1.2.4: Explains implications of pathological or physiological condition

Question 1

What is dry eye?

Answer 1

Dry eye is a common (chronic – once you’ve had it, it can go away it can come back) condition that may be caused because your eye do not produce enough tears or because the tears evaporate too quickly or are not even distributed by the lids.
Dry eye can make your eye feel scratchy or irritated. In severe cases, it may temporarily make your vision blurry. Its uncomfortable but rarely causes serious eye damage and is easily treatable / manageable.

Question 2

What can be done for dry eyes?

Answer 2

1. Avoid using eye make-up particularly eyeliner as this can block the glands which secrete the oily layer of the tears. Good lid hygiene is important especially if lids are inflamed and you have blepharitis
2. Be aware of your environment – central heating and air conditioning can both increase evaporation of tears, if its windy you may benefit from glasses or sunglasses and try to avoid smoky environment
3. Use eye lubricants – drops, gels or ointments and most available without a prescription and can be used as often as needed
4. If you find your eyes drying while using computers it may be beneficial to rest a blink away from screening regularly as you often forget to blink when on the computer

Question 3

What is blepharitis?

Answer 3

Blepharitis is an inflammation of your eyelids. It can make eyelids red and eyelashes crusty and make your eyes feel irritated or itchy can also lead to burning, soreness or stinging in your eyes. Symptoms tend to be worse in morning you tend to find your eyelids become puffy and your lids stick together. It is a chronic condition and can be uncomfortable but rarely causes serious eye damage and is easily treatable / manageable.
There are two types of blepharitis:
Anterior: This affects the outside front edge of the eyelids (around lashes) and may be caused by (staphylococcal) bacteria
Posterior: associated with MGD (MGD is where the glands which secrete the oily layer of the tears is blocked) affects the inside rim of the eyelids

Question 4

What can be done for blepharitis?

Answer 4

Although this is a chronic condition there are a few things we can do to make your eyes more comfortable
1. Warm Compress: warms the material that blocks the glands (butter analogy) and loosening the crusts on the eyelid. Compress and rock gently for 5 minutes and then clean the lids thereafter.
2. Lid Cleaning: special lid wipes or solution to clean the lids wiping from the inside to the outiside corner of the eye. Repeat twice a day
3. Lubricants: Use an ointment on the edge of lids after cleaning to help make them feel more comfortable. Use dry eye drops or gels to help lubricate eyes
4. Oral Antibiotics: if these treatments do not work you may be prescribed antibiotic for a course until resolution but it may return

Question 5

What is cataract?

Answer 5

Cataracts are formed when the clear lens inside the eye becomes progressively more cloudy or misty. This is a slow gradual process that usually happens as we get older. It does not hurt. The early stages of a cataract do not necessarily affect your sight.
The main cause is age and most people will eventually develop cataracts in both eyes however one eye may be affected before the other. However, smoking and exposure to sunlight have been linked to the formation of cataracts.
Younger people can develop cataracts if they have injury to the eye or a medical condition including diabetes or some medications (steroids). A very small number of babies are born with cataracts.

Question 6

What does cataract surgery involve and what are the risks?

Answer 6

You will have initial appointment with an eye specialist to discuss and assess suitability for surgery. The eye specialist may be able to correct any prescription so that you don’t require glasses post surgery. They will assess the eye and measure it to determine power of lens to be inserted into eye.
Most cataract operation are carried out under local anaesthetic and is day surgery. You will be awake but the specialist will make sure you cannot feel the area around your eye. The specialist will make tiny cuts to remove the cataract and replace it with a clear plastic lens usually takes around 20-45mins.
You will not normally need stitches but your eye will ne covered to protect it from knocks after the operation. You will be able to go home same day. Do not drive.
Most people find that cataract surgery is successful and are happy with the results. However as with all surgery there are risks involved and you should have surgery if its right for you but surgery has a very high success rate and the risks will be discussed with you before you make a decision

Question 7

What is glaucoma?

Answer 7

Glaucoma is a group of eye diseases in which the optic nerve, which connects the eye to the brain is damaged by the pressure of the fluid inside your eye.
This may be because the pressure is higher than normal, or because the the nerve is more susceptible to damage from pressure. This may affect one or both eyes. There is chronic glaucoma which slowly and acute glaucoma with happens more quickly.
If left untreated, glaucoma can lead to tunnel vision and blindness, but most people who go blind are those whom glaucoma is detected in the the late stage. As a result it is important to detect early
If you drive a car and have been diagnosed with glaucoma because of its affect on your vision by law you must inform the DVLA. You must have some extra test but most people are allowed to carry on driving.

