Macular degeneration is an age-related problem in the central part of the retina known as macula which gets destroyed causing chronic vision impairment. Disease is irreparable but can be managed with laser therapy, vitamin intake, vision aids and medication.

The disease is also known as age-related macular degeneration (AMD). It loses or minimizes the sharp central vision, and one cannot see the details correctly. AMD does not hurt but allows the macula cells to die. It is the leading source of vision impairment in aged Americans. Random eye tests can help in detecting the disease before it results in vision loss.

Types

Dry AMD

It is the early stage of the illness when light-sensitive macula cells gradually break down. Dry AMD results from reduction of macular tissues or pigment deposition in macula due to age, sometimes a combination of both processes. Dry AMD is diagnosed once yellowish spots also called as drusen accumulate inside or around the macula. These spots are presumed to be the trash from the decaying tissue. Depending upon the accumulation of debris, dry AMD is differentiated in three stages, early, intermediate and advance. It is a gradual vision loss, but not chronic as wet AMD.

However, slow degeneration of the retinal cells can cause severe vision loss, but eating a healthy diet rich in vitamins and protecting eyes from direct UV rays and dust can help to prevent it.

Wet AMD

Not similar to Dry AMD, it is more chronic. New blood vessels are known as Choroidal Neovascularization (CNV) that develops below the retina and leaks fluid and blood. This discharge results in persistent damage to fragile retinal cells which end up making spots in focal vision. People suffering from dry AMD are at high risk of developing wet AMD. Wet AMD has two categories:

1. Occult: Causes severe vision loss due to new blood vessels
2. Classic: Has clear outlines below the retina, also known as classic CNV, making vision loss more severe.

Stages

• Early AMD: This stage does not experience vision loss, and eye checkups are essential. Medium sized drusen help in recognition.
• Intermediate AMD: Vision loss with noticeable symptoms. Eye exams and tests will check for pigment changes and larger drusen.
• Late AMD: Complete vision loss.

Causes

Macular degeneration is connected to aging, but genetic component also contributes to the disease. However, other factors are found to be responsible according to the research.

Genetic Component

Deficiency of gene complement factor H (CFH) and Complement factor B is related with most of the AMD cases. Individual variants play a crucial role in the body’s immune system, and maximum examples have been found to be responsible for vision impairment.

Vascular endothelial growth factor

Oxygen divested cells produce (VEGF) vascular endothelial growth factor. The normal function of (VEGF) is to develop new blood vessels at the time of embryonic development. But excessive production of VEGF increases development of new blood vessels in the retina which opens and breaks quickly damaging the macula.

Symptoms

• Blurriness
• Distortion
• Painless vision loss
• Shadowy central vision

Risk Factors

• Aging: AMD is an age-related disease and its commonness increases with age.
• Inactivity &Obesity: Inactive people double the risk of AMD. Researches have proved that vigorous activity reduces the risk.
• Hereditary: Variants of genes present and ancestral disease plays a crucial role in the severity of AMD.
• Hypertension (High Blood Pressure): Might be involved indirectly.
• Smoking: Major factor in almost 50% of the cases resulting in vision loss. It was reported patients living with smokers increased the risks of AMD.
• Lighter Eye Color: People with darker eyes have extra pigment which acts as a protective shield and people with the lighter eye are more prone to the disease.
• Side Effects of Drug: Sometimes AMD is induced from toxic drug effects like phenothiazine, Aralen, Mellaril, profilin, trillion, etc.

Treatments

There is no specific cure for macular degeneration, but some changes in lifestyle can lower the risk and slow the development. Patients should pursue some changes like proper exercising, avoiding smoking, adequate dieting, protecting eyes from UV rays, etc.

Also, there is no particular medication for macular degeneration, but some medication can improve the vision and reduce the development. However, it entirely depends on the disease stage, advanced, dry form or wet form.

There are FDA approved medicines for wet AMD treatments that reduce the abnormal growth of blood vessels. Medications like Eylea, Lucentis, Visudyne, Macugen with PDT or Photodynamic therapy. Lucentis has shown improvement of vision in a considerable number of people suffering from AMD.

Nutrition

Diet

Dietary modifications reduce risks of vision loss. Diet with abundant cold water fish and salmon fish which are high in omega-3 fatty acids reduces AMD symptoms or prevents the disease. Additionally, green leafy vegetables are rich in vitamins and proteins helpful in keeping eye diseases at bay.

Supplements

Supplements like zeaxanthin and lutein are known to increase pigment density in the macula which are directly associated with AMD.

Complications

Progression of wet AMD development from dry macular degeneration is the main complexity. It increases the severity of the disease or complete vision impairment. However, there is no accurate way to anticipate that patient with dry AMD will progress or not. Eye diseases like glaucoma, cataracts, dry eyes or retinal detachment are not the direct complexities of AMD but can develop from abnormal eye health. People can develop AMD and other eye problems simultaneously.

Prognosis

With improper care, it can worsen with time, but proper care helps to reduce the symptoms. Hence, the time duration of the disease is not apparent yet. The disease affects the central vision, and the peripheral vision is retained. Therefore, people can see enough to visit familiar surroundings. Additionally, utilization of magnifying glasses can help to improve vision while reading or watching.

Prevention

Lifestyle plays a crucial role in inducing or reducing the risk of macular degeneration. Eating a diet rich in vegetables, fish and adopting healthy lifestyles without smoking, retaining weight and blood pressure to an average level and involving in regular moderate exercise will be helpful to prevent AMD.

Macular Degeneration Pictures

Intermediate age related macular degeneration

Human eye cross sectional view grayscale

The post Macular Degeneration | Pictures, Causes, Symptoms, Diagnosis & Treatments appeared first on Prime Health Channel.

An ingrown eyelash or trichiasis is a condition when the eyelashes grow in an inside direction instead of growing outside the eyes. To be more precise the eyelashes grow backward towards the eyes instead of growing away from it. As the ingrown eyelashes grow, it may cause a lot of discomfort and irritation in the eyes as well as the eyelids. An ingrown eyelid is more common in adults than children and it may occur on either side of the eyelid, i.e., upper or lower eyelid.

Trichiasis Ingrown Eyelash

Causes of ingrown eyelashes

Ingrown eyelashes may be caused due to various factors like inflammation, trauma, misalignment or any other issues with the eyelid. If the ingrown hair is not treated on time, it may cause damage to the eyes. A person may lose eyesight in severe cases of chronically ingrown eyelashes.  Some of the common causes of ingrown eyelashes are stated below:

1. Blepharitis: It is a chronic infection that is caused due to blockage of the meibomian gland (Small oil gland present in the eyelid). Streptococcal bacteria are among the most common bacteria leading to such a condition. Infections and allergies are other causes of blepharitis, whereby prolonged chronic blepharitis can cause an ingrown eyelash.
2. Sty on the Eyelid: Small bumps on the eyelids are called sty or stye that causes discomfort and irritation that are not serious. The main factors responsible for causing a sty are bacterial infections. It mostly takes around a week or two to heal on its own. The growth of the bacteria into the roots or follicle of the eyelashes and tiny oil glands on the eyelids causes a change in the growth of eyelashes. The blockage and infection of pores restrict the growth of eyelashes in the outward direction leading to this condition.
3. Trauma or Injury to the Eyelids: Trauma or injury to the eyelid can be threatening because eyelids protect the eyes. While the injury on the eyelid heals, the skin along the eyelid may deform and if the wound is left to heal in an uncovered state, it can cause ingrown eyelashes.

Symptoms of Ingrown eyelashes

Although considered as a minor issue, ingrown hair may cause some major issues and painful symptoms in the long run. Some common symptoms associated with ingrown hair are:

1. Inflammation in eyelids
2. Discomfort and pain
3. Watery eyes
4. Redness of eyes
5. Frequent eye infections
6. Scratching of cornea from eyelashes
7. Blurred vision
8. Sensitivity to light (Photophobia)
9. Eye watering
10. Red Eyes

Treatment for Ingrown Eyelashes

A temporary solution to the pain and irritation are medicines that are easily available over the counter. They include eye drops and ointments that are prescribed to treat redness, pain and irritation. However, the ultimate solution to this problem is removing the eyelash.

Home Remedies

• Warm compress
• Tea bag compress
• Tweezers
• Aloe Vera
• Honey
• Coconut oil
• Cucumber slices
• Turmeric paste

Medical Treatments

• Corticosteroids: This method is adapted to calm the redness and inflammation of the eyelids. Although they are easily available as an OTC medicine, it is recommended to consult a doctor before its usage. They can ease the symptoms but are not capable of treating ingrown hair. Prednisolone is another form of corticosteroids that help in reducing inflammation and redness. It is strictly advised that pregnant females, allergy to steroids or people with kidney or liver diseases should refrain from its consumption.
• Antibiotics: Antibiotics do not treat ingrown eyelashes but are prescribed to fight infections and germs. Offering temporary relief to inflammation and redness, the options include:
  • Gentamicin cream (kills bacteria)
  • Ciprofloxacin (treats eye infections)
• Artificial tears: These are used to treat dry eyes and act as an oral lubricant that relieves discomfort and irritation. They do not treat ingrown eyelashes but offer relief for dry eyes by reducing scratches in the retina and facilitating smooth movement of the eyes. They are available in forms of ointment and drops.
• Epilation: This method is used to remove hair from any part of the body. Shaving and waxing are the common forms of epilation that are either done manually or surgically. Although considered least complicated, there are chances of reoccurrence.
• Electrolysis: A process of electrolysis it removes ingrown hair using high-frequency electrical currents. They are three different types namely:
  • Thermolysis
  • Galvanic
  • Blend

How to remove an ingrown eyelash?

It’s completely safe to remove an ingrown eyelash. On most occasions to get relieved from the pressure, it becomes important to remove the eyelash. An infected person may pluck the eyelash himself/herself or take help of another person to do that. There is a possibility of the eyelash to grow again in future which is why it’s strongly recommended to consult an ophthalmologist to fix the problem.

