Many eye diseases have no early symptoms, and they may be painless. In fact, you might not notice any change in your sight until the disease has become quite advanced. The single best way to protect your vision is through regular professional eye examinations. Of course, between examinations, if you notice a change in your vision – or if you think your eye may be injured in any way – contact your eye care professional immediately.
Recommended frequency of eye examinations |
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| Age | Asymptomatic / Risk Free | At Risk |
| School age (6 to 18 years) | Before first grade and everytwo years thereafter | Annually or as recommended |
| Adults (19 to 40 years) | Every two to three years | Every one to two years or as recommended |
| Adults (41 to 60 years) | Every two years | Every one to two years or as recommended |
| Older adult (61 years and older) | Annually | Annually or as recommended |
A cataract is a clouding of the natural lens, the part of the eye responsible for focusing light and producing clear, sharp images. The lens is contained in a sealed bag or capsule. As old cells die, they become trapped within the capsule. Over time, the cells accumulate causing the lens to cloud, making images look blurred or fuzzy. For most people, cataracts are a natural result of aging. They are the leading cause of visual loss among adults 55 and older. Eye injuries, certain medications, and diseases such as diabetes and alcoholism have also been known to cause cataracts.
Cataract surgery is performed by an eye doctor (ophthalmologist) on an outpatient basis, which means you don’t have to stay in the hospital after the surgery. Cataract surgery is very common and is generally a safe procedure.
Keratoconus is a degenerative disease of the cornea that causes it to gradually thin and bulge into a cone-like shape. As the disease progresses, the cone becomes more pronounced, causing vision to become blurred and distorted. Because of the cornea’s irregular shape, patients with keratoconus are usually very near-sighted and have a high degree of astigmatism that is not correctable with glasses. Keratoconus is sometimes an inherited problem that usually occurs in both eyes.
Signs and Symptoms
Keratoconus is not usually visible to the naked eye until the later stages of the disease. Special corneal testing called topography provides the eye care practitioner with detail about the cornea’s shape and is used to detect and monitor the progression of the disease. A pachymeter may also be used to measure the thickness of the cornea. The first line of treatment for patients with keratoconus is to fit rigid gas permeable (RGP) contact lenses. Because this type of contact lens is not flexible, it creates a smooth, evenly shaped surface to see through. However, because of the cornea’s irregular shape, these lenses can be very challenging to fit. This process often requires a great deal of time and patience. When vision deteriorates to the point that contact lenses no longer provide satisfactory vision, corneal transplant surgery may be necessary to replace the diseased cornea with a healthy one.
Quick reactions and first aid can make the difference between sight and blindness. It can happen in the blink of an eye. while pouring liquid drain cleaner down a sink, some of the chemical splashes up in your face, chemical injuries don’t just happen in the workplace. Most homes have dozens of everyday products that pose tremendous danger to vision if they contact the eye.
The severity of the injury is related to whether the chemical is alkali (drain cleaner, metal polish, oven cleaner etc.) or acid (swimming pool acid, battery acid) based. Alkali chemicals are more destructive than acidic chemicals because of their ability to adhere to the eye and penetrate tissues. However, acid burns may be compounded by glass injuries caused by an explosion.
Often, the difference between a serious but treatable injury and losing vision is a matter of understanding a few principles of ocular first aid.
First aid for chemical burns to the eyes:
The easiest way to irrigate at home is for the patient to hold his or her head over a sink while the helper continuously pours water over the eye with a glass or cup. It is important to gently hold the lids apart while irrigating in order to rinse underneath the lids and wash away as much of the chemical as possible. Using a dry cloth is helpful because the lids are difficult to hold back when they are wet. Continue flushing the eye for approximately 20 minutes.
Retinal tears commonly occur when there is traction on the retina by the vitreous gel inside the eye. In a child’s eye, the vitreous has an egg-white consistency and is firmly attached to certain areas of the retina. Over time, the vitreous gradually becomes thinner, more liquid and separates from the retina. This is known as a posterior vitreous detachment (PVD).
PVDs are typically harmless and cause floaters in the eye; but in some cases, the traction on the retina may create a tear. Retinal tears frequently lead to detachments as fluids seep underneath the retina, causing it to separate and detach.
A retinal detachment occurs when the retina’s sensory and pigment layers separate. Because it can cause devastating damage to the vision if left untreated, retinal detachment is considered an ocular emergency that requires immediate medical attention and surgery. It is a problem that occurs most frequently in the middle-aged and elderly.
Signs and symptoms
Retinal detachments are usually found because the patient calls the eye care practitioner’s office with a symptom listed above. It is critical that these problems are reported early because early treatment can greatly improve the chance of restoring vision.
