Corneal Arcus
Corneal Arcus or Arcus senilis appears as a white, gray, or blue ring or arc around the cornea of the eye. The condition is usually seen in older adults but can affect people of all ages, even appearing at birth. Arcus senilis is generally harmless, and an involutional change modified by genetic factors. However, arcus is sometimes indicative of hyperlipidoproteinemia (involving low-density lipoproteins) with elevated serum cholesterol, especially in patients under 40 years of the age.

Causes of corneal arcus
Arcus is a deposition of lipid in the peripheral corneal stroma. Cholesterol and triglycerides are two types of fats in your blood. Some of the lipids in your blood come from foods you eat, such as meat and dairy products. Your liver produces the rest. Lipid deposition starts at the inferior and superior poles of the cornea and in the late stages encircle the entire circumstances. Arcus senilis is more common in men than in women. In people under age 40, arcus senilis is often due to an inherited condition and in rare cases, children are born with arcus senilis ( arcus juvenilis).

Arcus senilis can also appear in people with Schnyder central crystalline dystrophy. This rare, inherited condition causes cholesterol crystals to deposit on the cornea.

Symptoms
A person with arcus senilis may develop:

A white, gray, or blue circle around the cornea of the eye.
The circle or arc will have a sharp outer border but a blurred inner border.
If someone has an arc, the lines could grow to form a complete circle in front of the iris.
The presence of corneal arcus in patients younger than 40 year-old warrants evaluation for systemic lipid abnormalities.
Unilateral arcus is a rare condition associated with contra lateral artery disease or ocular hypotony. Usually it is an asymptomatic condition and does not affect your vision.

Diagnosis
Eye examination performed by eye doctor can diagnose arcus senilis. A slit lamp microscope is a very helpful tool to evaluate eye thoroughly. A special eye drop is used to widen the pupil of the patient. Once the eye drops works, ophthalmologist can inspect all parts of the eye with back of the eye as well for any disease. In arcus, thickness of the vessels increases due to fat deposition. Surgeon has to look for signs of atherosclerosis also, which is a condition where arteries become clogged with fatty substances.

A blood test will determine whether someone has high cholesterol. If they do, they may be prescribed medicine or advised on a suitable diet and exercise program to lower the cholesterol in their blood.

How corneal arcus is managed?
The good news is, you don’t need to treat arcus senilis. It typically affects both eyes, but in some cases only one eye has a grayish arc around the cornea, which may be a sign of poor blood circulation.

Eating healthy foods and exercising regularly are some good ways to keep your eyes healthy. We recommend wearing sunglasses with 100% UV protection when outdoors and safety goggles when doing hazardous tasks as well.

If arcus senilis is a sign of high cholesterol, a doctor may recommend a diet that is low in saturated fats and high in fruit, vegetables, and fiber.

If lipid levels are not controlled by diet and exercise are not enough, several medications can help lower your lipid levels:

Statin drugs block a substance your liver uses to make cholesterol. These drugs include atorvastatin, fluvastatin, pravastatin and rosuvastatin.
Bile acid binding resins force your liver to use more cholesterol to produce digestive substances called bile acids. This leaves less cholesterol in your blood. These drugs include cholestyramine, colesevelam and colestipol.
Cholesterol absorption inhibitors like ezetimibe reduce your body’s absorption of cholesterol.
Drugs may be used to lower triglyceride levels:
Fibrates reduce production of lipids in your liver and increase the removal of triglycerides from your blood.
Niacin reduces the production of lipids by your liver.
Increased exercise and quitting smoking can also help.
Possible complications
Arcus senilis alone is not known to have any complications unless it is a sign of high cholesterol. High levels of cholesterol in a person’s blood can cause significant problems, such as coronary artery disease or cardiovascular disease.

Follow-Up
Arcus senilis may sometimes appear as a white ring around the iris due to calcium deposits on the circumference of the cornea, where the white section of your eye (the sclera) and the colored part (the iris) meet (called the limbus). When the deposits consist of calcium, the limbus appears milky and may indicate tissue damage that needs correction.

