Retinal detachment

What is retinal detachment? Retinal detachment happens when the external retinal membrane (retinal pigment epithelium) separates from the internal retinal membrane (sensory retina). There are different types of retinal detachment: Rhegmatogenous: This is the most common retinal detachment. It happens when there is a tear in the retina that leads to fluid accumulation in the subretinal space. Tractional: This is the second most common type of retinal detachment. It happens when scar tissue grows on the retina and pulls it out of its normal position. Exudative (serous): This is the rarest type of retinal detachment. It happens when fluid collects under the retina (but there is no tear) due to inflammation or tumours. Disorder prognosis Prognosis after retinal detachment depends on the location and extent of detachment. In cases where the macula has no damage, prognosis is excellent. It should be noted that successful retinal repair does not always completely restore vision. Some types of retinal detachment can’t be repaired. What are the symptoms? Having two or more of the following symptoms may be an indication retinal detachment: Seeing flashing lights. Blurry vision. Floaters that appear suddenly or increase suddenly. Shadow or blind spot in the field of vision. Tests for retinal detachment An ophthalmologist will examine the eyes and check the retina and pupil: Angiofluoresceinography: Checks the blood flow in the retina by using a camera and special dye. Tonometry: Measures eye pressure. Ophthalmoscopy: Examines that back of the eye, including the retina. Refraction test: Used to verify prescription glasses. Verification of chromatic vision. Visual acuity test: Determines the smallest letters that can be read on a standardised chart (Snellen chart). Slit lamp test: Checks the structures in the front of the eye. Eye ultrasound. What causes it? The main causes for retinal detachments are due to retinal tears or holes. Other causes include: Ageing can cause retinal thinning and deterioration. Vitreous retraction: The vitreous is attached to the retina by many fibres. If it retracts, it may cause a tear or a hole. This is the most common cause of retinal detachment. Abnormal eye growth: Vitreous contraction may be caused due to myopia, inflammation or swelling, or eye trauma. How can it be prevented? It is crucial to have an ophthalmologic examination with pupillary dilation to be to check the retinal periphery. If degenerative lesions that could cause detachment are found, laser treatment will be recommended. Day-to-day tips: Wear protective glasses to prevent eye trauma. Diabetic patients should carefully monitor their blood sugar. See an ophthalmologist once a year. Be aware of new flashing light or floater symptoms. Early diagnosis and treatment are essential for a good outcome. What is the treatment? In most cases treatment will involve surgery, for example in both rhegmatogenous and tractional retinal detachment. The former is the most common type of retinal detachment. In cases of serous retinal detachment, the cause needs to be treated. This may be done by surgery, medications, or radiotherapy, amongst other treatments. There are different types of surgery that can be used, depending on each case. Currently, the most commonly used is microsurgery through posterior vitrectomy via pars plana. The aim of the treatment is: Close the tear or rupture that has caused retinal detachment using laser or cryotherapy. Put the retina back in its place. The procedure is normally done on an outpatient basis. Local anaesthetic and sedation are used. What specialist should I see? Retinal detachment is treated by an ophthalmologist. ...

Vitrectomy

What is a vitrectomy? A vitrectomy is a type of eye operation, in which the vitreous humour, a jelly-like fluid inside the eye is removed and replaced with a saline solution. The operation is usually performed under local anaesthetic. The function of the vitreous humour is to protect the retina; the sensory membrane at the very back of the eye that receives light and sends images of what the eye sees to the brain. The vitreous humour occupies the space behind the lens and in front of the retina. Why is a vitrectomy performed? In order for the eye to process visual information, the vitreous humour must be clear enough for light to pass through to the retina. Sometimes, this gel-like substance becomes cloudy from various diseases or trauma, making it difficult to see. A vitrectomy is performed if vision has been diminished considerably and inhibits the patient from having a normal life. A vitrectomy can be used to treat the following: Retinal detachment; sometimes the retina pulls away from the tissue around it and a vitrectomy makes it easier for the doctor to get to the retina to repair it. Diabetic retinopathy; a diabetes complication in which the retina becomes damaged due to uncontrolled blood sugars over a long period of time. Macular holes, diseases of the macula or macular degeneration; the macula is the central area of the retina, a hole in the macula can cause distortion of your central vision. Infections or inflammation of the eye, especially the middle eye or uvea (uveitis). Eye injuries or trauma Cataract operations with complications (occasionally) Pathologies related to high myopia, in which light reaches a focus point before hitting the retina, causing blurry vision. What happens during a vitrectomy? To begin with, small incisions are made into the sclera (white part of the eye) and the vitreous fluid is then removed with a needle. Instruments used in the procedure also include a fiber optic light and an irrigation cannula for suction. Once the vitreous fluid has been removed, the doctor will make any other necessary treatments that the eye needs and will then replace the vitreous fluid with saline or liquid silicone oil, depending on the pathology. The doctor may need to inject a tiny gas bubble into the eye to keep the retina in place. The operation usually lasts between one and two hours and, in some cases, further surgery may need to be performed, depending on the purpose of the operation. Preparing for a vitrectomy Before a vitrectomy, a detailed eye examination should be performed, usually accompanied by an ultrasound to provide the doctor with a detailed picture of the back of the eye. The doctor may need to insert drops into the eye to expand the size of the retina during the examination. Other tests that may be performed are the Retinal Optical Coherence Tomography (OCT) which uses light waves to take cross-section pictures of the retina, fluorescein angiography which examines the retina using a special camera and fluorescent dye or a full field electroretinography test. Aftercare Once the surgery has finished, the doctor will cover the eye with a patch, which can usually be removed after a few hours. The main side effect of the operation is eye pain, which can be treated with antibiotic drops or ointment and over the counter pain relievers. It is recommended to have someone accompany you home after the operation as your vision will be blurry until your eye has fully healed and the gas bubble has been dissolved. There are rarely complications with a vitrectomy, but if you experience vision loss, see floaters or experience severe pain, contact your doctor right away. ...

Amblyopia

What is a lazy eye? Amblyopia, better known as a lazy eye, is a common sight disorder where vision is decreased in an eye, and is not correctable by glasses or contact lenses. The eye suffers reduced vision because the brain is not acknowledging the information sent by that eye properly. It usually manifests in one eye, with the brain choosing to mainly accept visual information from the other, although in certain cases it may manifest as reduced vision in both. It is a childhood disease, so it is highly important that it is corrected during early ages so that it does not end up becoming chronic. What are the symptoms of amblyopia? Most lazy eyes do not cause symptoms, with many children being unaware that there is a problem, and younger children often being unable to explain what is wrong. Some older children may have difficulty reading, writing, and drawing. Sometimes, the eye may look different, although this is usually a direct symptom of another condition, which may be the root cause of the lazy eye. Such conditions include: The weaker eye may look in a different direction than the stronger one (strabismus) Childhood cataracts Refractive errors, such as myopia and astigmatism Actions such as rubbing the eyes often, winking eyes or constantly blinking eyes are also indications that the child (or adult, in those cases not detected in time) suffers from a lazy eye. Causes of a lazy eye The main cause is an underdeveloped nerve pathway from the eye to the brain, formed during childhood. These nerves transmit information from the retina (the light-sensitive layer at the back of the eye) to the brain, which interprets this information as vision. During the first eight years of a child’s life, this connection from the eyes to the brain is built, as the eyes show the brain images, and the brain learns to make sense of them. The brain may not be able to build strong pathways in the following situations: If a low amount of light is entering the eye (caused by cataracts, for example). If the eye is unable to focus light well (refractive errors). Where the images sent by the two eyes aren’t the same (e.g. in the case of strabismus). Can a lazy eye be prevented? As amblyopia is a predictable and treatable condition, it should be detected quickly. It is advisable that all children have a complete eye exam at least once between 3 and 5 years of age. Parents should watch out for the signs listed above. What is the treatment for amblyopia? If a lazy eye is a consequence of another condition, that condition must first be treated. Glasses can be used to treat hyperopia, myopia or astigmatism, while cataracts will have to be removed to allow light to enter the eye properly. The child must then be encouraged to use the weaker eye to improve its connection to the brain. This can be done by reducing the brain’s reliance on the stronger eye, either by covering it with an eye patch, or temporarily blurring its vision with eye drops. Treatment is usually effective, but gradual, usually taking months to work, and should not be stopped too soon, as progress can be lost. After 7 or 8 years of age, the effectiveness of this correctional treatment is uncertain. ...

Angiography

Angiography is a test to diagnose and treat diseases of the blood vessels. If done by MRI is called resonance angiography. This test can diagnose aneurysms in the aorta, arteriosclerotic disease of the carotid arteries in the neck, diseases in blood vessels of the brain as small aneurysms or arteriovenous malformations, ... ...

Angle closure glaucoma

Angle closure glaucoma, or acute glaucoma, is caused by increased pressure within the eye as a result of the build up of fluid. Symptoms are severe pain, blurred vision and nausea. ...

Aniridia

What is aniridia? Aniridia is a hereditary and congenital eye disorder characterised by incomplete development of the iris, usually occurring in both eyes. Although etymologically speaking the term “aniridia” suggests that no iris is present, it actually means that part of the iris is not fully formed because of incomplete development. Prognosis It is quite difficult to give general data about the prognosis, given the large variation between individuals. Hence, the pathology is managed in to completely individualised manner. Furthermore, given the low incidence of the pathology, results cannot be generalised. Symptoms The incomplete formation of the iris leads to impaired vision, which may be reduced by up to 20% in some cases. Furthermore, aniridia may lead to diverse visual diseases such as glaucoma or cataracts. Common symptoms are: Very large pupils from birth. Photophobia Glaucoma: In around half of cases, eyes with aniridia have difficulty draining the liquid of the eye. Nystagmus Loss of corneal transparency Lack of development of the optic nerve and the macula, the central area of the retina responsible for detailed vision. If it’s associated with aniridia, it can cause low visual acuity. Cataracts In some cases, aniridia may be associated with the presence of kidney tumours. Testing for aniridia The first diagnostic test, performed on newborns, is visual, given that the baby closes its eyes in the presence of light (photophobia). This is the first manifestation that can be assessed, although the ophthalmologist should check for and determine the severity, and also the possible associated impairments. There are several tests for a correct diagnosis: Chromosome banding Fluorescent in situ hybridisation (FISH) Renal ultrasound examinations Abdomen and brain images What are the causes of aniridia? Possible causes are: Hereditary Spontaneous mutation: The pathology is associated with mutations in the PAX6 gene, which is involved in the development of the eye. In addition to an underdeveloped iris, the patient’s eye may be underdeveloped in general, including a little-developed retina. Can it be prevented? Aniridia is a hereditary and congenital eye disorder and as such it cannot be prevented. It is important to carry out a genetic diagnosis in infants born with the disease in order to know its severity. In addition, exhaustive annual examinations by specialist ophthalmologists and paediatricians are required to detect and treat any associated pathologies in a timely manner, thereby improving the patient’s quality of life for a longer period of time. Treatment of aniridia Currently, there is no specific treatment for this disease. Given that many diseases are associated with aniridia, every patient should receive treatment according to their symptoms. In summary, there is no single treatment for all symptoms of aniridia; therefore, each symptom needs to be treated separately. One option is cosmetic contact lenses, but current eye microsurgery can, in many cases, reconstruct the iris and the pupil, when the defect is partial. When the defect is total or subtotal, one option is the use of 90° or 180° ring implants to form a complete iris. The most innovative option is the Artificial Iris (Dr. Schmidt, Humanoptics), a flexible iris with personalised photograph-based colouration that can be implanted without the need for sutures. Which specialist treats it? The ophthalmologist is the specialist who helps to prevent, diagnose and treat diseases affecting the eyes and vision, among them aniridia. The eyes are the key structures involved in vision and are susceptible to many pathological processes throughout life. Ophthalmology seeks to preserve every individual’s visual capacity, via medical or surgical techniques, or the aid of external elements such as glasses or contact lenses. ...

Astigmatism

What is astigmatism? Astigmatism is a condition where the shape of your eye is more like a rugby ball than a football, causing blurriness in vision. People with astigmatism are generally born with it, but sometimes the condition can develop as the result of surgery, injury, or an illness. Astigmatism usually comes with long- or short-sightedness. Astigmatism is very common – nearly 50% of people in the UK who wear glasses have some form of astigmatism. What are the causes of astigmatism? Astigmatism occurs when the curvature of the surfaces on your eye are irregular, resulting in a refractive error. Your eye has two curved surfaces – the cornea and the lens – which bend, or refract, light. In a perfectly functioning eye, both the cornea and lens have two curves that match each other, resulting in a sharp image. However, if the curves are mismatched in either the cornea or lens, your retina will receive a blurry image. A fault in the cornea is called corneal astigmatism while a fault in the lens is called lenticular astigmatism. Both of these types come under the bracket of regular astigmatism, which is by far the most common form of astigmatism. Irregular astigmatism involves a cornea or lens which is curved in multiple directions, curved asymmetrically, or uneven in other ways. It is much more difficult to correct and not usually possible to correct with eyeglasses. However, irregular astigmatism occurs much more rarely than the regular form, and is usually the result of an injury to the eye or illness. The rest of this article focuses on regular astigmatism. Symptoms of astigmatism The main symptom of astigmatism is blurry vision, which can come with: headache eye strain (especially from reading or looking at a computer for a long period of time) squinting Medical tests to diagnose astigmatism Astigmatism, along with long- and short-sightedness, can be diagnosed by an optician during a comprehensive eye exam. The doctor will be able to determine from this what degree of astigmatism you have, and therefore what your corrective options are. Treatments for astigmatism Astigmatism can usually be corrected with eyeglasses or contact lenses. Both involve the use of artificial lenses to give you clear vision. From your eye exam the optician will produce a prescription, which states what kind of lens you need. Previously it was not possible to buy soft contact lenses for astigmatism, and the only option was the use of rigid lenses. Now, however, a special form of soft lens called ‘toric’ lenses are available. For stronger forms of astigmatism the cost of contact lenses can increase, and the range of frames you can wear may be restricted. If you opt for eyeglasses or contact lenses, it is important to have your eyes regularly tested because the shape of your eyes change gradually over time, and your prescription might change. Finally, laser eye surgery is often an option, but can be more expensive and may carry the risk of complication. ...

