This section contains answers to questions (oldest to newest)  obtained from Web site visitors via the comments request form on the front page.  Currently, there is about a 78% chance that your question has already been answered below.  This page will be updated weekly with new material.  Also see the dictionary for terms and further information and review the past featured articles.   This information is provided for personal use only and is not meant to be "medical advice."  You should always consult with an Ophthalmologist or Optometrist about eye disease or eye problems.  It is recommended that children receive a professional eye exam by an eye doctor at birth, 6 months, 3 years and before entering school.  In general, adults should receive a complete eye exam every 2 years.

Topics:

Cone-rod degeneration     Retinal Detachment    Turning-in of Eyes    Stye

Bright red spots    Red eye    Best's Disease     Optic Atrophy    Pink eye

Conjunctivitis    Floaters    Toxoplasmosis    Anterior Chamber Dysgenesis    Dry eye

CRVO    Corneal abrasion    Blind spot    Esophoria vs Esotropia    Ozone treatment

Macular hole    Halos    Spot on iris     Back-and-forth eye movements

Swollen eye lids    Optometrist vs Ophthalmologist    Sharp pain in eye   

Wine and Macular Degeneration    Cysticercosis    Toxocara Canis   

Patches of light in both eyes     Amblyopia in an older child    

Niacin and blurred vision    Normal pressure and glaucoma surgery   

Eye removal in glaucoma    Color blindness    Needs     Dyslexia   

Vision therapy for Amblyopia     Dilated pupils    Choroideremia vs Chorioretinitis

Flashing light(s)    Computer Eye strain    Histoplasmosis     Dark circles under eyes

Recurrent corneal abrasion     Chronic Blepharitis     Photophobia

Delayed Visual Maturation    Cortical Visual Impairment    Vitamin A and Floaters

Retinitis Pigmentosa    Half of Eye Red    Swollen Eyes and Feet

Broken blood vessel in eye     Coats' Disease    Wife's swollen eye    Yellow Eyes

Why Eye Tests?    Stationary Black Spots in Eye    Twitching Eye(s)    Watering Eyes

Sclera scar    Uveitis     Tan Spot on Eye    Best    Pterygium     Viagra    Eye Clinic

Rod-Cone Specialist    Blepharospasm    Scotoma     Eye Color and Vision

Synesthesia(Mixing-up of Sensory info)     Episcleritis    Bi-focals and Burning Eyes

MSG    Scleritis     REM(Nystagmus)    Double Vision    Color Blindness   

Unequal Pupils    Contacts    Cataract Surgery and Floaters    Optic Nerve Drusen

Central Serous Retinopathy    Niemann-Pick Disease    Pseudophakia

Seeing Dots    Head Trauma and Diplopia    Blocked Tear Duct   

Watery Eyes and Upper Lid Swelling     Something in Eye(s)    Blurry Streaks

Constantly Red Eye    Strings in Eye    Prones      Loss of Side Vision in Histo   

Bubbles on Lid Margin    Busted Vein in Eye    Holes in the Macula

Flashes in Eye    Best Patterns for Seniors    PIC Disease    Pars Planitis   

Blufferitis (see Blepharitis)     Blood in Eye    Stinging Eye    Distorted Vision  

Grave's Disease    Adie's Pupil    Diplopia     Mucus in Eye    Lazy eye

Lights Dimmer than Normal    1/2 Red Eye    Herbal Products    Tunnel Vision

Stargardt's Disease    Different Pupil Size    Upper Eye Lid Swelling   

Sensitivity to Light     Heal Macular Degeneration     Transplant Worries

Dark Circles and Bags Under Eye    Florescent Lights    Eyelid Cysts   

Jumping or Twitching Eye       Poor Side Vision and Nausea    Red Hue   

Black Spots    Fuch's Dystrophy    Adie's Syndrome    Glasses to Correct Color Vision

Blind Spots in Visual Field     Film-like Growth on Eye     Lightening Bolts   

Blood Spots on Eye    Lights hurt at Night    Iritis and Autoimmune Disorders

Retinoschisis    Pengweckula(Pterygium)    Retinitis Pigmentosa (RP)     Scales

Holme-Adie Disease    Can't Open Eyes    Sparkly Wavy Lines    Rolling Eyes   

Central Serous Retinopathy     Bubbles    Stargard (Stargardt's) disease   

Post Chiasmal Vision Loss     Nightlights and Vision Problems    

Painful Burning Eyes   Pin Prick in Eye    Thyroid Eye problem    Red Itchy Eye Lids   

Treatment for Older Amblyopic Child     Test Your Eyes for Floaters     Sty (Stye)

Blindness at Night    Itchy, Red Eyes    Looking Through Curtain    Sore Eyes

Floopy Eyelid Syndrome     Wandering Eye   High Blood Pressure and Floaters

Small Triangular Area of Flashing Prisms in Periphery    Meniere's disease

Serpiginous Choroiditis     Vogt-Koyanagi-Harada (VKH) disease    

Epiretinal Membrane     Pavement Stone or Paving Stone degeneration

Laurence-Moon-Bardet-Biedl Syndrome    ERVAN'S [Eales] Disease

Nearsightedness    Steroid use in a Child    Pseudotumor Cerebri and Papilledema

Stigmatism (Astigmatism)    Retinal Implants    Diabetic Eye or Retinopathy

Congenital Hypertrophy of the Retinal Pigment Epithelium    Eye Disease vs Defect

Wearing a Patch to Avoid Diplopia    Rings Around Lights    Marcus Gun (Gunn) Pupil

Birdshot Retinochoroidopathy    Lattice Degeneration    Loss of the Ability to Focus

Fuchs' Heterochromic Iridocyclitis    Eye Replacement in Coats  Nystagmus

Broken Glass Blind Spots     Floaters, Halos and Dark Flashes     Large Pupils

Floaters, Halos and Dark Flashes Reply    Gray Oval in Eye    Congenital Cataract

Correction for Eyes that are not Straight    Seeing Tracers or Trails    Lesion in Eye

Funds for Surgery    Scerlitis (See Scleritis)       Bumps along Lid Margin and Floaters

Eyeritis (Iritis)     Parafoveolar Telangiectasia    Blood in Eye     Blurry Eye at Night

Fugndris Flarvinoculations (Fundus Flavimaculatus)    Yellowness in Corner of Eyes

Thrust and Blurry Vision    Droopy Eyelid    Neurologist     What an Amblyope Sees

Chalazion     Ceratocome (Keratoconus)    Pass Ishihara Test    Stargartz (Stargardt's)

Eye Higher Than Other    VDU Eye Problems     Panuvitus (Panuveitis)    Walleye

Sulzmann's (Salzmann's) Nodular Degeneration    Yellow Pupils (Iris)   

% of People Who need Glasses    Young Child not Dilating    Contacts and Red Ring

Radiculopathy, Steroids and Central Serous Retinopathy    Oscillatory Potentials

Corneal Transplant in Elderly    Screen Reader (Text-to-Speech Program)    

Floating Eye    Temporal Field Loss    OD and OS     Visual Aftereffect Phenomenon

Pneumatic Retinoscopy (retinopexy)    RP or Usher's Syndrome   Eyeritis (see Iritis)

Bilateral Reholental Fibvoplasin (Retrolental Fibroplasia)    Iristis (see iritis)

Mavular Degeneration (see Macular Degeneration)       Pale Nerves

Celinder Glasses (see astigmatism)         Treatment for nystagmus   

TV and Computer Screen Effect on Eyes    Slanted (abnormal shaped) pupil

Transient Blurred Vision in One Eye    Double Vision in One Eye    Thygeson's

Duane's Syndrome         Bright Spot when Shifting Gaze     Crusty and Itchy Eye Lids