The blue (or sometimes gray) ring around the iris often is associated with high cholesterol and triglycerides. In turn, this may be an indicator of heart condition that yor are more prone to heart attacks and strokes. When this condition appears in people younger than 60 years old, regular blood tests are normally recommended to monitor elevated lipid levels.

In few other cases, when corneas become opaque, due to genetic mutation it could be from a lowered high-density lipoprotein (HDL) cholesterol level. This condition can result in other eye problems. Principally, this opacification may be related to deficient levels of lecithin cholesterol acyl transferase (LCAT). LCAT is an enzymatic protein responsible for converting free cholesterol into cholesteryl ester.

Cholesterol ester, is then separated into the nucleus of the lipoproteins to produce a synthetic high-density lipoprotein (HDL) chain. This reaction is forced one way, since the deposits are removed from the exterior. So the enzyme is attached to both HDLs and low-density lipoproteins (LDLs) in blood plasma.

This process can result in the manifestation of fish eyes, and it is actually called “fish eye disease.� Corneal opacification can also result from mutations in another HDL protein, the adenosine triphosphate-binding protein ABCA1.

Just because you are younger than 40 and have arcus does not mean you absolutely have elevated lipid levels, but at a very minimum, it is recommended that you have them checked.

Unilateral corneal arcus may be associated with vascular or inflammatory etiologies.

Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.

Corneal Dystrophy

Corneal distrophies are a group of rare and genetic diseases affecting the cornea. It runs in a families and may be present asymptomatic. They affect both the eyes and other parts of the families are not involved. Main cause of corneal dystrophies is foreign material build up in the cornea and that results in clouding of cornea and visual impairment.

The cornea is made up of five distinct layers:
The Epithelium - the outermost, protective layer of the cornea.
The Bowman's membrane - this second layer is extremely tough and difficult to penetrate further protecting the eye
The Stroma - the thickest layer of the cornea, consisting of water, collagen fibers and other connective tissue components that give the cornea its strength, elasticity and clarity.
Descemet's Layer - a thin, strong inner layer that also acts as a protective layer.
The Endothelium - the innermost layer consisting of specialized cells that pump excess water out of the cornea
Types of corneal dystrophies:
There are 20 different types of corneal distrophies but are groped in 3 main categories:

Anterior or superficial corneal dystrophies. These affect the outermost layers of the cornea: the epithelium and Bowman’s membrane.
Stromal corneal dystrophies affect the stroma, which is the middle and thickest layer of the cornea.
Posterior corneal dystrophies affect the innermost parts of the cornea: the endothelium and the Descemet membrane. The most common posterior corneal dystrophy is Fuchs’ dystrophy.
Symptoms of Corneal distrophies:
Symptoms like watery eyes, dry eyes, corneal erosions, Blurry vision, halos around light, light sensitivity and difficulty in seeing at night often overlaps with diseases like glaucoma and cataract. Two differentiating symptoms are pain and a feeling of something in the eye occurs in the corneal distrophies. As the condition worsens vision becomes poor and irregularities in the cornea may lead to fluctuating vision.

Who is at risk for corneal dystropies?
People having family history of the disease are at more risk than others. Corneal dystrophies can appear at any age. Men and women are equally affected by most corneal dystrophies, except for Fuchs’ dystrophy. Fuchs’ affects women more frequently than men.

What are my treatment choices?
Treatment for corneal dystrophies may vary from eye drops to corneal transplant and depends on:

The type of dystrophy
The severity of symptoms
In few cases, people with corneal dystrophy may have repeated corneal erosion. This condition may be treated with antibiotics, lubricating eye drops, ointments, or special soft contact lenses that protect the cornea. If erosion continues, other treatment options may include the use of laser therapy or a technique for scraping the cornea.

In severe cases, a corneal transplant (called keratoplasty) may be necessary. The damaged or unhealthy corneal tissue is removed and clear donor cornea tissue is put in its place. For endothelial dystrophies, such as Fuchs’ dystrophy, a partial cornea transplant (or endothelial keratoplasty) is used.

