Cataracts is a total or partial clouding of the eye lens, whose function is to convert the light rays received into images on the retina. Therefore, when this part of the eye becomes obstructed, the vision becomes weak and blurred. It is a fairly common ailment that increases with age.
There are many types of cataracts:
Vision deterioration after cataract diagnosis is very variable. Some cataracts can progress rapidly, decreasing vision in the months following diagnosis, while with others there is very little change over time. Monitoring and assessing the evolution of the cataract can only be done through regular check-ups by an ophthalmologist.
Cataracts are the most common cause of reversible blindness in the world.
Cataracts cause decreased vision.
In the initial stages, you might notice more subtle symptoms such as:
The diagnosis of cataracts should always be made by an ophthalmologist, either during routine check-ups or when a person attends the clinic with suggestive symptoms.
The diagnosis and degree of cataract, if any, will be determined after a complete eye examination with the pupils dilated (dilated with eye drops). Each case must be assessed individually to establish the appropriate treatment.
The tests that are usually performed include:
In the eye is a structure called the crystalline lens, which focuses images onto the retina. Under normal conditions, this crystalline lens is transparent. However, over the years this structure becomes opaque and is what we call a cataract.
In addition to ageing, there are other factors that can lead to non-elderly people developing cataracts, including:
The following advice may help prevent cataracts:
The only treatment to cure cataracts and restore proper vision is to have them surgically removed, although this is only recommended if the person’s discomfort prevents them from going about their normal daily life or if they cannot wear glasses.
Surgery to correct cataracts involves removing the damaged part of the lens and replacing it with an intraocular lens.
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:
Dry macular degeneration:
Early diagnosis is key to starting a treatment as soon as possible. If it is not treated quickly, the prognosis can be poor.
Macular degeneration does not cause pain, but may present a number of visual symptoms that the patient should recognise:
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.
A complete diagnosis is usually made with:
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:
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.
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:
Ophthalmologists are responsible for preventing, diagnosing and treating diseases that affect the patient's eyes and visual capacity, such as macular degeneration.
Diabetic retinopathy is a complication of diabetes that affects the eye and can severely damage vision, even causing blindness if left untreated.
The retina is the layer of cells on the back wall of the inside of the eye. These cells, known as photoreceptor cells, are light-sensitive and can be divided into cones and rods. Light enters through the front of the eye and is focussed by the lens onto the retina, stimulating the cells, which triggers a nerve signal to be sent to the brain. The brain then forms an image, based on the signal sent from the retina, making the retina crucial to our ability to see.
To do its job, the retina needs a constant supply of blood to bring it oxygen and nutrients. If diabetes is not well-managed, the blood sugar level rises to dangerous levels, and one effect this can have is to cause the tiny blood vessels supplying the retina to bulge and leak and reduce the level of oxygen reaching the photoreceptor cells.
Diabetic retinopathy usually causes no symptoms in the early stages, which means it often progresses enough to affect vision. When this happens, certain symptoms may manifest:
What is more alarming is that in some cases, it can progress without warning signs, so for diabetic patients it is important to have regular eye exams.
Over time, a persistently high blood sugar level caused by diabetes can damage the blood vessels that supply the retina with oxygen and nutrients. There are three main stages to this:
The probability of suffering from diabetic retinopathy is greater if the patient:
To avoid diabetic retinopathy, it is essential for diabetic patients to keep their blood glucose, blood pressure and cholesterol under control. Smoking is strongly discouraged.
Patients suffering from the early form of the disease may not require treatment, although it is essential to manage diabetes and monitor the progression of the retinopathy.
For diabetic retinopathy that is affecting vision, the following treatments may be recommended:
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:
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.
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.
There are some steps that you can take to reduce the risk of a uveitis flare-up, such as:
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.
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.
Depending on the type of glaucoma, you will have one prognosis or another:
Depending on the type of glaucoma you have, you will feel some symptoms or other:
Open-angle glaucoma:
Angle-closure glaucoma: Symptoms may come and go at first or get worse all the time. You can feel:
Congenital glaucoma: Symptoms are almost always noticed within a few months of age in children:
The only way to diagnose glaucoma is to have a complete eye exam.
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.
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:
Congenital glaucoma occurs in new-borns from an inherited cause
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.
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:
Angle-closure glaucoma :
Congenital 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.
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.
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).
In order to diagnose it, your doctor will simply take a look at the infection to determine what stage it has reached.
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.
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.
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.
Ms Theresa Richardson is a highly experienced ophthalmologist with over 26 years of experience, based in London. From her private clinics at the Western Eye Hospital, BMI Shirley Oaks Hospital and Charing Cross Hospital, Ms Richardson specialises in cataracts, macular degeneration and diabetic retinopathy. At present, she is the leading ophthalmologist for eye casualties in west London and has received numerous clinical excellence awards for her work with the NHS.
Ms Richardson qualified in 1991 from the University of London with honours in medicine and surgery. She was awarded the Esther Frances Williams prize for best overall performance in her year, with more prizes won than any other student. She completed her specialist ophthalmology training at Moorfields Eye Hospital and the Western Eye Hospital, where she received a fellowship in retina conditions and uveitis. Ms Richardson has held the position of medical retina and cataract trainer at both Imperial Health Care Trust The Western Eye and Charing Cross since 2014 and has been consultant ophthalmologist at BMI Shirley Oaks Hospital since 2003.
Ms Richardson is a highly esteemed teacher of cataract surgery, with more than 26 years of training experience, having performed over 25 thousand cataracts, with a complication rate of less than 0.04 per cent. Her background in psychology ensures that her patients are not only provided with quality treatment but with quality care that is supportive and understanding of their individual needs.
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.
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:
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.
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:
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.
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.
An angiography is a type of X-ray which examines the blood vessels.
First, a catheter is inserted into one of your arteries, depending on the area which needs to be examined. Through this catheter, a dye is administered to contrast the area that needs to be visualised. The catheter is then guided through the arterial system to the area which needs to be examined. X-rays are then taken as the contrast dye flows through the blood vessels.
An angiography is done to check how the blood flows through the vessels, and the general health of the blood vessels too. An angiography is useful in investigating and diagnosing problems affecting the blood vessels, such as narrowing of the arteries, blood clots, or embolisms.
Before the test, the patient is examined, including a blood test. The clinic or doctor will ask you about your medical history and if you are taking any medications. The doctor will also ask if you would prefer to be sedated during the procedure.
The X-ray table can be somewhat uncomfortable, and the procedure generally lasts between 30 minutes and two hours. You may also feel a pinch when local anaesthesia is administered, but the area is generally numbed so it shouldn’t hurt. When the catheter is inserted and moved around the body, you may feel a pushing or pulling sensation, but it should not be painful.
After the angiography, you will be moved to an area where you can rest, and you have to lie still for a few hours to prevent bleeding. Generally angiographies are performed as a day case procedure, although in some cases you may be kept in overnight for monitoring. Generally results of the test are available after a few weeks. You may feel some discomfort, such as soreness at the entry site for a few days after the procedure. Some bruising may also occur.
