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Outer Eye Disorders

Since the outside of the eye is in direct contact with the environment, it is susceptible to infections and injuries. There are also a number of hereditary diseases which can impact the outer eye.

Dry Eye

Dry eye is a condition that results from inadequate tear production. Although dry eye often occurs in people who have rheumatoid arthritis or Sjögren’s syndrome, in many cases the condition occurs for no obvious reason. Dry eye usually develops in middle age and affects women more often than men. Usually both eyes are affected.

  • Treatments
  • To relieve discomfort, the doctor will probably prescribe eyedrops called artificial tears, which you may need to use for the rest of your life. In severe cases of dry eye, doctors may prescribe lubricating ointments or recommend a procedure to block the ducts that drain tears from the eye.

Corneal Ulcer

A corneal ulcer is an open sore or break in the surface of the cornea (the clear, protective covering at the front of the eye). In most cases, a corneal ulcer begins as a scratch or other injury to the cornea that becomes infected by a bacterium, virus, or fungus. An infection can also be spread from another part of the body, such as when a person with a cold sore (which is caused by the herpes simplex virus) touches his or her mouth and then touches his or her eyes. Conditions that interfere with normal lubrication of the eyes by tears—such as entropion, ectropion, or dry eye—or using extended-wear contact lenses can increase the risk of corneal ulcers. People whose eyes are exposed to a spray of particles, such as wood or metal shavings, are also at increased risk.

If a corneal ulcer is not treated promptly, a scar can form on the cornea and impair vision. An infected ulcer may perforate the cornea and allow the infection to enter the eyeball, causing blindness.

  • Treatments
  • To treat a corneal ulcer caused by a bacterial infection, doctors prescribe antibiotics, given as drops, ointment, tablets, or injections. For a corneal ulcer caused by a herpes simplex virus infection, doctors prescribe antiviral medication in eyedrops or in an ointment. Corneal ulcers caused by fungi are treated with eyedrops that contain antifungal medication.
  • If scarring from corneal ulcers severely impairs a person’s vision, a doctor may recommend a cornea transplant, a surgical procedure in which the damaged cornea is removed and replaced with a healthy cornea from a donor. If an ulcer has perforated the cornea, immediate surgery is required to seal the hole and prevent the infection from entering the eyeball.

Watering Eye

A watering eye is an uncommon condition characterized by continuous tearing of the eye. Sometimes the condition occurs when a foreign object in the eye causes excessive tear formation. In other cases, a blocked nasolacrimal duct (the duct that drains tears from the eye into the nose), either as the result of an injury to the bone at the side of the nose or from long-term inflammation such as sinusitis, prevents normal tear drainage. A blocked nasolacrimal duct can lead to an infection, as bacteria that would normally be washed from the eye build up inside the lacrimal sac. Watering eye usually occurs in people who are middle-aged or older.

  • Treatments
  • If the ophthalmologist finds a foreign object in the eye, he or she will remove the object, which should relieve the symptoms. If a nasolacrimal duct is blocked, the doctor may attempt to clear it by inserting a probe into the duct or by irrigating the duct with a sterile saline (saltwater) solution. If these measures are not effective, the doctor may recommend surgery to create an artificial nasolacrimal passageway that bypasses the blockage. If the blocked duct is infected, the doctor may prescribe antibiotics (in pills or in eyedrops) to clear up the infection before performing surgery.

Conjunctivitis

Conjunctivitis (also called pinkeye) is inflammation of the conjunctiva, the transparent membrane that covers the white of the eye and lines the eyelids. Conjunctivitis is a common condition that can result from a bacterial or viral infection or from an allergy.

Both bacterial and viral conjunctivitis are extremely contagious and can be transmitted from eye to eye or to another person through contact with a contaminated finger, handkerchief, washcloth, or towel. Viral conjunctivitis is very common among young children and can occur with a viral infection of the upper respiratory tract such as a cold. Bacterial conjunctivitis occurs less often but can be more serious. Allergic conjunctivitis is caused by exposure to an allergen (such as pollen or cosmetics) that causes an allergic reaction in which the immune system produces antibodies (infection-fighting proteins) to attack the allergen.

