If you have anisocoria, it means your pupils are not the same size. 

The pupil is the dark circle that appears in the middle of the eye. Its role is to let light come into the eye so you can see. 

Any person can have pupils of different sizes. However, having uneven pupils can sometimes indicate a serious eye issue or underlying health condition.

For example, people who are at risk of developing anisocoria include those with:

• A nervous system problem
• Eye trauma
• Possible stroke 
• Viral infection 

If you have anisocoria and experience accompanying symptoms like headaches or eye pain, you should seek immediate care. 

You may require emergency intervention to address the cause of the eye condition. 

Approximately 30% of the average population will have anisocoria. The degree of anisocoria can differ each day and even switch eyes.² 

American Association for Pediatric Ophthalmology and Strabismus

When is Anisocoria Normal? When is Treatment Necessary?

Not all types of anisocoria will require treatment or indicate a serious health condition. 

Some cases of anisocoria may be asymptomatic. For example, chronic anisocoria without accompanying symptoms is likely a benign form of physiologic anisocoria. 

However, a sudden onset of anisocoria with symptoms should raise concern. There may be an underlying neurological condition that requires immediate medical attention.

You should speak with your healthcare professional if you develop anisocoria. 

Anisocoria itself does not generally impact eye health. Visual acuity (sharpness) is minimally affected in most cases. 

How is Anisocoria Diagnosed?

If you think you have anisocoria, you should speak with your ophthalmologist or healthcare professional. 

You’ll undergo an eye examination to receive a diagnosis, which may include information on the cause and follow-up care. If you are experiencing additional symptoms, you might also need a neurological examination.

The examination will also let your specialist compare pupils in size, shape, position, symmetry, and reactivity in both light and dark settings. Depending on observations recorded, your specialist should better understand what is causing the anisocoria. Additionally, your specialist may use a slit lamp during the examination to obtain more details about any possible associated or coexisting eye condition. 

In the neurological examination, your specialist will look for lesions and neurological deficits in sensory, motor, and deep tendon reflex pathways. 

If anisocoria is more extensive in the dark, you may have a lesion in the sympathetic pathway (a type of pathway related to the nervous system). Possible causes could be: 

• Horner’s syndrome (disrupted nerve pathway that runs from the brain to the face and eye on one side)
• Argyll Robertson pupil (small pupils that reduce in size on a near object but not when exposed to bright light) occurs in advanced stages of syphilis
• Iritis (inflammatory eye disease of the iris)
• Mechanical anisocoria (due to damage to the iris or supporting structures)
• Pharmacologic anisocoria due to miotics, narcotics, or insecticides

Accompanying Symptoms of Anisocoria

Many people do not realize that their pupils vary in size. It may become apparent when they compare old and newer photos of themselves. 

If you develop anisocoria, you may also experience symptoms. Symptoms may be the sign of a more severe health issue. You should describe and report any symptoms or signs present during anisocoria to a healthcare professional. 

Symptoms may include:

• Drooping eyelid (ptosis)
• Trouble moving your eye
• Eye pain
• Fever
• Headache
• Reduced sweating

If you develop unequal pupil sizes of more than 1 mm and do not return to equal size, you may have an eye, brain, blood vessel, or nerve disease or condition. 

Types of Anisocoria

Characterization of anisocoria includes unequal pupil sizes. While the condition is common, the causes may or may not be benign. 

In some cases, anisocoria can develop due to a possibly life-threatening condition. 

The following list shows different types of anisocoria and their causes. 

Simple Anisocoria

Simple anisocoria (otherwise known as physiologic or essential) is the most frequent cause of uneven pupil sizes. 

This particular type can affect up to 20% of the population. It is benign. The difference in pupil size will be less than or equal to 1 mm, and the condition may be intermittent, persistent, or self-resolving. 

Health professionals do not know exactly why people develop simple anisocoria. 

Some believe that the condition occurs due to a type of inhibition of the Edinger-Westphal nucleus. This nucleus is responsible for the pupillary sphincter. This is a muscle located in the colored part of the eye called the iris.

Mechanical Anisocoria

Mechanical anisocoria will happen because of damage to either the iris or its supporting structures.  

Eye trauma, surgery, or inflammatory conditions like uveitis (inflammation of the middle tissue layer of the eye) are just some examples that could lead to mechanical anisocoria. 

Angle-closure glaucoma or intraocular tumors may also result in mechanical anisocoria. 

Pharmacologic Anisocoria

Pharmacologic anisocoria can appear as either mydriasis (dilation of the pupil) or miosis (constriction of the pupil). 

The following list details agents that can affect the pupillary dilator or sphincter muscles and cause this anisocoria:

• Anticholinergics, like atropine, homatropine, tropicamide, scopolamine, and cyclopentolate
• Glycopyrrolate antiperspirants
• Nasal vasoconstrictors
• Herbal plants, like Jimson weed, blue nightshade, and Angel’s trumpet
• Pilocarpine 
• Sympathomimetics (type of stimulant compounds), such as adrenaline, clonidine, and phenylephrine
• Prostaglandins
• Opioids 
• Organophosphate insecticides 

Pathologic Anisocoria

Pathologic anisocoria occurs due to an underlying disease or condition. If you experience symptoms alongside anisocoria, you should seek medical care. An eye doctor will be able to rule out any life-threatening conditions and perform a diagnosis. 

Examples of conditions that can result in pathologic anisocoria include:

• Iritis. This type of uveitis (inflammatory eye disease) results from an eye infection, eye injury, or separate inflammatory eye disease. 
• Horner’s syndrome. The disruption of a nerve pathway that runs from the brain to the face and eye (on one side of the body). It triggers a series of signs and symptoms, including a drooping eyelid.
• Adie’s tonic pupil. Also referred to as Adie’s Syndrome or Holmes-Adie Syndrome, this rare neurological disorder often involves non-progressive or limited damage to the nervous system. The disorder can also impact deep tendon reflexes. 
• Third nerve palsy. The third cranial nerve is responsible for moving four of the six eye muscles and pupil constriction, eye focusing, and upper eyelid positioning. Damage to the nerve can be due to various causes. It has been associated with brain tumors, diabetes, high blood pressure, and aneurysm. 

How to Correct Different Pupil Sizes 

Correcting different pupil sizes will depend on the type of anisocoria you have. 

For example, mechanical anisocoria due to eye trauma could require surgery to correct the structural defect causing the issue. 

Physiologic anisocoria does not often present with symptoms, nor does it require medical attention. 

If you have anisocoria due to Adie’s tonic pupil (rare neurological disorder), glasses can help vision. Pilocarpine (a medication used to reduce eye pressure) can also be used to constrict the pupil. 

In pharmacologic anisocoria cases, stopping the administration of the causative pharmacologic agent should address the issue. 

In atypical cases like anisocoria due to autoimmune autonomic ganglionopathy (when the immune system mistakenly attacks a person’s own autonomic nervous system), a consultation with a neuro-ophthalmologist or neurologist will be necessary. The consultation can help determine the proper treatment. 

You should seek medical care if you develop anisocoria to rule out any underlying life-threatening conditions. 

Is Anisocoria Preventable? 

Anisocoria may be preventable in some cases. For example, in pharmacologic anisocoria, stopping the administration of the pharmacologic agent causing the issue could provide relief. 

In other cases, anisocoria can occur due to an underlying health condition, like a stroke. 

While you cannot prevent anisocoria due to a stroke, you could minimize the risk of suffering a stroke by eating a well-balanced diet and staying active. 

The hyphema may extend to all of the iris and pupil (the circular, dark area in the middle of the eye). However, it may also cover a partial area. In some cases of hyphema, you may temporarily suffer partial or complete vision loss.

Because hyphemas often occur due to an injury to the eye, you should seek immediate medical care. You could lose your eyesight in one eye if you don’t receive medical attention.

People with a history of eye trauma or recent ocular surgery face a higher risk of developing a hyphema.

Hyphema Grading System

Hyphemas can receive a grading between I-IV:

• Grade 0 — No visible layering; however, you have red blood cells within the anterior chamber
• Grade I — A layering of blood taking up less than one-third of the anterior chamber
• Grade II — Blood has accumulated in between one-third to one-half of the anterior chamber
• Grade III — Blood has collected in one-half to less than the total of the anterior chamber
• Grade IV — Blood has entirely accumulated in the anterior chamber. If the anterior chamber is filled with bright red blood, eye care specialists will call it a total hyphema. If the blood takes on a dark red-black color, eye care specialists will call it a blackball or 8-ball hyphema.

