Information about Other Retina Problems

Squint (strabismus)

Squint (also known as strabismus) is a condition that arises because of an incorrect balance of the muscles that move the eye, faulty nerve signals to the eye muscles and focusing faults (usually long sight). If these are out of balance, the eye may turn in (converge), turn out (diverge) or sometimes turn up or down, preventing the eyes from working properly together.

Squint can occur at any age. A baby can be born with a squint or develop one soon after birth. Around five to eight per cent of children are affected by a squint or a squint-related condition, which means one or two in every group of 30 children.

What can be done about squint?

Treating squint varies accordingly to the type of squint. An operation is not always needed. The main forms of treatment are:

• Glasses – to correct any sight problems, especially long-sight.
• Occlusion – patching the good eye to encourage the weaker eye to be used. This is usually done under the supervision of an orthoptist.
• Eye drops – certain types of squint can be treated with the use of special eye drops.
• Surgery – this is used with congenital squints, together with other forms of treatment in older children, if needed. Surgery can be performed as early as a few months of age.

Retinal Artery Occlusion

A retinal artery occlusion occurs when the central retinal artery or one of the arteries that branch off of it becomes blocked. This blockage is usually caused by a tiny embolus (blood clot) in the blood stream. The occlusion decreases the oxygen supply to the area of the retina (i.e., a retinal “stroke”) nourished by the affected artery, resulting in permanent vision loss.

• The following conditions increase your risk of retinal artery occlusion:-Heart disease
• Arteriosclerosis
• Hypertension
• Diabetes
• Glaucoma
• Sudden, painless, loss of vision in one eye (complete loss of vision for central artery occlusion, partial loss of vision for branch artery occlusion)

Treatment

Unfortunately, there is no treatment that can consistently restore vision lost from an artery occlusion. However, if the problem is caught within the first hour and treatment begins immediately, partial recovery may be occasionally possible.

Common complications

Common complications of this condition include swelling, lack of blood supply to the retina, and glaucoma.

Visual symptoms can vary in severity, depending on whether the central retinal vein or a branch retinal vein is involved. For patients who experience a branch vein occlusion, vision usually improves partially and gradually as the hemorrhage and edema resolves. Since a central vein occlusion affects the macula, recovery is much less likely.

The following are common risk factors for vein occlusion;

• Diabetes
• Hypertension
• Cardiovascular disease

This problem appears equally in males and females and is more common in people over the age of 60.

Symptoms

• Sudden onset
• Blurred or missing area of vision (if a branch vein is involved)
• Severe loss of central vision (if a central vein is involved)

Treatment

Following a vein occlusion, your doctor’s primary concern will be to treat the secondary complications. If areas of the retina are oxygen-deprived, laser treatment may be used to prevent growth of delicate vessels that could break, bleed, or cause glaucoma.

Central serous chorioretinopathy (CSCR)

Central serous chorioretinopathy (CSCR) is a problem that affects the macula, the central portion of the retina. CSCR occurs when a small break forms in the pigment layer of the retina. Fluid from the blood vessels underneath the retina seeps up through the break, causing a small detachment to form beneath the retina.

CSCR usually affects people between the ages of 25 and 50, and is more likely to occur in men than in women. Though the exact cause is not understood, stress has been linked to this problem. CSCR typically resolves spontaneously, but can recur later. In many cases, it can result in moderate but permanent loss of central vision. Occasionally, it may result in severe, permanent central vision loss.

Signs and Symptoms

• Blurred central vision
• Wavy, distorted vision
• Central blind spot

CSCR Treatment

Most patients with central serous chorioretinopathy do not require treatment. Excess fluid is typically absorbed by the eye over a period of months. In some cases, anti-inflammatory eye drops are prescribed. Occasionally, laser treatment may be required to seal the leak and improve vision.

Treatment

Though most nevi are harmless, they should be monitored for changes. Your doctor may take photos or use ultrasound to document the size, shape, and other characteristics of the nevus. In rare cases, the nevus may be biopsied and examined for melanoma (cancer) cells.

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Choroidal neovascular membrane (CNVM)

Choroidal neovascular membrane (CNVM) can signal the presence of a number of retinal diseases, but is most commonly linked to age-related macular degeneration. With CNVM, abnormal blood vessels stemming from the choroid grow up through the retinal layers. The new vessels are fragile and break easily, causing blood and fluid to pool within the layers of the retina.

As the vessels leak, they disrupt the delicate retinal tissue, resulting in poor vision. The size of the CNVM and its proximity to the macula will determine the severity of symptoms. While some patients will note only a blurry or distorted area of vision, others may have symptoms as severe as a central blind spot.

Signs and Symptoms

• Blurred, grayed-out areas
• Distorted vision
• Central blind spot

Treatment

The appropriate treatment is dependent on the size and location of the membrane, as well as the amount of time that has passed since the symptoms first began.

Sub-Foveal Excision

If the CNVM is small and caught very early, a delicate surgery called a sub-foveal excision can be performed to remove it. This procedure has the most risk but also offers the best chance of visual improvement.

