EYE
DISEASES
GLAUCOMA
Glaucoma is a progressive optic neuropathy and is the leading cause of irreversible blindness worldwide.
Glaucoma can remain asymptomatic until central vision and reading function are affected, by which time the disease has already progressed to advanced stages. Therefore, early detection is crucial.
Glaucoma risk factors:
- Advanced age,
- Elevated intraocular pressure,
- Ethnicity,
- Family history of glaucoma,
- Stage of the disease,
- Extreme farsightedness.
The most common types of glaucoma are open-angle and closed-angle glaucoma. Primary congenital glaucoma, while rare, may lead to irreversible childhood blindness if left untreated. It affects children between birth and 3 years.
Diagnosis:
Patients should be checked for signs of glaucoma even if they do not present with a loss of vision to rule out glaucoma.
Diagnosis is made by direct ophthalmoscopy, tonometry, perimetry and visual acuity, and gonioscopy.
Treatment:
The accepted approach to treatment involves reducing intraocular pressure to prevent the progression of optic neuropathy. This can be achieved with drugs, laser therapy, or surgical methods.
DRY EYE
Dry eye is an inflammation of the ocular surface characterized by decreased tear production leading to tear-film instability, irritation of the eye and/or decrease in vision. Dry eye syndrome is a multifactorial disorder that may lead to vision loss.
There are several forms of dry eye that require a different treatment protocol, thereby necessitating accurate diagnosis for the best clinical outcome. The treatment’s effectiveness depends on identifying the factors causing dry eye and preventing conditions that exacerbate the symptoms.
Treatment ; is categorized as medical therapy using anti-inflammatory or blood-based agents, surgical or invasive procedures, or using agents currently in development.
How to prevent or reduce dry eye syndrome:
- Increasing the rate of blinking,
- Increasing ambient humidity,
- Adjusting ambient temperature,
- Altering airflow in the environment,
- Adjusting ambient light,
- Adjusting the computer screen,
- Reducing tobacco smoke and dust in the environment,
- Increased liquid intake.
OCULAR BACTERIAL INFECTIONS
Ocular infections are diseases that may lead to blindness.
Among these, orbital cellulitis, dacryocystitis, conjunctivitis, keratitis and endophthalmitis are considered urgent medical emergencies. Rapid and aggressive treatment is essential to limit damage to the eye and vision loss.
Treatment of ocular bacterial infections is primarily carried out with broad-spectrum antibiotics.
The pathology and incidence of ocular infection are based on age, gender, race, climate and other factors.
CONJUNCTIVITIS
Conjunctivitis is the inflammation of the conjunctiva.
It can be infectious or non-infectious. Conjunctivitis affects people of any age and socio-economic status. It is the most common cause of eye redness complaints in primary care clinics.
Conjunctivitis can result from viruses, allergies or bacteria, and can be acute or chronic.
50% of cases of infectious conjunctivitis are bacterial. Bacterial conjunctivitis accounts for the majority of infectious conjunctivitis cases in children.
Acute conjunctivitis is generally self-limited and rarely causes permanent vision loss. However, differential diagnosis is essential to rule out other causes of red eye.
Patient education and hand washing are essential to preventing the spread of contagious conjunctivitis.
It is important to differentiate between acute bacterial conjunctivitis from viral conjunctivitis during clinical evaluation. Medical treatment of acute bacterial conjunctivitis involves topical antibiotics. Topical antibiotic treatment enables acute bacterial conjunctivitis patients to return to their daily routines faster.
KERATITIS
Keratitis is an infectious or non-infectious inflammation that affects the cornea of the eye.
Bacterial keratitis is a common sight-threatening infection. The surface of the cornea is well-protected by various mechanisms. Bacterial keratitis develops in the presence of risk factors that deteriorate the immune mechanisms that protect the cornea. These include eyelid anomalies, corneal dellen, reduced tear production, use of contact lenses, chronic alcoholism, dementia, and Parkinson’s.
Local or systemic immune suppression is an important factor in increasing both incidence and severity of infectious keratitis.
The clinical signs and symptoms of bacterial keratitis are variable and depend on the virulence of the organism and the duration of infection.
Patients usually present with decreased vision, pain, discharge and photophobia.
Treatment should be initiated with a topical antibiotic as soon as a bacterial infection is suspected in keratitis, due to the risk of rapid damage to the cornea tissue.
