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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Visual snow is the name for a visual symptom that looks like static on a television not tuned to a station. It has also been likened to pixelation on a computer screen. Many tiny flickering lights are usually seen in both eyes at the same time and encompasses the entire visual field. In some instances, it is worse in bright illumination like a bright sunny day.
What is the difference between primary and secondary visual snow syndrome?
Visual snow may be seen in patients without an underlying disease. In these cases it appears to be caused by hyperexcitability of the visual cortex of the brain. This is often called primary visual snow syndrome (VSS). Primary VSS is a diagnosis of exclusion. That is, other diagnoses must be excluded before the diagnosis of primary VSS is made. Primary VSS is related to migraine; indeed, many people who report visual snow also have migraine visual symptoms with or without headache. Other related symptoms include palinopsia (visual persistence of an image after the eyes are closed or look away), floaters and spots (entopsia), difficulty seeing in dim light (nyctalopia), difficulty seeing in bright light (hemeralopia), and flashes of light (photopsia). Other associated symptoms include ringing in the ears (tinnitus) and dizziness that varies with head position (postural vertigo).
Visual snow may be a symptom of an underlying disease (secondary visual snow syndrome). In this situation, it is critical to identify the underlying cause and offer treatment where possible. Secondary visual snow may originate from the retina or the brain. A well-described retinal cause of visual snow is due to digoxin toxicity. It usually occurs in elderly people who take digoxin for heart problems. It indicates the need to stop taking digoxin or lower the dose. Failure to reduce the dose may result in severe complications, including death. Other rare causes of visual snow include eye disease, immune disease, infectious disease, psychiatric disease, prescription drugs, past use of hallucinogens, head trauma, brain tumor, seizure disorder, and brain degenerative disease.
What causes the primary visual snow syndrome?
The cause of primary VSS is not known. It is felt to be due to an error in central processing in the back of the brain (occipital lobe). Special brain scans show hypermetabolism in the lingual gyrus of the occipital lobe in the back of the brain.
How is primary visual snow syndrome diagnosed?
The diagnosis is made on the basis of typical symptoms after testing has ruled out an underlying disease of the eye or brain. MRI brain scan is often used to rule out tumor, multiple sclerosis, degeneration, and stroke. EEG may be used to rule out seizure disorder. A spinal tap may be needed to rule out idiopathic intracranial hypertension. Pattern reversal VEP usually demonstrates loss of habituation of the occipital lobe in the brain (indicative of hyperexcitability). A neurologist usually arranges for testing as needed. An ophthalmologist may be helpful in ruling out eye disease.
What can be done about these symptoms?
It is difficult to treat primary VSS. Medications such as lamotrigine and topirimate may be helpful in some patients. Tinted glasses or clip-on lenses may also be helpful to minimize the symptoms of visual snow. Placing a yellow or orange tinted cellophane sheet on top of reading material helps some. Riboflavin and magnesium supplements may be of benefit for migraine and visual snow, as well. For many patients it is helpful to know that primary VSS is a benign condition that does not progress to blindness.
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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What are these circular spots in my vision after an eye injection?
Sometimes after an eye injection, a patient may see one or more black circular spots that move in the vision with head movement. They are usually in the lower part of the visual field, though they move up toward the center of the visual field if you position your head face down.
What causes these symptoms?
These black spots are due to air bubbles in the medicine that is injected into the eye. They appear immediately after injection. They are harmless and take 1-2 days to dissolve and disappear. Less commonly, small black circular spots may float in the vision after injection due to small silicone bubbles that are used to lubricate the syringe. These silicone bubbles do not dissolve, but they may float away from the retina and become less noticeable over time.
What should be done about these symptoms?
If the spots are due to air bubbles, these symptoms fade without treatment. If the spots are due to silicone bubbles, they may come and go over time. It is best not to track them with your eyes as they may become more bothersome. Try to look past these floaters and ignore them if possible. If they persistently interfere with the vision, vitrectomy surgery may be considered to remove them. This is rarely necessary.
