optic nerve is sensitive to the pressure inside the eye. High intra-ocular pressure may cause loss of vision or blindness from glaucoma. The optic nerve may also be affected by blocked blood flow, inflammation, and pressure from outside the eye (tumors and aneurysms).
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
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Although it is best if you live near Tampa, we may be able to help even if you live afar. If you are local, we are available to examine your eyes directly if needed. If you live distant from Tampa, we can refer you to a reputable eye-care specialist in your area if you need an examination.
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For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Indicate your interest in a virtual exam and briefly state your eye problem. We will return your email or contact you by phone at your preference.
There are many conditions, which threaten loss of vision, that are treated by injecting various medications into the eye. The eye conditions include macular degeneration, diabetic retinopathy, retinal vein occlusion, uveitis, and others. The injections may be given into the tissues outside the eyeball (subtenon’s injections) or into the eyeball (intravitreal injections). It is very important to avoid pain as these injections may need to be given repeatedly over time.
Why do I have pain after eye injections?
Although pain during eye injections can usually be minimized with anesthetics given before the injection, sometimes there is pain for hours after the injection. There are many reasons why this may occur:
1.) The antibiotic (betadine) may irritate the eye for hours after it has been applied to the eye.
2.) The eye may become dried out after the injection due to insufficient blinking.
3.) The eye may be accidentally scratched by rubbing the eye while it is still anesthetized.
4.) The drug that is injected into the eye may cause an inflammatory reaction.
5.) Rarely, a severe infection called endophthalmitis may occur after injection into the eyeball.
What can be done to prevent pain after injections?
The key to eliminating pain after eye injections is to identify the underlying cause. This may take some detective work. Although betadine is given at the time of injection to prevent infection, only a small dose is needed. If a large amount of betadine is used or if the betadine has not been thoroughly rinsed off the eye, it may cause blurred vision, persistent burning, itching, and/or a scratchy sensation like sand in the eye (called a foreign body sensation). Therefore, it is important for the eye doctor or technician to completely rinse the betadine off the eye after an eye injection in order to avoid pain later.
Sometimes, the surface of the eye may become dry after an injection because the patient does not blink frequently enough or not completely enough. This often happens as a result of the anesthetic used in preparation for the injection. After the injection is over, the anesthetic may continue to work for 15-30 minutes. During that time, the patient does not have the normal sensation necessary to indicate that it is time to blink. If the eye does not blink often enough, the surface may dry out and cause blurred vision, pain or foreign body sensation. Therefore, the patient may need to purposefully blink frequently or simply rest the eye closed for a while after an eye injection in order to prevent drying. Similarly, if a patient does not close the eye completely with each blink, part of the eye can become dry. In some cases, it may be necessary to forcibly close the eyes with each blink in order to be sure the lids close completely.
At times a patient may unknowingly rub and scratch the eye after an injection because of persistent numbing after an injection. Therefore, it is very important to avoid touching the eye for 15-30 minutes after an injection. If the eye needs to be dried off, a clean tissue may be used with a gently damping or blotting motion in the corner of the eye where the lids come together at the bridge of the nose. It is best not to move the tissue left and right or up and down in a rubbing fashion. Once the eye becomes dry or irritated for any reason listed above, it may take 1-2 days for the pain to go away and the eye to return to normal.
Rarely, a drug that is injected into the eye can cause an inflammation that causes pain or blurred vision. The doctor makes this diagnosis by examining the eye under the biomicroscope (called a slit lamp). If a medication is determined to be the cause of inflammation, it is treated with prescription eye drops and the offending drug is not used again in that patient in the future.
Infection is an extremely rare cause of pain after an eye injection. In about one in several thousand injections, germs may enter the eye through the needle tract after an eye injection. This rare infection is called endophthalmitis (pronounced like “end-off-thal-my-tiss”). Symptoms usually start with pain, redness, and loss of vision several days to a few weeks after an injection. There is no perfect way to prevent endophthalmitis. The doctor uses techniques like applying betadine before the injection. The patient tries to avoid contaminating the eye by avoiding exposure the unclean areas (like a barnyard) and avoid rubbing the eyes after injection. Endophthalmitis is very serious and may result in permanent loss of vision. Therefore, any patient having deep aching pain, increasing redness, and loss of vision starting several days or weeks after an eye injection should notify their eye doctor for prompt evaluation.
