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Case Study On Different Eye Disease
Experience With Form Of Case Study
Cataract
What is cataract?
In the eye, the most important part is lens.it contains protein the denaturisation of protein is called cataract or in other word clear lens became opaque or cloudiness of clear lens is called cataract. Suppose if you take an egg after boiling the outer part of an egg became white the same process occurs in our clear lens slowly It becomes opaque and convert into cataract.
Causes of cataract?
- Aging : It is the most common cause. This is due to normal eye changes that happen starting around age 40. That is when normal proteins in the lens start to break down. This is what causes the lens to get cloudy. People over age 60 usually start to have some clouding of their lenses. However, vision problems may not happen until years later.
- Genetic : If your ancestor or in your family somebody like your parents brothers sisters have cataract you may get cataract
- Injury : Chemical, thermal trauma radiation or any type of injury on eye causes cataract now a days it is common
- Steroids : Excessive use of steroids on eye or in body like condition of arthritis asthma or renal disease will induce cataract excessive use of non-steroidal anti-inflammatory drugs also causes cataract certain major disease like diabetes, excessive malnutrition, bad habits like alcohol also causes cataract.
- Exposure to excessive sun light which contains more uv rays can cause cataract
- Congenital cataract normally due to rubella virus
- IN SHORT, ANY THING THAT CAUSES DISTURBANCES IN PROTEIN LENS FIBER WILL INDUCE CATARACT.
Types of cataract
- Normal cataract (nuclear sclerotic cataract, cortical cataract): which is age related and seen in both eyes occurs after age of 65 years looks white or pale yellow.
- Posterior polar cataract (posterior sub capsular) : seen usually due to steroid induce seen in mostly young patient, alcoholism diabetic induced cataract, steroid induced etc
- Spotted like cataract is usually seen in congenital cataract
- Traumatic cataract depends on types of injury
SIGNS OF CATARACT
- Blurry vision, excessive perception of light haloes around light, difficulty in taking judgement or patient says I can’t see, Clouded, blurred or dim vision.
- Increasing difficulty with vision at night.
- Sensitivity to light and glare.
- Need for brighter light for reading and other activities.
- Seeing "halos" around lights.
- Frequent changes in eyeglass or contact lens prescription.
- Fading or yellowing of colours.
DIAGNOSIS OF CATARACT
- Simple torch examination.
- Slit Lamp Examination.
- Visual acuity test.
- Need for brighter light for reading and other activities.
- Cataract is diagnosed very simply sometimes an eye specialist can diagnose naked eye also but in difficult case you need to have very good slit lamp.
TREATMENT OF CATARACT
- Now a days cataract should be removed depend on patient’s profession and need, you should not wait till you have much visual problems, better take advise of your eye specialist.
- Before removal of cataract certain test should be done, take advise of your surgeon
- To regain normal vision, you simply remove cataract and put lens by phacoemulsification
- During cataract surgery, the natural cataract-affected lens is removed entirely and replaced with an artificial lens. So, it is actually impossible to get another cataract. All of that said, there is a secondary condition that can occur after cataract surgery that has extremely similar symptoms.
- See your eye doctor regularly.
- Eat a diet rich in beneficial nutrients.
- Quit smoking -- or better yet, never start.
- Cut back on the cocktails.
- Protect those eyes from the sun!
- Keep your diabetes under control.
- Avoid using corticosteroid medications for any length of time
ADVISE YOU SHOULD GIVE TO YOUR PATIENT TO PREVENT
- Keep your health good.
- Avoid addiction of alcohol tobacco any unnecessary addiction which is harmful to your body.
- Keep diabetes hypertension or any major disease under control.
- Age related. Genetic and congenital cataract you cannot prevent but by healthy life you can delay it.
- STRESS : now a days stress is major factor for developing cataract as far as possible reduce stress.
- Take care of your eyes from having injury.
- Now a days UV protected sunglass are available compulsory wear it while exposing to sunlight like our cricketers are wearing
- Antioxidant vitamins and phytochemicals found in fruits and vegetables that may reduce the risk of cataracts include vitamins A, C and E, lutein and zeaxanthin. Consumption of fish, which is high in omega-3 fatty acids, also has been linked to potentially reduced risk of cataracts or their progression.
- Take prophylactic antioxidant drugs regularly
POSTOPERATIVE CARE
- Take post-operative medication as prescribe by your doctor.
- Wear sunglass as such normally also you should wear it.
- Visit regularly as advise by your doctor.
CERTAIN COMMON QUESTION REGARDING CATARACT
What are the risks of cataract surgery?
