External Eye Diseases

Dr. Burke is one of Cincinnati’s most trusted resources concerning Ptosis.

What is a droopy eyelid or ptosis?

A droopy eyelid or ptosis can be present at birth (congenital) or occur later in life (acquired). Poor development of the levator palpebris muscle in the upper eyelid with resulting abnormal function is the most common cause of congenital ptosis. Acquired ptosis has many causes. Ptosis can involve one or both upper eyelids, with or without asymmetry.

What problems can occur as a result of childhood ptosis?

One or more of the following vision problems may accompany ptosis in childhood: astigmatism (refractive error), obstruction of the visual axis, chin up head position, and amblyopia. The abnormal resting position of the eyelid on the cornea may result in astigmatism or other refractive error and is a risk factor to develop amblyopia. Another risk factor for amblyopia is an eyelid so droopy that it actually blocks vision into the eye. Also, a chin up head position to see below the droopy eyelid may be noted. Contraction of the frontalis muscle (in the forehead) to help elevate the eyelid is a very common compensatory mechanism.

What causes acquired ptosis?

Acquired ptosis can be caused by neurological conditions that affect the nerves and/or muscles of the eye. These include myasthenia gravis, progressive external ophthalmoplegia, Horner syndrome and third nerve paralysis. The ptosis may be combined with an eye movement disorder/ double vision. An eyelid mass can also cause ptosis.

How is ptosis treated?

When amblyopia is present, appropriate treatment is initiated. When potential amblyopia causing astigmatism is present, glasses are often prescribed. Early surgery is usually indicated for a droopy eyelid that blocks vision (which may cause delayed vision development) or causes a chin up head position (which may cause neck problems and/or delay of developmental skills). Children are usually observed serially to monitor for visual problems. During preschool years surgery may be indicated if facial maturation has not sufficiently improved the ptosis.

More technical information can be found on the EyeWiki Site

Dr. Burke is one of Cincinnati’s most trusted resources concerning corneal abrasions in children.

What is the cornea?

The cornea is the clear front window of the eye. It covers the colored portion of the eye, much like the watch crystal covers the face of a watch. The cornea is composed of five layers. The outermost layer of the cornea is called the EPITHELIUM.

What is a corneal abrasion?

A corneal abrasion is an injury – a scratch or cut – to the corneal EPITHELIUM. This injury exposes many of the nerve fibers making corneal abrasions a very painful experience.

How will the cornea heal?

The corneal surface usually heals within a day or two at the most. Until the corneal epithelium heals, the eye may be very uncomfortable, may tear a lot, is usually light sensitive, and there is often a feeling that there is something in the eye – “foreign body sensation.”

How are corneal abrasions treated?

The most common method of treatment is to PATCH the scratched eye. This prevents the eye from blinking and keeps the hands away (i.e., NO RUBBING). For smaller abrasions or when a patch cannot be used for whatever reason, repeated applications of an ointment to the eye helps heal and soothe the eye by forming a barrier between the eyelid and the corneal abrasion. For the pain, use your preferred over-the-counter pain relief medication. If that is not sufficient, ask your ophthalmologist to prescribe something stronger.

How long till the cornea is all better?

Even though the surface layer usually heals within a day or two, deep and total healing may take more than 7 to 10 days. During this time the eye may still be slightly light sensitive and sensitive to the wind and the dust. Hard eye rubbing may also slow healing or even cause the abrasion to recur. Preventive eye medications and additional lubrication for several days after the patch has been removed is highly recommended.

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Dr. Burke is one of Cincinnati’s most trusted resources concerning blepharitis.

What is Blepharitis?

Blepharitis is a common and persistent inflammation of the eyelids. The chief symptoms of blepharitis are irritation, burning, and itching of the lid margins. The eyelid margins may be red, scaly, and sometimes swollen. Many scales of greasy granulations can be seen clinging to the base of the eyelashes and accumulating on the skin edge of the lid margins of both the lower and upper lids. Occasionally, more serious cases cause the eye to be red and induce inflammation of the cornea (clear “window” of the eye). Corneal inflammation, or keratitis, may cause additional symptoms of tearing, light sensitivity, and foreign body sensation. Blepharitis is often linked to the development of styes and chalazia.

