Frequently Asked Questions About Eye Diseases

Cornea

  • What is “sore eyes”?

    “Sore eyes” or viral conjunctivitis is a common eye infection affecting the outer lining of the eyeball – the conjunctiva – as well as the inner lining of the eyelids. It usually occurs during the cooler and wet months of the year, during which the incidence of viral respiratory infections such as influenza is higher. Common symptoms are eye redness, stinging and foreign body sensation, itching, and sticky eye discharge. Vision may become blurred from excessive tearing, discharges and from photophobia (or extreme glare), caused by the inflammation. It is self-limiting, lasting 7-10 days but with some amount of variability depending on the viral strain. Treatment is aimed at reducing discomfort as there is no definitive medication against the viral infection. Cool compresses, ocular vasconstrictors and anihistaminics are helpful. In severe cases ocular steroids may be prescribed but should be monitored by an eyeMD. Antibiotics have no effect on viruses but may be used to cover a secondary infection. The infection is highly contagious, often resulting in epidemics, as it spreads easily by hand-to-eye primarily and to a lesser degree, droplet contamination.

  • What is a “stye”?

    A stye or “kuliti” (medical term: hordeolum) is an infected abscess of a hair follicle or an oil gland on the margin of the eyelid. It presents as a focal, reddish swelling of the eyelid margin which is tender to touch and causes mild pain and discomfort. Often, local treatment, including topical antibiotics and warm compresses is sufficient. If extensive swelling and spread of the infection along the adjacent eyelid (cellulitis) occurs, systemic antibiotics are given. If not resolved with medication then removal through minor surgery may become necessary.

  • Is it safe to use contact lenses?

    Contact lenses are used safely by millions of people globally. There are however certain guidelines and limitations to assure the continued safe use of these useful appliances. All contact lens users must maintain strict hygiene during all aspects of the handling of the contact lenses including insertion/removal into/from the eye, cleaning and storing. Contact lens solutions must be changed and the contact lens case washed with soap and water daily. Contact lens solution bottles must be replaced every month to decrease contamination risk. The wearing of contact lenses while asleep is ill-advised and is the cause of many serious eye infections, and should be done only in special situations with an eyeMD in supervision.

  • What is “dry eye”?

    Dry eye is a condition wherein one’s tears are insufficient or evaporate too quickly to maintain a healthy eye surface. This causes symptoms such as foreign body sensation, stinging, a heavy feeling in the eyes, build up of debris around the eye, itchiness, and even blurring of vision. It is commonly seen in persons from the older age groups but may affect all age groups. It is common in people with eyelid disease, ocular allergy, and other inflammatory conditions of the eye surface. Activities such as prolonged reading, computer use and TV watching are becoming frequent causes of dry eye. Systemic medications such anti-hypertensives, certain heart medicines, and sedatives commonly contribute to dry eye. Regular use of ocular vasoconstrictors, anesthetics, and anti-glaucoma medications are also implicated. The treatment of dry eye depends on its severity and can range from ocular lubricants or artificial tears to anti-inflammatory eye drops to implantable appliances to preserve one’s supply of tears. Modifications in one’s diet to increase intake of omega-3 essential fatty acids (flaxseed oil, fish oil, nuts) is also currently favored. Often dry eye is a chronic disease that can only be controlled but not completely cured.

  • What is “allergic conjunctivitis”?

    Allergic conjunctivitis is an inflammatory reaction of the lining of the front surface of the eye and the back of the eye lids. Like all allergies, allergic conjunctivitis is caused by an otherwise non-reactive substance, e.g., dust, that the body’s immune system regards as “foreign” and mounts an “attack” against it. This results in itching, lid swelling, eye redness, tearing, and sticky discharge. It is common to find other allergies like allergic rhinitis, asthma, and eczematous dermatitis present in a single person. Treatment for allergic conjunctivitis consists of antihistamine medications – primarily eye drops, sometimes, systemic -- ocular lubricants, and topical anti-inflammatory medications. Currently, allergies are controlled but not cured and therefore avoidance of the offending substance (the “allergen”) is an important part of the management.

Glaucoma

  • What is glaucoma?

    Glaucoma is the term for a large group of eye diseases that all produce gradual, progressive, and irreversible damage to the optic nerve (the nerve that connects the eye to the brain). Of the many types of glaucoma, primary open angle glaucoma and primary angle closure glaucoma are the most common types of glaucoma found in our population.

  • What is angle closure glaucoma?

    Angle closure glaucoma is a type of glaucoma where the anterior chamber angle (the part of the eye that drains the fluid within the eye) becomes blocked causing fluid to build up within the eye and causing increased eye pressure.

  • What is open angle glaucoma?

    Open angle glaucoma occurs when fluid builds up and eye pressure increases even if the anterior chamber angle is not blocked.