Blepharitis

What is it? Blepharitis is an inflammatory condition of the eyelids which, if occurring alongside with conjunctivitis (or pink eye), may also be called blepharoconjunctivitis. In this case, the inflammation will spread to the eyelids and to the conjunctive membrane. Blepharitis can become chronic, thus being recurrent and resistant to treatments. This is why it is very important to prevent it, by following some hygienic and general rules. Chronic blepharitis can cause red eyelids and crusting of the eyelashes and is more common among the elderly. Prognosis Blepharitis usually lasts a couple of weeks; however, the condition may become chronic. In this case, symptoms can be kept under control but you won’t be able to eradicate them completely. Proper eyelid hygiene is extremely important to prevent recurrent blepharitis. What are the symptoms? The most common symptoms of blepharitis show up on the eyelids. These may include: a burning sensation a hot sensation itching The itching usually makes you scratch your eyelid. However, it is essential that you avoid touching the swollen area with your hands, because this may spread the inflammation and, in some cases, cause some skin microlesions. In case of severe blepharitis, symptoms may also include: swelling of the eye localised pain, due to frequent and irregular blinking photophobia (light sensitivity) How is it diagnosed? A diagnosis can be made by looking at some signs on your eyelid - flaking of skin on eyelids, crusting of the eyelids and, in the most severe cases, even ulcers - and by telling your GP about the symptoms you have. Furthermore, an eye specialist may examine your eyes with a slit lamp. What causes it? The most common causes for this condition are: secretion imbalance of the Meibomian glands refractive errors, such as astigmatism and far-sightedness skin disorders (such as seborrhoeic dermatitis) disorders related to the digestive tract (problems with the digestion process or vitamin deficiency) diabetes high levels of fats in the blood allergies and environmental factors (smoking, fine dusts or particles) bacterial infections How can it be prevented? Blepharitis can be prevented by following some general hygienic rules, which can reduce the risk of developing this condition. You should make sure your hands are clean before touching your eyes. If someone in your family starts showing any of the symptoms of blepharitis, you should avoid sharing sheets, clothes or personal hygiene items with them, in order to avoid spreading it. It is also very important to eat a healthy diet with lots of fruits, vegetables and lean proteins (such as fish or chicken) and to avoid eating too much sugar and caffeinated drinks. How is it treated? Blepharitis can be cured with anti-inflammatory eye drops and antibiotics. To make sure you can cure it completely, you should also check your conjunctive membrane, because there could be some signs of keratitis on the cornea. In case of infectious blepharitis, you should avoid using contact lenses, to avoid spreading the infection any further within the eye. Women should avoid using eye cosmetics while treating blepharitis. Which doctor should I talk to? If you think you may have blepharitis, you should see an ophthalmologist. ...

Blepharoplasty

What is blepharoplasty? Blepharoplasty, or dark circles surgery, is a plastic surgery operation aimed at correcting eyelid defects and deformities, or to aesthetically modify the region around the eyes. It often involves the removal of excess skin, muscle, and fat that accumulates around the eyes with age, causing sagging and the appearance of bags under the eyes. Why is blepharoplasty done? As we get older, our skin loses its elasticity and the eyelids are no exception. As they stretch, creating excess skin, and the muscles that support them weaken, excess fat can start to collect above and below the eyelids, causing drooping eyebrows and upper eyelids and bags under the eyes. If this excess fat and skin prevents your eyes from opening fully, it can interfere with your peripheral vision, meaning that blepharoplasty may be done to improve vision. However, most cases (particularly operations on the lower eyelids) are performed purely for cosmetic reasons, as the removal of bags and dark circles has the effect of rejuvenating the face. What does blepharoplasty consist of? There are two ways to perform this surgery: External route: A small cut is made under the eyelashes allowing the surgeon to remove excess skin, muscle, and fat. It is then sealed by a very fine suture that facilitates skin tightening. Internal route: A small incision is made in the inner part of the lower eyelid, through which fat is extracted. Some surgeons do not even use a suture to close the incision, since this tissue heals easily by itself. The eyes are protected by an orbital metallic strip, which is inserted after the patient is under anaesthesia (local or general, depending on whether the blepharoplasty is part of a longer procedure). The duration of the surgery is usually between 30 minutes and one hour, depending on the number of eyelids that will be operated on. Preparation for blepharoplasty Before the blepharoplasty procedure, you will meet with an ophthalmologist and/or plastic surgeon, who will take your medical history and discuss your expectations with you. You will also have to undergo a physical examination, an eye test, and photos will be taken of your eye(s). Smokers will have to stop smoking several weeks before the operation. Care after blepharoplasty Once the surgery is completed, an ointment will be applied to the eyes to lubricate them and in some cases, a soft bandage. Patients may experience blurred or double vision, excessive production of tears, hypersensitivity to light, discomfort or pain, and some swelling and bruising for a short while after a blepharoplasty. Your doctor may suggest that you take steps such as sleeping with your head elevated higher than your chest for a few days and using cold compresses on your eyes in order to reduce inflammation and bruising. You will be informed if you are required to apply eye drops to keep your eyes hydrated. Oedema and bruising will gradually diminish until it disappears completely and you will begin to look and feel much better. ...

Blepharospasm

Blepharospasm is an involuntary and repetitive contraction of the orbicularis muscle (the circular muscle around the eye), which causes abnormal movements in the eyelids. This causes various visual disturbances (uncontrollable blinking, forced eye closure, reduced vision), and abnormal neck, head or mouth movements that only disappear while the patient sleeps (facial dystonia). It is one of the most common ophthalmological pathologies and it can be caused by side effects of some medications, neurological disturbances in the central nervous system or lack of lubrication of the ocular surface (causing increased eyelid activity to try to effect even distribution of moisture). Its treatment includes eye protection with sunglasses, the application of lubricating drops or Botox injections to avoid contraction of the orbicularis muscles. ...

Canthoplasty

What is canthoplasty surgery? Canthoplasty surgery refers to several procedures that reposition the lateral canthus, which is the outer corner of your eyes where the upper eyelids meet the lower eyelids. The end results of canthoplasty surgery is generally a wider-eyed appearance, with the eyes more cat-eye in style (i.e. they slant slightly upwards). This procedure is performed using either local anaesthetic or intravenous sedation. Why is canthoplasty surgery done? This procedure may be carried out for either cosmetic or medical purposes and can create a almond / cat-eye shape or reduce the effect of droopy eyes (ptosis) or eye bags that occur with ageing. Canthoplasty may also be performed to correct a lower lid malposition or laxity caused by either trauma or previous eyelid surgery (blepharoplasty). What does canthoplasty surgery involve? In canthoplasty surgery, the lateral canthal tendon is detached, shortened and re-attached to the lateral orbital rim. There are two main types canthoplasty surgery. The first is called a lateral canthoplasty. This achieves a ‘cat eye’ appearance. The second is called an epi-canthoplasty which involves the reshaping of the inner corner of the eyes. These procedures take between 1-2 hours, most frequently performed under local anaesthetic where the eye area is numbed. A special clear plastic shield will cover your eyeball, which is removed after the incisions are closed. The eye will then be dressed to protect the wound and reduce swelling. How do you prepare for canthoplasty surgery? After careful examination by a specialist where they will assess your eyes’ anatomy and treatment options, when you are admitted for the procedure the surgeon will usually begin by marking on the eyes with pen where the incisions will be made. Next anaesthesia will be administered. Local anaesthetic is most commonly used for this procedure. Aftercare following canthoplasty surgery Canthoplasty can be performed as a day case procedure, and you can generally return home the same day, but make sure someone can drive you home. You may feel some pain and discomfort following surgery, but over-the-counter painkillers can be used to manage this. Alternatives to this treatment Although it is not strictly an alternative, canthopexy is a less invasive technique that does not cut the tendons, but merely uses carefully placed sutures to tighten and stabilise the lateral canthal tendon. Hence, there is a quicker recovery time than with a canthoplasty. However, it is uncommon for a canthopexy not to accompany another form of lower eyelid surgery and is usually carried out in conjunction with this. ...

Chalazion treatment

A chalazion is an inflammation of the eyelid, it is caused by a blockage in the meibomian gland.

Childhood glaucoma

Glaucoma can be congenital (present from birth) or occur during childhood. It is the build-up of intraocular eye pressure and left untreated can lead to progressive loss of vision. ...

Coloboma

What is a coloboma? A coloboma is a developmental condition that causes part of the eye to have a “gap”. Coloboma can be classified into several types according to the affected part of the eye: coloboma of the iris (coloured part of the eye) coloboma of the eyelid coloboma of the lens (the part of the eye that focuses light on the retina) macular coloboma (of the macula, the central part of the retina responsible for giving a detailed view, daylight and colour) coloboma of the optic nerve (a group of nerve fibers that transmit light signals to the brain) uveal coloboma (of the uvea, the middle layer of the eye) chorioretinal coloboma (part of the retina) What are the symptoms of a coloboma? The symptoms depend on the affected area. For example, if it affects the iris, it has the appearance of a cat's eye or a lock, or, if it affects the eyelid, it is noticeable that it is not fully developed. Depending on the size, some types of coloboma can cause a loss of vision, which can involve the vision being blurred or not having vision in any specific location of the visual field. Another symptom that occurs occasionally is a greater sensitivity to light. What are the causes of a coloboma? Most are congenital, meaning they are present from birth. In most cases the cause is unknown; but sometimes it can happen due to eye surgery, hereditary conditions or trauma to the eye. What is the treatment for a coloboma? There is no direct treatment for a coloboma, so any corrective measures depend on what part of the eye is affected. If it affects the iris, one can use coloured contact lenses to disguise its appearance, or it can also be corrected with surgery. In other types of coloboma, it is necessary to help the patient to adapt to his/her vision problems through low vision devices. Other problems caused by a coloboma, such as the growth of new blood vessels in the back of the eye or cataracts, can also be treated. Finally, the specialist can recommend specific treatments if the patient only has a coloboma in one eye, such as patches, eye drops, glasses, among others. This helps prevent the development of amblyopia (lazy eye) and improve vision even in severe cases. ...

Colour blindness

What is colour blindness? Colour blindness (also known as colour vision deficiency) makes it difficult to identify and distinguish between certain colours. Total colour blindness (achromatopsia) is quite rare and it causes an inability to see any colour at all and an increased sensitivity to light. Colour vision deficiency can be classified into different categories, according to the following characteristics: Protanopia is a form of red-green colour blindness. It causes reduced sensitivity to red light, meaning the patient struggles to see different shades of red. They may confuse darker reds with black, and lighter shades with yellow and green. Violet, lavender and purple may appear blue due to the dimming of the red components of these colours. Protanomaly is a less severe variant. Deuteranopia is another form of red-green colour blindness, which causes different colour vision errors at different wavelengths of light. Deuteranomaly is less severe. Tritanopia is the inability to distinguish between blues and greens, and also between yellow and pink. Tritanomaly is a less severe form. What are the symptoms of colour blindness? People affected from colour vision deficiency find it hard to tell the difference between colours. Protanopia, deuteranopia, protanomaly and deuteranomaly principally cause problems distinguishing between reds, yellows and greens, while tritanopia and tritanomaly cause issues telling between blues and greens. How is colour blindness diagnosed? There are two tests that can be done to diagnose colour vision deficiency. The first one is the Ishihara test, where the patient is asked to identify numbers contained within images made up of different coloured dots. This is the most commonly used test by ophthalmologists. If you’re not suffering from colour blindness, you’ll be able to identify the right number. On the contrary, if you’re affected from it, you’ll read a wrong number or you won't see any number at all. The second one is the Farnsworth-Munsell hue test. It is a more detailed test, compared to the Ishihara one, and you’ll be shown a series of coloured discs which you’ll have to arrange by hue. What causes colour blindness? Colour blindness is usually a consequence of the fact that the colour-sensitive cells in the eyes, called cones, are either missing (in the case of protanopia, deuteranopia, tritanopia and achromatopsia) or not working properly (protanomaly, deuteranomaly and tritanomaly). This can be due to genetic factors or it can arise as a complication of other issues (acquired colour vision deficiency), such as: Lens opacity Alcohol abuse Brain injury Other eye conditions How can it be prevented? Inherited colour vision deficiency can’t be prevented. Acquired colour blindness may be preventable by avoiding an excessive alcohol consumption, going for routine checks and avoiding brain injuries. How is colour blindness treated? As of yet, colour vision deficiency has no definitive cure. However, there are special glasses which may help patients to distinguish colours better. Which doctor should I see? You should see an ophthalmologist if you have any difficulties with your colour vision. ...

Congenital glaucoma

Glaucoma in children is a congenital or inherited condition, it usually becomes apparent in the first year of life.