Exercise-Induced Vision Problem    Protruding eyes     Pseudomyopia   

Unable to move eye     Seeing Squiggly Lines    Constant Watering Eyes   

Swollen Upper Eye Lid    Accutane and Floaters    Eyes Focus at Different Points

   Star guards (see Stargardt's)    Eye Hemorrhaging     Blisters/Ulsers on Eye

    Droopy Eyelid    Eye Muscle Surgery for Crossed-eyes     TV and Eye Problems    

Loosing Sight in One Eye    Eyes Feel Pressure and Irritated    Eye Dominance

Map-Dot-Fingerprint Dystrophy         Krukenberg (Spindle)     Optic Nerve Atrophy

Dark Circles Under Eyes    Spelling of a Rare Eye Disease    Excessive Blinking

Double Vision in the Elderly    Red Glasses and Well Being    Orbital Cellulitis

Blepharitis and Permanent Vision Problem      Nevus   Tunnel Vision    Adie Eye

Holm's Adie (Holmes Adie)    Torn Retina    Diabetic Eye Disease

Seeing Flashing Lights when Moving Eyes    White Ring Around Iris    Seeing an Arc

Bump on White Part of Eye     Recurrent Swelling of Eyelids and Blepharochalasis

Papilledema    Flashlight and Eye Damage     Treatment for Blepharochalasis

Twitching Eye

Q.    My husband/wife has a cone rod degeneration or dystrophy.  Is there any treatment for this disease?

There is no known treatment for cone-rod degeneration or dystrophy. Nevertheless, there are certain things that you/your husband or wife with cone rod degeneration should consider:

1. Avoid or minimize exposure to excessive light levels by wearing a hat and dark sun glasses outside and limiting internal light levels. Some scientists/doctors believe in the "use it and lose it" hypothesis – if you’re exposed to excessive lights it will tend to aggravate the condition and lead to worsening sight.
2. Eat a diet rich in antioxidants. Some animal research suggests that antioxidants my protect the (remaining) retina from damage, including damage from excessive light exposure. As an alternative, take vitamin supplements.
3. Any diagnosis of a serious vision loss due to a retinal degeneration should be followed by genetic counseling. Because about 70% of retinal degenerations are autosomal recessive, there is a low probability that children of a person with a retinal degeneration will have the disease. In an autosomal disease, there is a 25% chance that the patient’s brothers and sisters from the same mother and father will also have the disease.
4. A person with a retinal degeneration should be seen by the local Bureau for Services for the Blind and Visually Impaired (BSVI) and, if available, a Low Vision clinic. These sites provide services and equipment such as low vision devices, optical aides, scanning and computer devices, etc. Through the use of certain low vision aides such as a bioptic lens, visually impaired and even legally blind patients can obtain a drivers license in some states, including Ohio.

Q.    What causes small red spots on the white part of the eye?

Bright red spot(s) on the white part of the eye are probably subconjunctival hemorrhage(s).  These are caused by a number of things including injury or may develop spontaneously in older adults.  You should see an Ophthalmologist for a diagnosis and treatment if applicable.

Q.    What causes red eye?

Red eye is caused when the blood vessels of the eye swell with more blood than usual.  Red eye may be associated with:

1. Infection, including AIDS
2. Allergic or chemical reaction
3. Glaucoma
4. Fatigue
5. More serious disease
6. Need for glasses

A person with red eye should see an Eye Doctor if:

1. There is pain
2. See floaters
3. Loss of vision
4. Caused by injury
5. There is discharge from the eye
6. Swelling or redness of the eye lid(s)
7. Cloudy cornea
8. Unequal pupil size
9. Presence of bright red blood in the eye, between the cornea and iris

Q.    What causes black floating spots in my vision?

Floaters are condensations of cells in the gel part of the eye, known as the vitreous.  Floaters appear as dark spots, as web-like objects, as a dot with arms, or strings.  Floaters are often associated with high myopia (very nearsightedness) and with aging.  A lot of floaters my be a sign of serious eye disease such as a retinal break, tear, or retinal detachment.  If you see a lot of floaters, suddenly, or see bright dots or flashing lights, you need to see an Ophthalmologist immediately.  There is no treatment available for typical, nonpathologic, floaters.  Also see Vitamin A and Floaters in this section.

Q.    What causes a retinal detachment?

A retinal detachment usually occurs when fluid accumulates between the retina, that part of the eye that contains the photoreceptors, and the underlying layer of cells, called the retinal pigment epithelium (RPE).  A retinal detachment can also occur because of abnormal bonding between the retina and vitreous by bands of fibrous tissue.  A retinal detachment my be the result of injury to the eye such as blunt trauma (remember Sugar Rae, the boxer), penetrating injury, or it may result from other things like high myopia or age-related macular degeneration.  In certain diseases, retinal breaks and tears occur and these may lead to a retinal detachment.  Early warning signs include bright dots or lights or some of your side vision may appear dark.   A retinal detachment may be treatable if detected early, so see your Ophthalmologist, immediately.

Q.    My child's eyes appear to really turn-in when he looks at close objects.

Your child may have an accommodative esotropia - this condition occurs when a child looks at near objects and the eyes turn-in too far, making their child appear cross-eyed (esotopic).  This may be a sign that your child needs glasses for seeing things close-up.  If left untreated the child may develop a lazy-eye.  You should see a Pediatric Eye doctor for evaluation and treatment.

Q.   What is Best's Disease?

Best's (not Best) disease, also called Vitelliform macular dystrophy, is an autosomal dominant (i.e., 50% of family members have it) form of generalized retinal pigment epithelium (RPE) dystrophy.  The RPE is a layer of cells in the back of the eye that provides nourishment to the retina and photoreceptors.   Clinically, Best's disease is characterized by one or more lesions in the back of the eye that sometimes takes on the appearance of a "sunny-side-up egg yolk" in the early stages of the disease and later appears as a "scrambled egg."   Depending on the locus of the lesion(s) it may or may not affect vision.  If it does not affect vision, then the patient is an asymptomatic carrier of the disease.   When it does affect vision, visual acuity may range from 20/30 to 20/200 (legal blindness).  There is no treatment available for Best's disease.  The diagnostic test for Best's disease is the electro-oculogram (EOG), which takes about one hour to perform, and a complete dilated eye exam.  All members of the family should be tested with the EOG to identify carriers of the disease, even if they are asymptomatic. 

Q.    What is optic atrophy?

The optic nerve is composed of mostly axons from the millions of ganglion cells within the inner layer of the retina.  The optic nerve goes from the eye, crosses at the optic chiasm, ( after which it is called the optic radiation) and innervates the vision centers of the brain.  In optic atrophy, some of the ganglion cell axons that make-up the optic nerve have died or are dying.  When the eye doctor looks into the eye, the optic nerve looks white or pale instead of the normal pink, healthy color.   A large number of things can cause optic atrophy, either things within the eye or things within the brain.  Sometimes optic atrophy can occur by itself, but most of the time its associated with or a symptom of another serious disease.  Optic atrophy is never a good sign, and often requires a through work-up to identify the cause.   Optic atrophy can lead to varying degrees of vision loss; from normal to near-normal vision to complete blindness.  Vision can decrease rapidly in some cases.   If you're diagnosed with optic atrophy, it is very important to follow-up on all doctor appointments with you Ophthalmologists, Neurologists, etc., your life may depend upon it!