Keratoconus is a vision disorder that occurs when the normally round cornea (the front part of the eye) becomes thin and irregular (cone) shaped. This abnormal shape prevents the light entering the eye from being focused correctly on the retina and causes distortion of vision. It is characterized by para-central corneal thinning and ectasia so that the cornea takes the shape of a cone. Visual loss occurs primarily from myopia and irregular astigmatism and secondarily from corneal scarring. Keratoconus often begins at puberty and most often is seen in teenagers or young adults.

Keratoconus causes distorted vision that cannot be corrected with eyeglasses. Tiny fibers of protein in your eye called collagen help hold your cornea in place. When these fibers get weak, they can’t hold their shape. Your cornea gets more and more cone-like.

It happens when you don’t have enough protective antioxidants in your cornea. Its cells produce harmful byproducts, the same way a car puts out exhaust. Normally, antioxidants get rid of them and protect the collagen fibers. But if levels are low, the collagen weakens and the cornea bulges.

Symptoms
Signs and symptoms of keratoconus may change as the disease progresses. They include:

Blurred or distorted vision
Increased sensitivity to bright light and glare, which can cause problems with night driving
A need for frequent changes in eyeglass prescriptions
Sudden worsening or clouding of vision
The swelling occurs when the strain of the cornea's protruding cone-like shape causes a tiny crack to develop. The swelling may last for weeks or months as the crack heals and is gradually replaced by scar tissue.
Monocular polyopia (perception of multiple ‘ghost’ images in the eye).
Streaking and flaring distortion around light sources.
Marked anisometropia (difference in vision of two eyes).
Photophobia (increased sensitivity to light).
Eyestrain, in order to read clearly.
Risk factors
Heredity. One in 10 keratoconus sufferers has a close family relative with the disorder.
Frequent eye rubbing, especially aggressive “knuckling� eye rubbing.
Having a history of asthma, allergies, Ehlos Danlers syndrome, Down’s syndrome
Keratoconus is categorised clinically as:
Latent stage: Latent stage was recognisable by placido disc only.
Early stage: Early stages were subdivided into two categories as:

Keratoconus fruste, which entailed 1- to 4-degree deviation of horizontal axis of the placido disc.
Early or mild keratoconus, which entailed 5- to 8-degree deviation of horizontal axis.
Causes
A family history of keratoconus has been established in some cases. Most researchers believe that multiple, complex factors are required for the development of keratoconus including both genetic and environmental factors.

With the advent of videokeratography to assess family members, however, pedigrees have been analysed. These studies show corneal changes consistent with keratoconus in some family members, which suggest an autosomal dominant pattern of inheritance.

Keratoconus may be associated with wide variety of systemic and ocular conditions.

Systemic associations:
Atopy (a genetic predisposition to develop an allergic reaction): Eye rubbing seen in systemic atopy may play a role in the development of keratoconus.
Down syndrome (Trisomy 21): In Down syndrome (Trisomy 21), frequency of acute hydrops is higher, perhaps because of eye rubbing and/or these patients are treated infrequently with keratoplasty and their disease is allowed to progress further.
Ehlers-Danlos syndrome.
Marfan syndrome.
Ocular associations:
Retinitis pigmentosa.
Retinopathy of prematurity.
Fuchs’ corneal endothelial dystrophy.
Posterior polymorphous dystrophy.
Contributory factors such as:
Enzyme abnormalities in corneal epithelium: Enzyme abnormalities such as increased expression of lysosomal enzymes (catalase and cathepsin) and decreased levels of inhibitors of proteolytic enzymes (tissue inhibitor matrix metalloproteinases), may play a role in corneal stromal degradation.
Differentially expressed corneal epithelium: Differentially expressed corneal epithelium between keratoconus and myopes (as controls) in both genetic expression and protein expression.
Molecular defect: Molecular defect producing unusual absence of water channel protein aquaporin 5 in keratoconus as compared to normal corneal epithelium.
Gelatinolytic activity: Gelatinolytic activity in stroma has been described, which may be due to decreased function of enzyme inhibitors.
Abnormalities in corneal collagen and its cross-linking: Abnormalities in corneal collagen and its cross-linking may be the cause of keratoconus.
Hard contact lens wear.
Pathophysiology:
First is thinning of the corneal stroma then fragmentation of the Bowman layer and the deposition of iron in the basal epithelial cells, forming the Fleischer ring. Folds and breaks in the Descemet’s membrane result in acute hydrops and striae, which produces variable amount of diffuse scarring.