What can be done to make the eye feel better?
If the cause of the pain and irritation is from betadine, drying, or rubbing the eye, the best treatment is lubrication. Lubricants are available over-the-counter in the form of eye drops, eye gels, and eye ointments (see examples at the end of this article). The thicker the lubricant, the better the relief of pain and discomfort. However, gels and ointments may be difficult to place into the eye and they tend to make the vision blurry for several minutes or more. Lubricants may be used as often as needed. Resting the eyes closed may also provide relief. Cold compresses help many patients. Over-the-counter pain medications like ibuprofen and/or Tylenol may be helpful. Prescription pain medications are rarely needed and may cause undesirable side effects.
If the cause of the pain and irritation is from a drug reaction or from infection inside the eye, the doctor will prescribe special anti-inflammatory eye drops. If the eye exam shows infection, antibiotic injections must be given into the eye and surgery in the operating room may be necessary.
If pain keeps occurring after eye injections despite taking the measures listed above, sometimes prescription eye medication can help. Non-steroid (NSAID) eyes drops or steroid/antibiotic ointments may help prevent the pain. Most instances of pain after eye injections may be avoidable. Please talk with your eye doctor to help resolve the problem in order to undergo treatment without pain.
Gels are easier to apply than ointments and may be used immediately after an eye injection to prevent eye pain and they may be used later to soothe eye discomfort.
Ointments are more difficult to place in the eye. However, they provide longer duration of action. They may be used immediately after an eye injection to prevent eye pain and they may be used later to soothe eye discomfort.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
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The retina in your eye is like the film inside a camera. The retina “takes the picture” of objects you look at and sends the message to the brain. The retina is a living tissue, which requires blood supplied by tiny vessels called arteries. If a retinal artery becomes blocked, it causes a sudden black-out of vision in one eye that may last minutes to hours. This symptom is called amaurosis fugax (pronounced, “am-a-ro-sis fyoo-jacks”).
What causes amaurosis fugax?
Amaurosis fugax (AF) is usually caused by a temporary blockage of blood flow to the eye from a piece of hardened artery in the neck (carotid artery) that breaks away and flows “down stream” to lodge in a small retinal artery. Abnormal tissue from a heart valve may also be the source of retinal artery blockage. Rarely, an interruption of blood flow to the eye may result from blood disorders or inflammation.
What is to be done?
First and foremost, a prompt eye exam is required to make an accurate diagnosis. Sometimes, intra-ocular hemorrhage, migraine, or retinal artery vasospasm may simulate amaurosis fugax. These other diagnoses are managed differently. If amaurosis fugax is confirmed, then evaluation is undertaken to find the cause of the blocked blood supply to the eye (retina or optic nerve). If the loss of vision is recent, the need for testing may be an emergency.
The reason for laboratory and x-ray testing is to identify treatable conditions that might cause stroke or permanent loss of vision if left untreated.
Where do I go for urgent care?
An urgent MRI brain scan (diffusion-weighted imaging) may be performed at a stroke center such as those available through the emergency room at Adventist Hospital, St. Joseph’s Hospital, or Tampa General Hospital. The brain scan can identify strokes that may be present without symptoms. Such strokes need to be treated in the hospital to prevent complications of paralysis and death.
Other important studies may also be performed to identify underlying treatable conditions. Blood tests may identify giant cell arteritis, a treatable inflammation of the arteries. A carotid sonogram studies the circulation of major arteries in the neck that lead to the brain and eyes. An ECHO cardiogram may identify an abnormal heart valve or a blood clot in the heart. These findings may be treatable to reduce the risk of future stroke.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Uveitis (pronounced, “you-vee-EYE-tis”) is a general term used to describe inflammation inside the eye. The uvea is the name given to the layer of tissue in the eye that has a brown color (melanin pigment) and blood vessels, which serve to provide blood supply and protect the eye from excessive light. The uvea can be divided into separate parts, which perform different functions in the eye: the iris, the ciliary body, the pars plana, and the choroid. The part of the uvea in the front of the eye is called the iris (the round, blue or brown part of the eye that you can see in the mirror). Behind the iris is the ciliary body, which produces the fluid that fills the eye. The pars plana serves as the boundary between the ciliary body and the choroid. The back part of the uvea that lies under the retina (the “film” in the eye that “takes the picture”) is called the choroid. Therefore, in any one patient uveitis is usually given a more specific name depending on where most of the inflammation is located in the eye. In intermediate uveitis the inflammation is primarily located in the vitreous gel that fills the eye, which is located in an intermediate position between the front and the back of the eye. It is sometimes referred to as vitritis or pars planitis.
