Dr. Ashley Roth is on the editorial board for

Check out her article on Eyelid Cysts:


While there are many forms of eyelid cysts, most consist of a localized swelling of the eyelid. Some eyelid cysts are caused by an infection, and these can be painful and can even alter a person’s appearance. If the infection is left untreated long enough, it can affect your vision. Most types of eyelid cysts go away on their own, but others need to be treated with antibiotics or surgery. Only your eye doctor can properly diagnose your cyst and determine the appropriate treatmen


  • Lumps on eyelids or around eyes
  • Redness
  • Eyelid swelling
  • Tenderness
  • Discoloration
  • Discharge
  • Eye crusting
  • Pain
  • Discomfort when blinking
  • Itchiness

Many people can feel an eyelid cyst forming, but others have no idea when one is developing. If you have any of the symptoms listed above, try your best not to touch or rub your eyes, and make an appointment with your eye doctor.


The transfer of dirt, debris, and bacteria into or around your eyes can lead to the formation of these unsightly lumps or cysts. The most common causes of eyelid cysts are:

  • Staph bacteria
  • Eye duct/gland blockage
  • Poor hygiene
  • Dirty contact lenses
  • Chronic blepharitis
  • Cosmetics
  • Leaving make-up on overnight
  • Touching or rubbing eyes, especially with unwashed hands


Certain risk factors can increase your chances of developing an eyelid cyst. These include:

  • History of cysts
  • Chronic blepharitis
  • Poor personal hygiene
  • Chronic skin problems
  • Problems with oil gland secretion in eyelids (Meibomian Gland Dysfunction)


There are many different types of eyelid cysts, including:

  • Stye (also known as a hordeolum): A stye is an abscess in the oil glands, and is one of the most common forms of eyelid cysts. A stye is an acute infection that causes the cyst to become red, swollen, and tender to touch. If a stye lasts longer than two days you should schedule an appointment with your optometrist or ophthalmologist.
  • Chalazia (also known as meibomian cysts): A chalazion is a lump on the eyelid that is commonly the result of an untreated stye. If a stye (infection) is not treated, the bacteria and debris can become a hard ball under the lid called a chalazion. Chalazia are non-infectious, chronic, and can last eight to sixteen weeks. Typically chalazia are not painful or tender, but they may need surgical removal if they do not resolve on their own. This surgery is performed by an ophthalmologist, and it entails cutting the cyst open and removing it.
  • Sweat Gland Cysts: These cysts tend to be round, shiny, transparent lumps that appear near the tear ducts. This kind of cyst should be examined by your eye doctor to ensure that it is not something more dangerous, such as a squamous or basal cell carcinoma.
  • Keratosis: These cysts are a combination of keratin and tissue and are found in various forms. There are three types of keratosis cysts: actinic, seborrheic, and keratosis pilaris.
  • Inclusion Cysts: These cysts are white, filled with fluid, and cause a painless swelling of the eyelid. Although they are generally considered to be harmless, they should be examined by an eye care professional.


If symptoms of an eyelid cyst develop, you should visit an eye doctor who can diagnose the type of cyst you have and determine the cause. Most eyelid cysts can be diagnosed with a complete eye exam. The eyelids and eyelashes will be examined closely, and your eye doctor will check your eyelid structure, skin, and eyelash appearance. Once a proper diagnosis is made an appropriate treatment plan can be created.


If you have a cyst on your eyelid, the best treatment starts with better personal hygiene. Keep your hands and fingers and the area around your eyes clean at all times. Try your best not to touch or rub your eyes. This can help prevent bacteria from spreading. If you use cosmetics, throw them away and buy new ones after the cyst is gone. This will prevent the spread of bacteria that could be infecting your eye make-up. Avoid sharing your eye make-up, even with those closest to you.

If your eyelid cyst is painful, becoming larger in size, or has lasted a long time, seek medical attention from an optometrist or ophthalmologist. Your eye doctor will determine the appropriate treatment plan. Common methods of treatment include antibiotics and surgical removal. Your doctor can also show you what steps to take to prevent the cyst from recurring.

A common way to relieve discomfort from a cyst on the eyelid is to apply warm compresses. Hold the compress to the eyelid for five to ten minutes several times a day. Wash your eyelids with baby shampoo diluted with water, or use a commercial product designed to wash eyelids.

Cysts are usually only removed for cosmetic reasons. Rarely do they pose a significant threat to anyone’s overall eye health or vision. Most eyelid cysts do not obstruct vision or pose an immediate problem for the eye. Talk with your eye care provider about possible treatment options for a cyst on the eyelid.


In many cases, the eyelid cyst will go away on its own within a few weeks. On rare occasions, the cyst will enlarge and symptoms will worsen. Cysts can usually be treated effectively, but they may recur in people who are at higher risk.


Most types of eyelid cysts can be prevented by maintaining basic hygiene habits and by avoiding sharing certain items with others (e.g., towels, make-up, and eye drops). Keeping your hands clean can prevent bacteria from being transferred when you touch your eyes. If you are prone to a certain type of eyelid cyst, such as chalazia, ask your eye doctor about additional prevention steps.


  • What can I do to prevent eyelid cysts from recurring?
  • Are there any over-the-counter products available to help reduce symptoms?
  • What is causing cysts to develop on my eyelids?
  • Which type of cyst do I have? Can you tell me a little more about this particular type of cyst?
  • Based on the type of cyst I have, what are my treatment options?
  • Will I need to see a specialist to have my eyelid cyst removed?

Original article :



Here is her article on Macular Degeneration:


Macular degeneration is also referred to as age-related macular degeneration (ARMD or AMD), due its tendency to affect older adults. There are different types of macular degeneration, and depending on the type and severity, vision loss can be minimal or it can causeblindness.

This disease affects the macula, the central part of the retina that allows you to see straight ahead and in fine detail. The macula is the most sensitive part of the retina. By the age of 65, the macula begins to degenerate or deteriorate in one out of every four people, and in one out of every three people over the age of 80. In most cases the disease affects both eyes, although it can be more advanced in one eye than the other.