How diagnosis is made?
Certain tests like refraction, keratometry, corneal topography/Computerised videokeratography, ultrasound pachymetry and slit lamp microscopy help in reaching final conclusion.

Computerized videokeratography, which takes pictures of your cornea so a map can be made of the surface while also measuring the thickness of your cornea

Severity of keratoconus depends on shape of cone:
Nipple cones
Oval cones
Globus cones
Treatment
If your keratoconus is progressing, corneal collagen cross-linking might be indicated to slow or stop the progression. Contact lenses can be used to correct astigmatism and mild near-sightedness. Improving your vision depends on the severity of keratoconus. Mild to moderate keratoconus can be treated with eyeglasses or contact lenses.

Lenses
Hard contact lenses. Hard lenses may feel uncomfortable at first, but many people adjust to wearing them and they can provide excellent vision. This type of lens can be made to fit your corneas.
Piggyback lenses. If rigid lenses are uncomfortable, your doctor may recommend "piggybacking" a hard contact lens on top of a soft one.
Eyeglasses or soft contact lenses. Glasses or soft contact lenses can correct blurry or distorted vision in early keratoconus. But people frequently need to change their prescription for eyeglasses or contacts as the shape of their corneas change.
Hybrid lenses. These contact lenses have a rigid center with a softer ring around the outside for increased comfort. People who can't tolerate hard contact lenses may prefer hybrid lenses.
Scleral lenses. These lenses are useful for very irregular shape changes in your cornea in advanced keratoconus. Instead of resting on the cornea like traditional contact lenses do, scleral lenses sit on the white part of the eye (sclera) and vault over the cornea without touching it.
Surgical Interventions
Some form of surgery may become necessary if the cornea progresses in its shape-changing until it is so steep that contacts cannot be tolerated at all.

INTACS are described as arc-like and plastic. These pieces are inserted into the center of the cornea to flatten it, thereby making the eye more contact lens-tolerant.
Collagen crosslinking (CXL) with UVA is a complex surgery that involves removing the topmost layer of your cornea, adding vitamin drops and then exposing the eye to a special UV lamp that helps the cornea fibers multiply, strengthening the cornea.
Corneal transplant surgery is the last resort for most doctors. In this procedure cornea would be removed and replaced with a healthy, normal-shaped cornea. This surgery has a long recovery time, a year or more in some cases, for clear vision.
Penetrating keratoplasty. If you have corneal scarring or extreme thinning, you'll likely need a cornea transplant (keratoplasty). Penetrating keratoplasty is a full-cornea transplant. In this procedure, doctors remove a full-thickness portion of your central cornea and replace it with donor tissue
Deep anterior lamellar keratoplasty (DALK). The DALK procedure preserves the inside lining of the cornea (endothelium). This helps avoid the rejection of this critical inside lining that can occur with a full-thickness transplant.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.

To schedule an appointment with our experts for Keratoconus Treatment in Ghatkopar, please call us at +91 8451045935, +91-8451045934 or visit our clinic at Address.

For more information = https://www.mumbaieyecare.com/

Cornea Surgery in Ghatkopar
The cornea is the clear dome shaped transparent, outermost layer of the eye, about 12 mm in diameter. It serves as a physical barrier against dust, microorganisms and other harmful particles. The cornea also plays an important role in vision. It filters some amount of ultraviolet light and protects iris, pupil and anterior chamber.

As light is refracted by the curvature of the cornea, it is focused on the object and forms a clear Image. Any infection, disease or trauma to the cornea can interfere with vision by blocking or distorting light as it enters the eye. It contains specialized tissue having no blood vessels and is nourished with your tears and aqueous humor (behind the cornea).