Signs & Symptoms of Hyphema

Hyphema can cause a range of symptoms and signs. If you have a hyphema, you may experience the following symptoms and signs, including:

• Bleeding in the front of the eye
• Sensitivity to light
• Pain in the eye
• Blurry, clouded, or blocked vision

If you notice any of the signs or symptoms above, you should visit your local eye care clinic and speak with your doctor. A comprehensive eye examination will be necessary to provide proper care and lower the risk of any complications.

One study reported hyphema due to eye trauma occurred in every 12 of 100,000 people; 70% of these cases were in children.¹

Can Hyphema be a Sign of Something Serious?

Yes, hyphemas may be a sign of something more serious. It’s important to seek medical care if you believe you have a hyphema.

When you undergo an eye examination, your eye doctor will grade your hyphema according to height and color. Color will vary according to how long you have had the hyphema. 

If the hyphema is darker in appearance, the blood has already clotted.

How to Manage Hyphema Symptoms

If you have a hyphema, there are steps that you can take to lessen symptoms. You can follow the recommendations listed below:

• Wear an eye shield. It’s important to wear eye shields if your doctor has prescribed one. This will keep the eye protected from further injury.
• Sleep with your head in an elevated position. This helps the red blood cells separate and move away from the line of sight.
• Avoid air travel until your eye has healed. The changes in air pressure could heighten the pain and impact your eye.
• Take the medications prescribed by your eye care specialist. If there is a problem, you should call your clinic.
• Don’t take aspirin or other anti-inflammatory medication. Medicines like ibuprofen or naproxen could increase bleeding if you take them without consulting your doctor beforehand.
• Avoid touching your eye. Always wash your hands before touching your eye and avoid rubbing the injured eye. Rubbing can make the problem worse.
• Contact lens and eye makeup restrain. Don’t wear contact lenses or put on eye makeup until your eye has fully recovered and your doctor gives you approval.
• Rest your eyes. Limit reading and other activities that require a lot of eye movement within the first 24-48 hours of the hyphema.

When is Hyphema an Emergency?

A hyphema can become an emergency when a person doesn’t receive proper treatment, and vision loss worsens. The hyphema can become more severe when a person does not receive medical care and has elevated intraocular pressure.

Increased intraocular pressure raises the risk of further complications, including partial or total vision loss. Always treat hyphema as a medical emergency to prevent complications.

What Causes Hyphema?

There can be two main causes of hyphema: blunt eye trauma or conditions that cause increased bleeding states. 

Blunt Eye Trauma

In many cases, a person develops a hyphema because of blunt eye trauma or open globe injury. This injury causes a tear of the eye’s iris or pupil and allows blood to accumulate.

Possible causes of blunt trauma may include:

• Sports injuries
• Car accidents
• Assault 
• Falling or hitting something with the eye area

Increased Bleeding States

You may develop a hyphema due to an underlying health condition or certain medications that increase eye bleeding.

The following list includes diseases or drugs that increase the risk of a hyphema:

• Rubeosis iridis (may be secondary to diabetic complications)
• Juvenile xanthogranuloma
• Iris melanoma
• Myotonic dystrophy
• Keratouveitis (e.g., secondary to herpes zoster)
• Leukemia
• Hemophilia
• Von Willebrand disease (VWD)
• Any substance that affects platelet or thrombin function (e.g., ethanol, aspirin, and warfarin)

Finally, you may also develop a hyphema after undergoing ocular surgery, such as placing an artificial lens in the eye during cataract surgery.

Hyphema vs. Subconjunctival Hemorrhage 

In some cases, you may mistake a broken blood vessel for a hyphema. However, a broken blood vessel is a common subconjunctival hemorrhage that will not cause pain.

A hyphema can cause eye pain and permanent vision issues and requires proper treatment.

Here are a few differences between the two: 

How is Hyphema Diagnosed?

If you believe you have a hyphema, visit your local eye clinic and speak to the ophthalmologist about any symptoms. During your visit, your doctor may do the following to diagnose hyphema:

• CT scan. This helps your doctor examine the bones forming eye sockets and other facial areas. 
• Slit lamp examination. Your eye doctor may also perform a slit lamp examination of the eye’s anterior chamber to diagnose correctly.
• Pen-light examination. A pen-light examination may be enough for people with a large hyphema. This involves shining a light directly onto the eye to look for blood in the area.

Risk Factors of Hyphema

Certain risk factors increase the likelihood of developing hyphema. These include:

Participating in Contact Sports

People who participate in sports activities are at risk of hyphemas, especially if they do not wear protective eyewear. Small balls like racquetballs are an example of sports items that could result in serious eye problems. 

Occupational Hazards

Those working in construction sites or manufacturing are more likely to get hyphema. This is because they’re more prone to accidents that affect the eyes at their workplace. 

Prior Eye Surgeries 

In some cases, people with previous eye surgeries can develop hyphema. Your condition may make your blood vessels more fragile.

Poor Eye Protection

Poor eye protection may also increase your likelihood of getting hyphema. You’re more likely to get hyphema if you don’t wear protective eyewear or safety goggles while doing high-risk activities. 

Possible Complications of Hyphema

The outlook for a person who suffers from hyphema depends on several factors, including the severity and location of the injury. 

Some of the most common hyphema complications include:

• Prolonged elevated intraocular pressure (IOP). This is when the blood buildup leads to elevated eye pressure. Eye care specialists will grade hyphemas to understand the extent of the risk present for IOP elevation.
• Optic nerve damage. The elevated intraocular pressure can lead to optic nerve damage and may possibly result in vision loss.
• Corneal bloodstaining. Bleeding in the anterior can result in corneal bloodstaining and lead to decreased vision.

What Treatment Options Are Available for Hyphema?

Your treatment options will vary according to the cause of the hyphema and severity grading. Here are some possible treatment options for hyphema:

General Treatment Recommendations

Your eye doctor may ask you to do the following:

• Wear a special eye shield for protection
• Reduce physical activities or rest at home
• Elevate your head (at least 45 degrees) to help with drainage and intraocular pressure

Medications

You may also receive prescribed eye drops to reduce swelling inside the eye and minimize pain or discomfort.

However, your eye doctor will tell you not to use aspirin or other anti-inflammatory medications to avoid worsening your hyphema. 

Hospitalization

Finally, hospitalization may be necessary for specific patient profiles, including:

• Non-compliant patients
• Those with bleeding diathesis (a tendency to suffer from a bleeding condition) or blood dyscrasia (an abnormal condition or disease of the blood)
• Those with severe ocular or orbital injuries
• Those with known sickle cell disease and increased intraocular pressure

An estimated 5% to 7.2% of patients with traumatic hyphema will require surgery.⁸

Follow-Up Care

Patients with a history of eye trauma will require follow-up care with a gonioscopic examination. This series of patients risk developing angle-recession glaucoma (extra fluid build-up could damage the optic nerve).

It is important to maintain follow-up visits, as intraocular pressure may increase and put you at risk of glaucoma (damage of the optic nerve) or corneal damage.

How to Prevent Hyphema

While recovering from hyphema is possible, it’s always best to avoid it first. To prevent future incidents of hyphema from blunt eye trauma, you should take these steps:

Wear Protective Eyewear

You should always wear protective eyewear when participating in contact sports or high-risk activities. It helps to protect your eyes from any potential injury. Goggles, safety glasses, and face shields can all help keep your eyes safe.

Never Drive While Intoxicated

Driving while intoxicated increases the risk of accidents and injuries. Have a designated driver or opt for ride-sharing apps instead. In addition, always wear your seat belt when inside a moving vehicle. 

Be Careful When Handling Sharp Objects

Be careful when handling tools or other sharp objects. Always use the appropriate protective gear and keep your hands away from your face. The same applies to other dangerous objects, such as firearms and explosives. 