What causes intermediate uveitis?
Uveitis may be caused by an infection, an injury from trauma, a disease in the body outside the eye, or sometimes for unknown reasons. Infection by a virus, bacteria, fungus, or other parasite may cause uveitis. Infections may be limited to the eye or may involve other organs as well. In intermediate uveitis, infection may be caused by syphilis, tuberculosis, Lyme disease, cat scratch disease, Whipple’s disease, toxocariasis, human lymphotrophic virus (HTLV-1), or toxoplasmosis.
In other situations, uveitis is caused by inflammation without infection. For example, multiple sclerosis, sarcoidosis, HLA-B27, and inflammatory bowel disease may cause intermediate uveitis. Pars planitis is a sub-type of intermediate uveitis that often starts early in life during childhood. Its cause is unknown.
Uveitis commonly occurs following an injury to the eye. Very rarely, cancer or cancer-fighting drugs may cause intermediate uveitis. In some cases, no underlying cause can be found to be the cause of uveitis. Tobacco may be an aggravating factor and should be discontinued.
What are the symptoms of intermediate uveitis?
The most common symptoms include tiny floating spots which move or “float” in the vision. They are usually numerous and may cause a veil-like appearance in the vision. Sometimes blind spots, blurred vision, distortion, or loss of side vision occurs. The eye may be painful, red, tearing, and light sensitive if other parts of the eye are also inflamed. Symptoms may be mild or they may be severe and disabling.
How is intermediate uveitis managed?
To effectively treat intermediate uveitis, it is important to find the underlying cause whenever possible. Take some time to carefully review and report to your doctor any unusual or unexplained symptoms such as rashes, back and joint problems. Tell your doctor if you travel abroad, spend time in rural settings, or may be exposed to animals or infections. Heredity may also play a role. You should tell your doctor about any family members with inflammatory disorders anywhere in the body. Also, review and report your ancestry (for example, Asian, Mediterranean, or American Indian ancestry). When the doctor diagnoses uveitis, laboratory tests may be ordered to help determine its cause. Occasionally, a surgical biopsy is needed for diagnosis. If infection is found, antibiotics are prescribed. To limit the damage from inflammation, intermediate uveitis is treated with anti-inflammatory medication in the form of eye drops, injections, or pills. When pills are used, the eye doctor frequently coordinates medical care with the expert assistance of a rheumatologist. Rarely, surgery is required to treat uveitis. In some cases, intermediate uveitis may be long-lasting. In these cases, years of therapy are needed to preserve vision. Intermediate uveitis is a serious eye problem and may result in loss of vision or blindness. However, by seeing your eye doctor and taking the medications exactly as recommended, damage to your vision can be minimized.
In some cases, intermediate uveitis may go away, but return at a future date. Therefore, if you become aware of symptoms of uveitis in the future, do not hesitate to contact your doctor. Preliminary evidence suggests that tobacco use may be an aggravating factor in some cases of uveitis.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Endophthalmitis (“end-off-thal-my-tis”) is a severe inflammation inside the eye. The inflammation may be due to an infection or it may be “sterile.” Endophthalmitis threatens profound loss of vision and possible loss of the eye. Bacterial endophthalmitis usually requires urgent treatment to save the eye.
What causes endophthalmitis?
Endophthalmitis may be caused by an auto-immune reaction (the body attacks itself), it may be due to a foreign substance introduced into the eye in an accident or surgery, or it may be due to an infection. Here we will discuss endophthalmitis due to infection.