Doctors use forceps or pincers to pluck out the ingrown eyelash. After plucking, doctors mostly prescribe eye drops to reduce the discomfort until the eye is completely healed. In severe cases, doctors might also perform radiosurgery wherein the doctor would pass a current inside the root of the eyelash termed as radio waves. It would eventually get rid of the eyelash. Eye surgery is mostly recommended for people having the recurrent condition.

Preventing ingrown eyelash

Some of the recommended precautions that can prevent ingrown eyelashes are:

• Maintaining good eye care habits
• Regular eye check up
• Removing your contact lenses before going to bed and washing your face
• Remove makeup at the end of the day
• Wear sunglasses whenever you go out in the sun to protect your eyes from UV rays
• Wear protective goggles when appropriate (like chemistry lab)
• Get adequate sleep
• Applying cucumber slices to eyes to keep them cool
• Avoid using mobile phones or computers for constant long hours
• Try to blink every 30 seconds
• While using computer make sure you’re at eye level with the screen
• Follow the 20-20-20 rule when using a computer (For 20 minutes look at something that is 20 feet away for 20 seconds)
• Work mostly in a well-lit area
• Adopt a healthy diet plan that includes foods rich in Vitamin E, Vitamin A, Zinc & Vitamin C

The post Ingrown Eyelash | Pictures, Causes, Symptoms, Diagnosis & Treatment appeared first on Prime Health Channel.

Nystagmus is a type of ocular condition that is characterized by involuntary movements of the eye. It can be acquired during infancy or at the later stages in life, and may lead to limited or reduced vision. It can be caused by toxicity, congenital factors, acquired or CNS disorders or from consumption of alcohol or pharmaceutical drugs.

The condition is also occasionally linked with vertigo.

Nystagmus Epidemiology

It is a common clinical condition that affects one in every 2000 to 3000 individuals. A survey in Oxfordshire, UK revealed that one in every 670 kids manifest nystagmus by 2 years of age. Another study revealed that it is more prevalent amongst the white Europeans as compared to Asians.

Nystagmus Types

Two main forms of nystagmus exist. These are:

Pathological Nystagmus

It involves a biphasic ocular oscillation that alternates a smooth pursuit or slow eye movement on one direction with a saccadic or fast eye movement on the other direction. The fast phase eye velocity or FPEV and slow phase eye velocity or SPEV are interrelated and can be taken as measurement of efficiency of system stimulus/response.

Nystagmus is considered to be pathologic when it occurs without accomplishing its normal functions. It thus deviates from healthy or normal ocular condition and is a result of critical damage to one or more vestibular system components (vestibular nystagmus), including the otolith organs, the semicircular canals, as well as the vestibulocerebellum. The pathological form generally causes impairment of vision to some degree, although its severity can vary greatly. Blind people might also have nystagmus in some cases, which is one of the reasons why some choose to wear dark glasses.

Pathological Nystagmus may have the following variations:

Central nystagmus

It is caused by normal/abnormal processes that are not related to vestibular organ. These might include lesions in the midbrain or the cerebellum, which might lead to upbeat and downbeat nystagmus.

Peripheral nystagmus

It might develop due to normal/diseased functional states of vestibular system and combine one rotational component with horizontal or vertical eye movements. It can either be evoked, positional or spontaneous. It is classified into the following four types:

Positional nystagmus

It develops when an individual’s head is placed in a definite position. Benign paroxysmal positional vertigo or BPPV is a condition in which this might occur.

Gaze Induced nystagmus

It is also known as Gaze Evoked Nystagmus. It might occur because of changing the gaze away from or towards a particular side that has an affected vestibular component.

Spontaneous nystagmus

It occurs randomly, without any regard to the placement of patient’s head.

Post rotational nystagmus

It is caused when stimulation of vestibular system by a rapid shaking or a rotational movement of the head leads to an imbalance between a diseased side and a normal side.

Physiological Nystagmus

It is a type of involuntary eye movement involving the vestibulo-ocular reflex or VOR, and is characterized by an alternating smooth pursuit movement in 1 direction and saccadic movement in opposite direction.

Direction of the nystagmus is determined by direction of the quick phase. For example, a left-beating nystagmus is marked by a left-moving quick phase and a right-beating nystagmus is marked by a right-moving quick phase. Oscillations might occur in horizontal, vertical or torsional planes as well as in other combinations. Thus the resulting nystagmus can be named as an overall description of the eye movement, such as:

• Upbeat nystagmus
• Downbeat nystagmus
• Periodic alternating nystagmus
• Jerk nystagmus
• Pendular nystagmus
• Seesaw nystagmus
• Mixed nystagmus

The two principal variants of physiological nystagmus are described below:

Opticokinetic nystagmus

It is induced when the patient looks at a moving visual stimulus, for e.g., moving vertical or horizontal lines, and/or stripes.

Post-rotatory nystagmus

It occurs if an individual spins continuously in a chair and then stops suddenly. The fast phase of this form is experienced in opposite direction of the rotational movement. The slow phase is felt in the direction of the rotation.

Nystagmus Causes

Pathological nystagmus can be caused by idiopathic or congenital factors. It can also occur as a condition that is secondary to a preexisting neurological disorder. Other factors, such as disorientation or usage of certain drugs may also lead to nystagmus.

Early-onset Nystagmus

This form occurs more often than acquired nystagmus. The condition can be either insular or follow other disorders such as Down syndrome or micro-ophthalmic anomalies. Early-onset nystagmus is generally non-progressive and mild. The affected individuals themselves are often not aware of having spontaneous eye movements. However, their vision can be seriously hampered due to such movements.

Early-onset nystagmus can occur due to the following disorders:

• Noonan syndrome
• Latent nystagmus
• Nystagmus blockage syndrome
• Infantile nystagmus, which is characterized into:

1. Aniridia
2. Albinism
3. Idiopathic factors
4. Rod monochromatism
5. Bilateral congenital cataract
6. Leber’s congenital amaurosis
7. Bilateral optic nerve hypoplasia
8. Optic nerve or a macular disease
9. Persistent form of tunica vasculosa lentis
10. Visual-motor syndrome of functional monophthalmos

X-linked infantile nystagmus is believed to be caused by mutations of gene FRMD7, located on X chromosome. The infantile form of nystagmus is also linked with 2 X-linked eye diseases referred to as complete and incomplete congenital stationary night blindness (CSNB and iCSNB or CSNB-2). Mutations in NYX or nyctalopin are believed to cause CSNB, whereas CSNB-2 is caused by mutations of the CACNA1F. It is a voltage-gated calcium channel that does not conduct ions when mutated.

Acquired Nystagmus

Certain diseases may present nystagmus that is acquired as a pathological symptom. These may include:

• Stroke
• Aniridia
• Head trauma
• Multiple sclerosis
• Whipple’s disease
• Tullio phenomenon
• Optic nerve hypoplasia
• Lateral medullary syndrome
• Pelizaeus-Merzbacher disease
• Wernicke-Korsakoff syndrome
• Superior canal dehiscence syndrome
• Benign Paroxysmal Positional Vertigo
• Ménière’s disease as well as other balance disorders
• Brain tumors, such as Astrocytoma, Medulloblastoma, or other tumor formations in posterior fossa

Nystagmus can be caused by the following toxic or metabolic reactions:

• SSRIs
• Lithium
• Ketamine
• Salicylates
• Barbiturates
• Amphetamines
• Benzodiazepines
• Phencyclidine (PCP)
• Thiamine deficiency
• Phenytoin (Dilantin)
• Alcohol intoxications
• Wernicke’s encephalopathy
• Lysergic acid diethylamide (LSD)
• Other sedatives or anticonvulsants
• Methylenedioxyamphetamine (MDA)
• Methylenedioxymethamphetamine (MDMA)

When in association with central nervous system disorders, the nystagmus can develop in any direction, including being horizontal (horizontal gaze nystagmus). Pure form of vertical nystagmus is commonly central in origin. However, it can also be caused by high phenytoin toxicity. The general causes include:

• Stroke
• Tumor
• Trauma
• Cerebellar ataxia
• Multiple sclerosis
• Chiari Malformation
• Thalamic hemorrhage

Other factors may include non-physiological causes, vitamin B12 or thiamine deficiency, malfunctioning of the trochlear nerve as well as vestibular pathology, such as Labyrinthitis, Ménière’s disease, superior canal dehiscence syndrome or SCDS and benign paroxysmal positional vertigo (BPPV).

Nystagmus Symptoms

Patients of nystagmus experience repeated involuntary oscillations of 1 or both the eyes. The disorder frequently affects the nerves that are behind the eye instead of the eye itself. The movements may be vertical (vertical nystagmus), horizontal (horizontal nystagmus), and circular (circular nystagmus) or combine various speeds and motions. The condition may manifest itself in varying degrees and ways. Although most affected individuals view the objects as being stationery since the brain is believed to make necessary adjustments, many people often experience reduced acuity due to the challenge of maintaining a fixed focus. Individuals having this condition often see objects in a lower contrast, with many also having issues with depth perception which affects balance and coordination. Many people having this disorder will tilt heads or nod frequently to compensate for impairments caused by it.

Many individuals having nystagmus are believed to be partially sighted, or mostly blind, and are generally unable to drive. A faster oscillation leads to lower visual acuity and a slower oscillation results in a higher visual acuity. However, it is necessary to note that visual impairment may also be caused by other underlying conditions. Most nystagmus patients have got a null point, i.e. a definite viewing angle when the eye movements get reduced and the vision is improved. Affected individuals often take on a certain body posture or head posture that facilitates best view, such as sitting sideways or moving the television screen.

