Blepharitis
Cataract
Diabetic Retinopathy
Glaucoma
Iritis
The Red Eye
Retinal Detachment
Vitreous Floaters & Flashes
The answers to the above questions are NO! A cataract is neither a tumour nor is it incurable.
A cataract is a clouding of the normally clear and transparent lens of the eye. It is most commonly the result of aging. There are other factors which can accelerate the formation of a cataract, such as diabetes and eye injuries.
The normally transparent lens of the eye focuses a clear image onto the retina in the same way a camera lens focuses a clear image onto the film. A cataract is like a dirty camera lens which causes blurring of the image.
A cataract is not a film, which is visible on the outside of the eye. It can easily be detected with special instruments by your doctor.
Upper lid the upper eyelid that blinks, covers and protects the eye.
Cataracts cause gradual and painless blurring of vision. There are however, other serious eye conditions that behave in the same way, especially in the elderly. Many of these conditions can be treated if detected early. Thus it is important to have an eye examination by your eye specialist to determine the cause of your poor vision.
Other symptoms of cataracts indude poor vision in bright surroundings or improved vision in dim surroundings like at night. Cataracts can also give rise to glare, seeing of multiple images or an abrupt change in the power of your spectacle prescription.
The treatment of the cataract is warranted when it affects your livelihood or lifestyle. The decision for the removal of the cataract should be reached after discussion with your eye specialist. Cataract can only be properly removed by surgery. It cannot be removed by laser or with medication.
Today, with modern surgical techniques, vision can be restored more rapidly and effectively with little immobilisation. Indeed, most cataract operations are performed as a day surgical procedure without the need for hospital admission. Likewise, with the advent of this modern cataract surgical techniques, you do not need to wait until the cataracts are "ripe". In fact delaying cataract operation may incur the risk of complications from advanced cataracts.
With the removal of the cataract, a lens replacement is required. The ideal replacement for the natural lens of the eye is with an intraocular lens implants This is placed in almost exactly the same position as the natural lens in the eye. The lens implant gives better vision. It is usually left securely and permanently in the eye. It is trouble-free and does not require any specific maintenance. Under normal circumstances, it is unlikely to be extruded from the eye.
The other alternatives to the implants are:
Remember
Cataracts are the most common cause of poor vision in the elderly. There are however, many other causes of poor vision, especially in adults over the age of 40. Do not always attribute poor vision to cataracts. Many of the other conditions can cause permanent damage to your eyesight unlike cataracts which can be operated upon. Most eye problems can be treated or prevented and your vision preserved if detected early by your eye specialist.
The eyelids are specialized fold of skin that act as protectors of the globes. The blinking reflexes protect the corneae from foreign matters and strong light. Involuntary, subconscious blinking keep the eyes clean and moist by continually secreting and spreading the tear film. The eye lashes acting as a barrier against falling raindrops from spilling into the eyes.
The eyelids have numerous glands. The glands produces various secretions, among them is sebum. These secretions are discharge into the skin via ducts. These secretions serve numerous functions: among which are to waterproof the skin and hair and keep th em supple. Some of these gland secretions lubricate the lid and retard the evaporation of the tear, thus retarding the dessication of the corneae.
Blepharitis are a group of diseases that afflict the eyelids. Most of these conditions are chronic and irritating to the afflicted persons.
Blepharitis can be divided into 3 main groups: seborrhoeic, staphyloccocal and mixed.
Seborrhoeic blepharitis usually affects the older population. It is a chronic condition characterized by waxing and waning episodes. The symptoms are itchiness, foreign body sensation, mattering and burning sensation. The eyelids have an oily seborrhoe ic sheen. Oily and greasy deposits are seen on the lid margin and hair follicles.
Staphylococcal blepharitis is a condition characterized by episodes of bothersome exacerbations and remissions. There may be redness of the involved lid margin. Crusting, scaling, hair losses, whitening of lashes are common.
Mixed blepharitis exhibits symptoms of both staphylococcal and seborrhea blepharitis.
In any of these blepharitis the conjunctiva and cornea can be involved. In mild form the conjunctiva may be minimally inflamed. In severe involvement, especially if neglected, blindness may be the end result due to corneal opacity and scarring.
Although a chronic and bothersome disease, blepharitis can be controlled if not cured. The irritating symptoms can be reduced greatly and the quality of life improved. The mainstay of treatment is maintaning lid hygiene. It is effective and simple. It can be performed by the patient himself or by an assistant in their convenience. The materials required are cheap, easily available and non-presciptive.
In severe or recalcitrant blepharitis, topical or even oral antibiotics may be prescribed by your physician to help control the condition and symptoms. The use of such antibiotics are usually short term but long term use may be necessary.
