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    • Comprehensive Eye Exams

    • Periodic eye and vision examinations are an important part of preventive health care. Many eye and vision problems have no obvious signs or symptoms. As a result, individuals are often unaware that problems exist. Early diagnosis and treatment of eye and vision problems are important for maintaining good vision and eye health, and when possible, preventing vision loss. 

      A comprehensive adult eye and vision examination may include, but is not limited to, the following tests. Individual patient signs and symptoms, along with the professional judgment of the doctor, may significantly influence the testing done. 

      List of tests included in a typical comprehensive eye exam: Patient History, Visual Acuity, Preliminary Tests, Keratometry, Refraction, Eye Focusing/Eye Teaming & Eye Movement Testing, Eye Health Evaluation, supplemental Testing.


      Comprehensive Contact Lens Exams

      Contact Exams

      Eye exams for contact lenses include special tests that typically are not performed in routine eye exams for eyeglasses.

      So if you are interested in contacts — or you already wear them and want to have your contact lens prescription updated — make sure you say so when you schedule your appointment for an eye exam. This will ensure your exam includes extra time for your optometrist to perform additional tests needed for a proper contact lens fitting or prescription update.

      What To Expect During a Contact Lens Fitting

      During your comprehensive eye exam, your visual acuity will be tested using an eye chart, and a number of tests will be performed to determine your eye health and whether prescription eyewear is required to correct refractive errors.

      After this testing has been completed, your eye doctor will gather additional information so you can be fitted with contact lenses.

      You may be asked general questions about your lifestyle and preferences regarding contact lenses, such as whether you might want to change your eye color with color contact lenses or if you're interested in options such as daily disposables or overnight wear.

      Your eye doctor may also discuss the option of rigid gas permeable (RGP or GP) contact lenses, which often provide sharper vision than soft lenses.

      Your eye doctor also might ask how you want to correct vision problems related to aging. Some time after age 40, you will develop a condition known as presbyopia that decreases your ability to read small print and focus on near objects.

      To correct presbyopia, your eye doctor may offer you the choice of multifocal or bifocal contact lenses. Another option is monovision, which is a special contact lens fitting technique where one eye is corrected for distance vision and the other eye is corrected for near vision.

      Contact Lens Measurements

      Just as one shoe size doesn't fit all, one contact lens size doesn't fit all.

      If the curvature of a contact lens is too flat or too steep for your eye's shape, you could experience discomfort or even eye damage. Other aspects of a contact lens fitting include:

      Cornea measurements

      An instrument called a keratometer will be used to measure the curvature of your eye's clear front surface (cornea).

      Tear film evaluation

      Contact lens fittings may also include a tear film.

      Evaluation of your eye's surface and contact lens fit

      The health of your cornea will be using a biomicroscope (also called a slit lamp). This lighted instrument provides a highly magnified view of the cornea and other tissues to enable your eye doctor to evaluate the health of the front of your eyes and detect any changes caused by contact lens wear.

      The biomicroscope also is used to evaluate the fit of a trial contact lens, because it enables your doctor to observe the alignment and movement of the lens as it rests on the surface of your eye.

      When trial lenses are used, you typically will need to wear them a few minutes so that initial tearing of the eye stops and the lenses stabilize. Your eye doctor can then make a proper evaluation of how the lenses fit without the presence of excess moisture caused by tearing.

      In follow-up visits, your eye doctor may stain your eye with fluorescein to check for defects and make sure your contact lenses are not damaging your eye's surface. You usually will need to remove your contact lenses before this test is performed.

      After finding contact lenses that fit properly, are comfortable for you, and provide good vision, your eye doctor can write your contact lens prescription. This prescription will designate contact lens power, a shape matching the curvature of your eye (base curve), and diameter.

      Usually, it takes two or three follow-up visits to complete an uncomplicated contact lens fitting. After that, you should have annual contact lens exams so your eye doctor can monitor the health of your eyes. In some cases, you may need more frequent exams or additional follow-up visits.

      Keep in mind that if you wear contact lenses, your annual eye exams typically will cost more than a routine exam for someone who doesn't wear contacts, due to the additional contact lens-related tests that are included. 

      Diabetic Eye Exams

      Diabetes can harm your eyes. It can damage the small blood vessels in your retina, or the back of your eye.is called diabetic

      Diabetes also increases your risk of glaucoma and other eye problems.You may not know your eyes are harmed until the problem is very bad. Your doctor can catch problems early if you get regular eye exams.

      You Need Regular Eye Exams

      Even if the doctor who takes care of your diabetes checks your eyes, you need an eye exam every 1-2 years by an eye doctor who takes care of people with diabetes.

      If you have eye problems because of diabetes, you will probably see your eye doctor more often. Sometimes, your doctor may tell you to come less often.

      You may see two different types of eye doctors:

      -An ophthalmologist is a medical doctor trained to diagnose and treat eye problems.

      -An optometrist is a health care provider trained to diagnose and treat eye problems. Many can do screening exams for damage from diabetes. Once you have eye disease caused by diabetes, you will see an ophthalmologist.

      What Is a Dilated Retinal Exam?

      The doctor will check your vision using a chart of random letters of different sizes. This is called the Snellen chart.

      You will then be given eye drops so that the doctor can better see the back of the eye. You may feel stinging when they are first placed. You may have a metallic taste in your mouth.

      To see the back of your eye, the doctor looks through a magnifying glass using a bright light. The doctor can then see areas that may be damaged by diabetes:

       -Blood vessels in the front or middle parts of the eye

       -The back of the eye

       -The optic nerve area

      Another device called a slit lamp is used to see the clear surface of the eye (cornea).