Nystagmus Diagnosis

Nystagmus is often very noticeable but hardly recognized. It can be investigated by using several non-invasive standard tests. An example of these is the caloric reflex test where an external auditory meatus is flooded with cold or warm water or air. This temperature gradient provokes stimulation of horizontal semicircular canal which helps in detecting nystagmus. The resulting eye movements can be recorded and studied by electrooculography methods like Electronystagmograph (ENG) or video-oculography (VOG) procedures like Videonystagmograph (VNG) that is supervised by an audiologist. A form of special swinging chairs having electrical controls might be used for inducing rotatory nystagmus. Electrooculography or optokinetic drum can also be used to study eye movements. Other tests associated with the diagnosis of this eye disorder include:

• CT scans
• Ear exam
• MRI scans
• Vision testing
• Neurological exam
• Examination of the inner parts of the eye using an ophthalmoscope

Nystagmus Differential Diagnosis

A number of conditions show signs and symptoms which are typical of nystagmus. Hence, while determining the diagnosis of Nystagmus, it should be distinctly identified from such similar disorders. The conditions that make up the differential diagnoses of Nystagmus include:

• Opsocionus
• Ocular flutter
• Ocular dysmetria
• Opsoclonus myoclonus
• Macrosquare wave jerks
• Macrosaccadic oscillations
• Superior oblique myokymia

Nystagmus Treatment

Although Congenital nystagmus has been traditionally viewed as being non-treatable, medications and drugs have been identified in recent years that can be used to cure this condition. A drug known as Baclofen could be used to remedy periodic alternating nystagmus. The anticonvulsant drug gabapentin was proven effective in almost 50% of all cases. Other drugs that can be used to manage nystagmus include:

• Levetiracetam
• Memantine
• 4-aminopyridine
• 3,4-diaminopyridine
• Acetazolamide

Various therapeutic measures, such as drugs, contact lenses, surgery, as well as low vision rehabilitation to help the patients have been proposed as well.

The clinical trials of the surgical procedure known as Tenotomy were concluded in 2001. This procedure has been proven effective in reducing the oscillations of the eye, which eventually leads to the improvement of visual acuity.

The symptoms of Nystagmus have also been effectively reduced by acupuncture in some cases. Benefits have been noticed in cases where the acupuncture points of neck were utilized, especially the points on sternocleidomastoid muscle. Acupuncture has been shown to reduce the frequency of eye movements as well as a decrease in the slow phase velocities that led to increase in the foveation duration periods during and after the treatment.

Nystagmus Prognosis

Congenital nystagmus generally persists throughout a person’s life whereas the forms that develop from viral infections or drug toxicity commonly resolve once the underlying problem is managed. It is normally not painful and does not lead to complete blindness. The overall quality of life might get affected by reduced depth perception, a decreased reading speed, as well as periods of Oscillopsia. Most people having Nystagmus can lead productive, independent lives.

Nystagmus Videos

Here are some videos that show the movement of the eyes that are affected by nystagmus.

Congenital Nystagmus

References:

https://en.wikipedia.org/wiki/Nystagmus

http://www.nlm.nih.gov/medlineplus/ency/article/003037.htm

http://www.allaboutvision.com/conditions/nystagmus.htm

http://www.whereincity.com/medical/topic/eye-and-vision/diseases/nystagmus-139.htm

http://www.thirdage.com/hc/c/nystagmus

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Scotoma Definition

Simply put, Scotoma refers to an obscure region in the field of vision. Many people with this condition notice a dark spot at the corner of the eye that obstructs peripheral vision. In medical world, it is defined as an island or area of impairment or loss of visual acuity circumvented by a field of normal or comparatively well-preserved vision.

The disorder is also commonly referred to as “Blind Spot.”

Scotoma Etymology

The word “Scotoma” is Greek in origin and actually stands for “darkness” in the language. In the plural form, it is known as “Scotomata” or “Scotomas.”

Scotoma ICD9 Code

The ICD9 Code for this visual condition is 368.44.

Scotoma Types

The major types of this condition are:

Central scotoma

It refers to a region of reduced or lost vision that impedes central vision. It is likely to affect the activities of daily life of patients. Those having this form of the condition may have problems in seeing details and colors. They may find difficulty in recognizing people by looking at their faces. They may also have a tough time in reading books and magazines printed in fonts of regular size. They may look from the peripheries or sides of the eye, and others may not know what they are actually looking at. Such people may see best in dim-lit regions. They may, however, be able to note things best while they are moving.

Hemianopic scotoma

It is the name given to an area of reduced or lost vision that has an adverse impact on half of the central visual field.

Peripheral scotoma

It is a region of lost or reduced vision towards the edge of the visual field. It is not likely to have as much impact on daily activities as the previous forms of the disorder. Those with these types of Scotoma may see well when looking at colors and details. They may have the best vision in well-lit regions. They may bump into objects while walking due to an inability to see them.

Pareacentral scotoma

It is an area of lost or decreased vision near the central visual field, although not actually in it.

Bilateral Scotoma

It is a type of Scotoma in which a pituitary tumor starts to compress the optic chiasm and leads to a bi-temporal hemicentral scotomatous hemianopia. Based on the symptoms, this form of defect of the visual field tends to be highly prominent. However, it often evades early diagnosis as it is harder to diagnose with the aid of cursory clinical examination rather than bi-temporal peripheral hemianopia. It may even avoid advanced electronic modes of assessment of the visual field.

It is only in rare cases that this condition is found to arise.

Scotoma Symptoms

The disorder is mainly characterized by one or more dark or light areas or even blurred regions in the visual field. People affected by loss of visual field may also suffer from an increased requirement of greater contrast and illumination while reading. They may also experience difficulties in perceiving some colors.

The retina is similar to a thin skin on the inner side of the posterior (back) region of the eye. These contain the nerves that receive light through the pupil and send it to the brain as visual messages. There are certain areas on the retina where these nerves are unable to function. The light fails to make them work. These spots are referred to as Scotomas.

In the majority of sufferers, these blind spots or dark regions are persistent. In some cases, however, the spots may be temporary and shifting in nature as is the case with the Scotomata of migraine headache. The visual fields of the left and the right eye overlap to a great extent. The visual fields may not be evident without separately testing each eye in a specific manner.

Those affected by this disorder may find it difficult to know the identity of people by looking at their faces.

Following a brain injury or stroke, a Scotoma of any size or shape may arise and can affect any part of the visual field. In some individuals, a Scotoma is likely to include and lead to the enlargement of the blind spot that naturally occurs in the eye of a person.

A pathological scotoma, or Scotoma that gives rise to symptoms, may include any section of the visual field and may be of any size or shape. A scotoma may involve and magnify the normal blind spot. A severe visual handicap may arise as a result of even a small scotoma that happens to affect the macular or central vision of sufferers. On the other hand, a big scotoma in the more peripheral section of a visual field may go undetected by a person having it.

In pregnant women, the condition can manifest itself as a sign of severe Preeclampsia which is a type of hypertension induced by pregnancy. Similarly, it can also arise due to elevated intracranial pressure that results in malignant hypertension.

Scotoma Causes

The condition may arise due to a variety of factors. This could be a result of a corrective surgical operation in the eye or an ocular infection that has left a scar in the eye. The infection could have occurred while the sufferer was still in the womb of his or her mother.

The disorder may also result from an eye problem known as Retinitis Pigmentosa, a degenerative hereditary condition of the retina that is characterized by various problems like:

• Night blindness
• Changes in pigment within the retina
• Eventual loss of vision

Some other possible causes of Scotoma include:

• Glaucoma
• Blockages in the retinal veins and especially, the optic nerve
• A stroke or a brain injury
• Side effects of high blood pressure and multiple sclerosis
• Serious vitamin deficiencies and poor nutrition
• Toxic substances, especially quinine and methyl alcohol

The condition is also found to occur along with a number if eye disorders, optic nerve disorders and other diseases.

The most common causes of Scotoma include the following:

• Nutritional deficiencies
• Demyelinating disorders, such as Multiple sclerosis (retrobulbar neuritis)
• Toxic substances, such as quinine and methyl alcohol
• Vascular obstructions, either in the optic nerve or in the retina

Scotomae that occur due to tumors or those arising from the pituitary gland are less common in nature. These may compress the optic nerve or impede the supply of blood to it. They are medically important. These are sometimes curable or reversible by operative methods.

What is a Scintillating Scotoma?

It refers to a localized region of reduced vision that is edged by shimmering colored lights. It indicates the onset of migraine in many sufferers. It is a special marker for migraine headaches. In this type of Scotoma, the dark spots may move about around the eye – creating arcs of light or zig-zag patterns. The occurrence of disturbances in the visual field can serve as warning signs to migraine sufferers about the impending headaches.

Scotoma Diagnosis

The diagnosis of this disease usually begins with a physical examination in the initial stages. Doctors examine the eyes of sufferers and also ask them questions about their symptoms. They are also asked about any other conditions or any eye surgery that they may have recently suffered or gone through.

Medical tests used for the detection of this disorder include:

• Amsler grid
• Perimetry
• Visual field test
• Horizontal eccentricity

Scotoma Differential Diagnosis

The differential diagnosis of this disease involves ensuring that the symptoms experienced by sufferers are those of Scotoma and not of similar conditions of the eye. These may include:

• Glaucoma
• Optic Neuritis
• Retinitis
• Vascular disorders
• Retinal degeneration
• Carotid Artery Thrombosis
• Optic Atrophy
• Ophthalmodynamometry

Scotoma Treatment

Once the condition has been diagnosed and its underlying cause has been determined, physicians develop a proper treatment option. In some cases, treatment helps the spot – assuming that there has not been a permanent damage to the eye. In other cases, Scotoma persists. However, it is vital to manage the underlying cause and to prevent further damage to the eye.

Earlier, only a few measures could be used to cure Scotoma. However, advanced research in neuroplasticity and the ability of the brain to develop and heal throughout adulthood has led to effective means rehabilitation of vision.

Some individuals find that eye exercises help them cope with the condition. Eye exercises help them use their eyes in abnormal ways to compensate for the loss of vision. Some companies also manufacture and promote vision treatment systems that can supposedly cure the symptoms of Scotoma. However, the credibility of such companies and their products have not yet been properly evaluated and established.

In the majority of cases, Scotoma cannot be cured. However, it is still important to seek treatment from an ophthalmologist in the event of occurrence of Scotoma as it can suggest an acute problem.

Scotoma Prevention

Proper medical treatment can be used to prevent the enlargement of the dark spot in the eye and address the underlying cause of development of Scotoma.

Scotoma Pictures

The following images will help you get an idea about the vision of Scotoma sufferers.

Picture 1 – Scotoma

Picture 2 – Scotoma  Image

If you suspect yourself to be exhibiting the symptoms of Scotoma, get in touch with an ophthalmologist at the earliest. Seeking optical care on an immediate basis can help you recover from the condition and its symptoms as early as possible. In the long run, it can safeguard the health of your eyes – two of your most vital sensory organs.

