Other Eye Diseases
Pterygium or "Nakhoona" in Hindi is a common affliction in Northern India where a fleshy growth comes on the black portion of the eye near the nose. The only treatment for this is surgical. The surgery can be of two types - with and without graft. Without a graft, the chances of recurrence are high. If a graft is taken from the same eye and placed in front of the pterygium, the chances of recurrence are much lower.
Squint may occur in young children or may suddenly appear in adults following any injury or nerve paralysis. For children, the first thing to do is check if they need glasses. Some types of squint may correct automatically on wearing glasses, while others are corrected only surgically.
Diabetes may affect the retina of the eye and therefore, it is important for diabetic patients to consult an ophthalmologist at least once a year for a fundus checkup. You are more likely to develop diabetic retinopathy if you have :
- High BP along with diabetes
- Poorly controlled diabetes
- Diabetes for a long duration
- Onset of diabetes at an early age (Insulin dependent diabetes)
When diabetic retinopathy reaches a certain stage, it becomes necessary to see a retinal specialist and get a fundus fluorescein angiography (FFA) and laser done. This laser is usually done to prevent any loss of vision. If vision has already been lost due to diabetic retinopathy, laser treatment only helps to preserve the existing vision and usually is not able to improve vision in the majority of cases. Sometimes in cases of advanced diabetic retinopathy, if the eye is filled with blood (vitreous hemorrhage) or there is tractional retinal detachment, vitreoretinal surgery is the only option. However, this surgery is difficult and expensive and we can only strive for partial improvement. However, if no treatment is done, the patient is likely to loose all sight slowly but surely and the disease at that stage becomes incurable.
Retinal detachment occurs when the retinal layer of the eye separates from its normal underlying layer and fluid collects beneath this detached retina. The only treatment for this is surgical and surgery should be undertaken by a specialist as early as feasible as late surgery leads to only partial benefit. The chances of a developing a retinal detachment are higher in patients who :
- Wear high minus number glasses (high myopia)
- Have a family history of retinal detachment
- Have previous history of eye trauma
Patients having high risk of developing retinal detachment should undergo regular dilated fundus examination by a specialist (indirect ophthalmoscopy) to rule out any break in the retina. If a break is found, it can be sealed by laser or cryo to prevent retinal detachment.
Flaoters are a common occurrence and many people see them specially with advancing age or after any eye surgery and are more likely in patients wearing high minus glasses. They are mostly harmless and do not harm the eye in any way. However, it is important to get the retina checked to rule out any break which may be present in a small proportion of these patients.
Oculoplasty is an emerging subspecialty of ophthalmology, which deals with surgery of the eyelids, tumours in this area, nasolacrimal blocks (Watery eyes) etc. as well as cosmetic surgery for aging eyelids.
DCR (Surgery for Nasoor)
Dcaryocystorhinostomy or DCR surgery is performed for nasolacrimal duct block (or "Nasoor" in Hindi). Most patients are scared of this surgery as they have seen patients with extensive swelling and nasal packs placed for 1-2 days and extensive scarring. However, if performed by a trained oculoplastic surgeon, these problems are avoided, the scar is quite small and inconspicuous in the majority of patients and the postoperative recovery is quite uneventful.
Endoscopic endonasal DCR has recently come in vogue and while it avoids a skin incision, the success rate for surgery performed through this route is lower as compared to a standard DCR
Ptosis (Droopy Eye Lid; Mundi Ankhe (Hindi)
Ptosis is a condition where the eyelid or lids appear droopy. This may be congenital (from birth) or may occur later in life following injury or due to aging. This can be corrected by surgery performed by a trained oculoplastic surgeon
In some cases due to congenital problems or because of loss of an eye due to various reasons, the socket appears small and shrunken. In such cases, surgery performed to create space in the socket and then fitting an artificial eye makes the face look much more cosmetically acceptable
Cosmetic Eyelid Surgery
With age, the eyelid skin becomes thin and wrinkled and the eyelids or eyebrows or both may start drooping down, and may appear boggy. This can be corrected by surgery performed by a trained oculoplastic surgeon
Glaucoma (or "Kaala Pani")
Glaucoma is a group of diseases affecting the optic nerve head and damaging the neurons of the optic nerve. The most common underlying factor for this damage is the intra-ocular pressure or IOP. Glaucoma occurs because of poor drainage of the aqueous humor (a fluid secreted inside the eye, which provides nutrition to eye structures).
There are two common types of glaucoma:
Open angle glaucoma - which has few signs and symptoms till there is a significant damage to the optic nerve and is discovered on routine eye examination
Closed angle glaucoma - which presents with acute pain in the eye and headache, often associated with blurring of vision and colored haloes around light. The attack may be either severe, forcing the patient to seek immediate ophthalmologist attention or it may occur slowly over a prolonged period of time (creeping angle closure glaucoma seen commonly in our country)
Treatment modalities for glaucoma include :
There are now a variety of eye drops available which lower the IOP to keep it controlled and avoid further damage. Most of these eye drops are quite effective and safe for long term usage; however the eye medication should be used regularly, with periodic checks of the IOP to ensure that the medication is still effective.
A Yag laser iridotomy creates an alternative opening in the iris for flow of aqueous humour, which is an effective treatment in some cases of angle closure glaucoma.
A trabeculectomy surgery is needed in advanced stages of glaucoma if the disease is not controlled by eye drops. This creates an alternative drainage channel for the aqueous humor to drain outside the eye. However, the IOP may begin to rise again after the surgery as the disease advances, and further surgical intervention or use of eye drops may be necessary.
All treatment modalities in glaucoma only aim to keep the disease controlled. The damage already done to the optic nerve can not be reversed.