Acute angle-closure glaucoma is a serious condition that makes the pressure inside the eye rise suddenly, within a matter of hours. It is not as common as other types of glaucoma that cause pressure to build-up much more slowly over a longer period of time. The rapid increase in pressure inside the eye is called intraocular pressure.
Acute angle-closure glaucoma is caused when the drainage in the eye is blocked because the iris has moved forward, closer to the cornea and caused the drainage angle to ‘close’ and eye pressure to rise. The system of canals that the eye fluid normally drains out of becomes completely blocked. The pressure that builds-up can damage the optic nerve. If the condition is not treated immediately and permanent damage occurs, it is known as primary angle-closure glaucoma.
Sometimes angle-closure glaucoma can have no symptoms and other times they can be very obvious. These may include:
Women are more likely to develop the eye condition than men. It is also common in people of Asian descent, those who are farsighted, have a family history of the disease, or those who are in the age range of 55-65.
The eye specialist will try to get rid of some of the pressure in the eye when treating angle-closure glaucoma. They may do this using drops that narrow the pupil or with medication that lowers the amount of fluid that the eye makes. Once the intraocular pressure has dropped, the ophthalmologist may use a laser to make a small hole in the iris to help the fluid start flowing inside the eye again. The doctor may also pull the edges of the iris away from the drainage canals. The doctor will most likely treat both eyes, even if only one is affected, as it is better to be safe than sorry.
An angle-closure glaucoma attack can be prevented if the eyes are checked regularly at the opticians, especially if you are at high risk. This is to monitor the pressure levels and how well fluid rains.
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.
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.
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:
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:
Possible causes are:
In addition to an underdeveloped iris, the patient’s eye may be underdeveloped in general, including a little-developed retina.
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.
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.
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 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.
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.
The main symptom of astigmatism is blurry vision, which can come with:
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.
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 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.
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.
The most common symptoms of blepharitis show up on the eyelids. These may include:
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:
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.
The most common causes for this condition are:
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.
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.
If you think you may have blepharitis, you should see an ophthalmologist.
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.
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.
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.
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.
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 is a type of muscle spasm or dystonia affecting the muscles that control the eyelids, which causes them to close involuntarily. This can cause rapid and/or frequent blinking, an inability to open the eye (apraxia), the eyes forcing themselves closed, or a combination of these symptoms. Other facial muscles can be affected too, with twitching symptoms radiating across the face and sometimes even the neck.
Blepharospasm is a spasm of the muscles around the eye, which can cause the following symptoms:
Exactly what causes blepharospasm is not fully understood. There is some evidence from neuroimaging that dysfunction of the basal ganglia may play a part.
Some patients have a history of dry eyes and light sensitivity before the onset of blepharospasm, but others do not. It has been theorised that genetics play a part, at least in some cases, with some patients having family histories of blepharospasm and/or chronic eye irritations.
In addition, other possible causes and risk factors include:
Benign essential blepharospasm (BEB), i.e. blepharospasm that is not associated with another disease or cause cannot be prevented. However, secondary blepharospasm may be prevented by taking steps to avoid the cause, e.g. by avoiding triggers and irritants like bright lights, treating the underlying condition or decreasing the dose of causal medication (if instructed by your doctor). If the patient tends to have dry eyes, it is recommended to apply lubricating drops
Keeping the eyes lubricated with eye drops, avoiding irritants and things that trigger twitching, and wearing dark sunglasses to avoid exposure to bright light can all aid in the management of the condition.
In the case of secondary blepharospasm, treating the underlying condition may cause the blepharospasm to disappear.
Medical and surgical measures may be necessary to deal with blepharospasm that is severely affecting the patient’s life:
Botulinum toxin, more commonly known as Botox™, is a neurotoxin that, despite being released by the microbe that causes botulism (a type of food poisoning), is also a drug used for medical purposes to treat various conditions. It is also used as a cosmetic treatment. It is administered via injection. Botox™ was the first drug developed to use the botulinum toxin, but others have also been developed.
The most common uses for the botulinum toxin are:
The botulinum toxin acts by temporarily paralysing certain muscles, for example, when used for facial muscles this smoothens their appearance. This also has the added benefit of preventing certain facial expressions, such as wrinkling your forehead which acts as an anti-ageing measure. Botulinum toxin injections weaken and paralyze certain muscles, blocking some nerves. They are injected with thin needles and the number you receive in a treatment session will depend on what they are being used for.
The effects of the injection are not immediate, they begin to reveal after three or four days have elapsed, depending on each patient. The results can be highly satisfactory. In addition, depending on the patient, the effect of botulinum toxin can last between four and eight months; so, to keep the same look regular treatments would be required.
Pregnant or breastfeeding patients cannot undergo a botulinum toxin treatment. Although the injections are not too painful, some patients will prefer to have the skin numbed beforehand using topical anaesthesia.
You can usually resume normal activities the same day as your treatment. You should avoid rubbing or massaging the treated area as this can move the toxin to other areas within the surrounding skin and muscle.
Possible side effects of botulinum toxin injections include:
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.
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).
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.
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.
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.
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.
Cataracts is a total or partial clouding of the eye lens, whose function is to convert the light rays received into images on the retina. Therefore, when this part of the eye becomes obstructed, the vision becomes weak and blurred. It is a fairly common ailment that increases with age.
There are many types of cataracts:
Vision deterioration after cataract diagnosis is very variable. Some cataracts can progress rapidly, decreasing vision in the months following diagnosis, while with others there is very little change over time. Monitoring and assessing the evolution of the cataract can only be done through regular check-ups by an ophthalmologist.
Cataracts are the most common cause of reversible blindness in the world.
Cataracts cause decreased vision.
In the initial stages, you might notice more subtle symptoms such as:
The diagnosis of cataracts should always be made by an ophthalmologist, either during routine check-ups or when a person attends the clinic with suggestive symptoms.
The diagnosis and degree of cataract, if any, will be determined after a complete eye examination with the pupils dilated (dilated with eye drops). Each case must be assessed individually to establish the appropriate treatment.
The tests that are usually performed include:
In the eye is a structure called the crystalline lens, which focuses images onto the retina. Under normal conditions, this crystalline lens is transparent. However, over the years this structure becomes opaque and is what we call a cataract.
In addition to ageing, there are other factors that can lead to non-elderly people developing cataracts, including:
The following advice may help prevent cataracts:
The only treatment to cure cataracts and restore proper vision is to have them surgically removed, although this is only recommended if the person’s discomfort prevents them from going about their normal daily life or if they cannot wear glasses.
Surgery to correct cataracts involves removing the damaged part of the lens and replacing it with an intraocular lens.
As opposed to vision problems caused by conditions of the eyes, cerebral visual impairment (CVI) refers to vision problems caused by the brain not being able to interpret the information from the eyes passing along its visual pathways.
Children affected usually find it difficult to focus on objects, especially if multi-tasking, and may have difficulty recognising people and objects against different backgrounds. Distractions, such as noise, can affect what the sufferer is seeing.
CVI is the most common type of visual impairment in children in the developed world.
Cerebral visual impairment affects different children in different ways and to different degrees. Here are some possible symptoms to watch out for:
There are several possible causes of CVI, although in many cases it may not be obvious which cause is responsible. Some of the major causes are:
Children born prematurely (before 34 weeks) should also be closely monitored for signs of CVI.