Conjunctivitis

What is conjunctivitis? Conjunctivitis is the inflammation of the conjunctiva, the mucosa that lines the layers of the eyelids, the front face of the eyeball. Its basic function is to protect the surfaces it covers, so when an infection occurs on them, it becomes inflamed. The main types of conjunctivitis, depending on their cause, are: Viral conjunctivitis Bacterial conjunctivitis Allergic conjunctivitis Conjunctivitis generally does not affect vision. Infectious conjunctivitis is easily spread from person to person. Prognosis: It usually affects both eyes at the same time, although it can affect one eye more than the other. It will usually last about 10 days to 4 weeks and is a very common disorder, especially in children, including new-borns. Symptoms of conjunctivitis: The most common symptoms of conjunctivitis are: Redness Burning Itchiness Appearance of yellow or green mucous, especially in the eyelashes. Medical tests for conjunctivitis: To determine if a patient has conjunctivitis, the doctor will examine the eyes for signs of conjunctivitis. Some specific tests that may be performed are: Tear drainage analysis Assessment of visual acuity What causes conjunctivitis? The causes may be: Viral infection: causes viral conjunctivitis, is very contagious, but usually disappears on its own within a few days, without the need for medical treatment. Bacterial infection: causes bacterial conjunctivitis, which can cause serious damage to the eye if left untreated. Allergies: causes allergic conjunctivitis, which is caused by eye irritants such as pollen or dust in susceptible individuals. This type of conjunctivitis can be seasonal (pollen) or appear in outbreaks throughout the year (dust and pet fur). Substances that cause irritation. Products used for contact lenses, eye drops or ointments that have been contaminated. Can conjunctivitis be prevented? Simple preventive measures can be taken on a day-to-day basis to significantly reduce the risk of getting conjunctivitis: Do not share personal hygiene items such as cloths and hand towels. Cover your nose and mouth when coughing and sneezing, and avoid rubbing or touching your eyes. Never share contact lenses. Wash your hands often. Keep surfaces clean, such as kitchen tables, bathroom utensils, taps and shared telephones with an appropriate antiseptic cleaner. If you have seasonal allergies, ask your doctor what you can do to minimise your symptoms before they start. If you wear contact lenses, you should make sure you follow the advice of your optometrist or ophthalmologist for their care and replacement. To go swimming, use swimming goggles to protect your eyes from bacteria or other microorganisms in the water that can cause conjunctivitis. Remove contact lenses to avoid retaining bacteria between your eyes and your lenses before showering, using a hot tub or getting into water of any kind. Treatments for conjunctivitis: Depending on the type of conjunctivitis, the following treatments might be needed: Viral conjunctivitis: In most cases, viral conjunctivitis will run its course within a few days without medical treatment. A home remedy is to apply cold wet wipes to the eyes several times a day to relieve symptoms. It is important not to share wipes, as viral conjunctivitis is highly contagious. Bacterial conjunctivitis: Antibiotic eye drops or ointments will usually be prescribed to treat this type of conjunctivitis. Allergic conjunctivitis: Anti-allergy medications often help prevent or shorten outbreaks of allergic conjunctivitis. Which specialist treats conjunctivitis? Ophthalmologists are in charge of preventing, diagnosing and treating diseases that affect the eyes and the visual capacity of the patient, such as conjunctivitis. ...

Cornea

What is the cornea? The cornea is the protective transparent membrane covering the front part of the eye, namely the pupil and the iris. It is about 0.5 mm thick and it is made of five layers: corneal epithelium, Bowman's layer, corneal stroma, Descemet’s membrane and corneal endothelium. The cornea is kept moist with a thin layer of tears (tear film) right on top of it. What is the cornea for? Besides protecting the inner part of the eye from injuries and pathogens, the cornea reflects light when it passes through towards the inner structures of the eye. What conditions can affect the cornea? Several corneal conditions are linked to genetic factors and to family history. If someone in your family has suffered from a corneal condition, you should go for an eye examination for early detection of any potential eye disorders. The most common injuries and conditions of the cornea are: Keratitis (inflammation of the cornea) Fuchs' corneal endothelial dystrophy (FCED) Corneal dystrophies Corneal ulcer Keratoconus Corneal abrasion (scratched cornea) – this can cause a loss of the surface epithelial layer of the cornea and thus a loss of transparency. Herpes Shingles How can corneal conditions be treated? With early detection it is possible to treat corneal conditions, which will avoid the risk of having to do surgery. If some corneal diseases and dystrophies are not caught early enough, the best option could be a corneal transplant. By substituting the diseased cornea with a new one, the eyes can be restored to normal. Artificial corneas (also known as keratoprosthesis) are also an option for patients whose transplants have not been successful, or who were ineligible for a transplant in the first place. Which doctor should I see? You should see a specialised ophthalmologist. ...

Cornea guttata

What is cornea guttata? The cornea guttata is an ocular condition characterised by the appearance of droplet shaped bulges in this part of the eye. As they affect the corne, which is the main refractive element of the eye that allows clear vision of objects, they can cause vision loss or impaired vision. The cornea guttata is the initial alteration of Fuchs' dystrophy, a corneal disease that presents in several stages. Prognosis of cornea guttata: This is a condition that gets worst with age and, except in very advanced cases, does not require treatment. Symptoms of cornea guttata: The most notorious symptoms of cornea guttata are those derived from the corneal thickening that it entails: Loss of transparency of the cornea Macular oedema (the build-up of fluid in the macular) Pain (in some cases) Vision may be compromised in more severe cases with loss of sharpness in the perception of images, which is a more marked symptom in the morning. Medical tests for cornea guttata: The diagnosis of cornea guttata is clinical, with observation of the cornea. In early stages, an endothelial cell count can be performed. What causes cornea guttata? The main causes of cornea guttata are initially due to genetic inheritance, as it is directly related to structural problems in the lens. However, there may be a situation in which there is no history in the patient's family and the appearance of this condition is due to the modification of the gene in the human genome. Can cornea guttata be prevented? As with many other conditions, the finding of a cornea guttata is usually a chance finding, so there is no way to prevent it. A complete, annual eye exam is recommended though for overall eye health. Treatments for cornea guttata: To alleviate the symptoms, special ointment or eye drops are applied, but in patients where the cornea guttata affects their daily life, a corneal transplant can be performed, a very common and simple procedure. Which specialist treats cornea guttata? Ophthalmologists are responsible for preventing, diagnosing and treating diseases that affect the patient's eyes and visual capacity, such as cornea guttata. ...

Corneal cross-linking

Corneal crosslinking is to treat the cornea with ultraviolet radiation to strengthen it and stop keratoconus deformation. In keratoconus, the cornea weakens and tends to shrink. It is the main way to treat this disease and can prevent the need for corneal transplantation.. The procedure is carried out under topical anaesthesia, riboflavin eye drops are applied to the cornea and a focused beam of ultraviolet rays. The procedure takes about 30 minutes and at the end of surgery, the patient must wear a soft contact lens. The results last from 3 to 10 years and the treatment can be repeated. ...

Corneal transplant

What is a corneal transplant? A corneal transplant, also called keratoplasty, is the total or partial replacement of the cornea, which is the transparent external lens located in the front of the eye, which is responsible for our vision. This is one of the most common transplants, in which the cornea of a recently deceased donor is used, whose eyes have been tested to ensure that they are suitable. Local anaesthetic is applied. Why is it performed? A corneal transplant is performed if you have severe vision problems due to a corneal dysfunction: Opacities in the cornea , the most common pathology treated, which can either be present from birth or acquired. In many cases, the opacity of the cornea is caused by Fuchs’ dystrophy. Thinning of the cornea , usually caused by keratoconus, resulting in vision problems. Scarring of the cornea , due to serious injury or infection. What does a corneal transplant involve? Corneal transplant surgery is a minimally-invasive operation. It requires only a local anaesthetic, so you remain awake throughout. The procedure consists of removing the central part of the cornea and inserting a donor cornea of the same size, using stitches to secure it in place. The ophthalmologist may use a femtosecond laser during the procedure. There are three types of transplant, which depend on the amount of cornea being transplanted: Anterior keratoplasty, when the two anterior layers of the cornea are transplanted Endothelial keratoplasty, when only the inner layer is transplanted Penetrating keratoplasty, when the entire cornea is transplanted. Preparing for a corneal transplant: The main guidelines to follow prior to surgery are: Tell the specialist about any medication you are taking or if you are undergoing any other medical treatment. You may need to reduce blood-thinning drugs before the procedure. You will need to limit your food and drink intake from midnight onwards, prior to the day of surgery. Depending on the case, you may be able to drink some liquids (water, black coffee, tea, etc.) up to two hours before surgery. You must not drink alcohol 24 hours before or after the procedure. You must not apply creams, lotions or make-up around the eyes or to your face on the day of surgery. You will need someone to take you home after the surgery. Post-operative care: You can return home the same day of the surgery. You must wear an eye patch for four days afterwards and the ophthalmologist will prescribe drops to help the eye heal and to prevent transplant rejection and possible infection. The stitches on the cornea will be removed by the ophthalmologist during a follow-up visit. The first healing phase will take about three weeks. During this time, you must not touch your eye, you must protect it during sleep and when showering and you must wear sunglasses during the day. After having this surgery, you will usually need to wear glasses or contact lenses. Alternatives to this treatment: A corneal transplant is a major operation and is only performed when there is no other way to restore the vision. There are some cases in which a corneal transplant is not required, but your cornea may need to be repositioned to cover or minimise the lesion or opaque region that is obstructing your vision. ...

Corneal ulcer

What is a corneal ulcer? A corneal ulcer is an open ulcer that is found in the outer layer of the cornea. If the corneal ulcer is not treated, it can lead to the appearance of scars on the cornea, to a considerable loss of vision or even to the loss of the eye. What are the symptoms of a corneal ulcer? The main symptoms are: blurred or cloudy vision itching and discharge eye that looks red or bloody tearful and very sore eyes photophobia (sensitivity to light) white patch on the cornea What are the causes of a corneal ulcer? The cause is usually an infection by bacteria, a virus, fungus or a parasite. Other causes are severe dry eyes, a severe allergic disease, the eyelids not closing well or foreign bodies in the eye. Can a corneal ulcer be prevented? The recommended measures to prevent a corneal ulcer are: washing one's hands thoroughly before using contact lenses avoiding contact lenses during the night receiving a timely and early treatment for any eye infection What is the treatment for a corneal ulcer? Treatment depends on the cause of the ulcer. Once it is known, drops may be prescribed to treat herpes, bacteria, other viruses or a fungus. If the exact cause is not known, antibiotic drops are usually prescribed since they are effective against many types of bacteria. In cases of severe ulcers, it is sometimes necessary to perform a corneal transplant, which involves replacing the cornea with the tissue of a donor. ...

Dacryocystorhinostomy

Dacryocystorhinostomy is a surgical operation for treating blocked tear ducts. During surgery, a new drain line is created with tissue from the patient. When the nasolacrimal duct no longer functions properly, the flow of tears into the nose is recovered using the lacrimal sac. ...

Dark circles

What is dark circle treatment? Dark circles (technically known as idiopathic cutaneous hyperchromia of the orbital region) refer to the darkest area under the eyes. They can be hereditary, caused by hyperpigmentation, shadows, allergies, asthma or eczema or be due to medication, fatigue, sadness, hormonal changes, age or nutritional deficiency. Dark circle treatment is a highly effective and satisfactory technique to enhance this area of the face by correcting the bags under the eyes, which are sunken and defined dark circles that can give the face a dull and fatigued appearance. Due to the delicate nature of the skin in this area, it is a complex though not painful treatment, although a local or topical anaesthetic can be applied to minimise any discomfort. Why is it performed? Dark circle treatment is suitable for men and women of all ages who wish to get rid of dark circles. What does it involve? Depending on the cause of their appearance, different techniques can be used to treat dark circles: Hereditary dark circles: you can try to eliminate them using cosmetics (which don’t contain any exfoliating acid), but if this proves unsuccessful, then injections of hyaluronic acid can be tried. Depending on the person and the amount of product injected, the result will last for a greater or lesser amount of time, and a perfecting session can be performed once a year. Dark circles due to hyperpigmentation: you can use depigmenting products to lighten the area. Dark circles due to tiredness: you can use cosmetic creams that stimulate oxygenation of the area, which prevents blood coagulation and fluid retention. You will also need to adopt some good habits: have 8 hours sleep, remove your makeup well and cut down on alcohol, tobacco and caffeine. How to prepare for it No special prior preparation is necessary. Post-treatment care There are no specific indications. ...

Diplopia (double vision)

Diplopia, or double vision, is a condition of the eyes that causes you to see two of everything.

Dry eyes

What is dry eye syndrome? Dry eye syndrome, also known as keratoconjunctivitis sicca, is a common condition that happens when the eye doesn’t make enough tears and isn’t lubricated enough, normally due to meibomian gland dysfunction (located in the eyelids and responsible for lubricating the eyes). This affects the ocular surface: the tear film, eyelids, conjunctiva, and cornea. This condition mainly affects women and the risk of getting it increases with age. Disease prognosis Dry eye syndrome does not tend to be a serious condition; people affected tend to have some discomfort but don’t normally have vision loss. By following the specialists’ advice, it normally disappears within a few days. What are the symptoms? The main symptoms of dry eye syndrome are tired eyes, light sensitivity, blurred vision, gritty sensation, burning, or redness. These symptoms are normally worse in environments with wind, smoke, air conditioning, dust, or low humidity. Another symptom could be an intolerance to contact lenses. Tests for dry eye syndrome Tests for dry eye syndrome include visual acuity measurement, slit lamp examination, measurement of the rate of tear production, tear concentration, and tear film rupture time. What causes it? It is normally caused by hormonal changes that make the eyes produce less tears, such as the menopause or ageing. Other causes include sun exposure, some antianxiety medications, contraceptives, a dry environment (for example air conditioning or wind), smoking, heat, or past surgery, among others. Other possible causes include allergies, rheumatic diseases, and the use of electronic devices. How can it be prevented? To avoid dry eye syndrome, it is recommended that low humidity places are avoided and some predisposing drugs. It is always important to see a dry eye specialist to have a correct diagnosis and, if necessary, treatment. ...