Q.   What is Toxoplasmosis and how did I/my child get it?

Toxoplasmosis is a parasitic infection that humans get from contaminated soil or cat litter, or can get from eating undercooked contaminated meat.  From 15% to 30% of North Americans are infected by Toxoplasmosis.  Toxoplasmosis can be transmitted from an infected mother to her unborn child, in 30 to 40% of cases, where it can severely affect the infant - called congenital Toxoplasmosis.  If it is active, it is called symptomatic congenital Toxoplasmosis.  In unborn and new infants Toxoplasmosis can cause numerous vision and neurological problems including; retinochorioditis (inflammation within the eye), seizures, hydrocephalus, microcephaly (small head), fever, glaucoma and ocular palsies. Visually, Toxoplasmosis can lead to retinal tears, retinal detachments and retinal bleeding and blindness.  To minimize infection, particularly of pregnant women, meat and eggs should be well heated and contact with cat stools, including cat litter, should be avoided.

Q.   What is "Anterior Chamber Dysgenesis?"

The anterior chamber is the front part of the eye from the cornea to the iris - the color part of the eye.  Dysgenesis means underdeveloped or maldeveloped, in other words the anterior chamber did not form completely.  If the iris is involved there is a high probability that glaucoma may develop and cause serious vision loss.   Sometimes, anterior chamber dysgenesis is associated with other systemic or whole body problems including dental defects, abnormal development of the skull and skeleton, and certain growth problems in the child.  The treatment of glaucoma in patients with anterior chamber dysgenesis is very difficult, requiring lots of surgery and eye exams.   Because of the serious nature of glaucoma, the patient MUST be seen regularly by an Ophthalmologist.

Q.    I have a Stye (or Sty) in my eye, why?

A Stye (external hordeolum) is caused by bacterial infection, typically Staphylococcus aureus.  There is usually painful swelling of the eye lid, that usually becomes localized with outbreaks  along the eyelash line.  Styes usually respond well to hot moist compresses ( 4 times/day for 15 minutes).  Removal of eye lashes in the affected area may promote drainage.  Topical ophthalmic antibiotics my be needed.  If there are other sites of infection, oral antibiotics may be necessary.   In general, styes are caused by poor hygiene whereby the patient goes to the bathroom, changes a diaper, for example, and then touches the eye area thus infecting the eye lid margin.  Proper hygiene and washing your hands with soap and water after going to the bathroom, for example, my reduce the chances of future infections.  See your eye doctor.

Q. What is "pink eye"?

Pink eye is a conjunctivitis caused by Koch-Weeks bacillus - a bacterial infection.  It is very contagious and causes wide spread epidemics, particularly in warm climates.  Once infected, the incubation period is 24 to 48 hours and is followed by an acute onset of inflamed, redness, and discharge of mucus and pus from the eye.  The patient often complains, if old enough, of scratchy, burning and pain of the eye and eye lid.  Subconjunctival hemorrhages are common and in some cases corneal ulcers may appear.  The infection reaches its peak in 3 to 4 days.  If you or your child has pink eye, immediate medical attention is needed.  Untreated patients often have recurrences of the disease.  Attention to personal hygiene is recommended.  See your eye doctor.

Q.    My eyes are very dry.

Dry eye disease (Keroconjunctivitis sicca) is a common and very frustrating disease to deal with in the aging population.  It typically affects women and symptoms include a dry, gritty sensation as well as foreign body sensation in the eye(s).   There are many causes of dry eye disease including the decrease in hormones with advancing age and reduction in eye tear production, sometimes associated with other disease.  Unfortunately, treatment options are limited, in part, because of the number of diverse factors that cause the disease.  Artificial tears and ointments provide temporary relief.  Better treatments will become available through research, some of which is being undertaken at the College of Optometry at The Ohio State University with support from the Ohio LIONS Eye Research Foundation. 

Q.    What is CRVO and what can be done about it?

CRVO stands for Central Retinal Vein Occlusion.   CRVO as well as occlusion of one or more of the central vein branches causes various degrees of vision loss depending on the extent and locus of the occlusion.    Upstream from the occlusion venous dilation and mild hemorrhages may be observed by the eye doctor.  There also may be swelling and so-called "cotton-wool" spots in the back of the eye (retina).  A percentage of patients will also develop neovascularization (i.e., growth of abnormal blood vessels) of the iris and, as a result,  develop glaucoma.  Most patients with CRVO are elderly and their eye problems are associated with arteriosclerosis.  Recovery of vision is dependent on the extent and location of retinal hemorrhages.  If glaucoma develops, the eye may have to be enucleated (removed).

Although there is no effective cure for CRVO, depending on conditions the eye doctor may use steroids to control edema (swelling) of the central retina (macula).   Anticoagulants have also been employed to reduce/prevent the chance of iris neovascularization and associated glaucoma.  However, it apppears that the use of anticoagulants are no longer considered effective for treatment/prevention.  Finally, photocoagulation (i.e., laser surgery) may be used to treat the abnormal blood vessel growth in the retina and to prevent retinal edema and subsequent loss of central vision.  The eye doctor may also run certain blood, urine and stool tests tests while the patient is taking anticoagulants.   Because of the dangers and seriousness of CRVO, the patient must been seen regularly by the eye doctor and must keep all of his or her appointments.

Q.   I have a Corneal abrasion (scratched cornea) and it hurts like ...., what can I do about it?

A corneal abrasion can be caused by a number of factors and is associated with severe pain, photophobia (light sensitivity), tearing and twitching/closure of the eye.   If there is penetration of the eye by a foreign object, very serious complications include cataract, hemorrhages and possible loss of the eye.  A person that has a corneal abrasion should by closely examined by their eye doctor for foreign objects.   Assessment usually includes the use of fluorescein stain of the cornea to localize the abrasion.  Topical antibiotic ointments are often given and patching of the eye may be recommended.  Topical corticosteroids and topical anesthetics are not recommended.  For severe abrasions the patient is usually reexamined in 24 to 36 hours.  Early treatment is essential for a corneal laceration or for penetrating injuries. 

Q.    We all have a blind spot in our visual field where the optic nerve leaves the eye, yet we don't usually see it.   Why don't people that have macular degeneration also compensate for the blind spot in their central vision?

A natural blind spot occurs in our visual field because there are no photoreceptors where the optic nerve head is located in the back of the eye or retina.   Yet, we are not typically aware of the blind spot in our vision.  To demonstrate the normal blind spot do the following;

On a piece of paper draw two small dots, separated horizontally by two inches.   Close your right eye and fixate on the right dot with your left eye.  Now hold the paper about 12 inches from your nose and move the piece of paper slowly straight towards your nose while maintaining fixation of the right dot with your left eye (no peaking).  Watch what happens to the LEFT dot when the piece of paper is about 6 inches from your nose - the left dot will actually disappear.  This is where your natural blind spot is located or observed.

Why don't we "see" the natural blind spot in daily vision?    Anatomical and electrophysiological studies on animals have revealed that the   visual areas of the brain corresponding to the optic nerve head (and thus the natural blind spot)  is filled-in so that there is no brain site that corresponds to the natural blind spot.  Anatomically, the brain sort of covers over the natural blind spot in our vision and, as a consequence, we do not see the blind spot in daily living.  In other words, there is no brain space devoted to the natural blind spot.   People with macular degeneration do not form such an anatomical filling-in process, possibly because the brain is no longer "plastic" or amenable to change in later life (i.e., beyond the critical period of vision development).

Important:  If you or someone you know actually sees one or more "blind spots" if your vision (other than the natural blind spot as described above), see an Ophthalmologist immediately!  The presence of blind spots in vision may be a sign of a very serious eye or/and neurological disease. 