What other symptoms can mimic this problem?
These black spots are considered a type of “floater.” Floaters are any visual spot in the vision that “floats” or moves somewhat independent of eye movement. Sometimes floaters may come on suddenly and appear like dots and fibers. This is typical for bleeding inside the eye. If dots and fiber-like floaters come on more slowly (hours to days), they may be a sign of infection or inflammation. Rarely, cancer may present as many tiny floating spots in the vision.
Floaters are distinct from blind spots (scotoma) that are fixed in the visual field and move only when the eye moves. You cannot “catch up” or move away from a blind spot by moving the eye. Blind spots are usually due to problems with the retina or optic nerve. A progressive blind spot that begins in the peripheral vision and enlarges over hours to days may be due to a retinal detachment and requires a prompt examination. Retinal detachment is often described as a curtain or shadow covering the vision.
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.
Copyright 2022 Designs Unlimited of Florida. All Rights Reserved
Sickle cell disease is the most common genetic disease, affecting about 400,000 newborns each year. It is caused by a mutation in the gene that codes for the hemoglobin protein that carries oxygen in the blood stream. Sickle hemoglobin tends to clump into a sickle shape when it gives up its oxygen molecule to the tissues it supplies. When this occurs, the red blood cells lose their flexibility and tend to block the small blood vessels in the body. 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. These blood vessels may be damaged in people with sickle cell disease.
Who is at risk of eye problems in sickle cell disease?
Although more extensive blockage of retinal blood vessels occurs in sickle cell disease, more severe complications (bleeding and retinal detachment) occur in people with a combination of sickle hemoglobin and hemoglobin C (called Hemoglobin SC disease). Some studies suggest men are more likely than women to have loss of vision.
What are the visual symptoms of sickle cell disease?
Blurring of vision may occur if excess damage occurs to the retinal blood vessels. Floaters can look like tiny dots or cobwebs moving about in your vision. They may be due to bleeding from the retina into the central gel of the eye. Retinal detachment may cause a dark shadow to appear off to the side (in the peripheral visual field) and may progress to total loss of vision. Pain is rare and may be due to high pressure in the eye (neovascular glaucoma).
What treatment is available?
There is no cure, but treatment may improve vision or keep the vision from worsening. If bleeding occurs inside the eye due to blocked blood vessels, floaters are seen by the patient. Medicine injections may help recover vision and may be applied without pain in most cases. Laser may stabilize or improve the vision. In some situations, surgery is required. The vision may not return to normal following treatment as there may be some permanent damage to the retina. The earlier retinal problems are found, the better the outcome of treatment. Therefore, annual exams are important and it is critical to report new floaters 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.
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.
Birdshot chorioretinopathy (BSC) is a type of uveitis (pronounced, “you-vee-EYE-tis”), a term used to describe inflammation inside the eye. BSC mainly causes inflammation of the choroid and retina, but may affect other parts of the eye as well. The choroid is the part of the uvea that lies under the retina, which is the “film” in the back of the eye that “takes the picture” of objects you look at. BSC is fairly rare form of inflammation affecting both eyes of men and women, usually starting in middle age.
What causes birdshot chorioretinopathy?
Birdshot chorioretinopathy (BSC) is strongly related to genetics. Most people with BSC have inherited a cell protein called HLA-A29. However, most individuals with HLA-A29 do not develop BSC; it appears to be triggered by an external event, such as an infection that “awakens” the immune response, which then abnormally attacks the eyes. BSC is most common in people of European ancestry.
What are the symptoms of birdshot chorioretinopathy?