  • How does one get glaucoma?

    For the majority of patients with glaucoma, there is no single cause of their glaucoma. It develops due to the interaction of multiple factors such as genetics (a family history of glaucoma), increasing age, smoking, certain medical conditions, and increased eye pressure (called intraocular pressure).

  • What symptoms does someone with glaucoma experience?

    The vast majority of glaucoma patients do not have any symptoms at all until the late stage of the disease when the optic nerve has already been severely damaged. Thus, many glaucoma patients are discovered only in the late stages of the disease. This is why it is important for people, especially those who have a greater risk of developing glaucoma, to have periodic check-ups with an ophthalmologist (eyeMD) even when they feel fine.

  • Will I go blind from glaucoma?

    Only a small percentage of glaucoma sufferers go totally blind. The majority keep at least some vision throughout their lives although they do have patches of blindness (called scotomas) in their peripheral vision. Chances of total blindness are greater if untreated.

  • Can my children also develop glaucoma when they are older?

    Some types of glaucoma have a strong hereditary element in their development. If you have been diagnosed with glaucoma, ask your eye doctor if you should have your children and other close relatives checked and at what age they should get checked.

  • How will I be treated for my glaucoma?

    Glaucoma can be treated with medications (usually eye drops, but sometimes tablets are also used), laser or surgery. These all lower the eye pressure and/or open the blocked drainage area. Lifestyle change (ie cessation of smoking) is sometimes also advised. The type of treatment used depends on many factors such as the type of glaucoma, the stage of the glaucoma, the availability of the treatment, the patient’s overall health, lifestyle and preferences, and the ophthalmologist’s preference.

  • How long do I have to be treated and have check-ups for glaucoma?

    Glaucoma is a disease that can only be controlled and not cured so patients with glaucoma need to have checkups for the rest of their lives. The duration of active treatment depends of the type of treatment used. Daily eye drops may need to be used indefinitely but surgical or laser procedures can have long lasting effects so that patients only need to come for periodic check-ups without having to have daily treatment.

  • Why should I undergo treatment for glaucoma if there is no cure anyway?

    Because of glaucoma’s progressive nature it will continue to destroy the optic nerve until it is barely functioning or not functioning at all. Blindness and loss of peripheral vision can be prevented by controlling the progression of the disease. Even though the disease can’t be cured or the damage reversed, its worst consequences can be prevented.

  • I’ve had a laser procedure or operation for glaucoma, does this mean I’m cured?

    The risk of worsening of the glaucoma still exists even if a laser or surgical procedure has been done. Laser and surgical procedures can only control or reduce the risk of worsening but do not eliminate it completely.

Low Vision

  • What is low vision?

    Low vision is a significant reduction of visual function not adequately correctable by standard glasses, contact lenses, medicine or surgery. People with low vision are considered to be partially sighted, with best corrected visual acuity of 20/70 or less in their good eye.

  • What causes low vision?

    Low vision can be caused by a number of diseases in the eye. An injury to the eye can also result in low vision. And some people are born with diseases causing low vision.

  • What are the symptoms?

    The symptoms of low vision depend on the cause of the vision loss and where the problem is in the eye. Symptoms can include: -Blank spots, dark spots or wavy lines in the center of your vision -Blurred, hazy, or cloudy vision or double vision -Loss of side (peripheral) vision

  • How do I know if I have low vision?

    There are many signs that can signal vision loss. For example, even with your regular glasses, do you have difficulty: -Recognizing faces of friends and relatives? -Doing things that require you to see well up close like reading, cooking, sewing or fixing things around the house? -Picking out and matching the color of your clothes? -Doing things at work or home because lights seem dimmer than they used to? -Reading street and bus signs or the names of stores?

  • What should a person do if he or she has low vision?

    The patient must take note of the kinds of vision problems that he’s experiencing. A person who is having vision difficulties should immediately make an appointment with an ophthalmologist for an eye examination. The eye doctor will be the one to decide if the patient needs a low vision rehabilitation consultation.

  • What does low vision rehabilitation offer?

    Low vision rehabilitation maximizes the patient’s remaining vision thru a different way of eye examination. Visual acuity at near and distance are measured as well as contrast sensitivity, visual field and color test. Patients are taught how to use low vision devices that will help them do their daily tasks and several techniques on developing eye positioning and eye hand coordination that will allow them to lead a more productive and enjoyable life.

Neuro-Ophthalmology Club

Oculoplastics

  • How do I know if I need cosmetic eyelid surgery?