There are two types of macular degeneration: wet and dry. Wet macular degeneration accounts for only 10 percent of all cases, and occurs when tiny abnormal blood vessels begin growing behind the retina, toward the macula. These abnormal blood vessels leak blood and fluid, damaging the macula and causing severe and rapid vision loss. Wet macular degeneration is much more severe than the dry form.

Dry macular degeneration occurs when small, yellowish deposits called drusen begin accumulating beneath the macula. The drusen gradually break down the light-sensing cells within the macula, which leads to distorted vision in the eye. Dry macular degeneration leads to gradual vision loss and can turn into the wet form in some cases.



Symptoms of dry macular degeneration include blurry vision and a small blind spot in the central field of vision. As time passes, the small blind spot grows larger and affects vision more, making it harder to read fine print or see details. Symptoms of wet macular degeneration include distorted shapes, blurry vision, and an enlarged blind spot in the central field of vision. The distortion is caused by leaky blood vessels under the macula.

Common symptoms of both types of macular degeneration include:

  • Painless loss of visual acuity

  • Difficulty seeing in bright environments (photophobia)

  • Difficulty adjusting from darkness to light

  • Distorted images


To diagnose macular degeneration, a complete eye examination with dilation is necessary. Occasionally, fluorescein angiography may be performed, especially if wet degeneration is suspected. During this procedure, flourescein dye is injected into a vein in the patient’s hand or arm, and photographs of your retina are taken as the dye circulates. A visual acuity test and an amsler grid test will help determine whether any central vision has been lost or any distortion of vision is present. During the Amsler grid test, patients cover one eye and focus on a black dot that is surrounded by a pattern of straight lines. If these lines appear wavy or are missing, it indicates a problem within the macula, and possible macular degeneration.


The exact cause of macular degeneration remains unknown, although many experts believe certain risk factors contribute to its development. See below.


The following risk factors are known to correlate with the development of macular degeneration:

  • Age

  • Genetics or family history of the disease

  • Race: macular degeneration is more common among Caucasians, though it can occur in all races

  • Skin pigmentation: fairer or lighter skinned people are at a higher risk

  • Eye color: those with lighter eyes are at a higher risk than those with dark colored eyes

  • Gender: women seem to be at greater risk than men

  • Smokers

  • Prolonged exposure to sunlight or other types of ultraviolet light

  • Obesity

  • Sleep apnea

  • Some systemic medications

  • Severe myopia

  • Cardiovascular disease


It is important to note that there is no specific treatment for dry macular degeneration, If a patient is diagnosed with the dry form, preventive steps such as eye vitamins and changes to diet are usually taken to prevent the disease from advancing

Taking a high-dose formulation of certain antioxidants and zinc slows the progression of macular degeneration. According to the research done by the NEI, “The specific daily amounts of antioxidants and zinc used by the study researchers were 500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene (often labeled as equivalent to 25,000 International Units of vitamin A), 80 milligrams of zinc as zinc oxide, and two milligrams of copper as cupric oxide. Copper was added to the AREDS formulation containing zinc to prevent copper deficiency anemia, a condition associated with high levels of zinc intake.” This high level of antioxidants is virtually impossible to achieve with diet or daily doses of multi-vitamins. Vitamins with the appropriate levels of nutrients will be labeled with the letters AREDS to indicate that they follow the NEI research recommendations.

In the past, wet macular degeneration was treated with laser surgery to destroy the abnomal blood vessels. This process can cause more vision loss, as it damages nearby tissue. Treatment for wet macular degeneration has significantly advanced in recent years. New medicines have been developed to slow or reverse the growth of the abnormal blood vessels. These new medicines, called anti-angiogenic or anti-vascular endothelial growth factor drugs, are administered as injections and have been known to improve vision loss. The two most common are Avastin and Lucentis. The medicine is injected into the eyeball and takes effect immediately. Injections are typically repeated every month or two until the treatment is complete.

In January of 2010, new clinical studies were conducted on a number of patients with age-related dry macular degeneration. Acucela (the company founded by Ryo Kubota, MD, PhD, the discoverer of a gene that causes glaucoma) believes they have found a new oral drug that is effective in treating the dry form of AMD. This breakthough study shows the oral therapy drug targets cells within the retina to protect visual acuity. In March of 2010, Acucela received the Fast Track designation from the FDA for ACU-4429 (the current name for the drug) for the treatment of dry AMD. This new drug is said to be a great alternative to the injections that are currently being used to treat more advanced stages of macular degeneration.

Another study published on April 28, 2011 shows promise in the use of gene therapy against AMD. Conducted by researchers at Tufts University School of Medicine, the study showed for the first time that CD59 (a protein used in gene therapy) delivered by a gene therapy approach significantly reduced the uncontrolled blood vessel growth and cell death that accompany macular degeneration. Siobhan Cashman, PhD, is the assistant professor in the department of ophthalmology at Tufts University School of Medicine. He states, “treatment was effective when administered at a very specific location beneath the retina, but importantly, also when it was administered to the center of the eye. This finding is especially encouraging because it would allow for a safer and more convenient route of administration of treatment.” The study’s conclusion suggests that CD59 may be useful in treating dry and wet forms of macular degeneration.


Prevention of macular degeneration includes reducing UV exposure and eating a healthy diet containing plenty of antioxidants and zinc. Eating foods rich in Vitamins A, C, and E may also help reduce your chances of developing this disease. A study conducted by the National Eye Institute suggests that lutein and zeaxanthin (nutrients found in eggs and green vegetables) may also be protective against the disease. Exercising and staying healthy are always a good way to prevent all diseases. For more information on nutrition and eye care visit our eye care nutrition pages.

If macular degeneration has already caused significant vision loss, it may be best to contact a low vision specialist. Low vision specialists can be found in communities worldwide, and can help you make the most of what vision you have left.

Additional ways to prevent macular degeneration include:

  • Wear sunglasses and/or hats to prevent UV exposure

  • Avoid smoking

  • Avoid excessive saturated fats and foods containing fats and oils that have been subjected to air or heat (lunch meats, hamburgers, fried foods, etc.)