Infections may be caused by a number of viruses, fungi, parasites, and bacteria. Infectious endophthalmitis is classified as endogenous and exogenous. Endogenous endophthalmitis occurs when an infection enters the eye from inside the body, usually through the blood stream. Exogenous endophthalmitis occurs when an infection enters the eye from outside the body, usually from an opening into the eye from trauma, surgery, or intraocular injections.
Although the risk of endophthalmitis is low for a single surgery, the risk increases over time with multiple Intraocular injections. For example, after 5-6 years of injections for macular degeneration, the risk rises to about one in 200.
How is infectious endophthalmitis diagnosed?
Infectious endophthalmitis is suspected when severe inflammation is found inside the eye on an exam. It is usually accompanied by pain and loss of vision. Diagnosis is confirmed with a culture of the fluid inside the eye taken in the office or the operating room.
How is infectious endophthalmitis treated?
Infectious endophthalmitis is treated with antibiotic injections into the eye performed in the office or in the operating room. In severe cases, vitrectomy surgery is needed to remove some of the infected material. Vitrectomy is performed in the hospital operating room as a major eye surgery involving small incisions into the eye. Eye drops (steroid and non-steroid) are used frequently to help treat infection and to decrease the inflammation that can damage the eye. Sometimes additional steroid medications are used. The recovery of vision is very slow, taking weeks to months. If permanent damage occurs as a result of endophthalmitis, little or no recovery of vision may be possible. Frequent visits to the doctor are necessary at first to give the best results.
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For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Ocular shingles (herpes zoster ophthalmicus) is an inflammation of the eye and surrounding skin caused by an infection of a virus in the Herpes group called the Varicella Zoster virus (the Chicken Pox virus). The name, shingles, comes from a Latin word meaning belt or girdle, as shingles usually presents as a rash along the path of a nerve in a band-like pattern.
Shingles
What causes shingles?
Shingles is caused by the Chicken Pox virus that reactivates after years of “hibernation” in the nerve cells. When you contract Chicken Pox, the virus takes refuge inside nerve cells and remains there for life after the rash goes away. This is a common behavior of all viruses in the Herpes group. Years later, when the immune system “forgets” the virus, it re-emerges as shingles.
Why is shingles becoming more common?
Currently, it is estimated that half of all people will develop shingles during their lifetime. The reason appears to relate to the use of the Chicken Pox vaccine. Prior to vaccination, adults would be routinely exposed to the Chicken Pox virus as they were intermittently exposed to children with active Chicken Pox. This frequent exposure to the virus by adults used to keep the immune system primed to keep the virus contained inside the nerve cells. Now that children no longer contract Chicken Pox, adults no longer receive the benefit of immune priming. Over time the immune system forgets the virus and allows the escape of the virus from the nerve.
What are the symptoms of ocular shingles?
The symptoms of shingles depend on the location of the nerves that harbor the virus. If the chest wall is affected, the eyes are spared. If the trigeminal nerve is affected, the forehead develops a rash. If the rash reaches the tip of the nose, the eye is often affected. The rash starts with redness and tiny blisters that crust and scar over time. Pain may occur before the rash appears and is described as burning, sharp, jabbing or tingling. Pain may be severe. It is the persistence of pain that may be disabling.
Aside from the possibility of long-term pain, other problems may relate to shingles. There appears to be an increased risk (4.5x) of stroke after shingles. There may also be an increased risk of cancer, inflammation of blood vessels (temporal arteritis), heart attack, and depression.
Ocular shingles is when shingles affects the eye. It may cause inflammation of the front window of the eye (the cornea) with scarring. Glaucoma may occur and require life-long treatment to prevent blindness. Intraocular inflammation may affect the front of the eye (iritis) or deep inside the eye threatening loss of vision. The inflammation may persist or return intermittently into the future.
What treatment is available?
Antiviral and anti-inflammatory medications may help treat shingles. The systemic treatment of shingles is managed by an internal medicine doctor (and sometimes by an infectious disease specialist). Treatment may hasten the recovery from shingles, but does not eliminate the late complications of infection.