Summary

• Hyphema is a condition involving blood collection in the eye’s anterior chamber.
• Blunt eye trauma or medical conditions such as sickle cell disease can cause this condition
• Treatment options vary depending on the cause and severity of the hyphema
• Limiting your activities that could potentially cause eye injury can help prevent hyphema in the future

Scleral icterus describes the yellowing (jaundice) of the eyes.

Different underlying medical conditions can cause the eyes to yellow. An increase in bilirubin levels causes the yellow hue. However, bilirubin doesn’t accumulate in the sclera (white part of the eye).

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The yellowish pigment builds up in the conjunctiva (tissue covering the sclera). This is why the condition is often called conjunctival icterus.  

Your liver is responsible for pulling the bilirubin from your blood. Liver problems or other health-related issues can cause bilirubin levels to rise.

Viral hepatitis is an example of a medical condition that can prevent the liver from performing correctly. 

What Causes Scleral Icterus?

Scleral icterus can indicate initial signs of an underlying condition. It can also precede systemic jaundice, in which yellowing of other body areas occurs. 

However, some healthcare providers may misdiagnose eye yellowing for scleral icterus. You could have prominent subconjunctival fat that results in a yellow hue.

A distinguishing feature of scleral icterus is that jaundice also affects the area near the cornea. 

Scleral icterus could represent the only sign of jaundice on physical examination in people with dark skin. 

What are the Symptoms of Scleral Icterus?

Scleral icterus refers to when your eyes become yellow. However, scleral icterus will not cause symptoms. Rather, symptoms are related to the underlying cause of jaundice.

Possible symptoms you may have with scleral icterus include:

• Itchy skin
• Joint aches
• Fullness in the stomach
• Fatigue
• Malaise
• Fever
• Changes in urine or stool
• Appetite loss
• Nausea
• Sudden weight loss

When to See a Doctor

Speak with your healthcare provider if you experience scleral icterus or jaundice symptoms. While the condition sometimes doesn’t require treatment, your doctor can diagnose your condition and rule out any possible health problems.  

Scleral icterus often occurs when your bilirubin levels are between 2 to 3 mg/dL. This does not mean your skin or other mucous membranes have also become yellow.

How is Scleral Icterus Diagnosed?

Your healthcare provider will perform multiple tests to determine the cause of scleral icterus. These may include liver function tests and physical examinations.

Furthermore, your doctor may ask a comprehensive series of questions related to your:

• Use of drugs, alcohol, or other toxic substances
• Risk factors for hepatitis, such as unsafe sexual practices
• HIV status 
• Family history of genetic disorders or hemolytic disorders 
• Duration of jaundice 

These details will help your doctor rule out various health conditions and reach a proper diagnosis.

How is Scleral Icterus Treated? 

There is no direct treatment for either scleral icterus or jaundice. Treatment options will depend on the underlying eye diseases or health problems causing the yellowing of the eyes and/or skin. 

Conversely, the prognosis of scleral icterus or jaundice varies based on the cause. For example, jaundice due to the resorption of hematomas or Gilbert syndrome will have a better prognosis than malignant biliary obstructions and liver cirrhosis.

What is the Difference Between Icterus and Jaundice?

There is no distinct difference between icterus and jaundice. Both refer to the yellowing of the eyes, skin, and/or mucous membranes due to elevated bilirubin levels. 

However, semantics could cause some people to believe there are differences.

Some healthcare professionals may consider jaundice (from the French root word “jaune” for yellow) as a complication because of an underlying health issue. Icterus, for example, could be a sign of systemic jaundice. 

Regardless, if you develop yellowing of the eyes or other body areas, speak to your healthcare provider. You may require treatment for an undiagnosed health problem. 

Summary

Scleral icterus pertains to the yellowing of the eyes. Aside from yellow eyes, you may experience other symptoms related to the underlying health condition. Your healthcare provider will diagnose the cause and provide treatment options if necessary.

The optic nerve (also called the second cranial nerve or CNII) transmits visual information from the eyes to the brain.

Papilledema or papilloedema is the swelling of the optic disc or the part of the optic nerve located inside the eye. It is caused by intracranial hypertension (IH) or increased pressure within and around the brain.

Papilledema can develop within hours or weeks, depending on the underlying cause. It is usually bilateral and affects both eyes.

In rare cases, it has a unilateral presentation and affects one eye.

Papilledema or optic nerve swelling indicates the presence of a serious and often life-threatening condition.

Unless treated, elevated brain pressure can lead to permanent nerve damage, vision loss, and death.¹

Is optic disc edema the same as papilledema?

No. Papilledema is not the same as optic disc edema. While both lead to optic disc swelling, they have different causes:

• True papilledema: Results from increased brain pressure due to an underlying condition
• Optic disc edema: Also known as pseudopapilledema, it is caused by optic nerve damage

Their symptoms also vary. Papilledema commonly affects your peripheral vision. It does not change your central vision and visual acuity until later.

Optic disc edema affects your central visual field at the onset, reducing your ability to distinguish objects and shapes.²

Signs and Symptoms of Papilledema

Papilledema often begins with temporary vision changes.

You may experience blurred or double vision, flickering eyesight, or complete vision loss for several seconds at a time.

Some people may not initially have changes in vision. But you can watch for signs of raised intracranial pressure:

• Nausea
• Vomiting
• Headache

Projectile vomiting is a sign of elevated ICP. It causes you to forcefully expel stomach contents up to several feet away.

You can also monitor for Cushing’s Triad. It refers to a set of signs that indicate increased pressure in the brain, namely:

• Decreasing heart rate
• Irregular breathing
• Widening pulse (or an increasing difference between the systolic and diastolic blood pressure)

Papilledema due to increased cerebrospinal fluid may lead to pulsatile tinnitus.

Pulsatile tinnitus is characterized by rhythmic sensations in one or both ears. These include thumping, whooshing, and throbbing that sync with the heartbeat.

Headaches usually worsen upon waking, while lying down, or when straining. Despite the headaches, papilledema does not cause eye pain.

People with severe papilledema may experience:

• Decreasing visual acuity
• Impaired color perception
• Limited visual field

What Causes Papilledema?

Papilledema can be caused by a variety of diseases, injuries, and conditions that increase intracranial pressure (ICP).

In general, any brain lesion that occupies space or causes cerebrospinal fluid (CSF) to accumulate can raise your brain pressure.

Infections that cause swelling of the brain and brain tissues may also lead to bilateral papilledema.

Some known causes of papilledema are:

• Brain tumor
• Brain abscess
• Head trauma
• Brain aneurysm
• Stroke
• Hydrocephaly
• High blood pressure
• Brain hemorrhage
• Cerebral edema
• Craniosynostosis
• Meningitis
• Encephalitis
• Cerebral venous thrombosis (CVT)

Certain medications can elevate your ICP as a side effect.

These include tetracycline, lithium, minocycline, nalidixic acid, corticosteroids, and some anti-hypertensive drugs such as nitroprusside, nitroglycerine, hydralazine, and nicardipine.

Unilateral papilledema is caused by an optic nerve glioma. It is a slow-growing tumor that increases ICP in 27% of cases.³

Sometimes, the cause of increased brain pressure is unknown. This is called idiopathic intracranial hypertension (IIH) or pseudotumor cerebri.

IIH mimics a brain tumor, so you will exhibit signs of papilledema.

Risk factors for papilledema

Papilledema is a rare optic nerve disorder. It can affect anyone regardless of age, gender, race, or ethnicity.

However, idiopathic intracranial hypertension (IIH) can increase your risk for papilledema.

IIH occurs in 1 out of 100,000 Americans. Obese women in their childbearing years (aged 15 to 44) are also 20 times more likely to develop the condition.

Obesity and sudden weight gain (at least 5 to 15% of your body weight) put you at risk for idiopathic intracranial hypertension and papilledema.⁴

Papilledema Diagnosis

The doctor will take your medical history, vital signs, and your height and weight. They will also try to see if you have been experiencing symptoms.

Doctors can use this information to identify risk factors and potential causes of papilledema. Sometimes, it’s all they need to diagnose and rule out optic nerve disorders.⁵

To confirm your diagnosis, an ophthalmologist may perform tests and request that you undergo additional imaging and lab tests.