Q.   What is the difference between an "esophoria" and an "esotropia"?

"Eso" is a prefix meaning that the eyes turn-in toward the nose, as opposed to an "exo" meaning that the eyes appear to turn-out).  A "phoria" means that the eyes are misaligned a little (usually defined  as less than 10 prism diopters).  A "tropia" means that the eyes turn-in a lot (10 prism diopters or more) and is very noticeable.  So, an esophoria is a small turning-in of the eyes and an esotropia is a large turning-in of the eyes.  [Although we refer to "eyes", usually only one eye turns-in]  A person with an esophoria may get along fine; use both eyes together and have normal visual acuity in each eye.  Depending on the circumstances, a child with an esophoria may need to have some prism in one or both of his or her glasses.  A person with an esotropia typically will not use both eyes together and may have a lazy-eye (amblyopia).  If the child has a lazy-eye, the standard treatment is patching the good eye and forcing the child to use the lazy-eye until vision becomes normal.  Often, a child with an esotropia will need corrective eye muscle surgery to align the eyes - ideally after the lazy-eye is cured and vision in both eyes is similar.  Sometimes the child with an esotropia may need glasses and the glasses may correct the esotropia - a condition called accommodative esotropia. 

Q.    I have retinitis pigmentosa (RP) and I recently heard about "ozone" treatment for RP.  Does it work?

No.  There is no valid scientific evidence that shows that ozone treatment works in patients with RP.  A few studies have been published showing that ozone treatment improves some aspects of vision in RP patients; however, the ozone studies that we have reviewed were poorly designed, lacked appropriate control groups and were based on very few subjects.  For more information about RP and valid research, go to the Web site for The Foundation Fighting Blindness at  http://www.blindness.org/

Q.    What is a macular hole?

A macular hole is a lesion in the fovea - that part of the macula or central part of the retina used for reading.   To the eye doctor a macular hole looks like a hole or depressed circular or oval area that typically is reddish in appearance.  To the patient a macular hole looks like a dark area or scotoma in which the patient can't see through.   Prior to a full-blown macular hole, a "pre-macular hole lesion" may be present and these have been referred to by various names including macular cyst, involutional macular thinning or impending macular hole.  Depending on the severity, size and location of the macular hole, the patient may have from about 20/50 to 20/400 visual acuity in the affected eye.  Some macular holes, about 10%, partially resolve or improve, but the majority are permanent as is the loss of vision. Usually only one eye is affected and  women are affected much more than men.  Trauma to the eye accounts for about 15% of macular holes, while the rest are typically associated with aging (50 and older).  Because a macular hole is difficult to diagnose, some tests that the eye doctor may order include a fluorescein angiogram and a biomicroscopy with a contact lens.  A retinal detachment may result from a macular hole and surgery may be needed.  Ophthalmologists have tried a number of treatments for macular holes with varying degrees of success.  A patient with a macular hole must see the eye doctor on a regular basis.

Q.    Halos around lights.

Halos are usually caused by light scatter.  Light scatter is typically caused by problems with the anterior (front) portions of the eye, such as the cornea, lens or/and lens capsule.  People that typically see halos include people with cataracts (or with the early beginnings of a cataract), people that have had "refractive surgery" and people that have had cataract surgery.  When a person has a cataract (clouding of the lens of the eye), the cataract scatters light and, as a consequence, when the person looks at on-coming head lights, for example, he or she experiences halos.  When a person has had cataract surgery, the lens of the eye has been replaced with an intraocular (inside the eye) lens; however, the lens capsule remains in the eye.  Sometimes the lens capsule will become cloudy and will cause light scatter and thus halos.  Halos are a common complaint of people that have had refractive surgery - surgery to correct a refractive error and remove the need for corrective lenses.

Q.    Small white spot on iris, what is it?

The white spot may actually be a foreign body on or in the cornea.  If so, you should see your eye doctor immediately, particularly if your eye is red and painful.  If you are convinced that it is part of the iris, it is unclear what it could be and you should also see your eye doctor immediately.

Q.    I have a 3 month old whose eyes move back-and-forth constantly.  Why is she doing this?

The technical name for eyes moving back-and-forth constantly is "nystagmus".  In an infant, nystagmus may be caused by a number of things - some very serious.  Therefore, you should take your infant immediately to a pediatric Ophthalmologist, who will probably have a number of diagnostic tests performed to determine the cause of the nystagmus.  Sometimes nystagmus is present at birth, or first noticed in the first few months of life, and occurs by itself. This is called congenital nystagmus (CN).  An infant with CN will sometimes be able to slow-down the size and frequency of the nystagmus by looking in a certain direction or turning the head a certain way (i.e., null point).  As the infant ages, the CN usually gets smaller in size, but may increase in frequency.  CN often gets worse (larger size and more noticeable) when the infant is tired or not feeling well.  Children with CN will show some degree of vision loss, and usually have visual acuity in the range of about 20/70 (visually impaired) to 20/200 (legal blindness).  Sometimes nystagmus in an infant is a sign of a more serious eye disease, such as a retinal degeneration, that can cause blindness.  Other times nystagmus may be a sign of another neurological problem with the brain or/and optic nerve(s).  So it is very important that a child with nystagmus be seen by a pediatric Ophthalmologist who is able to have a host of diagnostic tests done to determine the cause of the nystagmus.

Q   Swollen eyes.

Eye lid swelling may be caused by a number of factors including ocular allergies, infections, neurological disorders and trauma.  The eye lids are the most common sites for ocular allergies which may be triggered by drugs, cosmetics, insect bites and even sun light.  Even if cosmetics are not applied directly to the eye lids, they may nevertheless cause eye lid inflammation (called Eczema) because of indirect contact via rubbing of the eye lids or during sleep when cosmetics are rubbed-off of the face onto the pillow and onto the lids.  Contact allergies are usually caused by cosmetics and drugs.  The eye lids reflect diseases which primarily affect the skin, including Psoriasis.  More serious neurological problems associated with lid swelling include hypothyroidism (Graves disease), orbital cellulitis, orbital tumors and syphilis.  Individuals may also simply have a predisposition for swollen eye lids which may worsen with sleep, when the head is in a sublime position and blood flow is increased to the facial area.  See your eye doctor if you are concerned about swollen eye lids, particularly if the swelling is associated with any other symptom such as redness, pain, double vision, reduced vision or if you feel a lump on the eye lid.  Also see Stye in this section.

Q.    What is the difference between an Optometrist and an Ophthalmologist?

An Optometrist (designated as an O.D.) is an eye doctor whose is trained in the optical correction of the eyes with contacts or glasses, diagnosis and treatment of eye problems and eye diseases, and who may be trained and certified in the use of diagnostic and therapeutic drugs.  To become an Optometrist, you need a 4-year bachelors degree and three to four years of post graduate work at a college or department of Optometry.  An Ophthalmologist is a medical doctor (designated as an M.D.) or Osteopathic doctor (designated as a D.O.) whose is trained in the optical correction of the eyes with contacts or glasses or surgery, diagnosis and treatment of diseases of the eye and body, uses diagnostic and therapeutic drugs, and performs surgery.  To become an Ophthalmologist, you need a 4-year bachelors degree,  4-year medical degree, 1-year internship and three to four years of residency training specifically in Ophthalmology.  Optometrists and Ophthalmologists may have additional year(s) of training in a specialty area such as pediatrics.

Q.    My father complains periodically of   sharp pains in his eye, almost like that caused by a needle.  Can you explain?

Sharp pains in the eye may be an early sign of glaucoma - abnormally increased pressure in the eye that can lead to blindness.  The presence of glaucoma increases with age.  Your father should see an eye doctor ASAP for a complete eye exam which should include the measurement of the pressure of the eye.   If caught early, medicines and/or surgery may prolong sight.

Q.    Does drinking a glass of wine every day slowdown macular degeneration?

We are not aware of any scientific evidence that drinking a glass of wine every day slows any type of macular degeneration.  However, the is some evidence of a relation between antioxidants (related to those nasty free radicals) and age-related macular degeneration; the higher the level of antioxidants in the blood the lower the risk of macular degeneration.  Excessive alcohol consumption (and cigarette smoking) appear to decrease the amount of antioxidants in the blood.  Therefore, drinking (too much) wine may actually make the macular degeneration worse!  So, if you have macular degeneration DON'T SMOKE and LIMIT ALCOHOL CONSUMPTION.  For a great booklet on age-related macular degeneration and the dos and don'ts, the Web site for the Alliance for Aging Research.

