Burst blood vessel in eye - cause?
Question
I am a 62-year-old female, and am taking medication for raised blood pressure. Otherwise I am in very good health. My question is in regard to burst blood vessels occurring in my right eye. Can I alleviate this disfiguring appearance and is there a possible cause of the condition?
Answer
This sounds like a case of subconjunctival haemorrhage, which means bleeding under the conjunctiva. The conjunctiva is a thin transparent membrane that covers the sclera or white part of the eye. This membrane has a very rich blood supply and the subconjunctival haemorrhage occurs when one of these tiny blood vessels leaks. The blood gathers in the space between the sclera and conjunctiva giving rise to the disfiguring appearance of a blood red eye. The haemorrhage does not represent any threat to sight and the condition is not as serious as it may look. Sometimes these haemorrhages occur following a fit of coughing or from rubbing the eye too vigorously. Subconjunctival haemorrhages can also occur as a result of high blood pressure so it would be important for you to have your blood pressure re-checked in order to be sure that it is adequately controlled. There is no treatment available to eliminate the disfiguring appearance from the haemorrhage. Drops and ointments are of no benefit but fortunately the blood usually disappears completely within 10 to 14 days.
Glaucoma - varieties and treatment?
Question
I have glaucoma. Can you explain what this means and is there any treatment available to repair the damage?
Answer
Glaucoma is a group of eye diseases that result in loss of vision due to raised pressure within the eyeball. The eyeball is a fluid containing sphere and if the pressure within that sphere rises it can result in pressure on the optic nerve and retina. The retina is the light sensitive area at the back of the eye and the optic nerve can be compared to an electric cable that conducts the tiny electrical impulses that are generated within the retina. These impulses are conducted to the occipital cortex, which is the area in the back of the brain where the electrical impulses are transformed into that sensory experience that we know as sight. The commonest form of glaucoma is known as primary or open angle glaucoma. In this condition the drainage canals within the eye become blocked, however the entrance to the drainage system is open. It has been compared to a blockage in a domestic sink where the plughole is open but the kitchen drain is clogged. The loss of vision in open angle glaucoma is slow and insidious and may not be noticed until a significant degree of vision has been lost. It is treated with drops and medication. Acute glaucoma presents suddenly and the affected person may experience significant pain in the eye associated with a marked reduction in eyesight. They may also experience severe headache. This form of glaucoma has been compared to a sink blockage where the actual plughole is covered. Such cases are often treated surgically in order to open the entrance to the drainage canals thereby permitting the free flow of fluid through the system resulting in a reduction in pressure in the eye. Sometimes glaucoma can occur as a result of other conditions such as trauma to the eye, inflammation within the eye, advanced cataracts or advanced diabetes. All of the treatments for glaucoma are aimed at reducing the pressure within the eye thereby preventing further loss of sight. It is important to stress that treatment cannot restore the sight that has been lost. Therefore it is important that in the particular case of open angle glaucoma that the diagnosis is made early and treatment is commenced without delay.
High bood pressure - eye changes?
Question
I had my eyes tested and the tester told me that the vein and artery around my eyes were showing signs of high blood pressure and that I should see my doctor. Is this something to worry about?
Answer
The optician’s observations may or may not be of any great significance but it would be wise to follow up on the advice you have been given and visit your GP. There is a condition known as hypertensive retinopathy, which means that changes have taken place on the retina or light sensitive part of the eye that are due to hypertension or high blood pressure. When we look through the pupil with an ophthalmoscope it is possible to see the arteries and veins quite clearly on the retina. If a person has hypertension various changes may be seen that can range from very mild and relatively insignificant changes to grossly abnormal changes that could have implications for sight. These latter changes are relatively rare. The changes in the arteries and veins are directly due to the increased pressure of blood within the blood vessels. Clearly you have a very good optician who has been very diligent in referring you to your GP. The first step your GP is likely to take is to measure your blood pressure. If your blood pressure is normal and the eye changes are minimal the matter can probably left at that. However, if your blood pressure is high you may need treatment but usually you don’t need additional treatment for the eye changes unless they are severe.
