Dr. Brass is a Fellowship trained Corneal Specialist. This means that in addition to the extensive education and training that he completed to become a Board Certified eye physician and surgeon, or Ophthalmologist, Dr. Brass completed additional training in an academic medical center caring for patients requiring more specialized care to treat their corneal problems. Thus as a Corneal Specialist, Dr. Brass provides consultation, diagnosis, and treatment for the full range of medical and surgical conditions affecting the anterior segment of the eye. These include infections of the cornea, corneal decompensation, corneal dystrophies including Fuchs' dystrophy, keratoconus, corneal trauma and scarring, cataract, recurrent corneal erosions, pterygium, and dry eyes.
Allergies
Allergies, especially from pollen, are a very common eye problem. The usual symptoms of eye allergies include redness, itching, burning, tearing, stinging and a watery discharge or running. Occasionally, these symptoms are severe enough to cause you to seek medical care. When they are, Dr. Brass will carefully examine you and often be able to prescribe eye drops that contain decongestants, antihistamines, or anti-inflammatory medicines to help make you more comfortable and eliminate the allergic reaction.
It is not uncommon to be affected by an eye allergy caused by certain medications, contact lens solutions, animal hair, eye cosmetics such as mascara and eyebrow pencil, face creams, face scrubs, certain soaps, and even nail polish and remover cups vapors.
If you are suffering from the above symptoms of eye allergies and schedule a visit with Dr. Brass, please be sure to tell him if you have come in contact with any of the above materials.
Conjunctivitis or Pink Eye
The conjunctiva is the clear protective membrane that lines the eyelids and covers the exposed portion of the sclera, or “white” part of your eye. Conjunctivitis or Pink Eye is a term used to describe a number of eye conditions that result in inflammation of the conjunctiva. This typically presents as swelling, itching, burning and redness of the eyes that can be associated with a discharge of several types depending on the cause.
Conjunctivitis or Pink Eye can easily be spread from one person to another and may actually affect many people at the same time. A bacterial or viral infection, allergy, environmental irritants, a contact lens product, cosmetics, eye drops, or eye ointments can cause conjunctivitis.
At its onset, Conjunctivitis or Pink Eye is usually painless and does not adversely affect your vision. Conjunctivitis or Pink Eye may clear without requiring medical care. However, some types of Conjunctivitis do require medical attention, especially if they persist or are accompanied by a greenish colored or stringy discharge, significant crusting of the eyelids or any pain, change in vision or light sensitivity. In these instances you should call Brass Eye Center at 518.782.7827 as treatment will be needed.
Delaying treatment may cause the infection to worsen and result in corneal, scarring or infection.
Corneal Infections
The outermost layer of the cornea is called the epithelium. If it is damaged from trauma of any type, i.e. getting a foreign body in your eye such as piece of metal, a poke in the eye from a branch or a finger or even from a dirty or damaged contact lens, it is possible for bacteria, viruses or fungi to penetrate the cornea and cause an infection. An infection of the cornea is called a keratitis. Keratitis can cause a painful inflammation with a discharge, which if not treated quickly and appropriately, can lead to corneal erosion, corneal ulceration and corneal scarring. Corneal scarring results in a loss of corneal transparency and can require a corneal transplant in order to restore vision. Generally, the deeper the corneal infection, the more severe the symptoms and the greater the potential for loss of vision.
If he suspects that you have a corneal infection, Dr. Brass will look for certain diagnostic signs to help him decide the best course of treatment for corneal infections. Sometimes this might be an antibiotic eye drop, an antifungal eye drop, an antiviral eye drop and sometimes it might even include a steroid eye drop to reduce the inflammation.
Dry Eyes
Dry Eye Syndrome is a very common eye condition that can affect the cornea. Anytime there is either inadequate tear production, too rapid tear evaporation or drainage, the symptoms of dry eyes may become present. As discussed elsewhere, the symptoms of dry eyes include a scratchy dry sandy or gritty feeling that can be accompanied by a stringy clear white discharge with noticeable pain and redness. Dry eye creates additional risk of corneal infection as the tear film, which serves as a protective mechanism and contains a number of antimicrobial components, is deficient. You may wish to review the diagnosis of dry eyes, causes of dry eyes and treatment of dry eyes.
