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Ophthalmology

is a science that is progressing at a very fast pace, and deals with the diseases that can affect the eye. The idea of this article is to give an insight to the practical aspects of ophthalmology, and to create an awareness as to when we should consult an ophthalmologist. I have simplified the subject and will only be describing the most common diseases affecting the eye so that the symptoms may be recognised early and shown to an eye doctor and treatment started as early as possible.

DISEASES AFFECTING THE NEWBORN, INFANTS AND CHILDREN

CONJUNCTIVITIS

        A newborn baby may have difficulty in opening the eyes with sticky eyelids. There may be discharge around the eye. In adults, viral conjunctivitis is the most common and passes away in 10-14 days time. In children, disastrous side effects may be there.

 

EXCESSIVE TEARING

       Tears are normally drained through a passage into the nose. If it has not formed or opened properly, excessive tearing can occur.

 

  WHITENING IN THE PUPIL

        Normally the cornea (the black of the eye) and the pupil are transparent. If there is whitening, that indicates that there is a disease affecting the cornea, a cataract is developing in the child or there is a tumour in the eye.

 

  SQUINT

        When one or both eyes are not aligned straight, and one or both eyes deviate, it means that the child has squint and if not treated as soon as possible, there are chances that there may be permanent decreased vision in that eye. Many people consider squint to be a lucky charm. That is NOT true!!!

 

  NIGHT BLINDNESS

       When vision is normal in the day and grossly reduces at night, the peripheral retina is affected. Causes include Vitamin A deficiency, retinitis pigmentosa and optic nerve affection.

 

  REFRACTIVE  ERRORS

       A child holding a book too close to the face, sitting too close to the TV, unable to see the black board or squeezes the eyes too much, is most likely to have a refractive error and needs spectacles or contact lenses.

       Uncorrected refractive errors like short sightedness, long sightedness or astigmatism can lead to permanent decrease in vision.

       Spectacles do not cure a refractive error; they just aid in bringing the light rays to a focus on the retina (just as an umbrella stops the rain from falling on us- but does not stop the rain itself).

       Refractive surgery and laser surgery (LASIK) may be tried in persons over 18 years of age.

DISEASES AFFECTING THE ADULT

  MIGRAINE

        Severe throbbing headaches on one side of the head associated with vomiting or visual hallucinations suggest migraine. Cheese, coffee, chocolates and cake should be avoided. 2 tablets of paracetamol help in reducing the attack.

 

 COMPUTER FATIGUE

        People working with computers experience heavy and tired eyes. That is because the muscles of the eyes are strained to keep the screen in focus.

        Take multiple short breaks and stretch out. Use a protective computer screen to reduce flicker.

 

  WHITE PATCHES ON THE BLACK OF THE EYE

        When mud or sand falls on the eyes, viruses may enter too and cause white spots on the cornea. Treatment with acyclovir ointment and removal of the mud is needed.

 

  REDDISH BUMP ON THE  WHITE OF THE EYE

        Especially seen in people who bathe in ponds and river water. Germs enter and cause a localised nodular swelling on the white of the eyes. Steroid drops are needed to cure this.

 

  READING GLASSES

       Most people around the age of 40 need spectacles to read or to do near work, expect for people with myopia (short sight) or a nuclear cataract.

 

 LOSS OF VISION IN ONE EYE

      There are various reasons. The artery or vein to the eye may get blocked or the retina may have got detached.

 

  DIABETES AND THE EYE

Diabetes can affect the heart, kidneys, nervous system, limbs and eyes. Control of diabetes by diet restriction, tablets or insulin injections is the only way to delay eye involvement.      A person who has been a diabetic for more that 10 years is at increased risk of developing eye problems. Uncontrolled or fluctuating blood sugar levels may need frequent change of glasses.
The retina may bleed in uncontrolled diabetics. The treatment is by giving lasers to the retina, which does not cure the problem, but only stops further progression of the disease. Cataracts may develop, too, which may need surgery at a later date.

  HYPERTENSION AND THE EYE

      Long standing hypertensives or a sudden rise in Blood pressure may cause decreased vision due to fluid accumulation in the retina, macula and optic nerve head.