Ocular complications of shingles are treated by ophthalmologists. Apart from anti-viral pills, eyes drops can help prevent loss of vision. After the initial inflammation is controlled, regular exams are important to diagnose problems that may occur in the future.
What can be done to prevent shingles?
An ounce of prevention is worth a pound of cure. The chance of shingles can be reduced by the use of a vaccine. This vaccine reduces the risk, but does not eliminate the chance of getting shingles. If shingles does occur after vaccination, it us usually not as severe compared to those without the vaccine. Not surprisingly, the effect of the vaccine wears off over a period of five to ten years. Research suggests that booster shots may help extend the effect of the vaccine; however, the cost of the vaccine appears to hinder formal recommendations for repeat vaccination. The newest vaccine, Shingrix, became available in 2018 and offers the best protection.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Erectile dysfunction (ED) is a common problem among males involving an inability to achieve or maintain an erection. Medications have been developed to treat this condition. They work in part by promoting dilation of the blood vessels in the penis. This same dilation of the blood vessels also occurs in other parts of the body. Facial flushing, stuffy nose, and headache may result from vascular dilation in the head. A decrease in blood pressure may also occur due to pooling of blood in the larger dilated veins of the body. This drop in blood pressure may cause symptoms of insufficient blood flow, especially in patients with hardening of the arteries.
How can ED medications affect my eyes?
Medications prescribed for erectile dysfunction (ED) may cause temporary blurred vision, light sensitivity, or impaired color vision. If these symptoms occur, a decrease in dosage of medication may be in order. If these symptoms persist, contact your ophthalmologist.
Rarely, a severe permanent decrease in vision may occur after using ED medications…ischemic optic neuropathy. This condition occurs most often in patients with atherosclerosis (hardening of the arteries) and in eyes with crowded optic discs (often seen in far-sighted people). Any sudden decrease in blood pressure (including the use of ED medications) may precipitate ischemic optic neuropathy.
In some patients ED medications might aggravate central serous retinopathy (CSR). a condition more often seen in far-sighted eyes with a thick blood vessel layer in the choroid. This condition causes a round, blurred gray or brown spot in the center of the vision. If this symptom appears while taking ED medications, contact your ophthalmologist.
What other medicines or conditions might interact with ED Medications?
Certain foods and drugs may interact with ED medications. Eating grapefruit or drinking grapefruit juice may affect how your body eliminates ED medications from your body. The following medications should not be used with ED medications: nitrates (nitrogycerin, isosorbide), nitroprusside, certain recreational drugs called “poppers” (which contain amyl or butyl nitrite).
Other medications may also affect ED medications and should be reported to your doctor or pharmacist: prostate medications, blood pressure medications, HIV/AIDS medications, St. John’s wort, some seizure medications, and certain antibiotics.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
HLA-B27 is the name of an inherited marker found on white blood cells. It is found to be present with blood testing in one to ten percent of the population (higher in Scandinavians and some Native American groups). HLA is an abbreviation for Human Leukocyte Antigen. HLA-B27 is important to identify as it may be associated with medical problems such as inflammation of the eye, arthritis, psoriasis, and bowel inflammation, which may require medical treatment. There is an estimated risk of one-in-four that a person with HLA-B27 will develop eye or joint inflammation. Low vitamin D levels may play a role in causing the inflammation.
How does it affect the eye?
People who inherit HLA-B27 may develop iritis at some time during their lives. Iritis (also called anterior uveitis) means inflammation of the iris (the colored part of the eye). This inflammation is an irritation without infection. The inflammation is due to the natural immune system in the body mistakenly attacking the eye (similar to the way the immune system attacks the joints in rheumatoid arthritis). Symptoms include deep aching eye pain, redness, tearing, and light sensitivity. Other conditions of the eye may cause similar symptoms, so it is important to see an eye doctor promptly to make the correct diagnosis. Symptoms may be mild or severe. Treatment with drops (steroid and non-steroid), shots, and/or pills is important to prevent complications such as decreased vision, glaucoma, cataract, scarring, deformity, and blindness.