Q.    What is cysticercosis?

Cysticercosis (Cysticercus cellulosae) is a larva of pork tapeworm.   The parasite is usually ingested by eating raw or undercooked pork, vegetables or even water that is infected by the larva.  The parasite is easily found in Africa, Central and South America and Eastern Europe as well as southeast Asia.   In humans the parasite seems to prefer the eye and/or brain.  In the eye the parasite mostly affects the rectus muscles of the eye, but other eye sites include the retina, usually the macula, and sometimes even the anterior chamber (just behind the cornea) where the eye doctor can sometimes see the parasite.  Not all patients infected with the parasite show eye damage.  Early in the course of the infection the patient may have no symptoms.  Later in the course of the infection the patient may experience floaters, blind spots in central vision (scotomas), wide spread inflammation of the eye (panuveitis) and permanent loss of vision.  In rare cases, in which the parasites invade the brain, coma and even death occur.  If a patient is infected by the parasite, there are medical measures that can be taken to remove (via surgery), or kill (via photocoagulation or antiparasitic drugs), the parasite and to control the inflammation.

Q.    What is Toxocara canis and how the heck did [my kid] get it?

Toxocara canis is a roundworm parasite that lives in the intestines of puppies.   Parasites and their eggs are excreted into the soil or anywhere that the puppy "goes."  Patients can become infected by the parasite by ingesting the eggs in soil (eating with dirty hands) or from direct contact with the infected puppies.  The parasite can travel to the many parts of the body including the eye, where it causes inflammation and possible loss of sight.  Toxocara canis is described as "self limiting"; meaning that most people have limited problems with being infected.  Some doctors caution that trying to "kill" the parasite may actually cause more damage because of the toxins that are released into the body or eye when the parasites die. 

Q.    Every once-in-a-while I see a type of kaleidoscope effect of moving streaks of light that temporarily block-out my vision.  Sometimes it is directly in front and at other times it is off to the side.  I see the patches of light with both eyes at the same time and even see the lights with my eyes closed.  Otherwise my vision is 20/20.  Any ideas?

    Regarding your question about binocular (seen with both eyes) patches of light, we would recommend that you see a Neuro-ophthalmologist. Because you see the patches of light with both eyes at the same time means that the site of the effect is probably cortical – in the brain. That the patches of light cover parts of your visual field is analogous to what are medically referred to as "scotomas." The most common cause of transitory scotomas made-up of so-called flashing lights (fortification phenomena) is migraines. Typically, migraines that cause scotomas are also associated with subsequent headaches, but not always. Migraines can also be associated with other symptoms including ringing in the ears, loss of balance, light headedness, sensitivity to lights and other body sensations. However, temporary scotomas may be due to other, more serious, medical problems and this is why you really need to be evaluated by a Neuro-ophthalmologist; a medical doctor trained in both Ophthalmology and Neurology.

Q.    My 15 yr old son was just diagnosed with refractive amblyopia, even though he had previously passed all his eye tests.  The Ophthalmologist said that nothing could be done [since he is too old].  Is there any new treatment that could correct this?

We generally agree with your Ophthalmologist that your son is too old to be effectively treated, by conventional means, for his amblyopia.   By the age of 15 yrs the brain is no longer plastic or adaptive to change by, for example, occlusion of the dominant eye - the standard treatment for amblyopia.   Nevertheless, your son should be prescribed corrective lenses to correct the refractive error and, more importantly, to protect his remaining good eye.  And, he'll need to actually wear the glasses - no easy task for a teenager.

Scientists at Children's Hospital in Columbus, Ohio as well as other sites around the World have been studying the use of L-dopa (Levodopa/Carbidopa) in combination with part-time occlusion of the dominant eye in older children such as your son.  The results show that a 4 to 7 week treatment with L-dopa and part-time occlusion improves vision by about 1.5 lines on the eye chart or about 25% or so.  However, this is still an experimental treatment and requires further work.  

Q.    I've been taking a lot of iron [Niacin] tablets for ... and I've noticed lately that my vision is blurred.  Any connection?

Yes, there my be a connection between your blurred vision and Niacin.  About 10 years ago several case reports were published (Millay et al, 1988 in the journal Ophthalmology) about patients who were on large (3 - 4.5 grams per day) amounts of Niacin and complained about blurred vision.  Most of the patients were found to have swelling of the central part of the retina - the macula.  Stopping the Niacin cleared-up the vision problem.  If you are taking large amounts of Niacin and experience any vision problems, please see your eye doctor. 

Q.    I've had glaucoma for five years and although my pressures have been normal [ with medicine], my Ophthalmologist wants to do a trabeculectomy.  Is this really of any use with normal pressures?

Yes.  Even though your intraocular pressures may be normal (defined as below 22 mm Hg), there may be continuing damage occurring to the eye; for example, further loss of visual field or/and further damage (cupping) to the optic nerve head.  There is also a condition called "normal pressure glaucoma" - where the pressures are in the normal range even without medicine and, yet, there is damage to the eye.  So, even though your pressures are in the normal range, say 16 mm Hg, you may need to have your pressures lowered further, say 8 or 9 mm Hg, and this is probably why your Ophthalmologist wants to do the surgery.  A trabeculectomy. is one of several filtering operations and is preferred because of the chance for less complications.

Q.    Why is the eye sometimes removed in glaucoma?

An eye is sometimes removed (enucleated) in glaucoma because there is little or no vision remaining in the eye (the eye is "shot") AND the eye is very painful.  The eye is enucleated only as a last resort and, typically, to alleviate the pain.

17. My son’s teacher recently reported that my son is colorblind. How did he get that way and can anything be done to correct it?

Normal color vision requires three types of cones (i.e., daylight photoreceptors) and each contains a different type of pigment to capture light. The three types of cones are: red cones, green cones and blue cones. These three types of cones are then wired together in such a way as to yield all the colors of the rainbow. When a person has the correct number and type of cones then their mixture will result in correct, normal color vision.

So called "color blindness" occurs when one or more of the cone types contain the wrong pigment, or contains a mixture of pigments. So when the three different types of cones mix their signals together to form all the colors in the rainbow, the result is defective color vision if one of the pigments is the wrong one. In reality, very few people are colorblind (so-called achromats – only black - white vision): rather, they are color deficient. For example, deuteranomaly refers to a color deficiency in which the green cone pigment is replaced with red cone pigment. As a consequence, deuteranopes have a hard time telling the difference between green and red-purple colors. Protanomaly refers to people that have their red cone pigment replaced with green cone pigment. Protanopes have a hard time telling the difference between red and blue-green. There are levels to the color deficiencies ("-anomaly" means partial and "-anopia" means complete); some color deficient people may be able to correctly identify a certain color if it is really intense or "pure", but may not be able to identify the color if it is more mild or subtle or if the lighting is low. Due to the similarities between the different kinds of color deficiencies and the fact that special tests are required to differentiate between them, most people simply refer to the about types of color deficiencies as "red-green" deficiencies.

Red and green color deficiencies are usually male problems – occurring in about 6 – 8% (1 in 15) of male children and about .25 - .5% (1 in 300) of female children. This is why schools will often test for color deficiencies in male but not female students. Typically, color deficiencies are caused by a defect in the X-chromosome that is passed along from the mother to the son. Because the mother has two X-chromosomes that sort-of compensate for one another, she won’t experience any color problems or have only very subtle color problems. The son, on the other hand, has only the defective X chromosome (the other sex chromosome is a Y) and, as a consequence, manifests the color deficiency. Sometimes the mother’s father (son’s maternal grandfather) will also have the same type of color deficiency and thus will pin-down the X-linked nature of the color deficiency. If one son has a color deficiency there is a 50-50 chance that other sons from the same mother will also have a color deficiency.