There are a number of ways to treat retinal detachment. The appropriate treatment depends on the type, severity, and location of the detachment. Early detection is the key in successfully treating retinal detachments and tears. Awareness of the quality of your vision in each eye is extremely important, especially if you are in a higher-risk group such as those who are near-sighted or diabetic. Compare the vision of your eyes daily by looking straight ahead and covering one eye and then the other.
Notify your doctor immediately if you notice any of the following:
Conjunctivitis, commonly known as pink eye, is an infection of the conjunctiva (the outer-most layer of the eye that covers the sclera). The three most common types of conjunctivitis are: viral, allergic, and bacterial. Each requires different treatments. With the exception of the allergic type, conjunctivitis is typically contagious. The viral type is often associated with an upper respiratory tract infection, cold, or sore throat. The allergic type occurs more frequently among those with allergic conditions. When related to allergies, the symptoms are often seasonal. Allergic conjunctivitis may also be caused by intolerance to substances such as cosmetics, perfume, or drugs. Bacterial conjunctivitis is often caused by bacteria such as staphylococcus and streptococcus. The severity of the infection depends on the type of bacteria involved.
Viral conjunctivitis typically has a watery discharge, eye irritation, red eye and infection usually begins with one eye, but may spread easily to the other eye.
Allergic conjunctivitis usually affects both eyes, is itchy, causes tears, and swollen eyelids.
Bacterial conjunctivitis has a stringy discharge that may cause the lids to stick together, especially after sleeping, has swelling of the conjunctiva, redness, tearing, irritation and/or a gritty feeling, and usually affects only one eye, but may spread easily to the other eye.
The appropriate treatment depends on the cause of the problem. For the allergic type, cool compresses and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Some patients with persistent allergic conjunctivitis may also require topical steroid drops. Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria. Like the common cold, there is no cure for viral conjunctivitis; however, the symptoms can be relieved with cool compresses and artificial tears (found in most pharmacies). For the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation. Viral conjunctivitis usually resolves within 3 weeks.
To avoid spreading infection, take these simple steps:
Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma, but the disease’s effect on the retina is the main threat to vision. Most patients develop diabetic changes in the retina after approximately 20 years. The effect of diabetes on the eye is called diabetic retinopathy. Some common symptoms of diabetic retinopathy include blurred vision, floaters and flashes, and sudden loss of vision. However, diabetes may cause other eye symptoms.
Diabetic patients require routine eye examinations so related eye problems can be detected and treated as early as possible. Most diabetic patients are frequently examined by an internist or endocrinologist who in turn work closely with the eye care practitioner. Diabetic retinopathy is treated in many ways depending on the stage of the disease and the specific problem that requires attention. The retinal surgeon relies on several tests to monitor the progression of the disease and to make decisions for the appropriate treatment. These include fluorescein angiography, retinal photography, and ultrasound imaging of the eye.
Researchers have found that diabetic patients who are able to maintain appropriate blood sugar levels have fewer eye problems than those with poor control. Diet and exercise play important roles in the overall health of those with diabetes.
Diabetics can also greatly reduce the possibilities of eye complications by scheduling routine examinations with an eye care practitioner. Many problems can be treated with much greater success when caught early.
Millions of people worldwide suffer from dry eyes. It is usually caused by a problem with the quality of the tear film that lubricates the eyes. Dry eye syndrome has many causes. One of the most common reasons for dryness is simply the normal aging process. As we grow older, our bodies produce less oil – 60% less at age 65 then at age 18. This is more pronounced in women, who tend to have drier skin then men. The oil deficiency also affects the tear film. Without as much oil to seal the watery layer, the tear film evaporates much faster, leaving dry areas on the cornea.
Many other factors, such as hot, dry or windy climates, high altitudes, air-conditioning and cigarette smoke also cause dry eyes. Many people also find their eyes become irritated when reading or working on a computer. Stopping periodically to rest and blink keeps the eyes more comfortable. Contact lens wearers may also suffer from dryness because the contact lenses absorb the tear film, causing proteins to form on the surface of the lens. Certain medications, thyroid conditions, vitamin A deficiency, and diseases such as Parkinson’s and Sjogren’s can also cause dryness. Women frequently experience problems with dry eyes as they enter menopause because of hormonal changes.
Signs and symptoms include itching, burning, irritation, redness, blurred vision that improves with blinking, excessive tearing, increased discomfort after periods of reading, watching tv, or working on a computer.
There are several methods to test for dry eyes. The eye care practitioner will first determine the underlying cause by measuring the production, evaporation rate and quality of the tear film. Special drops that highlight problems that would be otherwise invisible are particularly helpful to diagnose the presence and extent of the dryness.
