Glaucoma

This is a disease of the eye, where the normal fluid pressure inside the eye gradually increases, leading to problems with vision or even blindness on occasions.

What Causes Glaucoma?

The basic problem in glaucoma is in the small space at the front of the eye, called the anterior chamber. There is normally a steady flow of clear eye fluid in and out of this chamber, bathing and nourishing the eye. For reasons which still remain unclear, in glaucoma this fluid begins to drain out too slowly and so the fluid pressure slowly builds up in the eye. This excess pressure causes damage to the optic nerve, which connects the light-sensitive retina at the back of the eye to the brain. It is the health of this optic nerve which is necessary for healthy vision and so progressive damage to it from glaucoma slowly damages the eyesight. Most people suffer from a form of glaucoma called ‘open-angle glaucoma’.

What Are Glaucoma Symptoms And Signs?

Initially there are no symptoms in open – angle glaucoma. There is no pain, and the vision is normal. However, if the glaucoma remains untreated, a person may notice that although they can see things directly in front of them clearly, anything to one side of their vision appears blurred or foggy. They may fail to see objects to one side of them, and feel as if they are ‘looking through a tunnel’. Over time, their vision may gradually disappear to nothing.

Will I Have Any Tests Or Investigations?

Specialized tests are vital for the diagnosis of glaucoma to be accurately made.

There are 4 main tests;

* 1. Visual acuity. This involves using the well-known ‘doctor’s eye chart’ with letters of different sizes on it to measure how well you see at various distances.

* 2. Visual field. This important test measures your side (peripheral) vision, the loss of which is an early sign of glaucoma.

* 3. Pupil dilation. Special drops are put into the eye to dilate the centre of it and allow for the optic nerve to be examined. This means you will have blurred vision for some hours until the drops wear off, and you should not drive in this time.

* 4. Tonometry.There are a number of different types of this test, all of which are designed to measure the fluid pressure inside the eye. A common type is the fair puff’ test which measures the resistance of the eye to a puff of air, and is quick and painless.

What Treatment Might I Need?

Glaucoma is readily treatable, although not curable. The usual treatment is medicines, either in the form of eyedrops or pills. Some of these help to drain excess fluid from inside the eye, and others cause less fluid to be produced in the first place. These have the disadvantage of having to be taken several times each day, and they may also become less effective with time. It is important that your doctor knows any other medicines you may be taking before starting such treatment in order to avoid drug reactions or side effects. Laser surgery is becoming an increasingly popular treatment option. In this case, a strong beam of light (the laser) is focused on the anterior chamber at the front of the eye. This is painless because the eye has been numbed first with anaesthetic eye drops.

You may see little flashes of red or green light, and the laser makes up to 100 evenly spaced burns around the anterior chamber. These allow fluid to drain more easily out of the chamber and so reduce the eye pressure. This is very effective at treating glaucoma, but pressure may slowly increase again after 1 -2 years in some patients. If medication and laser surgery have no effect, ‘conventional’ surgery is then an option and is performed at hospital. A new channel is created for fluid to drain away from the eye, and drops are needed for several weeks afterwards to prevent any swelling or infection. If the new drain in the eye closes up, a second operation is sometimes needed to re-open it again. This type of surgery works better if you have never had eye surgery before. It is always important to remember that the aim of glaucoma surgery is to save sight, not improve it and some people find that although their sight has been saved it is not quite as good as before they had their operation.

What Course Will The Illness Follow?

If untreated or unrecognised, the usual pattern is that the eyesight gradually deteriorates until vision is very poor or blindness occurs. Once treated, regular checks from eye professionals such as opticians and ophthalmologists are vital to make sure the eye pressure is steady and not increasing once more. If the pressure remains the same, the eyesight tends to stay the same also.

Can I Do Anything To Help Myself?

If you are aged over the age of 60, or have a strong family history of glaucoma, or are Afro-Caribbean in race then you should have annual eye checks, even if you are not aware of any eye problems or symptoms.

Tell Your Doctor

1. Do you think your eyesight is getting worse?
2. Can you see things in front of you better than to the side of you?
3. Do you have a family history of glaucoma or eye problems?
4. Have you ever had problems with eye tests in the past?
5. Have you had your glasses changed recently?

Ask Your Doctor

1. What are the side effects of treatment?
2. Am I allowed to drive with glaucoma?
3. What extra risk do my children have of developing glaucoma?
4. Can I go straight to laser surgery without needing to try medication?
5. Does eyestrain make glaucoma worse?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Free medical advice on glaucoma is published by Dr Viv Balonwu.
For further information on glaucoma, visit International Glaucoma Association.