As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before cataract surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision.
Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (near-sightedness), can further increase your risk of retinal detachment after cataract surgery. One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little “cobwebs” or specks that seem to float about in your field of vision. If you notice a sudden increase in floaters or flashes, see an eye care professional immediately. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. Your eye must be examined by an eye surgeon as soon as possible. A retinal detachment causes no pain. Early treatment for retinal detachment often can prevent permanent loss of vision. The sooner you get treatment, the more likely you will regain good vision. Even if you are treated promptly, some vision may be lost.
Talk to your eye care professional about these risks. Make sure cataract surgery is right for you.
What if I have other eye conditions and need cataract
surgery ?
Sometimes you need a cataract surgery if u have glaucoma or macular degeneration or for treatment of diabetic retinopathy ask your doctor details about it.
What doctor do before surgery?
A week or two before surgery, your doctor will do some tests. These tests may include measuring the curve of the cornea and the size and shape of your eye. This information helps your doctor choose the right type of intraocular lens (IOL).
What happens during surgery?
Now a days surgery is done without anaesthetic injection, you are awake during surgery it last less than half hour sometimes if the patient is afraid then doctor has to give slow relaxing agents. Doctor keeps some anaesthetist with patient.
What happens after surgery?
Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. Your eye may be sensitive to light and touch. If you have discomfort, your doctor can suggest treatment. After one or two days, moderate discomfort should disappear.
For a few weeks after surgery, your doctor may ask you to use eyedrops to help healing and decrease the risk of infection. Ask your doctor about how to use your eyedrops, how often to use them, and what effects they can have. You will need to wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye.
When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores.
In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress.
Can problems develop after surgery ?
Problems after surgery are rare, but they can occur. These problems can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double vision, and high or low eye pressure. With prompt medical attention, these problems can usually be treated successfully.
Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your vision. This condition is called an after-cataract. An after-cataract can develop months or years after cataract surgery.
An after-cataract is treated with a laser. Your doctor uses a laser to make a tiny hole in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG laser capsulotomy. It is painless and rarely results in increased eye pressure or other eye problems. As a precaution, your doctor may give you eyedrops to lower your eye pressure before or after the procedure.
When will my vision be normal again ?
You can return quickly to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your doctor when you can resume driving.
If you received an IOL, you may notice that colours are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, you will become used to improved colour vision. Also, when your eye heals, you may need new glasses or contact lenses.
What can I do if I already have lost some vision from
cataract ?
If you have lost some vision, speak with your surgeon about options that may help you make the most of your remaining vision.
What can I do to protect my vision?
Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract. If you smoke, stop. Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green leafy vegetables, fruit, and other foods with antioxidants.
If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years. In addition to cataract, your eye care professional can check for signs of age-related macular degeneration, glaucoma, and other vision disorders. Early treatment for many eye diseases may save your sight.
Retina
What is Retina ?
The retina is the sensory membrane that lines the inner surface of the back of the eyeball. It's composed of several layers, including one that contains specialized cells called photoreceptors.Light rays are focused by the cornea and lens onto the retina, where vision begins. The macula is a tiny, highly sensitive area of the retina that controls central vision and colour vision.
There are two types of photoreceptor cells in the human eye — rods and cones.Rod photoreceptors detect motion, provide black-and-white vision and function well in low light. Cones are responsible for central vision and colour vision and perform best in medium and bright light. Rods are located throughout the retina; cones are concentrated in a small central area of the retina called the macula. At the centre of the macula is a small depression called the fovea. The fovea contains only cone photoreceptors and is the point in the retina responsible for maximum visual acuity and colour vision.
Retina Function
- Photoreceptor cells take light focused by the cornea and lens and convert it into chemical and nervous signals which are transported to visual centres in the brain by way of the optic nerve.
- In the visual cortex of the brain (which, ironically, is located in the back of the brain), these signals are converted into images and visual perceptions.
Retina Problems
There is a wide variety of retina problems, conditions and diseases. Here is a short list of the more common retina problems:
- Macular degeneration:Age-related macular degeneration (ARRD) is the most common serious, age-related eye disease.
- Diabetic retinopathy:One of the devastating consequences of diabetes is damage to the blood vessels that supply and nourish the retina, leading to significant vision loss.
- Macular oedema: This is an accumulation of fluid and swelling of the macula, causing distortion and blurred central vision. Macular oedema has several causes, including diabetes. In some cases, swelling of the macula can occur after cataract surgery.