References:

http://en.wikipedia.org/wiki/Scotoma

http://www.britannica.com/EBchecked/topic/529529/scotoma

http://www.wisegeek.com/what-is-scotoma.htm

http://www.csb-cde.ca.gov/Documents/Causes%20of%20Visual%20Impairment/causes_scotomas.htm

The post Scotoma (Blind Spot) appeared first on Prime Health Channel.

What is Strabismus?

It is an ocular condition characterized by a misalignment of the eyes. It is a visual problem in which the eyes are not properly aligned and point in different directions.

The disorder is known by various other names, such as:

• Squint
• Misalignment of the eyes

Strabismus ICD9 Code

The ICD9 Code for this disorder is 378.

Strabismus Incidence

The condition has been estimated to affect 4% of the U.S population.

Strabismus Types

The disorder can be categorized into a number of types. The most common types of Strabismus include:

Esotropia

Also known as cross-eye or Convergent strabismus, it is a form of the visual disorder in which one or both eyes turn inward in the direction of the nose.

Exotropia

In this form, one or both eyes are pointed in an outward direction. It is also referred to as Wall-eye or Divergent strabismus. It is a common type of Strabismus and develops most often when a child focuses on distant objects. The condition may arise from time to time, specifically when a child is ill, tired or daydreaming.

Parents often notice that their children squint one of the eyes in bright sunlight.

Hypertropia

In this form, there is permanent upward deviation of the visual axis of one of the eyes of sufferers.

Hypotropia

In this type, there is permanent downward deviation of the visual axis of one of the eyes of sufferers.

Strabismus Causes

For both eyes to concentrate on the same object, six different muscles surround each of the eyes and work together to let a person focus. In people affected with Strabismus, these muscles fail to work in unison. Due to this reason, one of the eyes looks at one object and the other one turns in another direction to focus on another object.

When this takes place, two varying images are sent to the brain – one from each eye. This leads to confusion in the brain. In children, the brain may naturally learn to ignore the image sent by the weaker eye. If the Strabismus is left untreated, the eye ignored by the brain in this way may never see properly. This type of loss of vision is referred to as Amblyopia or “Lazy Eye”. In some cases Amblyopia is present first and leads to Strabismus at a later stage.

The cause of Strabismus is unknown in the majority of children affected by the disease. In over half of all cases of the disease, the problem manifests at birth or shortly after a child is born. This is termed as “Congenital Strabismus.”

In the majority of cases, the problem has its cause in muscle control and not muscle strength.

Strabismus and Trauma

The condition can arise from trauma in the following cases:

• Damage to the brain that impairs the control of movement of the eyes
• Damage to the nerves that control the movement of the eyes
• Damage to the eye muscles either in a direct or an indirect way from injury to the eye socket

Strabismus and Associated Disorders

Strabismus can arise due to the presence of many disorders. In adults, the condition may develop as a result of the following diseases:

• Stroke
• Injury to the eye
• Shellfish poisoning
• Guillain-Barre syndrome
• Botulism
• Traumatic brain injury
• Vision loss from any eye disease or injury
• Diabetes (causes a condition known as acquired paralytic strabismus)

Conditions related with in children include the following:

• Cerebral palsy
• Congenital rubella
• Apert syndrome
• Noonan syndrome
• Prader-Willi syndrome
• Incontinentia pigmenti syndrome
• Hemangioma near the eye during infancy
• Trisomy 18
• Traumatic brain injury
• Retinoblastoma
• Retinopathy of prematurity

Strabismus Risk Factors

The disorder is particularly common among children affected with conditions that may affect the brain, such as:

• Prematurity
• Brain tumors
• Hydrocephalus
• Cerebral palsy
• Down syndrome

The disease may have a hereditary association and run in members of the same families. However, many people with the condition have been found to have no relatives with Strabismus. Farsightedness can be a contributory factor, particularly in children. Any other condition that results in loss of vision may also lead to the development of this disorder.

Strabismus Symptoms

The symptoms of this disease may come and go, or be present at all times. The problems usually include:

• Double vision
• Crossed eyes
• Loss of vision or depth perception
• Eyes that do not align in the similar direction
• Uncoordinated eye movements (eyes do not move together)

Children can develop Amblyopia very quickly. Due to this reason, they may not suffer from double vision.

Strabismus Diagnosis

The diagnosis of this disorder involves a detailed physical examination of the eyes of suffering individuals. Follow-up tests might be needed to assess the degree of misalignment of the eyes. Such eye tests may include one or more of the following:

• Visual acuity
• Retinal exam
• Cover/uncover test
• Corneal light reflex
• Standard ophthalmic exam

In some cases, a brain and neurological examination may also be needed for a more accurate diagnosis of the disorder.

During ocular exams, optometrists typically make use of a cover test to diagnose Strabismus. If the eye that is under test is the Strabismic eye, it would fixate on the object after the “normal” eye is covered – provided the vision in the unaffected eye is quite good. Based on the direction of deflection of the Strabismic eye, physicians may determine the direction of deviation.

Strabismus Differential Diagnosis

The symptoms of Strabismus resemble those of another disease known as Pseudostrabismus. The condition usually develops in toddlers and infants who have flat and wide nose bridge and results in an appearance that is similar to that of Strabismus sufferers. With increasing age, the nose bridge become narrower and the folds in the corners of the eyes tend to go away. Physicians should make sure that an individual is not suffering from Pseudostrabismus at the time of diagnosing this disorder.

A Hirschberg test may be used to differentiate between this disease and Strabismus. It is a simple screening exam for Strabismus and involves shining a flashlight on the eye of a patient. When the suffering individual is looking at the light, physicians can see a reflection on the front surface of the patient’s pupil. If the eyes are aligned properly with one another, the reflection will be seen in the same spot of each eye. Due to this reason, the eyes cannot be said to be rightly aligned if the reflection is not observed to be in the same spot in each eye.

Strabismus Treatment

The first step in the treatment of the disease is handing over corrective glasses to affected children, if required. “Lazy eye” or Amblyopia may be addressed first. A patch is likely to be placed over the eye that is in better condition to make the weaker eye function more effectively.

An eye muscle surgery may be required if the eyes fail to move properly even after treatment. Post-operation, various muscles in the eye would be made weaker or stronger. Although operation is an invasive measure, it is considered to be effective and safe. Generally, patients do not need an overnight stay in hospitals.

A surgery for eye muscle repair does not fix the impaired vision of a “Lazy eye.” Following surgery, a child may have to wear corrective glasses. The outcome is usually better if the child is younger at the time the surgery is conducted.

In some cases, children refuse to wear an eye patch despite the efforts of parents. Physicians might use atropine drops in such children. The drops would blur the vision in the straight eye on a temporary basis, and force the misaligned eye to work harder.

Adults affected with mild cases of Strabismus that tends to come and go may have a better condition with eye muscle exercises and glasses that help keep the eyes straightened. If Strabismus arises due to a loss of vision, it needs correction before operation can yield successful outcomes.

Strabismus Complications

The potential complications of this disorder include impaired vision or loss of vision in the eye that is affected. As the condition worsens, patients tend to squint more often. Inability to cope up with the disorder in its initial stages may cause sufferers to develop permanent loss of depth perception apart from a lack of visual ability.

Strabismus Prognosis

The outcome is mixed in case of sufferers of this disorder. Following operation, the visual problems may persist although the eyes may look straight in a single direction. An affected child may continue to have problems in reading at school while adults may find driving more difficult. In athletes and sportsmen, the visual capability may be affected enough to impair their ability to continue their sports activities.

The problem can be generally corrected with early diagnosis and cure. Delay in treatment can result in permanent loss of vision in one eye. Around 1/3^rd of all kids affected with this disease tend to develop Ambylopia at a later stage. As the majority of affected children tend to develop Ambylopia or Strabismus again at a later stage, they need to be closely monitored.

Strabismus Prevention

The condition cannot be prevented as its exact causes are not known. However, the possible complications of the condition can be avoided by seeking medical attention on an early basis. If timely treated, the disorder can be checked at its initial stage and ensure better vision for patients.

Strabismus Pictures

Get an idea about the physical appearance of individuals affected with this disorder.

Picture 1 – Strabismus

Picture 2 – Strabismus Image

Strabismus patients need early medical evaluation and treatment. If your child has lately been appearing to be cross-eyed, having difficulties in seeing or complaining of double vision, consult a professional healthcare provider on an immediate basis and seek treatment. Difficulties in seeing and reading can adversely affect the educational life and performance of your child. Naturally, it is important to seek medical attention as early as possible.

References:

http://www.nlm.nih.gov/medlineplus/ency/article/001004.htm

http://www.aapos.org/terms/conditions/100

http://kidshealth.org/parent/general/eyes/strabismus.html

http://www.geteyesmart.org/eyesmart/diseases/strabismus-cause.cfm

The post Strabismus appeared first on Prime Health Channel.

Retinitis pigmentosa Definition

It refers to an eye disorder characterized by damage to the retina, the tissue layer situated at the posterior area of the inner eye that converts light images to nerve signals and transmits them to the brain.

Retinitis pigmentosa ICD9 Code

The ICD9 Code for this disease is 362.74.

Retinitis pigmentosa Incidence

This is a rare disease and affects only around one out of every 4,000 individuals in the United States. About 1 out of every 100 RP sufferers is assessed to be a carrier of associated genetic abnormalities that could be transmitted and could be manifested as RP in succeeding generations.

Retinitis pigmentosa Causes

The exact causes of this condition have not been fully determined or understood. The disease has been found to run in families and is hence, supposed to arise due to a number of genetic defects. The condition typically affects the rods, or the cells that are responsible for controlling night vision. In some cases, however, the retinal cone cells are found to be the most damaged. The presence of dark deposits in the retina is the primary symptom of this condition.

RP is supposed to be associated to other genetic disorders, which include:

• Amino acid disorder (Gyrate atrophy)
• A few physical abnormalities (Bardet-Biedl)
• Progressive neurological degeneration (Bassen-Kornzweig)
• Degeneration of the choroid of the eye (Choroideremia)
• Low retinal function at birth (Leber congenital amaurosis)

Around 70 varying types of genetic defects have been identified that lead to the development of different forms of RP.