To manage the problem, an understanding by patient that the conditions are chronic, occasionally recurring and remitting and that there may be no definitive cure. The routine of lid hygiene should be observed daily without lapse. It may be a life-long p rocess. The dividend lies in its effectiveness, if performed properly.
Diabetes mellitus is a very common condition among the general population. Unfortunately, diabetes is still a major cause of blindness. This is due to the related damage within the eye which is known as diabetic retinopathy.
Every part of our body thrives on nourishment derived from the circulating blood. Whenever blood supply to a particular tissue is compromised, the vitality of that tissue is threatened.
Diabetes mellitus damages the small blood vessels of the body. The retina is a nerve layer at the back of the eye. It sends a signal to the brain when the eye sees an object.
The retina is nourished by small microscopic blood vessels. Diabetic retinopathy is the damage to the retina due to the diseased blood vessels supplying the retina. Damage to the blood vessels causes:
Click to see Larger Image
Notice the yellowish deposits in the retina. There are the occassional retinal
bleeding as well.
This is another photograph of diabetic retinopathy. Notice again the yellowish
deposits as well as the various fibrous bands.
Gradual blurring of vision is the most common symptom. Severe bleeding into the eye from the new vessels however cause a sudden blurring of vision with black streaks seen before the eyes.
In the early stages you may not be aware of the ongoing damage to the retina because it may not cause significant blurring of vision yet. The degree of damage is related to the duration of the diabetes. The longer the duration and the poorer the control of the diabetes, the greater the likelihood of having significant diabetic retinopathy. The damage can worsen over time if not detected and treated early. The earlier treatment is started, the easier the damage is brought under control.
Laser treatment will save vision in most cases when diabetic retinopathy is still in the early stages.
Laser treatment will allow the swelling and deposits in the retina to subside. It can prevent the growth of abnormal new vessels. If new vessels are already present, laser can cause the vessels to regress and prevent more serious complications.
Vision however may not improve if the damage already done to the retina is severe. Laser will however help stabilize the condition and the level of vision.
Surgery is sometimes needed in cases with severe bleeding and
scarring within the eye. The blood and scars are removed with special microsurgical
instruments and sometimes laser is also applied during surgery. However,
not all cases may benefit from surgery once advanced stage is reached.
Regular screening by your eye specialist is important for early detection and treatment of significant diabetic retinopathy.
You need to do your part by controlling your diet and taking your medication or injections regularly. Consult your physician for optimal control and monitoring of your diabetes. Many patients with diabetes also have hypertension and this too needs to be controlled.
If you experience any blurring of vision or black streaks, contact your eye specialist promptly.
Glaucoma is an important cause of blindness in Singapore. It occurs more commonly in adults over 40, females and tends to run in families.
Glaucoma affects both eyes in most people though usually not at the same time.
Glaucoma is a condition in which there is raised pressure within the eyeball leading to irreversible damage to the optic nerve. The optic nerve is responsible for sending messages from the eye to the brain and so enabling us to see. Glaucoma will therefore lead to blindness if not detected and treated early.
There are many types of glaucoma. Two forms are however most common and they are:
This occurs with a sudden rise in eye pressure with an attack of pain and redness of the eye with blurring of vision. If severe, one may also experience nausea, vomiting and headache. Sometimes milder attacks occur with eye discomfort, blurring and haloes which are rings of light around a light source e.g. street lamp. These are warning signs which must not be ignored.
Acute glaucoma is common in Singapore and this part of the world. It is much less common in the West.
This occurs with a slow rise in pressure and no warning signs. There is a gradual loss of side vision which might not be noticed initially because central vision is not yet affected and still allows us to see clearly. Eventually central vision is lost permanently if not treated. Hence it infamous nickname:
This type of glaucoma is more commonly seen in the West. It is less common in Singapore and the East.
Other types of glaucoma are:
The risk of glaucoma increases with age. People with diabetes, long or short-sightedness and relatives with glaucoma are more likely to develop glaucoma. Warning signs must not be ignored.
Your eye specialist can diagnose glaucoma early even before you have symptoms. Instruments are used to measure your eye pressure, assess loss of side vision and examine your optic nerve for damage.
The form of treatment depends on the type of glaucoma.
In acute glaucoma, eye drops and oral or intravenous medication are given to initially lower the eye pressure. The essential treatment however consists of either laser treatment or surgery to reduce the eye pressure because only these can effectively prevent future attacks of acute glaucoma.
In chronic glaucoma, eye drops and oral medication may be sufficient. These medications have to be continued faithfully for the rest of one's life. Surgery however is sometimes required in severe cases which do not respond adequately to medication alone.
Glaucoma can worsen with time even with medication or surgery having
been done. It is therefore important that you see your eye specialist at
regular intervals as instructed. In this way, additional treatment can
be administered to prevent further damage.
Do Your Part Do not ignore any eye symptoms, be compliant with your medication and have your regular checkups with your eye specialist. Early detection and treatment prevents blindness.