  • Increase your consumption of green, leafy vegetables

  • Watch your weight and blood pressure


Macular degeneration can cause varying degrees of vision loss, and it is the leading cause of legal blindness in the aging population in America. Some people diagnosed with this disease are able to maintain a normal lifestyle and require no significant treatment. Untreated or advanced macular degeneration can lead to severe vision loss or even blindness. Complications can arise from the various forms of treatment for macular degeneration. For example, injections into the eyeball can be painful and carry a small risk of infection, bleeding, and retinal detachment. Always consult with your doctor about the benefits and risks involved with treatment.


Here are some questions to ask your eye care professional about macular degeneration:

  • Which type of macular degeneration do I have?

  • Which treatment options are available for me?

  • Based on my individual needs, what should my diet consist of?

  • What other preventive measures can I take to avoid this disease?

  • If my grandma has macular degeneration, how likely is it that I will develop it

  • Am I at a higher risk than others? Why?

  • Can you refer me to a low vision specialist?

  • How often should I schedule appointments to see you?Click here to access link to all of Dr. Ashley Roth’s published articles.

Click here to access link to all of Dr. Ashley Roth’s published articles.

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Dr. Ashley Roth is on the editorial board for Read her article on Ptosis below:


Ptosis (TOE-sis), also known as droopy eyelid or blepharoptosis, is the abnormally low position of your upper eyelid. Droopy eyelids vary in severity, and can range from hardly noticeable to completely covering the pupil, iris, and other parts of the eye. If severe or left untreated, the droopy eyelid can lead to other conditions such asamblyopia (lazy eye) or astigmatism.

There are two types of ptosis: acquired and congenital. Congenital ptosis is present at birth and is usually due to the lack of development of eyelid muscles called levators. Acquired ptosis is the most common type, and is usually due to the muscles that elevate the eyelid becoming weak, thin, or stretched with age.

Droopy eyelids interfere with vision and can lead to fatigue from straining to elevate the eyelids. When congenital ptosis affects visual development in children, surgery may be required to prevent the development of amblyopia. Ptosis must also be differentiated fromdermatochalasis, which is simply extra eyelid skin that can also cause the appearance of a droopy eyelid. The causes and treatment for dermatochalasis are very different than for ptosis.


The most obvious symptom of ptosis or blepharoptosis is the drooping eyelid itself. Other symptoms include difficulty opening the eye or the need to tilt your head back in order to see better. Eye fatigue, misaligned eyes, or double vision can also accompany ptosis. You or your doctor may compare a photo of yourself from ten years ago to a recent one to see if there is a difference in your eyelids.


The causes of droopy eyelid are diverse. One can be born with hereditary droopy eyelids, a condition known as congenital ptosis. Most cases of acquired ptosis develop as we age and the tendon that helps keep the eyelid open stretches and loosens. Droopy eyelids can also be caused by trauma, surgery, or by damage to the muscles that raise the eyelids or to the nerves that control these muscles. Tumors, neurological disorders, systemic diseases, and certain drugs have also been known to cause ptosis.

Depending on the cause, ptosis may be classified as:

  • Neurogenic ptosis: Refers to the condition in which the nerves attached to the muscle are affected

  • Myogenic ptosis: Refers to sagging of the lid due to a problem with the muscle that raises the eyelid

  • Aponeurotic ptosis: Refers to the stretching and weakening of the tendon responsible for raising the eyelid

  • Mechanical ptosis: Refers to a condition in which the weight of the eyelid is too great for the muscles to lift


A variety of factors may increase your risk for developing ptosis. They include:

  • Aging

  • Family history of ptosis

  • Birth injury

  • Eye surgery such as cataract removal

  • Paralysis of nerve fibers in eyelids

  • Diabetes

  • Stroke

  • Horner’s syndrome

  • Head or eyelid trauma

  • Brain tumor

  • Muscular dystrophy

  • Myasthenia gravis


Your eye doctor will be able to diagnose ptosis with an examination of your affected eyelid. He or she will ask you questions about your symptoms, family medical history, and personal medical history. In some cases medical tests are conducted to determine the cause of acquired ptosis. Because there are a number of reasons why an eyelid might droop, it is highly recommended that you get a diagnosis from an eye doctor, even if symptoms are mild.


If symptoms of ptosis are mild, treatment may not be necessary. Specific treatment is usually directed toward the underlying cause. Special glasses may be used in some cases; these glasses have a crutch attached to hold up the eyelid. In moderate to severe cases, surgery may be the only option to correct the eyelid.

The most common surgery used to treat ptosis is a levator aponeurosis advancement. During this procedure, the surgeon will tighten up the levator tendon, lifting the eyelids. Occasionally, such as in cases of congenital ptosis, the levator is too weak to allow for eyelid opening; in this case, a “sling” is used to allow the forehead muscles to assume the task of lifting the eyelid. Although they may not look symmetrical, the eyelids will be higher than they were before the surgery.

Bruising and swelling will typically last two to three weeks. Most people heal without complications within six weeks of surgery. Typically, this is done as outpatient surgery, meaning there is no hospital stay.

It is important to know that ptosis does not correct itself over time. The only way to fix a severe case of ptosis is with surgery. Most of these procedures are performed by oculoplastic surgeons, ophthalmologists who pursue extra training in eyelid surgery.


If a child’s droopy eyelid is left untreated and is severe enough, he or she may develop amblyopia, or lazy eye. Complications that may occur after eyelid surgery include excessive bleeding, infection at the surgical site, scarring, asymmetrical facial appearance, and facial nerve damage.


  • What is causing my droopy eyelid?

  • What tests will need to be performed to determine the cause?

  • Taking into account the severity of my case, what are my treatment options?

  • Will you be the one performing my surgery? If not, will you refer me to a specialist, or will I need to find my own?

Did you know … Actor Forest Whitaker refuses to have surgery to correct ptosis in his left eye?

Click here to access link to all of Dr. Ashley Roth’s published articles.

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Dr. Ashley Roth is on the editorial board for Read her article on Exotropia below:

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Exotropia in Children and Adults

Authored by
Michael Garin O.D.

Reviewed by
Dr. Ashley Roth

Exotropia is a common type of strabismus that occurs when misaligned eyes deviate outward.