The aim of the treatment is to suppress the infection, reduce inflammatory response and pain, prevent structural damage to cornea, and facilitate healing of the epithelium based on the suspected microorganism and individuals risk factors of the patient. Bacterial keratitis is treated with frequent use of strong, wide-spectrum antibiotics.
ENDOPHTHALMITIS
Endophthalmitis is a serious inflammation of the intraocular cavities.
It can be infectious or non-infectious. Endophthalmitis is a sight-threatening complication of cataract surgery. As such, patients who undergo cataract surgery are given prophylactic treatment against potential infections.
Infectious endophthalmitis can be either endogenous (internal) or exogenous (external) based on the route of infection. Exogenous endophthalmitis is caused by trauma or ocular surgery, while endogenous endophthalmitis is caused by hematogenous bacterial spread.
Non-infectious or sterile endophthalmitis occurs due to a surgically placed intraocular lens or a toxic agent. Majority of endophthalmitis cases are acute, which require urgent medical attention and treatment. Delayed or inadequate treatment can result in irreversible loss of vision. Applying the treatment protocol after the infection agent is identified improves the clinical outcome in patients. In patients requiring emergency treatment in particular, it is important to start treatment based on possible pathogens.
BLEFARİT
Blepharitis is a chronic inflammation of the eyelids. It is a very common condition worldwide and affects all age groups. Blepharitis can cause dry eye and may affect the cornea as well as the eyelid. Blepharitis is a recurrent condition. Treatment is long term.
The exact cause of eyelid inflammation cannot always be determined, but different factors are known to increase the risk.
Blepharitis is often secondary to the structural or functional deficiency of the Meibomian glands, which play an important role in preventing evaporation of the eye’s tear film and protecting the eyeball from environmental factors.
Signs and symptoms of blepharitis include itchy eyes, sensitivity to light, blurred vision, and red eyes. These are typically worse in the morning.
Eyelid hygiene is essential for the treatment. Treatment also involves ointments or eye drops containing antibiotic, steroid, or a combination of the two. Treatment alternatives include eye drops to reduce inflammation, as well as oral antibiotics. Omega-3 and 6 fatty acid supplements can also be used.
ALLERGIC CONJUNCTIVITIS
Allergic eye diseases primarily affect the conjunctiva, cornea and the eyelids.
Ocular allergies can be acute or chronic. Acute ocular allergies generally cause itching, tearing and swelling of the eyes. Chronic ocular allergies present with vision can be affected.
Ocular allergies are categorized into several clinical types, such as seasonal, perennial, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis.
Seasonal and perennial conjunctivitis account for 25 to 50 percent of all allergic conjunctivitis cases. Perennial conjunctivitis mainly results from an allergy to house dust mites, whereas seasonal conjunctivitis results from environmental factors, such as pollen. Swelling of the eyelids and ocular surface, itching, redness, and watery discharge are the most common symptoms. Symptoms in seasonal allergic conjunctivitis are more severe than the perennial form.
Allergic conjunctivitis medication:
Antihistamines, mast cell stabilizers, dual-acting drugs, nonsteroidal anti-inflammatory drugs, corticosteroids and immunomodulators. An allergist or dermatologist should be consulted in cases of seasonal allergic conjunctivitis that cannot be controlled by topical drugs and oral antihistamines.
For corticosteroid treatment of chronic and recurrent conjunctivitis, it is important to measure and monitor intraocular pressure during the course of the treatment.
The key principle in the treatment of allergic conjunctivitis is to evaluate and modify the environmental factors to reduce the patient’s contact with allergens.
Topical and oral antihistamines and topical mast cell stabilizers or dual-acting drugs are important in maintaining quality of life.
CATARACT
Cataract is an eye condition in which the eye's natural lens becomes cloudy, losing its transparency. A clear, healthy lens focuses the light that passes through the eye. When this lens becomes cloudy, it loses its ability to focus light properly. Cataract patients see it as if they are looking through frosted glass.
It is natural for the lens to lose its former transparency with age. While around 90 percent of cataracts are age-related, cataracts may appear due to other reasons as well, such as systemic or ocular diseases, long-term steroid treatment, physical trauma, or in newborns (congenital cataract).
If untreated, cataracts may lead to vision loss. Cataracts cause half of all cases of blindness worldwide.
