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Eye Disease

The most important information we can provide regarding developing eye disease such as cataracts, glaucoma, macular degeneration, retinal detachment, and vision loss due to diabetes and high blood pressure is that a presenting symptom of all of these can be blurred vision. And all, with exception to a specific type of glaucoma, are painless.


Amblyopia is a disorder of the visual system characterized by reduced vision in an eye that is otherwise physically normal. Amblyopia is the most common visual impairment in childhood, affecting approximately 3 out of every 100 children, and is due to differences in refractive errors between the eyes or strabismus (eye turn). In amblyopia, the brain receives different signals from each eye and begins to ignore the weaker eye. As this continues, the visual nerve fibers from the weaker eye do not develop as those fibers from the fellow eye. Unless treated successfully in early childhood, permanent reductions in vision and functional blindness can occur. At this point, further visual improvement can not be achieved with glasses, contact lenses or surgery.

Amblyopia is treated by forcing the brain to acknowledge the weaker eye. This is typically accomplished by wearing a patch over the better eye for a period of time over weeks or months. The treatment goal is to reduce the visual signal from the better eye while allowing the fibers from the weaker eye to better develop. Length of treatment depends on the severity of amblyopia, age of the child and achievable visual outcome. Amblyopia may also be treated using medication, which blurs the visual signal from the better eye.

Signs to look for include:

  • Reduced vision in one eye
  • Squinting or closing one eye during reading or watching Television
  • An eye that turns in or out
  • Tilting or turning the head while viewing

Although recent research has suggested that amblyopia is treatable after childhood, detecting it early (before age 9) increases visual outcome. Therefore, Williamsburg Eye Care recommends having your child’s eyes examined early and frequently throughout adolescence.


A cataract is a cloudy or opaque area in the normally clear lens of the eye. Depending upon its size and location, it can interfere with normal vision. Most cataracts develop in people over age 55, but they occasionally occur in infants and young children. Usually cataracts develop in both eyes, but one may be worse than the other.

The lens is located inside the eye behind the iris, the colored part of the eye. The lens focuses light on the back of the eye, the retina, and is made of mostly proteins and water. Clouding of the lens occurs due to changes in these proteins and lens fibers over time.

The lens is composed of layers like an onion, with the outermost being the capsule. The layer inside the capsule is the cortex, while the innermost layer is the nucleus. A cataract may develop in any of these areas and is described based on its location in the lens:

  • A nuclear cataract is located in the center of the lens and results in a change in clarity as the nucleus darkens from clear to yellow and sometimes brown.
  • A cortical cataract affects the layer of the lens surrounding the nucleus and is identified by its unique wedge or spoke appearance.
  • A posterior capsular cataract is found in the back outer layer of the lens. This type often develops more rapidly and is more visually significant relative to its size.

Normally, the lens focuses light on the retina, which sends the image through the optic nerve to the brain. However, if the lens is clouded by a cataract, light is scattered, causing blur, halos and glare.

Symptoms of cataracts may include:

  • Painless, gradual reduction in vision
  • Reduced intensity of colors
  • Increased sensitivity to glare from lights
  • Increased difficulty seeing at night
Normal vision View through a cataract

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The conjunctiva is the outer most layer of the eye as well as the inner surface of the eyelid. Inflammation of this tissue leads to a diagnosis of conjunctivitis. Conjunctivitis, also referred to as “pink eye,” is typically caused by an allergic reaction or infection due to a virus or bacteria. In those cases where a virus or allergy is the cause, an antibiotic will have no affect on the infection. Even among bacterial infections, not all antibiotics kill all types of bacteria. It is the belief that an antibiotic is needed for everything that has helped create antibiotic-resistant bacteria.

Conjunctivitis may affect one eye or both, or may begin in one eye and go to the other. A slit lamp (microscope) is needed to have any confidence in the actual cause of conjunctivitis.

There are other infections and inflammations of the eye that may mistakenly be diagnosed and treated as conjunctivitis. Therefore, it is important to see the doctors at Williamsburg Eye Care should you experience any of the following symptoms:

  • Redness
  • Clear or mucous discharge
  • Excessive mucous upon awakening
  • Light sensitivity
  • Itching
  • Swelling of the eye(s) and/or eyelid(s)
  • Eye pain
  • Burning
  • Blurred vision


Not all of these symptoms will be seen in conjunctivitis, while others may be more indicative of other diagnoses. If you are a contact lens wearer it is very important that you’re seen by our professionals, diagnosed and treated appropriately.

You can help to limit the risk of developing an eye infection by washing hands with soap and water often and avoid touching the eye if possible.

Diabetic Retinopathy

Diabetic eye disease is a leading cause of blindness in adults and refers to problems that people with diabetes may face as a complication of the disease. Diabetes can cause severe vision loss or even blindness. Diabetic retinopathy may be due to swelling blood vessels that leak fluid, drowning cells from reduced supply of oxygen. In other cases abnormal new blood vessels grow on the surface of the retina, which tend to leak more, compounding the demand for oxygen. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

Normal Vision View with diabetic retinopathy

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Dry Eye Syndrome/Ocular Service Disease

The tears we produce are necessary for overall eye health and clear vision. Under normal circumstances each blink provides a fresh tear film and refractive surface while washing away debris. Tear film deficiency is due to an improper chemical composition within the tears and can be due to a number of several factors.

Symptoms of ocular surface disease, also known as dry eye syndrome, may include irritated, scratchy, dry, uncomfortable or red eyes, excessive tearing, a burning, gritty, foreign-body sensation, as well as fluctuating vision.

