AMBLYOPIA - In some children, sight does not develop properly in one eye even though that eye is structurally normal. This condition is called “amblyopia” or “lazy eye”. Amblyopia is not uncomfortable, so the child doesn’t know he has decreased vision. It is usually picked up at a vision screening exam at the doctor’s office or at school.

Because their eyes are not sending one image to the brain, but two, the eye will subconsciously ignore the one image and eventually that eye will lose its ability to see clearly. Amblyopia can be caused by misalignment of the eye, or strabismus, as one eye looks straight ahead while another turns in or out, up or down.

The other main cause of ambloyopia is anisometropia – which means the eyes have two very different optical powers. You will not know is your child has a truly “lazy eye” until he has had an eye examination.

Treatment must begin right away. If the lazy eye’s cause is an optical one – it will be treated with prescription eye glasses. If the eyes are misaligned, surgery may be necessary to straighten them. Patching the “good eye” is almost always a way to improve vision. This method forces the lazy eye to work.

Early identification is very important. After age 8, the poor vision in the amblyopic eye will remain for life.

Dr. Craig treats amblyopia and both doctors manage these children with non-surgical intervention. If there is an associated crossed eye, surgery many be necessary. (back to top)

BLEPHARITIS - is also called “granulated eyelids” because of the granular appearance at the base of the eyelashes. It is an inflammation of the skin in the lash line. Small crusts form on the lids and lashes. Sometimes, the lids itch, causing the patient to rub them. All this inflammation turns the lids red, and makes your eyes look as though you’ve been crying.

It is a chronic condition that will never totally go away or be “cured”. But it can be brought under control, with a little time and effort.

Seborrheic blepharitis is sometimes associated with dandruff, a common condition of the scalp. Treatment may involve antibiotic eyedrops, ointments or pills. “Lid scrubs” are sometimes used, using either mild soaps or antibiotic ointments. Associated seborrhea of the scalp may require special shampoo.

Discontinue mascara or eyeliner during the active treatment phase. Replace any makeup that may be contaminated.

Remember--- blepharitis is a chronic condition, which requires time and effort to keep it under control.(back to top)

COMPUTERS AND YOUR EYES - If you work for hours at a time at a computer, you may experience symptoms such as eye strain, red, watery or itchy eyes, difficulty in focusing, blurry vision, headaches, back aches, neck aches, etc.

While the computer monitor can cause all of the above, you do not have to worry about radiation. Scientists have concluded that a screen emits less radiation than ordinary fluorescent lighting. Your symptoms are real, however, and should be addressed under the following:

Clarity - work with large type
Adjust the brightness and contrast to make type clearer
Change to a different type face (font)
Consider a new monitor- check the computer store and identify one you can easily read from

Lighting – position lights to minimize glare and reflections
Consider anti-reflective coating on your next pair of eyeglasses
Turn the monitor slightly to avoid reflection into your eyes

Rest – Take 15 minute breaks every 2 hours
Make an effort to blink your eyes and use lubricating drops
Occasionally rest your eyes by looking away, or closing them

Seating – Use a good chair and feet should rest comfortable on the floor

Height of monitor – use a table that is lower than your desk

Eyeglasses – This can be a major source of discomfort. Regularly positioned bifocals are too low, and the bifocal power may need to be adjusted because your screen is further away than your keyboard or reading material. Dr. Craig is sensitive to your needs and will prescribe computer eyewear to help you. This is the single, biggest improvement that can be made. Working at a computer should not be uncomfortable, or, at a minimum, discomfort should be minimized.(back to top)

CONJUNCTIVITIS - In this disease, the thin transparent membrane covering the eye becomes red. Another term is “pink eye”. It is very common, and can be caused by a viral or bacterial infection or by irritation from allergy, air pollution, smoke, or minor trauma from contact lenses. When the conjunctiva is irritated, the tiny blood vessels swell from increased blood flow, and make the transparent membrane visible against the white background of the eye.

“Is it contagious?” Maybe. If it is caused by infection, yes, but allergy or irritant, no. Just in case, wash your hands after touching the eye or lids.

If there is a pus-like discharge, or a crusty mattering of the eyelids, you may have to have an antibiotic eye drop or ointment prescribed.

Do not ignore a persistently red eye that will not go away. If symptoms last for more than 48 hours, or if your eye is painful, call immediately for an emergency appointment. Pink eye can be a disguise for more serious problems, such as a foreign body, iritis or other serious eye problems.(back to top)

DIABETIC RETINOPATHY - Diabetic retinopathy is an eye condition that affects the retina in some patients who have had diabetes for several years. The retina, which is the light-sensitive nerve tissue that lines the back of the eye, is vital for vision. Approximately 25% of diabetics have some form of this complication.