Exotropia (also known as wall-eye or divergent strabismus) differs from its opposite form, esotropia (eye turns in toward nose), in that exotropic eyes point outward or away from the nose. Exotropia can occur in one or both eyes. Although exotropia can appear at any age, it commonly appears between the ages of one and four.

Exotropia can be classified according to how frequently the eye deviates:

Intermittent: Only occurs from time to time; may or may not become more frequent throughout a person’s life; this is the most common form of exotropia.
Constant: Occurs at all times and at all distances.
Exotropia can also be classified by cause—it can be either congenital (present at birth; also known as infantile exotropia) or acquired. Acquired exotropia is found in females more than males; 63–70 percent of all adult cases are women. It is more common in the Middle East, Africa, and Asia, and at latitudes where there are higher levels of sunlight. It is less common in the United States and Europe.

Forms of acquired exotropia include:

Sensory: Found in conjunction with an eye with poor vision. Typically, the eye with poor vision cannot work effectively with the other eye, allowing a tendency for the eye to drift outward. This form of strabismus is preventable and can be treated easily with corrective prescription eyeglasses.
Mechanical: Mechanical exotropia is caused by a restriction or tightness of the muscles controlling the eye (fibrosis of muscle tissue, thyroid myopathy) or a physical obstruction of the extraocular muscles (orbital fracture).
Acute: Sudden onset exotropia usually in older adults with an underlying disease process such as cranial nerve problems or thyroid disorders. It can also be caused by trauma to the eye muscles or orbit.
Consecutive: Occurs after strabismus corrective surgery (to correct esotropia). It can develop shortly after surgery or may develop years later.
Other types of exotropia include divergence excess and convergence insufficiency.

Exotropia Signs and Symptoms

In most cases, the first signs of exotropia appear during childhood. Typically, it begins intermittently; occurring while the child is staring into space or daydreaming. The deviation may become more noticeable while the child is staring at something from a distance.

Most strabismic children do not know they have vision problems. Sadly, they think problems such as double vision or nearsightedness are normal and do not express their inability to see clearly because they do not know any better. Because of this, it is important to watch children for symptoms of all eye conditions, including exotropia.

Symptoms include:

Excessive rubbing of eyes due to eye strain
Covering or closing one eye to improve vision
Increasing sensitivity to light (photophobia)
Double vision
Intermittent exotropia is detectable after six months of age, and is considered a progressive disorder that can lead to constant exotropia if left untreated.

What Causes Exotropia?

This condition is believed to be connected to some defect involving the six extraocular muscles that control each eye’s movement. Normally, these muscles work together, sending signals to the brain and directing eye movements so that both eyes can focus on the same object.

But when there is a disruption and the muscles do not work together, some form of strabismus, including exotropia, may occur. Other causes may involve the nerves that transmit information from the brain to the muscles, or the part of the brain that directs eye movements. Eye injuries, head trauma, and other general health conditions can also cause exotropia.

Diagnosing Exotropia

Parents and other family members are typically the first people to notice exotropia in a child. Those who develop this condition later in life may notice the change in their eyes’ appearance while looking at old photos of themselves, after experiencing symptoms, and most commonly by having others tell them their eye is turning out

When exotropia is suspected in an infant, the eye doctor will shine a light into the eyes to see if the light reflects back from the same location on each cornea. In older children and adults, the eyes are examined more thoroughly. Several eye exams and visual tests can help your eye doctor determine which form of exotropia is present. These tests may include:

Ocular Motility Exam: This exam checks your eye’s ability to move in all directions. Your eye doctor will sit in front of you and perform a “follow my finger” test, in which the subject is asked to follow the doctor’s finger as it draws an imaginary double H figure that touches upon the eight fields of gaze.
Visual Acuity Exam: This exam measures the extent to which your vision may be affected. Typically, you are asked to read letters on distant and close-up reading charts. Normal distance-vision acuity is 20/20.
Alignment: This exam is to determine how well your eyes work together as a team. There are multiple methods for checking the eye’s alignment, and the most commonly used technique is called the Cover Test. The doctor will cover and uncover each eye while you are focusing on objects at different distances. The degree or magnitude (size) of exotropia can be determined by using a prism.
Refraction: This exam determines the appropriate prescription lens power you need to compensate for any refractive errors you may have (such as nearsightedness, farsightedness, or astigmatism).
Exotropia Treatment

There are many factors your eye doctor takes into consideration when determining the appropriate method of treatment for your exotropia:

The magnitude (size) of the exotropic deviation (how much the eye turns outward)
The frequency of the deviation
The age of the patient
The refractive error of the patient
The severity of symptoms the patient is experiencing.
For mild cases of exotropia, eyelasses and/or vision therapy (eye exercises) are the most common treatment methods. Eyeglasses are used to make each eye see as well as possible so that the eyes will work together as a team. Eye exercises benefit those with convergence insufficiency more than those with other types of exotropia.

Most people with intermittent exotropia (the most common form) can learn to recognize the problem and eventually control it with certain techniques taught in vision therapy. Special glasses with prisms can be used to decrease double vision in patients with constant exotropia

In moderate to severe cases in children, an eye patch may be recommended. Typically, eye patches are used for strabismic children who also have amblyopia (decreased vision in one eye). The idea is to get the weaker of the two eyes—the “lazy” eye—seeing as well as the better eye so that both eyes will work together as a team.

If these methods fail, eye muscle surgery may be performed. In general, however, eye muscle surgery is not recommended unless the patient:

Experiences exotropia more than 50 percent of each day
Experiences significant symptoms (squinting, eye strain, etc.)
Experiences an increase in the frequency and duration of episodes
Experiences significant exotropia when looking at objects that are near
Appears to be experiencing a decrease in binocular vision (depth perception)
Exotropia Surgery

During the procedure, the eye muscle is exposed by making a small incision in the tissue covering the eye. The appropriate muscles are then repositioned in order to allow the eye to move properly. This procedure is usually performed under general anesthesia.