Who gets Blepharitis?

This condition frequently occurs in people who have a tendency towards oily skin, seborrheic dermatitis, or dandruff. Blepharitis can begin at any age. One especially common time is pre-puberty and adolescence when hormones and oil glands are very active. Blepharitis often runs in families.

Why does Blepharitis happen?

The two most common reasons for the development of blepharitis are an over-growth of bacteria on the skin at the base of the eyelashes or over-activity of the eyelids’ oil glands — or a combination of both of them. Bacteria reside on the surface of everyone’s skin, but in certain susceptible individuals they thrive in the skin at the base of the eyelashes. The resulting infection, often associated with over-activity of the nearby oil glands of the eyelid, causes dandruff-like scales and crusty-like debris to form along the eyelashes and eyelid margins.

How is Blepharitis treated?

Eyelid hygiene is essential to the treatment of blepharitis. Follow these steps:

STEP 1. Wetting the eyelid margins and eyelashes. This will soften and loosen scales and debris. More importantly, it helps liquefy the oily secretions from the eyelid’s oil glands that help prevent the development of a chalazion or stye.

  • At the sink, wet a washcloth with very warm water, wring it out, and place over the closed eyelid for one minute. Repeat 2 or 3 times for a few minutes.
  • In the shower or bathtub, allow the warm water to run continuously over the face and closed eyelids for a one minutes.

STEP 2. Cleaning the lid margins. This will help remove the debris thus returning the eyelid to a healthier balance between the skin bacteria and oil glands.

  • Place a small amount of baby (tear free) shampoo in the palm of your hand. Mix with a small amount of water. Rub the hands together to form lots of suds. OcuSOFT Lid Scrub is an excellent prepared product in the eye-care section of most pharmacies.
  • Scrub the base of the eyelids and eyelashes with the suds softly and carefully in a side-to-side motion (not up and down) for about 30 seconds.
  • Rinse the eyelids and lashes with warm tap water.

What may be used in severe cases?

In those cases that are not managed by steps one and two above or where the blepharitis is not discovered early and the infection has progressed, the use of antibiotics is often necessary. In these cases, the additional step is added:

STEP 3. Antibiotics for infection.

  • Perform steps 1 and 2 above.
  • Antibiotic ointment medication, often mixed with a mild steroid to decrease inflammation, is gently massaged onto the lid margins and the base of the eyelashes with the tip of the finger.
  • For serious infections not responsive to ointment or for those individuals whose blepharitis is linked to recurrent chalazia, oral antibiotics may also be required for short or long-term prophylactic use.

Can blepharitis be cured?

For those susceptible to blepharitis, the condition tends to be a chronic condition that cannot be cured. However, blepharitis can usually be controlled through proper eyelid hygiene utilizing the routine use of the cleansing steps 1 and 2 listed above.

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Dr. Burke is one of Cincinnati’s most trusted resources concerning Tear Duct Obstruction.

What is a tear duct obstruction?

There is a drainage system to clear moisture from the eye. The final drain pathway is a tube, called the tear duct, that drains into the nose where the tears flow down onto the back part of the tongue and are eventually swallowed. The most common reason for overflow of tears and discharged in infants is a tear duct obstruction.

What are the symptoms of a tear duct obstruction?

The presenting signs of a tear duct obstruction are tearing and mattering without conjunctivitis or red eye. The over abundance and spontaneous overflow of tears is a common problem in infant’s occurring in up to 25%. The signs of excessive tearing and discharge may be present within the first few weeks of life. In other cases, overflow tearing may not be obvious for 3-4 months.

What happens to tear duct obstructions in infant?

The most common cause of excessive tearing in an infant is a tear duct obstruction. A great many infants, more than 90%, will show spontaneous resolution of the tear duct obstruction by 6-9 months of age. Thereafter, the likelihood of clearing without surgical intervention is very low. Therefore, there is very little benefit in delaying the surgical treatment past 9 months of age.