THERE ARE NO EARLY WARNING SIGNS. IF YOU HAVE DIABETES, YOU NEED TO HAVE A COMPLETE EYE EXAM AT LEAST ONCE A YEAR!

The retinal blood vessels gradually enlarge and begin to leak fluid, or become obstructed. Some patients develop “proliferative” retinopathy, when new abnormal blood vessels begin to grow over the surface of the retina and optic nerve. These new vessels are fragile, and can bleed and form scar tissue. This scarring can undergo “scar contracture”, resulting in retinal tears and detachment.

Dr. Robert Butner, our retina specialist, is skilled in diagnosing and treating this disease. Our on-site laser may be used to treat severe cases. Diabetic retinopathy is one of the major caused of blindness in our country, and can be prevented in many cases by early diagnosis and treatment. (back to top)

Link: www.nei-nih-gov/health/diabetic/retinopathy.asp

DRY EYE - “Dry Eye Syndrome” is a condition in which there is not enough moisture in the eyes. It is more common in women and in the middle-aged and the elderly. If you do not produce enough tears, or your eyelids do not close well, this condition can occur. It may be associated with other medical conditions such as arthritis or Sjogren’s syndrome, in which the mouth and nose membranes also lack moisture. The dryness usually leads to a constant burning or foreign body sensation, and your eyes may look red and blood shot.

Many patients complain of “watering” or “tearing” and are surprised to learn that this problem is really dryness. As the moisture decreases, the mucous increases and makes the eye feel blurred and watery.

The diagnosis of dry eye is confirmed by a Schirmer Test, in which a narrow strip of paper is placed in the corner of each eye for a few minutes and then the moisture is measured. Usually, artificial tear drops are prescribed to add sufficient moisture to your eyes. There is no permanent cure, but other treatments may be prescribed in severe cases. (back to top)

DYSLEXIA - The ability to read, something that most of us take for granted, is really a very complex skill. A child needs to have a certain level of brain “readiness” (maturation) in order to coordinate all the visual and perceptual tasks that reading requires.

Some children simply need more time than average to learn to read; others never seem to get the hang of it. Children with dyslexia, however, are not merely slow readers; they have a specific type of reading disability. Even when they see letters and words clearly, their brain is not able to “process” them in a way that permits reading. The problem may exist alone, or it may be part of a general learning disability.

About 1 out of every 10 children is affected to some degree, though not every child has exactly the same perceptual stumbling block. Some transpose letters (T-A-C for C-A-T). Others see letters in the correct order but their brain does not connect them into words, or they have difficulty connecting words into meaningful sentences.

Dyslexia is not related to intelligence. The fact is, most dyslexics have normal or above- normal intelligence and can understand material when it is read to them.

What Causes Dyslexia? - The interchanging of letters (and numbers) or inability to process them into words and sentences is thought to be associated with a “miswiring” of certain connections within the brain. The problem tends to run in families, so it probably has a genetic basis, though some cases may be related to mild brain damage, such as from a difficult birth or a viral infection. Some dyslexic youngsters merely have delayed maturation and may outgrow the problem.

The diagnosis of dyslexia cannot be made by examining the eyes. Because of the normal association between reading and eyesight, many people tend to assume that dyslexia is caused by or related to an eye problem. A need for glasses or the presence of poor eye alignment or focusing might slow reading somewhat, but these common eye disorders do not cause the severe types of reading difficulties that dyslexic children have.

Diagnosis and Treatment - Many dyslexic children have a short attention span, are hyperactive and fidget a lot, but that does not mean that these signs are reliable indicators of dyslexia. The diagnosis is best made by a team of experienced professionals (which may include a pediatric neurologist and a reading educator), who test for the specific type of reading difficulty and can then tailor educational methods to fit that particular problem.

With good teaching, most dyslexic children can be taught to read, though they are not likely to ever become “good” readers. The methods used will generally be different from those used to teach reading to other children. For example, children who cannot build words out of letter combinations by seeing them may learn to read by touching letters cut out of sandpaper. They can also develop other learning skills to take the place of reading.

The Future - Children who do poorly in school tend to have low self-esteem, resulting in misbehavior and/or emotional problems. Parents must stay aware of the need to build up their child’s ego and provide continuous emotional support. If you can help your child feel successful outside of school – perhaps in music, art or sports – he or she may gain the confidence to set goals and work toward achieving them.