      The doctor may take photos of the back of your eye to get a more detailed exam.

      After Your Eye Exam

      If you had drops to dilate your eyes, your vision will be blurred for about 6 hours. It will be harder to focus on things that are near.

      Sunlight can damage your eye. Wear dark glasses or shade your eyes until the effects of the drops wear off.

      LASIK Consultation & Management

      About LASIK

      LASIK is a surgical procedure that uses a laser to correct nearsightedness, farsightedness, and/or astigmatism. In LASIK, a thin flap in the cornea is created using either a microkeratome blade or a femtosecond laser. The surgeon folds back the flap, then removes some corneal tissue underneath using an excimer laser. The flap is then laid back in place, covering the area where the corneal tissue was removed. Refractive surgery is the term used to describe surgical procedures that correct common vision problems (nearsightedness, farsightedness, astigmatism and presbyopia) to reduce your dependence on prescription eyeglasses and/or contact lenses. Currently, a laser procedure called LASIK (LAY-sik) is the most popular refractive surgery performed in the United States. But there are other types of refractive surgery — including other laser procedures and intraocular lens (IOL) procedures — that might be an even better choice for you, depending on your needs.


      With nearsighted people, the goal of LASIK is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. LASIK can also correct astigmatism by smoothing an irregular cornea into a more normal shape.If you are considering LASIK eye surgery, your first step is to choose a good LASIK surgeon who can evaluate whether LASIK is right for you. Your LASIK surgeon will examine your eyes to determine their health, what kind of vision correction you need, and how much laser ablation (corneal tissue removal) is required. The doctor will also ask about any health conditions that may disqualify you altogether for LASIK surgery. If you are not a candidate for LASIK, you may qualify for another laser eye surgery such as PRK (similar to LASIK but without the flap), LASEK, or epi-LASIK. There are also non-laser vision correction procedures. Your prescription and eye structure will be considered to help determine which procedure is best for you.

      LASIK is an outpatient procedure, so you don't have to stay at the surgery center overnight. The LASIK surgeon uses a computer to adjust the laser for your particular prescription. You will be asked to look at a target light for a short time while the laser sends pulses of light to painlessly reshape your cornea. The actual LASIK surgery usually takes less than five minutes.




      Dry Eye Management

      Dry eye syndrome is caused by a chronic lack of sufficient lubrication and moisture on the surface of the eye.

      Its consequences range from subtle but constant irritation to inflammation of the anterior (front) tissues of the eye.

      Dry eyes also are described by the medical term, keratitis sicca, which generally means decreased quality or quantity of tears. Keratoconjunctivitis sicca refers to eye dryness affecting both the cornea

      Dry Eye Symptoms

      Persistent dryness, scratchiness, red eyes and a burning sensation are common symptoms of dry eyes. These symptoms alone may prompt your eye doctor to diagnose dry eye syndrome.

      Dry eyes can become red and irritated, causing a feeling of scratchiness.

      But sometimes your eye doctor may want to measure the amount of tears in your eyes. A thin strip of filter paper placed under the lower eyelid, called a Schirmer test, is one way to measure tear production.

      Another symptom of dry eyes is a "foreign body sensation," which is a feeling that something is in your eye.

      And it may seem odd, but dry eye syndrome also can cause watery eyes. This is because dryness on the eye's surface sometimes will overstimulate production of the watery component of your tears as a protective mechanism.

      What Causes Dry Eyes?

      Tears bathe the eye, washing out dust and debris and keeping the eye moist. They also contain enzymes that neutralize microorganisms that colonize the eye. Tears are essential for good eye health.

      Tears are complex, containing many different essential elements, including oils produced by special glands in the eyelids called meibomian glands. These oils prevent evaporation of the tears.

      Eyes Are Dry Most Often When Springtime Allergens Are in the Air

      May 2015 — Ever notice that your eyes are dryer in April than during other months? This happens to be the same month when springtime allergens are peaking, and a study seems to have found a definitive link between them.

      Researchers at the University of Miami reviewed 3.4 million visits to Veterans Affairs eye clinics between 2006 and 2011, when about 607,000 people were diagnosed with dry eye. They also looked at the prevalence of dry eye and allergies and found that both peaked in springtime, especially in April. (Dry eye also spikes in wintertime, likely due to lower indoor humidity.)

      Since dry eyes are linked to allergies, then allergy prevention such as wearing goggles outside and using air filters inside could also help prevent dry eyes.

      The study results appeared on the journalOphthalmology's website in late April. — L.S.

      In dry eye syndrome, the lacrimal gland or associated glands near the eye don't produce enough tears, or dysfunction of the meibomian glands reduces oil output, leading to excessive evaporation of the tears. This is called evaporative dry eye and is now considered to be the primary cause or a contributing factor of most cases of dry eye.Dry eye syndrome has many causes. It occurs as a part of the natural aging process (especially duringmenopause in women); as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills; or because you live in a dry, dusty or windy climate.If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.

      Dry eyes also are a symptom of systemic diseases such as lupus, rheumatoid arthritis, ocular rosaceaor Sjogren's syndrome (a triad of dry eyes, dry mouth and rheumatoid arthritis or lupus).Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among contact lens wearers.

      Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and evaporation of moisture from contact lenses worsens dry eye symptoms. Newer contact lens materials and lens care products can help reduce contact lens dryness.

      Incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.