Exophthalmos (bulging eyes)

What is exophthalmos (bulging eyes)? Exophthalmos is the term used to describe bulging eyes – eyes that protrude out of their normal position. It is also known as proptosis. Very often this can be a sign of a potentially serious underlying medical condition, such as hyperthyroidism. Generally, protruding eyes are considered bulging if the whites of the eyes are visible between the iris (the coloured part of the eye) and the upper eye lid. Sudden bulging should be treated as an emergency. Prognosis of exophthalmos: If bulging occurs suddenly, there is a small risk that the optic nerve is compressed by the pressure caused by exophthalmos, and therefore without rapid treatment your sight may be affected. However, if a symptoms of thyroid disease, exophthalmos can subside with time and treatment. Sometimes corrective surgery will be needed to stop the eyes from bulging permanently. In some cases of exophthalmos, patients are left with long-term sight problems, such as double vision, but permanent problems are rare. Symptoms of exophthalmos: Exophthalmos is the bulging outwards of the eyes. If it is a symptom of an underlying condition, you may have other symptoms of this condition. Medical tests to diagnose exophthalmos: If your eyes begin to bulge, either both or just one, see a doctor. Your doctor will want a full medical history and will conduct a physical exam. Further tests will be carried out to determine the underlying cause of the exophthalmos, including a vision test, a CT scan or MRI and blood tests. What are the causes of exophthalmos? The most common cause of exophthalmos is hyperthyroidism (an overactive thyroid gland). This gland is found in the neck and is responsible for releasing hormones that help to control the metabolism. Hence, with hyperthyroidism too much of these hormones are released. Another common cause of bulging eyes is Grave’s disease, which is an autoimmune disorder that causes hyperthyroidism. Other causes of exophthalmos include: Certain cancers (leukaemia, neuroblastoma, lymphoma) Haemangioma (an abnormal collection of blood vessels) Injury to the eyes Infections to the eye Sarcoidosis Treatments for exophthalmos: Treatment will depend on the underlying cause of your exophthalmos, but can include eye drops, antibiotics or surgery. If hyperthyroidism or Grave’s disease is diagnosed, then you will be treated for these conditions, either with medications, surgery or hormone therapy. If the underlying cause is cancer, then surgery, radiotherapy or chemotherapy will be recommended, however, you will be referred to a cancer specialist at this stage. Surgery may involve the following: Eyelid surgery – to improve the closure and appearance of the eyelids. Eye muscle surgery – aligns the eyes and reduces any double vision. Orbital decompression surgery – small sections of bone are removed from the eye socket. Which type of specialist treats exophthalmos? Depending on the underlying cause, different specialists will treat exophthalmos. However, it will likely be treated by a multi-disciplinary team including ophthalmologists, surgeons, endocrinologists and oncologists. ...

Eye cancer

What is eye cancer? Eye cancer encompass all forms of cancer that affect theeyelids, eyes and eye orbit. These tumours can be benign or malignant. In most cases they are benign, but tumours can grow larger over time and cause eye problems due to the compression of other structures in the area. The main intraocular tumours include: Ocular melanoma Retinoblastoma , occurs in childhood Choroidal haemangioma Orbital tumours Prognosis: Each type form of eye cancer has a different prognosis: Intraocular tumours , including melanoma, may occur in several tissues. However, the most common primary malignant intraocular tumours in adults are those that occur in the choroidal location (choroidal melanoma). Retinoblastoma is an aggressive cancer, so early diagnosis and treatment is essential. Choroidal haemangioma, on the other hand, is benign but spreads rapidly and can alter vision, as its growth threatens the optic nerve. Orbital tumours are the least common and have no specific causes. Symptoms of eye cancer: Most eye tumours are usually asymptomatic and may initially go unnoticed. Eyelid tumours, however, manifest as lumps or lesions that cause ocular discomfort; while orbital tumours manifest as ocular pain or alterations, decreased vision or displacement of the ocular globe (proptosis or exophthalmos). One of the most characteristic symptoms of an orbital tumour is exophthalmos, i.e. bulging eyes. Eye movement can also be affected and may result in double vision. Tumours that affect the optic nerve may alter vision more quickly. Pain is a less frequent and a more typical symptom of inflammation and/or orbital infections. Changes may occur in the eyelids, such as swelling of the eyelid (oedema) or redness of the eyelid (erythema), which are typical of infectious and/or inflammatory processes and some tumours. The eyelid may also be more retracted, as in the case of thyroid ophthalmopathy, or more drooping (palpebral ptosis). Medical tests for eye cancer: An ophthalmologic examination using an ophthalmoscope may reveal a simple oval or round lump (tumour) in the eye. Tests that may be performed include: CT scan or MRI scan of the brain, to check for spread of the disease (metastasis) to the brain Ultrasound of the eye Skin biopsy, if an area of skin is affected. What causes eye cancer? Some tumours are congenital, such as 50% of retinoblastomas, and are passed from generation to generation, affecting 1 in 15,000 newborns. Others, such as intraocular melanomas, have no specific risk factors. Some may be associated with a syndrome or may be secondary tumours due to spreading from adjacent areas or the result of metastasis. Can eye cancer be prevented? Intraocular tumours cannot be prevented, but they can be diagnosed early. You should therefore have a routine annual examination of the eyes from the age of 50, when they are most likely to appear. In addition, since malignant lesions can recur over time, regular monitoring is important following treatment. Treatments for eye cancer: Treatment depends on the type of tumour and its location within the orbit. Benign tumours are usually monitored with regular check-ups and routine imaging tests, unless they cause vision loss or other problems involving the eyeball, in which case treatment would entail surgical removal of the tumours. Malignant tumours will usually be removed completely. Surgery for these tumours is delicate and is performed by making small incisions in the skin of the eyelid (in the natural folds of the eyelid) or through the conjunctiva. Only very rarely does treatment involve the loss of the eyeball and all the structures of the orbit (orbital exenteration). In other cases, treatment is systemic, based on with radiotherapy and/or chemotherapy. Each case must be assessed on an individual basis in order to make the most appropriate decision. Which specialist treats eye cancer? All eye tumours require early and thorough evaluation by an ophthalmologist. ...

Eye examination

What is an eye examination? An eye examination is a series of tests which are usually conducted by an ophthalmologist (eye doctor), or other professionals such as optometrists. There are different types of eye examination to assess different parts of people's vision, and it is recommended that all people should have periodic eye examinations to check eye health and detect any potential abnormality or disease. What should I expect during an eye examination? If you go in for an eye exam, you can usually expect these basic steps: Giving a medical history and describing any problems in vision, if applicable Having your visual acuity (sharpness, acuteness) measured to check if glasses or contact lenses may be needed Having your eye pressure measured Getting your eye health checked, using lights shone in particular places on the eye to examine both the front and the inside Other tests may be performed during the examination, such as the reading of an eye chart, a cover test to check the alignment of the eyes, or an examination of the retina. Your ophthalmologist will advise the tests they wish to perform, and explain the steps as they perform them. After the examination they will explain what they have found, and answer any questions you may have. How can I prepare for an eye examination? If you wear contact lenses or glasses, make sure to take them with you when you go to the appointment, so the doctor can check if your prescription is accurate. Depending on the type of test performed, you may wish to arrange for someone to take you home afterwards, as certain tests can cause a little discomfort or blur vision. Other tests dilate the eyes, so you may want to have sunglasses at the ready, as bright lights can be uncomfortable after this type of exam. Why is an eye examination performed? Eye examinations should be performed regularly as part of routine health checks. This means the doctor or professional can see differences in your eyesight, check for any abnormalities, and correct any vision problems. A healthy adult with no vision problems should expect to have eye tests every 5-10 years whilst in their 20s and 30s, every 2-4 years from age 40-54, every 1-3 years from age 55-64, and evey 1-2 years after the age of 65. If you already wear glasses or contact lenses, this means you should have your eyes tested more frequently. You also may need more frequent eye tests if there is a history of eye disease in your family, or if you suffer from a chronic illness or disease which puts you at greater risk of developing some kind of eye disease (such as diabetes). ...

Eye floaters

What are floaters? Eye floaters, medically known as myodesopsia, are floaters that move across your field of vision. They may have different shapes: lines, shadows, dots, and cobwebs among others. It is one of the main reasons that people visit an ophthalmologist. Floaters are condensations of the vitreous, which is the gel-like substance in the back of the eye that casts shadows on the retina as light passes through. In floaters, these condensations appear due to dehydration of the vitreous. Most floaters are harmless and are a normal part of the ageing process of the vitreous. You should see a specialist if the floaters are appearing more frequently, suddenly, or you are seeing flashes of light. What are the symptoms? Floaters appear in the visual field as stains, dots, or cobwebs. They tend to move around as you move your eyes around and they seem to disappear or be difficult to see when you try to look at them directly. They tend to be seen better when looking at a bright and well-lit surface. Causes of floaters The exact cause for eye floaters is unknown, but it is known to be related to the ageing process as well as myopia, nearsightedness. Posterior vitreous detachment (PVD) can also cause floaters, and they can also appear after cataract or capsulotomy surgery. They can also appear due to other, more serious eye conditions. How can they be prevented? It is recommended to have your vision tested regularly, especially after the age of 40, to be able to check for floaters that may pose a risk to your vision. What is the treatment? There currently isn’t a treatment to completely get rid of eye floaters, patients have to get used to them. There are however medications that can delay the onset of floaters as well as two other treatments: Vitreolysis: uses laser which vaporises vitreous opacities that makes them less visible or moves them away from your visual field. Vitrectomy: surgery to remove some or all of the vitreous humour from the eye and replace it with a saline solution. This procedure is performed as a last resort as it is a high risk operation. ...

Eyelid malpositions

Eyelid malpositions can occur for various reasons and are relatively frequent. Along with being considered unsightly, they can lead to vision and eye problems that could become serious. ...

Facial paralysis

What is facial paralysis? Facial paralysis is a condition that causes partial or total motor paralysis of the facial nerve and, therefore, of the facial musculature. What are the symptoms of facial paralysis? The symptoms of facial paralysis include being unable to perform certain movements such as smiling, opening and closing the eye completely or raising the eyebrow. What causes facial paralysis? Facial paralysis can be caused by various factors, including tumours, trauma, acute and chronic ear infections and congenital disorders (Moebius syndrome). However, its causes are mostly unknown, and in this case it is known as Bell's palsy or peripheral facial paralysis. How is facial paralysis treated? Normally steroids are given to slow down the progressive deterioration of the nerve and massages are performed on the facial muscles. In the more severe cases, specific surgical treatments are also performed, using both static and dynamic techniques to restore the movement and functionality of the muscles. Treatment for Bell's palsy, or peripheral facial paralysis, should be started immediately after onset for a faster and more effective recovery. Are there any complications during recovery? Recovery from facial paralysis is sometimes incomplete because the nerve is damaged and unable to function normally. Complications may occur, such as hemifacial spasm (where some of the muscles are permanently contracted) or synkinesis (when an involuntary movement occurs during a voluntary movement). Fortunately, both complications can be improved through appropriate rehabilitative treatment such as neuromuscular facial retraining exercises or, in some cases, infiltration with botulinum toxin. ...

Fuchs' dystrophy

What is Fuchs' dystrophy? Fuchs' dystrophy is characterised by a reduction in the number of cells that form the inner layer of the cornea, called endothelial cells. Its function is to maintain a correct transparency in the cornea and to process the water that forms the structure of the cornea. Therefore, when these are reduced, the water is not processed properly and, as liquid accumulates, the corneal tissue thickens and causes it to lose its transparency. Fuchs' dystrophy usually develops in two stages: First stage: Dystrophy may produce no symptoms, or only mild symptoms. Cornea guttata is the initial alteration of Fuchs' dystrophy. Second stage: Once the disease has progressed, patients may experience pain and sensitivity to light, and the scars gradually form in the centre of the cornea. Prognosis: Fuchs' dystrophy gets worse over time. If a corneal transplant is not done, a person with severe Fuchs' dystrophy may become blind or suffer severe pain and very low vision. Symptoms of Fuchs' dystrophy: The typical symptoms are: Eye pain Sensitivity to light and glare Blurred or cloudy vision, initially only in the morning Seeing coloured halos around lights Other problems may occur, such as scarring of the cornea. Medical tests for Fuchs' dystrophy: Fuchs' dystrophy can be diagnosed during a slit-lamp examination. But it can also be diagnosed using: Corneal pachymetry : measures the thickness of the cornea Specular microscopic examination : looking at the thin layer of cells covering the back of the cornea Visual acuity test What causes Fuchs' dystrophy? The causes of Fuchs' dystrophy may be: Hereditary : Can be passed down through families. However, the condition may also occur in people with no known family history of the disease. Gender : It is more common in women than in men. Age : Vision problems do not appear before the age of 50 in most cases. However, a health care specialist may be able to see signs of the disease in people between the ages of 30 and 40. This is why annual eye checks are important in maintaining overall eye health. Can Fuchs' dystrophy be prevented? So far, no form of prevention is known. Corneal transplantation can be delayed by avoiding cataract surgery or by taking special care during cataract surgery. Treatments for Fuchs' dystrophy: If scarring develops in the cornea, a corneal transplant is necessary, through which the affected cornea is replaced by a healthy endothelium from a donor. Which specialist treats Fuchs' dystrophy? Ophthalmologists are responsible for preventing, diagnosing and treating diseases that affect the patient's eyes and visual capacity, such as Fuchs' dystrophy. ...