Free Medical Advice Online by Vivienne Balonwu

Conjunctivitis – or ‘pink eye’ as it is sometimes called – is the term used for redness and irritation of the surface of the eye and eyelids. One or both eyes may be affected.

The eyes and eyelids are very sensitive to a number of irritants:

either infections (such as bacteria and viruses) or non-infectious substances (such as pollen or chemicals).

Conjunctivitis very common in childhood and it is usually classified and treated according to whether it is due to an infection or not.

What Causes Conjunctivitis?

Conjunctivitis is caused either by infections (infectious conjunctivitis) or non-infectious substances (non-infectious conjunctivitis).

Infectious Conjunctivitis has two main causes – bacteria and viruses.

Bacterial conjunctivitis is caused by bacterial infections – usually either streptococci, staphylococci or pneumococci. These are contagious infections, and are spread by touch.

Viral conjunctivitis is usually seen along with typical symptoms of a cold, and the symptoms may differ very slightly from a bacterial infection (see below). Viral conjunctivitis is not as contagious as the bacterial form.

Non-infectious Conjunctivitis has three main causes.

The first is allergic conjunctivitis, produced by substances that cause an allergy (such as pollen and animal fur). The second is chemical conjunctivitis, this is when an irritating substance comes into contact with the eye (such as household sprays or smoke). Eye make-up, for example mascara, can cause symptoms.

The third form of non-infectious conjunctivitis is rare, and is due to an underlying illness. For example, inflammatory bowel disease and rheumatoid arthritis may sometimes cause this rare form of conjunctivitis.

Sometimes red eyes can be caused by another condition. Occasionally the whites of a person’s eyes can suddenly become bright red, but this is not due to a conjunctivitis. This is due to some of the tiny blood vessels under the whites of the eyes breaking when under pressure. This pressure can be caused by laughing, vomiting or even bending the head forwards. It is called a subconjunctival haemorrhage. While this
condition looks impressive (and worrying), it needs no treatment and will settle by itself.

What Are The Signs And Symptoms Of Conjunctivitis?

In bacterial conjunctivitis there is usually eye soreness or pain, with swelling and redness of the affected eye. There is a discharge from the corner of the eye, usually coloured greenish-yellow. The discharge is seen most commonly on waking. This discharge can ‘stick’ the eyes shut, sometimes to the concern of a child, but is easily cleared with a warm cloth.

Viral conjunctivitis causes the same sort of eye irritation but the discharge is more watery or clear rather than coloured.

With the non-infectious types of conjunctivitis, an allergic reaction causes considerable itching of the eye, often with much rubbing. This rubbing of eye only makes the symptoms worse. There may be a runny nose, sneezing and a sore throat associated with it too as part of the allergic reaction. Similar symptoms occur when the conjunctivitis is due to a chemical irritation or underlying disease too. However, if the conjunctivitis persists for a long time, it suggests that the cause may be an underlying disease.

Will I have Any Tests Or Investigations?

Doctors usually diagnose which type of conjunctivitis is present from the history and examination alone and rarely perform tests. In babies or children who have a persisting conjunctivitis or eye discharge, eye swabs may be taken to identify the organism that has infected the eye.

What Treatment Might I Need?

This depends on the underlying cause. 

In bacterial conjunctivitis, antibiotic eye drops or ointments are usually prescribed – usually chloramphenicol. Regular eye bathing with warm water, using a different cloth for each eye, is also recommended.

Note: It is important to use the eye treatment prescribed only for the person it was prescribed for. There are two important reasons. First, the medication will go out of date. Second, old bottles and tubes that have been used by one infected person may have been contaminated and this infection could be passed to the next person who uses that bottle or tube.

The easiest way to apply drops to a child is to lie the child down flat, ask them to shut their eyes and put the drops into the inner corner of the eye, next to the nose. The drops will form a tiny pool there. Ask the child to open their eyes, and the drops will then flow easily into the eye without worrying the child.

If your doctor thinks that the bacteria causing the conjunctivitis are part of a more general infection such as tonsillitis or an ear infection, the doctor will usually prescribe oral antibiotics rather than eye drops or ointments in order to treat the general infection.

In viral conjunctivitis there is no need for any anti-bacterial treatment, so no drops or ointments will be prescribed. All that will be needed is for the person with conjunctivitis to maintain simple eye hygiene, such as washing and drying each eye with a different cloth. Any flu-like symptoms, such as a runny nose, should be treated in the normal way.

With allergic conjunctivitis, the allergic symptoms are treated by placing cool cloths on the eyes regularly, and by using non-sedating anti-histamine eye drops or tablets. These eye drops or tablets can be obtained either over the counter from your local pharmacist or from your doctor.