Fuch’s Dystrophy
Fuch’s Dystrophy is a slowly progressive disease of the cornea that can be found in both eyes and is slightly more common in women than men. While it is possible to observe Fuch’s Dystrophy in people in their 30’s and 40’s, it usually does not compromise vision until people are in their 50’s or 60’s. The innermost layer of cells in the cornea, called the endothelium, is a single layer of non-regenerating cells. The endothelial cells are responsible for pumping water out of the cornea and helping to maintain the corneal transparency. While the reason is poorly understood, in Fuch’s Dystrophy, the endothelial cells die, which make the endothelium less efficient in it’s pumping activity, This results in the cornea swelling and distorting vision. In it’s later phases, Fuch’s Dystrophy is often associated with considerable pain as the epithelium “blisters” by forming “bullae”, which actually begin to burst open.
Early in the course of Fuch’s Dystrophy patients will wake up with blurry vision that gets progressively clearer as the day passes. This phenomenon occurs because the cornea normally takes on water and swells during sleep. A healthy endothelial pump is necessary in order to restore the cornea to a normal thickness. In Fuch’s Dystrophy, the endothelium removes fluid from the cornea less efficiently. As the Fuch’s Dystrophy disease worsens, the vision does not clear.
Dr. Brass will attempt to help reduce the corneal swelling each day with eye drops and ointments. However, when these measures fail to provide comfort and clear vision, it may be necessary to have a corneal transplant. There is a new experimental procedure to transplant endothelial cells, which may help Fuch’s Dystrophy patients in the future.
Herpes Zoster Keratitis (Shingles)
Herpes Zoster Keratitis is actually caused by the same virus that causes chicken pox, called Varicella-Zoster Virus. It is entirely possible that after having chicken pox as a child, the Varicella-Zoster Virus remains in the nerve cells of your body in an inactive state. For a number of possible reasons, the Varicella-Zoster Virus can reactivate later in life and travel through the nerves in different parts of your body causing a painful blistering rash. If the Varicella-Zoster Virus travels to your head or neck it can affect the eye and thus cause a corneal infection.
It is critical to have Dr. Brass diagnose this quickly as the infection can penetrate deeply into the cornea and it can cause scarring. The infection can also result in a loss of corneal sensation, which can be permanent. Dr. Brass may prescribe both oral medications and eye drops to try and resolve the infection and prevent serious damage from occurring.
It is possible for anyone who has been exposed to the Varicella-Zoster Virus to get shingles, however it seems to affect those of advanced age and those with weakened or suppressed immune systems many times more often. Further, corneal problems from shingles may occur many months after the facial shingles appear to have resolved. Therefore, if you have had facial shingles it is important for you to schedule regular follow up appointments with Dr. Brass.
Keratoconus
Keratoconus is disorder of the cornea characterized by a progressive thinning of the tissue, and instability of the cornea, The cornea begins to bulge outward and become cone like. It is the most common corneal dystrophy found in the in the United States. As the cornea begins to bulge it causes considerable changes in the refractive power of the eye producing nearsightedness and astigmatism. Keratoconus usually affects both eyes. At first it may be possible to correct the vision with contact lenses. Contact lens intolerance develops in about 20% of patients making a corneal transplant necessary.
Lattice Dystrophy
Lattice Dystrophy occurs as a result of the accumulation of abnormal protein fibers, or amyloid deposits in the middle cornea layer called the corneal stroma. If these deposits become dense enough they will become opaque and affect the corneal transparency so that vision is reduced. If these deposits occur under the outermost layer, the epithelium, they can cause recurrent erosions of the cornea, which can be painful and disturb the normal corneal curvature, effecting vision.
In instances where there are recurrent corneal erosions and pain, Dr. Brass may prescribe eye drops, ointments and occasionally an eye patch or bandage soft contact lens. Early Lattice Dystrophy seems to respond well to Excimer Laser Phototherapeutic Keratectomy (PTK) whereas more serious cases may require a corneal transplant.