    A: Cosmetic eyelid surgery is also known as blepharoplasty. You may need it if:

    • You have prominent fat pads or bulges in your eyelids (eyebags)
    • You have an excess of skin in your upper eyelids, draping down and covering your lid crease, reaching your lashes, or impeding your central or peripheral vision.
    • You have drooping upper lids (ptosis)
    • You have sagging lower lids
    • Your eye brows are drooping down (brow ptosis)
    • You have asymmetry in your eyelids or eyebrows.

  • What is usually done during cosmetic eyelid surgery?

    In an upper lid blepharoplasty, excess skin, muscle and fat may be removed. The upper eyelid crease may be enhanced. In the lower lid, fat responsible for the bulging, and sometimes a small amount of excess skin is removed. It is important that only a conservative amount of skin is removed, to avoid outward turning of the lower eyelids (ectropion) and retraction of the upper eyelids which may result in the inability to close the eyelids. (lagophthalmos). In younger individuals, a lower lid blepharoplasty may be performed through a transconjunctival approach. This means that in the lower lid, the bulges of fat may be removed from the inner aspect of the eyelid, to avoid external incision of the eyelids

  • Will there be a scar? What about stitches?

    Anytime an incision is made on the eyelid skin, a scar may result. However, fine incision lines can usually be hidden in the lid crease for the upper lid, and under the lashes in the lower lid. Keloid or hypertrophic scarring is quite uncommon in the eyelid and periorbital area, and can be modified with medications if necessary from 3-8 weeks after surgery. Scarring can also be avoided by good surgical technique and placement of fine sutures. Placement of sutures (stitches) depends on the preference of each individual surgeon. Absorbable sutures may be used inside the wounds to keep them from opening. These do not need to be removed, and absorb in time. Skin sutures may also be used, and they are generally removed in the clinic anywhere from 3-7 days.

  • How long does the procedure last?

    The procedure may last from 15 to 30 minutes per eyelid, or a total of 1-3 hours depending on the number of eyelids done. (including preparation)

  • Is it painful?

    No. Local anesthetic is injected into the eyelids before the procedure. There may be some initial discomfort due to the injection of the anesthetic, but there is no pain during the procedure itself. An anesthesiologist may be called to monitor the vital signs of the patient and to sedate or keep her comfortable throughout the procedure.

  • Do I have to be admitted in a hospital?

    No. This procedure can be done on an outpatient basis.

  • Who can perform cosmetic eyelid surgery?

    Although many plastic and cosmetic surgeons can perform blepharoplasties, Eye Plastic Surgeons also known as Oculoplastic Surgeons specialize in this procedure. These are eyeMDs (ophthalmologists) who have undergone specialized training in eye plastic surgery. The formal name of their specialty is Ophthalmic Plastic and Reconstructive Surgery. They are members of a society called The Philippine Society of Ophthalmic Plastic and Reconstructive Surgery (PSOPRS) which is a specialty society of the Philippine Academy of Ophthalmology (PAO), the national society of eye doctors. You can consult your eye doctor who is a member of the PAO, and ask for a referral to any qualified eye plastic surgeon.

  • What are some of the other conditions that eye plastic surgeons can take care of?

    Eye plastic surgeons have received special training in aesthetic as well as reconstructive surgery of the eyelids, orbit and lacrimal system. They can take care of any abnormality of the eyelids, such as turning in or turning out of the eyelids, drooping or retraction of the eyelids, excision of tumors or cancers of the eyelids and orbit, including reconstructive surgery for these conditions. They also take care of the tear duct system and surgery for the tear ducts. They also perform repair and reconstruction following eye trauma, including care of the eye socket and reconstructive surgery for fitting of artificial eyes.

Pedia Ophtha

  • How can I tell if my baby has normal eyes and can see normally?

    Usually the earliest indication for parents that their baby can see is when the baby stares and smiles back at them. This behavior should be noted at around 1 month of age. However, since an infant spends most of his/her time sleeping and smiling does not rule out poor vision in one eye, it is best to have your baby’s eyes screened by a pediatrician or an ophthalmologist. Eye and vision screening for children is recommended at birth, at 6 months of age , at 3 years and at 5 years of age.

  • Do all children with refractive errors need glasses?

    No. Majority of children have been found to have some kind of refractive error or “grade” but many of them will not require eye glasses. The need for glasses will depend on the amount and type of refractive error in both eyes, the eye alignment as well as the optical needs of the child. On the other hand, some children including those who may appear to have no visual problems may have to use glasses.

  • Can children also have cataracts?

    Unfortunately yes. While cataracts are found most often in elderly individuals, children may also have cataracts and with more dire consequences . They can be found at birth, in infancy and in early or late childhood. They could be a result of a maternal infection during pregnancy, a metabolic problem or trauma. Cataracts in children, and most specially in infants must be evaluated and treated by an ophthalmologist with urgency.

  • Is crossing of the eyes normal in children?

