Eye Diseases & Disorders

During cataract surgery, the clouded crystalline lens is removed and replaced with a artificial intraocular lens (IOL). The eye’s dimensions are carefully measured before surgery so that correct IOL power is used.

Unfortunately, blurry vision sometimes occurs after cataract surgery due to the IOL and other problems such as:

• IOL miscalculation, tilt, rotation, or misalignment
• The cornea is dry or inflamed
• Post-operative, intraocular inflammation

These issues may be corrected using glasses, contact lenses, dry eye management strategies, medical treatment, refractive surgery, or undergoing an IOL exchange

Another effect after cataract surgery is that the bag (or capsule) that holds the lens may become wrinkled or cloudy, a condition called posterior capsular opacity or secondary cataract. This can happen months or even years after cataract surgery, and occurs in as many as 20 – 50% of patients. This condition may develop as part of the normal healing process, but can slowly interfere with clear vision over time. If the posterior capsule interferes with vision it can be treated using a simple, safe, in-office laser procedure called a YAG posterior capsulotomy.

View YAG Capsulotomy Videos

The iris refers to the coloured portion of your eye and is responsible for controlling the size of your pupil, the small black circle in the centre. The pupil is actually an opening that allows light to enter your eye, much like the aperture of a camera.

The iris can become damaged or develop abnormalities for a variety of reasons, including trauma, infections, inflammation, tumours or cancer, systemic diseases, or genetic factors. Depending on the root cause of the iris disorder, the condition may require ongoing monitoring or require surgical or medical management.

During an eye exam, your eye care professional may use special eye drops to dilate your pupil. This allows more light into the eye and lets your eye care professional get a better view of the inside of your eye. The effects of these dilating drops typically last for several hours, so you shouldn’t plan on returning to work or school for at least a few hours after your appointment.

Uveitis is a condition that affects the uvea, causing it to become swollen and inflamed. Without correct treatment, uveitis can cause permanent damage, leading to vision loss.

There are 3 types of uveitis, which are classified based on which portion of the uvea is affected.

• Anterior uveitis causes the uvea near the front of the eye to begin to swell. It begins suddenly, and symptoms can last many weeks. This condition can either persist or fade and return, depending on the form.
• Intermediate uveitis affects the middle of the eye, and symptoms can persist for between a few weeks to a few years. This form of uveitis typically flares up and then temporarily recedes before returning again in full force.
• Posterior uveitis refers to swelling of the uvea towards the back of the eye. This form of uveitis typically develops gradually, and symptoms last for many years.

In extremely severe cases of uveitis, all 3 sections of the uvea could be affected.

Anterior uveitis can cause the iris to stick to the eye’s lens, causing it to become disfigured and affecting vision. Depending on the root cause of the uveitis (such as those forms caused by viruses), the iris may thin, and the eye muscles may become weak, making it difficult for the eye to regulate how much light is allowed to enter through the pupil, which can lead to problems with glare.

Depending on the root cause of your uveitis, your eye care professional may suggest long term monitoring, topical or systemic therapy and specific blood testing.

Different types of cysts, cancers, and tumours can develop in the iris:

• The ciliary body, which is located behind the iris, or the iris itself, can develop cysts that look like tiny bumps. Depending on where the cysts develop, they may be benign but may put a person at risk for glaucoma.
• The iris can also develop melanoma, a type of skin cancer. This condition may change the colouring of the iris either partially or completely and needs to be imaged and monitored very closely. Depending on the diagnosis and severity of your iris melanoma, surgical management may be required.

Diabetes affects the body in many ways and can affect our eye health and vision. Diabetic eye disease may cause new blood vessels to grow on the iris, blocking the drainage system of the eye. When the eye is not able to drain fluid effectively, it can cause the eye’s intraocular pressure to either rise slowly or spike suddenly, causing glaucoma.

Many genetic diseases can affect our eye health and vision. One of the most common is aniridia, which causes either some or all of the iris to waste away, revealing the crystalline lens beneath. This condition is challenging to treat as the eye is involved at multiple levels, including the ocular surface, the iris, the macula and the optic nerve.

Another common condition is posterior polymorphic dystrophy, which affects the internal layers of the cornea (the endothelium) and can cause the pupil to change. This abnormal endothelium structure can cause it to fold, or create lines or cysts. Though these may be alarming, they rarely affect vision.

