11 March 2019
We caught up with Consultant Ophthalmologist and Glaucoma Specialist, Dr Pankaj Agarwal to find out a few facts and a ta…
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Blepharitis is inflammation of the rims of the eyelids, which causes them to become red and swollen. Symptoms can include; burning, soreness or stinging in the eyes, crusty eyelashes or itchy eyelids. It is commonly caused by bacterial infection or can be a complication of a skin condition. Blepharitis will often be treated by your GP but occasionally, referral to an Ophthalmologist is required.
A chalazion is a cyst (a small sac of fluid) on the inside of the eyelid. Due to its location, it can be mistaken for a stye and can grow to the size of a pea. If a chalazion is large, it can cause discomfort or affect vision. It is caused by a blocked gland in your eyelid. The glands help to keep your eyes moist by preventing the watery layer on the surface of your eyes (tears) from evaporating. They do this by producing an oily film over the tears.
A chalazion will sometimes get better on its own. However, your ophthalmologist may suggest a surgical procedure to remove it if it is large, uncomfortable, affects your vision or doesn’t respond to other treatments.
Corneal and external eye disease is an umbrella term for a number of conditions which affect this section of the eye. Ophthalmologists evaluate and treat patients with corneal and external eye diseases including:
Diabetic retinopathy is a complication of diabetes. It occurs when high blood sugar levels damage the cells at the back of the eye, known as the retina. The retina is the light-sensitive layer of cells at the back of the eye. It converts light into electrical signals. The signals are sent to the brain through the optic nerve and the brain interprets them to produce the images that you see. For this to work, the retina requires a constant blood supply which it receives through tiny blood vessels. These blood vessels can become damaged over time in diabetics and become less efficient in transporting blood.
Retinopathy is not immediately noticeable in its early stages. It is only obvious to the sufferer in its later stages when eye sight is affected.
If you have diabetes and start to notice problems with your vision, contact your GP immediately.
Treatment for retinopathy will depend on the stage the condition has reached. If identified in its early stages, it may be possible to treat it by controlling your diabetes more effectively. If you have more advanced retinopathy, you may need to have surgery to prevent further damage to your eyes.
The eye depends on the flow of tears to provide constant moisture and lubrication to maintain vision and comfort. Tears have a combination of water (for moisture), oils (lubrication) and mucus (for even spreading) as well as antibodies and proteins against infection. These components are secreted by special glands around the eye. When there is an imbalance in this tear system, you may experience dry eyes. Other common symptoms include, pain, light sensitivity, gritty sensation, itching, redness or blurred vision.
There are a number of causes for dry eye. These include:
Sometimes a person with a dry eye will have excess tears. This is because dry eye syndrome is often caused when the eye isn't getting enough lubrication. The eye sends a signal to produce more lubrication and as a result, the eye is flooded with tears to cure the underlying dryness. However, if these tears are mostly water (rather than lubricating oils) they will not coat the eye surface properly. Because these emergency tears tend to arrive too late, the eye needs to regenerate and treatment is necessary.
In most cases, your GP will be able to treat dry eye, however, if the diagnosis is uncertain, you will be referred to an ophthalmologist.
An ectropion is where part or the entire lower eyelid turns outwards away from the eye. There are various causes but the most common cause is simply an ageing effect of the eyelid. It often affects both eyes but can occur in one eye alone. Apart from the aesthetic change to the eyelid, symptoms include the inner lining of the eyelid becoming dry and sore, the affected eye may become watery (due to proximity to the tear ducts) and damage to the cornea (If the eye is not able to close properly) due to lack of protection usually provided by the eye lid.
What is the treatment for an ectropion?
Surgery is usually required to correct the effects of ectropion. The operation 'tightens' the skin and muscles around the eyelid. The best results are obtained if the condition has not become too severe. However, in more severe cases, further surgery may be required.
An entropion is the turning in of an edge of the eyelid, causing the eye lashes to rub against the eye. It is either present from birth or can be caused later in life by infection or ageing.
Eye drops can prevent the eye from becoming dry and may relieve symptoms but surgery is required to permanently correct the condition.
Conditions that cause cysts and lesions of the eyelid may be benign but occasionally can have a more harmful diagnosis. Patients with eyelid abnormalities should go to the see their GP in the first instance. If the condition requires further attention, your GP will refer you onto a Consultant Ophthalmologist who will determine the most appropriate treatment for you.
There are many forms of eyelid cysts. Most types will go away on their own over time, while others require antibiotics or surgical treatment.
If you begin having any of these symptoms, try your best not to touch or rub your eyes. Eyelid cysts can be caused by bacteria transferred to the eyes from the hands or other utensils (such as make up brushes) that come into contact with the eyes.