Due to the nature of the causes, cerebral visual impairment is impossible to prevent. Children who have been affected by the possible causes listed above should be carefully monitored by their parents and doctors for signs of CVI.
While there is no cure, there are many ways to support a child suffering from CVI. Children with CVI and their families are entitled to support from their local authority in finding specialist teachers to aid their educational, social and emotional development. As sufferers can find it difficult to recognise familiar objects, keeping one with the child throughout the day can help them in recognising it in different environments, while using brightly-coloured objects and minimising background noise can help the child to ‘practise’ using the vision they have.
A chalazion is a small, painless lump which grows on the eyelid. Unlike a stye, a chalazion is not caused by infection but by a gland in the eyelid becoming clogged.
Chalazions often go away on their own after a few months, but there are some treatment options if it is causing symptoms such as:
You can often help treat a chalazion yourself with heat compression treatment. This involves soaking a cotton wool pad in hot water and gently pressing it against your eyelid, taking care not to get hot water in your eye. The pressure and heat can sometimes cause the chalazion to release its content.
If this hasn’t worked, your doctor can prescribe you antibiotics to reduce any inflammation.
If the treatments above haven’t worked, surgery may be required.
Surgery to remove chalazion is quick and can be carried out at an eye clinic. You’ll be asked to lie down on a couch and you will be given eye drops to numb the area around your eye. The surgeon will then make a very small incision to remove the chalazion from the eyelid.
After the procedure your eye will be bruised for a few days, and you’ll need to take antibiotic ointments a few times throughout the day to make sure that the eye doesn’t become infected. The risks of complications from surgery are very low and any complications that do occur will be minor.
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:
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.
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.
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 (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:
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.
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.
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:
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.
As of yet, colour vision deficiency has no definitive cure. However, there are special glasses which may help patients to distinguish colours better.
You should see an ophthalmologist if you have any difficulties with your colour vision.
Congenital glaucoma, or childhood glaucoma, is a rare condition which affects babies and young children, in which the drainage system in the eye does not develop properly, causing increased intraocular pressure. This pressure damages the optic nerve, which transmits information between the retina and the brain. It is usually diagnosed within a child’s first year of life. If left untreated, it can cause blindness.
While the underlying reason for congenital glaucoma is still not fully understood, it can occur when the drainage system in the eye does not develop properly. Family history of glaucoma is also a risk factor, and more boys than girls experience the condition.
Some of the symptoms of glaucoma in children include:
Congenital glaucoma is hereditary and as such cannot be prevented.
The main treatment of congenital glaucoma is surgery. The surgeon may recommend microsurgery, where a drainage canal is created in the eye using small surgical tools, or laser surgery, which uses a strong beam of light to lower eye pressure. However, laser surgery is much less commonly performed than microsurgery.
Drops and medication may also be administered to help lower pressure in the eye if surgery cannot be immediately performed.
An ophthalmologist can correctly identify and treat congenital glaucoma. It is important that your child’s eyes are regularly checked to identify vision problems and eye conditions at an early stage. Follow your doctor or healthcare provider’s recommendations for when your child should be given an eye test.
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:
Conjunctivitis generally does not affect vision. Infectious conjunctivitis is easily spread from person to person.
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.
The most common symptoms of conjunctivitis are:
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:
The causes may be:
Simple preventive measures can be taken on a day-to-day basis to significantly reduce the risk of getting conjunctivitis:
Depending on the type of conjunctivitis, the following treatments might be needed:
Ophthalmologists are in charge of preventing, diagnosing and treating diseases that affect the eyes and the visual capacity of the patient, such as conjunctivitis.
Wearing contact lenses can cause a range of problems, from mild discomfort and blurred vision, to dry eye, an allergic reaction, scratches on the cornea, and corneal infection. Some of these problems can be resolved by replacing the lenses with a new pair, or a pair in a slightly different size. To treat any infections or damage to the eye it is important to see an ophthalmologist.
Much of time when discomfort is experienced when wearing contact lenses, the problem is just mild irritation, but more rarely you could experience a sight-threatening infection that needs immediate medical attention.
Common symptoms experienced when wearing contact lenses could include:
If you are experiencing problems with your contact lenses, your ophthalmologist or optometrist should be able to provide guidance at your regular check-ups. If you are suffering dry eyes, for example, this will be identified in an eye appointment.
The most common causes of contact lens discomfort are:
Yes, as long as you keep your lenses clean and properly stored, as well as using lenses that are not old, you should not experience problems with your contact lenses. If you are having problems with a certain type of contact lens, there are other options you could try, under the recommendation of your ophthalmologist or optometrist. If you decide that contact lenses are not working for you, you could always consider either wearing glasses or having vision correction surgery (e.g. LASIK or RLE).
Whilst many problems will be solved by improving care and use, some people will only find comfort by trying a different type of contact lens, for example, or using special eye drops to prevent dry eyes whilst wearing contact lenses. If you develop an infection, seek medical attention immediately for treatment.
Optometrists would look after your daily use of contact lenses, advising on types and how to look after them. Ophthalmologists would also be able to advise on this, as well as treating problems such as dry eyes or infections.
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.
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.
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:
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.
You should see a specialised ophthalmologist.
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.
This is a condition that gets worst with age and, except in very advanced cases, does not require treatment.
The most notorious symptoms of cornea guttata are those derived from the corneal thickening that it entails:
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.
The diagnosis of cornea guttata is clinical, with observation of the cornea. In early stages, an endothelial cell count can be performed.
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.
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.
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.
Ophthalmologists are responsible for preventing, diagnosing and treating diseases that affect the patient's eyes and visual capacity, such as cornea guttata.
A corneal abrasion is one of the most common eye injuries and involves a scratch on the eye.
The cornea sits at the front of the eye and is a clear “window” to the back of the eye, where light is turned into optical signals. The role of the cornea is to focus the light that comes into your eye to provide a clear picture.
Corneal abrasion is a common injury and generally should heal within a day or two, but in some cases can result in infection. If you suspected your eye may be infected, it is important to see a doctor as urgently as possible.
The symptoms of corneal abrasion include:
Corneal abrasion is usually diagnosed by giving you an eye drop to numb the affected eye, then using a blue light or microscope to see the eye in more detail.
Anything that comes into contact with your eye can cause a scratch. Some common causes include:
You’re at a greater risk of corneal abrasion if you have dry eyes, as this can cause your eyes to tear after being asleep.
It can be difficult to prevent some causes of corneal abrasion, but you can take the following precautions to reduce your risk:
If you suspect you have a corneal abrasion, it’s important to resist the urge to rub your eye, as this can cause any foreign body in the eye to scratch it further. The first task is to safely remove anything foreign to your eye, by:
If you feel like something is in your cornea and you can’t remove it, see a doctor as soon as possible. Don’t try and remove it yourself with cotton swabs or tweezers.
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.
The main symptoms are:
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.
The recommended measures to prevent a corneal ulcer are:
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.
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.
Dark circle treatment is suitable for men and women of all ages who wish to get rid of dark circles.
Depending on the cause of their appearance, different techniques can be used to treat dark circles:
No special prior preparation is necessary.