 

  GLAUCOMA

       This is known as the silent killer of the eye because the patient will not know that he has the disease as it is painless and will only realise it when central vision reduces at the end stages.

       It is a condition where the pressure of the eye is increased, so as to damage the retina by mechanically compressing it, and eventually killing the nerve cells of the retina causing decreased vision.

       An entity called Acute congestive glaucoma occurs more commonly in the middle aged women, where the pressure suddenly increases causing intense headache, vomiting, blurring of vision and seeing coloured rings around a light.

      Glaucoma is a hereditary disease, hence if one member in the family has glaucoma, it is better to get all the members of the family checked.

 

  DRY EYE

        This occurs due to insufficiency of tears. Symptoms include hot and gritty eyes, burning sensation and frequent blinking. Artificial tears in the form of drops may be applied. 

 

  ALLERGY

       Allergy of the eye can occur to almost anything e.g. dust, fur, food, etc.  Symptoms include itching and watering. Anti allergic drops help cure this condition.

 

CATARACT

  An opacification of the lens is called cataract. It can occur in any age group. Children can be born with cataract, but is more common in old people.

       There is NO medication which will reverse cataract. Surgery is the only treatment.

       Following cataract surgery, the patient has to be optically rehabilitated, either using spectacles or contact lenses. Cataract glasses are very heavy. Everything seems enlarged. Walking up and  down steps is difficult.

       Contact lenses are delicate like onion peels and are small and transparent and has to be inserted over the eye every morning, which can be cumbersome for an old person. 

Intra ocular lenses is the answer in the modern era. However, spectacles are still needed to read.

       Cataract extraction by phacoemulsification is the  method of choice as it is a suture less surgery with a faster post operative recovery time.

       Intraocular lenses are placed in the capsular bag within the eye for good support. This capsular bag can get opacified with time and again cause decreased vision. The treatment  is with YAG laser and is a painless procedure which is done in a couple of minutes.

       People who have undergone previous cataract extraction without an intraocular lens implanted , can undergo a second surgery and place an intraocular lens.

 

  FLASHES OF LIGHT

        This is experienced when the retina gets detached and leads to loss of vision.

 

  FLOATERS

       Seeing black spots in front of the eye may be normal. If there is a sudden increase in the number of black spots, it indicates a pathology in the vitreous.     

 

  AGE RELATED MACULAR DEGENERATION

       As age increases, the strength of the retina decreases. This weakening results   in low vision.

       Low vision aids are available to improve quality of life.

 

  INJURIES

      Injury with lime (chunam) causes a heat and chemical reaction which can destroy the eye. Children should be kept away from sharp objects and fire crackers as they can cause irreparable damage.

 

  EYE DONATION

      Eyes should be removed within 6 hours after death. The whole eye is not replaced, but only  the cornea (black of the eye) can be transplanted.

      Registering your name as a donor with the nearest Eye Donation Society or Eye Bank will enable a blind person to see.

 

  CONSANGUINITY

      All humans have a few weak (bad recessive) genes. Brothers, sisters and blood relatives carry the same genetic pattern. When a baby is formed, it receives genes from both  father and mother. Therefore when close relatives get married,  2 weak genes carrying the same disease pattern may get together resulting in a baby being born deaf, blind, mentally retarded or deformed.

 

  PREGNANCY                                

        Mothers should get vaccinated against Rubella (German measles) if they have not been vaccinated against it as children as Rubella may cause heart, eye and ear defects in the child.

        Both partners should get screened for HIV, syphilis and gonorrhea as these diseases may affect the eyes of the child to be born.

DO’S

-         Consult your ophthalmologist for any doubts

-         All children should undergo a checkup, to see if the growth of the eye is normal. Most parents visit a pediatrician but never an eye doctor. An early diagnosis of eye problems and treating may prevent decreased vision and blindness in the future.

DONT’S      

-         Avoid consanguineous marriages.

-         Avoid lime, sharp objects and fire crackers

-         Avoid “quack” remedies and “local” treatments with plant juices as that itself may cause fungal ulcers of the cornea.

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