      Tears consist of three essential components:

      -The outer, oily lipid component

      -The middle, watery, lacrimal component

      -The innermost component, consisting of mucous or mucin

      Each component of the tear film serves a critical purpose. For example, tear lipids prevent evaporation and increase lubrication, while mucins help anchor the tears to the ocular surface.

      Each tear component is produced by a different gland:

      -The outer oily component is produced by meibomian glands in the eyelids.

      -The watery component is produced by lacrimal glands located above the outer corner of the eyes.

      -The inner mucoid component is produced by goblet cells in the conjunctiva.A problem with any of those sources can result in tear instability and dry eyes.

      Dry eye syndrome is more common among women, possibly due to hormonal fluctuations. A recent study also indicates that the risk of dry eyes among men increases with age.

      Recent research suggests that smoking, too, can increase your risk of dry eyes.

      With increased popularity of cosmetic eyelid surgery (blepharoplasty) for improved appearance, dry eye complaints now occasionally are associated with incomplete closure of eyelids following such a procedure.

      Dry Eye Syndrome More Prevalent in Larger Cities

      Residents of some of the largest U.S. metro areas now have another item to add to their list of concerns, apart from traffic. Research shows that cities with high levels of air pollution have an increased risk of dry eye syndrome.

      Cities cited in the study included Chicago, New York, Los Angeles and Miami. Study subjects in and around Chicago and New York City were three to four times more likely to be diagnosed with dry eye syndrome than those in less urban areas with relatively little air pollution.

      Using data from the National Veterans Administrative database, the National Climatic Data Center and National Aeronautics and Space Administration, researchers examined the health records of 606,708 U.S. veterans who had received dry eye syndrome treatment in one of 394 VA eye clinics from July 2006 through July 2011.

      Those living in areas with high levels of air pollution had the highest magnitude of increased risk for dry eye syndrome, at an incidence rate ratio of 1.4. Most metropolitan areas showed relatively high prevalence of dry eye syndrome (17-21 percent) and high levels of air pollution. In addition, the risk of dry eye syndrome was 13 percent higher in zip codes in high altitude areas. — T.M.

      Dry Eye Disease High Among Office Computer Users

      More than 75 percent of women who routinely use a computer at work may suffer from dry eye disease (DED), says a study.

      Researchers in Japan investigated the tear function and prevalence of dry eye symptoms among office workers who routinely use a computer on the job. Findings for 561 office workers (average age 43.3 years) were included in the study results. Participants completed questionnaires and underwent dry eye testing.

      The percentage of female computer users with "definite or probable" DED was 76.5 percent; among male workers, it was 60.2 percent. Risk factors for dry eye included being over 30 and using a computer more than eight hours per day.

      The study authors concluded dry eye disease is prevalent among young to middle-aged Japanese VDT users and that measures to reduce the adverse effects of computer use on the eye's surface may improve public health and quality of life for office workers. A report of the study appeared on the website of the American Journal of Ophthalmology in July 2013.

      Reading More Slowly? Maybe It's Your Dry Eyes

      Discomfort and redness aren't the only symptoms of dry eyes. Reading speed can slow down, too.

      This is according to a study that measured reading speed andcontrast sensitivity among 52 adult dry eye sufferers and a 20-member control group. The study showed that contrast sensitivity was not significantly different across the groups, but reading speed was. And reading rates decreased as the severity of the dry eye disease increased.Researchers concluded that reading speed could be a measure of treatment benefit for dry eye sufferers. A report of the study appeared in Optometry & Vision Science in January 2013.

      How Common Are Dry Eyes?

      Dry eyes and dry eye symptoms are very common, particularly among older adults. And a consumer survey commissioned by Allergan suggests dry eyes are even more prevalent than previously believed.

      The survey found:

      -48 percent of adult Americans regularly experience dry eye symptoms.

      -42 percent of women age 45 to 54 who have dry eye symptoms report blurred vision associated with the condition.

      -Women more frequently than men report having difficulty using a computer due to dry eye symptoms (62 vs. 44 percent).

      -43 percent of adults with dry eye symptoms say they experience difficulty reading due to their symptoms.

      -Among adults age 55 and older, 30 percent of men and 19 percent of women say they have experienced dry eye symptoms for more than 10 years.

      -19 percent of adults say they use over-the-counter eye drops at least five times per week to treat dry eye symptoms.

      -63 percent of adults who use non-prescription eye drops to treat dry eyes say the drops are not effective or only somewhat effective in managing their symptoms.

      The survey also found that though dry eyes cause problems for nearly half of adult Americans, many people fail to seek professional help for dry eye symptoms: 69 percent of respondents who experienced symptoms said they had not visited an eye care professional for dry eye treatment.

      The Allergan Dry Eye Survey was conducted online in March 2011 by Harris Interactive, with 2,411 adults (age 18 and older) responding.

      Smartphone Use Linked to Dry Eye in Schoolchildren

      There might be another cost associated with children using smartphones besides a large monthly bill from the phone company: It could be causing kids to develop dry eye disease at an early age.

      Researchers in Korea evaluated risk factors for dry eye disease among schoolchildren who used video devices, including smartphones. They examined 288 children and classified them as either having dry eyes or having a normal, moist eye surface (control group). Each child completed a questionnaire concerning the types of video devices they commonly used (computer, smartphone and television) and the amount of time they spent using each device.