Tests that can help diagnose papilledema include:

• Fundus exam
• Perimetry
• Optic coherence tomography
• Fluorescein angiography
• B-scan ultrasonography
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Magnetic resonance venography (MRV)
• Stereo color photography
• Lumbar puncture or spinal tap

Besides checking for optic nerve swelling, these tests can help your doctor find out what is causing it.

If papilledema is present, an eye specialist may use the Frisén scale to score the severity of your condition.

Complications of Papilledema

Failure to decrease the ICP can also lead to complications. The health consequences will depend on the underlying cause.

For example, increased intracranial pressure caused by a brain hemorrhage leads to an aneurysm or a stroke.

But if a brain abscess causes it, the possible complications are meningitis, thrombosis, and septicemia.

Some causes of papilledema require immediate treatment. If it is not addressed soon enough, it can cause death.

Is Papilledema Permanent or Reversible?

Without treatment, intracranial hypertension will apply increasing pressure to the optic nerve and cause permanent damage.

In turn, this can lead to vision loss.

Early treatment can prevent these complications.

The success of papilledema treatment depends on proper diagnosis. If your doctor does not find the exact cause, its symptoms may return.

Papilledema Treatment & Management

Treatment requires the involvement of an ophthalmologist, a neurologist, and a neurosurgeon.

Together, they will focus their care on treating the increased intracranial pressure and relieving optic disc swelling.⁶

Below are some general guidelines for treating papilledema:

Medications

If you are taking drugs that raise ICP, they have to stopped or replaced. The doctor may also prescribe these medications:⁷

• Antibiotics: Treat brain infection
• Anticoagulants: Dissolve blood clots
• Corticosteroids: Reduce inflammation
• Pain relievers: Manage or reduce headaches
• Diuretics: Reduce brain pressure
• Carbonic anhydrase inhibitors: Decreases CSF production

Topiramate (Topamax) can provide symptomatic relief of migraines and seizures. They can also decrease ICP.

People with idiopathic intracranial hypertension can use topiramate to help with weight loss.

Surgery

Your doctor may recommend the following procedures to decrease brain pressure:⁶

• Lumbar puncture: Decreases cerebrospinal fluid
• Brain shunt: Redirects cerebrospinal fluid
• Optic nerve sheath decompression: Relieves optic disc swelling and worsening vision problems

If you have IIH and obesity is a risk factor, bariatric surgery may be given as an option for weight loss.

But if the raised ICP is caused by abscess or a brain tumor, a surgeon may perform burr-hole aspiration or craniotomy.

How do I bring down my ICP?

Besides seeking treatment, there are a few things you can do to manage your papilledema and ICP.

For instance, you want to avoid laying down flat on the bed. This can increase your brain pressure and worsen your symptoms.

One study shows that elevating the bed by at least 30 degrees significantly decrease ICP.⁸

The Amsler grid test is one of the many standard tools used to perform a diagnosis. The grid consists of a single square with a grid pattern and a black dot in the middle. The test helps identify problem spots in your field of vision.

You can perform the test at home or in your local eye clinic.  

How to Use an Amsler Grid Test

If you want to use the Amsler grid test correctly, follow these steps once daily, every day:

• Put on your regular reading glasses if you have them. Hold the grid at eye level at approximately 12 to 15 inches away from your face in good light
• Then, cover your left eye
• With your right eye only (uncovered), look at the dot in the middle and lock your focus there
• While staring at the center dot with your uncovered eye, pay attention to the grid lines in your peripheral vision. If any lines or areas look blurry, wavy, dark, or blank, speak with your eye doctor
• After you have done one eye, switch and perform the same tasks with the other eye

What Does the Amsler Chart Look Like if You Have Macular Degeneration? 

A person with macular degeneration won’t see the Amsler grid/chart the same way as someone without eye health issues. The grid could appear to have wavy lines or blank spots if you have AMD.

If this occurs, you must speak with an eye doctor immediately. Early diagnosis could help your eye doctor establish a treatment regimen and prevent further damage.

Are Amsler Grid Charts Effective for Testing Macular Degeneration?

Current best practices will promote using an Amsler grid chart to test macular degeneration.

However, according to a study, the sensitivity of Amsler grids can be less than 50%.³ This means that some people with macular degeneration may not believe they have the condition when, in reality, they do.

Despite this, the Amsler grid chart is still useful. It’s economical, and you can perform it at home daily.

Until another adequate replacement comes about, using Amsler grids combined with knowledge of risk factors and clinical history can help with early detection.

What is Macular Degeneration?

Age-related macular degeneration (AMD) is an eye disease that can blur your central vision. You can develop it as you age due to macular damage. With early detection, you may be able to prevent or mitigate further macular damage.

If you believe you have AMD, consult an eye doctor. They will conduct a comprehensive eye examination, including various tests, to rule out or diagnose the condition.

Different testing approaches include:

• Amsler grid
• Retinal examination
• Fluorescein angiography
• Optical coherence tomography

What Causes Macular Degeneration?

AMD is a complex disease. Researchers and doctors still don’t know its exact cause. Some believe that genetic components and environmental factors play a role in your susceptibility to macular damage.

Here are some risk factors:

• Age. The majority of AMD cases happen in people over the age of 50. 
• Family history. There are specific genes related to AMD onset.
• Race. Caucasians face an increased risk of AMD. 
• Smoking. Smoking or exposure to secondhand smoke raises your likelihood of developing AMD.
• Unhealthy diet. Research suggests that obesity and unhealthy diets may amplify disease severity.
• Cardiovascular disease. You could have a higher chance of developing the wet form of macular degeneration if you have health issues that involve your heart or blood vessels (e.g., high blood pressure or hypertension).

What are the Symptoms of Macular Degeneration?

If you have macular degeneration, your symptoms may vary according to the disease stage. For example, dry AMD has three stages: early, intermediate, and late. Because it’s progressive, symptoms tend to get worse as time passes. 

Here is the progression of AMD:

• Early. People with early cases of dry AMD won’t show symptoms.
• Intermediate. Some may still not show changes in their visual field at this stage. Others may experience mild blurriness in central vision or have trouble seeing in low-lighting settings.
• Late/Wet. Those in this stage may observe a blurry area in their central vision. This blurry area could increase in size as time progresses, becoming a blind spot. Other effects include dimmer colors, straight lines appearing wavy, and poor vision in low light.

How to Treat Macular Degeneration

Macular degeneration can’t be cured. It’s a progressive disease. However, early detection can reduce symptom severity and slow disease progression.

Disease type and stage will determine the kind of treatment. In general, though, your healthcare provider may consider the following therapeutic approaches:

Nutritional supplements

Clinical trials found that combining vitamin and mineral intake could slow the progression of dry AMD.² AREDS supplements include:

• Vitamin C
• Vitamin E
• Lutein
• Zinc
• Copper
• Zeaxanthin
• Beta carotene (this is not recommended for smoker,s due to an increased risk of lung cancer) 

Antivascular endothelial growth factor (anti-VEGF)

This treatment for wet AMD includes blocking VEGF production, a protein that contributes to the creation of blood vessels. Your eye doctor will inject anti-VEGF into a numbed eye to delay or stop blood vessel development. Vision could improve as a result. 

Photodynamic therapy (PDT)

A healthcare professional will use both an injectable light-sensitive drug and laser treatment to eliminate extra blood vessels in the eye. You may undergo a combination treatment with anti-VEGF.

Summary

An Amsler grid is a tool that can help eye doctors perform an AMD diagnosis. While the sensitivity of Amsler grids can be less than 50%, it’s still useful.

Consult an eye doctor immediately if you experience symptoms of AMD. They can recommend ways to slow the disease’s progression.

Ocular hypertension is pressure build-up inside the eye. This intraocular pressure is higher than average (measured in mmHg). 

Many people with ocular hypertension do not have any symptoms. Because of this, you should get an eye exam regularly. 

Eye exams can determine the condition causing high intraocular pressure. Detecting early signs of other eye conditions minimizes the likelihood of optic nerve damage.

How is Ocular Hypertension Diagnosed?

At first, ocular hypertension will not show any noticeable signs or symptoms. A comprehensive eye examination can help ophthalmologists diagnose properly and rule out any possible structural damage to the eye. 