- Central serous retinopathy: This is when fluid builds up under the central retina, causing distorted vision. Though the cause of central serous retinopathy (CSR) often is unknown, it tends to affect men in their 30s to 50s more frequently than women, and stress appears to be a major risk factor.
- Hypertensive retinopathy:Chronic high blood pressure can damage the tiny blood vessels that nourish the retina, leading to significant vision problems. Risk factors for hypertensive retinopathy are the same as those for high blood pressure, including obesity, lack of physical activity, eating too much salt, a family history of hypertension and a stressful lifestyle.
- Solar retinopathy: This is damage to the macula from staring at the sun, which can cause a permanent blind spot (eclipse burn) in your visual field. The risk of eclipse burn (also called solar maculopathy) is greatest when viewing a solar eclipse without adequate eye protection.
- Detached retina: A retinal detachment — a pulling away of the retina from the underlying choroid layer of the eye that provides its nourishment — is a medical emergency. If the retina is not surgically reattached as soon as possible, permanent and worsening vision loss can occur.
- Macular hole: A macular hole is a small defect in the centre of the retina at the back of your eye (macula). The hole may develop from abnormal traction between the retina and the vitreous, or it may follow an injury to the eye.
Common Signs and Symptoms
- Seeing floating specks or cobwebs.
- Blurred or distorted (straight lines look wavy) vision
- Defects in the side vision
- Lost vision
Examination of retina
The funduscopic examination is important in the detection of certain systemic diseases and diseases that primarily affect the eye. This video demonstrates direct ophthalmoscopy, a technique that is widely used for examination of the retina.
1. Dilate properly
To conduct a good peripheral exam, the patient’s eyes must be well dilated. Use both 1% tropicamide and 2.5% phenylephrine for the best dilation. Patients with darker-coloured iris may need more than one set. A slit-lamp exam with a 90-diopter (D) lens or an improved digital lens can help identify areas of concern, but it does not replace the dynamic interrogation of the retina with indirect ophthalmoscopy and scleral depression.
2. Position the patient for optimal viewing
Successful indirect ophthalmoscopy depends on proper positioning. Ideally, you want the patient to lay flat in a reclining chair with room for you to move freely around the head. A partially upright position will help the shorter resident see the superior retina, but it will also make it nearly impossible to see the inferior retina.
Remember: When examining the superior retina, “the patient looks up and doctor gets small” When examining the inferior retina, “the patient looks down and doctor gets tall.” You will find that subtly tilting the head (usually in the direction of gaze) helps improve the view.
3. Choose the right lens
You have two main options for indirect ophthalmoscopy.
20 D:The most commonly used binocular indirect ophthalmoscopy (BIO) lens, the 20-D double aspheric lens has magnification up to 3.13°— and a 60° dynamic field of view. Use the 20-D lens to evaluate macular and peripheral pathology.
28 D:Initially, viewing pathology near the ora serrata is easier with a 28-D lens. The 28-D lens sacrifices some magnification (2.27°—) but offers a larger 69° dynamic field of view.
4. Minimize lens distortion
Because of the lenses’ aspheric nature, you have to hold the lens right-side up to minimize distortions. Move the lens in and out to focus and refine the view. If your hand is large enough, it helps to stabilize the lens with a finger on the patient’s head.
5. Adjust the indirect headset
First, adjust the headband so that the scope is secure on your head.
Then adjust the pupillary distance and height of the beam so you can see a full beam with each eye. Set the light aperture to the largest spot for a fully dilated patient. Use the smallest aperture for smaller pupils and intraocular gas. The medium light gives an 8-mm-diameter view when in focus with the 20-D lens.
Generally, use the white light filter. A diffuser can improve the field of view and is softer and more comfortable for the patient. Adjust the light intensity to allow yourself a clear view while attempting to make the patient comfortable.
6. Depress the sclera
This allows for dynamic viewing of the retina. Always perform scleral depression for patients with signs and symptoms concerning for retinal tears or detachments (flashes and floaters). The inward curvature of the anterior retina requires you to depress or deform the globe in order to bring the peripheral retina into your field of view. This is referred to as the “bump.” The dynamic exam allows you to elevate retinal breaks and more easily evaluate them. Topical anaesthetic can help make the patient more comfortable. Scleral depressors can vary in size and shape. When in a pinch, a cotton-tip applicator works nicely.
Diagnosis
Your doctor may use the following tests, instruments and procedures to diagnose retinal detachment:
- Retinal examination:The doctor may use an instrument with a bright light and special lenses to examine the back of your eye, including the retina. This type of device provides a highly detailed view of your whole eye, allowing the doctor to see any retinal holes, tears or detachments.