Conjunctivitis caused by chemical irritation should always be first treated by very thoroughly washing the eyes for 5 to 10 minutes with large quantities of water. The person should then visit their doctor for a medical opinion.

What course will the illness follow?

Most cases of bacterial conjunctivitis will start to settle within 24 hours of beginning treatment, and the usual length of treatment is 3 to 5 days. Viral infections settle along with the underlying viral symptoms, typically between 2 and 6 days after their onset.

Can I do anything to help myself?

If you have a red eye that is discharging fluid, you should try to resist rubbing your eyes and you should seek medical advice. It is important not to rub the eye because bacterial infections are highly infectious and you may easily transfer the infection to your other eye.

Make sure you use your own personal towel and flannel so that others are not infected, and bathe the eye regularly. Remember to wash your hands thoroughly each time after using the treatment. If you suffer from allergic conjunctivitis during certain seasons (for example, during the summer), it is often worth using antihistamine treatment throughout the allergic season to prevent attacks.

Tell Your Doctor

1. How long have you had your symptoms?

2. Do you get symptoms like this regularly?

3. Do your eyes itch rather than hurt?

4. Does anyone else in your family or who you work with have a similar
problem?

5. Did one eye have symptoms before the other?

Ask your Doctor

1. Am I allowed to wear my contact lenses?

2. If my baby has a conjunctivitis, have they caught it from me?

3. What is the right way to bathe my eyes?

4. How long should I leave it before returning to see you if my symptoms
do not clear?

5. How long will my eye drops last before needing to be thrown away?

By Dr Roger Henderson, MB BS, LMSSA.

Free Medical Advice Online by Vivienne Balonwu

Cataracts are a clouding or ‘misting over’ of the lens of the eye. This affects normal vision, and cataracts will affect most people if they live long enough.

What Causes Cataracts?

What Are The Signs And Symptoms Of Cataracts?

The most obvious symptom is a loss of clear or distinct vision, and occasionally poor vision in bright light such as car headlights or sunshine. Others include double vision, a reduction in the ability to distinguish colours, and an increase in the number of times reading glasses are being changed. Eyes with well developed cataracts in them have a characteristic ‘milky’ film over them, and one eye is usually affected before another.

Will I Have Any Tests Or Investigations?

A doctor will examine the eyes painlessly using an ophthalmoscope – a hand held eye instrument – and the cataracts can be clearly seen. There may also be colour vision tests or eye chart tests to try to assess the loss of vision.

What Treatment Might I Need For Cataract?

If a cataract only affects the very middle of the lens, eye drops are occasionally helpful. These dilate the eye, allowing more light to enter it and so reduce the symptoms. However, the vast majority of cataracts which require treatment will need surgery. There are three main methods used here;

Cataract Surgery And Cataract Surgery Recovery

In all cases, once the cataract has been removed then the vision needs to be corrected – the lens only accounts for a third of the power of the eye – which can be done with strong strength glasses or contact lenses. Spectacles can only be prescribed if both eyes have been operated on, or if one is no longer used.

Intra-ocular implants (IOLs) are useful in patients who have had cataract surgery to one eye. Under anaesthetic, a plastic lens implant is placed in the eye after the cataract has been removed. This remains in place permanently, requires no maintenance, and is not felt by the patient or noticed by others. Spectacles for reading may still be needed but thick glasses are usually not required.

In general, once a cataract has been operated on and vision corrected the patient has satisfactory sight and is able to lead a normal life.

What Course Will The Illness Follow?

Most cataracts develop extremely slowly, and so a gradual loss of vision may not be noticed until the loss is severe. Cataract surgery is usually considered when the visual problems interfere with normal daily activities. If cataracts are severe and not treated there is a risk of long-term blindness. Many patients however require no treatment for their cataracts as they are able to lead a normal life with them.

 Can I Do Anything To Help Myself?

There is some evidence that avoiding ultraviolet light can reduce cataract formation, so protecting the eyes from sunlight by wearing sunglasses when at altitude or on sunny days is sensible. Always report any change in your vision to your doctor and have an annual eye check with an optician.

Tell Your Doctor

1. How long have you noticed problems with your eyesight?
2. Do you have any blurred vision or sensitivity to light?
3. Have you always spent a lot of time in the sun?
4. Are there problems when you try reading close-up?
5. Is one eye worse than the other?

Ask your Doctor

1. Do I need to inform the driving license agency?
2. Will I need to stay in hospital for any length of time?
3. How quickly can I have surgery if I need it?
4. If I cannot have surgery, should I be registered partially sighted?
5. Can I have free eye checks?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond.

Free Medical Advice Online by Vivienne Balonwu