Question 8

What is acute glaucoma?

Answer 8

This is a type of glaucoma where the drainage channels inside the eye are blocked or damaged in some way. This causes the pressure to increase rapidly.
Sometimes the increase in pressure can come and go and can give people short burst of pain or discomfort and blurred vision. This can happen when the pupils get bigger (so at night, in dark room (cinema) or when reading). Other symptoms are ache in the eye, red eyes and haloes or coloured rings around light and it can feel like looking through
haze or mist. If you experience any of these symptom it is important to act quickly even if symptoms go away as can cause damage each time it happens.
If you experience any of these symptom you should go immediately to A&E so they can relieve pain and pressure.

Question 9

What is AMD?

Answer 9

Macula degeneration (AMD) happens when the macula at the back of your eye becomes damaged. This can make it harder to see finer detail such as recognising faces, read or watch TV. However, this does not normally affect your ability to walk around as the edge of your vision should not be affected.
* DRY AMD: As we get older the light sensitive cells in the macula can start to break down this occurs gradually over many years. Waste products begin to build up form deposits called drusen. As the condition progresses so does the amount and size of drusen. As dry AMD progresses you have less of these light sensitive cells and causes your central
vision to deteriorate and a blurred spot will develop in the centre of your vision.
* WET AMD: Tiny new blood vessels begin to grow underneath the macula. These blood vessels form in the wrong place and can leak blood and fluid into the eye pushing the macula away from its blood supply at the back of the eyes causing rapid loss of vision and damage and can lead to scarring of the macula. Wet AMD progresses a lot faster than Dry AMD and it is this scarring and damage which causes the more severe symptoms.

Question 10

What to do to protect against AMD?

Answer 10

Smoking is known as a major risk factor for developing AMD so if you smoke, try to stop. It is also believed that a diet rich in leafy greens (kale, spinach, celery and broccoli) may reduce your risk of developing AMD. Other factors that increase your risk of developing AMD include a family history. It is more common in woman than men. It is possible
that exposure to UV light may be linked to AMD.
There are lots of dietary supplements on the market which claim to be beneficial for eye health. There is no good quality evidence that general population should take there supplements. There is moderate evidence that those with existing AMD may delay progession by using certain supplements. (if you smoke you should not take beta-carotene)

Question 11

What is the treatment for AMD?

Answer 11

There is currently no treatment for dry AMD. Lighting is very important if you are struggling to see finer detail your optometrist can also advise special magnifier which can help you. Organisations such as RNIB and local social services can provide you with equipment that can help you manage your day-to-day activities
Wet AMD can often be treated if caught early enough and this normally done by injecting a drug into the gel inside your eye. This shrinks the new blood vessels that are pushing the macula away from the back of your eye. You may need this repeated every few weeks for a few months. It is important to spot any changes early by checking each eye seperately and contacting your optometrist if you notice any distortion or blank spots.
If you have wet AMD your optometrist will refer you to any eye specialist who will decide if you need treatment by taking some scans of the back of your eye. They will also inject your arm with special dye while taking photos inside your eye.

Question 12

What is a pterygium?

Answer 12

• A Pterygium is a growth of pink, fleshy tissue on the conjunctive (the clear tissue that lines the eyelids and covers the eyeballs) its usually forms on the side closest to your nose and grows towards the pupil. It can look scary but it isnt cancer. The growth may spread slowly throughout your life or stop after a certain point. In extreme cases can cover the
  pupil and cause vision problems. You can have a growth in one or both eyes. Although it can cause discomfort this isnt usually a serious condition.
• Risk factors for pterygium are lots of exposure to UV light, dry eyes and irritants like dust and wind.
• Wear sunglasses outside as much as possible a wraparound style is best as it sheilds from dust and wind too, wear a wide brim hat and use ocular lubricant when eyes feels dry.
• If the growth is causing discomfort or interferes with your vision you doctor can remove it during an outpatient procedure. Like any surgery there may be complications: the growth may return, scary or cuts to the cornea, blurry vision from a uneven cornea.

Question 13

What is a pinguecula?