There are no specific indications.
Dermal fillers are one of the most popular treatments used in cosmetic surgery in this day and age, due to the pleasing results they offer without the need to undergo a surgical intervention. The results are achieved by non-invasive techniques, with no risks or secondary effects.
The fillers are used to eliminate wrinkles and deep facial folds, volume replenishment or simply to rejuvenate and revitalise the skin. The infiltrations consist of hyaluronic acid, polycaprolactone threads, polylactic acid, calcium hydroxyapatite and tricalcium phosphate, collagen or fat fillers.
All fillers are applied under local anaesthesia, and can be applied as a complement to other treatments, such as facial surgery or botulinum toxin.
Dermal fillers are used to rejuvenate and revitalise the skin on the face. The different types of infiltrations help skin recover its natural feel and also restore aging signs, this is achieved by recovering lost volume, highlighting cheeks or cheekbones, and end with wrinkles and facial folds.
The fillers help to reduce the loss of tissue elasticity that manifest as a consequence of aging by ending the sensation of sagging skin, loosened skin and lack of facial skin firmness.
There are various techniques using different filling material infiltrations, which are used depending on the area to be treated, such as the type of wrinkle, the location or the depth.
Before undergoing this treatment, your doctor will explain exactly what is involved and set adequate expectations. There is no specific preparation required.
Dermal fillers are also popular as they pose minimal risk, and the main concern after the procedure is the local inflammation reactions that can follow-up after the treatment, such as irritation or pressure. However, these symptoms are only temporary.
Diabetic retinopathy is a complication of diabetes that affects the eye and can severely damage vision, even causing blindness if left untreated.
The retina is the layer of cells on the back wall of the inside of the eye. These cells, known as photoreceptor cells, are light-sensitive and can be divided into cones and rods. Light enters through the front of the eye and is focussed by the lens onto the retina, stimulating the cells, which triggers a nerve signal to be sent to the brain. The brain then forms an image, based on the signal sent from the retina, making the retina crucial to our ability to see.
To do its job, the retina needs a constant supply of blood to bring it oxygen and nutrients. If diabetes is not well-managed, the blood sugar level rises to dangerous levels, and one effect this can have is to cause the tiny blood vessels supplying the retina to bulge and leak and reduce the level of oxygen reaching the photoreceptor cells.
Diabetic retinopathy usually causes no symptoms in the early stages, which means it often progresses enough to affect vision. When this happens, certain symptoms may manifest:
What is more alarming is that in some cases, it can progress without warning signs, so for diabetic patients it is important to have regular eye exams.
Over time, a persistently high blood sugar level caused by diabetes can damage the blood vessels that supply the retina with oxygen and nutrients. There are three main stages to this:
The probability of suffering from diabetic retinopathy is greater if the patient:
To avoid diabetic retinopathy, it is essential for diabetic patients to keep their blood glucose, blood pressure and cholesterol under control. Smoking is strongly discouraged.
Patients suffering from the early form of the disease may not require treatment, although it is essential to manage diabetes and monitor the progression of the retinopathy.
For diabetic retinopathy that is affecting vision, the following treatments may be recommended:
Diplopia, also called double vision, is an eye condition in which the images perceived by the eyes are not processed in the brain as a single spatial image, and instead, the brain sees two images. Depending on its origin, it can be of two types:
In terms of symptoms, diplopia can be categorised as:
Apart from double vision, other symptoms can include:
There are many things which can cause diplopia, including:
Some causes of diplopia can be prevented, for example, by using the seatbelt in the car to avoid trauma, or by putting on glasses and head protection during any sporting activity or at work, if necessary. In addition, people with diabetes can lower the risk by controlling their blood sugar level.
The treatment will depend on the causes of the disease, so it is important to first come to a definitive diagnosis through thorough eye testing and in some cases, blood tests or scans. Treatment may include medication or surgery to correct damage to the eye. If the double vision cannot be fully cured, you will be prescribed special glasses to improve your vision.
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.
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.
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 include visual acuity measurement, slit lamp examination, measurement of the rate of tear production, tear concentration, and tear film rupture time.
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.
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.
An epiretinal membrane is a translucent cellular membrane that develops over the macula (the central part of the retina responsible for vision of detail and movement). These cells are normally derived from the retina but may also be derived from deeper layers, such as the pigmented epithelium.
These cells secrete collagen and form a mesh; when this membrane contracts, it distorts retinal tissue, giving rise to folds and wrinkles on the surface of the macula that affect its function.
If the epiretinal membrane is not treated, it may lead to loss of central vision; however, it will never lead to total vision loss because only the macula is affected. Hence it is important to undergo annual reviews.
This pathology may be asymptomatic, though the main symptoms that reveal the presence of an epiretinal membrane are loss of visual acuity, distortion of images (metamorphopsia), micropsia (seeing objects smaller), diplopia (seeing double), aniseiconia (seeing objects of different size in each eye) and vision loss.
To confirm metamorphopsia, the Amsler grid test is performed. To diagnose blurred vision, optotypes are used.
There are different factors that can cause epiretinal membrane, though the most frequent is posterior vitreous detachment (ageing process of the gel inside the eye, usually appearing in people aged over 50 years). Other causes are retinal detachment, vascular diseases, intraocular inflammation and severe ocular traumatic injury.
There are no concrete measures to prevent the development of an epiretinal membrane. Even so, it is important to consult with an ophthalmologist if you suspect any symptoms (such as floaters or flashes).
The epiretinal membrane can be monitored at regular intervals, but if the symptoms worsen, consideration should be given to vitreoretinal surgery (posterior vitrectomy), one of the retinal surgical procedures giving the best results. This technique can restore vision that has been lost since the membrane developed (however normally only about half is restored, so the intervention should not be delayed too much).
The epiretinal membrane should be treated by an ophthalmologist.
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.
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.
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.
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.
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:
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:
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 allergies, also known as allergic eye disease, describes a set of allergies similar to hayfever and asthma where the eyes display an excessive immune reaction to an external environmental factor.
The main types of eye allergies are:
Acute allergic conjunctivitis is most common amongst young children playing outdoors, often triggered by long grass or pets. The symptoms include itchy, watery eyes with some eyelid swelling as well.
The symptoms of chronic allergic conjunctivitis depends on the type.
Hayfever conjunctivitis:
Vernal conjunctivitis:
Giant papillary conjunctivitis:
The symptoms of eye allergies can be very similar to those of infectious conjunctivitis, but there are a few key differences that can help when diagnosing:
The best way to prevent allergic conjunctivitis is to avoid the allergen that triggers it. Some ways to do this include:
As well as at-home remedies, such as eye baths and using a cool cloth to compress the eyes, there are some medical treatments available. These include:
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:
Each type form of eye cancer has a different prognosis:
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).
An ophthalmologic examination using an ophthalmoscope may reveal a simple oval or round lump (tumour) in the eye.
Tests that may be performed include:
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.
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.
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.
All eye tumours require early and thorough evaluation by an ophthalmologist.
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.
If you go in for an eye exam, you can usually expect these basic steps:
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.
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.
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, 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.
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.
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.
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.
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:
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 is a condition that causes partial or total motor paralysis of the facial nerve and, therefore, of the facial musculature.