Birdshot chorioretinopathy (BSC) usually presents with the slow-onset of floaters and blurred vision in both eyes. The floaters appear as tiny floating dots, which move or “float” in the vision and are seen especially well in bright environments. Shimmering lights may also be reported. Some patients note difficulty seeing at night. Symptoms may be very bothersome despite normal vision as measured on the eye chart. Over many years without treatment, the vision deteriorates further with loss of contrast, color vision, peripheral vision, and central vision. The symptoms vary from person to person and some have more rapid and severe deterioration than others.
How is birdshot chorioretinopathy diagnosed?
The diagnosis of birdshot chorioretinopathy (BSC) may be delayed due to the slow onset of symptoms and the subtle findings on the eye exam. A retinal specialist or uveitis specialist may be needed to perform sophisticated testing and make the diagnosis. Inflammation may be detected in many different parts of the eye, but the most typical findings include numerous pale spots inside the back of the eye. Blood testing for HLA-A29 is positive in the vast majority of patients with BSC. However, not all patients with uveitis who are positive for HLA-A29 have birdshot chorioretinopathy. Therefore, it is necessary to exclude other diseases that may simulate BSC including lymphoma, sarcoidosis, tuberculosis, syphilis, and cancer medications such as pembrolizumab and others.
How is birdshot chorioretinopathy managed?
Birdshot chorioretinopathy (BSC) usually requires management by an experienced retinal or uveitis specialist. In most cases, systemic treatment (pills or injections into the skin) are needed to control the inflammation. In a small subset of patients, localized treatment to the eye is sufficient. This is more often the case in older patients at onset of symptoms. When pills are used, the eye doctor frequently coordinates medical care with the expert assistance of a rheumatologist (a medical specialist with expertise in auto-immune diseases, like rheumatoid arthritis). In BSC the rheumatologist monitors the patient for medication side-effects that may develop outside the eyes. In many cases, the uveitis may be long-lasting. In these cases, years of therapy are needed to preserve vision.
Your doctor will choose from a variety of medications. Steroids (pills, eye drops, and injections) may be used at the start of treatment to gain rapid control of inflammation. However, long-term steroid treatment in high doses is usually avoided to prevent side-effects of steroid therapy. For long-term control methotrexate (MTX) pills or skin injections may be given weekly. MTX has a long record of safety and is affordable. If MTX fails or causes side-effects (liver or bone marrow), CellCept is another suitable medication, though it may cause diarrhea. Cyclosporin has been used effectively, but is fraught with a high incidence of problems with hypertension (high blood pressure) and kidney toxicity. Humira is a new biologic treatment given as an injection into the skin every two weeks. It has been approved by the FDA for treatment of uveitis, such as BSC. All medications used to treat BSC may have adverse effects and must be monitored for effectiveness and safety in a given patient.
Birdshot chorioretinopathy 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.
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.
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.
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.
Copyright 2016-2022 Designs Unlimited of Florida. All Rights Reserved.
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. For example, inflammation of the iris is called iritis. When inflammation is mainly in the central vitreous gel of the eye, it is called intermediate uveitis.
What causes uveitis?
Uveitis may be caused by infection, injury from trauma, 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 other cases uveitis is caused by inflammation without infection. For example, arthritis, multiple sclerosis, lupus, and inflammatory bowel disease may cause uveitis. Uveitis commonly occurs following an injury to the eye. In some cases, no underlying cause can be found to be the cause of uveitis. Very rarely, cancer may cause uveitis. Tobacco may be an aggravating factor and should be discontinued.
What are the symptoms of uveitis?
Various symptoms may be experienced depending on where is uvea 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.
How is uveitis managed?
To effectively treat 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 (see uveitis questionnaire) such as rashes, inflamed tattoos, back and joint problems. Tell your doctor if you have been exposed to TB (tuberculosis), traveled abroad, spent 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, uveitis is treated with anti-inflammatory medication in the form of eye drops (steroid and non-steroid), eye injections, and/or systemic therapy (pills or injections into the skin). When systemic therapy is 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, uveitis may be long-lasting. In these cases, years of therapy are needed to preserve vision. 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, uveitis can return at a future date. 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.
anatomy of the eye (click on image to enlarge). Image courtesy of Caitlin Albritton.
