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H to O of Eye Diseases and Disorders

And the eye diseases and disorders keep coming.  As you can see we are just over half way with more to come yet.

Herpes and the Eye

Of the millions of people who get herpes cold sores every year only about 2% will go on to get an eye herpes infection, and whilst with a cold sore it’s just a case of waiting it out, with the eye version it’s best to consult an eye-care professional such as an optometrist.

There are several variations of eye herpes that need anything from mild attention to serious treatment to prevent serious vision loss.

Herpetic Retinitis

A herpes type 1 virus infection at the retina – any inflammation or infection can have serious consequences. Without effective treatment there is the possibility of retinal detachment leading to blindness.

Herpetic Uveitis

Uveitis is an inflammation of the middle layer of the eye which extends from the iris at the front, to the ciliary body holding the lens and then to the choroid to the rear.

Although it’s not certain what causes the various types of uveitis, if the herpes simplex virus (HSV) is thought to be responsible, then the inflammation will be given the specific description “herpetic uveitis”.

Hyperopia

This is the medical name for being farsighted or having farsightedness.

That of course is not a disease – but not being able to see near things clearly. Children often have hyperopia, sometimes only detected when they can see a distant screen but can’t see or concentrate on the detail in a picture book.

Often the child with have a turned eye (strabismus) caused by the Hyperopia.

Prescribed eyeglasses or contact lenses are treatment options.  Laser surgery is reserved only for adults once the condition stabilises.

Iritis

Iritis is an inflammation of the iris, the coloured part of the eye, and is one of the uveitis family, and is denoted as “anterior uveitis”.

There is no cure at the moment, but episodes of inflammation can be dealt with quite satisfactorily and further complications avoided using steroid eye drops.

Itchy Eyes

Symptoms that are found in many eye disorders such eye strain from too much computer work, and with diseases such as allergic conjunctivitis.

Keratoconus

This is an unusual (1 in 1000 people) degenerative disorder where the curved surface of the cornea changes to more of a cone shape. Since the cornea accounts for two thirds of the focussing power of the eye, vision is obviously affected.

Mainly genetic it’s thought, spectacles are the first line of treatment, but rigid gas permeable contact lenses are now being used to effect.  When managed by a specialist keratoconus optometrist 95% of people are managed without corneal transplant surgery.  Lately a procedure called collagen cross-linking has been used to slow down any progression.

No one with keratoconus goes blind.

Macular Degeneration

This relatively common eye disease currently is the most common reason become legally blind after the age of 50.  There are many risk factors many of which you can control.  Typically healthy living will protect you from this condition.

Make sure you have a regular eye exam to detect the very beginning of macular degeneration, as when found in the early stages it means that you have at least 15 years before it is likely to affect your vision – if you have not seen your optometrist in the last 2 years  – make an appointment now!

Macular Hole

The macula is the quite small area of the retina at the back of the eye. A vitreous jelly fills the eye and if it shrinks it may tear up part of the macula and eventually allow a macular hole to develop.

A day surgery procedure carried out is called a vitrectomy, in which the vitreous gel inside the eye is taken out to prevent it doing further damage to the retina and macula and is replaced with a bubble and gas mix to push everything back into place.

Prompt treatment will often preserve vision.  Luckily it usually affects only one eye but careful future monitoring is required as the second eye can be affected in 2% of cases.

Myopia

Common expressions for having Myopia are being “nearsighted” or “short-sighted”.

It can be detected in children when they can read well but can’t distinguish distant objects. A good idea is to check a child’s ability to see road signs at a distance.

Treatment is usually eyeglasses, since prescriptions change sometimes.

Lately a procedure called Orthokeratology has been shown to allow good vision all day and also slow down the progress by at least 50%.

Neurotropic Ulcer

The cornea loses its sensation as if it is permanently anaesthetised – the nerves on the surface of the cornea fail to work due to a reduction in blinking and ulcers may develop. If ulcers develop not only is vision impaired but this leads to scarring and eventual permanent damage to the cornea.

Any treatment needs to be promptly undertaken.

Nystagmus

Nystagmus is when the eyes move in an uncontrollable way, sometimes slowly at first in one direction before reverting back suddenly, or jerking back and forth repeatedly.

Infantile nystagmus cannot be readily treated but can be managed both in terms of minimising its physical effects and in dealing with lack of self esteem of both sufferer and parents and relatives. Acquired nystagmus can be treated through drugs, surgery.

Ocular Migraine

Unlike a migraine headache, an ocular migraine is painless and last up to thirty minutes. The symptoms are flashes of light and blurred or slight lack of vision.

The migraine connection in the name probably comes from the fact that conventional migraine sufferers also suffer from ocular migraines, in which case however the term “aura” is used.

Ocular Rosacea
Rosacea is an facial skin disorder that leaves sufferers leading an exasperating and sometimes painful life with constant flare ups and repetitive visits to the dermatologist.

Ocular rosacea includes symptoms of excessively bloodshot eyes and eyelashes falling out. It takes a dedicated patient to undergo treatment to achieve a successful and ongoing outcome, since it takes time, patience, persistence and organisation.

Ocular rosacea is treated with oral doxycycline and topical steroids.

Open Angle Glaucoma

About 90% of glaucoma cases are of the open angle type. The fluid behind the cornea of the eye is replenished but cannot escape through the fine mesh alongside the iris and cornea called the trabecular meshwork.  Increase in eye pressure because of this leads to damage of the optic nerve – glaucoma.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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