Retinitis pigmentosa Risk Factor

A family history of this disorder is the main risk factor for RP. Medical researchers have not yet conclusively proved the association of any other factor with this disease.

Retinitis pigmentosa Pathophysiology

The name of this condition is supposed to have partially originated from the tendency of the retinal epithelium to break down at the time of degeneration. With the progression of the disorder, the rods (cells which convert light waves to electrical impulses are affected first. This leads to loss of low-light or night vision. The rods are also responsible for providing a peripheral (wider) field of vision. With the deterioration of these cells, the peripheral vision may suffer deterioration until the patient is only left with “tunnel” or “straight-ahead” vision.

Retinitis pigmentosa Symptoms

The problems associated to this condition first become apparent in childhood. However, acute problems in vision do not generally manifest until patients are in the early years of their adulthood.

The characteristic symptoms of RP include:

• Reduced vision in low-lit surroundings or at night
• Loss of peripheral or side vision, resulting in ‘tunnel vision’ for sufferers
• Loss of central vision, in acute cases

In the majority of cases, sufferers first report of progressive loss of vision at nighttime (Nyctalopia) or even complain about night blindness. Affected individuals may also complain of a complete loss of vision in low light. The vision field may slowly reduce until the central sight is only retained. In the course of time, color perception and central vision may also begin to worsen. A few sufferers may first lose central vision and perception of color.

The gradual deterioration in visual capabilities may occur over a period of several years.

Retinitis pigmentosa and Cone-Rod Dystrophy

Cone-Rod Dystrophy is a type of RP that initially affects the central vision of its sufferers. Contact lenses or glasses fail to correct this eye problem. An RP patient may also lose the capability to perceive color. With the progression of the disorder, sufferers also lose their peripheral vision and suffer from night blindness.

Retinitis pigmentosa Diagnosis

The condition is initially detected by a physical examination. An illuminated apparatus, known as the ophthalmoscope, is used to magnify the interior section of the eye. In RP sufferers, ophthalmoscopy helps reveal mottling of the retina and a typical “bone-spicule” development. In patients, doctors also look for narrowing of the retinal arteries and a yellowish, waxy appearance of the optic disc.

The follow-up tests for the disease may involve:

• Color vision
• Visual acuity test, to check Central Visual Acuity
• Fluorescein angiography
• Visual field test, to determine peripheral visual field
• Intraocular pressure
• Pupil reflex response
• Slit lamp examination
• Refraction test
• Retinal photography
• Contrast sensitivity test
• Dark adaptometry, to find out the adaptive ability of sufferers to darkness
• Electroretinogram and Electro-oculogram tests, to measure electrical activity inside the retina as well as reaction to changes in light

Some other tests may also be performed to ascertain the absence of underlying conditions like neurological abnormalities or venereal disorders that might be the actual cause of the problems experienced by sufferers.

Retinitis pigmentosa Differential Diagnosis

The differential diagnosis of RP includes isolating its symptoms from those of similar conditions, such as:

• Friedreich’s ataxia
• Myotonic dystrophy
• Mucopolysaccharidosis
• Usher syndrome (a combination of hearing loss and RP)
• Laurence-Moon syndrome (also referred to as Laurence-Moon-Bardet-Biedl syndrome)

Some other syndromes and disorders that a physician must consider during differential diagnoses include:

• Bassen-Kornzweig Syndrome
• Batten’s Syndrome
• Homocystinuria
• Oxalosis
• End-stage chloroquine retinopathy
• End-stage thioridazine retinopathy
• Trauma
• Cancer-related retinopathy
• End-stage syphilitic neuroretinitis
• Glaucoma with retinal pigment epithelial changes

Retinitis pigmentosa Treatment

The disorder does not have any effective cure. Patients may wear sunglasses to protect their retina from ultraviolet light which may help in retaining the vision.

As per some studies, use of antioxidants (such as Vitamin A Palmitate in increased doses) may help in retarding the progression of the disorder. However, intake of this substance in high doses may result in acute liver problems. Physicians should weight the benefit of medical treatment against the risks to the liver.

Various clinical trials are being conducted to detect new cures for RP, including Omega-3 fatty acid. Researchers are in the early stages of determining the benefits of DHA microchip implants that enter the retina (and act as a microscopic video camera) for curing associated blindness and other acute conditions of the eye.

RP patients should get in touch with a low-vision specialist to adapt to loss of vision. Sufferers should make frequent visits to eye care specialists who can determine retinal swelling or cataracts, both of which can be cured.

At present, research is being carried out to determine whether or not prosthesis would help replace a natural retina that has been permanently damaged. Researchers are currently investigating the usefulness gene therapy (replacement of defective genes responsible for the disease) in curing the disorder, although it has not been tested on any human subject.

Certain researchers have reported of positive results with Hyperbaric Oxygen Therapy. The process involves the application of decompression chambers that deliver pure oxygen to cells inside the retina at high pressure. The therapy may help stimulate or preserve undamaged regions inside the retina, although there is no proof of improvement of already damaged visual acuity.

Retinitis pigmentosa Management and Supportive Measures

Low vision aids, mage intensifiers and dark sunglasses may be used as supportive measures for the improvement of patients affected by the disease. Yellow-filtered lenses are supposed to aid in enhancing the ability of affected individuals to view contrast.

In advanced cases of the condition, surgery may be needed to correct complications related with RP such as cataract formation. Operative procedures usually involve intraocular lens implantation and cataract extraction.

Patients may also derive some benefit from genetic counseling and getting in touch with agencies that render services to people who are visually impaired.

Retinitis pigmentosa Recovery and Return to Work

Following treatment, patients need to make some changes in work and lifestyle to accommodate the problem. The nature of changes depends on the type and extent of vision loss in affected individuals. In some cases, patients may be unable to work or drive at night. A patient of RP may need dark sunglasses to work outdoors in certain cases. Some others may need use of yellow-filtered lenses to enhance vision contrast.

In some individuals, supportive measures like larger print or magnification and contrast accommodation might be needed. Workplace might need more lighting to be illuminated for RP patients suffering from vision problems in low-lit environments. Some sufferers may need closed-circuit television readers.

Retinitis pigmentosa Prognosis

The condition continues to worsen and leads to complete blindness, although only rarely. Eventually, central and peripheral loss of vision may occur.

Retinitis pigmentosa Complications

Patients of Retinitis pigmentosa, who undergo cataract operation, tend to lose more the power to view contrast. As a result of this condition, Glaucoma may occur. Cystoid Macular Edema, or inflammation of the retina, may result in complications. If cataracts contribute to vision loss, they can be removed.

Retinitis pigmentosa Prevention

There is no way to prevent this disorder. However, couples planning pregnancy and with a family history of the disease or suffering from RP themselves can seek genetic counseling and testing to find out whether their children would be at risk of developing this disorder. Gene therapy may have a future role in the prevention of this condition.

Famous People with Retinitis pigmentosa

Some famous individuals found to have been affected with RP include:

• Lindy Hou, Australian triathlete and tandem cyclist
• Jon Wellner, American actor
• Neil Fachie, British paralympic cyclist
• Steve Wynn, casino developer and American business magnate

Retinitis pigmentosa Pictures

Take a look at these images to know how RP affects the vision of its patients. You would find these diagrams assistive in getting an idea of the ocular appearance of people who are affected by this disorder.

Picture 1 – Retinitis pigmentosa

Picture 2 – Retinitis pigmentosa Image

If you are suffering from one or more of the problems caused by Retinitis pigmentosa, it is recommended that you get in touch with an optometric physician at the earliest. Early diagnosis and treatment can help slow down the progression of this disorder and improve the condition of patients.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002024/

http://www.mdguidelines.com/retinitis-pigmentosa

http://www.patient.co.uk/doctor/Retinitis-Pigmentosa.htm

http://en.wikipedia.org/wiki/Retinitis_pigmentosa

The post Retinitis pigmentosa appeared first on Prime Health Channel.

Optic neuritis Definition

It refers to a swelling of the optic nerves, the cluster of nerve fibers that supply visual information from the eyes to the brain. Inflammation of these nerves results in pain and abruptly reduced vision in the affected eye. The loss of vision is usually temporary in nature.

The condition is also known by the name “Retro-bulbar neuritis.”

Optic neuritis ICD9 Code

The ICD9 Code for this condition is 377.30.

Optic neuritis Incidence

The disease usually affects adults in the age group of 18-45 years. The mean age of occurrence of the condition is 30-35 years. ON is more common in females. Annually, the disease affects 5 out of 100,000 individuals.

Optic neuritis Symptoms

The problem is primarily characterized by one or more of the following symptoms:

Loss of color vision

Patients often complain about their perception of colors being affected. Affected individuals may notice prominent colors, such as red, being less vivid than usual or apparently faded.

Loss of vision

Vision loss usually affects one eye for an hour or a period of few hours. The majority of sufferers have temporary loss of vision of this type. In case of a prominent vision loss, the condition generally persists for several hours or even days. The problem may be aggravated with exercise or heat. In some cases, the absence of visual capability may be permanent.

Pain on moving the affected eye

The majority of sufferers report of pain that is worsened as they try to move their eyes to view people or objects. The painful symptoms related with the condition usually peak in the course of a few days.

Altered bright light response

Some individuals suffer from changes in the manner of response of the pupil to bright light. In some cases, affected individuals may also report of seeing flickering or flashing lights.

In some cases, such signs and symptoms may indicate the presence of an autoimmune disorder known as Multiple sclerosis. Optic neuritis is usually the first problem that is reported in around 15-20% individuals who develop this autoimmune disease.

Optic neuritis Causes

It is not known what exactly leads to this disorder. The condition is supposed to arise when the immune system wrongly targets the myelin sheath over the optic nerve, leading to the swelling and damage of the sheath.

In healthy individuals unaffected by the condition, the myelin helps in quick transmission of electrical impulses along the optic nerve, to the brain from the eye. The electrical impulses are converted to visual information in the brain. In people affected by ON, this transmission of visual information is affected. It is not known what exactly leads to a swelling and damage of the myelin sheath and gives rise to ON.