What is metamorphopsia?
Metamorphopsia (“meta-more-FOP-see-ya”) is a medical term used to describe an abnormal visual perception in which images appear distorted. For example, straight lines appear curved or jagged. It is an important symptom of retinal disease. Metamorphopsia is not caused by the need for new glasses, cataract, glaucoma, or optic nerve damage. Metamorphopsia is a sign of a retinal problem. It is detected and monitored with an Amsler grid.
Distortion of lines on Amsler Grid in right eye (click on image to enlarge)
What causes metamorphopsia?
The retina is a thin layer of nerve tissue that acts like film inside a camera. The retina “takes a picture” and sends the image to the brain. The root cause of distortion in vision is a retina that is not smooth and flat against the eye wall. This distortion of the retina may be caused by many different conditions. Sometimes, problems under the retina cause fluid leakage resulting in metamorphopsia. Such conditions include macular degeneration, central serous retinopathy, histoplasmosis, high myopia, angioid streaks, and inflammation. In other situations, distortion may be caused by scar tissue under the retina from inflammation, trauma, bleeding, or chronic leakage of fluid under the retina. Distortion of the retina may also be caused by vitreomacular traction, macular hole, or macular pucker. The ophthalmologist (retinal specialist) will undertake examination and testing to determine the cause.
Is metamorphopsia an urgent situation?
Metamorphopsia may be an urgent situation if it is new in onset or has significantly increased recently. If the cause of distortion is inflammation or bleeding, prompt treatment is needed to prevent further loss of vision and worsening of symptoms. Longstanding distortion is less likely an emergency but merits an eye examination to determine the cause.
What is the treatment?
Metamorphopsia is a symptom rather than a diagnosis, so the treatment depends on the underlying cause of the distortion of vision. This is the reason why it is important to have an eye examination in order to determine the best course of action. Contact your eye doctor or retinal specialist if you have this important symptom.
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 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 is called a retinal artery occlusion.
What causes a retinal artery occlusion?
Usually a blockage occurs from a piece of hardened artery in the neck (carotid artery) which breaks away and flows “down stream” to lodge in a small retinal artery. Hardening of the arteries is due to aging, obesity, high cholesterol, high blood pressure, diabetes, and tobacco use. Therefor, patients with retinal artery occlusion are at risk of other complications of hardening of the arteries (e.g. heart attack and stroke).
Abnormal tissue from a heart valve may also be the source of blockage. Rarely, an occlusion may result from blood disorders or inflammation such as giant cell arteritis. Fibromuscular dysplasia is suspected in young patients with retinal artery occlusion. Trauma may cause retinal artery occlusion by dissection of the carotid artery, often associated with neck pain.
What are the symptoms of a retinal artery occlusion?
A sudden, painless loss of vision is common. There may be loss of only the central vision, the side vision, or there may be a dark bar or band above or below the center of vision. The loss of vision may be temporary or permanent.
What treatment is available?
If the blockage is mild, some or all of the vision may return with time. Sometimes it is necessary to help relieve the blockage with eye drops, pills, or an office procedure to lower the pressure in the eye. The blockage may be overcome and the blood flow may resume if the pressure in the eye is decreased quickly. This treatment may bring back some or all of the vision, but sometimes no treatment can bring back any vision. If an underlying medical problem is found, it must be treated.
Your doctor is going to order appropriate tests and recommend the best course of action to take at this time. The retinal artery occlusion will not be worsened by your daily activities or by using your eyes. If you have any questions, please feel free to ask.
What general health issues are there?