      Among the participants, 9.7 percent were diagnosed with dry eyes, and 90.3 percent comprised the control group. Smartphone use was more common in the dry eyes group than the control group (71 percent vs. 50 percent), and increased daily duration of smartphone use was associated with increased risk of dry eye disease, as was the total hours per day spent using all video devices combined.

      One interesting finding is that increased duration of computer use and television viewing measured separately did not increase the risk of dry eye disease.

      The study authors concluded that smartphone use is an important dry eye disease risk factor in children, and that parents should monitor the amount of time their children spend using video displays, especially smartphones, on a daily basis. The study report appeared in the April 2014 issue of Journal of Pediatric Ophthalmology and Strabismus.

      — G.H.

      Treatment for Dry Eyes

      Dry eye syndrome is a chronic and typically progressive condition that may not be completely curable (depending on the cause). But the accompanying dryness, scratchiness and burning can be managed. Because dry eyes can be caused by many different things, a variety of treatment approaches are used.

      Eye drops and other lubricants

      Your eye care practitioner may prescribe artificial tears, drops that may alleviate the dry, scratchy feeling. Some artificial tears address specific tear deficiencies, such as lack of sufficient lipids.

      Prescription eye drops called Restasis (Allergan) go one step further: they help your body produce more tears by reducing inflammation associated with dry eye syndrome.

      Another option for dry eye treatment is called Lacrisert, a tiny insert filled with a lubricating ingredient (hydroxypropyl cellulose). The insert is placed just inside the lower eyelid, where it continuously releases lubrication for the eye throughout the day.

      Sometimes people use eye drops that are advertised to "get the red out" to treat their dry eyes. While these drops can reduce or eliminate eye redness temporarily, they may or may not be effective at lubricating your eyes, depending on the formulation.

      Also, your eyes can develop a tolerance to the eye-whitening agents (vasoconstrictors) in these drops, which can cause even more redness over time. Redness-relieving eye drops can cause other adverse effects as well, especially if you use them too often.

      If you wear contact lenses, be aware that many eye drops, especially artificial tears, cannot be used while your contacts are in your eyes. You'll need to remove them before using the drops and wait 15 minutes or even longer (check the label) before reinserting your contact lenses.

      If your eye dryness is mild, then contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect usually is only temporary.

      Check the label on any eye drops you use, or better yet, check with your optometrist or ophthalmologistbefore buying any over-the-counter eye drops. It will probably save you a lot of money, because he or she will know which formulas are most effective and long-lasting and which ones are not, as well as which eye drops will work with your contact lenses.

      Eyesential sunglasses by Dioptics can help with dry eyes because their foam-lined frames keep out dust, wind and other irritants. Shown is the Mod Rectangle style.

      Left: Artificial tears help dry eyes feel better; don't confuse them with formulas that just reduce redness. Salmon is a good source of omega-3 fatty acids, which may reduce your risk for dry eyes. Sardine, herring and cod liver oils are even better, or try a supplement.

      Blocked Meibomian Glands

      Meibomian gland dysfunction (MGD) is now recognized as a primary cause ofcontributor to most cases of dry eye. LipiFlow treatment (TearScience) is an in-office procedure that clears blocked meibomian glands and restores normal function.

      Some practitioners may recommend warm compresses applied to the eyes, followed by manual expression of the meibomian glands to treat MGD and evaporative dry eye.

      Your Environment

      If the problem is environmental, wearsunglasses when outdoors to reduce exposure toand dust. You may want to try the kind that has a foam or other seal at the sides and/or a close-fitting, wrap-style frame to keep wind and dust from getting behind the lenses and in your eyes.

      Recent research suggests that cold temperatures may be another environmental cause of dry eyes. If it gets cold and windy where you live, try wearing goggles when you're outside in winter.

      Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that's too dry because of air conditioning or heating.

      Punctal Occlusion

      Temporary or permanent silicone plugs can be inserted in the lacrimal (tear) drainage ducts your eyelids to keep tears on your eye from draining away as quickly. Called lacrimal plugs or punctal plugs, they can be inserted painlessly while you're in the eye doctor's office and normally are not felt once inserted.

      This drawing shows the lacrimal glands and tear ducts. A lacrimal plug (or punctal plug) has been inserted into the lower tear duct to keep the eye's moisture from draining away too quickly. Image: Oasis Medical, Inc.

      A new type of punctal plug made of acrylic is a small rod that becomes a soft gel when exposed to your body heat after insertion. These plugs are designed to swell and conform to the size of your tear drainage canal.

      Advantages of this type of plug are that one size fits all, so measurement is unnecessary, and nothing protrudes from the tear duct that could potentially cause irritation.

      Another new kind of punctal plug is made of a hydrogel material that expands into a soft, pliable gel in the tear drainage canal. It has no cap, and should it need to be removed, the eye care practitioner can simply flush it out with saline solution.

      With some people, however, punctal plugs aren't effective enough, so their tear ducts need to be closed surgically (punctal cautery).


      Nutrition and Hydration

      Doctors sometimes recommend special nutritional supplements for dry found that supplements containing omega-3 fatty acids can decrease dry eye symptoms. Good sources of omega-3s include cold-water fish, such as sardines, cod, herring and salmon. Some eye doctors also recommend flaxseed oil to relieve dry eye. Drinking more water can help, too. Mild dehydration often makes dry eye problems worse. This is especially true during hot, dry and windy weather. Simply drinking more water sometimes reduces the symptoms of dry eye syndrome. The Institute of Medicine says that each day, women need 91 ounces of water and men need about 125 ounces to stay hydrated. Experts agree that about 20 percent of the water your body needs comes from the food you eat, while the rest originates from the fluids you drink. The best choices for beverages are water, 100 percent fruit and vegetable juices and milk.