In 15-20% of patients with ocular inflammation associated with HLA-B27, the posterior structures of the eye may be involved. This inflammation is called intermediate uveitis. Symptoms include floaters and blurred vision. Although eye drops may be helpful, steroid injections and systemic medications may be needed. It is important to know if there is joint inflammation when deciding how to treat eye inflammation, because Humira is preferred over other medications if immunosuppressive therapy is needed. Humira (and other TNF-apha inhibitors) are effective for both eye and joint inflammation. Whereas, methotrexate and mycophenolate are good for eye inflammation, but less effective against joint inflammation associated with HLA B27.
How can it affect other parts of the body?
HLA-B27 is associated with ankylosing spondylitis, reactive arthritis, inflammatory bowel disease, and psoriasis. Ankylosing spondylitis is an arthritis that involves the spine, and it usually causes back pain and stiffness. Reactive arthritis usually involves large joints like the knees, ankles, feet, and wrists. It may follow an episode of infection of the intestines, bladder, or genitals. Inflammatory bowel disease may involve the small intestine (Crohn’s disease) or the large intestine (ulcerative colitis). Psoriasis is a skin condition causing raised red areas of the skin with scaling. Rarely, patients with HLA-B27 will suffer from scarring of the lungs (apical pulmonary fibrosis) or inflammation of the large blood vessels (aortitis).
Who should I see for evaluation of HLA-B27?
If you test positive for HLA-B27, you should inform all of your doctors so they may be alert for associated medical problems. You may be referred to an ophthalmologist if you have eye symptoms. A rheumatologist may evaluate joint symptoms with examination and X-rays. A gastroenterologist evaluates stomach problems. Recognizing symptoms and reporting to the doctor in a timely fashion may prevent severe and permanent complications.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Ischemic optic neuropathy is condition in which blood flow to the optic nerve is inadequate. The decreased blood flow results in a sudden and sometimes progressive loss of vision. The optic nerve is the nerve that connects the eye to the brain. It sends the “picture” taken by the eye to the brain.
What causes ischemic optic neuropathy?
The cause of ION is not very well understood, but it occurs in people over the age of 40 and may be related to hardening of the arteries (arteriolar sclerosis) caused by high blood pressure, diabetes, high cholesterol, tobacco, or obesity. Some people are predisposed to ION because of the way the eye developed from birth with a small opening in the back of the eye for the optic nerve. This “crowded” optic nerve may be predisposed to blood vessel blockage. Sometimes, ION is caused by an inflammation of the blood vessels (temporal arteritis or giant cell arteritis). Sleep apnea may play a role in some patients and SSRI anti-depressants may be a risk factor.
How is ischemic optic neuropathy managed?
When the doctor diagnoses ION, laboratory tests may be ordered to determine if any underlying problem is present outside the eye. If there are signs of inflammation, a biopsy of a blood vessel over the temple may be performed and treatment with steroid pills instituted if the tests are positive. Most cases of ION are not associated with inflammation. Unfortunately, no treatment has been proven to be effective. The visual loss is usually permanent. Because the fellow eye may be affected at a later date, some doctors recommend the use of a half aspirin a day for prevention.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
A myopic eye has elongated somewhat like an egg. Incoming images do not focus on the retina in the back of the eye.
Although most people with myopia (near-sightedness) do not suffer from complications, highly near-sighted eyes (greater than 6 diopters) are at risk of vision loss. Myopia is fairly prevalent, affecting about 25-35% of adults in the United States. Extensive visual tasks focused at near may be increasing the risk of myopia. Highly myopic eyes are at increased risk of myopic macular degeneration, cataract, glaucoma, and retinal detachment. Therefore, treatment to reduce the progression of myopia is important to prevent loss of vision.
The simple act of spending time away from near work appears to offer help in reducing the onset of myopia. In one study the incidence of myopia was decreased by 10% by spending 40 minutes per day outdoors.
Recent studies support the use of dilute atropine eye drops to slow the progression of myopia. Atropine 0.01% must be prepared by a pharmacy with a doctor’s prescription. The cost is about $20-30 per month. The drop is used once per day. This low-concentration eye drop had minimal effects on the eye. A dilated pupil and difficulty focusing at near are rarely encountered. Therefore, light sensitivity is minimized. Very rare side effects of atropine including rapid heart rate, dry mouth, and urinary retention, constipation, and flushing of the skin are not generally reported with diluted atropine used to treat myopia. Allergic reactions with redness and itching are rare with low-concentration atropine, as well.