Another genetic disease that can affect the iris is neurofibromatosis type 1, a type of neurological disorder. A common symptom of this condition is the development of tiny coloured bumps (called Lisch nodules) on the iris. This symptom is common in most patients with this condition.

Without immediate treatment, eye trauma can have devastating consequences. 2 common injuries we treat are corneal perforations and iridodialysis.

• Corneal perforations cause a hole to form in the front of the eye (the cornea). A common symptom of corneal perforations is leakage when fluids leak out of the wound and push the iris forward. This may cause the pupil to become misshapen and become plugged by the iris. Corneal perforations require immediate surgical intervention.
• Eye trauma, caused by either blunt force or surgery, may cause the iris to pull away from its peripheral attachment, causing a condition called iridodialysis. Depending on how severe the situation is and what symptoms you experience, surgical intervention may be required.

Eyelid trauma includes lid lacerations (cuts), which can either go partially through or fully through the eyelid. A form of this is called lid avulsion, which causes one side of the eyelid to pull away from its original attachment point. Depending on the root cause and severity of your eyelid trauma, both medical and surgical management will likely be required.

Several conditions can cause the eyelid to become irritated or inflamed:

• Styes (also called hordeolum) and chalazion both cause the oil glands in the eyelid to become blocked. This, in turn, causes redness, swelling, and pain. Styes and chalazion can both be caused by secondary infections, usually stemming from bacteria. Typical treatments include warm compresses, topical or oral medications, and surgical drainage.
• Blepharitis is an infection caused by bacteria, parasites, or fungus, and typically affects the eyelashes, external eyelids, internal eyelid, lid margin, or some combination of the above. There are a variety of treatment options for blepharitis, and which treatment is best for you depends on a variety of factors. Treatments include warm compresses, lid massage, lid cleaning, topical or oral medications, in-office lid cleaning treatments, and in-office heated lid treatments.
• Rosacea is an inflammatory skin condition that may present with blepharitis or skin infections, particularly eyelid infections. Treatments may include a prescribed skin hygiene routine, topical or oral medications, and advanced in-office cleanings or heated lid treatments.
• Dermatitis is a condition that causes the eyelid margins or external skin to become inflamed and is typically caused by allergies (allergic dermatitis) or hypersensitive reactions to specific irritants (contact dermatitis). Treatment involves identifying the exact substance that is causing the reaction and either removing it or using topical medications to reduce the symptom severity.

Eyelid infections can be caused by viruses, parasites, bacteria, or fungi and can impact the lashes, eyelid skin, internal eyelid layers, and eyelid margin. Since these infections can have many root causes, it is vital to get a proper diagnosis. Common treatments include oral or topical medications, though the culturing and debridement of lesions may also be suggested.

Preseptal cellulitis can be characterized as a superficial infection of the tissues of the eyelid and surrounding eye. These infections may improve on their own or may need a course of oral antibiotics.

Postseptal cellulitis (also called orbital cellulitis) is an infection of the deeper tissues of the eyelid or the surrounding orbital tissues, which may progress to orbital cellulitis, a deeper also involving tissues around the eyeball. This type of eyelid infection can be quite severe, and typically requires medical imaging as well as treatment using either oral or IV antibiotics. In rare, serious cases treating these infections may require an urgent consult with either an oculoplastic or plastic surgeon or a pediatric ophthalmologist.

Some structural disorders of the eyelids and eyelashes require surgery to correct the issue and properly repair the issue. Depending on the severity of the situation, your eye care professional may need to consult with an oculoplastic or plastic surgeon.

Common structural disorders include:

