Eyes and Vision

What can I do to continue driving safely at night?

DEAR DOCTOR K: I am in my 60s. Over the last few years, my night vision has gotten worse, and I'm finding it increasingly difficult to drive at night. What can I do to continue driving safely after dark?

DEAR READER: Night vision does start to decline as we get older, usually after age 50. Perhaps you've noticed more difficulty seeing in dim light, or maybe you're more bothered by the glare from headlights. Problems with night vision are the result of several changes to the eye that occur with aging. The first change involves the iris and pupil. As we age, the iris muscle weakens and becomes less responsive.

How do you put in eye drops?

DEAR DOCTOR K: I have dry eye syndrome. My doctor prescribed artificial tears, but I can't manage to get the drops into my eyes. Any advice?

DEAR READER: Dry eye syndrome occurs when your body doesn't produce enough tears. Tears moisten, protect and cleanse our eyes. Without enough tears, your eyes may burn, itch, or feel like there is something gritty in them. Dry eye syndrome can also increase your sensitivity to light and cause excessive tears. Dry eye syndrome is often effectively treated with artificial tears. Available over the counter, they mimic the composition of natural tears. Of course, they work only if you can get them into your eyes. Like you, many people need to learn how to do it.

Can you tell me more about blepharitis?

DEAR DOCTOR K: I had some itching and burning in my eye. My ophthalmologist said I have blepharitis. Can you tell me more about this condition?

DEAR READER: Blepharitis is an inflammation of the edges of the eyelids and eyelash hair follicles. It is a common and sometimes long-lasting condition. The good news is that it will not permanently damage your eyesight. Blepharitis can be triggered by bacterial infections, though it is not contagious. You can also develop blepharitis if your eyelid glands make too much oil. People with skin conditions such as rosacea, seborrhea, oily skin, dandruff or dry eyes are more likely to get this condition.

Why is it harder for our eyes to focus on close objects as we get older?

DEAR DOCTOR K: Why does it become harder for our eyes to focus on close objects as we get older?

DEAR READER: The eye is like a camera: It has a lens that continuously focuses to sharpen the picture. As light rays enter the eye, the flexible lens alters its shape, allowing the eye to focus on objects at varying distances. The lens focuses light rays on the retina, the light-sensitive layer at the rear of the eye. As we age, the lens of the eye becomes increasingly inflexible. As a result, light rays focus behind the retina, rather than on it. This is called presbyopia. (Below, I've put an illustration of how the lens focuses light rays in a normal eye and in a presbyopic eye.)

What is endophthalmitis?

DEAR DOCTOR K: A few weeks after my cataract surgery, my eye began to hurt and my eyelid became swollen. My doctor said I have "endophthalmitis." What is this? Is it related to my cataract surgery?

DEAR READER: Endophthalmitis is inflammation inside the eye that is usually triggered by an infection. In the United States, most cases are caused by bacterial infections that develop after eye surgery. Endophthalmitis is a serious problem that can lead to permanent loss of vision.

My eyes are affected the most by allergies, what can I do for relief?

DEAR DOCTOR K: I have allergies, and my eyes are affected the most. They're puffy, red and itchy. What can I do?

DEAR READER: Pollens, animal dander, dust mites and mold: The same allergens that cause sneezing and an itchy nose and throat can trigger allergy symptoms that affect your eyes, too. If your eyes are red and itchy, you may also have tearing, mucous discharge and swelling of your conjunctiva (the inside of your eyelid). This constellation of symptoms is known as allergic conjunctivitis. It can be uncomfortable, but it is not a threat to vision.

What is an astigmatism?

DEAR DOCTOR K: At my last visit, my eye doctor told me I have astigmatism. He told me what that means, but I still don't really understand what it is. Please explain it to me.

DEAR READER: Astigmatism means that the eye's cornea has an irregular shape, which causes vision problems. Astigmatism is very common; I am among the several billion people who have it. Fortunately, it's easy to correct. Let's start with a little eye anatomy. The cornea is the clear, dome-like window at the front of the eye.

Poor vision is affecting my independence– are there tools to help with my daily activities?

DEAR DOCTOR K: I have poor vision that is making it more and more difficult for me to live independently. Are there tools that can help with my day-to-day activities?

DEAR READER: Like you, some of my patients have poor vision, which limits their ability to perform activities such as reading a newspaper, using a computer, watching television, cooking a meal or crossing the street. For some, poor vision means poor central vision. For others, it is blurry vision, loss of peripheral vision or even double vision. But however your vision is affected, there are ways to cope:

What can I do about a drooping eyelid?

DEAR DOCTOR K: My right eyelid droops and interferes with my vision. What can I do about this?

DEAR READER: The medical term for a drooping eyelid is "ptosis" (pronounced TOE-sis). In severe cases like yours, the drooping eyelid can cover all or part of the pupil and interfere with vision. Every part of our body is constantly tugged on by gravity. And something that is constantly being pulled downward (at least when we are standing or sitting) tends to sag. The eyelid is no exception. The effects of gravity can be exaggerated by any injury that weakens the strength of the eyelid.

What replacement lenses should I chose after cataract surgery?

DEAR DOCTOR K: I'm having cataract surgery in a few weeks. There are so many options for replacement lenses. Which one should I choose?

DEAR READER: I can't tell you which you should choose, since I don't know the specifics of your cataract. But I can suggest how you should think about several options that your ophthalmologist is likely to discuss with you.