In these types of examinations, an ophthalmologist may assess the following:

• Visual acuity and visual fields 
• Tonometry (used to measure intraocular pressure)
• Optic nerve damage (using keratometry readings)
• Signs of pigment dispersion, pseudoexfoliation, iritis, or trauma (using a slit lamp)

Ophthalmologists sometimes perform gonioscopy (to check the eye’s drainage angle) and assess for angle closure. Finally, they may also evaluate central corneal thickness. 

Side Effects & Risks of Ocular Hypertension

Although not everyone with ocular hypertension will develop glaucoma, there is an increased risk of developing it. Glaucoma is an eye disease that can lead to blindness. 

Eye pressure increases when the front of the eye doesn’t allow for proper fluid drainage. Elevated pressure can result in glaucoma.

Ocular hypertension can become serious if left untreated. Because of the risk of blindness, it’s important to maintain doctor visits and follow treatment regimens. This can prevent the progression of glaucoma or other damage to the eye.

Glaucoma vs. Ocular Hypertension

Glaucoma and ocular hypertension are not the same. Although they both have factors of high eye pressure.

Glaucoma is an eye condition in which the optic nerve becomes damaged, and vision loss occurs. In many cases of glaucoma, this damage may result from high eye pressure.

Ocular hypertension occurs when you have raised eye pressure, but standard tests may not find any signs of structural or functional damage. This is how ocular hypertension is distinguished from glaucoma, as glaucoma shows optic nerve damage. 

Nevertheless, people with ocular hypertension face a higher risk of developing glaucoma. Ocular hypertension is a leading risk factor for primary open-angle glaucoma (POAG).

5 Causes of Ocular Hypertension

Your eye constantly makes a clear liquid called aqueous humor. This enters the front section of the eye and supplies it with nutrition. An equal amount of fluid is also drained to maintain normal eye pressure.

Ocular hypertension occurs when your body is unable to maintain normal eye pressure. Five primary reasons can cause this to happen:

1. Fluid accumulation in the eye. An increased amount of aqueous humor (eye fluid) can raise intraocular pressure
2. Inadequate aqueous drainage. Due to structural differences in the eye, drainage channels may not correctly release fluid build-up; an example of this may be pigmentary glaucoma
3. Certain medications. Corticosteroids and other drugs like tricyclic antidepressants may increase eye pressure
4. Eye trauma. Damage to the eye caused by an accident or infection
5. High blood pressure. People with high blood pressure or diabetes are at risk of developing ocular hypertension

Risk Factors of Ocular Hypertension

There are specific risk factors that can increase the risk of ocular hypertension. Race, age, and genetics can influence the development of this condition.

Those at risk for ocular hypertension include:

• Black people age 40 and older
• People with a family history of ocular hypertension and/or glaucoma
• People with extreme nearsightedness (myopia)
• People with diabetes
• People with pigment dispersion syndrome
• People with exfoliation syndrome

Your sleeping position can also affect your eye pressure. To avoid this, consider raising your head at a 20-degree angle to lower intraocular pressure.

Treatment Options for Ocular Hypertension

For people with ocular hypertension, medical treatment is the most common approach. Your doctor may also prescribe eye drops to reduce pressure.

They may also use the following medications:

• Beta-blockers
• Prostaglandins
• Alpha-adrenergic agonists
• Carbonic anhydrase inhibitors
• Rho kinase inhibitor
• Miotic or cholinergic agents

In other cases, an eye doctor may also consider argon laser trabeculoplasty or selective laser trabeculoplasty. Both types of laser trabeculoplasty aim to ease and increase fluid outflow through the trabecular meshwork. 

This procedure can decrease eye pressure. Selective laser trabeculoplasty is more commonly used because it is less destructive to the tissue.

How Do Doctors Determine Treatment for Ocular Hypertension?

An eye doctor may consider many factors when determining the most suitable treatment. These factors include:

• Risk of progression to glaucoma 
• A person’s attitude about treatment
• A person’s age, health, and life expectancy

To minimize the likelihood of glaucoma progression or slow the disease’s onset, maintain follow-up visits. The frequency of these visits may vary according to intraocular pressure reduction. 

Home Remedies for Ocular Hypertension

Some remedies you can implement to help reduce your risk for glaucoma include:

• Follow a healthy diet
• Raise your head to an approximately 20-degree angle while sleeping 
• Drink small amounts of liquid (less than a quart) throughout the day 
• Exercise regularly
• Learn and practice relaxation and mindfulness techniques 

What Foods Help With Lowering Eye Pressure?

Improving your eating habits can reduce stress, lower blood pressure, and better sleep. Consider eating meals that provide:

• Antioxidants
• Vitamins A, E, and C
• Minerals like zinc, copper, and selenium

You should also avoid drinking large amounts of coffee or energy drinks. If you don’t want to stop drinking coffee, you should at least reduce your caffeine intake. This is because caffeine can contribute to increased eye pressure.

What is the Prognosis for Ocular Hypertension?

The prognosis for ocular hypertension is favorable. To lower your chances of progressing to glaucoma or severe complications, maintain follow-up visits and adhere to prescribed medical treatments. 

This decreases the risk of eye health complications, such as a progression to glaucoma. Although you can’t always prevent glaucoma, regular follow-up visits can detect early damage to the optic nerve and control further progression.

Can You Prevent Ocular Hypertension?

You cannot prevent ocular hypertension. However, treatments are available to help reduce eye pressure. 

You must attend frequent eye doctor visits and undergo clinical eye examinations to monitor any glaucoma progression. An eye doctor will adjust treatment accordingly to slow the disease’s progression in its early stages.

How Can I Lower My Eye Pressure Fast?

Don’t drink more than a quart of any liquid quickly. This could cause your eye pressure to go up. 

High levels of stress can also increase eye pressure. So, if you experience high stress, consider integrating relaxation and meditation exercises. 

You may also need to eliminate certain medications, such as antihistamines. Speak with your doctor before removing any daily care medication.

Can You Cure Ocular Hypertension?

According to the American Optometric Association (AOA), ocular hypertension has no cure. However, as mentioned before, there are ways to reduce the risk of ocular hypertension. 

You can decrease the chances of eye damage by following prescribed treatments and regularly visiting your eye clinic. Monitoring your condition can help lower your risk of progression to glaucoma. 

Summary

You can develop ocular hypertension when you have increased eye pressure. This condition can’t be cured, but you can minimize its progression.

Ocular hypertension is caused by various factors influenced by race, age, and genetics. If left untreated, it can damage your optic nerves and cause vision loss or blindness.

Remember to visit your eye doctor regularly to monitor your eye’s condition. Your eye doctor will provide treatments and other remedies to keep your eyes healthy.

Narrow-angle glaucoma is one type of glaucoma. Glaucoma includes a range of eye conditions in which the optic nerve is damaged, endangering your vision.

High intraocular pressure is the most common cause of optic nerve damage. 

Narrow-angle glaucoma is when your iris protrudes forward and blocks the drainage angle between your cornea and iris.

When fluid cannot move around the eye properly, pressure builds up. The pressure increases your risk of optic nerve damage and permanent vision loss. 

Narrow-angle glaucoma is also called closed-angle glaucoma or angle-closure glaucoma. 

Narrow-angle glaucoma can be either acute or chronic.

Acute Narrow Angle Glaucoma

Acute narrow-angle glaucoma is a sudden and severe onset of blockage. The symptoms are quite painful.

It is considered a medical emergency and requires immediate medical attention. To prevent vision loss, contact an ophthalmologist or visit an emergency room as soon as possible.

Chronic Narrow-Angle Glaucoma

Chronic narrow-angle glaucoma is a gradual or partial closure of the drainage angle.

It is less dangerous than acute narrow-angle glaucoma, but it can also result in permanent vision loss.

Undergoing regular eye exams can help catch glaucoma in its early stages. If they detect it early, your eye doctor may be able to slow or prevent vision loss. 

Symptoms of Narrow-Angle Glaucoma 

Chronic angle-closure glaucoma will not have symptoms until the condition has reached a certain level of severity.

If a person experiences an acute attack, symptoms will be severe and occur suddenly. 