Retina artery occlusion usually indicates the need for an urgent general medical evaluation for increased risk of stroke. About 10% to 15% of people who experience retinal artery occlusion will suffer from a stroke within three months. Half of those individuals will have a stroke within 48 hours of having eye symptoms. Those people who survive this initial high-risk period must still be monitored because there is a 40% risk of stroke or heart attack within ten years from the time of retinal artery occlusion. This important health issues are why it is important to undergo regular general medical evaluations and work to minimize factors that worsen hardening of the arteries. Such factors include physical inactivity, overweight, tobacco use, high blood pressure, high cholesterol, and diabetes.
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.
The retina is a “tissue-paper” thin layer of nerve tissue, which lines the inside 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.
What is retinal detachment?
When the retina detaches, it is no longer in proper position inside the eye. Instead, it is like film that has unrolled inside a camera. When this occurs, a camera cannot take a picture. Similarly, when the retina detaches the eye loses vision.
Horseshoe-shaped retinal tear as seen in an eye with retinal detachment (Click on image for enlargement)
What causes retinal detachment?
Retinal breaks (holes and tears in the retina) cause retinal detachment. These retinal breaks are usually caused by a degeneration of the vitreous (the clear gel that fills the eye and normally helps to hold the retina in place). Vitreous degeneration is common in aging and near-sightedness, but may also follow a direct blow to the eye, hemorrhage, infection, or inflammation inside the eye. When the vitreous degenerates and condenses, it pulls on the retina and may cause retinal tears, which often lead to retinal detachment.
What are the symptoms of retinal detachment?
Prior to retinal detachment, most people notice warning signs such as new floating spots or “cobwebs” in the vision. Sometimes, brief lightning-like flashes of light are seen in the side vision. These are the symptoms of vitreous degeneration and retinal breaks. The retinal detachment that follows usually causes a dark “curtain” or “shadow” to form in the side-vision. The “shadow” often comes from below and on the side near the nose. If it is not treated, the shadow gradually covers all of the vision resulting in blindness. There is generally no pain with retinal detachment.
How is retinal detachment treated?
The treatment of most retinal detachments requires surgery. Your doctor is skilled in a number of techniques to prevent blindness. Which type of surgery is recommended depends on the precise findings on examination. Surgery is not usually aimed at eliminating flashes and floaters. Flashes usually disappear in a few weeks or months. The floaters gradually fade over many months, but rarely disappear completely. Some retinal detachments that do not cause symptoms may be observed without initial surgery.
Laser/Cryopexy demarcation: Small areas of the retinal detachment (especially before any side vision has been lost) can sometimes be treated with laser or cryopexy to “seal down” the retinal along the edges of the detachment in an effort to prevent it from extending further. This surgery is performed in the office. If it is not successful in stopping the detachment, more extensive surgery is required.
Pneumatic retinopexy: Many retinal detachments can be repaired by this surgery performed in the office by anesthetizing the eye, sealing the break(s) with laser or a freezing probe (cryopexy), and pushing the retina into proper position with a gas bubble which is injected into the eye. Although this procedure is successful most of the time, it requires the strict cooperation of the patient to remain in proper head position for about five days. If this procedure fails, more extensive surgery in the hospital operating room is sometimes needed.
Scleral buckle surgery: Some retinal detachments require the placement of a permanent plastic supporting belt around the eye to create a “ledge of support” for the retina. This is a major surgery in which a belt is placed around the eye in the hospital operating room. The eye is often rendered more near sighted by this procedure. Rarely, permanent side effects include double vision. If this surgery is not successful, vitrectomy surgery may be recommended. Scleral buckle surgery is preferred over other methods of surgery if the retinal breaks are located in the inferior (bottom portion) of the retina, where gas bubbles may not be effective in holding the retinal in position. Scleral buckle is also preferred over vitrectomy in eyes with a clear lens, because vitrectomy surgery usually results in cataract formation. Scleral buckle surgery is often used when other attempts at surgery have failed.