• Ptosis or blepharoptosis occurs when the upper eyelids have moved down and appear to be drooping. This may seem like a mere cosmetic concern, but it can affect the shape of the cornea and prevent enough external light from entering the eye, affecting vision. Most forms of ptosis require surgery to correct.
• Ectropion is a condition that affects the lashes and eyelid margin and can affect the lower (most common) or upper (less common) eyelids. This condition causes the eyelids to turn outwards and away from the surface of the eye. This can cause the eyelid to tear, causing discomfort and inflammation and often presenting as redness, blurry vision, or foreign body sensation. Ectropion can be caused by a number of factors, and most forms require surgical correction.
• Entropion is a disorder that affects the eyelids and the lashes, causing them to turn inwards. This can cause the eyelashes and external eyelid skin to rub against the ocular surface, causing irritation, pain, tearing, redness, and blurry vision. Entropion can have a variety of different root causes, but most require either surgical correction or the removal of the eyelashes.
• Floppy Eyelid Syndrome is accurately named and causes the upper eyelids to loosen or weaken. This causes the eyelids to turn outwards, particularly when you are sleeping on your face. This chronic condition causes the inner layers of the eyelids, as well as the ocular surface, to become irritated and inflamed. This can also lead to dry eyes. Symptoms of this condition can be managed using dry eye treatments, surgical lid tightening procedures, or devices or steps that prevent the eyelids from turning outwards.
• Distichiasis is a disorder that causes the eyelashes to grow in the wrong direction or from the wrong glands, causing them to turn inwards towards the eye. This condition is typically caused by chronic inflammation of the eyelids or the eyelid margin. Though manual lash removal can offer relief, it is not a permanent solution and must be repeated. Permanent lash removal options include electrolysis, cryotherapy, and laser or eyelid surgery.
• Dermatochalasis is a disorder that causes extra folds of skin and fat to form on the upper and lower eyelids. These extra folds not only affect the overall appearance of the eyes and face but can also obstruct vision. This condition is typically treated using blepharoplasty, a type of eyelid surgery.

Though most bumps and lumps that grow along the outer eyelids, along the eyelashes, or eyelid margin are benign depending on their type, size, and location, they may cause irritation and require surgical removal. Your eye care professional will assess the situation and may refer you to an oculoplastic or plastic surgeon so that these lesions can be managed or removed.

Precancerous and cancerous lesions can present anywhere, including along the eyelid skin, along the eyelashes, or on the eyelid margin. Cancer requires aggressive treatment methods, so any suspicious bumps or lumps should be reported to your eye care professional.

Blepharospasms typically present as bilateral (meaning in both eyes) uncontrollable blinking or contractions of the eyelids and some surrounding facial muscles and may prevent you from opening your eyelids. Blepharospasms may be a sign of underlying eye disease. Depending on the root cause of your condition, your eye care professional may suggest medical imaging or, in serious cases, botox injections. They may also refer you to an oculoplastic surgeon for further treatment.

Our eyes drain using little holes (called punctum) on the inside part of the eyelid closest to the nose. Tiny tube-like pathways (called the canaliculus) take the tears from the inside of the eyelids to the nose, and then into a special gland in the nose called the nasolacrimal duct. Our tears are actually supposed to drain through our nose (which is why we need to blow our noses after crying).

When we produce too many tears, which can be caused by dry eye or reflex tearing, or the tear ducts become blocked or narrowed, the excess tears roll down our cheeks. Tearing disorders can have several root causes:

• Punctal atresia or obstruction is a disorder that occurs when the punctum are either too small or become blocked or restricted, disrupting tear flow. This disorder can be caused by age, trauma, topical medication toxicity, infections, auto-immune disease, allergies, tumours, or eyelid inflammation. Treatment depends on the root cause of the issue but may include attempting to dilate and then surgical increase the size of each punctum.
• Canalicular atresia or obstruction is a disorder that causes the tube-like pathway (the canaliculus) to become blocked or restricted. This can be caused by age, trauma, infections, topical medication toxicity, auto-immune diseases, allergies, eyelid inflammation, or tumours. Treatment typically requires unblocking or widening the canalicular tube and then keeping this channel unobstructed using tubes, which will be left in place for a set period of time. This condition requires surgery to treat, and the procedure is typically performed by an oculoplastic surgeon.
• Nasolacrimal duct obstruction is a disorder that causes significant portions of the canaliculus or the nose passageway to become blocked. This condition is typically caused by trauma, age, topical medication toxicity, infections, chronic sinus diseases, nasal polyps, auto-immune diseases, tumours, or inflammation of the nasal passageway. This condition requires surgical treatment and involves creating a new passageway for tears to drain into the nose.
• Dry eyes can have a variety of root causes and can range from mild to severe. Depending on the cause, dry eye may cause the eyes to tear excessively as they attempt to stay lubricated. The treatment for dry eyes depends heavily on the root cause.