Most people are able to go home the same day as their surgery, and recovery usually takes about two weeks. After surgery, your eye doctor may prescribe pain relievers, antibiotics to fight and prevent infection, and steroidal eye drops or ointment to reduce inflammation. Over-the-counter pain medications are usually allowed, except for aspirin or similar products that may thin the blood.

Your doctor may also recommend that you:

Avoid getting your eyes wet until told that you may do so
Avoid swimming for ten days
Wait one week to resume normal activities
Wear protective eye wear, especially right after surgery, to compensate for light sensitivity
Store your eye drops in a refrigerator; do not freeze them
Complications of Exotropia

Untreated exotropia can lead to permanent vision loss in the form of amblyopia or damage to the eye muscles. Intermittent exotropia may progress to constant exotropia.

If surgery is performed, possible complications can include bleeding, surgical wound infections, swelling of the eyelid, and repeat surgeries for recurring exotropia. Exotropia can sometimes recur after surgery. Talk with your doctor about the risks and benefits of eye muscle surgery.

When to Contact Your Doctor

Contact your eye care professional if:

You develop signs of infection (headache, dizziness, muscle aches, general ill feeling, and fever)
Pain, swelling, redness, drainage, or bleeding increases in the surgical area
New, unexplained symptoms appear
Drugs taken after surgery produce unwanted side effects


Dr. Ashley Roth is on the editorial board for Read her article on Hyphema below:

Hyphema — Why Is There Blood in My Eye?

Authored by Dr. Ashley Roth

The term hyphema denotes the accumulation of blood in the anterior (front) chamber of the eye, the fluid-filled space between the cornea and the iris.

Hyphemas can vary in appearance. A hyphema may be no more than a tiny spot—invisible in the mirror—or it may be severe enough to completely obscure vision in the affected eye.

What Symptoms Will Develop If I Have Hyphema?

Mild cases of hyphema are not always visible to the naked eye, but total hyphema can actually block the view of the iris and pupil. Symptoms may vary, depending on the cause of the bleeding, but may include blurred vision, severe eye pain, and extreme sensitivity to light.

Why Does Hyphema Occur?

The most common cause of blood in the eye is trauma, which can take the form of blunt trauma, laceration, or abrasion. Other possible causes of eye bleeding include:

Abnormality in a blood vessel
Iris inflammation
Certain blood diseases, such as sickle cell anemia
Retinal vein occlusion
Anterior uveitis
Eye surgery

What Are The Complications of Hyphema?

While the complications that may accompany bleeding in the eye vary, depending on the cause, the condition itself can damage the cornea, and can lead to high intraocular pressure and possibly glaucoma if not managed correctly.

What Are My Treatment Options for Hyphema?

Due to the potentially serious nature of any eye problem that causes bleeding, hyphema should always be treated as a medical emergency, and an immediate visit to an optometrist or ophthalmologist is warranted.

Diagnosis of the cause of bleeding in the eye will require a doctor to conduct a thorough eye exam, which may include dilation, a slit lamp examination, and measuring the intraocular pressure.

In mild cases, if there is no serious underlying condition, treatment with steroidal eye drops will cause the blood to be reabsorbed into the body. Your doctor may recommend that you wear an eye patch and take a few days’ bed rest, sleeping with your head elevated so as to not disrupt the blood that is settled. Depending on the severity, a cycloplegic drop (a dilation drop that lasts several days) may be prescribed if there is severe pain accompanying the hypema.

Steroids may be prescribed to reduce inflammation, and you will be advised not to take aspirin or ibuprofen.

In more severe cases, however, surgery may be necessary in order to drain the blood and clear any blockage that may have developed in the eye’s drainage system.

How Can I Prevent Blood in my Eye?

The best way to prevent hyphema is to guard yourself against injury to the eye. When participating in any sport, always wear protective goggles (in addition to whatever other protective gear is standard for your sport). If you wear glasses, always make sure to take them off before engaging in any kind of rough play or risky physical activity.

If you are having eye pain or any sort of vision problems, be sure to report them to your primary doctor, who will probably refer you to an optometrist or ophthalmologist.

Talking to Your Doctor

Here are some questions to ask your doctor about hyphema:

How severe is the injury to my eye?
(If there is no obvious injury to the eye) What is the cause of the bleeding in my eye?
Is it possible I could suffer from permanent visual impairment?
Am I suffering from ocular hypertension?
Is it possible that my hyphema was caused by my recent eye surgery?

The National Institute of Health
University of Rochester Medical Center
The Mayo Clinic
The British Journal of Ophthalmology
American Academy of Family Physicians

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Dr. Ashley Roth is on the editorial board for Read her article on Dacryocystitis below:

Everything You Need To Know About Dacryocystitis


Authored by
Dr. Ashley Roth

Dr. Hart MossReviewed by
Dr. Hart Moss

Dacryocystitis is an inflammation or infection of the lacrimal sac that occurs when the lacrimal drainage system is obstructed and bacteria infects the sac.

The lacrimal sac is part of the system that connects the eyes to the nasal cavity in order to drain tears away from the surface of the eye.

Dacryocystitis causes unilateral tearing, discharge, swelling, redness, and pain in the inner inferior canthus (the area adjacent to the nose). This inflammation may be acute or chronic, and it can be congenital or occur later in life.


What Are The Symptoms of Dacryocystitis?

The chief symptoms of a dacryocystitis infection are watery eye, pain, redness, and swelling in the inner part of the affected eyelid. If an infection is present, pressing on the area over the lacrimal sac may cause discharge to expel from the corner of the eyelid.

There will often be redness and crusting around the eyelids and lashes. If the infection goes untreated for long enough, a more serious infection can develop and can induce a high fever.

If you have the symptoms of a dacryocystitis infection—including a fever—or if you are feeling ill, it is very important that you seek medical attention immediately in order to avoid further complications and life threatening orbital cellulitis infection.

Excessive tear production is a common symptom of dacryocystitis, and in chronic cases it may be the only symptom. If you are frequently troubled by watery eyes, you may have an obstruction in your tear ducts, and you should see your eye doctor for a diagnosis.

What Causes Dacryocystitis?