There are many different types or forms of eyelid cysts, including:
Floaters are small shapes that some people see floating around in their field of vision. They can be different shapes and sizes. These floating shapes are small pieces of debris that float on the eyes vitreous humour. The visual effect is caused by the debris casting its shadow on the retina.
In most cases, floaters do not cause significant problems and don’t require treatment. However, in rare cases, they may be a sign of a retinal tear or detachment. If you notice an increase or a change in your floaters (especially white flashes) over short space of time it is advisable to see your GP. Your GP may recommend you see an ophthalmologist who can check your retina for tears.
In benign cases, when floaters don’t require treatment, your brain will learn to ignore floaters and you may not notice them. If your floaters do not improve over time, or if they significantly affect your vision, a vitrectomy may be recommended. This is a surgical operation to remove the vitreous humour in your eye along with any floating debris and replace it with a saline (salty) solution.
Glaucoma is the name given to a group of eye conditions which cause optic nerve damage and can affect your vision. Glaucoma damages the optic nerve at the point where it leaves your eye.
Glaucoma is caused when there is damage to the optic nerve, caused either by raised eye pressure or weakness in the nerve. In most cases, both of these factors are involved. The eye needs ‘pressure’ to keep the eyeball in shape to make it work properly. However, if the optic nerve comes under too much pressure, it can become damaged. The amount of damage there is depends on how high the pressure is and how long it lasts, and whether there is a poor blood supply or other weakness of the optic nerve.
There are four main types of glaucoma:
If you are diagnosed with glaucoma, an ophthalmologist will assess your condition and you will require regular appointments, at least at the outset, to make sure you are responding to treatment and that your eye pressure is in the right range for you and it is stable. With time, and if your eye pressure stays stable, you may only require an appointment once every six or 12 months. It is very important that appointments are kept to check your eye pressure continues to be stable. On each visit, you will have the pressure measured in the eye, the visual field tested and the back of your eye examined using drops to dilate your pupil.
The lacrimal system contains the structures required for tear production and drainage. Any disruption to either the production of tears or the drainage of tears will result in lacrimal disorders, which lead to acute or chronic discomfort of the eye.
The most common of these is ‘dry eye’. This is when the protective tear film on the surface of the eye diminishes, leaving the delicate tissues of the eye exposed to the drying effects of the outside world. The eye can still make tears, in fact many patients complain of wet eyes and tearing with this condition.
‘Wet eye’ occurs when there is a blockage in the lacrimal drainage system which prevents tears from draining effectively. This can cause a built-up of tears on the lower eyelid. The main symptom is constant tearing from one or both eyes with tears running down the face. Because access into the nose is blocked, mucous builds up in the lacrimal sac making the eye prone to infection. This condition is usually treated with antibiotics if there is infection but for permanent resolution, surgery is required to clear the obstructed duct.
The conjunctiva is the clear membrane that encircles and protects the eyeball. The conjunctiva has many small blood vessels (conjunctiva) running through it. These vessels provide lubrication to the eye for protection and to allow it to move in its socket.
Conjunctivitis is an inflammation of this membrane. It can be caused by bacteria, viruses, allergies, and more.
In bacterial conjunctivitis, the eyelid usually swells and the eye produces a yellowish discharge, the eye often feels uncomfortable as if there is something in the eye, or the eye has a scratchy or itchy sensation. The bacteria’s most commonly associated with conjunctivitis is staphylococcus, the streptococcus, and Haemophilus Influenza. They are very contagious.
Usually antibiotic drops will clear up the infection within just a few days. In rare cases, when a patient doesn’t respond to drops, another consultation with an ophthalmologist may be needed to take other measures. If left untreated, conjunctivitis can create serious complications, such as infections in the cornea, lids, and tear ducts.
View more information about Chalazion in the accordion above.
Spire Edinburgh Hospitals, we are pleased to offer treatment for macular degeneration (MD). This condition affects the macula which is a small area at the centre of the retina. The macula is responsible for what we see straight in front of us, allowing us to see fine detail for activities such as reading and writing, as well as our ability to see colour.
What is age-related macular degeneration?
Vision can be severely affected if the cells of the macula are damaged and stop working – this is known as age-related macular degeneration (AMD). Symptoms include blurred vision or distortion (with straight lines appearing wavy and objects appearing to be an unusual size or shape). In more advanced cases, sufferers develop a blank patch or dark spot in the centre of their sight which makes reading, writing and recognising some objects difficult.
Age-related macular degeneration (AMD) is a common condition affecting older people. About one in 100 people aged 65-75, and about one in eight people aged over 85 have AMD that is severe enough to cause serious visual loss*.