Cataract Signs and Symptoms:
- Blurry vision
- Trouble seeing at nigh
- Halos around light
- Needing more light to carry out daily tasks like reading, shaving, watching TV, cooking
- Frequent changes to glasses prescriptions
- Faded colors
Treatment: Cataract Surgery
Once cataracts begin to form, there are no eyeglasses or medications that can stop or reverse the process. The only treatment of cataracts is surgery.
Modern cataract surgery involves a small incision in the cornea and is completed in an average of 20 minutes. During cataract surgery the natural lens of the eye, which has become cloudy, is replaced by a clear artificial lens also known as an intraocular lens. It is recommended to use eye drops, which may include steroids, antibiotics and/or a combination of the two, for up to 3-4 weeks after the operation to prevent surgery-related complications and infections.
DIGITAL EYE STRAIN SYNDROME
As digital screens become part of everyday life, more and more people are experiencing a variety of ocular symptoms related to digital screen use. Individuals who spend a large amount time in front of screen often suffer from muscle and joint problems such as poor posture and neck pain, as well as eye complaints.
Digital eye strain syndrome, also referred to as computer vision syndrome eye strain, describes a group of eye- and vision-related problems that result from prolonged computer use.
Its symptoms include tired, itching, red, sore, burning eyes, watery or dry eyes, blurred or double vision, and changes in color perception. These may cause discomfort, reduce quality of life and affect productivity in the workplace, and may even cause long-term damage to the eyes if not kept under control. Air-conditioning and smoking may increase the severity and frequency of the symptoms.
Diagnosis
Patient history, detailed examination of the ocular surface and testing based on the symptoms of the syndrome are essential in the diagnosis.
Treatment
Limiting screen time and improving environmental factors are the first steps in the treatment of digital eye strain. Artificial tears and antiallergic eye drops can be used to treat the underlying ocular surface disorder or symptoms such as dryness and itching that are exacerbated by the use of digital displays. Treatment should be tailored to the individual patient and symptoms.
AGE-RELATED MACULA DEGENERATION
Age-related macular degeneration (AMD) is an ocular disease that causes damage to the retinal macula, mostly in the elderly.
AMD leads to the deterioration of central vision. AMD causes the patient to lose the ability to see fine details, both close-up and at a distance. For example, when an AMD patient looks at a clock, they can see the clock’s outline but cannot tell what time it is. AMD is grouped as two types, dry form and wet form.
Dry form AMD is very common. About 80 percent (8 out of 10) of people who have AMD have the dry form. Dry AMD is when parts of the macula get thinner with age and tiny clumps of protein called drusen grow. Patients slowly lose central vision. Currently, there is no treatment of dry AMD.
Wet form AMD is less common, but much more serious. Wet AMD is when new, abnormal blood vessels grow under the retina. These vessels may leak blood or other fluids, causing scarring of the macula. Patients lose vision faster with wet AMD than with dry AMD.
Main risk factors of age-related macular degeneration
Eating a diet high in saturated fat, being overweight, smoking, being over 50 years old, having hypertension, having a family history of AMD, having heart disease and having high cholesterol levels are risk factors for AMD.
Age-related macular degeneration diagnosis
Ophthalmologists may ask patients to look at an Amsler grid. Amsler grid is a practical test that can be taken at home. The grid helps notice any blurry, distorted, or blank spots in a person’s field of vision. Ophthalmologist will also look inside the patient’s eye through a special lens to see if there are any changes in the retina and macula. Fluorescein angiography and optical coherence tomography are also frequently used methods to examine the retina.
Dry AMD treatment:
There is no treatment for dry AMD.
However, patients with high amounts of drusen or serious vision loss might benefit from taking a certain combination of nutritional supplements. A large study named AREDS found that dry AMD patients may slow the progression of their condition by taking these vitamins and minerals daily:
- Vitamin C
- Vitamin E
- Lutein
- Zeaksantin
- Zinc
- Copper
Dark leafy greens, yellow fruits and vegetables, fish, and a balanced, nutrient-rich diet have been shown beneficial for people with AMD.
Wet AMD treatment:
To help treat wet AMD, there are medications called anti-VEGF drugs. Anti-VEGF treatment helps reduce the number of abnormal blood vessels in the retina, and also slows any leaking from blood vessels. This medicine is delivered to the eye through a very slender needle.