      Red Eye Treatment & Management

      We've all experienced red, bloodshot eyes from time to time, affecting one or both eyes. Red eye is caused by swollen or dilated blood vessels on the sclera, the white outer surface of the eye.

      Red eyes can be accompanied by eye pain, itching, eye discharge, swollen eyes or visual disturbances such as blurry vision. In other cases, a red eye may cause no irritation at all.

      Bloodshot eyes can develop over time or appear suddenly, particularly in response to allergies or an eye injury.

      What Is Red Eye?

      "Red eye" is a general term used to describe red, irritated and bloodshot eyes. It also may refer to:

      -Subconjunctival hemorrhage, or broken blood vessel on the sclera

      -Blepharitis, or inflamed eyelids

      -Stye, or a red bump on the eyelid

      -Special-effect contact lenses to create a "crazy" red-eye effect

      -Red eyes in photos

      Red eyes occur when the blood vessels on the surface of the eye expand.

      The appearance of red eye ranges in severity from a bright red that completely covers the sclera to a few enlarged blood vessels that look like wiggly red or pink lines across the "white" of the eye.

      Red eyes usually are caused by allergy, eye fatigue, over-wearing contact lenses or common eye infections such as pink eye (conjunctivitis).

      However, redness of the eye sometimes can signal a more serious eye condition or disease, such as uveitis or glaucoma. If your red eye persists or worsens, always contact your eye doctor for proper diagnosis and treatment.

      Common Causes of Red Eye

      Conjunctivitis. Also called "pink eye," conjunctivitis is one of the most common (and contagious) eye infections, particularly among school children.

      It occurs when the conjunctiva — the thin, normally transparent membrane that covers the sclera and lines the eyelids — becomes infected.

      When the conjunctiva is infected, the blood vessels within it become irritated and swell, giving the eye a red or pink appearance. In fact, a reddish-pink eye is a telltale symptom of conjunctivitis.

      There are different types of conjunctivitis — and therefore different ways to treat pink eye — so be sure to always visit your eye doctor for correct diagnosis.

      SEE ALSO: Various Kinds of Conjunctivitis and How to Tell Which One You Have >

      Dry eyes. Dry eye syndrome occurs when your tear glands produce either an insufficient quantity or quality of tears to properly lubricate and nourish your eyes. Chronic dry eye can cause the surface of the eye to become inflamed and irritated, making your eyes look red.

      While dry eye syndrome may not be curable, it can be managed. Treatment for dry eyes includes lubricating "artificial tears" eye drops and punctal plugs. Ask your eye care practitioner for the treatment options best for you.

      1. Red eyes often are referred to as "allergy eyes," given that eye redness is a common indicator of an allergic reaction.

      When your immune system reacts to a foreign substance, such as pollen, pet dander, dust or certain chemicals found in makeup or contact lens solutions, your body releases histamine as part of the inflammatory response that occurs to "fight off" the culprit allergens.

      As a result, the histamine released causes blood vessels in your eyes to enlarge, making your eyes become red and watery.

      Avoiding known allergens to which you are sensitive or taking medication advised by your doctor such as antihistamine eye drops can help keep dreaded hay fever and eye allergies at bay, especially during allergy seasons.

      SEE ALSO: How to Choose the Right Eye Drops for Your Condition >

      Contact lenses. One of the main culprits of red eye is over-wearing or not properly caring for your contact lenses, which can cause a build-up of irritating surface deposits and microbes on your eye.

      Red eyes while wearing contacts could be a sign of a serious eye infection, such as keratitis or fungal eye infections. If your eyes become red while wearing contact lenses, remove your contacts immediately and visit your eye doctor.

      Contact lenses also can worsen dry eye syndrome, as they typically reduce the amount of oxygen reaching your cornea and can restrict normal tear flow production, particularly with poorly fitting contacts

      You can minimize your risk of contact lens-induced red eye by keeping your lenses clean and disinfected, and replacing them according to your eye doctor's directions. Your doctor also may advise you to trydaily disposable lenses or a different type of contact lens material, such as gas permeable (GP) lenses.

      Your eyes have to work overtime when working at a computer for extended periods.

      Computer vision syndrome. Red, burning and tired eyes go hand-in-hand with staring at a computer screen for too long, which can cause computer vision syndrome. One reason is that you blink less when working at a computer, which dries out the surface of your eye.

      Tips to reduce computer eye strain include taking frequent breaks while working at a computer, modifying your workstation and wearing specially designed computer glasses. Lubricating eye drops also will can help to keep your eyes moist and healthy — and red-free.

      Eye injury. Trauma or injury to the eye, including cosmetic eyelid surgery, can result in red, bloodshot eyes, sometimes accompanied by a subconjunctival hemorrhage.

      As an inflammatory response to injury, blood vessels in your eye dilate to allow more blood flow to the site of the injury for quicker healing. This dilation (and sometimes breakage) of blood vessels on the eye is what causes the redness.

      Eye injuries can range from minor eye scratches (corneal abrasions) to deep puncture wounds and chemical burns. Whatever the source, always treat an eye injury as a medical emergency and see an eye doctor immediately.

      Other Causes of Red Eyes

      Corneal ulcer. Infections of the cornea, including acorneal ulcer, are potentially sight-threatening and should be treated as an emergency. In addition to red eyes, corneal ulcer symptoms almost always include eye pain, reduced vision and eye discharge.

