Highly Specialized Corneal Treatments
As the area’s most reputable corneal team, our providers offer a wide range of treatments and procedures for most corneal diseases and disorders. Whether a patient is suffering from a rare corneal disease or simply needs an artificial drop regimen, we can help.
Allergies
Allergies affecting the eye are common; the most common are those related to pollen, particularly when the North Carolina weather becomes warm and dry. Symptoms can include redness, itching, tearing, burning, stinging, and watery discharge, although they are not usually severe enough to require medical attention. Antihistamine decongestant eyedrops can effectively reduce these symptoms.
However, an increasing number of eye allergy cases are related to medications and contact lens wear. These problems are oftentimes more serious and require diagnosis and treatment from a corneal specialist. If you are experiencing corneal issues and regularly wear contact lenses or have started a new medication, it’s important to schedule an appointment with our corneal team to properly treat the problem.
Causes of Eye Allergies
- Pollen
- Animal hair
- Cosmetics such as mascara, face creams
- Touching/rubbing the eyes with nail polish, soaps, or chemicals
- Certain medications
- Improper contact lens usage
Conjunctivitis (Pink Eye)
Conjunctivitis describes a group of diseases that cause swelling, itching, burning, and redness of the conjunctiva, the protective membrane that lines the eyelids and covers exposed areas of the sclera, or white of the eye. Conjunctivitis can spread from one person to another and affects millions of Americans at any given time. Conjunctivitis can be caused by a bacterial or viral infection, allergy, environmental irritants, a contact lens product, eyedrops, or eye ointments.
In most cases, the infection will clear in a few days without requiring medical care. But for some forms of conjunctivitis, treatment will be needed. If treatment is delayed, the infection may worsen and cause corneal inflammation and a loss of vision.
Causes of Conjunctivitis (Pink Eye)
- Touching/rubbing the eyes
- Exposure to bacteria or virus through corneal membrane
Corneal Infections
Sometimes the cornea is damaged after a foreign object has entered the tissue, such as from a poke in the eye. At other times, bacteria or fungi from contaminated contact lenses can pass into the cornea. Situations like these can cause painful inflammation and corneal infections called keratitis. These infections can reduce visual clarity, produce corneal discharges, and erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant.
As a general rule, the deeper the corneal infection, the more severe the symptoms and complications. It should be noted that corneal infections, although infrequent, are the most serious complication of contact lens wear.
Minor corneal infections are commonly treated with anti-bacterial eye drops. If the problem is severe, it may require more intensive antibiotic or anti-fungal treatment to eliminate the infection, as well as steroid eye drops to reduce inflammation. Frequent visits to an eye care professional may be necessary for several months to eliminate the problem.
Causes of Corneal Infections
- Poke in the eye
- Foreign object puncturing cornea
- Contaminated contact lens
Dry Eye
Tears keep the eye moist, help wounds heal, and protect against eye infection. In people with dry eye, the eye produces fewer or less quality tears and is unable to keep its surface lubricated and comfortable.
The main symptom of dry eye is usually a scratchy or sandy feeling as if something is in the eye. Other symptoms may include stinging or burning of the eye; episodes of excess tearing that follow periods of very dry sensation; a stringy discharge from the eye; and pain and redness of the eye. Sometimes people with dry eye experience heaviness of the eyelids or blurred, changing, or decreased vision, although loss of vision is uncommon.
Artificial tears, which lubricate the eye, are the principal treatment for dry eye. They are available over the counter as eye drops. Sterile ointments are sometimes used at night to help prevent the eye from drying. Using humidifiers, wearing wrap-around glasses when outside, and avoiding outside windy and dry conditions may bring relief. For people with severe cases of dry eye, temporary or permanent closure of the tear drain (small openings at the inner corner of the eyelids where tears drain from the eye) may be helpful.
Causes of Dry Eye
- Climates with dry air
- Most-menopause
- Use of antihistamines, nasal decongestants, tranquilizers, and anti-depressant drugs
- Rheumatoid arthritis
- Sjögren’s syndrome
Fuchs’ Dystrophy
Fuchs’ dystrophy is a slowly progressing disease that usually affects both eyes and is slightly more common in women than in men. Fuchs’ dystrophy occurs when endothelial cells gradually deteriorate without any apparent reason. As more endothelial cells are lost over the years, the endothelium becomes less efficient at pumping water out of the stroma. This causes the cornea to swell and distort vision. Eventually, the epithelium also takes on water, resulting in pain and severe visual impairment.