Itchy eyes - change sunglasses?
Question
I have just returned from a holiday in Spain and while there had a problem with very itchy eyes. Since my return the problem has disappeared. Do I need better sunglasses?
Answer
I don’t think that your sunglasses have anything to do with your eye problem. Eye irritation can happen for a variety of reasons. Perhaps you had a minor infection in the eyelids or alternatively the infection could have been located on the surface of the eye. It is also possible that you had an allergic reaction to dust, aerosols or pollens in the air. Perhaps your eyes became irritated from the seawater or swimming pool. Maybe you rubbed your eyes after putting some sun block on your skin and inadvertently put a trace of the cream on your eye. It might even have happened as a result of soap or shampoo getting into your eyes. Fortunately the problem has cleared up so no further action is needed. Getting a better pair of sunglasses is an unnecessary expense.
Laser eye surgery - contraindications?
Question
Can you have eye laser surgery if you have conjunctivitis?
Answer
It would be normal practice to postpone laser refractive surgery until conjunctivitis had been successfully treated, assuming that the conjunctivitis had been of infectious origin. Such surgery would also be contraindicated in the case of allergic eye disease that was sufficiently severe as to require regular treatment. It is also contraindicated in the case of severe dry eye disease. Further contraindications to such surgery would include; a previous history of abnormalities of the cornea, autoimmune diseases such as rheumatoid arthritis and SLE, immunodeficiency states and drugs such as steroids and cytotoxic agents. Laser refractive surgery is also contraindicated during pregnancy.
Laser surgery - correct eyesight?
Question
How do I go about getting laser surgery to correct eyesight? What hospitals provide this service (specifically any in Cork)?
Answer
Your first step should be to visit your GP who would be aware of which centres perform laser surgery in your area. Your GP can then assist you with the referral. You should also be aware that not every person is suitable for such surgery. If you have pre-existing eye disease the procedure is contraindicated. The procedure is also not recommended for people suffering from diabetes. Those people suffering from autoimmune conditions such as SLE and rheumatoid arthritis are also excluded because of the possible eye complications that can be a feature of those diseases. The cost of the procedure is tax deductible and is only available as a private treatment in a private hospital. There are several hospitals providing the treatment in both Dublin and Cork. I am not aware if it is available in other centres in the Republic of Ireland but it is also available in Belfast. There are two forms of laser treatment available called LASIK and PRK. These are both acronyms with LASIK standing for laser assisted in situ keramatomileusis and PRK standing for photorefractive keratectomy. The former procedure costs approximately €2,000 per eye and the latter costs approximately €1,500 per eye.
Macular degeneration - treatment?
Question
My brother has serious complications from diabetes, the worst of them being macular degeneration. Glasses will not help him. He has had laser treatment and that has dried up the back of the eye but his eyesight is still very poor. We are wondering if there is anything else we can do to try to help him see again?
Answer
Macular degeneration is a process of gradual deterioration in the macula, which is the most light sensitive part of the retina. People with macular degeneration suffer from a scotoma, which is the technical term for a defect in the centre of their field of vision. This visual defect gradually enlarges over time until the person has a large blind patch in the centre of their field of vision and a thin rim of peripheral vision. Despite the many advances that modern medicine has made the search for an effective treatment for macular degeneration is still beyond our grasp. There are several experimental treatments available but they are only suitable for a minority of cases and we do not have data to indicate what the long term outlook might be following such treatment. It is important to realise that such treatments will not restore lost sight but will simply attempt to contain whatever sight remains. In other words you cannot restore what has been lost. You might like to visit the following web site that is devoted exclusively to the discussion of macular degeneration: http://members.aol.com/danlrob2/MDpeople/md_description.html
Measles - eye risk?
Question
Our baby girl is 9 months old. She has not had the MMR and now has measles. Is there anything else I should do besides keeping the temperature down and keeping her in a dark room? I am concerned about her eyes because it looks like it’s going into her eyes.
