The common man is often in a situation where he is unable to decide whether a condition is abnormal or normal & if abnormal, does the condition need attention. A brief overview of the commonest problems of the eye is being made in this article. For the sake of convenience the problems are grouped into those of children, adults and elderly.
Watering of eyes:
In newborns, it indicates incomplete canalization of the duct draining tears from the eye to the nose. Simple massaging along the side of the root of the nose in the direction of normal fBoth these conditions can lead to hemorrhages and edema of the retina, thrombosis of the blood vessels or vitreous hemorrhage. Adequate control of blood sugar and blood pressure is the first step in preventing these complications. LASERS and vitreo-retinal surgery are useful in the treatment of these conditions.low of tears, which can be taught to the mother, cures most cases. However in some cases where massaging doesn¡¦t clear the obstruction, it becomes necessary to perform `Probing¡¦. In Probing, under a very short general anesthesia of 10 to 15 minutes a thin wire like probe is passed and the canal is opened relieving the child of watering for the rest of his life.
Cataract at birth:
Any whitish spot or opacity in the normally black appearing pupillary area (center of the brown pupil) should alarm the parents. It could be a cataract or even a tumor of the retina. Both the conditions require intervention and an eye specialist’s opinion must be sought Presently, childhood cataracts are being successfully managed by performing microsurgery with intraocular lens implantation. It must be understood that cataract in children should be operated at the earliest. Delay in such a situation often results in `Amblyopia’ (lazy eye).
could be present at birth or develop later. Specialist’s opinion must be sought Depending on the cause; glasses, exercises or surgery may be advised. Where surgery is required, earlier the operation is performed better the results. Unfortunately most parents wait till the child attains marriageable age when surgery results only in cosmetic correction without the functional component.
Like all other allergies this also heals with age. The common Vernal conjunctivitis could manifest as itching of the lids in its simplest form or with severe redness, muddy discoloration of the white of the eye and discharge. Treatment is mostly aimed at reducing the symptoms with anti allergic drops including weak steroids. Most children are relieved by the age of 15 or 20 years. Parents need to be reassured in the meantime so that they do not run from pillar to post.
Myopia (minus power):
A child who watches TV from close or holds books close to the face or squeezes his lids to see objects at a distance in all probability has myopia. Most parents in such a situation scold the child to correct his `bad habits¡¦, without realizing that the poor child is helpless and simply cant see from distance. It is necessary that parents have good understanding of myopia so that they can bring their child to the doctor regularly for check ups and advice. Myopia is a result of the eyeball being longer than normal from front to behind resulting in the rays of light falling in front of the light sensitive retina. This can be corrected by wearing minus glasses in front of the eye. The power required may either remain stationary, increase slowly or increase rapidly, depending on the genetic constitution of the child which is pre destined at birth and cannot be altered by any medicines, vitamins, exercises or surgery. However, in most cases the power reaches its maximum by the age of 18 to 20 years and thereafter remains stationary. Spectacles are the simplest means of correcting myopia. Contact lenses are advisable where the power is more than 0.5 Dioptre or when the difference in the power between the two eyes is more than 2.5 Dioptre. Contact lenses provide better quality of vision apart from the cosmetic benefit.
This accompanies the patient throughout the life though progressive increase in the power of spectacles stops by the age of 20 years. After the age of 18 years Excimer Laser surgery (LASIK) can be done but before undergoing this procedure one must weigh the risks and benefits and the financial considerations. Whatever be the means to correct the myopia, a retina check up by Indirect ophthalmoscopy is a must every 6 months. This helps to detect & treat retinal holes, thus preventing Retinal Detachment, which is common in myopes. Any complaints of seeing flashes or floaters in front of the eyes necessitate a visit to the retina specialist.
It is important to realize here that the degenerative changes in the retina continue even after the power stops increasing. Thus visits to the Doctor must continue for retina check ups. Retinal holes or tears could be detected early and treated preventing a retinal detachment.
Dry eye Syndrome:
This condition is being seen more frequently these days, as most offices are air conditioned and computerized. Symptoms may range from simple grittiness to intense burning and redness of eyes especially on working at the monitor or watching TV or prolonged reading. Splashing water on the eyes provides temporary relief. A little understanding of the normal physiology helps solving this problem better. The surface of the eye is kept continuously moist by a tear film. This tear film is reformed every time we blink. On an average we blink about 15 times a minute. When we are watching TV, reading or looking at a computer screen we tend to blink less often. In most of us our reserve capacity allows us to perform these activities smoothly. Those with a poor reserve suffer from dry eye syndrome. Air conditioning reduces the humidity and causes faster evaporation aggravating the problem. Splashing water does provide temporary relief but dilutes the tears and does more damage in turn. Application of artificial tears and changing work atmosphere and habits are simple solutions.
Around the age of 40 people experience difficulty in reading fine print from near and have to hold books a bit away. This is because the fine muscles within the eye that helps in focussing for near start weakening. This leads to poor performance at work and headaches at the end of the day. Wearing the necessary glasses for near work provides prompt relief.
Opacification of the normally clear lens within the eye with age leads to cataract. Blurred vision not correctable by glasses, scattering of lights and inability to face headlights, are the commonest symptoms. These days with advanced surgical techniques it is no longer required that a patient wait till the cataract matures. In fact, it is technically easier to operate when the cataract is immature. Microsurgery with intraocular lens implantation is has become very popular. An even more advanced technique called Phacoemulsification(stitchless cataract surgery) is gaining quick popularity because of its advantages. In this surgery, an ultrasound needle is used to break up the cataract into small pieces, which are easily sucked out. A small or foldable lens is then put into the eye. This operation enables the patient to get back to office or kitchen the very next day with no physical restrictions.
Simply put, an increased pressure within the eye is called glaucoma. Broadly there are two types, acute and chronic. The acute type presents with pain, redness, blurred vision and coloured haloes around lights. The chronic type, which is more common, presents with no symptoms and is detected by the eye specialist on routine examination. Hence it is a silent killer. The intraocular pressure, the amount of erosion of nerve within the eye and examination of the visual fields by automated perimetry help the physician make the diagnosis. Treatment by medical or surgical methods depends on the extent of damage and progress of the disease.
Effect of Diabetes & Hypertension on the retina:
Both these conditions can lead to hemorrhages and edema of the retina, thrombosis of the blood vessels or vitreous hemorrhage. Adequate control of blood sugar and blood pressure is the first step in preventing these complications. LASERS and vitreo-retinal surgery are useful in the treatment of these conditions.