Epithelial swelling damages vision by changing the cornea’s normal curvature and causing a sight-impairing haze to appear in the tissue. Epithelial swelling will also produce tiny blisters on the corneal surface. When these blisters burst, they are extremely painful.
At first, a person with Fuchs’ dystrophy will awaken with blurred vision that will gradually clear during the day. This occurs because the cornea is normally thicker in the morning; it retains fluids during sleep that evaporate in the tear film while we are awake. As the disease worsens, this swelling will remain constant and reduce vision throughout the day.
When treating the disease, doctors will try first to reduce the swelling with drops, ointments, or soft contact lenses. They also may instruct a person to use a hair dryer, held at arm’s length or directed across the face, to dry out the epithelial blisters. This can be done two or three times a day.
When the disease interferes with daily activities, a person may need to consider having a corneal transplant to restore sight. The short-term success rate of corneal transplantation is quite good for people with Fuchs’ dystrophy. However, some studies suggest that the long-term survival of the new cornea can be a problem.
Causes of Fuchs’ Disease
- Genetics
- Advanced age
Corneal Dystrophies
A corneal dystrophy is a condition in which one or more parts of the cornea lose their normal clarity due to a buildup of cloudy material. There are currently over 20 corneal dystrophies that affect all parts of the cornea, each affecting vision in widely differing ways. Some cause severe visual impairment, while a few cause no vision problems and are discovered during a routine eye examination. Other dystrophies may cause repeated episodes of pain without leading to permanent loss of vision.
Corneal dystrophies are not caused by outside factors, such as injury or diet and most can occur in otherwise healthy people, male or female.
Causes of Corneal Dystrophies
- Genetics
Herpes Zoster (Shingles)
The herpes infection is produced by the varicella-zoster virus, the same virus that causes chickenpox. After an initial outbreak of chickenpox (often during childhood), the virus remains inactive within the nerve cells of the central nervous system. But in some people, the varicella-zoster virus will reactivate at another time in their lives. When this occurs, the virus travels down long nerve fibers and infects some part of the body, producing a blistering rash (shingles), fever, painful inflammations of the affected nerve fibers, and a general feeling of sluggishness.
In about 40 percent of those with shingles near the eye, the virus can infect the cornea. Doctors will often prescribe oral anti-viral treatment to reduce the risk of the virus infecting cells deep within the tissue, which could inflame and scar the cornea. The disease may also cause decreased corneal sensitivity, meaning that foreign matter, such as eyelashes, in the eye are not felt as keenly. For many, this decreased sensitivity will be permanent.
Be aware that corneal problems may arise months after the shingles are gone. For this reason, it is important that people who have had facial shingles schedule follow-up eye examinations.
Causes of Herpes Zoster (Shingles)
- Advanced age
- Weakened immune system
Keratoconus
Keratoconus is a progressive thinning of the cornea and is the most common corneal dystrophy in the U.S., affecting one in every 2,000 Americans. It is more prevalent in teenagers and adults in their 20s. Keratoconus arises when the middle of the cornea thins and gradually bulges outward, forming a rounded cone shape. This abnormal curvature changes the cornea’s refractive power, producing moderate to severe distortion (astigmatism) and blurriness (nearsightedness) of vision. Keratoconus may also cause swelling and sight-impairing scarring of the tissue.
At first, people can correct their vision with eyeglasses. But as astigmatism worsens, they must rely on specially fitted contact lenses to reduce the distortion and provide better vision. Although finding a comfortable contact lens can be an extremely frustrating and arduous process, it is crucial because a poorly fitting lens could further damage the cornea and make wearing a contact lens intolerable.
In most cases, the cornea will stabilize after a few years without ever causing severe vision problems. But in about 10 to 20 percent of people with keratoconus, the cornea will eventually become too scarred or will not tolerate contact lenses. If either of these problems occur, a corneal transplant may be needed. This operation is successful in more than 90 percent of those with advanced keratoconus. Several studies have also reported that 80 percent or more of these patients have 20/40 vision or better after the operation.