How is a tear duct obstruction surgically treated?

A probing and irrigation procedure is recommended as the initial surgery to treat chronic tear duct obstruction that persists after 9 months of age. To be performed accurately and safely, this brief, outpatient procedure requires the use of general anesthesia. The success rate – the elimination of tearing and mucus in the eye – following the probing and irrigation procedure for tear duct obstruction is about 80% when performed before 14 months of age. For those children who failed a probing and irrigation or are treated at after 15 months of age, there are alternative treatments available including balloon dacryoplasty and the temporary insertion of a tube or stent.

Is all tearing a tear duct obstruction?

Not all tearing in infants is a tear duct obstruction. There are other serious causes of tearing. Infantile glaucoma and corneal problems (such as a scratch or foreign body) may also cause tearing. The symptoms of these problems include tearing, excessive light sensitivity, squinting or blinking, pain, and, in the case of infantile glaucoma, haziness or clouding of the cornea and increased corneal size.

Should I be worried about a tear duct obstruction?

Congenital tear duct obstruction is a very common problem in pediatric ophthalmology. Diagnosis of tear duct obstruction can be made by history and by complete ophthalmologic evaluation to separate this common problem from potentially more serious disorders. Tearing and discharge problems that persist after 9 months require pediatric ophthalmologic surgical intervention. Probing and irrigation is an extremely safe and effective method of treatment.

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What is a Chalazion?

A chalazion refers to the bump or mass in the eyelid caused by the inflammatory swelling surrounding an oil-producing gland in the eyelid called the meibomian gland. The swelling is ususally away from the edge of the eyelid. These are not serious and many will respond well to home treatment. We are not sure why most chalazia (plural of chalazion) occur. However, those individuals with chronic blepharitis are predisposed to the development of chalazia.

What is a Stye?

A stye, or hordeolum, is a very small, but often painful, inflammatory swelling caused by an infection at the edge of the eyelid involving the eyelash follicles and the surrounding tissue.

What causes a chalazion?

The tiny tube, or orifice, draining the meibomian gland becomes obstructed preventing the natural outlet for the secretion of the oil. The gland’s oil continues to accumulate causing the gland to enlarge. If the obstruction persists, the tissue may rupture into the lid causing inflammation, more lid swelling, and sometimes discomfort. In an attempt to limit the spread of the inflammation, a membraneous wall or capsule will surround the inflamed gland. Sometimes the swelling may point anteriorly toward the skin or posteriorly into the subconjuntival space. Either may allow for spontaneous drainage. However, if absorbtion or drainage does not occur, the inflamation will eventually resolve but leaves a painless, hard lump visible in the lid. Antibiotics are not often indicated as the cause of a chalzion is not an infection.

What causes a stye?

Although a stye may develop without any apparent predisposing factor, eyelid margin inflammation associated with blepharitis, accumulation of excessive discharge caused by conjunctivitis, or poor eyelid hygiene associated with frequent eye rubbing are common causes of a stye.

How is a chalazion treated?

As soon as one suspects that a chalazion may be starting, warm compresses or warmed water balloon should be applied. Heat the compress or balloon till warm but not hot. Re-heat as necessary to maintain warmth. The purpose of the moist warmth is to liquefy the thickened oil in the gland in hopes of encouraging drainage and absorption. Apply directly to the involved area. It is best done in short 2 to 5 minutes applications used as often as possible the first few days and then 4 times a day to complete a full week.

How is a stye treated?

As soon as one suspects that a stye may be starting, warm compresses or warmed water balloon should be applied. Heat the compress or balloon till warm but not hot. Re-heat as necessary to maintain warmth. Apply directly to the involved area. It is best done in short 2 to 5 minutes applications used as often as possible the first few days and then 4 times a day till resolved. Topical ophthalmic antibiotics may be helpful. Treat the discomfort using your desired over-the-counter analgesic. Most styes resolve in about a week.

What is a chalazion does not go away?

If the chalazion does not resolve after the first month, it is unlikely to improve further. It is at this time that surgical drainage is recommended. This is a short procedure done in the operating room under anesthesia.

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