      A corneal ulcer typically is caused by an untreated eye infection or trauma to the eye.

      Ocular herpes. Also called eye herpes, this is a recurrent viral infection caused by the type 1 herpes simplex virus — the same virus that causes common cold sores.

      Signs and symptoms of ocular herpes include eye redness, swollen eyes, eye pain, watery discharge and light sensitivity.

      Herpes of the eye can cause scarring of the cornea if left untreated, and in some cases may require a cornea transplant to restore vision.

      SEE ALSO: What's Involved in a Cornea Transplant >

      1. An inflammation of the middle layer of the eye (uvea), uveitis typically is characterized by red eyes, light sensitivity and visual disturbances such as floaters and blurry vision.

      Uveitis has many known causes; the most common are eye infections, eye injury or trauma, or a systemic autoimmune disorder. But in many cases, the underlying cause of uveitis is unknown.

      If not treated early enough, uveitis can result in a detached retina, cataracts and high ocular pressure, all of which can lead to permanent loss of vision.

      1. In most cases, glaucoma is gradual and asymptomatic when it first develops. But a sudden onset of painful, bright-red eyes accompanied by halos around lights, vision loss and nausea may signalacute angle-closure glaucoma.

      Acute angle-closure glaucoma is a sight-threatening condition that warrants urgent medical attention. The spike in intraocular pressure (the internal pressure in your eyes) can cause permanent vision loss within a matter of hours if it is not reduced.

      Whitening eye drops. Eye drops marketed for red eyes contain vasoconstrictors, which are chemicals that shrink the blood vessels on the surface of your eye to reduce redness.

      Ironically, whitening eye drops can cause more harm than good over the long term. Many people who regularly use eye drops formulated to "get the red out" build up a resistance to their whitening effects and need to use more and more drops to achieve the same results. Also, chronic use of eye whitening drops can actually cause the redness to worsen after the drops wear off — a condition called rebound hyperemia.

      Cold and flu. Bloodshot and puffy eyes, along with a runny nose, are common symptoms of a cold or flu. Red eyes in this instance typically are caused by a sinus infection or blocked sinuses, especially when accompanied with sneezing and coughing.

      Pregnancy. Hormonal changes during pregnancy can affect your eyes in many ways. Your eyes may become red and bloodshot, as well as dry, itchy and sensitive to light.

      Pregnancy also can alter the shape of your cornea and you may develop an intolerance to contact lensesor even experience blurry vision. These problems, including eye redness, usually are temporary and resolve completely within weeks or months after childbirth.

      1. The dangers of cigarette smoking to your heart and lungs and other diseases associated with smoking are well-known, but did you know smoking harms your eyes, too?

      In addition to significantly increasing the risk of age-related macular degeneration (AMD), cataracts and uveitis, tobacco smoke is a toxic eye irritant that also can cause dry, red and itchy eyes.

      Smoking marijuana also causes red, bloodshot eyes. THC, the main psychoactive ingredient in marijuana, causes significant dilation of blood vessels on the eye, producing eye redness that can last several hours or even longer.

      Excessive alcohol consumption also can cause eye redness. Alcohol reduces oxygen to your red blood cells, causing blood vessels to clump together and resulting in a ruddy complexion and red, bloodshot eyes.

      Environment and workplace hazards. Extremely dry air, dust, smoke and excessive sun exposure are known eye irritants that can cause red eyes, among other symptoms.

      Corneal scratches caused by windblown particles such as sand and wood filings or flying bits of metal and glass can cause a serious eye injury.

      Always wear protective eyewear such as safety glasses when you're at risk of foreign objects striking your eye, whether it be at work, playing sports or performing chores around the house such as mowing the lawn.

      Lack of sleep. The appearance of your eyes is a dead giveaway when you're tired. Puffy eyes and dark circles are telltale signs you haven't had enough sleep. And remember: rubbing sleepy eyes will only aggravate eye redness!

      Swimming. Chlorine and other pool sanitizers — as well as bacteria found naturally in any type of water, including oceans, lakes and rivers — can wreak havoc on swimmers' eyes. If you are prone to red eyes, use swim goggles before taking a dip to avoid irritated, bloodshot eyes after swimming.

      Also, never swim with contact lenses. Doing so puts you at significant risk of contracting a sight-threatening eye infection such as Acanthamoeba keratitis.

      Red Eyes Treatment

      Treatment for red eyes varies, depending on its cause. Contact your eye doctor for proper diagnosis and treatment anytime you develop red, irritated eyes.

      If you wear contact lenses, always remove them if you are experiencing bloodshot or irritated eyes.

      Remedies for red eyes range from rest, cool compresses over your eyes and over-the-counter eye drops to more aggressive treatment such as antibiotics or even surgery.

      Remember, if red eyes are accompanied by eye pain, light sensitivity, swelling or blurry vision, see your eye doctor immediately for urgent treatment.


      Cataract & Glaucoma Diagnosis & Management

      Glaucoma refers to a group of related eye disorders that all cause damage to the optic nerve that carries information from the eye to the brain. Glaucoma usually has few or no initial symptoms.

      In most cases, glaucoma is associated with higher-than-normal pressure inside the eye — a condition called ocular hypertension. But it also can occur when intraocular pressure (IOP) is normal. If untreated or uncontrolled, glaucoma first causes peripheral vision loss and eventually can lead to blindness.

      According to the American Academy of Ophthalmology, the most common type of glaucoma — calledprimary open-angle glaucoma — affects an estimated 2.2 million people in the United States, and that number is expected to increase to 3.3 million by 2020 as the U.S. population ages.