When it comes to treating dry eyes, everyone’s needs are a little different. Many find relief simply from using artificial tears on a regular basis. Some of these products are watery and alleviate the symptoms temporarily; others are thicker and adhere to the eye longer. Preservative-free tears are recommended because they are the most soothing and have fewer additives that could potentially irritate. Avoid products that whiten the eyes – they don’t have adequate lubricating qualities and often make the problem worse.
Closing the opening of the tear drain in the eyelid with special inserts called punctual plugs is another option. This works like closing a sink drain with a stopper. These special plugs trap the tears on the eye, keeping it moist. This may be done on a temporary basis with a dissolvable collagen plug, or permanently with a silicone plug.
There are also simple lifestyle changes that can significantly improve irritation from dry eyes. For example, drinking eight to ten glasses of water each day keeps the body hydrated and flushes impurities. Make a conscious effort to blink frequently – especially when reading or watching television. Avoid rubbing the eyes. This only worsens the irritation.
Treating dry eye problems is important not only for comfort, but also for the health of the cornea.
Anyone who has felt as if there was a grain of sand in his or her eye has probably had a foreign body. Foreign bodies might be superficial, or in more serious injuries, they may penetrate the eye. Fortunately, the cornea has such an incredible reflex tearing system that most superficial foreign bodies are naturally flushed out with our natural tears. But if the object is more deeply embedded, medical attention is required.
The symptoms of a foreign body may range from irritation to intense, excruciating pain. This is dependent on the location, material, and type of injury. In rare situations where an object penetrates the eye, there may be few or no symptoms. If you have no symptoms, but suspect an object may have penetrated your eye, it’s always best to seek medical attention. The entry point of an intraocular foreign body is sometimes nearly invisible. Depending on their location, foreign bodies inside the eye may or may not cause pain or decreased vision.
If a foreign object becomes embedded within the cornea, conjunctiva, or sclera, a medical professional must remove it. Attempting to remove it yourself is dangerous and could result in a permanent scar that could affect your vision.
Superficial foreign bodies are usually treated in the office. After numbing the eye with topical anaesthetic, the particle is carefully removed using a microscope. Afterward, antibiotic medications are generally prescribed to prevent infection. In some cases, foreign bodies become trapped underneath the eyelid. It is extremely important to examine under the eyelid for any remnant particles.
Intraocular foreign bodies typically must be removed in the operating theatre using a microscope and special instruments designed for working inside the eye. These injuries are often vision threatening and should be treated quickly.
Wearing appropriate safety glasses is the best way to prevent this type of injury. Protecting the eyes is especially important when working with machinery that could cause chips of wood or metal to splinter, as well as lawn equipment such as hedge and line trimmers.
If a particle of wood, glass, metal, or any other foreign substance becomes trapped in your eye, here are some tips:
Glaucoma is a disease caused by increased intraocular pressure (IOP) resulting either from a malformation or malfunction of the eye’s drainage structures. Left untreated, an elevated IOP causes irreversible damage to the optic nerve and retinal fibres resulting in a progressive, permanent loss of vision. However, early detection and treatment can slow, or even halt the progression of the disease.
Open angle (also called chronic open angle or primary open angle) is the most common type of glaucoma. With this type, even though the anterior structures of the eye appear normal, aqueous fluid builds up within the anterior chamber, causing the IOP to become elevated. Left untreated, this may result in permanent damage of the optic nerve and retina. Eye drops are generally prescribed to lower the eye pressure. In some cases, surgery is performed if the IOP cannot be adequately controlled with medical therapy.
Only about 10% of the population with glaucoma have acute angle closure glaucoma. Acute angle closure occurs because of an abnormality of the structures in the front of the eye. In most of these cases, the space between the iris and cornea is more narrow than normal, leaving a smaller channel for the aqueous to pass through. If the flow of aqueous becomes completely blocked, the IOP rises sharply, causing a sudden angle closure attack.
While patients with open angle glaucoma don’t typically have symptoms, those with angle closure glaucoma may experience severe eye pain accompanied by nausea, blurred vision, haloes around lights, and a red eye. This problem is an emergency and should be treated by an ophthalmologist immediately. If left untreated, severe, and permanent loss of vision will occur in a matter of days.
Secondary Glaucoma occurs as a result of another disease or problem within the eye such as: inflammation, trauma, previous surgery, diabetes, tumour, and certain medications. For this type, both the glaucoma and the underlying problem must be treated.
Glaucoma is a terrible disease because it rarely causes symptoms. Detection and prevention are only possible with routine eye examinations. However, certain types, such as angle closure and congenital, do cause symptoms. Because glaucoma does not cause symptoms in most cases, those who are 40 or older should have an annual examination including a measurement of the intraocular pressure. Those who are glaucoma suspects may need additional testing.
The glaucoma evaluation has several components. In addition to measuring the intraocular pressure, the eye care practitioner will also evaluate the health of the optic nerve (ophthalmoscopy), test the peripheral vision (visual field test), and examine the structures in the front of the eye with a special lens (gonioscopy) before making a diagnosis.