Eligible patients include children (aged 5-15) with progressively worsening myopia (1 diopter of more in one year). However, there are no hard and fast rules; a strong family history of high myopia may play into the decision to treat a child with myopia to slow its progression. Treatment may continue until age 18 years. More studies are needed to better define the best time to start treatment and the optimal duration of treatment. For now, however, it appears that atropine may be the safest and most effective pharmacological treatment to slow the progression of myopia.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Iritis (pronounced, “eye-RYE-tis”) is a general term used to describe inflammation in the front of the eye. Specifically, it means inflammation of the iris. The iris is the name given to the layer of tissue in the eye that gives it a brown or blue color and serves to protect the eye from excessive light. Iritis is also called anterior uveitis.
What causes iritis?
Iritis may be caused by systemic inflammatory disease, trauma, infection, or sometimes for unknown reasons. Infection by a virus, bacterium, fungus, or other parasite rarely causes iritis. Infections may be limited to the eye or may involve other organs as well. More commonly, iritis is caused by inflammation without infection. For example, sarcoidosis, arthritis, lupus, and inflammatory bowel disease may cause iritis. The most common type of arthritis that causes iritis is ankylosing spondylitis, a condition that causes low back stiffness in the morning. Iritis also commonly follows an injury to the eye. In some cases, no underlying cause of iritis can be found.
What are the symptoms of iritis?
The eye may be painful, red, tearing, and light sensitive. Tiny floating spots which move or “float” may be seen. Symptoms may be mild, or they may be severe and disabling. Iritis may cause glaucoma, cataract, or scarring of the iris producing a distorted pupil (the part of the eye that is normally round and black). Blurred vision is common, and blindness may occur if iritis is not treated.
How is iritis managed?
When the doctor diagnoses iritis, laboratory tests may be ordered to help determine its cause. A questionnaire may be reviewed. Occasionally, a surgical biopsy is needed. If infection is found, antibiotics are prescribed. Dilating drops are used to limit pain and scarring of the iris. To limit the damage from inflammation, iritis is treated with anti-inflammatory medication in the form of eye drops (steroid and non-steroid), injections, or prednisone pills. The eye drops must be used very frequently to break an acute attack of iritis. Sometimes, non-steroid pills (e.g. methotrexate) or biologics (e.g. Humira) maybe needed. Aggressive treatment is recommended to prevent complications and permanent injury to the eye. Surgery may be required to treat complications of iritis such as glaucoma and cataract. Iritis is a serious eye problem and may result in loss of vision or blindness. However, by seeing your eye doctor promptly and taking the medications exactly as recommended, permanent damage from iritis can be minimized. In some cases, iritis can return in either eye at a future date. Therefore, if you become aware of the return of symptoms of iritis in the future, contact your doctor without delay.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Multiple Sclerosis is a condition of the brain and spinal cord in which there is a loss of the insulating coat of the nerve cells (demyelination). The cause is unknown, but viral and auto-immune causes are suspected along with genetic predisposition. Because the brain controls movement and sensation, multiple sclerosis may cause a variety of symptoms. The symptoms may occur from time to time with normal periods in between (relapsing form). Alternatively, the symptoms may slowly progress and persist over time (progressive form).
How does multiple sclerosis affect the eyes?
Multiple sclerosis may disrupt the nerves that affect the vision or the movement of the eyes. It may also cause inflammation inside the eye. The following are well-recognized problems involving the eyes:
Optic Neuritis: Inflammation of the optic nerve may cause a sudden loss of vision. Often, there is pain in or behind the eye made worse with eye movement.
Internuclear Ophthalmoplegia (INO): An interruption of the nerve fibers that coordinate movement of the two eyes may cause a loss of alignment. If the two eyes are not pointing in the same direction, double vision occurs.
Intermediate Uveitis: A low-grade inflammation inside the eye (vitritis) may cause the slow-onset of fine floating specks in the vision. Over time, the vision may become blurred due to the accumulation of specks, as well as swelling of the retina.