Map-Dot-Fingerprint Dystrophy
The outermost layer of the cornea, called the epithelium, is attached or anchored to an underlying basement membrane in order to remain healthy. Sometimes the epithelial basement membrane develops abnormally making it difficult or impossible for the epithelium to adhere properly to the basement membrane. If the epithelium does not adhere properly, recurrent corneal erosions will occur. Recurrent corneal erosions are painful and cause the corneal surface to become irregular resulting in intermittent blurry vision along with the discomfort and foreign body sensation. Map-Dot-Fingerprint Dystrophy is also known as Epithelial Basement Membrane Dystrophy because it is caused by a lack of the healthy formation of the Basement Membrane. It affects adults between the ages of 40-70 and can sometimes begin earlier. As the name implies, its appearance is of a map of gray areas, which may also be accompanied by opaque dots, and fingerprint like whirls or lines.
Dr. Brass will often discover Map-Dot-Fingerprint Dystrophy during a routine eye examination in patients who do not have any noticeable symptoms. If treatment is required to control the pain for those patients who are symptomatic, Dr. Brass may prescribe lubricating eye drops, patch the eye, apply a soft bandage contact lens or in more severe cases, scrape the cornea to attempt to achieve better adhesion of the epithelium. In some cases, Dr. Brass may suggest that the best results can be achieved using Excimer Laser Phototherapeutic Keratectomy (PTK) to smooth the surface of the cornea.
Ocular Herpes and Herpes Keratitis
Ocular Herpes, or Herpes of the eye is caused by the Herpes Simplex Virus and is the most common cause of corneal blindness in the United States today. Up to 50% of people who have a single Herpes Simplex viral infection of the eye will experience a flare up or recurrence. The virus often leads to irreversible scarring of the cornea.
Ocular Herpes may start as a painful sore on the eyelid or surface of the eye. If left untreated, it may multiply and begin to destroy epithelial cells and progress deeper into the cornea. If the Ocular Herpes penetrates the deeper layers of the cornea and causes a Stromal Keratitis it may cause corneal scarring-so prompt diagnosis and treatment of Ocular Herpes is important.
It is estimated that 400,000 people in the United States have had some type of Ocular Herpes, with more than 50,000 initial and recurring cases being diagnosed each year. Of these, it is believed that 25% are the more severe form of Herpes Stromal Keratitis. It is important that if you have had any type of systemic Herpes infection you alert Dr. Brass at your eye examination. The recurrence of Herpes Simplex eye infections is significant in that it appears to recur in about 10% of patients within one year, 23% of patients within two years and 63% of patients within 20 years of their initial infection. Sometimes a recurrence can be prompted by sunlight, stress, fevers or an unrelated eye injury.
Prompt diagnosis and anti viral drug therapy is key to preventing any vision loss.
Pterygium
A pterygium is a fleshy triangular growth of tissue on the cornea that may grow slowly throughout a person’s life. Rarely, a pterygium can grow across the cornea and block the pupil. People who live in sunny climates where they are exposed to more sunlight and UV light are more prone to developing pterygia.
Pterygia may become red ,swollen and inflamed. Occasionally they need to be removed. Removal of a pterygium is a surgical procedure that has recently undergone medical advances. As a Corneal Specialist, Dr. Brass uses a surgical technique called Amniotic Membrane Graft in order to prevent recurrences and obtain the best possible results for Pterygium surgery.
Stevens-Johnson Syndrome (SJS)
Stevens-Johnson Syndrome , also called Erythema Multiforme, is a disease of the skin that also affects the eyes. SJS causes blistering and painful lesions on the skin and mucous membranes throughout the body. If SJS is extreme it can cause conjunctivitis, corneal blisters and erosions or iritis-an inflammation of the iris.
While the exact cause of SJS is not clear, it is believed that it can occur from an adverse reaction to drugs such as sulfa containing drugs. SJS can occur in any age group but seems more common in those under 30 years of age.
As you can see there are many conditions that can affect the cornea. Dr. Brass can often treat most of these eye conditions and corneal diseases using non-surgical treatment options. However, if they are not diagnosed and treated early or if they progress to where vision is compromised beyond an acceptable level, it may be necessary for Dr. Brass to perform a Corneal Transplant.
Brass Eye Center is conveniently located for patients seeking examinations for Corneal Diseases, Corneal Surgery and Cornea Transplants from Albany, Troy, Schenectady, Saratoga Springs, Clifton Park, Cohoes, East Glenville, Loudonville, Mechanicsville, Niskyuna, Rexford, Westmere, Colonie, Half Moon and Delmar New York. Please phone 518.782.7827 to schedule an appointment for a Consultation.