Answer 13

• A pinguecula is a yellowish, slight raised thickening of the conjunctiva on the white part on the eye, close to the edge of the cornea. Pinguecula are non-cancerous bumps on the eyeball on the white of the eye between the lids and appear on the side closer to the nose generally
• UV radiation from the sun is the primary cause of the development of pingueculae, but frequent exposure to dust and wind is a risk factor. Dry eyes may also be a factor.
• Pinguecula treatment depends on how severe the symptoms are. It is especially important to wear UV protection to stop them developing in first place and growing. If symptoms mild and accompanied by dry eye and irritation ocular lubricants may help relieve symptoms. Pinguecula can lead to localized inflammation and swelling in this case it may be
  treated with steroids or NSAID. Surgical removal is possible if extremely uncomfortable or interferes with blinking

Question 14

What is a chalazion?

Answer 14

A chalazion is a benign (non-cancerous) painless bump on the lids. They are a result of a healed stye that are no longer infectious. They form around the oily gland within the lids resulting in red, swollen eyelids. Theyre filled with blocked fatty secretion which normally help lubricate the eye. Many chalazion drain on their own especially after a course of warm compress and massage of lids. However some may grown large and become comestically unappealing but also they can sometimes press on the front surface of the eye which can cause blurry vision.
* Its not always possible to identify a cause. Chalazion are more common in px with blepharitis (inflammation of the eyelids). People with rosacea are also more prone.
* If your are prone to developing chalazion your doctor may prescribe treatment such as lid hygiene and oral medication to treat underlying condition (MGD or Blepharitis) your doctor may aso advise regular warm compress on a closed eye to promote drainage. Most common medication is doxycycline. Direct antibiotics for chalazion are ineffective as it is
not actively infectious. In the case of bothersome, persistant or large (causing blurring) chalazion an eye surgeon may remove the chalazion from underneath the lid under local anaesthetic.

Question 15

What is a hordeolum (stye)?

Answer 15

A stye is a small painful lump on the insider or outisde of your eyelid. They are usually caused by a bacterial infection.
They usually affect one eye. They don’t usually affect your vision.
* External Stye: A swelling that develops along the edge of your eyelid. It may turn into a yellow pus-filled spot that’s painful to touch
* Internal Stye: a swelling that develops on the inside of your eyelid, it usually less painful than an external stye.
* Most styes will get better without treatment within one to three weeks. In meantime there are a few treatments to ease symptoms. Warm compress on the area for 5 minutes, gently massage the area, repeat 3-4 times a day. Warmth encourages stye to discharge. Keep lids free from crusting and clean. Painkillers may be used if very painful.
* If stye persistent you may need to be referred to an eye specialist to have the stye drained. Complication of styes are uncommon however if infection spreads to whole lids and surrounding this is a condition knows as pre septal cellulitis you must see your doctor or optican immeadiately.

Question 16

What is conjunctivitis?

Answer 16

• Conjunctivitis is a common condition that causes redness and inflammation of the thin layer of tissue that covers the front of the eye and the eye to become sticky or watery. Conjunctivitis can affect one eye at first but usually affects both eyes after a few hours. Conjunctivitis can be caused by bacteria, viruses or other organisms and can be allergic
• Viral: tends to cause a watery red eye that last 2-3 weeks. In most cases it doesn’t affect your vision and is self resolving. Rarely you may notice your vision become blurry and experience glare this is due to inflammatory reaction causing small white dots on the cornea (front surface of the eye). These usually fade with time but can take few weeks to few months
• Bacterial: is more likely to cause a red sticky eye with yellow discharge
• Allergic: is more likely to cause a watery swollen red eye
• Treatment isnt usually needed for conjunctivitis because symptoms often clear up within a couple of weeks. If treatment is needed it will depend on the cause. In severe cases of bacterial antibiotic (chloramphenicol) eye drops can be used to clear the infection. Allergic conjunctivitis can usually be treated with anti allergy medication and cold
  compress. There is no antiviral medication for conjuncitivitis. Avoid wearing contact lenses and because it is contagious washing hands and not sharing towels or pillows and good lid hygiene to avoid crusting is important.

Question 17

What is episcleritis?

Answer 17

• Episcleritis is a common condition where the tissues between the conjunctiva (clear membrane which cover the eye) and the sclera (firm white bit of the eye) become red and inflamed. It often causes irritation, soreness or gritty sensation. It can be reccurrent.
• The cause is mostly unknown. It sometimes flares up when youre tired reading or working on computer for long periods or in a dry, dusty environment. Very rarely is it due to underlying inflammation in the body.
• In most cases, episcleritis recovers on its own and my not need any treatment but the symptoms can be relieved using ocular lubricnts. If persistant or significant discomfort you may require a course of steriods drops.