In spite of handicaps, some dyslexics have become artists, musicians, scientists and mathematicians, and some have been able to enter professional and technical careers. With desire and hard work, dyslexics can be very successful! (back to top)

GLAUCOMA  - is the term given to the set of eye diseases in which the intraocular pressure within the eyeball may be increased and progressive damage to the optic nerve results. The optic nerve is like a main telephone trunk, transmitting images from the retina of the eye to the brain. As glaucoma slowly damages the optic nerve, blind areas develop that can progress to loss of vision or even total blindness, usually painlessly. That is why we call it “The Sneak Thief of Sight”.

Ninety percent of patients with glaucoma have the open angle or chronic type. It usually affects both eyes, often one before the other and in mid or late life. It may be hereditary, is not contagious, and is not related to cancer. High pressure in the eyes is not the same as high blood pressure.

As part of your routine eye exam, Dr. Craig will do a painless test called tonometry to measure your eye pressure. Elevated pressure is one sign of glaucoma, but other tests to confirm this diagnosis may be needed. A visual field to measure your side vision and examination of the retina and optic nerves is an integral part of your exam. Appointments with Dr. Craig every few months will follow, so that he can monitor your condition, in order to prevent progression of the disease. Eye drops to lower pressure can be prescribed and, in some cases, laser surgery or filtering surgery may be required. For more detailed information on glaucoma diagnosis and treatment go to: www.allaboutvison.com/conditions/glaucoma.html
www.eyesurgeryeducation.com/glaucoma-detection.html
(back to top)

HYPEROPIA

• Most farsighted (hyperopic) people can see clearly at a distance, but not up close
• Hyperopia results when the eyeball is too short or the cornea too steep
• It is not affected by diet, vitamins or eye exercises
• Children who are very farsighted may have a poor attention span and their focusing mechanism has to work extra hard
• That effort may spill over into the eye muscles, causing the eyes to “cross”
• The extra optical power the eye needs to see objects in the distance and up close can be provide by accommodation
• If there is enough accommodation, the eyes will automatically “correct” for farsightedness
• If symptoms occur and the child’s eyes cross, eyeglasses will certainly be required to keep the eyes aligned and to prevent “lazy eye” (amblyopia) from developing
• Children should be checked every year ( or more often if directed) to make sure “lazy eye” is not developing
• Adults should be checked every 2-3 years
• Refractive surgery is another option to reduce dependence on contacts or eyeglasses
• LASIK or PRK procedures may be appropriate for adults, but should not be done on a person under age 21 as his or her eyes are still growing (back to top)

IRITIS - The iris is the colored part of the eye whose job is to change the size of the pupil by contracting or relaxing muscles that lie within it.

Iritis is an inflammation of the iris and is a serious condition. Sometimes, the eye looks bloodshot, or there is aching in the eye or brow. Vision may be blurred. The eye may be very sensitive to light.

There are many causes, but it usually is not due to an infection. It is not contagious and is not related to conjunctivitis, (pink eye). If not treated promptly, the fluid flow within the eye is blocked, and this can lead to secondary glaucoma, cataract, retinal swelling or internal eye damage. Eye drops, including steroids, anti-inflammatory agents, and dilating drops that blur your vision, may be prescribed. In severe cases, steroid injections may be necessary. Iritis may resolve completely after treatment, or it may recur again, years later. It can last six to eight weeks. Self-treatment is not wise. Please call Craig Eye Associates for an appointment immediately. (back to top)

MYOPIA

• when you are nearsighted (myopic) your vision is clear for objects close to your eyes, but blurred for everything in the distance
• approximately 40% of the population will develop myopia at some time in their lives
• this is not a disease. In fact, most myopes have perfectly healthy eyes. Their only symptom is blurred vision for distance objects
• the myopic eye is oblong – too long for its optical power which is often hereditary
• it is not caused by using your eyes “too much”
• myopia that appears ordinarily in middle or old age may be the start of a cataract
• in uncontrolled diabetes, myopia may occur suddenly and change erratically from day to day

Fortunately, eyeglasses or contact lenses are a simple, effective way to provide clear vision. Our Optical Department fits both glasses and contact lenses. LASIK or PRK surgery for adults to re-shape the cornea using an excimer laser is a modern way to reduce your dependence on eyeglasses. Dr. Craig performs this out-patient procedure in Dallas at U.T. Southwestern medical campus. (back to top)

