Corneal Associates, PC
840 Walnut Street
Suite 920
Philadelphia, PA 19107-5109

Phone: 866-337-7167
Fax: 215-928-3854

Treatment for Dry Eyes, Viral Diseases, Corneal Dystrophy, Corneal Edema, and Other Eye Conditions

The Corneal Associates at Wills Eye Institute offer effective treatment for a variety of common eye afflictions. If you experience any sudden changes to your eyes, such as loss of vision, halos, floaters, or blurring; pain, swelling, or blood in the eye; double vision, or a sudden crossed, turned, or wandering eye; discharge, crusting, or excessive tearing; or any other irregularity, we urge you to visit your eye doctor immediately.

Dry Eyes
Herpes Simplex Keratisis
Corneal Dystrophy
Corneal Edema
Recurrent Erosion Syndrome
Pterygium
Skin Cancer of the Eye
More Information and Web Links

Dry Eyes

Dry eyes can result either from decreased tear production or too much evaporation of the tears from blepharitis or exposure. Blepharitis is inflammation of the eyelids, where the oily coating of the tears is produced. Exposure occurs when the eyes do not close properly, for example during sleep.

The tear film is composed of three main layers, like a sandwich. The outer layer, called the lipid or oily layer, is produced by the meibomian glands in the eyelids. The middle layer, the aqueous layer, is produced by the tear (lacrimal) glands. The inner layer, the mucin layer, is produced by cells in the conjunctiva. If anything is wrong with any of these layers, patients can suffer dry eye symptoms.

Decreased tear production, known as aqueous tear deficiency, has the technical name of keratoconjunctivitis sicca. There are many reasons for this problem including aging and certain medications, but the cause is often unknown. Sjogren’s syndrome – dry eye and dry mouth – can be either primary (no known systemic disease) or secondary – related to a connective tissue disorder, such as rheumatoid arthritis.

The Symptoms of Dry Eye Syndrome

Decreased tear production can result in burning, stinging, itching, foreign body sensation, dryness, soreness, heaviness of the lids, light sensitivity, and/or ocular fatigue. Occasionally there may be episodes of excessive tearing due to dryness, causing severe irritation of the eyes. Symptoms often are worse at the end of the day and can be aggravated by certain activities (e.g., reading, watching television, or working on the computer) and certain environments (e.g., airplane cabins, air conditioners, smoky rooms.)

Diagnosing Dry Eyes

Evaluation of dry eyes includes several tests done in our office. Fluorescein dye (yellow drops placed in the eye) is used to mark areas where the tear film isn’t healthy. It can detect microscopic corneal scratches and areas where the tear film isn’t covering the cornea well. Rose-Bengal dye (red drops placed in the eye) staining, which is more sensitive in early or mild cases and picks up less severe dry eyes, may also be used. Schirmer testing involves placing small filter paper strips in the eyes to measure tear production. Less than 10 mm of tears is abnormal. Most of these tests are done as a part of a complete evaluation for dry eyes.

Treating Dry Eyes

Treatment for dry eyes starts with the most minimally invasive steps, such as lubrication (drops, gels, and ointments). If lubricants are being used more than four times a day, preservative-free preparations are recommended. Gels and ointments may blur vision. Most patients prefer to use them later in the evening when they don’t have high visual needs. A new eye drop, cyclosporine 0.05% (marketed as Restasis®), has been shown to stimulate tear production. It is useful for patients whose dry eyes have an inflammatory component and some capacity to make tears. It causes temporary burning in about one-fifth of the users and may take several weeks to have an effect. Closure of the tear drainage ducts (punctal occlusion) can be helpful in some patients as it blocks the exit of tears from the eye, ideally keeping it more lubricated. Punctal occlusion can be done with a plug or cautery and may be beneficial when adequate relief is not obtained from other treatments.