Treatment for an unstable tear film depends on the cause, severity and signs. Previously, symptoms played a significant role but we now know it is better to discuss treatment before symptoms develop.

Causes of Ocular Surface Disease/Dry Eye Syndrome

There are three layers of the tear film—inner mucin layer, middle aqueous (water) layer and outer lipid (oil) layer. These three layers work together to provide lubrication and form a protective barrier.

Dry Eye Syndrome/Ocular Surface Disease can be caused by one of several factors or a combination of them all. Causes include inflammation of the ocular surface, a disruption in the lipid layer known as Meibomian Gland Disease/Dysfunction (MGD) and/or insufficient production of aqueous from the lacrimal gland. Further, there are separate causes to each of these that might include autoimmune disorders, medication side effects, allergens, and/or environmental causes.

Meibomian Gland Disease/Dysfunction (MGD)

The meibomian glands are thin glands within the upper and lower lids responsible for secreting the oily (lipid) layer of the tear film. Without the outer lipid layer the aqueous component of the tear film is exposed and evaporates quickly. In order to remain vibrant meibomian glands require stimulation. This occurs with the blink as the interaction between lids creates pressure causing the glands to secrete oils. In MGD, the meibomian glands become obstructed as the lipids become more solid. Due to the obstructive glands, there is a lack of stimulation and the glands begin to dilate (thicken), truncate (shorten) and atrophy (die). Once a gland has atrophied there is no ability to revive it. The lack of lipids in the tear film leads to early evaporation of the tears, otherwise known as evaporative dry eye. The images below demonstrate a normal tear film (left) and one that is evaporating quickly (right).

Below is an example of MGD progression. In the top photograph you can see the long, thin meibomian glands. As MGD advances the glands begin to thicken, shorten and drop-out, eventually leading to a loss of glands.  MGD is chronic, progressive and obstructive.

Treating Meibomian Gland Disease/Dysfunction

Lipiflow® is FDA-approved to remove the obstructive nature of MGD by providing direct, controlled heat and pressure to the eyelids. This 12-minute procedure warms the eyelids to melt the dead cells and solid-state lipids within the glands and then removes the obstructions through applied pressure. Follow this link for information on Lipiflow®.

MGD is diagnosed by examining gland structure and function.


Glaucoma is an eye disease in which the pressure within the eyes typically increases enough to damage nerve fibers in the optic nerve, leading to vision loss. This increase in pressure happens when the passages that normally allow fluid within the eyes to drain become clogged or blocked. If left undetected or untreated, glaucoma leads to blindness.

Glaucoma is one of the leading causes of blindness in the United States and most often occurs later in life. Risk factors for developing glaucoma include the following:

  • Increasing intraocular pressure
  • Thin optic nerves
  • Family history
  • Race – African ancestry increases risk
  • Increasing age
  • Diabetes
  • Smoking

The most common type of glaucoma develops gradually and painlessly, without symptoms. A rarer type occurs rapidly and its symptoms may include blurred vision, loss of peripheral or side vision, seeing colored rings or halos around lights and pain or redness in the eyes as well as nausea and vomiting.

The treatment for glaucoma includes prescription eye drops and medicines to lower the pressure within the eye to prevent further damage to optic nerve tissue and loss-of-vision. In some cases, laser treatment or surgery may be effective in reducing pressure. Diagnosed and treated early, glaucoma can be controlled. Vision lost due to glaucoma cannot be restored.

Normal vision View with progressive glaucoma

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Macular Degeneration

Macular degeneration is a disease associated with aging that gradually destroys central vision, which is needed for seeing objects clearly. Age-related macular degeneration (AMD) affects the macula, the part of the eye responsible for seeing fine detail and is a leading cause of vision loss in Americans age 60 years and older. Macular degeneration is painless.

There are two forms of AMD; dry and wet. Dry AMD is much more common than wet, although the wet form leads to significantly more vision loss. Current treatment may include use of multivitamins and anti-oxidants specifically shown to reduce progression in certain cases of macular degeneration. Treatment of wet macular degeneration may include a combination of two or more different medications and the use of a laser.

Risk factors for developing macular degeneration include the following:

  • Smoking
  • Obesity
  • Race – Caucasian ancestry increases risk
  • Family history
  • Gender-females appear to be at greater risk for unknown reasons

Development of macular degeneration is painless and may include symptoms of blurred vision and distortion of straight lines.

Normal vision View with macular degeneration

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Retinal Detachment

The retina is the light-sensitive tissue that lines the inside of the eye and sends visual information through the optic nerve to the brain. A retinal detachment is the process by which the retina becomes separated from its supply of oxygen. A retinal detachment is an eye emergency and our office should be called immediately. If after hours, the doctor on-call may be reached directly.

Symptoms of retinal detachment include:

  • Flashing lights
  • Sudden or gradual increase in the number of “floaters”
  • A curtain covering the field of vision

Although a retinal detachment can occur at any age, specific risk factors include:

  • Age over 40
  • Extreme myopia, or nearsightedness
  • History of retinal detachment in the fellow eye
  • Cataract surgery
  • Other diseases of the eye
  • History of injury or trauma

A retinal detachment is painless.

You can help to limit the risk of developing an eye infection by washing hands with soap and water often; avoid touching the eye if possible; and use appropriate care when handling contact lenses, which includes following guidelines for cleaning and storage as well as the replacement schedule prescribed.