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Eye diseases

Diseases of the eye are numerous and varied.

The eye has specific disorders that can affect one or more of the ocular structures but have no effect on the rest of the body. Similarly, a variety of whole body (systemic) diseases may produce changes in the eye. In fact, from careful examination of the eye, it is possible to detect many diseases that affect the whole body.

Some of the most common eye diseases are described below.

Cataracts

Cataracts result in opacity of the eye and have a number of causes.

  1. Age related

    With age, biological changes occur within the lens causing it to gradually become opaque. These changes begin at about fifty and progress at a variable rate during later life. Cataracts can occur in eyes that are otherwise healthy.

  2. Trauma

    Trauma is the commonest form of cataracts in the young, as a result of blunt or lacerating injury, infrared energy or electric shock. A cataract can also be caused by irradiation of an ocular tumour. This type of traumatic cataract can develop over a few hours with rapid loss of vision.

  3. Diabetes related

    Diabetes can produce cataracts. In diabetics, age related cataracts develop earlier and are more progressive than in non-diabetics. Other associated conditions are galactosaemia, Fabry's Disease, Wilson's Disease and hypoparathyroidism.

  4. Drugs

    Several drugs can cause cataracts, especially steroids.

  5. Congenital

    Cataracts can run in families and are passed on genetically from one generation to the next.

Treatment for cataracts

Surgery is undertaken to improve vision or where the cataract is likely to cause complications that may damage the eye, with permanent loss of vision. Cataracts do not need to be removed, however, just because they are there.

Surgery can be performed under general or local anaesthetic; an estimated 78,000 cataract operations are performed every year in the UK.

Eye care after an operation

Once a cataract is removed, the eye becomes long sighted. To remedy this, try cataract glasses, contact lenses or a lens implant within the eye.

Glaucoma

Glaucoma refers to a group of disorders characterised when pressure in the eye is so high as to damage the nerve fibres in the retina and optic nerve.

Open angle glaucoma

This is chronic, slowly progressive and accounts for 20% of those registered blind in UK. Symptoms are almost non-existent until well into the disease, when a patient may suffer visual problems. Open angle glaucoma is not painful. Treatment is initially by drops and tablets with the aim reducing pressure. Surgery may be necessary at a later date.

Narrow angle glaucoma

Seeing coloured haloes around streetlights at night identifies this type of glaucoma. This may then be followed by severe pain in and around the eye and a rapid fall in vision. One eye is usually affected first, which alerts the surgeon so that action can be taken to prevent a similar condition in the other eye. Treatment must be urgent and normally involves intensive drops and tablets to reduce the pressure. Surgery is necessary to prevent recurrence.

Disorders of the Retina

Diseases that affect the retina alone or diseases that affect the whole body can damage the retina.

Retinopathy

This is the term used to denote an abnormality of the retina without specifying a cause.

Diabetic Retinopathy occurs in patients with diabetes mellitus. This is the commonest form of blindness registered in UK of people between 20 and 65 years of age. Treatment is by rigid control of blood sugar levels combined with laser treatment.

Hypertensive Retinopathy is caused by high blood pressure and is treated by control of the blood pressure.

Sickle Cell Retinopathy can be developed by people with sickle cell disease.

Retrolental Fibroplasia affects low birth weight premature babies exposed to high oxygen pressures. Detached retina and poor vision can result from this exposure.

Senile Macular Degeneration

This is the leading cause of blindness in the elderly in the western world. (The word 'senile' in this context has no bearing on mental state, it merely indicates the age at the onset of the disorder). The average age of onset is 65.

Patients initially notice a disturbance of their vision, which progresses over months or years. They lose the ability to recognise fine detail such as print and people's faces. However, the ability to recognise large objects, is such as a door, is retained. There is no effective treatment in the majority of cases.

Retinitis Pigmentosa

This is a group of rare inherited diseases characterised by the development of night blindness and tunnel vision. Symptoms start in childhood and are progressive. Many sufferers retain good vision although peripheral vision is limited. There is no effective treatment.

Retinal Detachment

A detached retina usually occurs because of a hole in the retina, sometimes caused by injury. Sufferers lose the ability to detect light. This is a common disorder in the elderly or following a cataract operation. Symptoms include spots before the eyes (floaters), flashing lights, and a shadow over the eye with progressive loss of vision.

Treatment by laser is very effective if caught early. The outcome of surgery depends largely on the extent of the detachment and its duration.

Conjunctivitis

This is caused by inflammation of the conjunctiva (which lines the back surface of the eyelid) due to bacteria, viruses, allergy and chlamydia.

Disorders of the Cornea

Arcus Senilis is a common finding in elderly people. Deposits of fat in the circumference of the cornea appear as a white crescent or a complete ring. It is a normal ageing change.

Corneal Dystrophies are a group of inherited disorders of the cornea, causing the cornea to go opaque to a greater or lesser degree. In some cases a corneal graft is required.

Keratitis is an inflammation of the cornea. There are numerous types:

  • bacterial
  • viral
  • exposure

Urgent treatment by a specialist is necessary.

Disorders of the Eyelids

Blepharitis is a chronic inflammation of the margin of the eyelids. It can be treated with antibiotic eye drops and artificial tear drops. It frequently begins in childhood, but is not troublesome in later life. It is difficult to cure but is not dangerous to sight.

Blepharospasm is an involuntary repeated twitching or full closure of the eyelids due to muscle spasm. It usually affects the elderly but may occur occasionally in younger people. Some people respond to drug treatment but may require surgery.

Ectropion is when the lid turns outwards. Surgery is required.

Entropion is when the lid turns inwards. Surgery is required.

Ptosis is drooping of the upper lid. Causes may be damage to, or weakness of, the muscles lifting the lid. Scarring or the presence of a large lid cyst or tumour could also cause ptosis. Treatment depends on the cause, but surgery may be necessary.

Stye is an acute inflammation of an eyelash follicle, which causes a small abscess. Styes are common and appear as localised red swellings at the margin of the lid. Treatment includes hot compresses, removal of the eyelash to allow pus to drain and antibiotic drops or ointment.

Squint (or Strabismus)

A squint occurs when each eye is not pointing at the same object at the same time.

Paralytic is where one or more of the muscles or their nerve supply is damaged, which results in double vision.

Non-paralytic is where the muscles and nerves are normal, and is usually found in children. This type of squint can result in poor vision or occasionally from poor vision. An eye specialist should see all squints as soon as possible. Exercises or glasses can correct some squints, whilst others require surgery.