PRESBYOPIA - is a loss in focusing ability that comes with getting older and everyone will experience it eventually. Usually it affects people between the ages of 40-50, when they become aware that the telephone directory or newspaper type is too small to read – and they must hold it out further. Soon your arms become “too short” and you can no longer read comfortably. Presbyopia occurs as a natural aging process. The eye’s natural lens is soft and pliable when you are young and can change shape easily, moving from near to far focus. With increasing age, the lens gradually loses its flexibility, and focusing at near becomes more difficult. When this time comes, you will need optical help and need to have your lenses changed very few years. Then between ages 65-70, the focusing power stabilizes and your prescription for reading will stay the same. Dr. Craig can fit you with a reading prescription in eyeglasses or contact lenses. Either bifocal contacts or mono-vision contact lens fitting (one eye is distance power – the other near power) works well for many people. (back to top)

PTERYGIUM - A pterygium is a small, triangle-shaped pinkish growth over the membrane covering the eye, the cornea. It is not cancerous, nor a cataract. It usually does not interfere with vision unless it begins to cover the pupil, but it can cause astigmatism. Pterygium are most common in sunny climates, with people exposed to a lot of sun, wind or dust, and are three times more common in men than in women.

Surgery is the only way to remove a pterygium, but isn’t recommended unless it impairs your vision. It has a high recurrence rate. (back to top)

PTOSIS - This is an upper eyelid that droops. A lid may droop so much that it partially blocks your vision, and your eyes can tire, trying to open the lids wider. Ptosis often is part of the natural aging process, when the tissue supporting the lid thins and loosens, causing a droop.

Surgery is necessary only if you are concerned by appearance, or if vision is blocked. It is an out-patient procedure, performed under local anesthesia. Most patients are delighted with their improved appearance and unobstructed vision! If ptosis obscures your vision, insurance may pay all or part of the cost. (back to top)

SPORTS EYE INJURIES - These injuries are almost always preventable. If you play racquetball, baseball, squash, or tennis, you are risking serious eye injury from a ball which can travel at speeds up to 145 miles per hour. It can happen to expert as well as novice players. Ordinary glasses offer a little protection, but not enough. Your best choice is polycarbonate lenses and frames, with solid side-pieces or shields. These are also available in lenses with no prescription for athletes who don’t normally wear glasses. We carry sports glasses with or without prescription in our Optical department.

Remember: Prevention is the best treatment of eye injuries. (back to top)

STRABISMUS - is a broad medical term that refers to various misalignments of the eye, such as “crossed eyes”. For two eyes to be properly aligned each needs to have good vision and focusing ability and the two eyes need to “track” together. Only then can a person have binocular vision and depth perception. This means that the image from each eye is blended into a single image that appears three dimensional. If one eye does not look in the same direction as the other, the misaligned eye can eventually lose the ability to see clearly. This is called ambloyopia or “lazy eye”, and usually develops before age 6-8 years.

Strabismus affects 2-4% of all boys and girls, and tends to run in families. There are no identifiable causes – the child is simply born with a misalignment and develops it in early childhood. Intentionally crossing the eyes does not cause strabismus; the eyes cannot get “stuck” in a crossed position.

The eyes should be examined as soon as you suspect that they might be crossing or wandering, no matter how small the misalignment. The sooner treatment is begun, the better your child’s chances to achieve normal vision in each eye. Correction after age 6 or 7 is more difficult, as amblyopia many have begun. Every child should have a pre-school eye screening to diagnose possible problems that could affect learning.

Dr. Craig works with children with strabismus. Treatment may consist of eyeglasses, patching and/or surgery on the eye muscles. (back to top)

TEARING AND YOUR BABY - Babies do not begin producing tears until they are 3 weeks old. The tears, which are necessary to lubricate the eye, flow through a series of drainage channels that carry the fluid into the nose. A baby who has noticeable watering of the eyes, with tears flowing onto the cheeks, probably has a blockage in the drainage system. This is a common occurrence in one out of three babies. Usually it corrects itself completely.

If the eyelashes have crust or pus on them, especially in the morning, there may be an infection which happens when the tears back up. The eye and lids may become red and swollen. If this occurs, an appointment should be made with an eye physician, who can show you how to gently massage the tear sack. Along with antibiotics, massage can sometimes promote spontaneous clearing of the obstruction.

In a few cases, if the tearing does not improve, the physician will use a thin metallic instrument that is slipped into the duct. This is done under anesthesia so that the baby is kept from moving while the delicate channels near the eye are being probed. This is a same day surgery procedure. Dr. Craig has successfully performed tear duct probing on infants.

Fortunately, tearing problems are usually managed simply and successfully. Occasionally, more complex surgery is required to relieve the obstruction. (back to top)