Color deficiencies cause particular problems for children starting school – when the color deficiency is not yet identified and the child is having problems coloring certain scenes the right color (e.g., green grass or blue skies). Such children and their parents may become frustrated in trying to teach the child his colors or the child may even be labeled "slow" in school because he just can’t get his colors right. Early identification is important for the child’s learning and to prevent unwanted labels on the child. In addition, the above discussion assumes that the child with the color deficiency has normal visual acuity, is not real sensitive to lights (i.e., not photophobic) and does not have nystagmus (e.g., eyes do not constantly move back-and-forth). If the child does have one or more of these symptoms then the child may have a more serious retinal disease called a "cone dystrophy" or "macular degeneration."

Although there are no treatments or cures for children with color deficiencies, parents and teachers can minimize the adverse impact of a color deficiency on the developing child by "working around" the deficiency; for example, by labeling crayons and the scenes to be colored with the appropriate color names. Early detection will also help prevent failing or poor grades in certain school subjects.

Q.    "This @*#@ sucks u don't have what I need!!!!

If you describe exactly what you need and if it is of general interest to our Web site visitors, we will attempt to address your needs.

Q.    What is dyslexia and can anything be done about it?

Q.   My 6 year old daughter's amblyopia has not fully responded to patching, although we have been patching full time for a year.  I am considering vision therapy for her.  Are there any scientific studies validating the use of vision therapy (eye exercises)?

"Vision therapy" is a highly controversial issue that pits Ophthalmologists with Optometrists.  On the one hand, Ophthalmologists argue that vision therapy is appropriate for very few things and Optometrists, for the most part, swear that vision therapy is good for a wide range of problems from learning disabilities to amblyopia.  One underlying problem is that 'vision therapy' is a catch-all phrase that has no specific meaning.  Depending on the practitioner, vision therapy may refer to orthoptics, which has been shown to be beneficial for certain eye coordination problems (e.g., double vision, eye strain), or it may refer to watching flashing lights through colored filters, which has no scientific basis. 

If you search some of our cool links sites, compare what the American Academy of Ophthalmology says about vision therapy and what the American Optometric Association says about vision therapy.  For example, the AAO states that vision therapy should not be confused with orthoptics while the AOA states that vision therapy includes orthoptics.

Back to your question however, yes there are a host of studies that have reported that vision therapy works to improve visual acuity in children who do not respond well to conventional patching therapy.  Unfortunately, most of the studies have been poorly designed, lack appropriate controls or are simply case reports that this or that type of vision therapy worked for this or that kind of amblyope.  The lack of valid and reliable studies on vision therapy and the fact that vision therapy is not a clearly definable treatment modality is probably why there is such controversy in the area and also why most insurance companies do not pay for "vision therapy."

Before one considers vision therapy for a 6 year old you must ask if the child AND you have been good about the patching therapy.  A major reason why patching does not work in amblyopic children is because of noncompliance.  Also, ask your eye doctor what he/she thinks about vision therapy.  Also review the AAO and AOA Web sites about "vision therapy".  If you decide to do vision therapy watch out for the following warning signs:

Whatever you decide to do for your daughter remember that the success of accepted forms of therapy, including patching and penalization therapy (e.g., dilating eye drops in  the stronger eye), is dependant on age:  The younger the child the more plastic and adaptive the brain and the more rapid the improvement with appropriate therapy.  If you delay effective therapy for amblyopia the harder it will become to cure it and the greater the chance that she will have a permanent loss of vision in the lazy eye.  One must always be careful not to delay a proven treatment method by undertaking a less than proven method.

Q.    I am a 21 year old male and for the past week or so my eyes have been dilated even during the light of day.  I don't do drugs or alcohol but I do smoke cigarettes.  I'll probably go to see an eye doctor, but what do you think?

Dilated pupils is most commonly the result of legal or illegal drug use.   Any of a large number of drugs that you take by mouth or inhale or inject can have a side-effect of dilating the pupils.  We are not aware of any relation between cigarette smoking and dilated pupils.  A less likely possibility includes closed-angle glaucoma, in which the pupils are sometimes "fixed" in a mid position, say about 4-5mm.  If you have any pain or redness in one or both eyes you see an eye doctor immediately because if you have closed-angle glaucoma you could permanently loss your vision real fast.  Whatever the cause for your dilated pupils, we suggest an immediate eye exam - ASAP.

Q.    What is the difference between Choroideremia and Chorioretinitis - symptoms, causes,diagnosis, prognosis and treatments?

Choroideremia is a progressive retinal degeneration that males get from their mothers, who are the carriers of this X-linked disease.  The mothers who carry this gene may show mild signs of the disease.  Because Choroideremia is an X-linked disease, it will appear to skip generations and will affect 50% of the male off-spring of the carrier mother.  The signs of Choroideremia include poor night vision, visual field constriction and loss of visual acuity.  There are no known treatments for Choroideremia and the vision loss progresses to light perception by about 50 years of age.   Choroideremia is diagnosed based on the dilated eye exam, and special tests include the electroretinogram, electro-oculogram and fluorescein angiogram.

Chorioretinitis implies an inflammation of the choroid - that layer of cells between the sclera (white part of the eye) and neural retina that contains the photoreceptors.  Chorioretinitis may be caused by a number of factors including blunt trauma to the eye (Chorioretinitis sclopetaria), fungal infections (e.g., candidiasis), or due to a congenital infection such as Rubella.  Chorioretinitis sclopetaria may be due to a high velocity projectile, such as a BB, hitting the eye and causing internal bleeding and retinal tears.   Chorioretinitis may be due to a fungal infection or due to other types of infections the involve the whole body (systemic) such as viral or bacterial infections.  Vision loss will vary depending on the site of the inflammation in the eye and whether the inflammation includes the macula - the central reading part of the eye.  The presence of Chorioretinitis may be a sign or the result of immunosuppression, although the literature is divided on this point.  The treatment for Chorioretinitis depends on the cause and type of Chorioretinitis.   Vision loss, whether permanent or temporary, also depends on the type and cause of the chorioretinitis.  Chorioretinitis is usually diagnosed by a dilated comprehensive eye exam and medical history.  Special blood work and other tests may be required depending on the specifics of the case.

Q.    I see flashing lights in my right eye when I walk into a dark room.  What is this?

Q.    Occasionally I get flashes of light like lightening bolts...they subside after a while...what causes this?

You are probably having flashing lights in your right eye all the time but only "see" them when you go into a dark room.  In older persons, zigzag flashes of light in one eye that occur in darkness may be associated with vitreous tags.   These flashes of light have been named "Moore's lighting streaks."

Flashing lights also may be a sign of a serious eye problem, possibly involving the retina or optic nerve of the eye.   Retinal holes, tears and retinal detachments can cause a person to see flashing light(s).  Certain optic nerve diseases also can cause flashing lights.  If you see flashing lights, streaks of light or a bunch of little dots that are bright and moving through your field of vision you need to see an eye doctor for a complete dilated eye exam ASAP.  If the flashing lights are due to a retinal problem such as a retinal tear, it may be treatable if caught early.  If you wait to late you could have a permanent loss of vision in the affected eye.  Play it safe and see your eye doctor.

Q.    My son surfs the internet for 4 hrs/day.  Now he complains of eye problems.  What's the problem and can anything be done?