Answer
The rash associated with measles does not affect the eyes. This is one of the enduring myths about the infection and this is why the advice has been passed down over the generations about the need to keep the infected child in a darkened room. Sometimes the child’s eyes may appear to be very watery and irritated and perhaps that is what you are observing. It is not necessary to keep the child in a dark room. Children with measles often develop high temperature and I note from your query that you are already attending to that. It is also important that the child drinks sufficient amounts of liquid because the body can lose significant amounts of fluid as a result of a raised temperature. The nature of the liquid is not of critical importance. Juice, milk, soft drinks or tap water are all fine. It is the volume of fluid consumed that is important. If the child will eat for you it is reasonable to keep feeding the child however, children with measles are often quite irritable and lose their appetite. In that situation there is nothing significant to be gained by forcing a sick child to eat if it really doesn’t want to. Children often lose weight as a result of measles but they usually regain that weight reasonably quickly once they have recovered from the infection. Measles is highly infectious so it is important to keep the child isolated from your neighbours’ children.
Optician's advice - see my GP - why?
Question
I recently got my eyes tested for new glasses. After examining my eyes my optician advised me to get my blood pressure tested. Earlier this year I had a full medical with an ECG and every thing was ok. I jog regularly and am reasonably fit. Should I be concerned or just get it checked anyway?
Answer
Since you were given the all clear earlier this year I certainly don’t think you need to worry but I do suggest that you follow the opticians advice. There are certain visible changes on the retina, which is the light sensitive membrane at the back of the eye, that indicate that the blood pressure may be elevated. These changes are detected when the optician looks though your pupil with the aid of a special torch that we call an ophthalmoscope. This instrument allows the examiner to directly inspect the condition of the retinal blood vessels, which are clearly visible on the retina. Certain conditions such as kidney disease, diabetes and high blood pressure can cause particular changes to the appearance of the retinal blood vessels. Your optician is being cautious and thorough by suggesting that you have your blood pressure measured. The changes noted were probably very minor and probably non-specific but the optician thought it prudent to suggest you simply have the blood pressure measured just to be sure that it is all right. It is unlikely that your blood pressure has suddenly become elevated in recent months but in view of these minor findings it is reasonable to have it checked again.
Photophobia - light sensitivity?
Question
I would like to ask you about light sensitivity. For the last 3 years or so I have noticed that the glare of daylight hurts my eyes causing me to squint. This seems to be associated with headaches around my sinus areas. Wearing sunglasses seems to ease the problem somewhat. Indoor lights, especially florescent lighting, hurts my eyes too. I use a computer in work and after using it each day my vision is blurred and I have extreme fatigue. I also suffer from occasional migraines. Suggestions? Advice?
Answer
Photophobia or light sensitivity can be triggered by sunlight, fluorescent light, the light from VDUs (visual display units) and in severe cases can be triggered by any light even if it is not particularly bright. The intolerance of light induces squinting as the sufferer attempts to reduce the amount of light getting into the eye. It is not uncommon for this squinting action to induce headache. Some migraine sufferers are also prone to being intolerant of bright light. Photophobia can be a symptom of an underlying eye problem such as conjunctivitis, uveitis, corneal abrasion, cataracts or even colour blindness. Certain medications can also contribute to the problem such as tetracycline and doxycycline, which are frequently prescribed antibiotics. I note your comments about working with computers, which leads me to suggest that you should attend an optician and have your sight tested. Working at a VDU for several hours a day could trigger symptoms such as you describe especially if your eyesight is deficient. Some people need to wear glasses while working in front of a VDU even though they might not otherwise experience visual deficiency while reading a newspaper or other printed material.
Glaucoma - new treatments?
Question
I have glaucoma in my right eye. Is there anything that will repair the damage available yet?