Causes of Keratoconus
- Genetics
- Eye injury
- Excessive eye rubbing
- Wearing hard contacts for many years
- Certain eye diseases, such as retinitis pigmentosa, retinopathy of prematurity, and vernal keratoconjunctivitis
- Systemic diseases, such as Leber’s congenital amaurosis, Ehlers-Danlos syndrome, Down syndrome, and osteogenesis imperfecta
Epithelial Basement Membrane Dystrophy
This dystrophy occurs when the epithelium’s basement membrane develops abnormally. When the basement membrane develops abnormally, the epithelial cells cannot properly adhere to it. This, in turn, causes recurrent epithelial erosions, in which the epithelium’s outermost layer rises slightly, exposing a small gap between the outermost layer and the rest of the cornea.
Epithelial erosions can be a chronic problem. They may alter the cornea’s normal curvature, causing periodic blurred vision. They may also expose the nerve endings that line the tissue, resulting in moderate to severe pain lasting as long as several days. Generally, the pain will be worse on awakening in the morning. Other symptoms include sensitivity to light, excessive tearing, and foreign body sensation in the eye.
Typically, epithelial basement membrane dystrophy will flare up occasionally for a few years and then go away on its own, with no lasting loss of vision. Most people never know that they have epithelial basement membrane dystrophy, since they do not have any pain or vision loss. However, if treatment is needed, doctors will try to control the pain associated with epithelial erosions. They may patch the eye to immobilize it, or prescribe lubricating eye drops and ointments. With treatment, these erosions usually heal within three days, although periodic flashes of pain may occur for several weeks thereafter. Other treatments include anterior corneal punctures to allow better adherence of cells; corneal scraping to remove eroded areas of the cornea and allow regeneration of healthy epithelial tissue; and use of the excimer laser to remove surface irregularities.
Causes of Epithelial Basement Membrane Dystrophy
- Advanced age
Ocular Herpes
Herpes of the eye, or ocular herpes, is a recurrent viral infection that is caused by the herpes simplex virus and is the most common infectious cause of corneal blindness in the U.S. Previous studies show that once people develop ocular herpes, they have up to a 50 percent chance of having a recurrence. This second flare-up could come weeks or even years after the initial occurrence.
Ocular herpes can produce a painful sore on the eyelid or surface of the eye and cause inflammation of the cornea. Prompt treatment with anti-viral drugs helps to stop the herpes virus from multiplying and destroying epithelial cells. However, the infection may spread deeper into the cornea and develop into a more severe infection called stromal keratitis, which causes the body’s immune system to attack and destroy stromal cells. Stromal keratitis is more difficult to treat than less severe ocular herpes infections. Recurrent episodes of stromal keratitis can cause scarring of the cornea, which can lead to loss of vision and blindness.
Like other herpetic infections, herpes of the eye can be controlled. An estimated 400,000 Americans have had some form of ocular herpes. Each year, nearly 50,000 new and recurring cases are diagnosed in the United States, with the more serious stromal keratitis accounting for about 25 percent. If you have been diagnosed with ocular herpes or are experiencing a flare-up, schedule an evaluation with your cornea specialist.
Causes of Ocular Herpes
- Exposure to herpes virus
Pterygium
A pterygium is a pinkish, triangular-shaped tissue growth on the cornea. Some pterygia grow slowly throughout a person’s life, while others stop growing after a certain point. A pterygium rarely grows so large that it begins to cover the pupil of the eye.
Because a pterygium is visible, many people want to have it removed for cosmetic reasons. It is usually not too noticeable unless it becomes red and swollen from dust or air pollutants. Surgery to remove a pterygium is not recommended unless it affects vision. If a pterygium is surgically removed, it may grow back, particularly if the patient is less than 40 years of age. Lubricants can reduce the redness and provide relief from chronic irritation.
Causes of Pterygium
- Extended exposure to sunlight
- Climates with lots of sun
- Age
Refractive Errors
About 120 million people in the United States wear eyeglasses or contact lenses to correct nearsightedness, farsightedness, or astigmatism. These vision disorders–called refractive errors– affect the cornea and are the most common of all vision problems in this country. Refractive errors are usually corrected by eyeglasses or contact lenses. Although eyeglasses or contact lenses are safe and effective methods for treating refractive errors, refractive surgeries are becoming an increasingly popular option.
Causes of Refractive Error
- Irregular cornea
We are proud to have some of the most talented corneal specialists in the region. These highly specialized doctors offer complete care, from diagnosis and treatment to post-operative care. If you are experiencing an issue with your vision, schedule an appointment with our doctors today.