Question 18

What is scleritis?

Answer 18

• The sclera is the white part of the eye. It is the protective outer layer which is connected to the muscles that help the eye move. Scleritis is a disorder when the sclera becomes severly inflamed and red. It can be very painful. It is believed
  it occurs as a result of the body immune system overreacting. The type depends on location of the inflammation. Most people feel severe pain with this condition.
• This is a serious condition and early treatment with medication is necessary to prevent it progressing. Untreated cases can lead to partial or complete visual loss.
• The main symptoms of scleritis are severe eye pain, pain on eye movement (the pain may spread throughout the side of the face affected) other symptoms include excessive tearing, decreased vision, blurry vision, photobphobia, redness
  of the white of the eye.
• Symptoms of posterior scleritis are NO pain, deep seated headahce, pain on eye movement, eye irritation, double vision.
• The theory is that immune systems T cells (these are cells which prevent illness by destroying incoming bacteria, viruses and other pathogens) are believed to attack our own scleral cell. Doctors are unsure why this happens.
• Scleritis may occur at any age. Woman are more likely to develop it than men. People with rheumatoid arthritis, imflammatory bowel disease, sjorgens syndrome and lupus or those with previous trauma to sclera are more at risk of developing scleritis.
• Treatment of scleritis focuses on fighting the inflammation before it can cause permenant damage. Pain from scleritis is also related to inflammation, so decreasing swelling will reduce symptoms.NSAID and oral steriods are used to treat scleritis immunosuppressant may also be used if non responsive to NSAID or steroids. Surgery may be necessary for severe cases of scleritis this process involves the repair of tissues in the sclera to improve muscle function and prevent vision loss.
• Scleritis can cause significant eye damage, including partial or complete vision loss. Therefore scleritis is considered a serious eye condition that requries prompt treatment. As there is risk of scleritis returning after treatment its is important you attend follow up appointments. Treating the underlying autoimmune disorder is also important

Question 19

What is diabetic retinopathy?

Answer 19

• Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and untreated. However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight. To minimise risk people with diabetes should: ensure
  they control their blood sugar, BP and cholesterol. Attend diabetic screening regularly.
• The retina is the light sensitive layer of cells at the back of the eye that converts light into electrical signals. The signals are sent to the brain and the brain turns then into images you see. The retina needs a constant supply of blood which it receives through a network of tiny blood vessels. Over time, a persistent high blood sugar level can damage these vessels in 3 main stages:
  1. Tiny bulges develop in the blood vessels, which may bleed slightly but don’t usually affect your vision – this is known as Background Retinopathy
  2. More severe and widespread changes affect the blood vessels, including more significant bleeding into the eye – this is known as Pre-Proliferative Retinopathy
  3. Scar tissue and new blood vessels, which are weak and bleed easily develop on the retina – this is known as Proliferative Retinopathy and it can result in some loss of vision
  However, if a problem with your eyes is picked up early, lifestyle changes and/or treatment can stop it getting worse.
• Treatment for diabetic retinopathy is only necessary if screening detects significant problems that means your vision is at risk. If the condition has reached this stage the above advice to manage your condition is recommended. The main treatments for more advanced diabetic retinopathy are: laser treatment, injection of medication into your eye and
  operation to remove blood or scar tissue from your eye.

Question 20

What is diabetic maculopathy?

Answer 20

• Diabetic maculopathy is a complication of diabetes where persistant high blood sugar levels damage the blood vessels near the macula. The macula is the part of the eye that is important for central vision. These damaged blood vessels leak fluid and protein and causes a build up (swelling / oedema) this is known as Diabetic Macular Oedema
• Mild macular oedema may resolve itself without treatment however in persistant cases DMO can be treat by laser to the back of the eye however, nowadays injection into the jelly of the eye to reduce the build up of fluid is the preferred treatment.

Question 21

What are floaters?