The eye care practitioner evaluates the optic nerve and grades its health by noting the cup to disc ratio. This is simply a comparison of the cup (the depressed area in the centre of the nerve) to the entire diameter of the optic nerve. As glaucoma progresses, the area of cupping, or depression, increases. Therefore, a patient with a higher ratio has more damage.
Most patients with glaucoma require only medication to control the eye pressure. Sometimes, several medications that complement each other are necessary to reduce the pressure adequately. Surgery is indicated when medical treatment fails to lower the pressure satisfactorily. There are several types of procedures, some involve laser and can be done in the office, others must be performed in the operating theatre. The objective of any glaucoma operation is to allow fluid to drain from the eye more efficiently.
Headaches may occur for any number of reasons including sinus conditions, hypertension, allergies, tumours, hormonal changes, and most frequently, stress. They are not usually associated with problems related to the eyes.
Eye-related headaches typically occur after extended periods of reading, watching television, computer work, or other close work that requires intense concentration. This type of headache usually disappears after a period of rest. In some cases, headaches may be caused by eyestrain related to eyeglasses. A tendency for the eyes to cross or drift outward may also bring on headaches.
One eye problem known to cause an intense headache is angle-closure glaucoma. With this type of glaucoma, the headache is only part of the problem. Patients suffering from an angle-closure attack also may experience nausea, intense pain around the eye, blurred vision, and haloes around lights. Headaches caused by eye disease are unique in their symptoms and types of pain. It is important to make detailed notes of your symptoms, type of pain, lifestyle and what you were doing when the headache began. This information is very helpful to the physician to diagnose the type and cause of the headache you are experiencing.
The symptoms from headaches can be extremely variable and depend on the underlying problem. Because the scope of the various types and causes is so immense, the following headaches are described with the typical symptoms as they relate to the eye.
Stress relief, control of blood pressure, or medication to maintain appropriate hormonal levels may be necessary. New glasses or different work lighting may be prescribed by your eye care practitioner. If you have persistent headaches, it is important to consult your medical doctor about them for a medical evaluation.
Computer vision syndrome (CVS) is a term that describes eye-related problems and the other symptoms caused by prolonged computer use. As our dependence on computers continues to grow, an increasing number of people are seeking medical attention for eye strain and irritation, along with back, neck, shoulder, and wrist soreness.
These problems are more noticeable with computer tasks than other near work because letters on the screen are formed by tiny dots called pixels, rather than a solid image. This causes the eye to work a bit harder to keep the images in focus.
There is no scientific evidence that computer screens are harmful to the eyes. A common myth is that eye strain caused by reading and close work is damaging to the eyes. This is not true; however, those who work at computers often experience many frustrating symptoms.
Signs and symptoms include blurred near vision, difficulty focusing from close to far and back again, sore, irritated eyes, dry eyes, red eyes, eye fatigue, headaches that disappear after a period of rest, irritation and discomfort while wearing contact lenses, soreness and pain in the neck, shoulder, and back.
Your eye care practitioner will perform a complete eye examination that includes near and distance visual acuity, refraction, tonometry, and an examination of the eye structures with a slit lamp microscope and ophthalmoscopy.
It is important to provide the eye care practitioner with detail about your work environment, work habits, and detail about the symptoms and their patterns. Bring your prescription glasses with you so the eye care practitioner can determine if they are appropriate for computer work.
Your optometrist will advise you on the correct eye wear, sitting position, and simple exercise you can do to combat the discomfort.
Age-related macular degeneration (ARMD) is a degenerative condition of the macula (the central retina). It is one of the most common causes of vision loss in the over 50’s, and its prevalence increases with age. AMD is caused by hardening of the arteries that nourish the retina. This deprives the sensitive retinal tissue of oxygen and nutrients that it needs to function and thrive. As a result, the central vision deteriorates.
Macular degeneration varies widely in severity. In the worst cases, it causes a complete loss of central vision, making reading or driving impossible. For others, it may only cause slight distortion. Fortunately, macular degeneration does not cause total blindness since it does not affect the peripheral vision.
Signs and symptoms include loss of central vision, difficulty reading or performing tasks that require the ability to see detail, and distorted vision (Straight lines such as a doorway or the edge of a window may appear wavy or bent).
There is no proven medical therapy for dry macular degeneration. In selected cases of wet macular degeneration, laser photocoagulation is effective for sealing leaking or bleeding vessels. Unfortunately, laser photocoagulation usually does not restore lost vision, but it may prevent further loss. Early diagnosis is critical for successful treatment of wet macular degeneration. Patients can help the eye care practitioner detect early changes by monitoring vision at home with an Amsler grid.