Glaucoma

What is glaucoma? Glaucoma is an eye disease that causes the progressive loss of nerve fibres in the optic nerve, whose proper functioning is essential for clear vision. Primary open-angle glaucoma or simple chronic glaucoma: this is the most common type of glaucoma, affecting approximately 80% of patients with this disease. Angle-closure glaucoma or narrow-angle glaucoma Normal, low-voltage, or normotensive stress glaucoma Congenital glaucoma : occurs in new-borns or young children where the drainage system of the eye has developed incorrectly or incompletely during the prenatal period. Secondary glaucoma : it appears associated with other visual problems (tumours, cataracts, inflammations, etc.) or is caused by an external agent (use of certain drugs). Prognosis: Depending on the type of glaucoma, you will have one prognosis or another: Open-angle glaucoma cannot be cured, although it can be treated as directed by a specialist. Angle-closure glaucoma is understood to be a medical emergency, so immediate treatment can save the patient's vision. Babies with congenital glaucoma usually recover well when the surgery is done early. The outlook for secondary glaucoma depends on what is causing the condition. Glaucoma symptoms Depending on the type of glaucoma you have, you will feel some symptoms or other: Open-angle glaucoma: Most people have no symptoms Once vision loss is noted, the damage is already severe There is a slow loss of side (peripheral) vision (also called tunnel vision) Angle-closure glaucoma: Symptoms may come and go at first or get worse all the time. You can feel: Sudden, severe pain in one eye Blurred or decreased vision, called "blurred vision Nausea and vomiting Rainbow-like halos around lights Redness of the eyes Sensation of swelling in the eye Congenital glaucoma: Symptoms are almost always noticed within a few months of age in children: Opacity in the front of the eye Enlargement of one or both eyes Redness of the eyes Sensitivity to light Tearing Medical tests for glaucoma The only way to diagnose glaucoma is to have a complete eye exam. Tonometry : Test to check eye pressure Gonioscopy : An exam in which a special lens is used to look at the angle of the eye. Laser-scanned pictures or images of the inner part of the eye (optic nerve images) Laser-scanned images of the angle of the eye Examination of the retina Pupillary reflex response test , i.e., how the pupil responds to light Three-dimensional view of the eye : slit-lamp examination Evaluation of visual acuity , i.e., clarity of vision Visual field evaluation : visual field measurement What causes glaucoma? Among its causes, which are many, vascular diseases and high blood pressure are the most important. Open-angle glaucoma: the cause is unknown. This type of glaucoma tends to run in families. People of African descent are also at higher risk for this disease. Angle-closure glaucoma: Eye drops to dilate the eyes as well as certain medications can trigger an acute glaucoma attack. If you have had acute glaucoma in one eye, you are at risk for it in the second eye. Your health care provider will probably treat your second eye to prevent a first attack in that eye. Secondary glaucoma occurs due to a known cause. Both open-angle and closed-angle glaucoma can be secondary when caused by something known. Causes include: Drugs such as corticosteroids Eye diseases such as uveitis (an infection of the middle layer of the eye) Diseases such as diabetes Eye injury Congenital glaucoma occurs in new-borns from an inherited cause Can glaucoma be prevented? As this is a generative condition, it is important to make an early diagnosis. In this sense, specialists advise eye exams from the age of 40, although the age of greatest risk for glaucoma is established from the age of 60. In addition, a complete eye exam can help detect open-angle glaucoma early, when it is easiest to treat. Regular eye exams are also recommended as directed by your doctor. Treatments for glaucoma Although the vision that is diminished by this disease cannot be restored, glaucoma progression can be prevented by lowering intraocular pressure. This can be done, depending on the patient and medical recommendations, with the administration of drugs, with laser techniques or with non-invasive surgery. Treatment depends on the type of glaucoma the patient has: Open-angle glaucoma: Eye drops Pills to decrease pressure in the eye Laser therapy: A painless laser is used to open the channels through which the fluid exits. This treatment is applied when the drops have not worked. If the drops and laser treatment do not work, you may need surgery. Angle-closure glaucoma : You may be given drops, pills, and medicines through a vein (intravenously) to lower your eye pressure. Some people also need an emergency operation, called an iridotomy. The doctor uses a laser to open a new channel in the iris. Sometimes this is done with surgery. The new channel relieves the attack and will prevent another attack. Congenital glaucoma : By surgery: performed under general anaesthesia Which specialist treats glaucoma? Ophthalmologists are responsible for preventing, diagnosing and treating diseases that affect the eyes and the visual capacity of the patient, such as glaucoma. The eyes are the essential organ of vision and are susceptible to many abnormalities throughout life. Ophthalmology is responsible for preserving the patient's visual capacity, through medical treatment techniques, surgery or with the help of external elements such as glasses or contact lenses. ...

Glaucoma surgery

Glaucoma is one of the most common eye conditions, and surgical techniques are often used to correct the issue. The operation is usually done on an outpatient basis, with a local or general anaesthetic. Surgery is one of the treatment options for glaucoma. Other options are topical eye drops or laser treatment. ...

Glaucoma surgery - MIGS

What is MIGS? MIGS or minimally invasive glaucoma surgery is the latest advance in surgical treatment for glaucoma. This type of surgery has been implemented for cases where medication has not proven to be effective enough in reducing intraocular pressure and in slowing the progression of this condition. Your doctor will determine which technique would work best for reducing the production of aqueous humour (fluid), which causes an increase in intraocular pressure, based on your needs and on the condition’s progression. What is MIGS for? MIGS or minimally invasive glaucoma surgery refers to a group of surgical procedures which constitute the latest advance in surgical treatment for glaucoma. In this condition, the aqueous humour of the eye doesn’t flow normally: it thus builds up and increases intraocular pressure, which ends up damaging the optic nerve and causing sight loss. New techniques have been developed to drain the excess aqueous humour and to decrease intraocular pressure. One of the main benefits of this procedure is that if you have glaucoma eye drops will not be needed several times every day. Another benefit is that this technique slows down the progression of this disease. How does MIGS work? Minimally invasive glaucoma surgery is done with much smaller equipment (compared with traditional surgery) which makes microscopic incisions into the eye, producing the same beneficial results with less trauma to the eye. There are several types of MIGS: Microtrabulectomy – microscopic ducts are used to drain the excess fluid to the outer membrane of the eye (conjunctiva). Trabulectomy – done to eliminate or bypass the trabecular meshwork (the tissue responsible for draining the aqueous humour), making a small incision to drain the excess liquid within the eye. Internal or suprachoroidal micro-stents – microscopic stents with an open end, connection the anterior of the eye to the suprachoroidal area, making the fluid flow much better Advanced laser surgery – by using endocyclophotocoagulation and micropulse cyclophotocoagulation laser, it is possible to prevent the formation of aqueous humour, widening the area between the iris and the cornea. How can I prepare for it? Before the procedure, you may need to use specific eye drops prescribed by the specialist. Your intraocular pressure will also have to be monitored in the days before the surgery. Post-operative progress New glaucoma surgery techniques not only cut down surgery time to 15 minutes; they also make recovery much quicker and prevent the disease from progressing. For the first 60 days, you’ll have to go for a follow-up visit once a week. There are very few to no complications; however, the micro incisions made on the eye can occasionally become infected because of the presence of bacteria. Should your eye become irritated or red, talk to a specialist as soon as possible. ...

Hyperopia (farsightedness)

What is hyperopia? Hyperopia (also known as hypermetropia, farsightedness or long-sightedness) is a very common eye condition in which distant objects will appear clearly, but objects closer up can appear blurry. If you suffer from hyperopia, your eyes are better at focusing on distant objects than nearby ones. Hyperopia generally affects adults over the age of 40, however, it can affect people of all ages and children too. Hyperopia can be corrected with glasses or contact lenses. Symptoms of hyperopia: The symptoms that you might experience if you have hyperopia include: Nearby objects can appear blurry or fuzzy You might have to squint to see clearly Your eyes may feel tired or strained when focusing on nearby objects, such as reading or writing. You may have headaches Children who have hyperopia may not have obvious symptoms at first, but if left untreated can develop other conditions such as a squint, crossed-eyes or a lazy eye. Medical tests to diagnose hyperopia: If you think you may be suffering from hyperopia, you will need to have an eye test, which can be booked at any local opticians. An eye test will confirm whether or not you are long-sighted and what prescription you will need for glasses or contact lenses. You should have an eye test every two years to ensure your prescription is kept up-to-date. If you think your prescription has changed, book an eye test to confirm this. What are the causes of hyperopia? Hyperopia will occur when your eyes do not focus light on the retina correctly. The retina is the layer at the back of the eye. This may result from your eyeball being too short, the lens being unable to focus or having a flatter cornea. The cornea is the transparent layer at the front of the eye. Treatments for hyperopia: Children and younger adults do not always require glasses to fix their hyperopia because their eyes are able to adjust and adapt. However, adults will require glasses or contact lenses to adjust their vision. Adults who are interested in being independent from glasses can consider laser eye surgery to correct their vision. Which type of specialist treats hyperopia? Ophthalmologists will treat and diagnose hyperopia. ...

Intravitreal injection

What is an intravitreal injection? An intravitreal injection is a drug administration method used for treating eye disorders, such as macular degeneration. Treatment consists of using anti-VEGF drugs, which prevent the formation of new blood vessels, or immunosuppressive agents and anti-inflammatory drugs. What are intravitreal injections for? Intravitreal injections can stop the progression of a number of visual disorders and allows for a much quicker post-operative healing process. Conditions treated with intravitreal injections include: Diabetic retinopathy Macular oedema Exudative age-related macular degeneration Uveitis Retinal vein occlusion What does an intravitreal injection involve? An intravitreal injection is done under local anaesthetic, administered via eye drops, in a sterile operating theatre. A special instrument, the blepharostat, keeps the eyelids still and prevents the eyelids from closing. The doctor will instruct the patient to look away from the site of the injection. The procedure is extremely quick: it lasts only a few minutes and the patient will only feel a slight discomfort. Medicine is injected into the vitreous humour – the clear gel that fills the eye between the lens and the retina (the back of the eye). The injection administers the drug locally, fighting the eye disorder more effectively. Potential risks arising from this procedure include retinal damage, vision loss, inflammation within the eye, floaters, bleeding, and infections. How can I prepare for an intravitreal injection? Before getting started on intravitreal treatment, you should tell your doctor about any risk factors, for instance, if you’re suffering from any cardiac or vascular condition or if you’re allergic to any medication. Post-operative process After the procedure, you can go back to your daily routine fairly quickly. The doctor will likely recommend the use of eye drops to facilitate the healing process. The patient will need to go for a check-up two or three days and then a month after the injection, to evaluate how effective the treatment is and how is their eyesight progressing. ...

Keratitis

What is it? Keratitis is a condition in which the eye's cornea becomes inflamed, mostly due to an ongoing infection. However, surgical trauma or any foreign object entering the eyes can also cause inflammation. This condition can affect anyone, but people with weakened immune function (caused by diseases such as HIV) and people who wear contact lenses have a higher risk of developing keratitis. What are the symptoms of keratitis? The symptoms of keratitis are usually clear. These usually include: moderate to severe pain in the eye area photophobia (light sensitivity) hyperaemia (red eyes) excessive tearing vision abnormalities (blurred vision) a sensation that there is something in your eye What causes it? Any tear or superficial trauma of the cornea can lead to keratitis. Factors which increase the risk of developing keratitis include: wearing contact lenses (with poor hygiene or incorrect care of the contact lenses solution) a decrease in quality and quantity of tearing immune conditions some medications (such as corticosteroids) chemotherapy How is it treated? Treatment for keratitis will depend on the cause of the infection to the cornea. The inflammation may be of bacterial, fungal, protozoal, viral or ulcerative nature. Usually, you start by using some eye drops, medications or injection therapy. Any foreign object found in the eye will also be removed. More specifically, the main treatments according to the nature of the infection are: Bacterial keratitis: Often due to poor hygiene and improper contact lenses care, although it can arise following an abrasion to the cornea and after using make-up contaminated by bacteria. You may need to take antibacterial drugs or, in the most severe cases, oral antibiotics. Viral keratitis: There are two types of viral keratitis: dendritic or adenovirus keratitis. Dendritic keratitis can lead to a chronic inflammation of the cornea and, in the most severe cases, it can cause glaucoma or even blindness. Adenovirus keratitis is usually less severe and it can lead to the formation of corneal opacities. Both types of viral keratitis are treated with eye drops and antiviral medications. However, viral keratitis may become a recurrent condition. Fungal keratitis: A very rare and dangerous condition which requires immediate treatment, as it can cause permanent sight loss if it reaches an advanced stage. Immunosuppressed individuals have a higher risk of developing fungal keratitis. It can be treated with eye drops and oral antifungal drugs; Acanthamoeba keratitis: This type of keratitis is caused by a parasite and it is very hard to treat. In the most severe cases, a corneal transplant may be required. Which doctor should I talk to? You should see an ophthalmologist in order to treat keratitis. ...

Keratoconus

What is keratoconus? Keratoconus is an eye disorder in which the corneal tissue thins and deforms. The cornea is unable to support the internal eye pressure and it bulges out in a cone shape, hence the name, kerato, which means cornea, and conus, which means cone shaped. It is a degenerative condition of the cornea that appears progressively in one or both eyes. Disease prognosis Although keratoconus is a degenerative disease, it can be corrected with glasses, with contact lenses, and different surgical procedures. A patient with keratoconus should have regular corneal topographies to detect changes in the cornea. What are the symptoms? Keratoconus usually affects young people in the form of myopia and astigmatism as well as blurred vision. It may also cause eye irritation and increased photophobia (light sensitivity). A specialist will confirm the disease when and if they detect corneal thinning in the central or paracentral part of the cornea. Tests for keratoconus A corneal topography is done to detect mild forms of the disease, it involves capturing an image of the cornea and creating a topographic map of the eye surface. In cases where the keratoconus is more advanced, a slit lamp exam is done, a keratometer (also known as an ophthalmometer) may also be used, which is a device that is used to measure corneal curvature by focusing a circle of light on it and measuring its reflection. What causes it? The exact cause for keratoconus developing is unknown, but it is believed that many cases are due to genetic factors. This disorder is also linked to collagen related diseases, skin conditions, systemic diseases (such as Down’s syndrome), and eye injuries caused by excessive rubbing or by long term use of hard contact lenses. How can it be prevented? To prevent keratoconus, it is recommended that you have your eyes checked at least once a year. There are also some actions that are best avoided, such as continuously rubbing your eyes. Early detection is crucial to be able to treat the symptoms and prevent corneal degeneration. What is the treatment? There isn’t a cure for keratoconus but there are different treatments available that can slow down its progression, which will depend on how advanced the disease is: Glasses or contact lenses Semi-rigid lenses Crosslinking (CXL): is a minimally invasive procedure in which vitamin A and ultraviolet light are used on the cornea to strengthen bonds and structures of inner collagen fibres. The procedure is performed in an hour on an outpatient basis. Ring implants or intracorneal ring segments; implants designed to make the central cornea more homogenous. Corneal transplant; although this is only necessary in 10-20% of cases and it involves replacing damaged cornea with a healthy one from a donor. What specialist should I see? Keratoconus should be managed by an ophthalmologist. ...

Keratoprostheses (artificial cornea)

This is a surgical treatment where an artificial cornea is inserted to replace a damaged or diseased one.It is usually undertaken if a donor cannot be found or has not been successful., ...