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.
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.
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.
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 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:
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.
The typical symptoms are:
Other problems may occur, such as scarring of the cornea.
Fuchs' dystrophy can be diagnosed during a slit-lamp examination. But it can also be diagnosed using:
The causes of Fuchs' dystrophy may be:
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.
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.
Ophthalmologists are responsible for preventing, diagnosing and treating diseases that affect the patient's eyes and visual capacity, such as Fuchs' dystrophy.
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.
Depending on the type of glaucoma, you will have one prognosis or another:
Depending on the type of glaucoma you have, you will feel some symptoms or other:
Open-angle glaucoma:
Angle-closure glaucoma: Symptoms may come and go at first or get worse all the time. You can feel:
Congenital glaucoma: Symptoms are almost always noticed within a few months of age in children:
The only way to diagnose glaucoma is to have a complete eye exam.
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.
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:
Congenital glaucoma occurs in new-borns from an inherited cause
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.
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:
Angle-closure glaucoma :
Congenital 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 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.
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.
The symptoms that you might experience if you have hyperopia include:
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.
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.
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.
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.
Ophthalmologists will treat and diagnose hyperopia.
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.
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:
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.
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.
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 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.
The symptoms of keratitis are usually clear. These usually include:
Any tear or superficial trauma of the cornea can lead to keratitis. Factors which increase the risk of developing keratitis include:
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:
You should see an ophthalmologist in order to treat keratitis.
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.
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.
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.
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.
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.
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.
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:
Keratoconus should be managed by an ophthalmologist.
Intraocular lenses (IOLs) are lenses used to replace damaged lenses. They are placed in the eye so that the light that enters goes to the retina.
There are two types of intraocular lenses:
They tend to be made from flexible and foldable material which are the same size as the original lens.
The procedure is normally carried out under topical anaesthetic which is administered in drops. It is a painless procedure that is done on an outpatient basis, and doesn’t require the eye to be covered for longer than half an hour afterwards.
Intraocular lenses tend to be used in cases of cataracts, myopia, or other visual disorders. Another reason intraocular lenses are used is for patients without presbyopia. This preserves the lens and corrects different refractive errors. The patient can return to normal life shortly after surgery.
Intraocular lenses are implanted in the eye during cataract surgery to replace the natural lens.
An ophthalmologist will run a series of tests to determine patient suitability and what the best option is according to their needs.
The depth of the anterior chamber is measured to ensure that the intraocular lens fits the eye without altering anatomical structures.
The post-operative period is short, and the patient can return to normal life and continue with daily activities without any issues.
Complete bed rest is not necessary after the procedure, just take care to avoid traumas and apply eye drops. The application of the drops will depend on the procedure that has been done. They tend to be applied two to four times a day for the three weeks following the surgery.
Laser refractive surgery may be considered. This type of surgery reshapes the cornea (which is responsible for our vision) using a laser. Corneal tissues are lifted to do this, they will be replaced after surgery and do not require stitches.
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.
After being diagnosed with low vision, a good quality of life can be achieved with treatments that aim to improve vision.
The main symptoms of low vision are:
To diagnose low vision, different tests are performed to determine the following:
Low vision can be caused by a number of factors, including the following:
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.
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.
The specialist who treats low vision is an ophthalmologist.
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:
Dry macular degeneration:
Early diagnosis is key to starting a treatment as soon as possible. If it is not treated quickly, the prognosis can be poor.
Macular degeneration does not cause pain, but may present a number of visual symptoms that the patient should recognise:
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.
A complete diagnosis is usually made with:
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:
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.
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:
Ophthalmologists are responsible for preventing, diagnosing and treating diseases that affect the patient's eyes and visual capacity, such as macular degeneration.
A macular hole is a traction tear in the macula, which is the centre of the retina. The retina is responsible for providing the high resolution required for everyday activities such as reading.
There are two types of macular hole: lamellar macular holes do not affect the entire thickness of the retina, while full-thickness macular holes do. There are also different stages of macular hole:
The prognosis is very good: today, more than 90% of cases are treated successfully. In some cases, they resolve spontaneously.
The main symptoms of a macular hole are loss of central vision and distorted vision in one eye. The distortion causes straight lines to become wavy, such that numbers and letters seem to jump out.
Other symptoms include a central grey area, or a blind area in the central vision.
In the early stages of the disease, a yellowish lesion can be detected in the fovea.
To diagnose a macular hole, the back of the eyes are examined. The specialist dilates the pupils then examines the retina.
Optical coherence tomography (OCT) is an examination used to determine the size of the hole, allowing the specialist to determine the prognosis and also to confirm closure of the hole post-operatively.
Most cases of macular hole are idiopathic, i.e. the macular hole develops in healthy patients without any evidence of other eye diseases. Macular holes are more likely to occur as you get older.
A macular hole may develop as a result of:
Macular holes cannot be prevented, although they can be detected in the early stages. The sooner the hole is detected, the better the visual recovery is.
Macular holes are treated by vitrectomy (removing the innermost retinal layer); however in some cases, at an early stage, they can be treated via an intravitreal injection.
Macular holes are treated by ophthalmologists.
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.
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.
The symptoms of macular oedema affect central vision, causing:
If it is not treated properly, the patient may have very limited central vision.
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:
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:
Good control of predisposing factors, such as diabetes or high blood pressure is essential.
Treatment of macular oedema will depend on the cause and the degree of progression. The following are possible treatments for 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 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:
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.
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.
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.
There are different ways to treat myopia, depending on its degree:
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.
Neuro-ophthalmology can treat and diagnose several conditions, including:
There are several conditions which can affect the visual system, thus interfacing with neuro-ophthalmology, such as:
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.
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.
The neuro-ophthalmology field is mainly composed of neurologists and ophthalmologists.
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:
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.
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.
This condition cannot be prevented. However, it is important to control alcohol consumption. It is also important to undergo annual ophthalmological evaluations.
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.
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).
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.
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).
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.
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 occurs when the pressure inside the eye (intraocular pressure) is higher than normal. This pressure is measured in millimetres of mercury (mmHg) and is considered normal when it is between 10-21mmHg. It should be noted that intraocular pressure increases with age.
Although ocular hypertension often doesn’t cause any symptoms, if left untreated it can lead to glaucoma – the high intraocular pressure damages the optic nerve, which causes vision loss. For this reason, it is important to have regular eye check-ups to catch the condition before it causes more serious problems.
Ocular hypertension does not typically manifest with any specific symptom, which makes it difficult to detect. The only way to diagnose ocular hypertension is through an eye exam, in which the ophthalmologist will use a tonometer to measure the eye pressure. If it is elevated on two different occasions, ocular hypertension will likely be diagnosed.
The main cause of ocular hypertension is insufficient drainage of the aqueous humour (the fluid inside the front of the eye). The eye is constantly making this fluid, while an equal amount flows out of the eye. If more fluid enters the eye than is drained from it, this causes an increase in pressure inside.
People at particular risk of this occurring include those with a family history of ocular hypertension, myopia or diabetes.
In some cases, hypertension can be causes by an eye injury, certain diseases, and certain medications.