People with the following symptoms should speak with an ophthalmologist or visit an ER immediately:

• Sudden blurred vision
• Severe eye pain
• Headache
• Nausea
• Vomiting 
• Rainbow-colored rings or halos around lights

Causes of Narrow-Angle Glaucoma

Causes of narrow-angle glaucoma include:

Pupillary Block

This is a primary cause of narrow-angle glaucoma. It occurs when the iris and lens come in contact. This obstructs the flow of aqueous into the anterior chamber.

Surgery may help relieve or prevent this blockage.

Posterior Pressure on the Iris

If there is pressure on the iris, it can come into contact with the trabecular meshwork. This tissue fluid drains aqueous fluid from the eye.

If this drainage is blocked, it can increase eye pressure.

Mature cataracts, lens dislocation, intraocular tumors, and swelling of the uvea (middle layer of the eye) can all put pressure on the iris.

Neovascularization

Iris and angle neovascularization is new, abnormal blood vessel growth.

Examples include diabetic retinopathy, retinal vascular occlusions, and ocular ischemia (restriction in blood supply).  

Medication Side Effects

Some prescription drugs may increase the risk for angle-closure, such as eye drops to dilate the pupils.

Who Is at Risk of Developing Narrow-Angle Glaucoma?

People with the following risk factors have an increased risk of this form of glaucoma:

• High intraocular pressure 
• Narrow drainage angles in eyes
• Aged 60 or up
• Being black, Asian, or Hispanic 
• A family history of glaucoma
• Have diabetes, heart disease, high blood pressure, or sickle cell anemia
• Thin corneas
• Extreme farsightedness
• Eye injury
• Certain eye surgeries
• Taking corticosteroid medications for an extended period

Many people will develop narrow-angle glaucoma slowly and gradually. No symptoms are present until eye damage is severe or an acute attack occurs. 

Stages and Types of Narrow-Angle Glaucoma

There are 3 stages to describe narrow-angle glaucoma:

• Primary angle closure suspect
• Primary angle closure
• Primary angle closure glaucoma

Narrow-angle glaucoma can present any of the following types:

• Latent — No symptoms are present
• Subacute — Mild symptoms are presented but resolve on their own
• Acute — Sudden and severe onset of symptoms
• Chronic — Persistent, gradual progression of symptoms
• Absolute — Irreversible vision loss has occurred

Potential Complications of Narrow-Angle Glaucoma

If you do not seek treatment for narrow-angle glaucoma, you are at risk of serious complications, including:

Permanent Visual Acuity Loss

People with narrow-angle glaucoma can lose visual acuity (sharpness).

In many cases, symptoms of this eye narrow-angle glaucoma are delayed. This can increase your likelihood of vision loss.

Regular comprehensive eye exams can help prevent this.

Central Retinal Artery Occlusion

Central retinal artery occlusion (CRAO) is when a vessel carrying blood to the eye’s retina becomes blocked.

This can happen without notice or pain and result in eyesight loss. Neovascular glaucoma can develop after a CRAO.

Malignant Glaucoma

This term refers to a rare but aggressive form of treatment-resistant postoperative glaucoma.

This condition causes increased intraocular pressure and a shallow or flat anterior chamber. 

In severe cases, it causes blindness.

Eye doctors may also use the following terms to describe this condition:

• Ciliary block glaucoma
• Aqueous misdirection syndrome
• Direct lens-block glaucoma

Fellow Eye Attack

A “fellow eye” refers to the other eye where the condition is not present.

Symptoms in one eye could cause an attack or increased eye pressure in its fellow eye.

To minimize the likelihood of the event, an eye doctor may perform:

• A prophylactic iridectomy (preventative partial removal of the iris)
• Laser iridotomy (creates a hole in the outer edge of the iris)

How Common is this Form of Glaucoma? 

This form of glaucoma affects many people worldwide.

Approximately 15.7 million people suffer from primary angle-closure glaucoma.

Asian populations have an increased risk of this condition. 

Treatment can help manage glaucoma and prevent blindness in most cases.

However, even with care, approximately 15% of people with glaucoma lose complete vision in at least one eye within 20 years. 

Open-Angle vs. Narrow-Angle Glaucoma

There are different forms of glaucoma. Narrow-angle glaucoma and open-angle glaucoma are two examples.

Open-angle glaucoma is the most common form.

In these cases, the drainage angle remains open. The main issue is blockage of the trabecular meshwork.

As a result, eye pressure begins to go up. This increases the risk of optic nerve damage and vision loss. 

Symptoms of open-angle glaucoma include the following:

• Patchy blind spots in peripheral or central vision (often in both eyes)
• Tunnel vision (during advanced stages of the condition)

Unlike acute narrow-angle glaucoma, the onset of symptoms of open-angle glaucoma is slow.

Most people remain asymptomatic until the open-angle glaucoma is more advanced. Acute narrow-angle glaucoma can inflict damage to the optic nerve quickly.  

How is Narrow-Angle Glaucoma Diagnosed?

To diagnose narrow-angle glaucoma, your eye doctor will perform a thorough eye examination.

During the examination, they may use the following tests:

• Measuring intraocular pressure (tonometry)
• Assess optic nerve damage (dilated eye examination and imaging tests)
• Examine areas of vision loss (visual field test)
• Measure corneal thickness (pachymetry)
• Examine the drainage angle (gonioscopy)

The American Academy of Ophthalmology (AAO) recommends an eye exam every 5 to 10 years for ages 40 and younger. They recommend people over 65 receive an eye exam every 1 to 2 years.

Frequent screening is necessary for those who are at risk of glaucoma.¹ 

Treatment Options for Narrow-Angle Glaucoma 

If you have narrow-angle glaucoma, treatment options are available.

Taking steps to improve your eye health can prevent or slow vision loss and damage to the optic nerve. 

Speak with your ophthalmologist immediately if you think you are at risk for glaucoma.

Treatment possibilities include:

Oral, Topical, or Intravenous Medications

These medical treatments are used on patients undergoing an acute attack. They are meant to provide relief until the patient can see an opthalmologist

Sometimes these will be enough to “break the attack” and are sufficient treatment.

Further treatment will try to resolve the underlying cause.

Peripheral Iridotomy

This surgery creates a hole in the iris. A laser will typically be used to make the hole.

It allows the aqueous to flow and relieves eye pressure.

Lensectomy (Cataract Surgery)

If a cataract is the underlying cause, your doctor may elect to remove the affected lens immediately.

Your ophthalmologist may recommend preventive surgery for the fellow eye as well.

Tips for Managing Narrow-Angle Glaucoma 

To prevent vision loss, follow the steps prescribed by your eye doctor. A

surgical procedure may be necessary to slow the onset of the eye condition. 

Other lifestyle changes to promote eye health include:

• A healthy diet rich in zinc, copper, selenium, and antioxidant vitamins C, E, and A
• Limiting caffeine intake 
• Exercising regularly 
• Sleeping with your head elevated at approximately 20 degrees
• Integrating relaxation and meditation techniques 

Common Questions & Answers

How serious is narrow-angle glaucoma?

Narrow-angle glaucoma is a serious condition. If left untreated, it can cause permanent blindness. 

What should I avoid with narrow-angle glaucoma?

You should avoid antihistamines, decongestants, asthma medicine, motion sickness drugs, and tricyclic antidepressants.

Speak with your doctor beforehand about any changes in medication regimens. 

Can narrow-angle glaucoma be cured?

In some cases, treatment can create successful and long-lasting results. It is important to maintain check-ups, as a chronic form of glaucoma may still arise. 

Can you go blind from narrow-angle glaucoma?

Yes. If you do not receive proper care, especially after an acute attack, your risk of blindness increases. 

Can stress cause narrow-angle glaucoma?

Stress may affect intraocular pressure and influence the severity of the eye condition. However, more research is needed. 

You should integrate mindfulness and relaxation techniques to lower stress levels.

Graves’ ophthalmopathy is an autoimmune disease. It occurs when the immune system attacks the tissues around the eyes.

Other names for this condition include:

• Graves’ eye disease
• Thyroid eye disease
• Graves’ orbitopathy
• Thyroid-associated ophthalmopathy

Around one in three people develop Graves’ eye disease from Graves’ Ophthalmopathy. It causes the thyroid gland to produce too much thyroid hormone (hyperthyroidism), affecting the rate of metabolism in the body.