Lens Replacement

Intraocular lenses are transparent artificial lenses used to replace the natural lenses of the eyes when they are damaged. The eye lens is responsible for receiving light rays which carry images, so when the lens is damaged, vision is impaired. Replacing it with an intraocular lens restores normal vision. Normally, intraocular lenses are made from flexible and pliable material and are the same size as the natural lens. The intraocular lens is generally implanted in the eye during cataract surgery. ...

Low vision

What is low vision? Low vision is suffered by people who have difficulties in their daily lives because of alterations in vision that can be limiting. They usually have a visual acuity of 0.3 or less or a loss of visual field of less than 20 degrees. Hence, low vision is when you have lost a certain amount of your vision, making daily tasks difficult. Low vision may be characterised by a loss of visual acuity or visual field, loss of contrast sensitivity, abnormalities in colour vision and night vision and increased sensitivity to light. It is a problem whose incidence has grown a lot in recent decades especially with the increase in life expectancy. Prognosis: After being diagnosed with low vision, a good quality of life can be achieved with treatments that aim to improve vision. Low vision symptoms: The main symptoms of low vision are: Blurred vision Reading with difficulty Inability to write Difficulty watching TV or reading signs from afar Problems in driving Difficulty for recognising faces Low vision medical tests To diagnose low vision, different tests are performed to determine the following: Visual acuity at a distance and up close Refractive error Contrast sensitivity Reading speed Visual fields Colour vision Sensitivity to glare What causes low vision? Low vision can be caused by a number of factors, including the following: Diabetes Glaucoma Congenital defects Diabetic retinopathy Cataracts Macular degeneration Inherited diseases Ageing Can low vision be prevented? There is no specific prevention for low vision, but it is possible to take care of your eyes, by wearing sunglasses and by having regular eye appointments. Treatments for low vision: Low vision cannot be corrected with glasses, contact lenses or surgery. The aim is to improve the vision that has been diminished, by learning new ways of reading and writing and performing different tasks. Which specialist treats you? The specialist who treats low vision is an ophthalmologist. ...

Macular degeneration (AMD)

What is macular degeneration? The macula is the part of the eye that provides us with clear vision. As we grow, its function loses its abilities, causing macular degeneration, also known as AMD. It is a fairly common ailment from the age of 60 onwards and can occur at various levels, sometimes it is imperceptible. On the contrary, it can also be developed in a much more virulent way, causing a total and progressive loss of sight. There are two types of AMD; wet macular degeneration and dry macular degeneration. Wet macular degeneration: New blood vessels grow under the retina, causing bleeding and fluid leakage. New vessels form neovascular membranes. The evolution of this AMD is fast and can damage the central vision in a very important way. Wet macular degeneration can be hidden or classic. Dry macular degeneration: This type of AMD evolves slowly over time (years). It occurs when spots begin to accumulate in and around the macula. It is a much more common type of AMD. More than 85 percent of all people with intermediate or advanced macular degeneration have the dry form. Prognosis: Early diagnosis is key to starting a treatment as soon as possible. If it is not treated quickly, the prognosis can be poor. Symptoms of macular degeneration: Macular degeneration does not cause pain, but may present a number of visual symptoms that the patient should recognise: Straight lines that may appear wavy or broken Distance and height estimation alteration Increased sensitivity to light Needing more light to read Blurred vision When the disease is in a more advanced stage, a black spot can be seen in the central area of vision, which gets darker as the condition progresses. Medical tests for macular degeneration: A complete diagnosis is usually made with: Visual acuity test Ophthalmologic examination , paying special attention to the condition of the macula Optical coherence tomography : It is a scan of the macula, which aims to show the presence or absence of a neovascular membrane. What causes macular degeneration? Macular degeneration is related to ageing. Although age-related macular degeneration can occur in middle-aged people, studies indicate that people over the age of 60 are at a higher risk. Other risk factors include: Smoking Obesity Family history: People with directly related family members who have age-related macular degeneration are at increased risk of developing this disease. Gender: More women develop AMD than men. Can macular degeneration be prevented? Whilst it cannot be prevented, once it is diagnosed, it is important to regularly and closely monitor these patients so that its progress can be observed and treatment applied. Treatments for macular degeneration: Although there is no definitive treatment to repair the effects of age-related macular degeneration, early diagnosis is important to slow its progression. It has also been shown that consumption of antioxidant vitamins and zinc may contribute to the reduction of advanced macular degeneration (dry macular degeneration) and associated vision loss. The treatments available for wet macular degeneration are: Laser surgery: Laser thermal photocoagulation surgery is the only proven surgical treatment option available for people with wet macular degeneration. Injections into the eye with new medications, such as vascular endothelial growth factor antagonist therapy (VEGF) . Which specialist treats macular degeneration? Ophthalmologists are responsible for preventing, diagnosing and treating diseases that affect the patient's eyes and visual capacity, such as macular degeneration. ...

Macular oedema

What is macular oedema? Macular oedema is an eye disease that causes fluid to build up in the macula, the part of the eye that provides clear, sharp vision. As this is a very sensitive and important area of the eye, when this accumulation of fluid occurs, vision is lost and objects are observed in a distorted way. It may also affect only certain parts of the eye or the entire macular. It is a pathology associated with diabetic patients, as it is one of the main visual problems they suffer from. Prognosis: The prognosis is very variable in each situation, and in all cases it is advisable to consult an ophthalmologist specialising in retinas to make an accurate diagnosis and the most convenient treatment. Symptoms of macular oedema: The symptoms of macular oedema affect central vision, causing: Blurred vision Distortion of the lines If it is not treated properly, the patient may have very limited central vision. Medical tests for macular oedema: The most common method of diagnosing whether or not a patient has macular oedema is a stereoscopic clinical examination with a biomicroscope or slit lamp. Sometimes, however, it is necessary to use additional imaging tests: Optical coherence tomography Fluorescein angiography What causes macular oedema? There are many causes that can lead to macular oedema, but it is often associated with diabetes. Also, eye surgery may increase the risk of developing macular oedema due to irritation of the blood vessels that may allow fluid to leak out. A macular oedema that develops after cataract surgery is called cystic macular oedema (CME). Other causes of macular oedema include: Age-related macular degeneration Uveitis Blockage in the small veins of the retina Injuries to the eye Side effects of certain medications Some eye tumours Certain genetic disorders, such as a form of macular dystrophy Can macular oedema be prevented? Good control of predisposing factors, such as diabetes or high blood pressure is essential. Treatments for macular oedema Treatment of macular oedema will depend on the cause and the degree of progression. The following are possible treatments for macular oedema: Drug treatment with eye drops, or intraocular and periocular injections, aimed at sealing fluid leaks from the macula. Laser photocoagulation of the points in the blood vessels where the loss of fluid that accumulates in the macula alters its function. Vitrectomy surgery : this treatment is used in the most severe cases. Which specialist treats macular oedema? Ophthalmologists are responsible for preventing, diagnosing and treating diseases that affect the patient's eyes and visual capacity, such as macular degeneration. ...

Myopia

What is myopia? Myopia is an optical refractive defect caused by biological variations that give rise to non-correlation between the different components of the eye: corneal curvature, lens power, depth of anterior chamber and axial length. Two types of myopia may be distinguished: Simple myopia: this is more frequent and cannot be prevented. It is corrected with glasses, contact lenses or surgery. High or pathological myopia: This is more than 6.5 dioptres. It is usually caused by excessive elongation of the eye ball. Sometimes, this type of myopia can lead to degenerative changes. It is believed to be hereditary. Symptoms of myopia: Myopia can develop in childhood or adulthood, although it tends to stabilise from the age of 18 years. In addition, it may be associated with other eye conditions, such as astigmatism. Myopia manifests as blurred vision of distant objects. There may also be headaches, eye strain and the need to get close to objects or scrunch one’s eyes to see them. Children who develop myopia will often complain of not being able to read the whiteboard at school. What are the causes of myopia? Myopia develops when the eye ball is too long in comparison to the focusing power of the cornea and lens. This means that light rays are focused at a point in front of the retina rather than directly on its surface. Another possible cause of this optical defect is when the cornea, the lens, or both, are too curved for the length of the eye ball. Can myopia be prevented? Simple myopia cannot be prevented. There has been an increase in this eye condition in recent years, and this may be related to use of computers and other practices that entail prolonged close vision. What is the treatment? There are different ways to treat myopia, depending on its degree: Glasses Contact lenses Refractive surgery, which reduces or even eliminates the need for the two previous techniques. The most common techniques are PRK and LASIK. ...

Neuro-ophthalmology

What is it? Neuro-ophthalmology is a field of medicine which studies and treats diseases of the nervous system that affect the visual system. This includes analysing ocular motility, the functionality of cranial nerves and of all the other nervous structures coordinating eye movement, which are integrated with other sensory systems. Neuro-ophthalmology is a clinical and scientific subspecialty vital in identifying neurological conditions or systemic diseases. What conditions does it treat? Neuro-ophthalmology can treat and diagnose several conditions, including: Eyelid twitching and some types of adult strabismus Optic nerve tumour Cranial nerves palsy, gaze palsy and oculomotor nerve palsy Pupillary abnormalities, myopathy and ocular myasthenia gravis Hereditary retinal dystrophies and inflammatory optic neuropathies, be it or dysimmune or associated with multiple sclerosis (MS) There are several conditions which can affect the visual system, thus interfacing with neuro-ophthalmology, such as: diabetes glaucoma multiple sclerosis cardiovascular disease infectious diseases What symptoms can be traced back to a neuro-ophthalmologic condition? The symptoms vary according to the condition you may be suffering from. However, the main and most common symptoms are functional visual loss, diplopia (or double vision), headache, ptosis (drooping eyelids), exophthalmos (bulging eyes) and pain. What tests can you take? Neuro-ophthalmologic conditions can be diagnosed by using tools and techniques such as a visual field test, optical coherence tomography (OCT) for looking at the cornea and retina, or an optical electrophysiology test. Usually these tests can be done at an outpatient clinic: you will only need to stay in hospital if you need a complex diagnosis or complex treatment. What doctor will you see? The neuro-ophthalmology field is mainly composed of neurologists and ophthalmologists. ...

Nystagmus

What is nystagmus? Nystagmus is an ophthalmological condition characterised by an involuntary, repetitive movement of the eyes. The velocity of the movement varies, from fast to slow, and generally both eyes are affected. Nystagmus can be classified into different groups: Neurological nystagmus is related to the central nervous system; it can occur after different diseases, such as a brain tumour or multiple sclerosis. Idiopathic nystagmus appears in childhood, normally in the first 6 months of life. The cause is a congenital defect in the part of the nervous system responsible for stabilising the gaze. Sensory nystagmus is caused by a profound visual deficit during the earliest stages of growth. It is frequently due to congenital cataracts or early retinal diseases. Symptoms of nystagmus The most visible symptom is involuntary movement of the eyeball. However, the primary symptom is poor vision, especially with idiopathic nystagmus, given that it is more difficult to fix the gaze on the object correctly and to project a clear image onto the retina. As a result, the eye does not develop as it should. Oscillopsia is a condition that may occur with acquired nystagmus; it is the sensation that your surroundings are moving about. In some cases, there is a gaze position in which the movement is minimal or almost disappears. This is called the neutral zone and it may lead to torticollis, as a result of the patient moving their head and eyes to achieve this neutral zone. Torticollis refers to an abnormal, asymmetrical head or neck position. What are the causes of nystagmus? The cause may be congenital, either due to a genetic condition or congenital eye disease. Other causes include ingestion of certain medications, hereditary factors, trauma, inner ear problems, drug or alcohol abuse etc. Can it be prevented? This condition cannot be prevented. However, it is important to control alcohol consumption. It is also important to undergo annual ophthalmological evaluations. What is the treatment? The treatment depends on the type of nystagmus, given that each type has a range of potential causes. Treatment may consist of certain medications to reduce the movement or the use of botulinum toxin for its “paralysis” action; however both types of treatment can sometimes be associated with side-effects. In cases of torticollis, glasses with prisms or surgery of the muscles can help to improve the position of the head, as they shift the neutral zone to somewhere in front. In addition, it may reduce the intensity of nystagmus. ...

OCT (optical coherence tomography)

What is OCT (optical coherence tomography)? An optical coherence tomography (OCT) scan is an imaging test that uses low coherence light beams analyse different sections of the human body, obtaining highly precise and reliable pictures of several levels of tissue. This scan is primarily used in ophthalmology (to study the cornea and retina) and cardiology (to assess the state of the blood vessels where there may be a potential narrowing, which could lead to more severe complications). What does OCT involve? An OCT is similar to an ultrasound, however, light waves are used instead of ultrasound waves. For ophthalmology purposes, this procedure is minimally-invasive, and it uses the infra-red laser rays to analyse the retina and cornea, generating precise and high definition pictures. Thanks to the possibility of analysing each tissue section, this exam can identify several conditions, especially those of the macula and of the optic disk. The test takes just a few minutes, during which the specialist will use certain reference points on the optic disk to receive and store the laser beams. The result is an image of all the strata of the retina, allowing the specialist to determine if there are any abnormalities, from which they can formulate a diagnosis. For cardiology purposes, this procedure is more invasive, as the light waves are sent from a catheter to the area of interest. That means that the catheter has to physically reach the test area by making an incision. Once the light waves emitted by the transducer hit the clot and bounce back, they produce photon fluctuations which are sent back and received by an interferometer, allowing for an assessment of the problem. What is OCT for? In ophthalmology, OCT is used to diagnose and assess the advancement and stage of retinal conditions such as maculopathies, glaucoma, hereditary retinal dystrophies, vitreoretinal diseases and macular oedemas. In cardiology, OCT is used to determine whether there are thromboses, plaque, and calcium build-up or if a stent was placed incorrectly (especially when trying to prevent atherosclerosis). How can I prepare for OCT? When doing an eye OCT there is no need for any kind of preparations. You won’t need to use eye drops as the machine won’t physically touch your eyes. However, you won’t be allowed to wear contact lenses during the exam. On the other hand, when doing a heart OCT, you will be under local anaesthetic (the catheter will need to reach the area to be analysed). Therefore, you should not take anticoagulants, to avoid potential complications during or after the procedure. What does it feel like during the procedure? It is not painful during an OCT scan. During an eye examination, you’ll have to stay still and look at the light from the equipment, whereas during a heart scan you will be under local anaesthetics which will avoid any pain. ...