      And because most cases of glaucoma have few or no early symptoms, about half of Americans with glaucoma don't know they have it.

      Glaucoma is the second-leading cause of blindness in the U.S. (behind macular degeneration), and the second-leading cause of blindness worldwide (behind cataracts)

      Types of Glaucoma

      The two major categories of glaucoma are open-angle glaucoma (OAG) and narrow angle glaucoma. The "angle" in both cases refers to the drainage angle inside the eye that controls the outflow of the watery fluid (aqueous) that is continually being produced inside the eye.

      If the aqueous can access the drainage angle, the glaucoma is known as open angle glaucoma. If the drainage angle is blocked and the aqueous cannot reach it, the glaucoma is known as narrow angle glaucoma.

      Variations of OAG include: primary open angle glaucoma (POAG), normal-tension glaucoma (NTG), pigmentary glaucoma, pseudoexfoliation glaucoma, secondary glaucoma and congenital glaucoma.

      Variations of narrow angle glaucoma include include acute angle closure glaucoma, chronic angle closure glaucoma, and neovascular glaucoma.

      Study Identifies Symptoms Experienced by Patients With Varying Stages of Glaucoma

      November 2014 — Most people being treated for glaucoma experience no symptoms. But those with advanced glaucoma are more likely to report eye irritation, as well as visual complaints, according to a new study.

      Researchers reviewed the medical records of 401 patients with mild, moderate or severe glaucoma-related visual field loss who had been examined at Wills Eye Hospital Glaucoma Research Center in Philadelphia. The objective of the study was to identify the symptoms that patients voluntarily reported and determine if there was a correlation between reported symptoms and glaucoma severity.

      A majority of patients (56 percent) did not report any symptoms; 25.8 percent reported visual complaints; and 24.2 percent reported symptoms of ocular surface disease (OSD), such as burning, stinging and intermittent blurry vision. The symptoms correlated with the severity of glaucoma, and older patients were significantly more likely to report eye irritation and other OSD symptoms.

      The study authors concluded that patients should be specifically asked about OSD symptoms and treatments should be initiated as needed. They also suggested that burning, stinging and other OSD symptoms might be alleviated by switching to new preservative-free medicated eye drops.

      A report of the study appeared in the October issue ofCanadian Journal of Ophthalmology. — G.H.

      -Primary open-angle glaucoma. This common type of glaucoma gradually reduces your peripheral vision without other symptoms. By the time you notice it, permanent damage already has occurred.

      If your IOP remains high, the destruction caused by POAG can progress until tunnel vision develops, and you will be able to see only objects that are straight ahead. Ultimately, all vision can be lost, causing blindness.

      -Acute angle-closure glaucoma. Also called narrow-angle glaucoma, acute angle-closure glaucoma produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting.

      These signs constitute a medical emergency. The attack may last for a few hours, and then return again for another round, or it may be continuous without relief. Each attack can cause progressively more vision loss.

      -Normal-tension glaucoma. Like POAG, normal-tension glaucoma (also called normal-pressure glaucoma, low-tension glaucoma or low-pressure glaucoma) is a type of open-angle glaucoma that can cause visual field loss due to optic nerve damage. But in normal-tension glaucoma, the eye's IOP remains in the normal range.

      Also, pain is unlikely and permanent damage to the eye's optic nerve may not be noticed until symptoms such as tunnel vision occur.

      The cause of normal-tension glaucoma is not known. But many doctors believe it is related to poor blood flow to the optic nerve. Normal-tension glaucoma is more common in those who are Japanese, are female and/or have a history of vascular disease.

      -Pigmentary glaucoma. This rare form of glaucoma is caused by clogging of the drainage angle of the eye by pigment that has broken loose from the iris, reducing the rate of aqueous outflow from the eye. Over time, an inflammatory response to the blocked angle damages the drainage system.

      You are unlikely to notice any symptoms with pigmentary glaucoma, though some pain and blurry vision may occur after exercise. Pigmentary glaucoma most frequently affects white males in their mid-30s to mid-40s.

      -Secondary glaucoma. Symptoms of chronic glaucoma following an eye injury could indicate secondary glaucoma, which also may develop with presence of eye infection, inflammation, a tumor or enlargement of the lens due to a cataract.

      -Congenital glaucoma. This inherited form of glaucoma is present at birth, with 80 percent of cases diagnosed by age one. These children are born with narrow angles or some other defect in the drainage system of the eye.

      It's difficult to spot signs of congenital glaucoma, because children are too young to understand what is happening to them. If you notice a cloudy, white, hazy, enlarged or protruding eye in your child, consult your eye doctor. Congenital glaucoma typically occurs more in boys than in girls.

      Who Is at Risk?

      Open-angle glaucoma is three times more likely to affect African-Americans, compared with non-Hispanic whites in the United States, and blindness from glaucoma is at least six times more prevalent among African-Americans than non-Hispanic whites.

      Watch this video that explains what glaucoma is and who is at risk for the disease. (Video: National Eye Institute)

      Studies also suggest open-angle glaucoma affects Hispanics and Latinos at comparable rates to African-Americans.

      And in a study published in 2014 that compared the frequency of two types of open-angle glaucoma — primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG) — among Filipino and white Americans age 40 and older, researchers found Filipino Americans were more commonly diagnosed with both types of open-angle glaucoma than white Americans (11.9 vs 8.2 percent for POAG; 6.8 vs. 2.5 percent for NTG).