Answer
Glaucoma means that the pressure within the eyeball is high. It may occur in acute or chronic form and is quite rare before middle age. Glaucoma may occur as a consequence of any eye condition that interferes with fluid drainage within the eye. I am specifically referring to intra-ocular fluid (fluid within the eye) and not the tears, which are extra-ocular or on the surface of the eye. Most cases of glaucoma occur for no apparent reason. Unfortunately there is no treatment available that can restore the sight that has been lost. Current treatments are aimed at conserving the sight that remains.
Eyelid - lump present?
Question
Ever since the birth of my second child last August I have had a small lump on my eyelid, and complain of never-ending irritation in my eyes. Can you tell me what it is or at least if I should go to my doctor.
Answer
I would suggest that you visit your GP in order to have this lump identified properly. It sounds like a chalazion or meibomian cyst. A meibomian cyst is a painless swelling in the eyelid that has usually been present for many weeks or months. A stye or hordeolum, in contrast, tends to be acutely painful and tends to last for a few days. Meibomian cysts often occur in association with inflammation of the eyelids which may account for the irritation that you are currently feeling. These cysts can persist for a very long period of time and tend not to regress. It is possible to have the cyst removed and this can often be done as a day case, which eliminates the need for hospital admission. You can learn more about meibomian cysts by reading our special feature on this subject, which can be accessed at: http://www.irishhealth.com/index.html?level=4&id=249
Cataract surgery - my granny is going blind?
Question
My grandmother's sight has been getting progressively worse for the last number of years! Could she be going blind? Is there anything that can be done? She was told 5 years ago it was cataracts but they weren't 'ripe' enough to be dealt with, which seems ridiculous to me! I mean she can barely see. So could it be cataracts or was that just an excuse?
Answer
The term “ripe” was used in the past to describe a cataract that had become so advanced that the person was nearly blind. Cataract removal was deferred until a late stage because the complication rate was high. The person also had to be hospitalised for a week and then had to adjust to the difficulties of wearing thick heavy spectacles for the rest of their lives. With the advent of modern treatment cataract management has been transformed. It is often possible to perform cataract surgery as a day case without requiring overnight admission to hospital. It is also possible to replace the damaged lens with an artificial lens, which obviates the need for spectacles. Many people who have been through this surgery are able to see perfectly well without the need for heavy spectacles. The complication rate from this surgery has been dramatically reduced when compared with results in the past. Assuming that there are no other associated eye problems with your grandmother I think that it would be perfectly reasonable to revisit the decision of five years ago.
Conjunctivitis - causes?
Question
My eyes seem to get bloodshot fairly often. Could you tell me what might be causing this?
Answer
By bloodshot I assume you mean that the tiny blood vessels on the white of your eyes are more noticeable. This condition is generally referred to as conjunctivitis, which means inflammation of the conjunctiva or membrane that covers the surface of the eyeball and inner surface of the eyelids. Bacterial infection is a common cause of conjunctivitis and this is easily remedied with antibiotic drops and ointment. Sometimes conjunctivitis can occur as a result of allergy. A typical example of such allergy is hay fever, which often results in inflamed eyes once the sensitised person is exposed to grass pollen. Sometimes the eyes become bloodshot because of irritation from dusts and fumes. Exposure to cigarette smoke will often cause irritation of the conjunctiva because smoke consists of very fine dust particles that can settle on the front of the eye. People with sparse eyelashes are more prone to developing irritation of the conjunctiva. The eyelashes offer a form of physical shield to the eye through the act of blinking. If fewer hairs are present it is easier for particles to land on the conjunctiva. It is also possible that you might have dry eyes, which means that the tear sac is not producing sufficient amounts of tears thereby resulting in insufficient lubrication of the inner surface of the eyelids during the act of blinking. Since you are experiencing this discomfort on a regular basis it would be appropriate to attend your doctor for an assessment.
Conjunctivitis - contagious?
Question
Is conjunctivitis contagious?