Laser Photocoagulation

Photocoagulation, a procedure that seals leaking blood vessels, is one of the simplest treatments for CNVM. It is performed only on patients who have bleeding outside of the central macula (fovea) because it results in a scar that affects the vision. Treating the retina with a laser gives the surgeon the most control over placement and size of the scar. Allowing a leak to resolve on its own results in a much more devastating affect on a patient’s vision.

For some patients, no treatment is appropriate. All patients with CNVM should monitor their vision with an Amsler Grid and report any changes to their doctor immediately.

Cystoid macular edema (CME)

Cystoid macular edema (CME), or swelling of the macula, can occur as a result of disease, injury, or, occasionally, eye surgery. With CME, fluid collects within the layers of the macula, causing blurred, distorted central vision. Though this eye condition rarely causes a permanent loss of vision, recovery is often a slow, gradual process. Most patients recover in two to 15 months.

Signs and Symptoms

• Blurred central vision
• Distorted vision (straight lines may appear wavy)
• Vision is tinted pink
• Light sensitivity

CME Treatment

Many cases of CME can be treated with anti-inflammatory drops. Occasionally, medication is injected near the back of the eye for a more concentrated effect. Oral medications are sometimes prescribed to reduce swelling.

Epi-retinal Membrane (Macular Pucker)

Epi-retinal membrane (ERM), or macular pucker, is a thin layer of scar tissue that forms over the macula. It is a problem that usually progresses slowly, affecting a patient’s central vision by causing blur and distortion. The stress that the membrane places on the macula may also cause swelling.

ERM typically affects people over 75 years of age. The formation of a macular pucker is often associated with certain eye problems such as: vitreous detachment, diabetic retinopathy, retinal detachment, and trauma.

Signs and Symptoms

• Blurred vision
• Double vision that is noticeable even with one eye covered
• Distorted vision (straight lines may appear bent or wavy)

Macular Pucker Treatment

If vision has deteriorated to a point where it is significantly affecting your lifestyle, your doctor may perform a procedure called a membrane peel. Since this procedure is somewhat risky, it is only recommended when absolutely necessary for improvement of your lifestyle.

The membrane peel is performed under a local anesthesia in an operating room. The surgeon performs a vitrectomy and uses very fine forceps and high magnification to carefully remove the ERM.

Flashes and Floaters (Posterior Vitreous Detachment)

Flashes and floaters usually occur as a result of posterior vitreous detachment (PVD). This is a very common condition that occurs when the vitreous separates from the back of the eye, typically as a result of the aging process. PVD is usually harmless.

Floaters are caused by tiny bits of vitreous gel or cells that cast shadows on the retina. Flashes occur when the vitreous pulls on sensitive retinal tissue.

Occasionally, floaters and flashes can be an indication of a more serious problem than PVD. Other possible causes include: retinal tears, retinal detachment, infection, inflammation, hemorrhage, and eye injury. Occasionally, flashes of light are caused by migraine headaches. When related to a headache, they usually appear in both eyes and last for 20-30 minutes before the headache starts.

Signs and Symptoms

• Black spots or “spider webs” that seem to float in a cluster or alone
• Spots that move or remain suspended in one place
• Flickering or flashing lights that are most prominent when looking at a bright background like a clear, blue sky

Symptoms that may indicate a more serious problem

• Sudden decrease of vision along with flashes and floaters
• Veil or curtain that obstructs part or all of the vision
• Sudden increase in the number of floaters

Eye Floater Treatment

Surgery is not necessary for most patients with floaters or flashes. Often, floaters become less noticeable over time as they settle below the line of sight. In cases where floaters are significantly obstructing vision, your doctor may suggest surgical eye floater treatment at our center. A vitrectomy may be performed. If flashes and floaters are related to a problem other than a PVD, another form of surgery may be required.

Ocular Histoplasmosis Syndrome

Histoplasmosis is caused by a fungus commonly found in the dust and soil of the Mississippi-Ohio River Valley region. About 62 percent of all adults living in this region are carriers of the syndrome. Men and women are equally affected.

Histoplasmosis is contracted by inhaling dust that carries the fungal spores. The effect of the syndrome on the body varies greatly from one person to another. Many carriers have no symptoms at all, while others experience flu-like symptoms and mild respiratory infections. People who already have a weakened immune system are more likely to be seriously effected by histoplasmosis.

The fungus can affect the eye by causing small areas of inflammation and scarring of the retina. These are called “histo spots” and can occur in both eyes. The affect of histo spots on vision depends on their location. Spots in the peripheral area of the retina may have little or no impact on vision, while those located in the center of the macula may cause prominent blind spots. Most people with histo spots in the retina are completely unaware of their presence unless the central vision is affected. Studies indicate that only about 5 percent of people with histo spots are at risk of losing vision.

Signs and Symptoms

Many patients with histo spots have no symptoms. Others may experience the following

• Distorted vision
• Blind spots
• Scars in the retina, ranging in severity

Histoplasmosis Treatment

Often, ocular histoplasmosis does not require any treatment from our Florida retina surgeons. If you are diagnosed with this condition, your doctor will probably recommend that you closely monitor your central vision with an Amsler grid. When the condition causes abnormal blood vessels to develop in the central retina, laser treatment may be used. In some cases, surgical removal of the tiny, abnormal vessels has been successful.