There are two types of AMD, dry macular degeneration and wet macular degeneration. At Spire Edinburgh Hospitals we are able to treat Wet AMD.
“Wet” macular degeneration is caused by the growth of abnormal blood vessels within the retina, leading to a build-up of fluid, bleeding and scarring. Wet AMD can cause serious visual loss in a much shorter space of time than dry AMD, sometimes within a few months.
Wet AMD treatment
One possible treatment for wet AMD is the injection of a drug that controls the build-up of fluid under the retina. The drugs are known as vascular endothelial growth factor (VEGF inhibitors. The injections are not a cure for AMD but they may stop it from getting worse and in some cases, may improve sight providing treatment is started at an early stage.
The injections are usually carried out as a day-case or out-patient procedure, with no overnight stay in hospital. They are usually performed under local anaesthesia, which means that you will be awake during the procedure. Your consultant will discuss the benefits and associated risks of injections for wet AMD together with any alternatives to the treatment.
About the injections for Wet AMD
Before the injection you will be given local anaesthetic eye drops and the area around your eye will be cleaned with an antiseptic. Once the anaesthetic has taken affect, your consultant will inject the drug through the wall of the eye.
The injection takes a few minutes and you will usually be able to go home about an hour later.
You may need regular repeat injections for the treatment to be successful – please ask your consultant for further advice.
Injection for wet AMD is a relatively new treatment. Like all medical procedures, there are risks as well as benefits. Although a rise in pressure within the eye is expected immediately after the injection, occasionally an incision is required to release fluid from the eye if the pressure is too great.
In rare cases the inside of the eye can become infected. This can be serious and can lead to permanent loss of vision - antibiotic eye drops are used to reduce the risk of infection. Also in rare cases, the retina can become detached, which may require surgery. The chance of complications depends on the exact type of injection you are having and other factors such as your general health. Your consultant will advise how any risks apply to you.
*For more information on AMD, visit Age UK
Presbyopia is usually caused by the lens becoming larger and harder and results in the eye becoming less able to focus. The effects of this are most acutely felt when we are trying to read, or focus intently on something close up. The most common treatment for presbyopia is to use of reading glasses, but there are other alternatives. Your Consultant Ophthalmologist will be happy to discuss your options with you and help you decide on the best solution for you.
If you have previously had successful cataract surgery and can see much better, but are dissatisfied because you do not wish to be reliant on spectacle wear for some or all activities, you may be suitable for a new type of implant which restores clear vision for near and distance without the need for glasses or contact lenses.
Eyelid ptosis affects the muscles in the eyelid that are designed to lift the upper eyelid. It is most commonly caused by ageing but can also occur in younger adult patients who wear contact lenses. This is due to the continuous contact with the eye during insertion and removal of the lenses. Very occasionally, ptosis can be caused by neuromuscular disease. Eyelid ptosis can also occur with the use of some drugs, following eyelid trauma or as a by-product of an eyelid lump such as a large chalazion or tumour.
A full ophthalmic examination is performed to check visual function, eye movement, the eyelid condition and the ocular surface. A full face examination is performed where special eyelid measurements are taken and a phenylephrine test is performed to assess the degree and type of ptosis. This helps decide the specific surgery that may be required. The only permanent way to treat eyelid ptosis is with surgery. Occasionally, injection treatments or eye drops can be used to temporarily rectify minor upper eyelid ptosis.
Reconstructive eye surgery may be required following injury, previous eye surgery or ocular burn. Oculoplastics is a highly specialised area of ophthalmology. The procedures that fall under this category of eye care deal with the management of signs of aging, as well as any deformities and/or abnormalities that patients may have on the eyelids, the lacrimal (tear) system, and the bony cavity surrounding the eye called the orbit, and the surrounding areas of the face.
Your eye is very similar to a camera. Inside the eye there is a lens, which sits behind the pupil. The eye’s ability to focus depends on three main factors, the cornea (which is known as the “window of the eye”, the lens inside the eye and the length of the eye. The cornea and the lens should work together to focus an image on the retina at the back of the eye. However, when these three elements don’t work together eyesight problems can result.
The tear drainage system moves excessive liquid on the eye to the corners of the eyes where there are tiny ducts. These ducts direct tears into a larger duct at the back of your nose. If any part of this system is blocked, the eye may hold extra solution and can become sticky.
An ophthalmologist will determine the cause of a watery sticky eye and may recommend surgery to clear the blockage.
11 March 2019
We caught up with Consultant Ophthalmologist and Glaucoma Specialist, Dr Pankaj Agarwal to find out a few facts and a ta…
06 March 2019
Come along to our next free patient information event for your chance to hear from our specialist consultant surgeons an…