Ocular hypertension

Ocular hypertension is the term to describe an increase in pressure in the eye. Anyone can suffer this condition however people with eye injuries, eye diseases, on certain medications, and diabetics are more inclined to develop ocular hypertension. Symptoms are not always visible so it is very important to perform eye examinations as a means of prevention of disease. Ocular hypertension can be treated with medication to reduce eye strain and prevent damage to the optic nerve and to reduce the risk of glaucoma thus avoiding the permanent loss of vision. ...

Ocular melanoma

Ocular melanoma is a form of cancer that affects melanin, the cells that produce pigment in the body. Despite being a rare disease, it is the most common type of cancer that occurs in the eyes. It can affect all parts of the organ, especially those less detectable, so it is essential eye examinations are undertaken regularly. Treatment depends on the degree of development in melanoma when detected, but there are two main types: radiation therapy, which aims to stop the growth of melanoma or, if possible, eliminate it; and ocular melanoma surgery, in which the tumour is removed, unless it is too large (which would require complete removal of the eye and an implant). ...

Oculoplastics

What is oculoplastics? Oculoplastics, also known as oculoplastic surgery, is an umbrella term for a number of surgical procedures on the eye and the surrounding structures, including the eye socket, eyelids, tear ducts, and parts of the face. Oculoplastic surgeons are specialised ophthalmologists, who have undergone additional fellowship training. Some surgeons from certain other specialties, such as plastic surgeons, ENT surgeons and oral and maxillofacial surgeons may be trained in some procedures that fall under oculoplastics. Why is it done? Oculoplastic procedures may be done for a number of reasons. Many, such as upper and lower eyelid blepharoplasty, eye bag removal and eyebrow lifts, are done for cosmetic reasons, while others, such as eyelid repair for entropion, ectropion and ptosis are done for functional reasons – to make life easier for the patient. Other procedures, such as eye removal and reconstruction may be essential for the patient’s wellbeing. What does oculoplastic surgery involve? Oculoplastics can involve a number of techniques, depending on the specific operation. Oculoplastic procedures can range from the cosmetic, such as Botox injections, liposuction, and blepharoplasty to essential surgery, such as eye removal and orbital reconstruction. Types of oculoplastic procedures Eyelid surgery Cosmetic/Aesthetic Upper eyelid blepharoplasty – removal of excessive upper eyelid skin and hooding Lower eyelid blepharoplasty – A procedure to reduce bags by removing excessive skin and subcutaneous fat. Brow lifting – raising or reshaping of the brow Eyelid Malposition Ptosis (droopy eyelid) repair Lower eyelid entropion (inturning) or ectropion (out turning) repair Eyelid lesions benign and cancerous Excision or biopsy of cysts/moles/lesions of the eyelids Eyelid tumour removal – the eyelids can be affected by skin cancers, like basal cell carcinoma or squamous cell carcinoma Tear duct surgery Procedures to reduce watering and unblock tear ducts Biopsy or removal of a lacrimal gland Removal of part of a lacrimal sac Eye removal Complete removal of the eye and possibly also the connecting tissue and muscles – usually done due to the presence of a malignant orbital tumour. Removal of the inside of the eye, leaving the scleral shell – usually done to reduce pain in a blind eye. Orbital reconstruction Artificial eyes Orbital decompression for Graves’ disease Cosmetic procedures Botox injections Facelift – part of the facelift procedure can involve the eyelids and surrounding area. Eyebrow/forehead lifts Liposuction of the face and neck ...

Open angle glaucoma

This is the most common form of glaucoma and tends to build up slowly over years. It happens when the eye is correctly positioned but does not drain properly, causing a build up of pressure. Treatments can be topical, surgical or by laser. ...

Optic neuritis

What is optic neuritis? Optic neuritis (ON) is the swelling or inflammation of the optic nerve. The optic nerve is responsible for transmitting the image from the retina to the brain. It is one of the most common disorders of the optic nerve, others include glaucoma, eye atrophy, or drusen. Disease prognosis Patients who get optic neuritis and do not have a linked disease, such as multiple sclerosis, have a higher chance of full recovery. However, although people with an autoimmune disease have a more negative prognosis, they may still regain vision in the affected eye. What are the symptoms? If the neuritis affects the eye nerve fibers then it could cause short or long term vision loss. There can also be changes in the way the eye reacts to bright lights, a chromatic vision loss, and the patient may also have pain with eye movement. Tests for optic neuritis To rule out other diseases, the patient will be given an eye colour test, a visual acuity test, visual field test, a brain MRI, and an indirect ophthalmoscopy to examine the optic disc. What causes it? The exact cause for optic neuritis remains unknown, but it is quite often linked to the following diseases: Multiple sclerosis which is a chronic neurological disease that causes inflammation and demyeliation of the nerve fibres. Optic neuritis is often the first symptom of the disease, while it is estimated that half of all people with MS will develop optic neuritis at some point. Cryptococcosis Respiratory infections Autoimmune diseases such as lupus Bacterial infections such as meningitis Viral infections such as chicken pox Vitamin B12 deficiency Leber’s optic neuropathy When it develops with no known cause, it is known as idiopathic neuritis. How can it be prevented? Consult an ophthalmologist and a neurologist so that they can study each case and detect risk factors. Quite often a brain MRI will be done if it is suspected that the patient may have one of the related diseases. What is the treatment? Treatment for optic neuritis will vary depending on the related disease; sometimes intravenous or oral tablet form corticosteroids are used to shorten the duration of symptoms and accelerate visual recovery. In some cases, vision may return within 2-3 weeks without any treatment. What specialist should I see? The specialist that diagnoses optic neuritis is an ophthalmologist. ...

Orbital cellulitis

Orbital cellulitis is an acute infection of the tissues surrounding the eye, particularly the eyelids, eyebrows and parts of the cheeks. This condition is often caused by a sinus infection where the virus spreads to the aforementioned areas. It most commonly occurs in childhood and it is essential it is treated properly to ensure treat without causing damage that can be maintained in adulthood....

Paediatric ophthalmology

What is paediatric ophthalmology? This is the medical specialty that prevents, diagnoses and treats diseases that affect children's eyes and visual health. Good ophthalmic care is essential during childhood, as these are the years when visual problems may appear while the eyes of growing and may affect their future development. Children's eyes are constantly growing until they are about 8 years old. Diseases that are treated with children's ophthalmology The most common conditions which affect eyesight during childhood are: congenital diseases amblyopia (commonly known as lazy eye) strabismus inflammation infection It has been shown that academic performance can be significantly affected by vision problems that have not been properly diagnosed or treated, harming the child’s capacity to learn and develop vital skills. When to see a paediatric ophthalmologist Eye exams are essential throughout childhood. In the first few months of life, an eye examination can detect serious diseases such as retinoblastoma. Strabismus and eye motility problems in particular are diagnosed from the ages of one to four. After the age of four, refractive visual disorders such as myopia (nearsightedness) and hyperopia (farsightedness) are the most commonly treated pathologies, in addition to prevention or treatment of amblyopia or lazy eye. Annual check-ups are necessary up to the age of 15, to check the stability of the child’s vision and the development of the eye organs. ...

Presbyopia

What is presbyopia? Commonly known as tired eyes, presbyopia is the loss of accommodation, the ability to maintain a clear image of an approaching object. In other words, presbyopia the increase in optical power, for example, we need to use 3 dioptres to focus 33 centimetres away. It is estimated that by 2020 there will be 2.3 million people with tires eyes. Disease prognosis Tired eyes develop gradually and evolve over time. It can be treated with temporary or permanent techniques, so prognosis will depend on the technique used, even though it isn’t a serious condition. What are the symptoms? Presbyopia can cause the inability to focus up close; it can also cause headaches when looking at a book or computer screens. Tests for presbyopia and accommodation The specialist will study the patient’s ability of accommodation (near focusing), measuring the amplitude and the monocular and binocular accommodative flexibility. If the ability to accommodate is unbalanced, exercises that have been proven to work will be recommended. These exercises involve reading visual therapy at close vision with positive and negative different strength lenses. Flipper training for short distance or changing focus from long to short distance using the Hart Chart is also used, among other techniques. What causes it? Tired eyes occur due to a loss of lens elasticity, which is the eyes natural lens for focusing on objects. Over time, the lens loses elasticity and the ability to focus. How can it be prevented? Tired eyes can’t be prevented as it is a condition associated with the ageing process. Even so, it is important to have your eyes tested regularly, especially after the age of 40, to detect any age related conditions. What is the treatment? There isn’t a permanent treatment for tired eyes, there are however techniques to compensate for loss of focus. The most common one is glasses, and there are different types of lenses according to the issue: Bifocal lenses: for far and near vision. Trifocal lenses: for short, medium, and long distance vision. Progressive lenses (also called multifocal lenses): the upper part of the lens is for distance, the lower part for near, and the middle part for all distances. Occupational lenses: for short and intermediate distances; particularly suitable for people who work with computers. Even so, surgery is quite often used to get rid of tired eyes. There are different techniques: Laser surgery: the cornea is moulded to increase the depth of focus and compensate for the loss of focusing ability. Intracorneal lens implants: are placed on the cornea and change the corneal curvature to address the inability of accommodation. Intraocular lens implant: the lens is replaced by an intraocular lens, which can be monofocal, bifocal, or trifocal, depending on the distance reach needed. What specialist should I see? Tired eyes should be treated by an ophthalmologist. ...

Pterygium and pinguecula

What is pterygium and pinguecula? Pterygium and pinguecula are two abnormal bumps in the conjunctiva of the eye. The pterygium appears as fleshy tissue on the cornea, its size may vary The pinguecula sprouts as a yellowish bump on the white of the eye. Prognosis: These conditions are not cancerous (benign) and have a good prognosis with treatment. Symptoms of pterygium and pinguecula: In many cases, the pinguecula does not produce symptoms but other times it can become acutely inflamed and result in pingueculitis, which causes red eye and discomfort. The pterygium in its initial stages is also usually asymptomatic, but when it develops it usually causes eye discomfort and occasional redness. In addition, growing on the cornea can modify its curvature, producing visual alterations, or if it reaches the visual axis, vision is reduced significantly. Medical tests for pterygium and pinguecula: An ophthalmological examination of the ocular surface is enough to identify a pterygium or pinguecula. Rarely is it necessary to biopsy the problem and analyse it under a microscope to distinguish it from other potentially malignant conjunctival lesions. What causes pterygium and pinguecula? Pterygium and pinguecula often develop from excessive exposure to ultraviolet rays. It is also more frequent in patients exposed to irritants such as dust and sawdust. Other factors involved are chronic dry eyes and aging. Can pterygium and pinguecula be prevented? Pterygium and pinguecula are more common in tropical countries and especially in mountainous areas. This is because the most common cause of these bumps is life-long exposure to UV light, hence sunglasses or even wearing a hat are helpful in preventing them. Treatments for pterygium and pinguecula: Pterygium : its treatment can range from the application of drops to surgery. Several strategies can be combined according to their severity. A clean surgery might be needed to completely remove the affected tissues. The eye surface is then reconstructed by transplantation (often from the conjunctiva itself). It is an outpatient, painless surgery under local anaesthesia. The pinguecula does not grow on the cornea, so no specific treatment is usually required unless it is frequently inflamed or because of cosmetic reasons, in which case it would be necessary to remove it with surgery. Which specialist treats pterygium and pinguecula? Ophthalmologists are in charge of preventing, diagnosing and treating diseases that affect the patient's eyes and visual capacity, such as pterygium and pinguecula. The eyes are the essential organ of vision and are susceptible to many abnormalities throughout life. Ophthalmology is responsible for preserving the patient's visual capacity, through medical treatment techniques, surgery or with the help of external elements such as glasses or contact lenses. ...

Ptosis (droopy eye)

Ptosis is the drooping of the eyelid as a result of relaxation of the muscles that hold it. This is one of the most common eyelid malpositions, and can occur in patients of all ages. There are numerous causes, from injuries to neurological factors. They all cause difficulty in vision, so it is necessary to surgically intervene to repair the tendon or muscle shortening. Various surgical techniques exist and the option will depend on the eye condition of each patient. ...

Retina

What is the retina? The retina is a thin layer of tissue on the back wall of the eye made up of different cells (retinal pigment epithelium, nerve cells and photoreceptor cells). The photoreceptor cells (cones and rods) react to light, and send electrical signals to the brain, which interprets these signals as vision. The retina is therefore the thing that allows us to see. The retina, along with the optic nerve, develops in the embryo as part of the brain tissue, making it part of the central nervous system. Being a nervous tissue, the retina doesn’t have the ability to regenerate itself. What does the retina do? The retina is responsible for our vision. The photoreceptor cells (cones and rods) react to light entering the eye, releasing chemicals, which in turn trigger a nerve impulse, which is sent to the cerebral cortex via the optic nerve. The pattern of light hitting the photoreceptor cells triggers a unique set of electrical signals, which are interpreted by the brain as an image. Rod cells function well in low light, providing us with our night vision. They contribute little to colour vision, which is why we find it difficult to distinguish colours in darkness. They tend to be concentrated around the edge of the retina and are also used for peripheral vision. Cone cells, on the other hand, are less sensitive to light, making them of little use in low-light conditions. However, they are responsible for our colour vision. Most people have three kinds of cone cell. Each type is sensitive to a different visible wavelengths of light, giving us trichromatic vision. The mixture of signals sent by the different cone cells being stimulated to different degrees creates the mixture of colours we can perceive. Some people are born with only two types of cone cells, limiting the range of colours they can perceive, causing them to easily confuse colours that appear different to someone with all three types of cone cell. What conditions can affect it? Retinal conditions can affect your eyesight with different degrees of severity. They can be either acquired or inherited: Diabetic retinopathy – diabetes causes the capillaries that supply the retina to leak fluid into or under the retina, leading to swelling and distorted vision. Retinal tear – when the gel-like vitreous inside the eye shrinks it can tug at the retina, and sometimes this can cause a tear. Retinal detachment – a disorder in which the retina becomes loose and detaches from the tissue underneath. It is usually caused when fluid passes through a retinal tear. Retinitis pigmentosa – a degenerative disease of the retina Macular degeneration (AMD) – age-related deterioration of the macula – a small part of the retina with a high concentration of cone cells, responsible for central colour vision. Macular hole – a small defect in the macula, perhaps caused by trauma or traction between the retina and the vitreous. Cancer of the retina How can such conditions be treated? The treatment will vary according to the specific condition. Some conditions can be treated with intravitreal injections; for others, the only option is surgery. Which doctor should I see? You should see a specialised ophthalmologist. ...