Severe forms of Graves’ eye disease can lead to vision loss. See your doctor right away if you experience symptoms of Graves’ eye disease.

What Are the Symptoms of Graves’ Ophthalmopathy?

Eye symptoms associated with Graves’ disease are generally mild and easy to treat. Graves’ eye disease typically affects both eyes, but symptoms may only be apparent in one eye.

Common symptoms of Grave’s eye disease include:

• Dry, itchy, irritated eyes
• Bug-eyed look due to bulging eyes
• Light sensitivity (photophobia)
• Teary eyes
• Eyelid swelling
• Eye pain or pressure around the eyes
• Trouble closing the eyes completely
• Double vision (diplopia)
• Pain when you move your eyes either up and down or left to right

Rarely, swelling around the eyes can pressure the optic nerve and cause vision loss.

What Causes Graves’ Eye Disease?

Many people with Graves’ disease develop Graves’ eye disease. This is due to the negative response of the immune system from an overproduction of thyroid hormones.

Graves’ disease causes the immune system to attack the muscles around your eyes (extraocular muscles). This leads to swelling behind your eye sockets. The swelling causes eye symptoms like bulging eyes and difficulty closing the eyelids.

Because thyroid hormones play a vital role in various body systems, the disease severity of Graves’ ophthalmopathy can differ significantly.

Hashimoto’s thyroiditis is another type of thyroid dysfunction that may cause Graves’ eye disease. 

How Is Graves’ Eye Disease Diagnosed? 

If you believe you have Graves’ eye disease, you should seek medical attention. Your eye doctor will check for Graves’ ophthalmopathy with a comprehensive eye exam. They’ll carefully examine your eyes and eyelids.

Your eye doctor may recommend additional testing to diagnose Graves’ disease as an underlying cause of other symptoms. Your doctor will review your medical and family history and perform a physical exam. 

They may order one or more thyroid tests to confirm a diagnosis of Graves’ disease. These include:

• Blood tests
• Radioactive iodine uptake test
• Thyroid scan
• Doppler blood flow measurement

What Does Graves’ Eye Disease Look Like?

Graves’ eye disease causes swelling in the muscles and other tissues behind the eyes. This may make the eyes bulge and stick out beyond their normal position. 

Other clinical features of Graves’ eye disease include:

• Upper eyelid retraction
• Swelling of tissues in and around the eye socket
• Eye redness
• Swollen eyelids
• Proptosis (bulging eyes)

Hashimoto’s Thyroiditis vs Graves’ Disease

Hashimoto’s thyroiditis has some overlaps in symptoms with Graves’ disease, but their treatments differ. Hashimoto’s thyroiditis comes from hypothyroidism, while Graves’ disease comes from abnormal thyroid response leading to hyperthyroidism.

When left untreated, hypothyroidism from Hashimoto’s disease can lead to health problems, including high cholesterol, heart disease, and heart failure.

Thyroid disorders like Grave’s disease and Hashimoto’s thyroiditis are not contagious, so you can’t catch these conditions from people who have them. However, they both have genetic links, so you’re more likely to inherit these conditions if someone in your family has one of them.

Who is at Risk of Developing Graves’ Ophthalmopathy?

People who have Graves’ disease face a high risk of developing Grave’s eye disease.

Graves’ disease is the underlying health problem in nearly all cases of Graves’ ophthalmopathy. Women and people over age 40 are more likely to develop Graves’ disease.

Other risk factors for Graves’ eye disease include:

• Smoking cigarettes
• Hyperthyroidism
• Receiving radioactive iodine treatment
• Having a family history of Grave’s disease
• Having another autoimmune disease, such as rheumatoid arthritis or Crohn’s disease

Not only does smoking increase your risk for Graves’ eye disease, but it also makes the condition more severe. This is because smoking compromises the immune system, increasing your risk for various diseases.

How Is Graves’ Eye Disease Treated?

Treatments for Graves’ eye disease vary depending on the severity of your symptoms. Mild thyroid eye disease is typically not highly progressive and often goes away on its own, usually lasting approximately 1-2 years.

However, it’s essential to speak with your eye doctor because thyroid eye disease is a potentially vision-threatening condition. People with this condition may not always return to their normal orbital anatomy.

Home Remedies

Most cases of Graves’ eye disease are mild and can be managed at home. Home remedies include:

• Over-the-counter eye drops (artificial tears). This common treatment can relieve irritated or dry eyes
• Wearing sunglasses. This addresses light sensitivity and prevents you from exacerbating symptoms
• Sleeping with your head raised. This reduces eyelid puffiness and swelling
• Taping your eyelids shut at night. This helps prevent dry eye
• Quitting smoking. It’s best to avoid smoking since it can weaken the immune system and make it more prone to Graves’ disease symptoms.

Professional Treatments

If your eye symptoms are severe, or if home remedies don’t work, your doctor may recommend one or more of the following:

• Prescription medicines. Oral steroids like prednisone can reduce swelling, or your doctor may prescribe a new medicine called teprotumumab that specifically treats Graves’ eye disease.
• Thyroid hormone medication. If Graves’ disease is the cause of your eye problems, you will need treatment to balance your thyroid hormones. This usually involves taking levothyroxine to manage your hyperthyroidism.
• Special eyeglasses. To fix double vision and help you see more clearly.
• Orbital radiotherapy. A radiation treatment to help reduce swelling around the eyes.
• Orbital decompression surgery. This procedure makes the eye socket larger, which helps relieve pressure on the optic nerve and moves the eye into its correct position.
• Eyelid surgery. This procedure fixes eyelids pulling back too far and allows them to return to their normal position.

Summary

Graves’ eye disease is a group of eye problems commonly associated with Graves’ disease. Graves’ disease is an autoimmune disorder that causes the immune system to attack healthy tissues around the eye.

Although Grave’s eye disease is usually mild, its symptoms may lead to vision loss. It’s essential to see an eye doctor if you see signs of this condition, which include bulging eyes and eyelids that don’t close all the way.

Common treatments include eye drops and oral steroids. Some people may require special glasses to correct double vision. In severe cases, radiotherapy or surgery may be necessary. It’s best to consult your eye doctor to receive the best treatment for your condition.

Lattice degeneration is an eye condition that involves irregular thinning of the retina. 

It affects the side (peripheral) retina, the light-sensitive nerve tissue that lines the back of the eye. This part of the eye is essential for good vision. 

People with lattice degeneration are at greater risk for:

• Retinal tears
• Retinal holes
• Retinal breaks

Conditions associated with lattice degeneration can lead to retinal detachment, which can cause vision loss. That’s why people with lattice degeneration need to get routine eye exams.

There’s no prevention or cure for lattice degeneration, but treatment can reduce the risk of vision-threatening complications like retinal detachment.

How Common is Lattice Degeneration?

Lattice degeneration is common, affecting 6% to 8% of the population.^1,2 However, past studies suggest the prevalence has been as high as 10%.^3-5 

This type of peripheral retinal degeneration typically affects both eyes but can occur in only one.

Symptoms of Lattice Degeneration

Lattice degeneration doesn’t cause symptoms. The only way to know you have it is to see an eye doctor for a dilated fundus examination.

If a retinal tear or detachment occurs, you may experience these symptoms:

• Blurry vision or other changes in vision
• The appearance of new eye floaters
• Flashing lights
• A shadowy curtain blocking your peripheral vision

See an ophthalmologist or retina specialist immediately if you have symptoms of a retinal tear or detachment. Timely treatment can save your vision.

What Causes Lattice Degeneration? 

Healthcare professionals don’t fully understand the cause of lattice degeneration. There’s not enough conclusive evidence to suggest that lattice degeneration is inherited. However, it’s possible to find clusters of family members with the condition.

Risk Factors

Lattice degeneration is more common in people with:

Myopia (Nearsightedness)

According to one study, lattice degeneration occurs in 33% of people with myopia.⁷ This is compared to a 6% to 10% prevalence of lattice degeneration in the general population.

It can also occur in those with the following conditions:

• Stickler syndrome. People with this genetic disorder can experience early-onset retinal detachment.
• Ehlers-Danlos syndrome. This genetic condition increases the risk of lattice degeneration and retinal detachment.
• Marfan syndrome. People with this connective tissue disease have an increased risk of lattice degeneration and retinal detachment.