Any obstruction of the nasolacrimal duct can prevent tears from draining properly. When this happens, the undrained fluid can become a hospitable environment for bacteria (especially Staphylococcus aureus), making the eye vulnerable to infection. In congenital forms the drainage system near the lacrimal sac is obstructed, stenosed (abnormally narrowed), or not fully developed. One form of congenital dacryocystitis can be caused by a dacryocystocele, which is a type of cyst that usually forms during fetal development. These cysts can often be detected with an ultrasound examination.

Diagnosing Dacryocystitis – Your Doctor’s Perspective

If you are experiencing some of the symptoms of dacryocystitis—or even if you have chronically watery eyes and want to find out why—you should make an appointment to see an ophthalmologist as soon as possible.

Your doctor will examine your eyes thoroughly with a microscope, looking closely at your drainage system to determine whether it is obstructed, and to what degree.

Your doctor may flush fluid through the eyelids to see if the drainage system is flowing properly, and may take a sample of any discharge in order to test for the presence of infectious bacteria. The results of this testing will confirm or rule out a diagnosis of dacryocystitis, and will also help to determine the appropriate treatment.

How Is Dacryocystitis Treated Properly?

If the dacryocystitis is acute and was caused by a bacterial infection, the method of treatment is usually oral antibiotics. Other treatment methods include topical antibiotic drops, warm compresses with gentle massage, and over-the-counter pain medications.

If a fever is present or the patient is very ill in addition to the dacryocystitis, hospitalization is required.

Depending on the cause and severity of your condition, your doctor may advise you to consider a surgical procedure known as dacryocystorhinostomy. The purpose of this procedure is to restore tear flow from the lacrimal sac into the nose.

To accomplish this, a hole is created between the lacrimal sac and the bone of the lacrimal fossa in order to open a connection for the tears to drain. Tubes and drains are left in place in order to prevent the gap that has been created from closing. Other surgical options include balloon surgery, which involves opening narrow tear ducts with balloons.

Talking to Your Doctor

Here are some questions you can ask your doctor about dacryocystitis:
• I have always been troubled with watery eyes. Could chronic dacryocystitis or a tear outflow obstruction be the reason for this?
• Ever since my eye injury, I have suffered recurrent eye infections; is it possible my lacrimal sac was damaged?
• Are there any non-surgical treatments that might help me?

Oill PA, Montgomerie JZ, Cryan WS, Edwards JE (March 1977). “Specialty conference. Infectious disease emergencies. Part V: patients presenting with localized infections”. The Western Journal of Medicine 126 (3): 196–208.
Yanoff, Myron; Duker, Jay S. (2008). Ophthalmology (3rd ed.). Edinburgh: Mosby. pp. 1482–1485
NYU Department of Pediatrics
This article was last updated on 09/2015

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Dr. Ashley Roth is on the editorial board for Read her article on Hyperopia below:

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Hyperopia (Farsightedness) in Children and Adults

Authored by
Michael Garin O.D.

Reviewed by
Dr. Ashley Roth

What is Hyperopia?

Hyperopia is the medical term for farsightedness. Farsighted individuals usually have difficulty seeing objects up close, but can see distant objects clearly. Tasks like reading, sewing, or typing can be difficult and can cause blurry vision or eye strain. People with high hyperopic prescriptions will have difficulty seeing objects up close as well as far away. Most children are born with some degree of hyperopia, but this typically corrects itself by around five years of age. Farsightedness affects approximately 5–10 percent of the US adult population.

Several factors contribute to farsightedness, such as the shape of the cornea, the placement and shape of the lens, and the length of the eyeball. Normally, images are clearly and directly focused on the retina. With hyperopia, the focal point of the image is behind the retina, so a blurry image is sent to the brain.

Hyperopia Symptoms

People with hyperopia tend to have eyestrain, poor focusing control, spasms of focus, headaches, trouble reading, and eye fatigue. Children with high hyperopia may display crossed eyes (a condition known as strabismus). A child’s behavior may signal that they are having trouble with their vision. Farsighted children sometimes display a lack of interest in school, especially in reading. Children who have vision problems may also squint and rub their eyes often. People who are highly farsighted may experience blurry vision when looking at objects near and far.

Hyperopia Complications

Hyperopia is easily treated with corrective glasses or contact lenses. Hyperopia may be a risk factor for a lazy eye in children with high hyperopic prescriptions. Hyperopic eyes, due to their compact shape, may also be more prone to narrow-angle glaucoma. Children with hyperopia may develop problems in school, such as difficulty reading books and chalkboards, which can lead to a lack of interest in learning.

Causes of Hyperopia

Hyperopia typically occurs because the eyeball is shorter than normal or the shape of the cornea is too flat. This causes the image to focus behind the retina rather than on it. In some cases the lenses of the eye may not converge properly due to weakness of the ciliary muscles, which are responsible for changing focus to adjust for variation in distance (a process known as accommodation).

Risk Factors for Hyperopia

The biggest risk factor for hyperopia is genetics. If you have a farsighted family member, chances are you and other relatives will develop the same refractive error as you age. Age plays another role in hyperopia.

Diagnosing Hyperopia

Farsightedness is measured in units called diopters. A diopter is the measure of the power of the eyeglasses lens, determined by the distance from the lens surface at which light is brought into perfect focus. On an eyeglass prescription, a plus sign indicates a prescription for farsightedness, which is followed by numbers indicating the degree of hyperopia.

+0.25 to +1.00 diopters = mild farsightedness
+1.25 to +4.00 diopters = moderate farsightedness
+4.25 to +8.00 diopters = severe farsightedness
+8.00 diopters or higher = extreme farsightedness
Some schools give students vision screenings, but not all of them test for farsightedness. If you or a family member has hyperopia, you should consider taking your child in to see an optometrist or ophthalmologist for a complete eye exam. Annual exams are recommended. To diagnose hyperopia, an eye doctor will perform a visual acuity test as well as a refraction test to determine the amount of correction needed in eyeglasses or contact lenses.

Treatment for Hyperopia

Glasses are prescribed for patients with farsightedness. This corrects for the refractive error, allowing the individual to see well. Like treatments for myopia, treatments for hyperopia are designed to refract or bend light so that it focuses on the retina of each eye, either through corrective lenses or by reshaping the cornea.