However, researchers have associated ON to certain conditions. These include:

• Multiple sclerosis
• Cranial arteritis
• A fungal infection known as Cryptococcosis
• Autoimmune disorders, including Behcet’s disease, sarcoidosis, neuromyelitis optica and lupus
• Bacterial infections, which include syphilis, meningitis, tuberculosis and Lyme disease
• Respiratory infections, which include common upper respiratory tract infections and Mycoplasma pneumonia
• Viral infections, that include measles, chickenpox, rubella, viral encephalitis,mononucleosis, mumps and herpes zoster infections

Some other factors, that have been linked to the occurrence of ON, include:

• Drugs, such as Ethambutol
• Radiation therapy
• Any condition that can lead to the compression or inflammation of the optic nerve, such as toxins, tumors or malnutrition

Optic neuritis Diagnosis

The diagnosis of the condition usually involves:

Physical examination of the eye

Eye doctors usually check the vision of sufferers and assess their ability to perceive various colors.

Ophthalmoscopy

In this process, doctors shine a bright light over the eye of patients and check the structures present at the back of the eye. The test makes an evaluation of the optic disc, the point of entry of the optic nerve into the eye. In around one third of all ON sufferers, the optic disc gets inflamed.

Pupillary light reaction test

The technique involves moving a flashlight before the eyes to check the response of the pupils on exposure to bright light. Pupils affected by ON do not constrict as much as eyes normally do when stimulated by light.

In some cases, doctors may order for some additional tests like:

Blood tests

These are used to detect the presence of antibodies for neuromyelitis optica. Those with acute ON may go through this exam to assess whether they are susceptible to neuromyelitis optica. An ESR blood test is used to check for swelling in the body. The exam may help in assessing whether cranial arteritis (inflammation of cranial nerves) is responsible for ON.

Visual response test

The exam is able to detect the retardation of electrical conduction from optic nerve areas that have become damaged.

Brain MRI scan

MRI of the brain is conducted with the aid of special optic nerve images. During an MRI conducted for detecting ON, patients are injected with a contrast solution. The solution makes the optic nerve and various other brain areas more visible on the images. MRI is also important in determining whether certain regions of the brain have suffered any damage. The presence of lesions in the brain indicates a high risk of development of Multiple Sclerosis.

Certain medical exams may help rule out the presence of associated conditions. These include:

• Visual field testing
• Visual acuity testing
• Color vision testing
• Optic disc examination by Indirect Ophthalmoscopy

Optic neuritis Differential Diagnosis

The differential diagnosis of Optic neuritis involves distinguishing its signs from those of other conditions that give rise to similar symptoms. These include:

• Acute Glaucoma
• Anterior Ischemic Optic Neuropathy
• Compressive Optic Neuropathy
• Interstitial Keratitis
• Meningioma of Optic Nerve Sheath
• Sarcoidosis
• Sudden Visual Loss
• Thyroid Ophthalmopathy
• Toxic or Nutritional Optic Neuropathy

Diagnosticians should make sure that the problems experienced by patients are not the result of the abovementioned disorders.

Some other conditions that physicians should consider during differential diagnosis, include:

• Branch retinal artery occlusion
• Central retinal artery occlusion
• Hereditary optic neuropathies
• Herpes simplex
• Neuromyelitis optica
• Nutritional optic neuropathies
• Wegener granulomatosis
• Necrotizing herpetic retinopathy in immunocompromised individuals

Optic neuritis Treatment

ON usually resolves on its own but in some individuals, physicians may use steroid medicines to reduce optic nerve inflammation and treat ON. However, steroid treatment may give rise to certain possible side effects such as:

• Insomnia
• Weight gain
• Stomach upset
• Changes in mood

In cases where steroid therapy fails to cure the condition and acute loss of vision continues, a treatment option known as Plasma exchange therapy may be used to help some patients recover their visual ability.

Medications may prove to be useful in curing acute cases of the disease. Intravenous (administered through vein) administration of corticosteroids may be useful in speeding up the pace of recovery. Physicians should use higher doses with caution as acute side effects have been known to be associated with the use of too much corticosteroids.

While use of methylprednisolone quickens the pace of recovery in the severe stages of ON, they are found to have no effect on the final visual acuity of sufferers. Oral prednisolone is not generally recommended as certain unconfirmed studies suggest that they may elevate the risk of recurrence in affected individuals.

Optic neuritis Management

In patients suffering from a worsening of ON symptoms due to raised body temperature, doctors recommend avoiding hot surroundings and consuming cool drinks to maintain lower body temperature. Physicians should assure sufferers that the symptoms are reversible and do not usually cause greater damage to the vision.

Optic neuritis Risk Factors

The risk factors for ON, arising from autoimmune conditions, include:

Age

Although ON may develop at any age, it is most often evident in young adults aged between 20-40 years. The average age of onset of the condition is around 30 years.

Sex

The disorder affects women two times more than men.

Race

The condition is more common in white population than black ones.

Genetic mutations

Certain mutations in gene may elevate the risk of development of ON or multiple sclerosis.

Optic neuritis Complications

The condition may give rise to a number of complications, which include:

Reduced visual acuity

The majority of sufferers regain their vision partially or almost completely within a period of several months. In some people, however, the loss of vision may continue even after ON has resolved.

Damage to the optic nerve

Most affected individuals, following an episode of ON, suffer from some permanent damage of the optic nerve. However, they may not experience any symptoms occurring due to this damage.

Side effects of cure

As aforesaid, patients may suffer from side-effects due to steroid treatment. Steroid medicines used to cure ON subdue the immune system. This makes the body more vulnerable to infections. Prolonged use of steroids may also result in thinning of the bones, a condition known as Osteoporosis.

Optic neuritis Prognosis

The outcome of the disorder is usually good. The majority of sufferers of ON regain their vision almost completely within a year after the onset of the condition. In some cases of Acute ON, patients may have a recurrence of the condition in either eye. Most people suffering from a single episode of the disease eventually gain their vision back. Treatment with steroid drugs may quicken recovery of vision after the development of this disease.

In patients of ON found to be at an elevated risk of having Multiple Sclerosis (MS), based on MRI findings, doctors are likely to use medications to prevent the development of MS.

Optic neuritis Recovery Time

The visual abilities of ON sufferers usually return within 2 to 3 weeks even without any treatment measures.

Optic neuritis Pictures

The following images show the physical appearance of ON patients.

Picture 1 – Optic neuritis

Picture 2 – Optic neuritis Image

If you, or any of your family members, are suffering from short-term loss of vision, it is important to seek immediate diagnosis and treatment for the condition. Timely diagnosis and cure can be helpful in restoring visual capability and avoiding progression of ON and occurrence of complications in future.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001750/

http://www.mayoclinic.com/health/optic-neuritis/DS00882

http://www.patient.co.uk/doctor/Acute-Optic-Neuritis.htm

http://en.wikipedia.org/wiki/Optic_neuritis

The post Optic neuritis appeared first on Prime Health Channel.

What is Keratoconus?

It is a disorder that affects the corneal structure in the eye. The cornea is the transparent layer of tissue that covers the front area of the eye. In individuals affected with this disease, the cornea gradually changes shape and transforms from a normal round size to a conical appearance. This leads to a protrusion (bulging) of the eye, thereby resulting in vision problems.

The disease generally affects both eyes. It typically surfaces during puberty or in the late-teen years of a person.

Keratoconus ICD 9 Code

The ICD 9 Code for this disorder is 371.6.

Keratoconus Incidence

Around 1 out of 2,000 people of the general population are believed to be affected by this eye disorder on an annual basis.

What Causes Keratoconus?

Doctors and medical researchers are still baffled regarding the exact cause of this condition. Certain individuals are supposed to be predisposed to this disease due to heredity. However, an association of this condition with genetic factors has not yet been proved conclusively.

Picture 1 – Keratoconus

The condition is believed to be the result of a defect in collagen, the tissue that renders shape and strength to the cornea.

Certain other possible factors, that are supposed to lead to trauma and degeneration of the ocular tissue, include:

• Rubbing the eye
• Eye allergies
• Wearing contact lenses

Some experts are of the opinion that the disease may be caused due to various factors rather than a single disease.

Keratoconus Symptoms

The disease is characterized by progressive thinning of the cornea as well as its distortion, which occurs over a period of 5 to 10 years. The progression stops after this period.

When the cornea turns cone-shaped, there is an inability of the eye to focus light distinctly on the middle region of the macula (fovea centralis). This leads to significant loss of vision.

In the initial stages of the disease, patients experience mild cases of blurred vision. This cannot be corrected with the aid of glasses. In most cases, however, firm, gas-permeable contact lenses can be used to correct vision to 20/20. Over a period of time, however, sufferers can experience glare, eye halos or other problems with night vision.

Most individuals with this condition suffer from myopia. Distant object appear blurred to them. Over time, this nearsightedness gets worse. Astigmatism arises as the condition worsens.

Certain problems associated with the condition may change over a period of time. These include:

• Problems with night vision
• Heightened sensitivity to glare and bright lights
• Headaches, arising from eyestrain
• Distorted or blurred vision
• Sudden clouding or worsening of vision, resulting from Hydrops (a disorder characterized by rupture of the back of the cornea and its filling with fluid)

Keratoconus Diagnosis

The condition is often diagnosed during adolescence. Certain problems in the eye, as noted by a physician during an ocular exam or as reported to him or her by a patient, can initiate the diagnosis. The typical problems, that doctors use to detect this condition, include:

• Double vision, while looking with only one eye
• Sudden vision change, in only one eye
• Spotting of halos while looking at bright light
• Distortion of objects, both near and far ones

Corneal topography, which renders a map of the corneal curve, is the most exact test for this disease. It involves use of computerized instruments that create three-dimensional map-like images of the cornea.

Some other effective diagnostic techniques for this disorder are:

Eye refraction

It is the standard test used for detecting vision problems. It involves use of a special apparatus that measures the eyes and looks for astigmatism as well as other visual abnormalities. This may involve a measurement done by a computerized refractor which checks the power of focus of the eyes automatically. It may also include Retinoscopy, an ocular exam that makes an assessment of the light reflected by the retina.