- Ultrasound imaging:Your doctor may use this test if bleeding has occurred in the eye, making it difficult to see your retina.Your doctor will likely examine both eyes even if you have symptoms in just one. If a tear is not identified at this visit, your doctor may ask you to return within a few weeks to confirm that your eye has not developed a delayed tear as a result of the same vitreous separation. Also, if you experience new symptoms, it's important to return to your doctor right away.
Treatment
Surgery is almost always used to repair a retinal tear, hole or detachment. Various techniques are available. Ask your ophthalmologist about the risks and benefits of your treatment options. Together you can determine what procedure or combination of procedures is best for you.
Retinal Tears
When a retinal tear or hole hasn't yet progressed to detachment, your eye surgeon may suggest one of the following procedures to prevent retinal detachment and preserve vision.
- Laser surgery (photocoagulation) : The surgeon directs a laser beam into the eye through the pupil. The laser makes burns around the retinal tear, creating scarring that usually "welds" the retina to underlying tissue.
- Freezing (cryopexy) : After giving you a local anaesthetic to numb your eye, the surgeon applies a freezing probe to the outer surface of the eye directly over the tear. The freezing causes a scar that helps secure the retina to the eye wall.
Both of these procedures are done on an outpatient basis. After your procedure, you'll likely be advised to avoid activities that might jar the eyes — such as running — for a couple of weeks or so.
Retinal Detachment
- If your retina has detached, you'll need surgery to repair it, preferably within days of a diagnosis. The type of surgery your surgeon recommends will depend on several factors, including how severe the detachment is.
- Injecting air or gas into your eye. In this procedure, called pneumatic retinopexy, the surgeon injects a bubble of air or gas into the centre part of the eye (the vitreous cavity). If positioned properly, the bubble pushes the area of the retina containing the hole or holes against the wall of the eye, stopping the flow of fluid into the space behind the retina. Your doctor also uses cryopexy during the procedure to repair the retinal break.
- Fluid that had collected under the retina is absorbed by itself, and the retina can then adhere to the wall of your eye. You may need to hold your head in a certain position for up to several days to keep the bubble in the proper position. The bubble eventually will reabsorb on its own.
- Indenting the surface of your eye. This procedure, called scleral buckling, involves the surgeon sewing suturing a piece of silicone material to the white of your eye (sclera) over the affected area. This procedure indents the wall of the eye and relieves some of the force caused by the vitreous tugging on the retina.
- If you have several tears or holes or an extensive detachment, your surgeon may create a scleral buckle that encircles your entire eye like a belt. The buckle is placed in a way that doesn't block your vision, and it usually remains in place permanently.
- Draining and replacing the fluid in the eye. In this procedure, called vitrectomy, the surgeon removes the vitreous along with any tissue that is tugging on the retina. Air, gas or silicone oil is then injected into the vitreous space to help flatten the retina.
- Eventually the air, gas or liquid will be absorbed, and the vitreous space will refill with body fluid. If silicone oil was used, it may be surgically removed months later.Vitrectomy may be combined with a scleral buckling procedure.
- After surgery your vision may take several months to improve. You may need a second surgery for successful treatment. Some people never recover all of their lost vision.
- Causes of retinal disease-diabetes is the most common cause other causes are hypertension trauma kidney failure or patients are on dialysis or any other major systemic illness eye condition like high myopia
- What care you should take to prevent retinal diseaseRegular eye cheque up in any of the above condition or you suspect any of the above symptoms.
Pterygium
What is Pterygium ?
A pterygium is an elevated, wedged-shaped extension on the eyeball that starts on the white of the eye (sclera) and can invade the cornea.
CAUSES
- Although ultraviolet radiation from the sun appears to be the primary cause for the development and growth of pterygium, dust and wind and sometimes genetic but exact cause is still unknown.
- Pterygium usually develop in 30- to 50-year-olds, and these scleral extension on the eyeball rarely are seen in children. Having light skin and light eyes may put you at increased risk of getting a pterygium.
SIGNS AND SYMPTOMS
- Pterygium usually occur on the side of the eye closer to the nose, but they can also develop on the side closer to the ear as well and can affect one eye or both eyes.
- Many people with mild surfer's eye may not experience symptoms or require treatment. But large or growing pterygium often cause a gritty, itchy or burning sensation or the feeling something is "in" the eye (called a foreign body sensation). Also, these pterygium often become inflamed, causing unattractive red eyes.
- If a pterygium significantly invades the cornea, it can distort the shape of the front surface of the eye, causing astigmatism and higher-order aberrations that affect vision.