At a young age, depending on the degree of hyperopia, eyeglasses or contacts are usually the first option. Refractive LASIK Eye Surgery is a popular treatment that eliminates the need for contacts or eyeglasses. Refractive eye surgery is usually not performed until the patient’s eyes have finished growing, which happens around the age of 21.

Phakic Intraocular Lenses can be used to correct severe hyperopia. This treatment implants a lens much like a contact lens inside the eye to allow better light refraction. Advancements in Lens Replacement Surgery with technology such as Crystalens or ReSTOR intraocular lenses offer a promising option for patients with hyperopia and don’t want to depend on reading glasses or bifocals after the surgery.

Prognosis for Hyperopia

With proper treatment, vision can be corrected and symptoms reduced.

Preventing Hyperopia

Farsighted individuals who have flat corneas or short eyeballs cannot prevent hyperopia from developing. Reducing your visual demand may improve symptoms. Modifications to reduce your visual demand include improving lighting or reducing glare, using better quality printed material, and keeping reading material 14–16 inches away from your eyes.

Talking to Your Eye Doctor

If you or a family member has hyperopia, use these questions to begin a conversation with your eye care provider:

How often should I wear my glasses or contact lenses?
Am I a good candidate for LASIK eye surgery?
How often should I come in to see you for my farsightedness?
At what age should I bring my infant in to check for farsightedness?
Now that I know I am farsighted, what symptoms should I watch for that may indicate a more serious problem?


Dr. Ashley Roth is on the editorial board for Read her article on Iritis below:

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Iritis — Symptoms and Treatment

Authored by
Michael Garin O.D.

Reviewed by
Dr. Ashley Roth

The iris is the colored part of the eye, and iritis is an inflammation of the iris. Iritis can also be referred to as anterior uveitis.

The iris contains muscles that relax and contract the pupil (dilate and constrict the pupil) and it serves as a divider between the anterior and posterior chambers of the eye. Iritis can affect people of all ages. The cause may be unknown, or it may be associated with certain systemic inflammatory disorders or autoimmune disorders.

Iritis can be acute or chronic. Acute iritis presents suddenly, typically as a painful red eye with light sensitivity. Chronic iritis can last months or years, and may not respond to treatment as well as acute iritis. People with chronic iritis are often at higher risk for developing visual impairments.


What Symptoms of Iritis Should I Know About?

Symptoms of iritis can appear suddenly or come on gradually, and may vary from person to person. Sudden symptoms of this condition can include:

Severe eye pain
Eye redness
Eye soreness
Photophobia (sensitivity to light)
Excessive tearing
Blurred vision
Eye may appear swollen
Uneven pupil sizes between the two eyes
What Causes Iritis in People Like Me?

In most cases, the cause is unknown, although it can sometimes be associated with a secondary inflammatory disease that affects other parts of the body.

Common inflammatory disease that can cause iritis include Rheumatoid arthritis, Crohn’s disease, ulcerative colitis, sarcoidosis, and collagen vascular disease. Talk with your eye-care professional about possible causes of your iritis and possible medical conditions that may lead to iritis.

Diagnosing Iritis

During a routine eye examination, your eye doctor will use a slit lamp (a special microscope designed for eye exams) that allows him or her to look inside the eye and examine the anterior chamber, in order to look for specific signs of inflammation.

Your examination may also involve various diagnostic techniques such as checking the pressure inside your eyes (glaucoma test), pupillary response, and vision testing. Dilation is routinely required due to concomitant risk of inflammation inside the eye. In many cases additional medical tests such as blood work will be needed to help diagnose the secondary condition that may be causing the iritis.

What Can I Do to Treat My Iritis?

Your doctor’s goals will be to reduce the inflammation, pain, and redness, prevent complications, and treat any other health problems that may be evident. In most cases, prescription drug therapy is used to treat this condition.

With early detection, treatment can preserve vision. Eye drops will be prescribed, and treatment length varies on severity and cause of the iritis. Oral cortisone drugs or cortisone eye drops may be prescribed to reduce inflammation. In most cases, diet and normal activities are not affected, although most people will need to wear dark sunglasses due to photophobia until treatment is complete.

Risk Factors for Iritis

Here is a look at some of the factors that may increase your risk of developing iritis:

Ankylosing spondylitis
Inflammatory bowel disease
Herpes infections
Lyme disease
Eye injuries
Candida infection
Reiter’s syndrome
Unfortunately, there are no preventive measures known for this condition. Talk with your eye care professional about what risk factors you may have.


Dr. Ashley Roth is on the editorial board for Read her article on Vitrectomy below:

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Authored by
Michael Garin O.D.

Reviewed by
Dr. Ashley Roth

Vitrectomy is a procedure that involves removing the vitreous humor (the gel-like substance that fills the inside of the eye). In most cases the vitreous is replaced with a saline solution, silicone oil, air, or gas.

Why Vitrectomy Is Done

Vitrectomy can often improve a patient’s vision, or at least stabilize it, preventing it from worsening due to whatever condition made the vitrectomy necessary.

During the course of vitrectomy surgery, the surgeon may remove blood that has clouded the patient’s vision, or possibly debris that was introduced by an injury. Such blood or debris can block light from reaching the retina, causing vision to become blurred.

Other reasons for vitrectomy include:

Treatment of bleeding and removal of scar tissue caused by diabetic retinopathy, a condition suffered by diabetics that causes new, unnecessary blood vessels to form in the eye and scar tissue to form on the retina
Macular pucker, a condition in which the area of the retina called the macula becomes wrinkled and disrupts vision
To treat problems caused by cataract surgery
To treat problems caused by eye infection
To treat intraocular bleeding or other problems caused by an eye injury
To treat eye floaters
Different Types of Vitrectomy Surgery

Anterior vitrectomy involves the removal of small amounts of the vitreous from the anterior, or front part of the eye.

Pars plana vitrectomy is the removal of some or all of the vitreous from deeper within the eye. This procedure was developed in the early 1970s as a way to remove vitreous gel that had become clouded, usually by blood. The success of the procedure led to the development of other procedures related to it, including methods for removing scar tissue from the retina.