      Also, among Filipino Americans diagnosed with open-angle glaucoma, 46.7 percent had the normal-tension variety, whereas only 26.8 percent of whites with open-angle glaucoma had NTG, which can be more challenging to treat than POAG.

      Glaucoma Symptoms

      Glaucoma often is called the "silent thief of sight," because most types typically cause no pain and produce no symptoms until noticeable vision loss occurs.

      For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss.

      But with acute angle-closure glaucoma, symptoms that occur suddenly can include blurry vision, halos around lights, intense eye pain, nausea and vomiting. If you have these symptoms, make sure you see an eye care practitioner or visit the emergency room immediately so steps can be taken to prevent permanent vision loss.

      Diagnosis, Screening and Tests for Glaucoma

      During routine eye exams, a tonometer is used to measure your intraocular pressure, or IOP. Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers send a puff of air onto your eye's surface.

      Intraocular pressure (IOP) is measured with an instrument called a tonometer. Some tonometers blow a puff of air onto your eye's surface. Others gently touch the surface of your eye after it is numbed with eye drops. (Image: National Eye Institute)

      An abnormally high IOP reading indicates a problem with the amount of fluid (aqueous humor) in the eye. Either the eye is producing too much fluid, or it's not draining properly.Normally, IOP should be below 21 mmHg (millimeters of mercury) — a unit of measurement based on how much force is exerted within a certain defined area.

      If your IOP is higher than 30 mmHg, your risk of vision loss from glaucoma is 40 times greater than someone with intraocular pressure of 15 mmHg or lower. This is why glaucoma treatments such as eye drops are designed to keep IOP low.

      Other methods of monitoring glaucoma involve the use of sophisticated imaging technology — such asscanning laser polarimetry (SLP), optical coherence tomography (OCT) and confocal scanning laser ophthalmoscopy — to create baseline images and measurements of the eye's optic nerve and internal structures.

      Then, at specified intervals, additional images and measurements are taken to make sure no changes have occurred over time that might indicate progressive glaucoma damage.

      Visual field testing is a way for your eye doctor to determine if you are experiencing vision loss from glaucoma. Visual field testing involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals to make sure you are not developing blind spots from damage to the optic nerve or to determine the extent or progression of vision loss from glaucoma.

      Gonioscopy also may be performed to make sure the aqueous humor (or "aqueous") can drain freely from the eye. In gonioscopy, special lenses are used with a biomicroscope to enable your eye doctor to see the structure inside the eye (called the drainage angle) that controls the outflow of aqueous and thereby affects intraocular pressure.

      Ultrasound biomicroscopy is another technique that may be used to evaluate the drainage angle.

      Another Study Finds Link Between Sleep Apnea and Glaucoma

      May 2014 — A new study has added to the growing evidence that sleep apnea is a risk factor for glaucoma. (Also see "Connection Found Between Glaucoma and Sleep Apnea.")

      Researchers in Turkey investigated a possible link between obstructive sleep apnea syndrome (OSAS) and normal-tension glaucoma — a poorly understood variation of glaucoma where damage to the optic nerve occurs even without the high eye pressure that characterizes other forms of the disease.

      Risk factors for normal-tension glaucoma (NTG) include low blood pressure, abnormal blood flow to the eye, other blood and vascular disorders, and autoimmune diseases. But the actual cause of this type of glaucoma is unclear.

      Study participants included 24 people diagnosed with NTG and 24 age- and sex-matched healthy controls (who also were similar for body mass index, neck circumference and systemic risk factors such as diabetes). All underwent overnight polysomnography (PSG), which is a standard test for obstructive sleep apnea.

      The testing revealed that 41.7 percent of those with normal-tension glaucoma had obstructive sleep apnea syndrome, compared with 12.5 percent of the controls.

      The study authors concluded the prevalence of obstructive sleep apnea syndrome was significantly higher among individuals with normal-tension glaucoma, suggesting an association between the two conditions. The study report was published by the journal BMC Ophthalmology. — G.H.

      Glaucoma Treatments

      Treatment can involve glaucoma surgery, lasers or medication, depending on the severity. Eye drops with medication aimed at lowering IOP usually are tried first to control glaucoma.

      Because glaucoma often is painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage.

      In fact, non-compliance with a program of prescribed glaucoma medication is a major reason for blindness caused by glaucoma.

      If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.

      Glaucoma Prevention

      Can you reduce your risk for glaucoma? According to a recent European study, exercise might do the trick for some people.

      Researchers in the U.K. found that higher levels of physical exercise appear to provide a long-term benefit of reducing the incidence of low ocular perfusion pressure (OPP), an important risk factor for glaucoma. OPP is a mathematical value that is calculated using a person's intraocular pressure and his or her blood pressure.

      The results showed that study participants who engaged in moderate physical exercise approximately 15 years prior to the study had a 25 percent reduced risk of low OPP that could lead to glaucoma.

      "It appears that OPP is largely determined by cardiovascular fitness," said study author Paul J. Foster, MD, PhD, of the University College London Institute of Ophthalmology. "We cannot comment on the cause, but there is certainly an association between a sedentary lifestyle and factors which increase glaucoma risk."

      Maintaining an active lifestyle appears to be an effective way for people to reduce their risk of glaucoma and many other serious health problems, Dr. Foster concluded.

      In addition to regular exercise and an active lifestyle, you also can reduce your risk for glaucoma by not smoking, maintaining a healthy weight, and eating a varied and healthy diet.