A patient may also be asked to look through different lenses to help doctors know which of them helps the person have the sharpest vision. This test also helps physicians understand the extent of vision problems in sufferers.

Pachymetry

This can be used to measure the corneal thickness.

Slit-lamp examination

It can detect the disorder in its later stages. A vertical light beam is projected onto the surface of the eye to let a physician view the corneal shape. The exam may be performed again after eye-drops have been used to dilate the pupils to allow physicians to view the back of the cornea.

Keratometric exam

It involves the use of an apparatus, known as the ‘Keratometer’, which projects a circle of light onto the cornea. The shape of the reflected light lets physicians determine the extent of ocular curvature in affected individuals.

Keratoconus Treatment

The treatment for this disorder depends on its severity and its rate of progression. Contact lenses or eyeglasses are usually enough to address mild to moderate cases of this condition. In case of most sufferers, the cornea is found to stabilize after some years. No serious vision problems arise in affected individuals.

However, around 10-20% of affected people are found to suffer from scarring of the cornea or inability to continue wearing contact lenses.

The standard treatment options for the condition involve:

Contact lenses

These are effective for treating most individuals with this ocular disorder. There are various types of contacts available for curing this condition:

Soft lenses

These are useful in correcting distorted or blurry vision in the initial stages of this eye disease. However, sufferers often need to change these lenses as their corneal shape changes.

Rigid lenses

Also known as “Gas permeable lenses,” these are effective in curing progressive stages of the condition. At first, such lenses may feel uncomfortable to wear. However, most wearers get used to these after a point of time.

Customized lenses

These refer to rigid lenses which are customized to fit a cornea that has changed shape following the development of this disease.

Hybrid lenses

These lenses have a firm center with a softer outer ring to provide added comfort to people who find it hard to tolerate rigid contact lenses.

Piggyback lenses

These are ideal for people who do not like wearing rigid lenses. The name for this type of lens comes from the fact that doctors use a hard contact over a soft lens. In other words, a hard lens is piggybacked over a soft one. Fitting one lens over another requires a lot of precision. Due to this reason, only a doctor who is experienced in performing this technique should be trusted to carry out this job.

Scleral lenses

These are effective in addressing irregular changes in the cornea. Scleral contacts are rested on the white region of the eye (sclera) and vault over the cornea, rather than resting them over the cornea (as is the case with traditional lenses).

Patients who need to wear contact lenses for visual correction should get them fitted by a doctor who has good experience in curing the disorder. Affected individuals also require regular refitting and check-ups. This is due to the fact that a badly-fitting lens can cause further damage to the cornea in case of Keratoconus.

Surgery

A surgical correction is necessary if a patient is unable to wear contact lenses or suffers from poor vision, corneal scarring or extreme corneal thinning despite using the best prescription lenses. A number of surgical procedures are available. The type of operation required depends on the severity of the disorder as well as the location of the bulging cone.

The various operative methods for addressing this disease involve:

Corneal inserts

In this process, two small crescent-shaped plastic segments are inserted into the cornea to support the corneal shape, flatten the cone and improve vision. A local anesthetic is injected into the region around the eye to induce numbness into it. The surgeon uses a laser or precision blade to make a small cut in the cornea. This is immediately followed by the placement of inserts in particular locations, based on the shape of the cornea. The incision is stitched shut and a soft lens is put over the eye to provide it with protection while it heals.

Cornea transplant

Also known as Keratoplasty, this operative technique is used in patients suffering from scarring or extreme thinning of the cornea. In Lamellar keratoplasty, a partial-thickness transplant, only a portion of the corneal surface is replaced. In Penetrating keratoplasty, a total corneal transplant procedure, the full surface of the cornea is replaced.

In Deep Anterior Lamellar Keratoplasty (DALK), the inner corneal layer (known as the endothileum) is kept preserved. The technique helps prevent risks of rejection by endothelial cells, as can occur in a full-thickness transplant.

A new technique, known as collagen cross-linking, is being seen as a promising treatment option for Keratoconus. The procedure involves exposing the cornea to ultraviolet light after applying riboflavin drops onto it. The process strengthens the corneal tissue and prevents its bulging or thinning in later stages. The process is still being tested in the U.S and is likely to be used for general purpose after conclusive results.

Keratoconus Risk Factors

The risk factors for this condition are:

Inherited disorders

A few disorders that are acquired from parents, such as Down Syndrome, can increase the risk of development of this condition.

Certain conditions

A few conditions, such as retinal disorders, connective tissue ailments, asthma or allergies may also make a person susceptible to this disease.

Heredity

Although most sufferers of the disease do not have any family history of Keratoconus, heredity may be a causative factor in certain cases.

Keratoconus Complications

The condition may give rise to the following complications in its sufferers:

Scarring of cornea

Corneal scarring may occur in the advanced stages of the disorder, especially at the site of development of the cone.

Vision problems

Scarring of the cornea may lead to a worsening of visual problems and may need to be cured by corneal transplant operation.

Anxiety

Continuous vision problems arising from this condition can severely affect daily life and activities. This may lead to anxiety in sufferers.

Keratoconus Prevention

In most cases, the condition cannot be prevented. However, certain measures can be adopted to ensure that the disorder does not arise. These include:

Picture 2 – Keratoconus Image

Proper hygiene

Vigorously rubbing the eyes can damage the cornea and consequently give rise to this eye disorder. Although a direct relationship has not yet been established between rubbing and the disorder, it is better to wipe or rub the eyes as gently as possible.

Safe wearing of lenses

It is important to follow instructions while wearing lenses and using them as per the directions of a doctor. The fitting of the lens should be checked on a regular basis to prevent any risk of damage to the eyes. One should strictly avoid using the lenses of someone else.

It is necessary for you to visit an optometrist if your eyesight is rapidly worsening or if you are suffering from irregular ocular curvature (Astigmatism). It is important that you seek medical attention on an immediate basis to safeguard your eyes, two of the most vital sense organs of your body.

References:

Jain A, Paulus YM, Cockerham GC, Kenyon KR. Keratoconus and other noninflammatory corneal thinning disorders. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology. 19th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 16C.

Sugar J, Wadia HP. Keratoconus and other ectasias. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, Mo: Mosby Elsevier; 2008:chap 4.18.

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What is Narrow Angle Glaucoma?

It is a type of acute glaucoma that occurs unexpectedly as fluid gets deposited behind iris. This building up of fluid leads to a sudden and dangerous rise in intraocular pressure, which may lead to a major eye emergency situation. Unless treated in time, acute NAG may even lead to permanent blindness. On many occasions, the symptoms of NAG are not immediately apparent, thereby making it difficult for the patient to understand he or she is having vision difficulties.

NAG is also known as Closed-angle glaucoma or Angle-Closure Glaucoma.

Narrow Angle Glaucoma Causes

The anterior chamber is located at the front portion of the eye. Some individuals have got a shallow anterior chamber, which narrows the angle of the eye. In such cases, dilation of the pupil can close off this angle which can get the iris constricted. The iris can occasionally close the angle of the eye by dilating in some dark room.

Picture 1 – Narrow Angle Glaucoma

Certain inflammatory diseases can make the anterior chamber very sticky. This causes the back of iris to attach itself to the lens. This can cause eye fluid to allocate at the back of the eye and push the iris forward, thereby closing off the ocular angle in a process which is known as pupillary block.

Other health conditions such as severe diabetic eye diseases, hyperopia and tumors can also lead to NAG.

Narrow Angle Glaucoma Risk Factors

Various other risk factors for NAG, apart from Hyperopia, include the following:

Age

As people grow older, there is an increase in the size of the lens inside the eyes. This increases the risk of pupil block. The anterior chamber also becomes increasingly shallow. With age, the angle of drainage also gets narrower.

Race

The anterior chamber angles of Asians, the Inuits as well as other northern indigenous tribes are comparatively narrower than the white people. As a result, these people are more prone to be affected by NAG.

Sex

Caucasian women are three times more affected by narrow angle glaucoma than men. African-American men and women seem to be equally affected by this eye disorder.

Apart from the above mentioned risk factors, cataracts can also thicken the eye lens by pushing the iris forward and thereby leading to pupillary block.

Narrow Angle Glaucoma Symptoms

Due to the rapid rise in eye pressure within a short period of time, most patients experience the following signs and symptoms. The symptoms may come and go, with intermittent periods of normalness. The difficulties intensify in case of acute NAG.

• Nausea
• Red eyes
• Vomiting
• Headaches
• Swollen eyes
• Blurred vision
• Tender eyeballs
• Severe headache
• Mid-dilated pupils
• Hardness of eyeballs
• Severe pain in the eye
• Deterioration of vision
• Halos around lights and objects

Narrow Angle Glaucoma Diagnosis

The following tests are done to diagnose cases of NAG.

• Tonometry, a painless procedure which measures the intraocular pressure of the patient’s eye by numbing the eyes with drops.
• Check-up of the fibers of the optic nerves, to detect any possible damage which may indicate the onset of glaucoma.
• Visual field test, which is conducted to determine the peripheral vision of a patient.
• Pachymetry test, to measure the thickness of the cornea.
• Tonography test, to measure the drainage of fluid from the eyes.
• Gonioscopy test, to distinguish between open angle glaucoma and narrow angle glaucoma. In this test, a lens is put on the eye for inspecting the drainage angle.

Narrow Angle Glaucoma Treatment

The prime objective of treating NAG is reducing the intraocular pressure as quickly as possible. A doctor can prescribe systemic medications, which can be taken orally or intravenously. A patient may also be required to use topical eye drops to treat this form of glaucoma.

Picture 2 – Narrow Angle Glaucoma Image

NAG is also treated by a procedure known as Peripheral iridectomy or Peripheral iridotomy. This process involves creating a small hole in the iris through laser surgery to allow the eye fluid to move easily to drainage site. Peripheral iridectomy is commonly performed in a doctor’s office on both the eyes. This is because the risk of development of this condition is very high in both the eyes.

Narrow Angle Glaucoma Complications

Certain nonprescription medications can aggravate the chances of developing the symptoms of glaucoma. An individual should consult an eye care specialist before consuming such medications if he or she has a family history of hyperopia or farsightedness and acute narrow angle glaucoma.