Answer
Conjunctivitis is an inflammation of the membrane that covers the eye and lines the inner surface of the eyelids. The membrane is called the conjunctiva. Conjunctivitis can be caused by irritants, by allergy and by infection. Irritants would include smoke, soap, hairspray, cosmetics, chlorine in swimming pools etc. Allergic causes would include grass and other pollens. The third category I have listed would include infection, which could be due to bacteria or viruses. This form of conjunctivitis is indeed contagious and can be spread by contaminated hands, face cloths or towels. It can also be transmitted through contaminated eye make up, false eyelashes and contact lenses.
Dry eyes - what to do?
Question
I am in my early fifties and notice that my eyes have been getting increasingly irritated for the past few months. They feel OK in the mornings but as the day progresses they get sore and blood shot. What could be wrong?
Answer
It would be worth visiting your optician in order to have your eyes examined. It sounds to me as if you have dry eyes and your optician can easily confirm this. Tears act as a lubricant on the front of the eye and they allow the eyelids to glide up and down on the front of the eyeball as we blink. I suspect that your tear sacs are not producing sufficient amounts of tears, which results in a friction effect as the eyelid rubs off the eyeball. This explains why the eyes become progressively more irritated as the day goes on. Typically a sufferer from dry eyes is relatively comfortable in the morning time because the eyes have been closed during sleep and the eyelids have not been blinking periodically. It is not possible to increase the amount of tears being produced by the tear sacs therefore it is necessary to supplement the volume of tears by adding artificial tears periodically during the day. There are also special eye lubricants available that can be used at night before going to sleep. The artificial tears should alleviate the friction effects that are giving rise to your current discomfort.
Elderly diabetic - now has glaucoma?
Question
Could you please provide me with some information suitable for a 74-year-old male who has been diagnosed approximately 8 years ago with “type 2 diabetes”? He has now developed glaucoma in both eyes, and does not understand the relevance of adhering to a sugar free diet.
Answer
Type 2 diabetes is also known as NIDDM (non insulin dependent diabetes mellitus). People with type 2 diabetes do not need to use insulin injections and their condition can usually be managed adequately through diet alone or through a combination of diet and drugs. The gentleman you refer to has recently been diagnosed with glaucoma, which means that he now has a second threat to his eyesight because type 2 diabetes can adversely affect the eyes if the special diet is not adhered to. It might help the man if he had more information about his condition and you could access such information for him in our special feature on diabetes, which can be accessed at: http://www.irishhealth.com/index.html?level=4&id=238. The Diabetes Federation of Ireland is another useful source of information and they have a wide range of information available on their website, which can be accessed through the following link: http://www.diabetesireland.ie/view.asp?ID=210.
Episcleritis - prevent recurrence?
Question
For the last year, my eye has become red and painful every two to three months. I was referred to a specialist who diagnosed episcleritis. She mentioned that it could be related to other inflammatory conditions in the body. Could you explain what these conditions could be and also if there is anything I can do to avoid another recurrence?
Answer
Episcleritis presents as an acute redness in the eye. It can be confused with conjunctivitis but in the case of episcleritis only a sector of the white of the eye becomes injected. Sometimes small nodules may be present in the centre of the injected area. The cornea is spared from the acute inflammatory reaction and remains clear. The condition is relatively benign and occurs for no known reason in the majority of cases. However, as the specialist has indicated it can occur in association with systemic inflammatory conditions such as rheumatoid arthritis, SLE, inflammatory bowel disease, sarcoidosis, polyarteritis nodosa, gout and herpes zoster infection. The inflammatory bowel diseases, Crohn’s disease and ulcerative colitis, are the two diseases most commonly associated with episcleritis but again I stress that most people develop the condition for no known reason. The majority of cases of episcleritis resolve spontaneously without treatment. This recovery can take approximately two to three weeks. More severe cases may require treatment with NSAIDs (non-steroidal anti-inflammatory drugs) and possibly topical steroids but again this is not usually required. Since most cases of episcleritis occur for no known reason it cannot be prevented.
Eye angiogram - explain?