Early diagnosis is very important so that ocular hypertension does not cause damage to the optic nerve or loss of vision. Depending on how high the pressure is, the ophthalmologist might not prescribe a treatment immediately, but instead monitor the intraocular pressure with frequent check-ups.
If treatment is needed, it may include medication to reduce the intraocular pressure, often in the form of eye drops. In order for the treatment to work, it is essential to strictly follow the doctor's instructions.
In some cases, surgery in the form of laser trabeculoplasty is used to lower eye pressure.
Ocular melanoma is a form of cancer that affects melanin, the cells responsible for producing pigment in the body. Although this disease is rare, it is the most common type of cancer that affects the eyes. It can affect all parts of this organ, especially hard-to-access parts that make detection difficult. This is why it is essential to have regular eye examinations. Treatment for ocular cancer will depend on the degree to which the melanoma has developed at the time of detection, but there are mainly two types of treatment: radiation therapy, aimed at halting the growth of the melanoma or, if possible, eliminating it; ocular melanoma surgery, whereby the tumour is removed, unless it is too large (which would require complete removal of the eye and replacement with an prosthesis).
The prognosis for a person affected by ocular melanoma will be different depending on the characteristics of the type and location of the tumour and the stage of melanoma progression. If the cancer is diagnosed before it reaches an advanced stage, the probability of survival is around 100%. However, if the melanoma is diagnosed at an advanced stage, this percentage decreases exponentially. It is precisely for this reason that early detection is necessary through regular check-ups with the ophthalmologist.
In some cases, ocular melanoma may not have any specific cause or produce any symptoms. However, in other cases, the following signs and symptoms may appear:
There are different tests to diagnose this disease. The ophthalmologist may recommend some of the following:
Eye exam: the ophthalmologist will check the outside of your eye for inflamed blood vessels, which may be a symptom of a tumour in the eye. Then, using other devices, they will examine the inside of your eye.
Eye ultrasound: this test uses high-frequency sound waves emitted from a portable, rod-shaped device called a transducer, which reflects images of the eye. The device is placed on the closed eyelid or on the front surface of the eyeball.
Eye angiography: this allows the specialist to see images of the blood vessels in the tumour and surrounding area. With this procedure, a dye is injected into a blood vessel in your arm. The dye reaches the veins of the eye and then a camera with built-in filters detects the dye and takes pictures for several minutes.
Biopsy: sometimes the ophthalmologist may decide to remove a sample of tissue from your eye for analysis. A fine needle is inserted into the eye to remove tissue that is suspected of being cancerous. This is then taken to a laboratory to be tested for ocular melanoma cells.
Researchers acknowledge that the causes of ocular melanoma are not clear. Specialists believe that it manifests itself when errors develop in the DNA of healthy eye cells. These errors allow the mutated cells go on living, whereas they would normally die. The mutated cells concentrate in one of the eyes and lead to ocular melanoma.
It is not 100% certain that ocular melanoma can be prevented. There are theories that indicate that melanomas can develop after prolonged exposure to the sun, but there are no studies that confirm that the two factors are related. Even so, exposure to the sun between 11am and 5pm and not wearing sunglasses can be detrimental to the health of the eye. It is advisable to visit the ophthalmologist at least once a year so that the disease can be detected in its initial phase if it does appear.
Treatment for ocular melanoma depends on the location and the size of the melanoma, as well as on your preferences and state of health.
Sometimes small eye melanomas do not need immediate treatment. As long as the melanoma is small and does not increase in size, your doctor may recommend waiting until growth symptoms are detected.
Surgery: surgery is one of the most common treatments for ocular melanoma. This involves removing part of the eye or removing the eye completely.
Radiation therapy: this technique uses high-powered energy sources, such as protons or gamma rays, to destroy cancer cells. Radiation therapy is used for small to medium-sized ocular melanomas.
Laser treatment: sometimes a laser is used to destroy the melanoma cells. Thermotherapy involves using an infrared laser and is sometimes combined with radiation therapy.
Cold treatment: cryotherapy is used to destroy the cells of smaller ocular melanomas, although this treatment is the least used of all those described.
An ophthalmologist is the specialist who treats ocular melanoma.
Oculofacial plastic surgery is a medical speciality that focuses on surgery to the eyelids, brow, nose and tear duct system to treat disease, remove tumours, and restore the cosmetic appearance of the face.
There are very few oculofacial plastic surgeons in the world, concentrated in only a handful of clinics. Surgeons generally undergo specialist fellowship training learning specific surgical techniques to treat the delicate tissue around the eye.
Oculofacial plastic surgeons treat a wide range of conditions affecting the eyes and surrounding tissue, including:
This may include the treatment of the condition itself and reconstruction of the face after surgical treatment.
Oculofacial plastic surgeon can also carry out a range of procedures to improve the cosmetic appearance of the face and tackle the signs of ageing, focussing in particular on:
If you have a condition that is affecting the tissue around the eyes, the clinic may first perform some diagnostic procedures including tear production testing, ultrasound, visual field testing, and endoscopy. They may also refer you to a radiologist to carry out imaging tests such as a CT scan or MRI.
Problems affecting the tissue around the eyes can be complex, so making a diagnosis may involve a range of specialists including ophthalmologists, otolaryngologists, and oncologists.
When treating a condition or cosmetic issue, oculofacial plastic surgeons employ a number of surgical and non-surgical techniques including:
The precise treatment plan will depend on what condition you have. If you are treating a cosmetic issue, treatment might be combined with other kinds of plastic surgery to tackle other signs of facial ageing.
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.
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.
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.
Eyelid surgery
Cosmetic/Aesthetic
Eyelid Malposition
Eyelid lesions benign and cancerous
Tear duct surgery
Eye removal
Orbital reconstruction
Cosmetic procedures
Open-angle glaucoma is one of the most common types of glaucoma. Glaucoma is a condition that causes damage to the optic nerves of the eyes, which becomes worse over time and if it continues to worsen, can lead to permanent vision loss.
It comes on slowly and painlessly and patients can go for years without noticing that they have it. This is because the initial loss of vision is of the side, or of the peripheral vision, whilst general vision is maintained until late into the disease. Open-angle glaucoma tends to occur in people over the age of 50 and generally has no symptoms in the early stages.
The eye produces a fluid (aqueous humour), which keeps it healthy and maintains its pressurised state. As new fluid continually comes in the old has to drain out of the trabecular meshwork, which is a network of cells that sits in an area called the drainage angle. This “open-angle” is where the clear part of the eye (cornea) meets the coloured part (iris) and wraps 360 degrees around the circumference of the front part of the eye.
As we age, the trabecular meshwork does not function as well, which affects the flow of the fluid into and out of the eye, and the level of pressure can rise over time. The elevated eye pressure causes damage to the optic nerve cells, which leads to permanent vision loss.
The eye specialist will numb the eyes with a drop. The doctor checks the eye pressure, looks for an open angle and measures the thickness of the cornea. The patient may also have a dilated eye exam, where the doctor can put a drop on the pupil to make it open wide and to check on the optic nerve health.