Blepharitis, or eyelid inflammation, can give similar symptoms to aqueous tear deficiency as it affects production of the eyelid oils, which coat the tears. The outer oily layer of the tear film slows down the evaporation of tears from the eyes. Loss of this layer can lead to increased evaporation of tears and dry eyes. Treating blepharitis involves warm compresses that, when applied for five to ten minutes, make the thickened oily component of tears more liquid. If there is significant crusting of the eyelashes, lid scrubs with diluted baby shampoo may decrease some of the inflammation. Lid massage, topical antibiotic ointments such as bacitracin or erythromycin and oral antibiotics (tetracycline family or erythromycin) also may help treat blepharitis. In some circumstances, topical steroids are used to decrease the eyelid inflammation. Their use, however, should be minimized. Patients using topical steroids need careful follow-up, as they could lead to cataracts and glaucoma. A physician needs to monitor these medications and check intraocular pressure regularly.

As with all eye conditions, patients with symptoms of dry eye should have a careful and complete eye examination before any treatments are started.

Herpes Simplex Keratitis

Herpes simplex type 1, the kind that causes corneal problems, is the same type of herpes that causes cold sores in the mouth and on the lips. It is not the sexually transmitted type of herpes. Some people get herpes in the eye, usually in the cornea. We can treat it using drops, ointment, pills or a combination of these medications. This therapy generally cures the infection, but it can recur. Recurrent infections may lead to mild to severe scarring and cause decreased vision.

Inflammation of the cornea can also occur after a herpes infection and may need to be treated carefully with steroid drops. Recurrent bouts of inflammation can lead to mild to severe corneal scarring. If severe scarring develops, it may be treatable with a corneal transplant.

Herpes treatment has progressed significantly since Dr. Laibson started here at Wills Eye Institute. He started doing herpes research in his first year of residency, before there were any antiviral drugs. He did this with the director of research at Wills, Ted Sery.

The research was progressing when IDU, the first antiviral drug effective against herpes, was discovered. Dr. Laibson was immediately put on a research project, which lasted for two years. After that research, Dr. Laibson continued his interest in Herpetic Eye Disease with the department’s involvement in the HEDS NIH funded studies, which spanned ten years.

Corneal Dystrophy

Corneal dystrophies are inherited non-inflammatory diseases that affect both eyes. There are several types of corneal dystrophy. Some corneal dystrophies, such anterior basement membrane dystrophy, affect the front surface of the cornea.

Dystrophies that affect the front layer of the cornea can cause painful episodes, decreased vision, or both. Some dystrophies affect the body of the cornea, such as granular or macular lattice dystrophy. These dystrophies can also cause decreased vision, painful episodes, or both. Dystrophies that affect the back surface of the cornea, such as Fuchs' dystrophy, can lead to corneal edema (see below). Treatment options include eye drops, eye ointments and surgery. Surgical options include removing the surface layer of the cornea with a diamond burr or excimer laser, phototherapeutic keratectomy (PK), and corneal transplantation.

Corneal Edema

Corneal edema means that the surface layer of the eye, the cornea, is swollen. It can cause mild to severe irritation and decreased vision. Causes include surgery (including cataract surgery), trauma, and corneal dystrophy. Treatment with eye drops may help. Patients with advanced corneal edema may require surgery, such as a corneal transplant.

Recurrent Erosion Syndrome

Loosening of the surface layer of the cornea can cause mild to severe pain, depending on the amount of damage. The pain usually develops during the night or upon waking in the morning, and can recur. Traumas to the eye or certain cornea dystrophies predispose people to these painful episodes. Recurrent erosions often respond to treatment with eye drops and ointments. If not, they may be treatable with anterior stromal micropuncture, diamond burr polishing of the cornea, or with laser surgery.

Pterygium

A pterygium is a wedge-shaped scar tissue growth on the surface of the cornea caused by sun exposure. Pterygia can cause redness and inflammation of the eye. If pterygia become large, they can cause decreased vision. Occasionally, an inflamed pterygium may respond to eye drops. When vision becomes affected or the pterygium grows quickly, surgery to remove it is often recommended. At Corneal Associates, we remove pterygia on an outpatient basis.

Skin Cancer of the Eye

Just like on the skin, there are many types of cancers that can affect the eye. The most common is similar to a common skin cancer and develops on the surface of the eye. It is typically treated with surgical removal of the cancer to prevent it from affecting your vision or spreading to other parts of the body. Occasionally, eye drops can be helpful. While this type of cancer does not usually grow back, patients will need to be monitored for recurrence following removal.