The video below demonstrates scleral buckle surgery. If you are uncomfortable watching surgery, please do not click on this video:
Vitrectomy surgery: Performed in the hospital operating room as a major eye surgery, vitrectomy surgery involves making small incisions into the eye to remove floaters, dissect scar tissue, remove fluid from under the retina, apply laser, and place a gas bubble or silicone oil into the eye to hold the retina in place. Specific head positioning is sometimes needed. Sometimes a cataract or lens implant must be removed to adequately repair the retina. This surgery may be repeated if necessary to prevent blindness.
The video below demonstrates vitrectomy surgery. If you are uncomfortable watching surgery, please do not click on this video:
With one or more surgeries most retinal detachments can be repaired keeping useful vision. Vision may not return to normal, as there may be some permanent damage from the retinal detachment resulting in blurred or distorted vision. In some cases additional surgery is needed to removed scar tissue that forms after retinal reattachment surgery. There are always risks to surgery including hemorrhage, infection, scarring, glaucoma, cataract, double vision, deformity, loss of vision/loss of the eye. Sometimes despite all efforts with surgery, all vision may be lost. Surgery is recommended for retinal detachments because blindness usually results if treatment is withheld. If you have questions, please do not hesitate to ask 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.
Central serous retinopathy (also known as central serous chorioretinopathy) is an abnormal leakage of clear fluid under the retina, which causes symptoms of blurred vision often associated with a round or oval dark spot in the central vision. The retina is a thin layer of delicate tissue in the back of your eye, which lines the inside wall like the film in a camera. The retina “takes a picture” of objects you look at and sends the message to the brain.
What causes central serous retinopathy (CSR)?
The exact cause of CSR has not been well-defined. Classically, it occurs in middle-aged people with type-A personality and who are often under stress at home or work. However, anyone may be affected regardless of age, personality type, and level of stress. Individuals with type-A personality are perfectionists who often feel pressured by time constraints. Research suggests that hormones released under stress can affect the blood vessels beneath the retina (in the choroid). These vessels may leak an abnormal amount of fluid, which then works its way under the center of the retina. Far-sighted eyes are more commonly affected than near-sighted eyes.
What other things can aggravate central serous retinopathy (CSR)?
In many cases, the symptoms will disappear with time. Over a period of weeks to months, the abnormal leakage may stop with normal healing. Importantly, avoiding known triggers (listed above) may help. Other helpful measures include stress management, getting 8 hours of sleep per night, and treatment of sleep apnea.
What are medical treatments of CSC?
The doctor can recommend the best course of action by taking special pictures of the eye called a fluorescein angiogram. The fluorescein angiogram shows where the leak is coming from and how active the leak is. Prescription medication may be helpful if fluid leakage does not go away with time alone. Patients with high blood pressure may benefit from beta-blocker medications. Thermal laser photocoagulation may be helpful if the site of leakage is not close to the center of vision. Side-effects are rare, but may include the appearance of a small, permanent blind spot in the vision. Another laser called Visudyne photodynamic therapy (PDT) may successfully avoid blind spots in the vision in eyes with areas of leakage close to the center of vision. Medicine injections may also be used to treat this condition.
What will happen to the vision?
Usually the vision returns to normal or near normal. Rarely, central serous chorioretinopathy will cause permanently limited central vision with distortion. In about a third of cases, CSC will return at a later date in the same or other eye. Repeated episodes of leakage may result in a build-up of permanent damage to the retina. Therefore, any future decrease in vision should be promptly reported to the doctor. The vision may be monitored with the Amsler grid test.
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.