The damage to the optic nerve and to vision cannot be fixed but the progression of glaucoma can be slowed down. This is achieved by lowering eye pressure, even if it seems normal. The patient will be provided with eye drops for glaucoma. If these do not work then there is laser therapy, which helps the eyes to drain better. The last resort is surgery with either of the following procedures:
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.
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.
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.
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.
The exact cause for optic neuritis remains unknown, but it is quite often linked to the following diseases:
When it develops with no known cause, it is known as idiopathic neuritis.
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.
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.
The specialist that diagnoses optic neuritis is an ophthalmologist.
Orbital cellulitis is an acute infection of the tissues surrounding the eyes, specifically the eyelids and eyebrows that can spread to the cheeks.
Symptoms can include:
Your doctor will diagnose the condition with a simple physical exam and take a look at your medical history. If eye pain and vision problems are present, your doctor may perform a blood test. Sometimes a CT scan or MRI scan will be used to get a clearer picture of the eye and the inflammation.
This condition is usually the result of a sinus infection which spreads to the eyes, eyelids and areas surrounding the eyes, like the brows and cheeks. Bacterial infection, that might occur after an injury or an insect bite can also lead to orbital cellulitis. Children are more likely to be infected in comparison to adults. The bacteria that most commonly causes orbital cellulitis are:
Hib (Haemophilus influenza type B) vaccines can prevent Haemophilus influenza type B infection in children and prevent this from causing orbital cellulitis. It is also possible that children who share a family group with someone who has this infection have to take antibiotics to avoid becoming infected.
On the other hand, adequate treatment of a sinus infection or a dental infection can prevent bacteria from spreading to the eyes and causing cellulitis of the eyelids and tissues around the eyes.
It is essential to treat orbital cellulitis adequately so that it does not cause damage that can persist into adulthood. Most cases will require hospitalization. Antibiotics will be given intravenously through a vein in the arm.
Surgery may also be needed to drain the abscess or relieve pressure around the eyes. Orbital cellulitis should be treated rapidly to avoid complications or loss of vision.
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.
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.
Presbyopia can cause the inability to focus up close; it can also cause headaches when looking at a book or computer screens.
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.
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.
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.
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:
Even so, surgery is quite often used to get rid of tired eyes. There are different techniques:
Tired eyes should be treated by an ophthalmologist.
Pterygium and pinguecula are two abnormal bumps in the conjunctiva of the eye.
These conditions are not cancerous (benign) and have a good prognosis with treatment.
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.
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.
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.
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.
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.
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.
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.
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.
Retinal conditions can affect your eyesight with different degrees of severity. They can be either acquired or inherited:
The treatment will vary according to the specific condition. Some conditions can be treated with intravitreal injections; for others, the only option is surgery.
You should see a specialised ophthalmologist.
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:
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.
Having two or more of the following symptoms may be an indication retinal detachment:
An ophthalmologist will examine the eyes and check the retina and pupil:
The main causes for retinal detachments are due to retinal tears or holes. Other causes include:
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:
Early diagnosis and treatment are essential for a good outcome.
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:
The procedure is normally done on an outpatient basis. Local anaesthetic and sedation are used.
Retinal detachment is treated by an ophthalmologist.
What is retinal detachment surgery?
The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages via the optic nerve to the brain. When the retina detaches, it is pulled from its normal position. Retinal detachment is caused by a retinal tear and can lead to blurred or lost vision. Surgery is the only treatment for retinal detachment. The goals of retinal detachment surgery are to reattach the retina and to prevent or reverse vision loss.
What is retinal detachment?
Retinal detachment is an eye condition, which involves the separation of the retina from the underlying tissues within the eye. Retinal detachments are usually caused by a retinal break, hole or tear. These types of detachments are known as rhegmatogenous retinal detachment and occur when the vitreous gel (a clear liquid that fills two-thirds of the inside of the eye) pulls loose or separates from its attachment to the retina.
When the retina has torn, the vitreous gel passes through the tear and gathers behind the retina. This build-up behind the retina is what separates the retina from the choroid and retinal pigment epithelium (lining tissue). As more liquid vitreous collects behind the retina, it can lead to a total retinal detachment. It always affects one eye at a time.
Types of procedures for retinal detachment surgery:
There are three types of eye surgery to treat retinal detachment, which are performed by an ophthalmologist.
Risks of retinal detachment surgery
There are a few complications, which are not too common but may occur following a surgical procedure and another operation may be needed to fix the retina. Possible complications include:
Retinal vein occlusion is a blockage in the vein that carries blood away from the retina.
The retina is a layer of tissue at the back of your eyeball and is responsible for turning light into brain signals. The retina needs a steady supply of blood to function. If it has too little blood or blood becomes trapped in the retina, it can cause cell damage.
Because retinal vein occlusion involves a blockage in the vein, blood is unable to drain from the retina, and the blood leaks into the eye causing damage in a number of ways.
The symptoms almost always affect only one eye, and can vary depending on exactly where the damage has occurred:
Sometimes you can experience pain in the eye.
If you have any of the symptoms above it is important to see a doctor right away.
Retinal vein occlusion is diagnosed with an eye exam that may involve the use of eye drops to open up your pupils, and tests such as a fluorescein angiography or optical coherence tomography.
Retinal vein occlusion is more common if you have a condition that affects how blood flows around your body. For example, if you have diabetes or high blood pressure, you are more likely to experience blood clots, and if this occurs in the retina it can cause retinal vein occlusion.
Other conditions which increase your risk of developing retinal vein occlusion include:
Finally, you are more likely to experience retinal vein occlusion if you smoke, you are overweight, or you are over the age of 60. Retinal vein occlusion is much less common in younger adults and in children.
You can help reduce your risk of developing retinal vein occlusion by stopping smoking and taking steps to reduce your blood pressure through a healthy diet and regular exercise.
It’s also important to make sure the symptoms of any other conditions, such as glaucoma or diabetes, are under control.
Damage to your eye from retinal vein occlusion is not always completely reversible and it is not currently possible to unblock the vein that is causing the problem. However, there are several treatments to help restore your vision stop the problem getting worse:
Retinal vein occlusion is treated by a specialist ophthalmologist.
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 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.
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.
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:
The aims of obtaining a second medical opinion are:
Possible disadvantages of seeking a second medical opinion include:
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.
Glaucoma is a common eye condition where the optic nerve that connects the eye to the brain has become damaged. There are different types of glaucoma, the most common being primary open-angle glaucoma. Other types include acute angle closure, secondary glaucoma and childhood glaucoma. Secondary glaucoma is caused by an underlying eye condition. As with primary glaucoma, it can be of open-angle and angle-closure (which means there are various ways in that the eye pressure rises) and can occur in both eyes.
Secondary glaucoma is the result of another eye disease, which could be any of the following:
There may be no symptoms during the early stages of secondary angle closure glaucoma. The condition is normally picked up by the eye specialist when the primary cause of glaucoma has been identified. As secondary glaucoma progresses, symptoms include the loss of field vision and using stairs becomes difficult. Reading and vision are still normally good. If left untreated, sight may be lost. Some patients report eye ache with cloudy vision.
Secondary glaucoma is detected through regular routine eye examinations. Everyone aged-40 plus should have regular sight tests every two years to see if their eyesight has deteriorated. There are three eye tests to check for glaucoma. The first looks at the appearance of the main nerve in the eye (ophthalmoscopy). The second measures the pressure in the eye (tonometry), and the third glaucoma test checks the field of vision (perimetry).