Q.    I would like to know it TV or computers will make my eyes bad?

Extended close viewing of a computer monitor (or TV) can cause eye strain and fatigue as reflected by neck and shoulder problems, headache, blurred vision, double vision, red or watery or dry eyes and pain around the eyes and face.  Extended close work can also cause a person to become more near-sighted (myopic), requiring the need for stronger corrective lenses.  Problems are usually two-fold; due to poor ergonomics and due to extended accommodation and convergence to a near object, in this case a computer screen.   Ergonomics can be improved by having the top of the monitor screen close to eye level - don't look down or up at the monitor, have the monitor straight-ahead.  The monitor should also be at arms length, or about 62cm (about 25 inches) from the face.  At 62 cm, the eyes are close to their resting (ideal) state of accommodation and convergence - minimizing both eye eye muscle strain as well as accommodative strain.  If you use glasses, the monitor should be positioned to minimize eye strain and your eye doctor may be able to tell you your ideal monitor viewing distance.  Avoid glare or light reflections of the screen - if this is not possible use a screen filter (neutral density filter or Polaroid filter or micromesh filter) to reduce glare.  Don't tilt the screen up - it will create more glare problems.   Take frequent rest breaks, say about 15 minutes per 45 minutes of work and, importantly, during the rest break try to look at objects in the distance - 20 ft or more.  Finally, have your eye doctor evaluate you/your son for corrective lenses that may be required for only near work.

Q.    Can a person have ocular histoplasmosis but have no symptoms of chronic or acute histoplasmosis, like lung problems?  Can ocular histoplasmosis be treated?

Q.    I've been working with the computer a lot for the past three years and now I have dark circles under my eyes.   What can I do about them?

Dark circles under the eyes or darker appearing skin under the eyes can be due to a number of factors.  The lack of adequate sleep will cause the eyes to appear swollen or puffy and darker than normal.  In women, hormonal changes can cause the skin under the eyes to darken.  As part of the aging process, small wrinkles under the eyes will also cause the appearance of dark skin under the eyes.  Finally, the skin under the eyes will appear dark because of shadow. 

What can you do about it?  See an Ophthalmologist that specializes in cosmetic surgery or reconstruction surgery for an opinion.  Although surgery is not typically an option, the Ophthalmologist will diagnose the problem.  If the skin is indeed darker than normal certain bleaching agents can be used to lighten the skin.   If the eyes appear darker because of wrinkling of the skin, certain laser surgery can be used to remove the wrinkles.  Certain cosmetics, even for men, can be used to cover-up the darker appearing skin.  Finally, be sure to get enough sleep and take regular rest breaks every hour when using the computer.

Q.    My cornea was scratched two months ago and it healed after a few days.  Since then, however, it has recurred several times, always in the late evening or early morning.  Can you give me more information?

Corneal abrasions, typically caused by fingernails or twigs, can cause pain, photophobia, reduced vision, watering of the eye and blepharospasm (twitching).   Corneal abrasions usually heal after a few days; however, some patients may experience recurrences for up to a year.  The patient often reports that he/she awakens in the morning with a painful eye that is difficult to open.  The problem is that the epithelium, the very front of the cornea, has been more or less rubbed-off (debrided) during the night.  Recurrent erosions of the epithelium may be due to dry eyes and this is why it recurs in the late evening and during the night.  To reduce the chance of recurrence of the corneal abrasion some eye doctors will suggest an eye ointment applied in the evening or before bedtime.  For more serious corneal abrasions, the excimer laser has also been used for treatment.  If you have a corneal abrasion it is very important to keep your eye doctor appointments to ensure that the wound heals properly.

Q.    After months of burning in my eyes and not being able to wear my contacts, a doctor finally told me that I have chronic bletharitis [blepharitis].  I know there isn't a cure but is there anything that can be done so that I can wear contacts again?

Blepharitis is a common condition that can be controlled but not cured.   Blepharitis is caused by several things including Staphylococcal infection and Seborrhea (excessive secretion of lipid from glands). Blepharitis may also be associated with dandruff, eczema, allergy, drugs and Acne rosacea.  Signs of Blepharitis include scales on the lashes, red swollen lids, burning and itchy eyes and discharge (e.g., serum-like or mucus like) from the eyes.

Staphylococcal blepharitis typically is an acute inflammation and occurs mostly in females.  It is also associated with Dry eye.  Seborrhea blepharitis is reflected by oily,greasy scales around the lashes and there may be excessive secretions or the glands may become plugged.

Treatment often includes the following:

Will you be able to wear contacts again?  That is a good question for your eye doctor.  Blepharitis waxes and wanes over the years and if you're able to control the outbreaks by following the above recommendations you may be able to wear contacts again.  Unfortunately, since blepharitis is associated with dry eye in some cases, be careful - blepharitis can lead to complications including corneal ulcers and conjunctivitis.  See an eye doctor for diagnosis and possible treatment.  Good luck

Q.    I am looking for information on photophobia with bilateral vision loss.  Any help?

Photophobia is defined as a severe aversion to light.  Photophobia would include problems with glare, including glare aversion and glare disability.  A normal person experiences photophobia when, for example, one exits a movie theater into bright sunlight.  The eyes hurt, you squint and cover your eyes until you get used-to the light.  A person with photophobia always experiences the pain and discomfort with bright lights but they never "adapt" to the light.

Photophobia is associated with certain retinal diseases that may be progressive or stationary.  Photophobia is also associated with a cataract, even before the cataract "ripens."  If the photophobia is associated with decreased vision, typically defined as decreased visual acuity, in a younger person then we're probably talking about a retinal disease that is either stationary or progressive.  If the photophobia is stationary; that is, has been steady and has not been getting worse, the patient may have albinism, Leber's congenital amaurosis or monochromatism (rod or blue cone).  These conditions are present from birth and can be distinguished with the electroretinogram (ERG).  In these patients, visual acuity is usually 20/200 or worse.  Visual acuity is more or less stationary in patients with albinism and monochromatism and gradually worsens in patient's with Leber's.

If the photophobia is associated with decreasing visual acuity and the patient does not have cataracts, then we're probably looking at a progressive retinal disease such as a cone dystrophy or cone-rod degeneration.  Patients with cone dystrophies have visual acuities that decrease over time and stabilize around 20/200 - legal blindness.   They also may have nystagmus (eyes move back-and-forth), color vision defects and retinal changes, depending on the stage and specific type of cone dystrophy.   Patients with cone-rod degenerations or dystrophies have visual acuities that decrease significantly, often worse than 20/200.  They may also show visual field losses and have poor night vision (late in the disease process).   Finally, some patients with macular degeneration, such as Stargardt's disease, may also have photophobia, decreased visual acuity in the range of 20/30 - 20/200 and a central scotoma or blind spot in central vision.  Most cone dystrophies and cone-rod degenerations start to appear before the age of 20 years or so.

Although the vast majority of retinal diseases have no treatment, photophobia can be reduced by the use of sunglasses or special light filters such as the Corning Photochromic filters (CPF 511, 527, 550).  Wearing a hat with a brim also decreases photophobia.  A person with a retinal disease should be assessed by a retinal specialist who can also perform or refer the patient for specialized testing (e.g., ERG, EOG) as well as for genetic counseling.

Q.    What is Delayed Visual Maturation?

Q.    What is Cortical Visual Impairment?

Q.    I've been wanting to tell someone about my experience with floaters in my eyes.  I was taking vitamins and eating a healthy diet, dried fruit and vegetables and fruit juices.  The skin on my feet started to crack, my skin became dry and I developed floaters in both eyes so bad that the nurse sent me to a specialist....I was consuming three to four times the recommended vitamin A.  I stopped taking vitamins.  It's taken two years and the floaters are gone.  I seriously believe the vitamin A was to blame.   I would like to see a study done on this, since so many drinks are adding vitamin A to fruit drinks our children are consuming.