Cornea is made up of three major components.
Epithelium – Cornea has numerous nerve endings, that’s why you experience pain while rubbing your eyes. It absorbs oxygen and nutrients from the tears. Epithelium is connected with stroma with the help of basement membrane.
Stroma – The stroma is the thickest part of the cornea and is made up of collagen and water. Collagen fives elasticity and keeps cornea firm. These collagen fibres are arranged in strictly in a regular, geometric fashion. This arrangement is responsible for clear cornea, while in case of trauma, collagen fibres laid down in repair, often leads to cloudy cornea. Below stroma is the Descemet’s membrane, which connects it with endothelium.
Endothelium - The innermost layer of the cornea is made up of endothelium. Function of endothelium is to maintain fluid balance by acting as a pump, expelling excess water as it is absorbed into the stroma. Without this specialized function, the stroma could become waterlogged and hazy and opaque in appearance, also reducing vision.
Symptoms of corneal conditions
Minor injuries of cornea heal by itself while major injuries may result in scarring and impaired vision.

Intense pain.
Blurred vision.
Double vision
Tearing.
Redness.
Extreme sensitivity to light.
Corneal conditions
Injuries/Trauma
Eye allergies
Keratitis.
Ocular herpes
Herpes zoster (shingles)
Dry eye.
Nutritional Deficiencies like Vitamin A
Corneal dystrophies – Keratoconus, Map-dot-fingerprint dystrophy, Fuch's dystrophy
Common diseases that can affect the cornea — Abnormal growths, autoimmune diseases, Stevens - Johnson syndrome, iridocorneal endothelial syndrome and pterygium.
Treatment
Simple corneal conditions can be treated with antibiotic or anti-inflammatory eye drops or pills. If you have advanced corneal disease, you may need an advanced treatment.

Laser treatment – In Corneal dystrophies, doctors can use a type of laser treatment called phototherapeutic keratectomy (PTK) to reshape the cornea, remove scar tissue, and make vision clearer.

Corneal transplant surgery – In case cornea is damaged and cannot be repaired, doctors can remove the damaged part and replace it with healthy corneal tissue from a donor.

Artificial cornea - As an alternative to corneal transplant, doctors can replace a damaged cornea with an artificial cornea, called a keratoprosthesis (KPro).

To schedule an appointment with our experts for Cornea Surgery In Ghatkopar, Mumbai, please call us at +91 8451045935, +91-8451045934 or visit our clinic at Address

For more information = https://www.mumbaieyecare.com/

Dr. Rajiv Bajaj Is The Best Lasik Eye Surgeon In Delhi

Dr. Rajiv Bajaj is a renowned Ophthalmologist practising in Pitampura area of Delhi. He is the founder of Bajaj Eye Care Centre, a centre equipped with ultra modern facilities that provides solutions to a wide range of eye ailments. The NABH accredited centre known for its professional excellence is present on the panel of leading insurance companies, Govt. Organizations and majority of TPA’s for Cashless Mediclaim Facilities Dr. Bajaj is an MBBS graduate from Maulana Azad Medical College, Delhi. He further pursued post graduation MS in Ophthalmology from Delhi University at Safdarjang Hospital which has added immensely to his surgical experience in the subject.

Prior to independent practice, Dr. Bajaj served at Safdarjang Hospital, Dr. Ram Manohar Lohia Hospital, Maharaja Agrasen Hospital and Sant Parmanand Hospital which have been his immense sources of experience in the ophthalmic field. He later established Bajaj Eye Care Centre which caters to patients from Delhi /NCR and beyond.

As a part of surgical education, Dr. Bajaj has demonstrated live surgery of MICS in national level conferences. He is among the first few doctors to incorporate advanced technology such as MICS, Phaco surgery and Refractive surgery in his practice. Dr Rajiv Bajaj has a keen interest in the field of glasses removal techniques and has always adopted the latest technology in this dimension. BAJAJ EYE CARE CENTRE takes pride to install the FIRST zeiss VISUMAX FEMTOSECOND LASER machine – SMILE for flapless, bladeless technique in the whole of NORTH Delhi.