The underlying condition is addressed first. Vision loss from glaucoma is permanent, which means that glaucoma therapy is started immediately to minimise any further damage. Treatment is important, even if in some cases vision appears normal, as it may get worse without the patient realising. The goal behind the treatment of glaucoma is to reduce the level of eye pressure to a point at which no further damage to the optic nerve is possible. This is achieved with a variety of means, including eye drops, tablets, laser eye treatment, and surgery.
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.
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).
In order to diagnose it, your doctor will simply take a look at the infection to determine what stage it has reached.
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.
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.
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.
Tear trough filler is a treatment to remove the appearance of dark coloured lines beneath your eyes. The tear trough is the area between the lower eyelid and upper cheek where the tears often flow if you cry. Over time, these tear troughs can become darker, more shadowed, and longer in length, and can give the impression of being tired. A new treatment can remove the appearance of these lines, leading to a more youthful appearance.
Tear trough filler is a non-surgical treatment, involving a series of injections below the eye. As we age, the skin below the eyes becomes looser. Tear trough filler involves an injection of hyaluronic acid gel formula that replaces lost volume while retaining skin hydration. The treatment usually takes only 20-30 minutes, and you will be able to leave the clinic following the treatment.
Tear trough filler treatment is not usually reported to be very painful by patients of this procedure. The small injections can cause some discomfort, but the pain is minimal. Many patients report that the treatment is less painful than they expected. The dermal filler formula also features a local anaesthetic, which helps to further relieve any pain experienced.
Following treatment, you will be able to see the results almost immediately. You may experience some swelling below the eyes, and often some bruising may appear for a few days following the procedure. For this reason it is advised not to have this treatment before a social event, and you may want to have some time off work.
It is also advised to avoid physical activity and rough physical contact to the eye area in the days following the treatment, to allow healing and swelling to decrease. Avoiding alcohol helps to avoid further swelling of the eye area.
If you are not happy with the results of the tear trough filler treatment, it is possible for it to be removed. A dissolving enzyme treatment can be applied which instantaneously dissolves the filler.
If you are interested in tear trough filler treatment, you can make an appointment with a specialist.
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.
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.
Upper eyelid filler is a treatment to add volume to the upper eyelids, and to give a more youthful appearance. It involves the injection of a filler into the upper eyelid, to improve a hollow appearance that can occur over time as the skin loses fat cells, leading to a more sunken appearance, and with a darker skin tone.
Eyelid filler treatments can also be used for functional reasons such as to help the eyelid to close where there are physical problems limiting this, such as because of facial palsy following a stroke.
A series of small injections will be given around the upper eyelid, using a dermal filler. This will give a plumper appearance to the skin on the upper eyelids. Hyaluronic acid is used as a filler, often with some anaesthesia included to help reduce any pain associated with the injections.
Although some anaesthesia is used, it is not always necessary as patients report that the pain from the injections is minimal.
Some swelling and possible bruising is likely following the procedure, but this will reduce after a few days. Despite the initial swelling, the results will be seen almost instantaneously.
The eyelids can begin to appear hollow as you age, and to appear darker in colour. This is due to the skin losing elasticity, and losing the fat cells which give a fuller appearance to the skin. This is a natural process as we age, but in some people the affects can appear more prominent if it runs in the family, and they may want to correct this.
Another kind of filler treatment is adding weights into the upper eyelid to help them to close if they do not function as they should. This may be due to facial palsy or paralysis associated with a stroke.
The hyaluronic acid filler will last around one year following the surgery, giving a fuller appearance to your eyelids. Repeat applications can be given as necessary.
If you are not happy with the results, it is possible to reverse them using an enzyme injection which dissolves the hyaluronic acid.
Click here to make an appointment with a specialist.
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:
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.
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.
There are some steps that you can take to reduce the risk of a uveitis flare-up, such as:
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.
A visual impairment refers to loss of vision or the decreased ability to see at a ‘normal’ level. The WHO estimate that there are approximately 1.3 billion people in the world living with some form of visual impairment. Visual impairment can be mild or severe, or refer to a complete loss of sight (blindness). Roughly 1.87 million people in the UK live with sight loss that has some kind of impact on their daily lives.
The leading causes of visual impairment on a global scale are:
The risk of visual impairment increases with age, as many visual impairments are connected to conditions occurring in old age. Diabetics and those who smoke are also at greater risk of developing a visual impairment.
Symptoms depend on the cause of the specific impairment, however some signs that may point to a visual impairment include:
Visual impairments may also cause problems with everyday activities, for example you may find that you bump into things more frequently, or you have trouble walking downstairs/upstairs, or over uneven surfaces.
You may also find that reading becomes more difficult – you may notice that you have to hold material closer to your face, or you find it difficult to read in low light.
Treatment for visual impairment depends on the type of impairment itself. For example, refractive error can be corrected with glasses or the use of contact lenses, but other conditions, such as glaucoma, may need managing in other ways. Visual impairments may be treated through optical aids, medication, or surgical procedures such as laser eye surgery or glaucoma surgery.
The WHO estimates that roughly 80% of visual impairment cases worldwide are avoidable. Refractive error can be corrected with glasses (or contact lenses) and there are certain surgical procedures which can restore vision (e.g in cataracts). You can reduce your risk of developing a visual impairment by not smoking, and, if you are diabetic, following your doctor’s advice to monitor the condition.
Regular eye checks are recommended to spot the signs of visual impairment early on, particularly in older age.
An ophthalmologist (eye doctor) typically treats and manages visual impairments.
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.
The causes of watery eyes are:
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).
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.
e-Consultation is a private messaging and video conference service that allows contact with leading specialists at the time you choose, from any place.
In patients with chronic eye inflammation (uveitis), cataracts are a common complication because of prolonged use of high-dose steroids used to treat the primary condition. Leading ophthalmologist Ms Theresa Richardson explains why it is still important for patients to use the steroids as it would be more detrimental without.
Read more
Many things can irritate your eyes, and all of us will experience the symptoms of pink-eye in our lifetimes. While conjunctivitis or infections are more common causes, a more unusual possibility is that of uveitis. What exactly is this condition? Top ophthalmologist Ms Theresa Richardson explains all.
Read more
Age-related macular degeneration (AMD) is a common cause of vision loss as we get older, but, besides ageing, what things put us at risk of developing this condition? And how is AMD treated? In the second part of our interview with leading ophthalmologist Ms Theresa Richardson, she answers these questions.
Read more
The leading cause of vision loss in people over the age of 60, age-related macular degeneration (AMD) is a common condition in which a small part of the central retina called the macula deteriorates, affecting the patient’s central vision. What is having this condition really like? What are the signs to watch out for? What are “dry” and “wet” AMD? We talked to respected ophthalmologist Ms Theresa Richardson, who answered our questions:
Read moreVery friendly and reassuring. Good, clear explanations given. Will definitely recommend her to others.
Yes I would recommend this doctor. Best I have ever had. Very kind friendly person
High quality and professionalism, very easy hospital to get to