TREATMENT OF PTERYGIUM
- Treatment of surfer's eye depends on the size of the pterygium, whether it is growing and the symptoms it causes. Regardless of severity, pterygium should be monitored to prevent scarring that could lead to vision loss.
- If a pterygium is small, your eye doctor may prescribe lubricants or a mild steroid eye drop to reduce swelling and redness. Contact lenses are sometimes used to cover the growth, protecting it from some of the effects of dryness or potentially from further UV exposure. Topical cyclosporine also may be prescribed for dry eye.
- If pterygium surgery is required, several surgical techniques are available. Your ophthalmologist who performs the procedure will determine the best technique for your specific needs.
- Pterygium excision may be performed either in a room at the doctor's office or in an operating room. It's important to note that pterygium removal can induce astigmatism, especially in people who already have astigmatism.
- Surgery for pterygium removal usually lasts no longer than 30 minutes, after which you likely will need to wear an eye patch for protection for a day or two. You should be able to return to work or normal activities the next day.
RECURRENCE
- Unfortunately, pterygium often return after surgical removal, possibly due to oxidative stress and/or continued UV exposure.
- Some studies show recurrence rates up to 40 percent, while others have reported recurrence rates as low as 5 percent. Some research even shows higher rates of recurrence in those who have pterygium removed during the summer months, potentially because of their increased exposure to sunlight.
- To prevent regrowth after a pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, has been shown to safely and effectively reduce the risk of pterygium recurrence.
- A drug that can help limit abnormal tissue growth and scarring during wound healing, such as mitomycin C, also may be applied topically at the time of surgery and/or afterward to reduce the risk of pterygium recurrence.
- After removal of the pterygium, the doctor will likely prescribe steroid eye drops for several weeks to decrease swelling and prevent regrowth. In addition to using your drops, it's very important to protect your eyes from the sun with UV-blocking sunglasses or photochromic lenses after surgery, since exposure to ultraviolet radiation may be a key factor in pterygium recurrence.
Glaucoma
What is Glaucoma ?
Glaucoma is a group of related eye disorders that cause damage to the optic nerve that carries information from the eye to the brain.
In most cases, glaucoma is associated with higher-than-normal pressure inside the eye — a condition called ocular hypertension. But it can also occur when intraocular pressure (IOP) is normal. If untreated or uncontrolled, glaucoma first causes peripheral vision loss and eventually can lead to blindness. In most types of glaucoma, elevated intraocular pressure (IOP) is associated with damage to the optic nerve in the back of the eye.
TYPES OF GLAUCOMA
- The two major categories of glaucoma are open-angle glaucoma and narrow angle glaucoma. The "angle" in both cases refers to the drainage angle inside the eye that controls the outflow of the watery fluid (aqueous) which is continually being produced inside the eye.
- If the aqueous can access the drainage angle, the glaucoma is known as open angle glaucoma. If the drainage angle is blocked and the aqueous cannot reach it, the glaucoma is known as narrow angle glaucoma.
SYMPTOMS OF GLAUCOMA
Most types of glaucoma typically cause no pain and produce no symptoms until noticeable vision loss occurs, but with acute angle-closure glaucoma, one experiences sudden symptoms like blurry vision, halos around lights, intense eye pain, nausea and vomiting.
DIAGONSIS AND TEST GLAUCOMA
- During routine eye exams, a tonometer is used to measure your intraocular pressure, or IOP. Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers send a puff of air onto your eye's surface.
- An abnormally high IOP reading indicates a problem with the amount of fluid in the eye. Either the eye is producing too much fluid, or it's not draining properly.
- Normally, IOP should be below 20 mmHg
- If your IOP is higher than 30 mmHg, your risk of vision loss from glaucoma is 40 times greater than someone with intraocular pressure of 15 mmHg or lower. This is why glaucoma treatments such as eye drops are designed to keep IOP low.
- Other methods of monitoring glaucoma involve the use of sophisticated imaging technology to create baseline images and measurements of the eye's optic nerve and internal structures.
- Then, at specified intervals, additional images and measurements are taken to make sure no changes have occurred that might indicate progressive glaucoma damage.
GLAUCOMA TREATMENTS
- Treatment for glaucoma can involve surgery, laser treatment or medication, depending on the severity. Eye drops with medication aimed at lowering IOP are usually tried first to control glaucoma.
- Because glaucoma is often painless, people may become careless about strict use of eye drops that can control eye pressure and help to prevent permanent eye damage.
- In fact, not complying to prescribed glaucoma medication program one of the major reasons for blindness caused by glaucoma.
- If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.
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