Retinal vein occlusion

Retinal vein occlusion is when the veins carrying blood away from the retina become blocked.

Retinitis pigmentosa

Retinitis pigmentosa is considered a serious eye condition and is the most common hereditary degenerative retinal condition. Progression causes decreased vision due to the death of photoreceptors, the retina cells and it can end up causing blindness. Its first symptoms are lack of capacity to adapt to the dark (nocturnal blindness) and a decreased visual field, causing tunnel vision. As the disease progresses, symptoms worsen, so it is important to know how the disease developed in close relatives to understand how it will affect the patient. Although there is currently no specific treatment for this disease, consumption of vitamins, minerals and other nutrients may help slow its evolution. In addition, vision therapy is advised; exercises monitored by an ophthalmologist to improve the visual conditions of the patient. ...

Retinopathy

Retinopathy is the common name of any non-inflammatory disease of the retina, the innermost layer of the eyeball responsible for receiving and sending visual images from the eye to the brain. That is why the term encompasses a range of conditions, but the most common is diabetic retinopathy, which occurs due to elevated blood glucose levels in these patients. The symptoms are not evident during the early stages of this type of retinopathy, which can lead to vision loss, so it is important that diabetics undergo regular eye examinations. Its main treatment is photocoagulation, laser surgery to repair abnormal blood vessels that have been manifested in the retina. Another common condition is blood in the vitreous humour. When bleeding has been severe enough to warrant surgical treatment, a vitrectomy is performed. ...

Second medical opinion

What is a second medical opinion? A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse. Why would you get a second medical opinion? Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease. In addition, there are certain situations where a second medical opinion is sought after: Potential treatment is risky and could be life-changing or the diagnosis is possibly life-threatening The diagnosis is not clear-cut If you are considering a new treatment approach that is experimental The aims of obtaining a second medical opinion are: To confirm whether a diagnosis is correct and/or appropriate. To confirm whether a suggested treatment is correct and/or appropriate. To compare information received from each doctor so that you can make an informed decision – sometimes a second medical opinion can rule out the need for a potentially unnecessary invasive procedure. Possible disadvantages of seeking a second medical opinion include: The process can delay the start of treatment. Logistically, seeing another specialist might be difficult and possibly time-consuming. It might be stressful to hear the same diagnosis again. How would you seek a second medical opinion? You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion. Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals. ...

Secondary glaucoma

Glaucoma is considered secondary when it has an underlying disease or condition. It can also be of the open or closed variety.

Strabismus

What is strabismus? Strabismus, also known as crossed eyes, is the deviation of the line of sight of one of the two eyes. Whilst one eye directs its gaze towards a particular object, the other is pointed in another direction. This is both a visual and aesthetic problem. Strabismus can be classified into two types, based on the direction of the eyes: Converging strabismus : It occurs when the eye points inward. Diverging strabismus : It occurs when the eye points outward. Prognosis: In most cases, the problem can be corrected if it is detected and treated early. If treatment is delayed, permanent vision loss may occur in one eye. If amblyopia or commonly known as ‘lazy eye' is not treated by age 11, it is likely to be permanent. About one-third of children with strabismus will have amblyopia as the underlying cause. Symptoms of strabismus: Symptoms of strabismus may include: Crossed eyes Double vision Impaired vision Uncoordinated eye movements (eyes do not move together) Loss or decreased depth perception Medical tests for strabismus: A physical examination, including a detailed examination of the eyes, is usually performed. The following tests are performed to determine how misaligned the eyes are: Corneal reflex when exposed to light Cover/uncover test Examination of the retina Standard ophthalmic exam Visual acuity test (tests how well you can read from a distance) A brain and nervous system (neurological) examination will also be done if other symptoms present. What causes strabismus? Many adult patients who suffer from strabismus experience this condition from childhood, although in a controlled manner. However, in most cases, strabismus has its origin in other diseases such as: Diabetes Thyroid disease (Graves' disease) Myasthenia gravis (a neuromuscular disease) Central nervous system tumours Head trauma Stroke: heart attacks or bleeding in the brain Occasionally, strabismus may result following eye surgery, such as cataract surgery, retinal detachment surgery, eyelid surgery, etc. due to unwanted involvement of the extraocular muscles during these procedures. Can strabismus be prevented? Strabismus is a disease that cannot be prevented. The best option is to treat it from its diagnosis to avoid possible loss of vision. If your child suffers from amblyopia, make sure it is treated. Treatments for strabismus: As this is a deviation that occurs from a very early age, it is crucial that measures are taken as quickly as possible to prevent it from leading to complications. To treat this disorder there are multiple techniques such as: Wearing an eye patch Eye exercises Wearing special glasses Corrective lenses Surgery to correct certain eye muscles. This is usually reserved for more severe cases that have not responded to other treatments. Which specialist treats strabismus? Ophthalmologists are in charge of preventing, diagnosing and treating diseases that affect the eyes and the visual capacity of the patient, such as strabismus. The eyes are the essential organ of vision and are susceptible to many abnormalities throughout life. ...

Stye

What is it? A stye is the result of an inflammation on or inside the eyelid or around the eye. It is a red, hard and painful lump originating from the eyelid’s sebaceous glands or from the eyelashes’ follicles. What are the symptoms? The symptoms of a stye include a painful lump which grows more and more red, lacrimation and, sometimes, a scratchy sensation on the inside of your eyelid. The signs of a stye on the outer eyelid are caused by bacteria attacking the follicles, thus accumulating pus. If you do not have treatment early on, the infection may evolve into a chalazion (a type of cyst). How is it diagnosed? In order to diagnose it, your doctor will simply take a look at the infection to determine what stage it has reached. What causes a stye? A stye originates from a bacterial infection, mainly from the Staphylococcus bacterium, which penetrates into the eyelashes’ follicles and causes an infection of the sebaceous glands. The bacterium is transmitted by direct contact: the simple act of touching your eyes can be enough. How can it be prevented? Avoiding infection involves proper eye and facial hygiene and refraining from touching your eyes excessively. It is also very important to pay attention to proper hand hygiene and to changehand towels as frequently as possible. If you wear make-up, remove it completely before going to bed. You shouldn’t share any eye cosmetics. Make sure you replace your eye make-up regularly. How is it treated? Most cases of styes usually resolve on their own after seven to ten days. From the moment the stye bursts open and starts releasing the pus, it will heal on its own. However, you should remember not to touch or try to burst the stye open yourself, because this could further aggravate and spread the infection. In order to help the stye heal, you could apply warm compresses on your eyelid. If the infection has been going on for a long time, you could also use a macrolide antibiotic-based ophthalmic ointment - that should stop the bacteria from spreading. For more severe cases, the doctor may decide to remove the eyelashes closest to stye, so that the pus is released more easily. ...

Thyroid eye disease

Thyroid eye disease is an autoimmune disease in which the cells that protect us from infections or other aggressive agents act defectively, attacking different organs or tissues of the body such as the thyroid and eyes. For example, with hyperthyroidism (excessive or out of control hormone production), inflammation of the eye may occur or there is an increase in pressure behind the eyes. This can lead to protruding eyes (proptosis), misalignment of the eyes (strabismus) and dysfunctions in the eyelids where, in severe cases, visual disturbances occur. Tobacco and stress are risk factors for developing hyperthyroidism. Treatment includes endocrine control, steroids or, in more severe cases, surgery. ...

Trabeculectomy

The most common glaucoma treatment, a trabeculectomy is a surgical procedure which involves draining part of the eye to relieve pressure. A trabeculectomy is the most common surgical procedure used in the treatment of glaucoma. The specialist will make a small incision to remove part of the eye's trabecular meshwork to relieve pressure in the eye. ...

Uveitis

What is uveitis? Uveitis is the inflammation of the uvea, the middle part of the eye made up of the choroid, the ciliary body, and the iris which surround the inner part of the eyeball. As there are many blood vessels in the head, this area is very prone and sensitive to many infectious and inflammatory processes. Inflammation in this area can cause severe vision loss, so it is very important to treat it as soon as possible. Uveitis can affect people of any age, but it is most common in people aged between the ages of 20 to 50, it can also affect children. There are different types of uveitis depending on what part of the uvea is affected: Panuveitis: is often considered the most dangerous form as it affects every part of the uvea. Posterior uveitis (choroiditis): affects the back of the eye and may be related to a systemic infection or an autoimmune disease. Intermediate uveitis: is a rare type of uveitis that affects the vitreous in the centre of the eye. It can develop at any age but is most common in children and teenagers. Anterior uveitis (iritis): is the most common type of uveitis and it occurs in the front of the eye. What are the symptoms? Uveitis symptoms vary according to the part of the uvea that is affected; if it is the posterior part there will normally be a loss of vision, and if it’s the anterior segment there will normally be blurry vision, eye pain, red eyes, and photophobia. It can appear in one or both eyes and may be gradual or sudden. What causes it? Causes for uveitis include infectious, autoimmune, osseous, and rheumatic diseases as well as eye injuries. Some examples of these are; arthritis, AIDS, syphilis, tuberculosis, and psoriasis. Other causes can also be exposure to toxins and other injuries. It can also be caused by exposure to toxins and other injuries. How can it be prevented? There are some steps that you can take to reduce the risk of a uveitis flare-up, such as: Follow treatment recommendations Don’t use contact lenses Don’t smoke Maintain good hand and eyelid hygiene. What is the treatment? Treatment depends on the area to be treated; in anterior uveitis anti-inflammatory eye drops are used, for posterior uveitis oral cortisone is normally used. Immunosuppressant drugs are used when it is linked to a chronic condition. Occasionally surgery is carried out if related complications arise, such as glaucoma or cataracts. ...

Vision therapy

What is vision therapy? Optometric vision therapy is a technique for children based on eye exercises to optimize and improve various vision dysfunctions. It should be a personalized treatment for each child. It may be recommended for children who suffer from an ocular pathology and those with visual dysfunctions that cause poor school performance. Vision therapy works to correct problems related to eye movements, focusing and reading and writing caused by issues with vision. Vision therapy or vision training (VT) is a form of eye training aimed at inducing a correct stimulus from the brain to the eyes. It can be done by children starting from six years old and it is quite helpful in terms of sports, to improve and increase visual-motor abilities. What is vision therapy for? Vision therapy is not only helpful when improving one’s performance in sports; it is also done to treat conditions such as visual-motor dysfunctions, non-strabismic binocular disorders, strabismus, amblyopia, accommodative disorders, and visual processing disorders. What is does vision therapy consist of? VT usually consists of specific training you can do under the supervision of an optometrist. The number of sessions the patient needs depends on the severity of their disorder. Some of the training exercises are: Visual fixation Tracking exercises Binocular vision Convergence training Stereopsis Vision field Shapes perception ...

Visual impairment

Visual impairment can have many causes, either congenital, degenerative, due to disease or trauma.

Watery eyes

Watery eyes, also known as epiphora, is a condition where there is an overflow of tears onto the face. It is very common and can develop at any age, although it is more common in babies and people over the age of 60. It may affect one or both eyes and usually manages to get better without any treatment or, if need be, it can easily and effectively be treated. What causes watery eyes? The causes of watery eyes are: Blocked tear ducts Some people are born with underdeveloped tear ducts and it is normal for newborn babies to have watering eyes, which clear up as the ducts develop. In adults and older children, the most common cause is blocked ducts or ducts that are too narrow. Narrowed ducts are a result of swelling or inflammation. If the tear ducts are blocked, the tears will build-up and not be able to drain. The build-up of tears in the tear sac increases the risk of an infection, meaning the eye will produce a sticky liquid. Overproduction of tears Eyes that become irritated may produce more tears than normal. The eyes can become irritated by a number of factors, including; some chemicals, such as fumes, infective or allergic conjunctivitis, an injury to the eyes, such as a scratch or from grit, from the eyelashes growing inward or to the lower eyelid turning outward. Other causes Watering eyes can result from an infection of the cornea (keratitis), an open sore on the front surface of the eye (corneal ulcer), styes, Bell’s palsy, dry eyes, allergies such as hay fever and the use of certain medications due to the preservatives as an ingredient. . Treatment of watery eyes In mild cases of watery eyes, the doctor may recommend ocular lubricants in the form of dry eye drops and monitor progress. Depending on the cause of watering eyes, there are different treatment options. For watery eyes caused by an irritation, if it does not clear up by itself then a course of antibiotics may be necessary. For blocked tear ducts, surgery may be required to create a new channel between the tear sacs to the inside of the nose. The surgical procedure is called dacryocystorhinostomy (DCR). Home remedies for watering eyes It is recommended to take a break from reading, computer or phone screens. Most dry eye drops are available to purchase over the counter at a pharmacy to keep the eyes lubricated. Holding a warm, damp cloth over the eyes may help to release any blockages also. Cleansing the eyelids with lid wipes or a saline solution can also help alleviate symptoms of dry eyes if linked with blepharitis. ...

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Professor Tom Williamson Ophthalmology Central London

Professor Tom Williamson

Ophthalmologist in London & Ashtead

MD MBChB FRCS(Glas) FRCOphth

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Professor Tom Williamson
Ophthalmology
Central London

Ophthalmologist in
London &
Ashtead