Retinitis Pigmentosa

Retinitis pigmentosa (RP) is a rare, hereditary disease that causes the rod photoreceptors in the retina to gradually deteriorate. The rods are located at the edge of the retina and are responsible for peripheral and night vision.

People with RP usually first notice difficulty seeing in dim lighting and gradually lose peripheral vision. The effect this disease has on vision can range from mild problems to blindness.

RP affects males more than females. Though it is frequently diagnosed during childhood, some people do not have noticeable symptoms until later in life.

Signs and Symptoms

• Difficulty seeing in dim lighting
• Tendency to trip easily or bump into objects when in poor lighting
• Gradual loss of peripheral vision
• Glare
• Loss of contrast sensitivity
• Eye fatigue (from straining to see)

Retinitis Pigmentosa Treatment

Currently, there is no standard retinitis pigmentosa treatment or therapy available to patients. However, researchers are studying possible treatment options such as retinal implants and drug therapy. Work is also being done to isolate the genes that are responsible for the disease.

Stargardt’s Disease

Stargardt’s disease (also known as fundus flavimaculatus) is a type of macular degeneration that typically surfaces before the age of 20. This disease is an inherited disorder that causes a progressive loss of central vision of both eyes, but does not affect peripheral vision. Signs and Symptoms

Stargardt’s is a progressive disease. Symptoms may be mild at first, but will usually worsen over time.

Early symptoms include

• Blurred vision not correctable with glasses or contact lenses (this is one of the earliest symptoms)
• Difficulty adapting from bright sunlight to a dimmer room
• Later symptoms
• Progressive deterioration of central vision
• Missing areas of central vision
• Central blind spot
• Diminishing ability to perceive colors

Treatment for Stargardt’s

Unfortunately, there is no known cure for Stargardt’s. However, some patients may receive laser treatment to seal leaking blood vessels in the retina.

Temporal Arteritis (Giant Cell Arteritis)

Temporal arteritis, also known as giant cell arteritis, is an inflammatory condition that affects the medium-sized blood vessels that supply the head, eyes, and optic nerves. Patients with temporal arteritis experience swelling and tenderness in the blood vessel of the temple and scalp. The disease is most common in people over age 60 and affects women about four times more than it affects men.

If allowed to progress, temporal arteritis can be sight threatening. Vision loss occurs when the inflamed arteries obstruct blood flow to the eyes and optic nerves. Temporal arteritis may also start to affect arteries in other areas of the body. Prompt treatment of this condition is essential to prevent permanent vision loss and other health problems.

Signs and Symptoms

Patients with temporal arteritis usually notice visual symptoms in one eye at first, but many notice symptoms in the fellow eye within days if the condition is untreated. The following are some of the most common warning signs of the condition;

• Headache
• Tenderness of scalp (combing hair may be painful)
• Pain in temple area (may be excruciating)
• Transient blurred vision
• Loss of appetite
• Fever
• Fatigue
• Depression
• Drooping lid
• Double vision
• Sore neck
• Jaw soreness, especially when chewing food

Treatment

The ophthalmologist often works in conjunction with the patient’s internist to treat this disease. The primary treatment is oral steroid medication to reduce inflammation. Most patients notice an improvement in their symptoms within several days of receiving treatment. In some cases, long-term steroid use is necessary.

Uveitis

Uveitis is a general term that refers to inflammation or swelling of the structures of the eye that are responsible for its blood supply. These structures are collectively known as the uveal tract, and include the iris, ciliary body, and choroid. Uveitis is often caused by infection or underlying disease, but sometimes the cause is unknown. The condition usually affects people between 20 and 50 years of age.

Forms of Uveitis

There are four main categories of uveitis

•  Anterior Uveitis (also known as Iritis) – involves the iris and ciliary body and is the most common type
• Intermediate Uveitis – affects the ciliary body, vitreous, and retina
• Posterior Uveitis – involves the retina, choroid, and optic nerve
• Diffuse Uveitis – affects structures both in the front and back of the eye

Signs and Symptoms

Anterior

• Light sensitivity
• Blurred vision
• Redness around the iris
• Pain that may range from aching or soreness to intense discomfort
• Small pupil
• Tearing
• Elevated intraocular pressure

Intermediate

• Often affects both eyes
• Floaters
• Blurred vision

Posterior

• Blurred vision
• Pain (if the optic nerve is involved)

Diffuse

Combination of symptoms from anterior, intermediate, and posterior uveitis

Uveitis Treatment

• The appropriate treatment for uveitis is dependent on the severity of the disease and the ocular structures involved. Topical eye drops and/or oral medications may be prescribed to reduce inflammation. In some cases, medication is required to reduce intraocular pressure.
• After inflammation has subsided, treatment may be required for secondary conditions such as cataracts, glaucoma, or the presence of scar tissue.

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