Vitamin A is the active principle in carotene which has three types; alpha, beta and gamma.  Beta carotene is about twice as strong as alpha and gamma.   Vitamin A is essential in retinal function since the rod photoreceptors are made-up of vitamin A (retinene, retinal) and a protein substance called opsin.  A vitamin A deficiency can cause nightblindness and xerophthalmia (drying of the conjunctiva and cornea).  Deficiencies of vitamin A are rare, and usually occur as a result of malabsorption (due to intestinal surgery for Chrone's disease or Cystic fibrosis), liver disease (alcohol cirrhosis) or excessive intake of vitamins C or E.  Too much vitamin A, called hypervitaminosis A, causes symptoms similar to a brain tumor including increased intracranial pressure, blurred vision and swelling of the optic nerve (papilladema), headaches, dizziness, vomiting, diarrhea and a protruding of the front of the head.  Hypervitaminosis A occurs when daily intake exceeds about 50,000 IUs/day.    However, the dosage that causes hypervitaminosis A depends on body weight and may be substantially less if you're a female, child or are of small stature. 

Can hypervitaminosis A cause floaters?  We were unable to uncover any scientific evidence about such a link.  However, since hypervitaminosis A can cause papilledema it is possible that it could also cause excessive floaters.  Also, it is interesting that it took almost two years for the floaters to disappear.  Since vitamin A is stored in the liver in relatively large amounts, it can take years for excessive amounts of vitamin A to leave the body or, conversely, for a vitamin A deficiency to develop after absorption is reduced.  For example, in Crohn's disease large amounts of the intestines are removed and about 7 - 9 years later patients sometimes develop nightblindness due to vitamin A deficiency.  So the time frame of a few years for the elimination of excessive amounts of vitamin A to leave the body and for the floaters to disappear is the ball park.

Can hypervitaminosis A cause cracked feet?  The scientific literature is also moot on this point.  Vitamin A is essential for epithelial (skin) function so we would not eliminate the possibility that excessive amounts of vitamin A could cause epithelial dysfunction - including cracking feet and dry skin.  We do agree that more research is needed in the adverse consequences of excessive vitamin intake, particularly since Americans consume large amounts of vitamins.

Web site visitors, if you have any personal experiences with problems associated with supplemental vitamins please send us your comments and we'll tabulate the comments in a future Featured Article on the subject of supplemental vitamins and your vision.

Q.    I would like to know whether there is a cure for retinitis pigmentosa (RP).

There is no cure for RP.  There is a controversial treatment for RP, vitamin A palmitate therapy,  that may slow the progression of the disease.   However, there is much controversy over this treatment, which involves taking 15,000 IUs of vitamin A palmitate (a special form of vitamin A) per day.    Pregnant women or women that may become pregnant should NOT take vitamin A.   Treatments that have not been proven effective include panretinal laser photocoagulation, Encad, Ozone and "the Cuba cure."

Q.    What could cause half of my eye to [become] red?  No itchiness, soreness or irritation.

If you wear contacts you could have contact lens induced keratopathy, which may first involve the upper part of the eye.  If so, you need to stop wearing contacts immediately and see an eye doctor.  If left untreated or/and you continue to wear contacts you could permanently loss vision in the affected eye.  See an eye doctor.

Q.    I have painful, itchy, swollen eyes.  Also, probably unrelated, swollen, itchy feet.

The two are, in fact, possibly related and may be signs of an allergic reaction.  If you are taking medicine(s), ask your doctor if the medicine(s) can cause an allergic reaction.  Cosmetics, environmental irritants, dyes, certain foods, etc., can cause an allergic reaction as you described.  Whenever there is pain involved see your eye doctor ASAP.  Also see "Swollen eyes" in this section.

Q.    Is there anything you can do for a broken blood vessel in the eye?

Go to small red spots.  Also, if the broken blood vessel causes blood to accumulate in the front of the eye, between the cornea and pupil/iris, this condition is called a hyphema and warrants immediate medical attention.   If the broken blood vessel is inside the eye, for example related to diabetes (diabetic retinopathy) or to another retinal condition such as age-related macular degeneration, treatment may be available and immediate medical attention needed so see your eye doctor ASAP.

Q.    I have recently been through a divorce and haven't been able to eat or sleep for the past four months...  Now I am seeing tracers - trails after moving objects.  Have you ever heard of anybody seeing tracers before?  Do you think that this is a permanent condition or do you think that it may correct itself after I take better care of myself?  Any references or Web sites about tracers...?

So-called tracers are not discussed at any great length in the medical literature.  Tracers may be thought of as a series of afterimages to a moving object and, as a consequence, appear to trail the real image.  Certain prescribed drugs as well as hallucinogens (e.g., LSD), are known to cause visual disturbances including tracers.  The elderly and sometimes patients with psychiatric problems complain of afterimages interfering with their vision and peace of mind.  Given your physical and mental exhaustion, the tracers that you are experiencing may be more psychological than physiological.  Rest and recuperation may go a long way in alleviating the tracers.  Also, see your general practitioner or internist for his/her opinion.

Q.    My 3 year old son has recently had his right eye removed due to retinal detachment, the cause of this has been diagnosed as "Coats" disease.  I am seeking further information on this disease and any related effects, as he also has behavioral problems, poor coordination, obsessive tendencies and is very clumsy.  We are having difficulty finding any information and any help would be appreciated.

Coats' disease, either congenital retinal telangiectasia or Leber's military aneurysms, is a developmental abnormality of the retinal blood vessels and is associated with lipid (fat) deposits within and beneath the retina.  Although most common in preteenage boys, Coats' disease has been found in infants as young as four months and in adults in their 70s.  Coats' disease usually involves only one eye of otherwise healthy patients.  No hereditary pattern has been found and it does not appear to be in specific ethnic or racial lines.  Therefore, the cause of Coat's disease is not known.

Coats' disease is usually progressive and leads to lipid accumulation in or/and underneath the retina, the development of subretinal masses, retinal hemorrhages and detachment, neovascular glaucoma, cataract formation and uveitis.  Enucleation or removal of the eye may be indicated if there is pain associated with the glaucoma.   An early sign of Coats' disease may be the turning-in of the affected eye (esotropia), particularly in preverbal children.

Coats' disease is an ocular, usually monocular, problem.  As a consequence, other problems or conditions may not be directly associated with the Coats' disease, per se.  Nevertheless, the loss of one eye will cause a patient to be clumsy and have poor coordination because of the loss of binocular vision and loss of depth perception.  When a patient has one eye it is very important that the patient wear protective glasses with polycarbonate lenses to protect the remaining eye.

Psychological and behavioral problems are common in patients that have experienced a loss - in this case a loss of an eye.  Whole family psychological counseling may be necessary for THE WHOLE FAMILY to deal with the loss (as well as with the guilt).  Children are very adaptive; however, the affected child will react to how his/her parent(s) and sibs handle the loss.  If the parents and sibs avoid the issue or are repulsed by the sight of the child, particularly before a prosthesis (artificial eye) is fitted, the child will have a difficult time with adjustment.   Also, lack of knowledge about Coats' disease may cause parents to attribute other problems to the disease or for the parents to become too analytical and attribute normal childhood behaviors as pathological and associated with the disease.

Q.    One of my wife's eyes is swollen, and pulling down the eyelid revealed a small clear cylindrical substance inside the lid.  Using a cotton swab, I removed it carefully and some bleeding is also present.  I have done this twice, and she has rinsed her eye, but the substance returns.  What could it be?

DO NOT MESS WITH YOUR WIFE'S EYES.  She should be seen by an eye doctor for the problem ASAP, particularly since bleeding is involved.  See the previous question about swollen eyes.  A swollen eye may be a sign of an allergic reaction, typically to cosmetics, a reaction to a foreign body or a sign of a more serious problem.   The substance inside the lid may be drainage and an attempt by the eye to decrease the irritant.  Don't mess with it - you c