Narrow Angle Glaucoma Prognosis

The outcome is good if the eye disorder is diagnosed at an early phase and treated properly. Uncontrolled NAG may lead to damage of optic nerves and development of secondary glaucoma types. In case of acute NAG, permanent vision loss may occur if the symptoms are not dealt with immediately.

Narrow Angle Glaucoma can cause excessive pain in the eyes, blurred vision and even loss of eyesight in some extreme cases. However, such complications can be avoided with timely diagnosis and proper treatment.

References:

http://vision.about.com/od/eyediseases/p/Narrow-Angle-Glaucoma.htm

http://www.rightdiagnosis.com/c/closed_angle_glaucoma/symptoms.htm

http://www.allaboutvision.com/conditions/narrow-angle-glaucoma.htm

http://www.visionrx.com/library/enc/enc_anaglaucoma.asp

http://www.glaucoma.org/glaucoma/angle-closure-glaucoma.php

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What is Amblyopia?

It is an ocular disorder that is characterized by the loss of ability of one eye of a person to view details of the images that it sees. In children, it is regarded as the most common visual problem. The possibility of development of this condition in adulthood is rare.

Amblyopia ICD 9 Code

The ICD 9 Code for this disorder is 368.0.

Amblyopia Incidence

As aforesaid, the disorder affects 1-5% of the population of the world. It is more common that you think. Around 1 in 25 children develop the disorder to a certain degree. It is the most common condition treated by ophthalmologists and orthoptists.

Amblyopia Types

The disorder can be differentiated into three types:

Strabismic Amblyopia

It is characterized by a misalignment of the eyes. This type of “Lazy eye” usually leads to a normal vision in one eye but an abnormal vision in the affected/wandering eye. This happens as a result of the difference of images projected to the brain from the two eyes. In adults, an onset of the disease generally leads to Diplopia (double vision) as the focus of the two eyes do not fixate on the same object. The brain of children are more neuroplastic and can adapt more easily to the problem by suppressing images from the one of the eyes and thus prevents duality of vision.

Anisometropic/Refractive Amblyopia

It may arise as a result of Anisometropia or a difference in refractive error between the eyes. The problem exists when there is dissimilarity in the refraction between the eyes of an individual. The eye that renders clearer image to the brain becomes the dominant one. Due to the blurriness of the image in the other eye, there is abnormality in development of one half of the visual system.

Refractive Amblyopia is typically less severe than the Strabismic form of the disorder. It is usually overlooked by primary health care providers due to its reduced prominence and absence of apparent physical symptoms, such as those occurring in the Strabismic type. Amblyopia is often associated with a combination of the Strabismic and Anisometropic forms. In some sufferers, there can be as severe a vision difference between the eyes as to result in twice the average vision in one eye and total blindness in the other.

Occlusion/Form-deprivation Amblyopia

It occurs when the ocular media turns opaque, as happens in case of corneal scarring due to trauma from use of forceps at the time of delivery or due to a congenital cataract. The opacities in ocular media prevent transmission of adequate visual input to the eye. Unless treated in time, the condition may continue to persist even after the underlying factor for the opacity has been removed. In some cases, Ptosis (droopy eyelid) or some other ocular problem may lead to occlusion of vision (of a child) by the upper eyelid. This may quickly result in Amblyopia.

This subtype may also be a complication of a Hemangioma that obstructs the eye partly or in its entirety.

Mild and Permanent Amblyopia

In mild cases of the disease, patients do not have a proper sense of depth while looking at objects. The three-dimensional effect of image-perception is missing in such people. Sufferers experience some difficulties in carrying out some tasks in the absence of good vision in one eye. With proper vision in only one eye, there is risk of acute vision problems if the patient develops disorders in the normal eye or injures it in some way at a later time.

In permanent Amblyopia, patients fail to see accurately with one eye. The severity of visual impairment may differ. Although patients can manage vision with one eye, it is always better to have another for proper viewing of objects and having visual perception in totality.

Amblyopia Symptoms

The classic signs of this disorder are:

• Eyes that turn outwards or inwards
• Reduced vision in one eye
• Lack of ability to judge depth of objects properly
• Apparent inability of eyes to work together

Although this disease affects only one eye of a person, there is a possibility that both eyes may suffer due to it.

Amblyopia Causes

The condition typically arises when there is a lack of development of the pathway of nerve from one eye to the brain during childhood. This happens as the affected eye sends a wrong image or blurred image to the brain of the sufferer. This makes the signals confusing for the brain which chooses to ignore the image that it receives from the affected eye.

The disease can occur due to any of these three causes:

Strabismus

It is a condition marked by an abnormal alignment of one or both eyes. It arises due to impaired balance in the muscles that are responsible for the positioning of the eyes. This imbalance may force the eyes to turn out or get crossed. A muscular imbalance prevents the eyes from tracking with each other in a coordinated manner.  Strabismus is the most common cause of Amblyopia.

However, the disorder may arise even in the absence of Strabismus. Similarly, people are found to suffer from Strabismus without having “Lazy Eye”.

Heredity

It may also arise due to hereditary factors as sufferers of the disorder are often found to have a family history of it.

Tumor

In rare cases, an underlying ocular tumor may lead to wandering eyes – which arises as a first sign of a timorous growth in the eye.

Structural abnormality of the eye

In some cases, “lazy eye” is the direct consequence of an ocular abnormality – such as abnormalities in the central retina or a cataract (cloudiness in the eye lens). In other cases, the condition develops due to difference in size between the eyes or abnormalities in eye shape.

Amblyopia Diagnosis

The diagnosis of this condition is generally easy. It is usually detected with the help of a complete examination of the eyes. Usually, special medical exams are not essential. Doctors usually look for a visual difference between the eyes or impaired vision in both eyes of a sufferer.

The evaluation begins with an assessment of the ocular history of patients and observations of their parents. Doctors typically enquire parents whether they have observed any of the following problems:

• Difficulty in viewing
• Tilting of head
• Drifting/wandering of the eye

A vision assessment, as a part of the physical examination, should be conducted. The eyelids and the eyes should be carefully inspected to detect signs of other ocular issues such as cataracts, corneal lesions or Ptosis. Red reflex and extra-ocular movements should be carefully examined.

Amblyopia Treatment

The treatment options for this disease may involve any of the following:

Corrective eye wear

Children would require correction by glasses if they are found to be suffering from a refractive error like:

• Astigmatism
• Farsightedness
• Nearsightedness

In cases where vision does not fully recover in children, or if they have only one functional eye (due to the other being damaged as a result of some other condition), glasses fitted with protective polycarbonate lenses should be worn. Polycarbonate glasses are scratch as well as shatter-proof. In some cases, eye wears alone are enough to correct the condition.

Eye patches

A patch is positioned on the weak eye to compel the brain to receive and recognize images from it.

Eye drops

In some cases, drops are used instead of patches to blur the vision of the healthy eye to force the brain to take the mages rendered by the weakened eye seriously. A daily or twice-a-week administration of a drug known as Atropine can temporarily cause blurring of vision in the healthy eye. This helps complete development of the area of the brain that controls vision.

Surgery

The eye muscles of a child need to be surgically repaired if he or she is found to have eyes that are crossed or outwardly developed. Any ocular condition, such as cataracts or droopy eyelids, that gives rise to poor vision in the affected eye also needs to be treated through operative procedures.

Amblyopia Prognosis

The outcome of the condition is generally good. Children who receive proper treatment before the age of 5 are usually found to recover their vision almost completely. However, they may continue to suffer from difficulties in perceiving depth of objects. In most children affected with this syndrome, accurate treatment helps improve vision within a span of a few weeks to a few months. Although research shows the treatment is possible through at least 17 years of age, it is better to initiate cure in the early stages of childhood. The earlier treatment is initiated, the better it is for sufferers.

Amblyopia Complications

Some of the possible complications of this disease include:

• Permanent loss of vision in the impaired eye
• Post-surgical problems arising after operations for correcting defects in muscles of the eye

A delay in treatment can lead to permanent problems in vision. After a sufferer has become over 10 years old, the disorder can only be partially reversed. According to the National Eye Institute, “Lazy Eye” is the most common case of vision impairment in a single eye in young as well as middle-aged adults. When left untreated, the brain pays little attention to the images transmitted by the weakened eye. Gradually, the eye becomes virtually non-functional and the condition becomes permanent. It becomes quite difficult to treat the disorder at this juncture.

If attempts at improving vision become unsuccessful, the quality of life of patients may be affected in an adverse fashion. The loss of stereoscopic vision would make patients incapable of perceiving depth of objects and make them susceptible to life-threatening injuries. In the absence of treatment in time, bilateral vision loss may occur due to damage to the normal eye.

Amblyopia Risk Factors

The risk factors of this disease include:

• Having a family history of the disorder
• Premature birth
• Manifestation of developmental delays with increasing age

Amblyopia Prevention

Permanent loss of vision associated with this disorder may be avoided through early diagnosis and treatment of Amblyopia. It is necessary to conduct a complete ocular examination at least once before they are over 5 years of age. Specific techniques are required to assess visual acuity in kids who are too young to describe their condition. These techniques can be performed by the majority of eye care professionals.

Amblyopia Pictures

Take a look at these images to know how the condition affects the eyes of its sufferers.

Picture 1 – Amblyopia

Picture 2 – Amblyopia Image

If your child is too young and you suspect vision problems (suggestive of Ambyopia, such as wandering eyes) in him/her at any time after the first few weeks of life, get in touch with an ophthalmologist or an eye care professional to diagnose and cure this condition on an immediate basis. As aforesaid, early treatment is the key to cure this disorder. The faster you seek treatment, the higher is the chance of reversing the condition completely.

References:

1. Facts about amblyopia. The National Eye Institute. http://www.nei.nih.gov/health/amblyopia/amblyopia_guide.asp. Accessed Sept. 27, 2010.
2. Olitsky SE, Hug D, Smith LP. Disorders of vision. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 620.
3. Annual Evidence Update on Amblyopia, Royal College of Ophthalmologists, 2010

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