How is Lattice Degeneration Diagnosed?

An ophthalmologic examination is necessary for the diagnosis of lattice degeneration. 

Your ophthalmologist will review your medical history and perform a dilated fundus examination. To perform this eye exam: 

1. The eye doctor will administer dilating eye drops to widen your pupil. This allows them to examine your retina carefully.
2. They use a headlight and a special lens to look for signs of retinal thinning.
3. Depending on the initial discoveries, the doctor may apply some pressure around the eye. This process is called scleral depression.
4. The eye drops will cause your pupils to remain dilated for several hours. During this time, you may have blurry vision and increased sensitivity to light.

No imaging tests are required for diagnosis. However, wide-angle photographs of the retinas can help with managing the condition. 

How is Lattice Degeneration Treated?

The vast majority of people with lattice degeneration don’t require treatment. However, routine eye exams will assist with managing the condition should it worsen. 

In rare cases, an eye doctor may recommend preventive treatment to strengthen weak areas of retinal tissue. The goal is to reduce the risk of a retinal tear or detachment.

Treatment options include:

Laser Treatment

This treatment involves using a medical laser to burn areas of abnormal thinning. The laser causes scar tissue to form, which repairs the retina.

Cryotherapy

Like laser therapy, cryotherapy heals the retina by creating scar tissue. The main difference is this treatment uses a freezing probe instead of a laser.

Potential Complications of Lattice Degeneration

This condition doesn’t always lead to a retinal detachment. However, in rhegmatogenous retinal detachments (RRD), the prevalence of lattice degeneration was 20% to 30%.^{2, 3} 

Without proper care for lattice degeneration, there is a risk of retinal tear or detachment. If that occurs, treatment is possible. However, it should be immediate.

Untreated retinal detachment can result in permanent vision loss. 

Prognosis

Lattice degeneration is minimally progressive. You may never develop a retinal tear or detachment if you have it. 

However, it’s important to see your eye doctor and undergo regular dilated fundus exams to monitor the condition.

Summary

Lattice degeneration is a common eye condition. It involves abnormal thinning of the peripheral retina and usually affects both eyes. About 6% to 10% of the population has lattice degeneration, but the prevalence is higher in people with myopia (nearsightedness).

By itself, lattice degeneration doesn’t cause vision problems. However, it increases the risk of retinal tears, breaks, and holes. These conditions can lead to retinal detachment, which can cause vision loss.

There are no symptoms of lattice degeneration, but your ophthalmologist can detect it with a dilated eye exam. Most people don’t require treatment, but regular eye exams are necessary to monitor the condition.

It’s not the same as esotropia. In this condition, either one or both of the eyes turn inward. 

Exotropia is a common condition. It accounts for 25 percent of all ocular misalignment cases in young children.³

While it could happen periodically, it could also be constant. However, it is more typical to find exotropia developed while a child is 1 to 4 years old.

Parents may notice this form of strabismus, especially when the child is:

• Daydreaming
• Sick
• Tired 

It may also be apparent when the child attempts to focus on distant objects. When a child focuses on items up close, it may be difficult to notice the eye condition. 

If there is suspicion of exotropia, it is essential to seek an eye care specialist. An eye doctor can perform a comprehensive eye exam and differential diagnosis to rule out other possible conditions. 

Signs & Symptoms of Exotropia

Those with exotropia may experience some symptoms of exotropia or show signs.

For example, they may have:

• Loss of binocular vision
• Loss of depth perception
• Outward turning of the eyes. This can begin as intermittent
• Eyestrain
• Sensitivity to bright light or bright sunlight (this can cause people to squint) 

These symptoms do not always suggest exotropia. However, it is essential to seek an eye consultation if one or more of these symptoms are present. 

Different Types of Exotropia

There are 4 types of exotropia.

Speak with your ophthalmologist and undergo an eye exam to see which type of exotropia you or your child has.  

1. Sensory Exotropia

If a person has sensory exotropia, the eye may suffer from poor vision or blindness. It will also turn outward. 

Initially, if an infant or young child has a blind or poorly seeing eye, esotropia develops. However, in older children, the eye often becomes exotropic. These children are usually between the ages of 2 and 4 years.

2. Intermittent Exotropia

With intermittent exotropia, one eye turns outward on occasions.

Other times, the eyes are straight. During these times, there is no apparent suggestion of the condition. Family members or friends may observe the exotropia when the person with the disorder is either tired or daydreaming. 

Intermittent exotropia may be more noticeable when the person looks at distant objects. 

This type of exotropia is rare and will cause no to few symptoms. However, intermittent exotropia can occur more often or progress to becoming constant. 

3. Congenital Exotropia

Some may refer to congenital exotropia as infantile exotropia. This outward turning of the eyes is present since birth or during early infancy. 

While esotropia is more common in infants, a pediatric ophthalmologist should assess constant exotropia. The latter condition may link with an underlying medical condition. 

4. Alternating Exotropia 

People with an alternating exotropia have an outward eye turn that alternates both eyes. The condition can be constant or intermittent. It varies in degree of severity. 

Intermittent exotropia is the most frequent type of strabismus. The condition impacts as much as 1 percent of the U.S. population.⁸ It is more common in females than in males. 

Potential Complications of Exotropia

Exotropia can cause complications, including:

• Headaches
• Trouble reading 
• Eyestrain
• Blurry vision
• Decreased 3D vision
• Abnormal head posture

More than 90 percent of children with intermittent exotropia develop myopia by 20 years of age.¹

What Causes Exotropia?

There is no specific, known cause of exotropia. 

It may be common in children with either sensory exotropia or an underlying genetic disorder that affects eye movements. 

Here is a list of some eye diseases that could increase the likelihood of developing exotropia:

• Duane’s syndrome —  this is a congenital strabismus syndrome. People with the condition may experience diplopia (double vision), anisometropia (the two eyes have different refractive errors), and amblyopia (lazy eye). 
• Slipped or lost medial rectus muscle — loss of this muscle can happen after different types of eye surgery. These eye surgeries include retinal detachment surgery or paranasal sinus surgery. 
• Internuclear ophthalmoplegia — this is an ocular motility disorder. This condition affects the lateral gaze and causes ophthalmoplegia. This is paralysis or weakness of the eye muscles. 
• Orbital fibrosis — this rare condition is characterized by an infiltrating orbital mass and thickening of connective tissue. 

Additionally, these risk factors may increase the probability of exotropia:

• Family history of strabismus, amblyopia, childhood cataract, or glaucoma (increased eye pressure) 
• Some genetic disorders. For example, cerebral palsy or Down syndrome 
• Childhood cataracts or glaucoma

It is essential to understand that exotropia is not a disease in and of itself. The condition refers to a motility disturbance. This disturbance includes abnormal eye movements or trouble managing eye movements.

Exotropia can occur as a result of a particular medical disease or disorder. 

How is Exotropia Diagnosed?

An eye doctor, such as an ophthalmologist or optometrist, will perform an exotropia diagnosis based on:

• Family history
• Symptoms
• Vision testing 

Vision tests can consist of:

• Reading letters from an eye chart 
• Refraction to test for uncorrected refractive error. In these cases, glasses may be prescribed
• Eye drops that dilate the pupils of the eyes and enable an exam of the eye’s internal structures

Treatment Options for Exotropia

Those with exotropia can explore both non-surgical and surgical treatment options. 

Non-surgical treatment possibilities include:

• Patching 
• Over-minused spectacles or glasses
• Orthoptic therapy. These exercises enable the re-education of binocular vision
• Prism glasses 

Surgical treatments may be performed to maintain or restore binocular capability. Diplopia refers to double vision, while cosmesis means to enhance physical appearance.

There is a higher success rate in the long run for those with intermittent exotropia and with stronger binocular function at the time of surgery. 

To learn which treatment is most suitable, you should visit your local eye clinic. There you can speak with a professional eye care specialist.

Is it Possible to Outgrow Intermittent Exotropia?

Intermittent exotropia may occur in infants as young as 1 to 2 months of age. If the condition is mild, it may go away on its own within 6 to 8 weeks of birth. 

In other cases of exotropia, it is not common to find a complete resolution of the condition.

Patching, glasses, or vision therapy can help. However, exotropia may remain present.