Cornea

Corneal Transplant

When a patient has reduced vision due to corneal disease or injury, they can be placed on a corneal transplant list. When you are placed on a transplant list, you must wait until the eye bank notifies our office that there is a suitable donor cornea available. Once the eye bank notifies our office, you must have the transplant within a short period of time. When you are placed on the list you must leave phone numbers with our office so that we can reach you at all times. If you are leaving to go out of town please, notify our office.

There are several different diseases that can cause serious damage to your cornea:

1. Corneal Dystrophy may develop later in life and results in cloudiness of the cornea, which reduces vision.
2. Bullous keratopathy is a degenerative process characterized by small blister-like pockets that form in the swollen corneal epithelial layer.
3. Keratoconus is a hereditary degenerative corneal disease characterized by generalized thinning and cone-shaped protrusion of the central cornea. It usually affects vision in both eyes, although it may be a symmetric.
4. A sever corneal ulcer can cause the need for a transplant. A corneal ulcer is caused by bacterial, fungal or viral infection.
5. Injuries to your cornea may cause corneal scarring. If the scar is sever enough to decrease your vision you may need a transplant.

Dry Eye Syndrome

Dry Eye Syndrome is due to deficient tear production, it is usually age related. When your eye is dry, it can be painful. The doctor will have you try artificial tears first. If it is found that the tears are not helping, the doctor can insert punctal plugs. The plug is plastic material inserted into the punctum to prevent tear drainage to preserve the tears and moisten the cornea and conjunctiva. This is a painless procedure done in the office.

Pterygium and Pinguecula

A pterygium is fleshy tissue that grows over the cornea (the clear front window of the eye). It may remain small or may grow large enough to interfere with vision. A pterygium most commonly occurs on the inner corner of the eye, but can appear on the outer corner as well. The exact cause is not well understood. Pterygium occurs more often in people who spend a great deal of time outdoors, especially in sunny climates. Long-term exposure to sunlight, especially ultraviolet (UV) rays, and chronic eye irritation from dry, dusty conditions seem to play an important causal role. A dry eye may contribute to pterygium.

When a pterygium becomes red and irritated, eyedrops or ointments may be used to help reduce the inflammation. If the pterygium is large enough to threaten sight or grows rapidly, it can be removed surgically.

Despite proper surgical removal, the pterygium may return, particularly in young people. Protecting the eyes from excessive ultraviolet light with proper sunglasses and avoiding dry, dusty conditions and use of artificial tears may also help.

A pinguecula is a yellowish patch or bump on the white of the eye, most often on the side closest to the nose. It is not a tumor, but an alteration of normal tissue resulting in a deposit of protein and fat. Unlike a pterygium, a pinguecula does not actually grow onto the cornea. A pinguecula may also be a response to chronic eye irritation or sunlight.

No treatment is necessary unless it becomes inflamed. A pinguecula does not grow onto the cornea or threaten sight. If particularly annoying, a pinguecula may on rare occasions be surgically removed, but the postoperative scar may be as cosmetically objectionable as the pinguecula.

Lacrimal Drainage Surgery (DCR: Dacryocystorhinostomy)

Keeping the eyes moist and healthy requires tears. Tears are produced in the lacrimal gland, located under the upper eyelid. Tears drain from the eye into the nose through the nasolacrimal duct, or tear duct. A blockage of this drainage duct can cause wet eyes or excessive tearing. A blocked tear duct can also cause mucus buildup in the eye or ongoing infections in the lacrimal sac where tears collect. Infections are noticeable as a swelling of the inner corner of the lower eyelid.

Nasolacrimal duct obstructions can happen with no obvious cause. Sometimes previous sinus or nose surgery, or facial trauma with broken facial bones, can obstruct the tear duct.

Lacrimal drainage surgery is called dacryocystorhinostomy (DCR) and can be performed in different ways. One type of operation is an external DCR where an incision is made on the side of the nose, where eyeglasses might rest. A small amount of bone is removed to permit a new connection between the lacrimal sac and the inside of the nose. Small plastic tubes are inserted at the time of surgery to keep the newly created opening from scarring shut during the healing process. The tubing is removed a few months after surgery.

Another type of operation uses a special instrument called an endoscope. The endoscope is a small tube with a fiberoptic light that facilitates the creation of a new opening into the nose. Various types of laser have also been used to perform the DCR operation.

In extreme cases where the tear duct cannot be reopened or repaired, an artificial tear duct can be implanted. The artificial tear duct is called a Jones tube and is implanted behind the inner corner of the eyelid to drain tears into the nose.

Strabismus (Eye Muscle Surgery)

Strabismus refers to misaligned eyes. If the eyes turn inward (crossed), it is called esotropia. If the eyes turn outward (wall-eyed), it is called exotropia. Or, one eye can be higher than the other which is called hypertropia (for the higher eye) or hypotropia (for the lower eye). Strabismus can be subtle or obvious, intermittent (occurring occasionally), or constant. It can affect one eye only or shift between the eyes.

Strabismus usually begins in infancy or childhood. Some toddlers have accommodative esotropia. Their eyes cross because they need glasses for farsightedness. But most cases of strabismus do not have a well-understood cause. It seems to develop because the eye muscles are uncoordinated and do not move the eyes together. Acquired strabismus can occasionally occur because of a problem in the brain, an injury to the eye socket, or thyroid eye disease.

When young children develop strabismus, they typically have mild symptoms. They may hold their heads to one side if they can use their eyes together in that position. Or, they may close or cover one eye when it deviates, especially at first. Adults, on the other hand, have more symptoms when they develop strabismus. They have double vision (see a second image) and may lose depth perception. At all ages, strabismus is disturbing. Studies show school children with significant strabismus have self-image problems.

Amblyopia, or lazy eye, is closely related to strabismus. Children learn to suppress double vision so effectively that the deviating eye gradually loses vision. It may be necessary to patch the good eye and wear glasses before treating the strabismus. Amblyopia does not occur when alternate eyes deviate, and adults do not develop amblyopia.

Strabismus is often treated by surgically adjusting the tension on the eye muscles. The goal of surgery is to get the eyes close enough to perfectly straight that it is hard to see any residual deviation. Surgery usually improves the conditions though the results are rarely perfect. Results are usually better in young children. Surgery can be done with local anesthesia in some adults, but requires general anesthesia in children, usually as an outpatient. Prisms and Botox injections of the eye muscles are alternatives to surgery in some cases.