Common eye conditions

The macular is the central part of the retina (the film at the back of the eye). It responsible for detailed central vision (reading, writing, TV watching, driving, face recognition) and colour recognition. Macular degeneration is one of the main causes of vision loss in the elderly.

Macular degeneration can occur due to a range of reasons, when occurring in older age, it is referred to as age related macular degeneration or AMD. AMD is the name of a group of degenerative conditions leading to the loss of central vision due to retinal degeneration. Most cases are due to advancing age but genetic and lifestyle factors (high blood pressure, smoking) are also important factors. Although it is a progressive condition it does not affect the peripheral retina and thus never leads to complete blindness.

Symptoms of AMD may include: difficulties with reading, loss of distance vision, distortion and dark patches in vision. Treatment of AMD depends on clinical findings and may range from vitamin supplementation to intraocular injections of medications.

Blepharitis is an inflammation of eyelid margins. The condition is usually caused by bacterial overgrowth in the glands of the eyelid and lashes. It is common, usually affects both eyes and affects both children and adults. Blepharitis can cause irritation to the eyes making them red, sore, itchy and watery.

The condition is difficult to treat and in majority of cases it can only be controlled but not cured.
A simple approach with good eyelid hygiene, warm compresses to the lids and lid massages may help. For more severe or persistent cases, antibiotic ointments or systemic treatment may be recommended to help reduce symptoms and manage the condition.

Cataracts are a common condition particularly with those over age 65. A cataract is a ‘clouding’ of the lens of the eye, where the transparency of the lens is lost due to various causes but commonly due to ageing. Other causes can include eye injury, long term ocular inflammation or prolonged steroid drop use.

Generally, cataracts are not a medically urgent condition and as a rule, they do not require immediate surgical removal unless the cataract is causing impairment of vision such as persistent blur or glare. The only available treatment for cataracts is surgery where the patient’s lens is removed and a new artificial lens is inserted. The surgery is performed through a small incision and is relatively straightforward.

CSR is a 'blistering' condition of the retina, where leaking fluid collects under the retina. This fluid accumulation collects as a 'blister' causing a small detachment, which in turn causes distortion of vision. It affects mostly males between 30-50 years and usually affects one eye at a time. The known risk factors for CSR include: steroid use, stress, hypertension (high blood pressure), caffeine, smoking and so called 'type A' personalities (busy, stressed, on-the-go individuals).

Symptoms of CSR include distorted central vision, persistent blurred vision and objects may appear smaller or further away than in reality. Most cases of CSR will resolve themselves in a matter of months without particular treatment and most people will regain good vision, however vision may not be as good as before. There is a significant chance of recurrence of the condition and it is important to have regular eye check ups as long term fluid accumulation may lead to permanent loss of vision.

Diabetes can affect all parts of the body including the eyes. Diabetic retinopathy is a commonly seen condition where the retina or 'seeing film' of the eye is damaged by high blood sugar levels in the blood vessels. Damage to these retinal blood vessels causes them to be blocked, leak serum or blood. It creates a condition of poor blood circulation to the retina and may also stimulate the abnormal growth of new blood vessels on the retina which in themselves can cause significant problems, all of which can eventually cause serious loss of vision or blindness.

The condition progresses slowly, usually without noticeable symptoms until the disease is well progressed and causing blurred vision, floaters or sudden catastrophic loss of vision. Diabetic retinopathy usually affects both eyes. Anyone with diabetes, type 1 and type 2 are at risk and the longer a person has had diabetes, the more likely diabetic retinopathy will develop. Regular eye checks are vital, good diabetes management and control of blood sugar levels is key to slowing the onset of diabetic retinopathy.

Diabetic smokers have a higher risk factor. Symptoms may be hard to detect, nor will there be any pain. Anyone with diabetes and experiencing changes in their vision including blurring or the appearance of 'floaters' should seek medical review immediately.

Flashes and floaters are a common condition often regarded as part of the normal ageing process of the eye. Flashes appear as streaks of light usually experienced in the peripheral vision. These flashes of light may be experienced over a prolonged period of time. Floaters are due to the progressive liquefaction of the normally thick gelatinous core of the eye (the vitreous) and appear like floating specks or threads in the field of vision. Despite the initial distraction, most people adjust and most floaters are harmless and require no treatment. Any sudden increase in the number of floaters may indicate a more serious condition of vitreous detachment from the retina (Posterior Vitreous Detachment or PVD). PVD is relatively common and in the majority of cases, it is a harmless condition however 10% of patients experiencing floaters and flashes may develop retinal tears or retinal detachment requiring urgent treatment.

Any sudden onset of flashes and floaters may be an indication of retinal damage and needs to be seen immediately. Similarly any new and sudden flashes experienced with floaters should be examined carefully.

Glaucoma is the name of a group of eye diseases causing damage to the optic nerve at the back of the eye which, left untreated is a leading cause of blindness. Early diagnosis and treatment is vital to prevent serious loss of vision. This damage to the optic nerve is mostly caused by an increased pressure inside the eye due to poor fluid drainage from the eye.

Incidence of glaucoma increases with age and carries a significant family hereditary risk factor. At present there is no cure for glaucoma so early detection and regular monitoring is important to minimise the extent of vision loss. Current treatment methods will slow the progression of the disease but cannot cure it. Vision lost through glaucoma cannot be restored.

Initially there are no symptoms of the most common forms of glaucoma. The damage to the optic nerve progresses very slowly and starts with peripheral vision loss. At the beginning most patients are unaware of the condition until the irreversible loss of sight is significant.

