My Doctor Online The Permanente Medical Group

Symptoms

A scar on the cornea can cause a variety of mild to severe vision symptoms. These include:

• Astigmatism. This is blurry vision caused by the distortion of the cornea.
  
• Hazy vision. This is caused by a scar that obscures an area of your visual field.
  

Causes

Anything that damages the eye can lead to a corneal scar.

• Corneal abrasion or eye injury. If an abrasion is deep enough, it can cause a scar. Corneal abrasions are not uncommon but usually damage only the outer layer of the cornea. Tree branches, pens and pencils, sports equipment, and contact lenses can all cause minor abrasions. Contact lens overuse can cause microscopic injury. More serious injuries can be caused by sharp instruments or a ball directly hitting the eye. These injuries are more likely to be deep and generate a scar. 
• Corneal infection. Corneal infections can be mild and treatable; however, if an infection is left untreated, it can spread to a deeper layer of the cornea known as the stroma. These infections, known as stromal keratitis, are much more difficult to treat and may lead to scar formation. A number of viruses can cause corneal infections. Most can be treated effectively with antiviral medications. However, some viruses, such as herpes simplex, can recur and cause further infections that may be difficult to treat and may cause scarring.
• Epithelial basement membrane dystrophy. This condition causes abnormal growths of the tissue layer that covers your eye (epithelium). Raised ridges of this tissue layer on your cornea can cause irregular types of astigmatism and visual distortion. In addition, the cornea can sometimes become cloudy, and scar tissue can develop on the epithelium. 
• Keratoconus (pronounced ker-uh-toh-CONE-uhs). This is a genetic eye condition in which the cornea becomes thinner and weaker. Over time, the weakened cornea starts to bulge outward in a cone shape, due to the natural pressure exerted on it from inside the eye. This coning eventually leads to scarring on the cornea.
  

Diagnosis

We can schedule a general eye exam for you in either our Optometry or Ophthalmology department. However, if you have sudden vision changes or symptoms that concern you, contact us to schedule an urgent appointment in Ophthalmology.

We will ask you about your symptoms and examine your eyes. If we suspect a corneal scar, the examination will include the following tests:

• Visual acuity test. Just like a regular eye exam, this tests the strength of your central vision by requiring you to read letters on a wall chart some distance away.
  
• Slit-lamp exam. During the exam we use a slit-lamp microscope to examine the cornea. The instrument uses a narrow beam of light – like a slit – that helps us see the cornea clearly. 
  

Prevention

There are a number of things you can do to keep your eyes healthy and reduce your risk for developing a corneal infection or injury that may lead to the development of a scar.

• Practice consistent eye hygiene. Always wash your hands before touching your eye or the area around your eye. Keep makeup utensils clean and replace them regularly. If you wear contact lenses, wash your hands thoroughly before inserting or removing your lenses. Use the cleaning solution(s) we recommend for your type of lens and keep your contact lens case clean. Ask us how long to keep the lenses in your eyes. We strongly recommend that you not sleep with your contact lenses in place, even the extended wear type, since most contact lens-related corneal infections are caused by sleeping with your contact lenses in place.
• Schedule regular eye exams. We recommend that everyone come in for regular eye exams. If you wear contact lenses, you need to come in every year to have your prescription checked. 
• Protect your eyes. According to the American Academy of Ophthalmology (AAO), 90 percent of eye injuries could be avoided by wearing proper eye protection. Wearing effective goggles or glasses during sports, home do-it-yourself projects, or work can prevent blunt trauma or a sharp object from damaging your cornea. We recommend that you review the American Academy of Ophthalmology guidelines about appropriate eyewear for all activities.
  

Treatment

There are a number of treatment options that we wiIl discuss with you. They include the following:

• Glasses or hard contact lenses. If your vision is significantly reduced by a corneal scar, we may recommend glasses or a hard contact lens to rehabilitate your vision.
• Laser treatment. We may use a laser to gently remove the scar if it is very shallow. This procedure is called PTK (phototherapeutic keratectomy).
• Corneal transplant surgery. For the deepest scars, we may recommend a complete or partial transplant of your cornea. The exact type of surgery will depend on the nature and location of the scar. During a standard corneal transplant surgery, we remove the damaged cornea and replace it with a donated human cornea. After a period of time, your vision will usually improve.
  

Your Care With Me

If your optometrist identifies scarring on your cornea during your regular eye exam, he or she will make an appointment for you to see me or one of my colleagues in the Ophthalmology department. If you are not scheduled for a regular eye exam, and you notice symptoms such as blurry vision or other vision changes, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you.

Your first appointment is likely to take at least 1 hour and possibly longer. During your office visit, we will discuss your medical and family history and I will perform a comprehensive eye exam and some diagnostic tests.

I may administer eyedrops to dilate your pupils so that I can clearly see the structures of your eyes. Your pupils will remain dilated for several hours, so you may wish to bring someone who can drive you home after your exam.

I will explain the findings of your exam and answer any questions or concerns you may have. If you notice any new changes, please let me know.

If we decide that you need further evaluation, or further treatment or surgery, I will discuss the treatment options that are available, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.