Tobacco use is widely known to cause lung damage, but the eyes are also affected. Bothersome irritation of the eyes is caused by smoke from tobacco especially in patients with dry eyes. However, permanent loss of vision may occur from such problems as macular degeneration, retinal vein occlusion, ocular histoplasmosis syndrome, glaucoma, cataract, Grave’s Disease (a thyroid condition that affects the eyes), uveitis (inflammation of the eye), ischemic optic neuropathy, and diabetic retinopathy. Tobacco appears to play a role in causing and/or worsening these conditions. Tobacco is known to promote hardening of the arteries, and this may harm blood flow to the eye. Tobacco also promotes the development of blood clots, which may block blood flow in the eye. Tissue damage also occurs from toxic compounds in tobacco that cause a chemical reaction called oxidation. More research is needed to fully understand the role of tobacco in causing loss of vision.
What resources are available to help stop tobacco use?
Because most people cannot stop tobacco “cold turkey,” many resources are available to help quit the habit. Counseling may provide much needed support in the process of stopping tobacco use. For free classes and one-month’s supply of nicotine replacement therapy, your doctor can refer you to the Area Health Education Center. Alternatively, you may call 1-877-848-6696. The class schedule may be viewed at www.ahectobacco.com/calendar. If you are interested in talking to informed support staff, please call 1-800-QUIT-NOW. Nicotine replacement therapy plays an important role and several preparations are available over-the-counter. These non-prescription forms of nicotine include gum, lozenges, and patches. Medicare and most insurance companies now cover the costs of prescription medications to help stop tobacco use. These include nicotine nasal sprays, nicotine inhalers, as well as pills (Zyban and Chantix). With the help of counseling, nicotine replacement, and prescription medication, you can live a longer and healthier life without tobacco. For more information please visit www.smokefree.gov.
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 posterior vitreous detachment (PVD) occurs when the vitreous gel inside the eye condenses and pulls away from the retina. The vitreous is a thick, clear gel with invisible fibers that fills the inside of the eye. From birth the vitreous gel is attached to the retina and helps to support it. The retina is a thin layer of tissue that lines the inside of the eye like film in a camera. Just like film, the retina serves to “take the picture” of objects you look at. The primary cause of PVD is a degeneration of the vitreous, in which the tiny fibers clump together causing the vitreous to pull away from the retina.
Clear vitreous gel fills the eye (click on image to enlarge)
A. Vitreous gel fills the eye at birth. B. Vitreous fibers begin to pull away from retina. C. Further separation of vitreous fibers that remain attached to the optic disc. D. Complete separation of vitreous fibers from the posterior retina.
What symptoms does posterior vitreous detachment cause?
The most common symptoms of PVD are floaters and flashes. Floaters are specks, fibers, or veils that appear to move in front of your eye. Floaters are actually tiny clumps of gel or cellular debris within the vitreous. PVD sometimes causes bleeding inside the eye. Blood in the vitreous appears as floaters described as hair-like strands or tiny round dots. Over time floaters may appear like a cloud or veil that moves across the vision. 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 tugging on the retina with eye movement. Although the sudden onset of new floaters is reported by almost everyone with PVD, flashes are only seen by half of all people with PVD.
Why is it important to be seen for these symptoms?
Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters, with or without flashes, is an important symptom to report to your eye doctor. In about 10-20% of people with these symptoms, the vitreous pulls on and tears the retina. A retinal tear by itself causes no pain or visual problems. However, if a retinal tear is not detected and treated, it may go on to cause blindness from retinal detachment. A retinal detachment is when the retina stops functioning because it is pulled away from the inner eye wall and floats freely inside the eye. A retinal detachment causes a progressive loss of vision appearing like a curtain or shadow that slowly moves across the vision from the side.
What causes posterior vitreous detachment?
PVD is usually due to degeneration of the vitreous gel from aging. Over time, the thick vitreous gel tends to become liquefied and the microscopic fibers in the gel tend to condense together becoming visible and causing traction on the retina. The following conditions tend to accelerate the degeneration and cause PVD to occur earlier in life: trauma, inflammation, diabetes, and myopia (near-sightedness).
How is posterior vitreous detachment managed?