Answer 21

Floaters appear as black spots or something that looks like hair or small pieces of cobweb. These can be semi transparent or dark and appear to float in front of your vision. If you’ve had these for years your eyes and brain learns to ignore them. Sometimes the number of floaters increases as you get older. Occasionally an increase in floaters can
be a sign of problem inside the eye.
Because they ‘float’ in the jelly of the eye you will find if you move your eye to try to look at the floaters it will move in direction you move your eye. You may only see floaters if you look at light coloured surface or the sky. Some people find that floaters can be nuisance but most people become used to them and they rarely cause problems with your vision.
* Some people are born with floaters. Other floaters occur as you get older when the gel in your eye (vitreous humour) naturally shrink. The gel seperates into watery fluid and wavy collagen fibrils. The fibrils are seen a line shaped floaters.
Sometimes the gel shrinks enough to collapse away from the light sensitve lining at the back of the eye which is called the retina. Once the gel has collapsed some people may see are large ring shaped floater.
The collapse of the vitreous gel can pull on your retina. If this happens you would see this as a flash of light.

Question 22

What are flashes?

Answer 22

• Some people may see flashes of light infront of one of their eyes, like small sparkles, lightening or fireworks. These tend to be in the extreme corners of your vision and come and go but don’t obscure any part of your vision. The flashes don’t last for a set length of time. You may notice them when you go from a light to dark environment. This may continue for several months. These are different to shimmering or zig zags caused by a migraine. Migraine shimmers or flicking of light often only happen on one side of vision, which then expands to the outside of you vision with some sort of jagged pattern and will obscure some portion of your vision. The shimmers disappear after 10-20 minutes followed by a headache however some people with vision only migraines do not experience headache after
• Flashes occurs when there is a pull on the retina. This might happen as the vitreous gel inside your eye becomes more liquid and collapses. You may experience flashes occasionally on and off for weeks or months. Flashes can also occur if you are hit in the eye.
• Flashes related to the collapse of the gel inside the eye are more likely to happen as you get older. Sometimes flashes indicate a tug on the retina and nothing more. However constant flashes may be a sign of a retinal detachement.
• A retinal tear or retinal detachment may lead to a sudden increase increase in floaters as well as flashe. You might notice a shadow at the edge of your vision too. This need immediate attention. If you notice these symptoms you should contact your optometrist straight away. If you cannot do this you should get urgent attention from eye casualty. A specialist will need to use drops and a special light to look inside your eyes to check if your retina is
  damaged.

Question 23

What is PVD?

Answer 23

• Posterior Vitreous Detachment or PVD is a common condition that occurs in about 75% of people over the age of 65. As we get older the jelly like substance in the eye called the vitreous shrinks and becomes more liquid. As is it shrink it collapses away from the light sensitive layer of the eye called the retina.
• No treatment is generally required for a PVD as the symptoms tend to calm down after six months and people get used to living with floaters and the brain learns to ignore them.
• PVD does not in itself cause a permenant loss of vision. Your vision should remain the same and you should be able to see as well as you could before the PVD. You may just notice annoying floaters and flashes which do not impair your vision. The only threat to vision is the very small change a retinal tear occuring during a PVD which in turn can lead to a
  retinal detachment. It is important to stress that retinal tears and detachments are much rarer and very few people with PVD go on to develop these problems.

Question 24

What is retinal detachment?

Answer 24

• Retinal detachment is a serious eye condition occurs when the light sensitive layer at the back of the eye begins to pull away and away from the blood vessels that supply it with oxygen and nutrients and without prompt treatment will lead to blindness in the affected eye
• The retina lies at the back of your eye and is the light senstive layer which sends signals to the brain, allow it to see. Without a blood supply the nerve cells die and lead to sight loss. Retinal detachment is most often the result of the retina becoming thinner and more brittle with age and pulling away from the underlying blood vessels. It can also be caused by a direct injury to the eye, but this is less common.

Question 25

How is retinal detachment treated?

Answer 25

• If a retinal detachment is suspected an optometrist or ophthalmologist will use special drops to make your pupil big and using a microscope (slit lamp) examine in detail the back of the eye. If there is a poor view of the retina an ultrasound scan may be used.
• The quicker the retinal detachment is treated, the less risk there is of permanently losing some or all of your vision in the affected eye. Most detached retinas can be successfully reattached with surgery. There are a number of a different types of surgery available, depending on the individual.
• It can take months to fully recovery from surgery on your eye. During the period you may have reduced vision, which means you may not be able to do some your usual activities, such as driving & flying. Some peoples eyesight does not
  fully return after surgery and they have permanently reduced peripheral (side) or central vision. This can happen even if the retina is reattached successfully. The risk is higher the longer the retina is left detached.