A cataract is an opacity or cloudiness of the eyes internal focusing lens.  As the opacity  gets larger or more dense vision is gradually more blurred.  

The most common cause of a cataract  is the normal ageing process and most people start developing cataracts in the late 60's.  Diabetics often develop cataracts at a younger age.  Some people are born with cataracts as a result of a toxic influence on the lenses development before birth.  Trauma, radiation and some medications also can produce cataracts.

When the cataract reduces vision to a point that it is affecting a persons life style cataract surgery is preformed.

Glaucoma

Glaucoma is the No. 1 cause of blindness in the black population, but anyone can have it.  It is a disease in which the optic nerve fibers are damaged.  Normally this is a result of elevated eye pressure due to an impaired drainage of the aqueous fluid within the eye.  There are several types of glaucoma.   

Open angle glaucoma is the most common type.  There are usually no symptoms.  The appears to look and see normal.  Mild pressure elevations gradually damage the nerve fiber layer.  When enough damage takes place peripheral vision develops defects.  Only in the later stages of the disease does the patient notice a loss of vision.

Closed angle glaucoma is a result of a significant impairment of the fluids drainage ability.  Pressure increases significantly is accompanied by pain, blurred vision color lights round halos, headache nausea and vomiting.

Other causes of glaucoma are trauma, steroid medications, pigmentary disturbances of the iris, pathologic changes to the human lens, vascular disease, structural defects, and inflammation within the eye.

Treatment normally consists of medications to reduce the eye pressure, but there are several surgical procedures also. 

Macular degeneration

Macular degeneration is a disease in which the macula, which is the area on the back of the eye that has straight ahead good vision, degenerates.  This disease is much more common in white people.  It's also six times more common among smokers than nonsmokers

The most common type is called age related macular degeneration (ARMD).  Ninety percent of people with ARMD have the "dry" form, in which there are pigmentary changes and/or degenerative spots called drusen within the macula.  As these degenerations get worse straight ahead vision becomes less clear. There is no treatment for this disease, however some studies indicate nutritional supplements may be a benefit.

Ten percent of people with ARMD develop the " wet" form of the disease.  In these cases blood vessels grow into the macula and then hemorrhage significantly reducing straight ahead vision.  The wet form is often treatable if caught soon enough.  Several new surgical procedures are now being developed to treat this form of the disease.

Flashes and floaters

Floaters are grayish particles which appear to move within the field of vision.  They are most noticeable when looking at the sky or an illuminated background.  They appear to move with eye movement.  There are several causes of floaters. 

The most common cause is degeneration of the vitreous gel within the eye.  With aging, the gel becomes more watery and fibers within the gel form larger ropes of fibers.  With the right illumination these ropes cast a shadow on the back the eye which we see as "floaters".  This type of floater is very common.

A more serious type of floater is produced when that watery vitreous gel is unable to support itself and caves in causing what is called a vitreous detachment.  When the vitreous caves in it pulls on the retina and sometimes causes a retinal tear, hole or detachment.  This potentially could cause blindness. Another serious cause of floaters is hemorrhaging within the eye.

Many adults see floaters, but any "new" floaters are always a concern and require prompt examination.

Flashing lights, or "photopsia" is a common but potentially very serious sign.  The most common cause is the tugging of the liquefied vitreous gel away from the retina.  When the vitreous tries to pull away from the retina it stimulates the nerve which we see as a flash of light.

An equally common cause of flashing lights is migraine.  These may happen in both eyes at the same time or in one eye.  They are not always accompanied by a headache.

Flashing lights also require prompt examination.

Pingueculas and ptyrgium's are degenerative changes to the outside of the eye.  A pinguecula is most commonly an elevated yellowish area on the white of the eye nasal to the iris.  Ultraviolet exposure is a leading cause of their development.  They are more common in areas with dry environments and in people with dry eyes.

 As the eye becomes more irritated and the pinguecula gets larger it sometimes develops into a ptyrgium.  In this condition the growth grows across the front of the eye.  They can cause blindness if not treated with surgery.

Sunglasses, UV absorbing lenses, lubricant drops and some medications are normally recommended for pingueculas and early ptyrgium's.

Dry eye syndrome

Dry eye syndrome is a very common condition.  It's a result of the tear film being unstable or deficient.  As the tear film breaks up the eye burns and feels uncomfortable.  Paradoxically with dry eyes the eyes tear often.  

Anyone can have dry eyes, but it is much more common in females.  Hormones often are a factor so the condition is very common in menopausal women.  Certain medications can cause dry eyes.  Autoimmune diseases like arthritis also can cause dry eyes.

Treatment consists of lubricant drops and ointments.  Also, sometimes small plugs are inserted into the tear drainage canals to prevent the tears from draining away.

Diabetic eye disease

Diabetic eye disease is the No. 1 cause of blindness in the white population, but anyone can have it.  In cases of poorly controlled diabetes, blood vessels on the back of the eye leak fluid and blood.

If the fluid or blood leaks into the macula, or area of straight ahead vision, vision becomes worse.  The fluid disrupts the function of the nerve fibers resulting in loss of function.  The condition can progress to the point of scarring producing significant vision loss.  Laser surgery can be done to help stop leaking blood vessels. 

In some cases new blood vessels grow into retinal areas with poor circulation.  This is a very serious sign, which can lead to retinal detachment and blindness.  Laser surgery is used to destroy those new blood vessels.

Several new treatments are now being developed to treat diabetic eye disease.

Styes & chalazions

Styes and chalazion's are common eyelid problems.  A chalazion is usually a plugged and inflamed oil gland within the eyelid.  It is felt as a hard painless bump within the eyelid.  If it becomes infected it becomes very tender and is called a hordeolum or "stye".  Treatment normally consists of warm compresses, but sometimes medication or surgery is required.

Chronic lid disease

This very common group of eye diseases includes several different conditions.  The symptoms typically include itching, burning, mild pain, foreign-body sensation, tearing and lid crusting.  Signs include red eyes, swollen eyelids and mild discharge.

Treatment often includes lid scrubs, warm compresses, lubricant drops and sometimes antibiotics.  In some cases allergy medications are also helpful.

This extremely common complaint simply reflects the fact that the eyes are irritated by something.  Whenever they are physically irritated they respond by dilating the blood vessesls in the area.  This allows more blood flow which brings in more inflammatory cells to fight off the source of the irritation and to make repairs to any damage done.

Common causes of red eyes are:

• Allergies -  Almost always with itching
• Infection -  Almost always with a discharge
• Dry eyes - Almost always with a burning sensation
• Irritation - Smoke, smog, lack of sleep