Glaucoma may affect anyone however people in higher risk groups should have their first eye check by age 35 and for other people by age 40. Regular checks are encouraged at least every 2 years thereafter. High risk groups include people who:

• have a family history of glaucoma
• are diabetic or have high blood pressure
• experience migraines
• are short sighted or long sighted
• have past eye injuries
• are currently or in the past used cortisone drugs (steroids)

In the majority of cases, gritty eyes are due to tear film instability. The tear film is made up of a mixture of water proteins (99%) and fat on the surface of the eye protecting it from the drying influences of the environment. The stability of the tear film reduces with age and poor eyelid health (eg blepharitis) and results in the uncomfortable feeling of grit or sand in the eyes. Reduced blinking during visually demanding tasks of reading, watching TV or computer work may further exacerbate the condition.

A true form of dry eye disease (called keratoconjunctivitis saecca) is rare and is due to the reduction or absence of watery content in tears as a result of an abnormality in the main tear producing organ, the lacrimal gland. People who suffer from tear film instability may also experience watery eyes due to excessive tear production in response to poor tear film stability. Further, watering may also be due to poor lid position or blockage in the tear draining system. (see below 'Epiphora' and 'Dacryocystitis')

Red eye results from inflammation of the white part of the eye. It can range from harmless to vision threatening. The most common causes of inflammation are due to surface disorders of the eye. Common presentations causing red eye include blepharitis (chronic inflammation of the eyelid), conjunctivitis and allergic eye conditions. These are mainly harmless in nature and can be successfully managed by your GP.

Patients with more critical symptoms such as severe pain, reduction or loss of vision, double vision, dilated pupil or changes in eyeball position need to be assessed urgently by an ophthalmologist. Patients presenting with these symptoms and who have recently undergone ocular/orbital surgery and those who use contact lenses should take extreme caution and seek help immediately.

A chalazion is a cyst or mass which results from blockage of one of the many meibomian glands on the eyelids. Symptoms include localised lid swelling with associated redness and tenderness. Hot packs applied to the eye several times a day may help reduce the mass. Chalazions mainly affect adults, can occur on either the upper or lower lids and are often recurrent.

Some 60% of chalazions resolve themselves after a few months however if it persists beyond 6 months it may need to be excised. If the mass persists or is very large, it can be surgically removed as a day procedure in the rooms.

Dacryocystitis is an infection in the tear drainage system of the eye. Tears made by the lacrimal gland are required to lubricate the surface of the eye, excess tears are then drained into the nose through the drainage system located in the eyelids and on the side of the nose, the nasolacrimal system. The most common point of obstruction leading to infection of this draining system is at the point where the duct passes through the bone at the side of the nose.

Symptoms of duct obstruction include excessive watering of the eye (epiphora) and/or stickiness of and lids. Pain, redness and swelling may also be a feature if the infection is severe. Surgical treatment is usually required in a procedure called a DCR - dacrocystorhinostomy.

The out-turning of an eyelid is called an ectropion and is more commonly seen in older people. Similar to entropions (inward turning lids), ectropions are due to the lid loosening from its bony attachments and from weakened muscles at the lid margin. The condition can also be caused by the growth of a tumour pulling on the lid, injury or contraction of scar tissue or skin around the eye.

Because the outward turning lid leaves the inner lining of the eyelid exposed, it can cause chronic irritation to the eye resulting in excessive tearing and infection. As the tear film across the eye cannot be properly maintained by the eyelid, the eye can become dry and inflamed and as a result potentially affect vision. Artificial tears and other lubricants may be used to prevent the drying of the cornea however, most ectropions will require surgical correction.

The in-turning of an eyelid and eyelashes is called an entropion. More commonly the lower lid is affected. The condition is due to the lid loosening from its bony attachments and imbalance of muscles at the lid margin pulling the lid and the lashes inwards during blinking.

As this occurs, scratching of the eye by the inward turning eyelashes can cause watery eyes, corneal irritation and in severe cases, cause corneal ulceration. The eye can become red and painful and due to the risk of scarring and infection to the cornea, surgical correction is often recommended.

An overflow of tears from the eyes is called epiphora and can be caused by a number of reasons. Irritation of the eye surface (eg allergy, dust particles, infection), blockage in the tear ducts, or mixture of both may cause tears to overflow. Persistently watering eyes can cause blurred vision, or be socially awkward. The efficiency of the nasolacrimal drainage system can be tested in our rooms and if blocked, surgical correction (a DCR procedure) to open the blockage can be considered.

Lid lesions (lumps and bumps) are common. In assessing lid lumps, it is important to differentiate benign lesions from those that are or may progress to malignancy. Generally majority of lid lumps are benign, however malignant skin tumours on the eyelids are not uncommon.

If a lesion persists, increases in size, changes colour, bleeds or recurs in the same area is it advisable to have it checked out.

Ptosis is the medical name for drooping upper lids present in one or both eyes. Drooping lids can interfere with part of the visual field or it may be a cosmetic concern. People experiencing ptosis may have difficulty in keeping their eyelids open, experience eyestrain or eyebrow ache from constantly having to raise their lids to see properly. It can also cause fatigue especially when reading.

Ptosis can be present at birth (congenital) or it can be acquired. Ptosis occurring in later life (acquired ptosis) is mostly due to age related changes. Other causes include long term contact lens wear or trauma to the eyelid. Less common causes of acquired ptosis include damage to nerves and muscles of the lids. Droopy lids are usually surgically corrected as a day procedure.