General Practitioners

• Arthritis
• Pediatric Care
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• Primary Care
  When calling to schedule your appointment, please have all your information ready including birth dates, Social Security numbers, Health Insurance Cards, your Primary Care Physician or Pediatrician name, and a calendar to mark the date.
• Emergency Care
  Chemicals that burn should be rinsed from the eye immediately. Chemical burns can cause severe damage, so eyes should be flushed immediately. If sterile solutions or eyewashes are readily available, use them to flush the affected eye. If not, flush the eye with liberal amounts of water from the nearest sink, shower, or hose for ten minutes. Be sure water is getting under both the upper and lower eyelids. After the eyes have been flushed for ten minutes, bring the child to the eye doctor or emergency room immediately. The ultimate visual outcome after a chemical burn depends on the severity of the injury, which cannot always be identified in the initial examination.

Ophthalmologists

• Glaucoma
  Congenital nasolacrimal duct obstruction is usually caused by the failure of a thin tissue at the end of the tear duct to open properly when the child is born. It can also be caused by a lack of openings to the duct system at the eyelids, by infections, and by abnormal growth of the nasal bone, which pinches off the tear duct. Some infants may have excessive tearing due to narrow tear ducts rather than an obstruction. In this case, the tearing may be intermittent, occurring when the infant has a cold or during especially windy or cold weather. Finally, congenital glaucoma can cause tearing in children. This serious condition is often accompanied by other signs, including an enlarged eye, a cloudy cornea and light sensitivity.
• Ophthalmology
  Jane Hughes, M.D.; Joseph Paviglianiti, M.D.; and Eric Pennock, M.D. are diplomates of the American Board of Ophthalmology and members of the American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus. They are Pediatric Ophthalmologists, that is, medical doctors who have received additional training in the medical and surgical care of the eyes and the visual system. They also have an understanding of the eyes' interaction with the other functions of the body. Pediatric Ophthalmology is a subspecialty of general Ophthalmology. Drs. Hughes, Paviglianiti, and Pennock have received additional fellowship training about eye problems specifically affecting children.  Included in this training is the evaluation and treatment of adult eye movement disorders, adult strabismus, and double vision.
• Laser Eye Surgery
  Strabismus may begin in childhood and persist, reoccur, or become symptomatic in adulthood. Strabismus also can result from certain medical problems. Graves' disease (thyroid eye disease), diabetes, strokes, and trauma are some of the more common conditions that can lead to strabismus. Less common causes are diseases that affect the muscles such as myasthenia gravis, demyelinating diseases such as multiple sclerosis, or brain and orbit tumors. Occasionally strabismus can develop after eye surgery, such as cataract, retinal, refractive or glaucoma surgery.
• Cataracts
  Strabismus, or misaligned eyes, is the most common cause of amblyopia. The eye that is misaligned is ignored by the brain and "turns off." A refractive error (meaning an eye is nearsighted, farsighted, or has astigmatism) is another cause of amblyopia. If one eye has a very different refractive error from the other eye, or if both eyes have a very strong refractive error, amblyopia can develop in the eye or eyes that are out of focus. The most severe form of amblyopia occurs when cloudiness of the eye tissues prevents any clear image from being processed. This can happen in conditions such as infantile or developmental cataracts.
• Cataract Surgery
  Aphakia: The most common use of contact lenses in younger children is the treatment of aphakia. Aphakia refers to an eye that has had cataract surgery. When a child's cataract has been removed, the use of a contact lens is the method of choice to optically rehabilitate the eye. The aphakic contact lens replaces the focusing power of the human lens that was removed surgically. Young children can be fit with contact lenses as early as one week after cataract surgery and for children who have congenital cataracts, we frequently fit children with lenses during their first month of life.
• Eye Exam
  During the eye examination, your child's eyes may be dilated.  Dilation causes the pupils to stay enlarged so that a thorough examination retina and optic disc (inside of the eye) can be performed.  Some of the dilating drops also cause blurred vision at near by decreasing the eye's ability to accommodate, or focus.  This must be done for the doctor to determine your child's refractive error (need for glasses) more accurately. The dilating drops typically last for 4 to 24 hours.  The blurriness may typically last from 4 - 6 hours. It is not uncommon for a child with blue or green eyes to stay dilated for up to 72 hours.  Because of the effects of the dilation, you should bring a pair of sunglasses to the examination for your child.  Your child can return to school with one of our school excuses alerting the teacher that the eyes were dilated.

Neurologists

• Multiple Sclerosis

Psychiatrists

• Depression
• Anxiety

Endocrinologist

• Diabetes Care
• Thyroid

Radiologist

• MRI
  Unlike fourth cranial nerve palsies which usually do not require an evaluation, all third cranial nerve palsies must be evaluated to determine their etiology. In children, MRI or CT scanning with contrast enhancement will help to clarify the cause of the third cranial nerve palsy. In adults, evaluation may include imaging studies and glucose tolerance testing. If there is strong suspicion of an aneurysm, a cerebral arteriogram may be requested. In select cases, Tensilon testing may be useful to establish or exclude a diagnosis of myasthenia gravis which may mimic third nerve paralysis.

Plastic Surgeons

• Eyelid Surgery
  Following corrective strabismus and eyelid surgery, the position of the eye may be "fine tuned" with glasses incorporating a prism and a bifocal. A realistic goal should be to center the eye in primary gaze and provide the patient comfort in the reading position. If the third cranial nerve palsy is profound, a zone of single binocular vision can usually be achieved. However, diplopia will occur when moving the eyes to look right, left, up or down. Once a zone of single binocular vision has been achieved in a useful position or gaze, the patient must move his or her head to fixate on objects out of the primary gaze position.

Dermatologists

• Lesions
  Excessive blinking may be related to either increased duration of lid closure or it may be due to an increased rate of blinking. Prolonged lid closure may be related to blepharospasm (which is very uncommon in children), central nervous system stimulation, and tardive dyskinesia (a side effect of some tranquilizers). Increased blinking rate may be due to irritative lesions in the central nervous system (meningitis) or ocular abnormalities.
• Burns

Allergists

• Allergies
  Since mild forms of allergic conjunctivitis are self-limited, usually no specific allergy testing is necessary. A thorough history and review of the common allergic agents may be sufficient to minimize or eliminate the child's contact with the allergen, and therefore, control the symptoms. If the discharge is purulent, eye cultures may be recommended and a conjuctiva scrapping may be performed to look for eosinophils. If the symptoms are repetitive and severe, skin testing may be considered. If the allergen suspected is ragweed, RAST testing may be requested.