Question
My mother has bleeding behind the eye and has to have an angiogram on her eye. Could you explain what this involves please? She suffers from high blood pressure, which the doctor thinks is the cause of the bleeding.
Answer
An angiogram is a special imaging technique that allows the examining doctor to obtain pictures of the blood vessels on the retina, which is the light sensitive membrane at the back of the eye. A special dye is injected into a vein in the arm and photographed as it passes through the arteries and veins of the retina. A digital camera is focussed on the back of the eye through the pupil but it is important to realise that this is a non-invasive technique and does not involve inserting anything into the eye. The photographer takes a series of photographs to document any abnormalities or leakage from the retinal blood vessels. After the test the examining doctor will make a careful interpretation of the angiogram, and the precise location of abnormalities can be documented for future reference. I agree with your mother’s doctor that high blood pressure is the most likely cause of the bleeding.
Eye strain
Question
For the last 3 years I have been working on a computer for 8 hours a day. My eyes feel dry and itchy and they are also very sensitive to light. Over the last year I have developed almost permanent pain and pressure above and below my eyes. What could be wrong?
Answer
The symptoms you describe are becoming increasingly common as more workers are now working at VDU screens throughout the day. You should have your eyes examined by an optician and do specifically mention that your work involves the use of a computer. You might have a slight visual defect, which would make it necessary for you to wear glasses while working with the computer. Also make sure that your screen is free of glare from sunlight or overhead lighting in the office. Glare can give rise to strain in the small muscles around the eyes giving rise to pain and tension in those muscles. It might be worth using some artificial tears to moisten your eyes because they can dry out when you are working at a screen for long periods of time. Try to vary your office routine so that you are away from the screen periodically during the day.
Eye strain - assessment?
Question
I need to get my eyes tested as they are becoming strained from years of computer use. Who is the best person to judge whether I need glasses? Is it more reliable to get a referral from my GP or should I visit an optician?
Answer
Anybody working with computers should undergo periodic testing of their eyesight in order to ensure that their visual acuity is adequate for the job. This should be an ongoing process of review and can be quite easily performed by an optician. Most GPs would not have the necessary equipment to perform such an assessment unless they had a specific interest in occupational health. You could clarify that point by contacting your GP’s secretary. I don’t think it is necessary to be referred to an ophthalmologist (an eye specialist) to undergo such assessment because the primary focus here is on visual acuity and not diseases of the eye. I want to emphasise that I am making these remarks in the context of visual acuity checks for people working with computers. Computer users may be looking at a VDU for many hours and this can result in strain injury if they have reduced visual acuity. Such workers may compensate for reduced visual acuity by adapting their posture thereby giving rise to muscle or ligament strain, which in turn causes neck, shoulder or back strain. Leaving aside work and safety issues there is a school of thought that the sale of glasses should be completely deregulated. For example in some countries you can purchase glasses in the same way that you buy a hat. You simply try on a pair from the display stand and if you are happy with the improvement in vision you simply pay for them at the till. In summary, in your particular case a visit to an optician should address your needs.
Strabismus - surgery available?
Question
I am interested in obtaining information on surgical treatment for strabismus. Are there ophthalmologists in Ireland that perform surgery on this disorder?
Answer
Strabismus is colloquially referred to as a “turn in the eye”. There are several ophthalmologists in Ireland that are skilled in surgery for this condition. It is important to realise that the purpose of such surgery is to realign the eyes and that it has no impact on any underlying defect in vision. Poor vision can only be corrected by wearing an eye patch or glasses or both. Surgery involves resection of the extraocular muscles, which are the muscles that are responsible for moving the eyes. These muscles are attached to the surface of the eyeball. The procedure results in a lengthening or shortening of particular sets of muscles, which corrects the misalignment of the eyes. Comprehensive preoperative assessment is essential so that the ophthalmologist can measure the degree to which the extraocular muscles need to be realigned. The goal of surgery is to realign the eyes as close to normal as possible. However, it must be understood that a perfect result cannot be guaranteed.