Retinal detachment is a potentialy blinding condition which occurs more commonly in people with short-sightedness, eye injury and diabetes. It requires urgent treatment to limit the damage and restore some lost vision.
The retina is a thin layer of tissue lining the inside of the eyeball. It converts light into a message which is sent by the optic nerve to the brain thus allowing us to the perception of sight. Without a healthy retina we would not have sight.
The retina due to certain factors can become detached. The detached retina cannot survive for long when it is detached and thus results in blindness if not treated urgently.
These symptoms must not be ignored or the detachment may spread onto the important central part of the retina. This causes loss of central vision which allows us to see fine detail such as in reading small print.
An eye specialist can detect a retinal detachment with special optical instruments which allow him to examine your retina.
Retinal holes and tears must be sealed to prevent the fluid from seeping in and detaching the retina.
The eye specialist will, after examining the eye, be able to judge which is the best method. Apart from laser or cryopexy, surgery may entail the following:
Surgical success in terms of reattachment can be achieved in the large majority of cases.
The return of sight however is gradual and depends on several other factors.
Iritis refers to an inflammation of the iris, the colored part of the eye surrounding the black pupil. It should actually be 'iris-itis', or 'irisitis', but this is too unwieldy a word to pronounce.
Inflammation of the iris, or any bodily tissue, is characterized by symptoms of swelling, pain, redness, and loss of function. Microscopically, there is an invasion of inflammatory cells within the area and a concentration of certain chemicals produced directly by these cells and the agent(s) responsible for their presence. The latter includes bacteria, viruses, and other infectious causes of inflammation; however, it is fairly common to find no external causes for the iritis. Instead, the iris tissue itself (or an alteration of the iris through an autoimmune process) is often the inciting focus of the resulting inflammation. Consequently, the cause of most cases of iritis is never 'proven', only suspected. Past efforts to obtain bacterial and viral cultures on cases of iritis have seldom been rewarded with success; blood tests and Xrays have similarly come up empty in terms of a causative entity except for occasional abnormalities in people with ankylosing spondylitis and other ?auto-immune type disorders.
The symptoms of iritis are:
The signs (what the clincian sees) of iritis are:
If left untreated many cases of iritis resolve with time. However, during the inflammatory process the cells and sticky protein produced may cause the draingage area of the eye (the angle) to be closed due to the production of adhesions (synechiae) which can cause the pressure inside the eye to escalate producing a secondary glaucoma. This can lead to loss of vision by injury to the optic nerve and blood vessels of the retina. Also, the same type of adhesions may cause the iris to stick to the lens of the eye resulting in a pupil that is no longer round. The continued inflammation may cause a cloudiness of the lens inside the eye (cataract).
In most cases of iritis the inflammation is treated indirectly with eye drops that reduce inflammation (topical steroids) and eye drops that enlarge the black pupil while temporarily paralyzing the muscles in the iris (cycloplegics). Rarely, oral or injected steroids are administered. The few cases of iritis thathave a specific cause, e.g., herpes simplex virus, are also treated with drugs specific to that entity. Most cases of iritis resolve quite readily with treatment and do not produce significant damage to the eye.
Dr. Dave feels that all cases of 'red eyes' that do not respond readily to antibiotic eye drops should be evaluated for the possibility of iritis. This is especially indicated in persons who have only one eye involved and have some of the associated symptoms noted above.
When a person has an eye that is red, it may indicate something very serious or only a temporary condition of no concern whatsoever. Therefore, how can one distinguish between 'red eyes' that are signficant and those that can be safely ignored?
To obtain a better understanding of possibly relevant symptoms (what the patient expereiences) and signs (what the medical practicioner observes), it is best to breakdown the causes of 'red eyes' into categories. These categories are not only causes of this abnormality but general causes of all medical disorders:
Obviously, there is some overlap in these general areas, e.g., a 'red eye' at birth may be due to the trauma of the event; a chemical injury to the eye is both traumatic and toxic; areas of degeneration occur within tumors of the eye, etc. However, this is a good starting place.
Congenital causes of a 'red eye' include the above but are also due to the eye drops placed in an infant's eye to prevent infections, rare malformations of the blood vessels of the external eye, and other causes.
Infections are the most common cause of 'red eyes' and are deemed 'pink eye' by the general public. The germs most commonly responsible are bacteria, such as Staph or Strep, and viruses, such as the adenorvirus or rhinovirus, which are frequent causes of the common cold. Other microorganisms such as fungi and parasites infrequently cause this problem.
Sometimes, it is difficult to separate immunological causes from infectious ones. A good example is iridocyclitis (iritis) which is an inflammation of the iris caused frequently by what is probably the immune-based reaction of the body to a protein produced by the combination of a virus particle and the iris itself.