The Vitrectomy Procedure—What to Expect

Vitrectomy surgery is generally preformed with local anesthesia, rather than general—i.e., the patient is awake (although usually sedated). The procedure often takes less than an hour, although treating more complex problems can take longer.

After anesthetic has been administered, the surgeon will make an incision into the sclera (the white part of your eye). The surgeon will then use a suction tool to remove a portion of the vitreous gel, along with whatever may be causing a visual obstruction (blood, a foreign object, etc.). He or she may then place a gas bubble against the retina to ensure that it remains in place while you heal (this gas bubble will dissolve on its own within a few weeks).

The space left by the vitreous gel that has been removed may be filled with saline solution, or it may be filled with silicone oil, in which case another operation may be necessary a few months later in order to remove the oil, which will not dissolve into the eye.

What Are the Possible Complications of Vitrectomy?

As with any type of surgical procedure, it possible for things to go awry during a vitrectomy. One possible complication that can arise is a retinal detachment, a condition in which the retina peels away from the back of the eye.

Other possible complications include:

Increased pressure within the eye
Cataract formation (this is the most common complication of vitrectomy)
Recovery Following Vitrectomy

There will be some discomfort after vitrectomy surgery, and you may need to wear an eye patch and avoid physical exercise for a while. If a gas bubble has been placed against your retina it is very important that you not fly in an airplane until your doctor tells you it is safe to do so.

Most people can expect to go home the same day. Recovery takes approximately six weeks without complications, during which time vision should improve. During the first week after surgery you will likely use antibiotic eye drops to prevent infection, and a follow-up schedule with your doctor will be set.


Dr. Ashley Roth is on the editorial board for Read her article on Corneal Transplants below:

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Corneal Transplant (Keratoplasty): Before, During, and After

Authored by
Dr. Hart Moss

Reviewed by
Dr. Ashley Roth

While complete eye transplantation is not possible due to the complexity of the human eye and brain, it is possible to transplant the cornea, the transparent tissue in the front of the eye. Corneal transplantation is performed more than 40,000 times each year, but it usually only performed as a last resort, as the procedure is quite complex and risky.

Why Corneal Transplantation Is Performed

When the cornea is damaged by disease or injury, it may become slightly opaque or have an irregular surface, which prevents clear, focused light from reaching the retina; the result may be impaired vision, or even blindness. There are many reasons why a corneal transplant may be performed, including Fuchs’ dystrophy, corneal ulcers, scarring, keratoconus, viral infections, and injury.

Cornea donors are recently deceased people whose eyes are healthy, without any condition or disease that might affect the viability of the corneal tissue.

Types of Corneal Transplantation

Penetrating Keratoplasty

Penetrating keratoplasty is the removal and replacement of the entire thickness of the cornea.

Lamellar Keratoplasty

Lamellar keratoplasty involves replacement of only the anterior (front) layers of the cornea. The most commonly performed lamellar transplant is called a Deep Anterior Lamellar Keratoplasty (DALK), in which only very deepest layer of tissue, called Descemet’s membrane, is left. This procedure leaves the eye with more strength than the traditional penetrating keratoplasty, and may decrease the rates of rejection.

Endothelial Keratoplasty

Endothelial keratoplasty involves replacement of the endothelium, the back surface of the cornea. This layer is responsible for pumping fluid out of the cornea back into the eye. Without a healthy endothelium the cornea would swell with fluid and get cloudy. This procedure is usually only performed for diseases that affect only the endothelium.

What to Expect

Unlike other types of transplantation, corneal tissue in many countries is readily available and is not scheduled on a “waiting list.”

Your face will be washed and draped, and you will be sedated; you may be put under general anesthesia, or you may only be given a local anesthetic, in which case you will be awake (but relaxed) during the procedure. Your eye will be held open with an eyelid speculum.

Using a powerful surgical microscope, the surgeon will remove the center of the cornea—the damaged part—with a cookie-cutter-like instrument called a trephine. The donated tissue is then placed in the spot where the old tissue was removed and sewn into place with a thread that is one third the thickness of a human hair. The procedure will generally take an hour or two.

After the operation is performed, the eye will be covered with gauze and a hard plastic shield or eye patch, in order to protect the eye from injury or infection. Your eye will be examined the following day. Typically, vision is still extremely blurry the day after surgery.

Your surgeon will prescribe multiple eye drops that prevent infection and minimize inflammation. You will need to use these drops regularly throughout the healing process, which may take several months to a year, depending on the type of transplant. For a penetrating or lamellar keratoplasty, the sutures will be left in the eye for some time, and your ophthalmologist may remove some or all of them. Removing the sutures is not painful.

Risks of Corneal Transplant

Apart from the risk of infection (which is a concern in any surgery), the most significant risk associated with this procedure is rejection of the transplanted tissue. Roughly 20 percent of recipients (around 7,000 each year) reject their transplants. Rejection is when the immune system does not recognize the donor eye tissue and starts to attack it.

RSVP is a helpful mnemonic you can use to know when you should contact your surgeon. You should call your doctor immediately if, following corneal transplantation, you experience:

Redness of the eye lasting more than a few days
Sensitivity to light (photophobia)
Vision blurring
Most surgeons recommend an extended (or even lifelong) course of topical steroid eye drops to reduce the risk of corneal transplant rejection.

Alternatives to Keratoplasty

Many diseases of the cornea can be effectively treated with rigid, gas-permeable contact lenses. These lenses provide a smooth, regular surface, which can minimize the blurring associated with distorted, irregular corneal surfaces. Often, these lenses can provide good enough vision that a cornea transplant is not needed.

Talking to Your Doctor

Here are some questions you can ask your doctor about corneal transplantation:

Will a corneal transplant restore my vision?
Are there any non-surgical alternatives to transplantation?
Am I a candidate contact lenses rather than transplantation?
How long will it take for my eye to heal following surgery?
What type of corneal transplant is best for my eye?
Is there anything we can do to minimize the risk of tissue rejection?
Are my eyes healthy enough to allow for me to donate my corneal tissue? Do I need to contact an eye bank, or is it enough just to have my driver license indicate that I am an organ donor?


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