The most important step is to have a thorough, dilated eye examination. The eye doctor will check for the presence of a tear in the retina. If a tear is found, laser or cryopexy is usually recommended to decrease the chances of blindness from retinal detachment. If a retinal detachment is found, more extensive surgery is required in an attempt to repair it. If there is no retinal tear or retinal detachment found at the initial exam, another exam several weeks later may be performed to be certain that a delayed tear has not occurred. Generally, there are no restrictions to your activities.
What happens to the floaters and flashes?
There is no treatment to make the floaters and flashes go away even though they may be quite annoying. The flashes gradually subside and disappear over days to weeks without treatment. However, the floaters rarely completely disappear. They will gradually fade and become less obvious over weeks to many months. For the first few days or weeks, many people find that the floaters are less annoying if they wear sunglasses when out of doors and turn the lights down when indoors.
What to be on the lookout for?
After examination or treatment, any new floaters or loss of side vision should be reported to the doctor without delay. Sometimes, new tears or a retinal detachment can occur after the eye examination. In fact, 7% of eyes with PVD will develop a retinal break sometime after the initial eye exam; about half occur more than one year after PVD. This is more likely to occur in near-sighted eyes and eyes with lattice degeneration.
PVD may stimulate the formation of macular pucker, which may cause symptoms of distortion of vision. Treatment of a retinal tear does not prevent macular pucker.
When one eye develops a PVD, the fellow eye will usually do so at a future date. Whether the floaters and flashes are more or less severe in the second eye, they should be promptly reported to the eye doctor. If the first eye develops a torn retina, the second eye runs about a 20% chance of developing a tear as well. But even if the first eye does not have a torn retina, the second eye may still develop a tear when a PVD occurs.
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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Retinal vein occlusion means blockage of a vein in the retina. 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. Retinal veins are blood vessels that drain blood out of the retina. An abnormal blood clot in a retinal vein causes a blockage (occlusion) of the blood flowing out of the retina. Depending on the location of the occlusion, vein occlusions are divided into branch retinal vein occlusion and central retinal vein occlusion.
Retinal vein occlusions occur in 1-2% of people over 40 years of age. Retinal vein occlusions are more common in people who are overweight, use tobacco or estrogen, or have hardening of the arteries, diabetes, high blood pressure, sleep apnea, glaucoma, or blood disorders.
What are the symptoms of a retinal vein occlusion?
Blurring of vision may occur if excess fluid (edema) leaks from the veins into the center of the retina. Floaters can look like tiny dots or cobwebs moving about in your vision. They may be due to bleeding from the retina into the central gel of the eye. Pain is rare and may be due to high pressure in the eye (neovascular glaucoma).
What treatment is available?
There is no cure, but treatment may improve vision or keep the vision from worsening. Your doctor may allow time for the vein to heal. Sometimes eye drops or pills may be prescribed. Medicine injections (Avastin, Lucentis, Eylea, steroids) may help recover vision and may be applied without pain in most cases. Injections may be required for the long-term; about half of eyes with central retinal vein occlusion require injections for at least three years. Injections for retinal vein occlusion are safe in regard to risks of problems outside the eye. However, there appears to be a low risk of stroke (intracranial hemorrhage) of <4/1000 every year of treatment.
Laser may stabilize or improve the vision. The vision may not return to normal following treatment as there may be some permanent damage to the retina from the occlusion. In some cases when treatment cannot improve the vision, laser is used to prevent severe pain and complete blindness.
Your doctor is going to order appropriate tests and recommend the best course of action to take at this time. The retinal vein occlusion will not be worsened by your daily activities or by using your eyes. You may monitor the vision with the Amsler grid test. It is important to be seen by your primary care doctor to treat risk factors of hardening of the arteries to prevent stroke and heart attack.
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.
blood spots and white exudates in retina from recent brach retinal vein occlusion (click on image to enlarge)
Fewer blood spots as vein occlusion heals with Avastin (click on image to enlarge)
Recent-onset central retinal vein occlusion of left eye