Traumatic and Toxic causes of a 'red eye' are often combined in instances of chemical injury in which not only the traumatic force itself, but the chemical makeup of the compound, can cause signs of inflammation.
Metabolic problems such as diabetes mellitus and thyroid dysfunction can lead to a red eye., as can tumors of the external eye and degenerative conditions, such as pinguecula and pterygium.
This is a very short list with some examples of different causes. What is important to learn is that there are probably a thousand different causes of a 'red eye' and some of them can be very serious. Fortunately, most are not...
In order to separate the important causes from the mundane, an individual with a red eye should seek medical care if any of the following associated symptoms or signs are encountered:
Different lifestyles and environments influence the frequency of this problem. For example, people who wear contact lenses are at increased risk for 'red eyes' because the contact lenses inhibit the tears of the eye from keeping the surface of the eye free from infection. This is due to the mechanical presence of the contact lens itself and is not necessarily related to a poorly fit or damaged contact lens. Also, people who are exposed to increased levels of sunlight because of high altitude, nearby beaches, etc. tend to not only have 'red eyes' due to continued irritaion of the conjuctiva of the eye from the ultraviolet light but also develop degenerative conditions of the eye, such as pinguecula and pterygia.
The treatment for a 'red eye' should be aimed at the underlying cause. It is senseless to use a decongestant eye drop for chronic causes of red eyes, as this is not only ineffective after a few months but may hinder the detection of an underlying disease. It is much more important if find out the reason for the 'red eye' and then treat it with antibiotics, artificial tear drops, corticosteroids, or whatever is specifically indicated for that problem.
Dr. Dave feels that most 'red eyes' are related to minor irritation from environmental factors such as ultraviolet light, tobacco smoke, etc. However, it is very important to see a medical professional if any of the above five symptoms/signs occur. Virtually all cases of 'red eyes' can be efficiently treated once the cause is known.
The human eye is a sphere with a slight elevation (convexity) on its front surface called the cornea, a 1/2" clear, 'bubble dome', which allows passage of light rays from the cornea to its final destination at the back of the eye, the retina.
During this passage from the front to the back, the light rays go through two spaces separated by the colored iris. The front space, or cavity, is called the anterior chamber; the space behind the iris is known as the posterior chamber - it is filled with the vitreous humor.
The vitreous humor is a clear jelly-like substance composed of complex carbohydrate materials known as hyaluronic acid and various derivatives of this, called hyaluronates. Also, the vitreous humor contains fibers of collagen and a few white blood and other cells. The vitreous humor is lightly attached to the entire retina and more strongly attached to the very front (anterior) part of the retina and around the optic nerve. Its purpose is to provide support for the developing eye during its formation; after birth, the vitreous humor has no function other than providing a clear passageway for the light rays on their journey to the retina.
As the eye ages, the vitreous jelly undergoes change. It gradually becomes more and more watery, thereby losing its gelatinous nature. During this process, it loses its mechanical stability as the hydration of the vitreous is uneven, with pools of water occurring in a scattered distribution. This is significant because of the attachments to the retina.
As the vitreous humor moves inside the eye, because of this mechanical instability, it can lightly pull on the retina where it is attached, causing the retina to be temporarily stimulated, producing a flash of light. This is most often seen in the peripheral (side) field of vision because of the strong attachments of the vitreous to the anterior retina. These light flashes are very fleeting, and sometimes of an arc shape, mimicing the internal curvature of the temporarily stimulated retina. If the pull (traction) on the retina is severe, it may actually tear a hole in the retina. Should the watery fluid of the vitreous or surrounding tissue go into this hole, it can gradually separate the layers of the retina, producing a very serious condition known as retinal detatchment. This will cause a scotoma (blind spot) in the field of vision which pertains to that part of the retina - this scotoma is very complete, appearing as if a 'shade' had come over that part of the visual field. Should a retinal detatchment go untreated, it can result in permanent loss of vision.
If a hole is torn in an area in the retina with a blood vessel, it may produce a vitreous hemorrhage in which there are hundreds, or thousands of blood cells which appear in the posterior chamber. Therefore, it is important to immediately notify one's eye professional if one suddenly notices a very large number of 'spots' or 'floaters' (they move when the eye moves.) However, it is normal to see a few spots/floaters as the eye ages. These usually represent the collagen fibers or cells floating around in the pools of fluid within the gelatinous vitreous jelly.
In summary, the important symptoms of viteous humor problems are:
Should any of these symptoms appear, it is vital to contact one's eye doctor immediately!
Other locations with useful information on this problem are:
Dr. Dave feels it is very important to distinguish 'floaters' by their quantity. Obviously, a single very large floater is of concern. Nevertheless, floaters are rarely of any significance unless they are more than fifty (50) in number. It is very normal to see a few floaters which occur occasionally in certain types of lighting conditions.
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