If a pregnant woman is infected with the sexually transmitted disease genital herpes, chlamydia, or gonorrhea, her newborn (up to about 3 days old) may develop a form of conjunctivitis called neonatal ophthalmia from coming into contact with the lining of the cervix during delivery. Neonatal ophthalmia is a potentially serious condition that can result in blindness if not treated.

  • Treatments
  • To treat bacterial conjunctivitis, the doctor will recommend gently washing away any discharge with warm water and applying prescription antibiotic eyedrops or ointment to the eyes. The condition should clear up after 1 week. Viral conjunctivitis usually goes away on its own within 7 to 10 days. To treat allergic conjunctivitis, a doctor may recommend using nonprescription or prescription eyedrops to reduce the allergy symptoms. You will also need to identify and avoid exposure to the allergen to prevent future episodes of allergic conjunctivitis. To treat neonatal ophthalmia, a doctor may cleanse the baby’s eyes and eyelids of any discharge, apply antibiotic eyedrops to the eyes, and give antibiotics intravenously (through a vein).
  • To help prevent conjunctivitis from spreading, wash your hands frequently, and keep them away from your eyes. Use your own towels and washcloths and change them daily, and wash your towels, washcloths, sheets, and pillowcases in hot water.

Subconjunctival Hemorrhage

A subconjunctival hemorrhage is leaking of blood from a small blood vessel in the eye into the area between the conjunctiva and the sclera (the white of the eye). A subconjunctival hemorrhage may be caused by an eye injury or infection, or may develop as a result of coughing, sneezing, straining, or any other activity that increases the pressure in the blood vessels in the head and neck. A subconjunctival hemorrhage also may be associated with taking blood thinners. Sometimes a subconjunctival hemorrhage occurs suddenly, for no obvious reason.

  • Treatments
  • In most cases, a subconjunctival hemorrhage is harmless and the red patch goes away on its own after about a week. However, if the patch results from an injury or is painful, call your doctor right away. You may have a serious eye injury or an underlying disorder that needs treatment. If you are taking anticoagulant drugs (blood thinners), talk to your doctor as soon as possible. He or she may need to reduce the dosage of the drug or prescribe another anticoagulant.

Scleritis

Scleritis is inflammation of the sclera (the white of the eye). The condition is rare and sometimes occurs along with rheumatoid arthritis or a digestive disorder such as Crohn’s disease. Scleritis usually affects people between ages 30 and 60. If the condition is not treated, the inflamed tissue could become perforated. Scleritis can affect one or both eyes.

  • Treatments
  • Mild or moderate cases of scleritis are usually treated with anti-inflammatory medications such as corticosteroids, taken in eyedrops or in tablets. In severe cases, doctors may prescribe immune-suppressing drugs, which dampen the abnormal immune response and relieve inflammation. If the sclera is perforated, surgery is necessary to repair the damage.

Uveitis

Uveitis is inflammation of the uvea, which consists of the iris (the colored part of the eye), the ciliary body (the ring of muscles that focus the lens), and the choroid (the layer of blood vessels beneath the retina). The condition is called iritis when the inflammation is confined to the iris, cyclitis when it is confined to the ciliary body, and choroiditis when it is confined to the choroid.

Uveitis is rare, and the cause is usually unknown. However, in some cases, the disorder may result from an autoimmune disorder (in which the immune system mistakenly attacks body tissues) or from infection with a virus such as the herpes simplex virus or herpes zoster virus. Uveitis can occur at any age, but it occurs most frequently in young adults. The disorder can affect one or both eyes.

Because untreated uveitis can lead to serious complications—such as cataracts; glaucoma; the growth of new, abnormally fragile blood vessels on the retina; or blindness—early detection and treatment are crucial.

  • Treatments
  • To treat uveitis, a doctor usually prescribes a corticosteroid drug in the form of eyedrops, an ointment, an injection, or a pill to relieve the pain and inflammation. Doctors may also prescribe eyedrops that dilate the pupil to prevent the back of the inflamed iris from sticking to the front of the lens, which could block the flow of fluid out of the eyeball, increasing pressure inside the eyeball. Even with effective treatment, the condition may recur.
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