How is multiple sclerosis diagnosed?
When visual symptoms occur, the ophthalmologist may undertake a number of tests in the office to diagnose multiple sclerosis. The optical coherent tomogram (OCT) can identify defects in the optic nerve and diagnose macular edema. Usually, an MRI scan is needed to identify degenerative plaques seen in the brain due to multiple sclerosis. Ultimately, a neurologist is consulted to confirm the diagnosis.
How is multiple sclerosis treated?
A neurologist orchestrates the treatment of multiple sclerosis. Medication and physical therapy help to manage symptoms. There is no cure. The clinical course of multiple sclerosis is variable. The least long-term disability is usually seen in women, those with onset of symptoms early in life, and those with few intermittent symptoms at onset.
The ophthalmologist manages the ocular symptoms. Loss of vision usually returns over time and may be accelerated with the use of IV steroids. Double vision may also improve over time and may be managed by patching one eye.
Intermediate uveitis usually requires medication to prevent progressive permanent loss of vision. Although mild cases may be carefully observed, treatment is needed if floaters interfere with vision or if macular edema (retinal swelling) is present. Steroid medications may be used by pills or by injection. They are best used for short-term management of flare-ups of inflammation. Other non-steroid medications help to suppress the inflammation over the long-term. These medications often require the assistance of a rheumatologist who watches for side effects while the ophthalmologist monitors the inflammation.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Vitreous is the gel that fills the eye (click on image to enlarge)
What is vitreous hemorrhage?
Vitreous hemorrhage means blood has leaked into the vitreous gel of the eye. The vitreous is a clear gel that fills the center of the eye and helps to hold the retina in place against the eye-wall like wallpaper in a room. The retina is a thin layer of delicate nerve tissue, which acts like film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. The retina has many fine blood vessels, which sometimes leak blood into the vitreous and cause a loss of vision.
What symptoms does vitreous hemorrhage cause?
Vitreous hemorrhage usually causes many new floaters in the vision. Floaters may appear as round specks, hair-like or bug-like debris, or clouds moving in your vision as though they were in front of your eye. They are more noticeable when looking at a blank surface and may interfere with the good vision in the fellow eye.
Flashes are brief streaks of light that are usually seen off to the side, especially at night when you turn your head or eyes. Flashes are caused by vitreous gel pulling on the retina with eye movement.
Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous. In some people with these symptoms, the retina may tear and detach resulting in loss of vision.
What causes vitreous hemorrhage?
There are many causes of vitreous hemorrhage. Diabetes can cause vitreous hemorrhage by weakening the blood vessels in the retina and by causing the vitreous gel to shrink and pull on the retinal vessels. Hardening of the arteries in the eye can cause vitreous hemorrhage by blocking a retinal vein where the arteries cross over the veins in the retina. Ageing changes of the vitreous gel can cause it to pull on the retina and tear it. The tearing of the retina may result in bleeding into the vitreous. Less common causes of vitreous hemorrhage include birthmarks inside the eye, inflammation, trauma, tumor, surgery, blood disorders, and macular degeneration.
How is vitreous hemorrhage treated?
The most important step is to have a thorough eye examination with ultrasonography. The ultrasound machine uses sound waves to safely and effectively “look through” the blood in the vitreous to see if the retina is attached. If a retinal detachment is found, surgery (scleral buckle, pneumatic retinopexy, and/or vitrectomy) is required in an attempt to repair it. If no retinal detachment is found on ultrasound exam, your doctor may allow the vitreous hemorrhage to clear on its own with time. The ultrasound exam may be repeated periodically to assure the retina remains attached. In many cases the cause of the vitreous hemorrhage cannot be determined until the hemorrhage has cleared. If the hemorrhage does not clear on its own, vitrectomy surgery as a one-day surgery in the hospital operating room may be considered. The amount of visual return depends on several factors including the health of the underlying retina.
What should I be on the lookout for?
After examination or treatment for a vitreous hemorrhage, you should notify your doctor if you have a burst of new floaters, a loss of side vision, or pain. Sometimes, retinal tears or a retinal detachment occur at a later date after the examination.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
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