    Infant’s eyes occasionally cross or even deviate outwards but these occur intermittently and briefly. These episodes normally do not go beyond 6 months of age. If an infant older than 6 months is still noted to have episodes of eye misalignment, a consultation with a pediatric ophthalmologist is highly recommended.

  • Should surgery for eye misalignment be postponed until adulthood?

    No. Normal eye alignment is extremely important during infancy and childhood. If a child has an eye misalignment problem, it is necessary to estabish or restore normal alignment early rather than later. An ophthalmologist will often determine initially if the problem can be corrected by non-surgical means. If surgery is thought to be the best means to realign the eyes, then it should be carried out without hesitation.

  • What is a “lazy eye”?

    Lazy eye or amblyopia is poor vision in an eye that did not develop normal sight during early childhood. While amblyopia usually affects only one eye, both eyes may be involved. Amblyopia is the most common cause of decreased vision in childhood. More importantly, amblyopia can be prevented if children at risk are identified early and appropriate measures are taken such as using eye glasses or surgery. Parents must be alert to this visual threat if their child is to see properly in later life.

Retina

  • What are those little black spots and lines that I see especially in bright light? Are they dangerous? What are those lightning like flashes that I occasionally see in the sides of my visual field ?

    Those are called “floaters” by your eye doctor. Most of the cavity of the eye is filled with a gel-like substance called the vitreous gel. These floaters are clumps of vitreous collagen meshwork that have formed as a result of liquefaction of the vitreous gel, a physiologic process called “syneresis”. When we are young, the vitreous is a gel that has an invisible meshwork- like structure . When we age the gel liquefies. At age 50 years of age, 60% of us already have liquefaction of the vitreous, either partially or complete. When this happens the collagen meshwork collapses and forms little clumps that now become big enough to cast shadows on our retina. We see them as black or gray dots, patches, lines that move upwards and downwards, and left and right as if floating in our field of vision.

    As a general rule these are not ominous signs as they occur as part of the aging process. In certain situations however, they can be dangerous. Occasionally people with vitreous floaters have retinal thinning called “lattice”, retinal breaks or tears and holes that must be treated right away with focal laser to prevent retinal detachment. Occasionally the floaters are actually red blood cells and clumps of vitreous hemorrhage. The hemorrhage is due to the avulsion of retinal blood vessels that are pulled by the collapse of the vitreous meshwork and separation of the posterior vitreous cortex from the retina.

    Flashes are extremely bright lightning like streaks of light seen in the periphery of one’s visual field. They are caused by stimulation of the retina by pulling of the posterior vitreous cortex on the retina to which it is attached. They are actually similar to hallucinations since they are generated by the brain, as responses of the retina to the physical stimulation of pulling or traction.

    Although usually harmless, it is best to see an Ophtahlmologist ( eyeMd) if you experience “floaters” or “flashes” just to make sure they are not signs of more serious conditions of the retina.

  • How does diabetes mellitus affect the eye?

    Will good blood sugar control reverse the bad effects of diabetes on my eye? Diabetes is a potentially blinding disease. It causes diabetic retinopathy which happens as a result of poor blood circulation and therefore inadequate oxygen supply. Diabetic retinopathy is a retinal disease that results in retinal hemorrhages, ischemic patches and abnormalities in the retinal blood vessels. Abnormal vessel growth eventually leads to massive bleeding and/or traction membrane growth, and eventually traction retinal detachment. The major risk factors are the duration of diabetes, level of blood sugar control, concomitant hypertension, pregnancy. The longer the patient has diabetes, the more he is at risk of developing the disease. By the 15th year of diabetes mellitus, 80 % of diabetics have the lower stages of diabetic retinopathy and approximately 20% already have the blinding stages of the disease.

    Good blood sugar control has been proven to reduce the chance of developing diabetic retinopathy or its progression by about 30%. If a patient already has diabetic retinopathy, control of blood sugar will neither reverse the process nor reduce the damage already done to the retina. Any treatments instituted , both to the eyes and the diabetes, including laser treatment to the eyes, blood sugar and blood pressure control are aimed at preventing progression to the higher stages of retinopathy.

    The pregnant diabetic patient deserves special attention as progression of the disease can be aggravated by the pregnancy.

    Diabetes can also cause affectation of the optic nerve, a condition called diabetic papillopathy. Eye muscle problems ( deviation of the eyeball) can also be caused by diabetes mellitus as it can affect the nerve supply of the eye muscles. Cataracts can also be aggravated by diabetes mellitus.

  • If I eat plenty of carrots and yellow foods will my retina be stronger and more resistant to retinal disease?

    The eye and the retina certainly need vitamins . While eating carrots and yellow veggies and foodstuffs rich in vitamin A can help one get this vitamin from natural sources, the eye and retina in particular need more than just vitamin A but also vitamin E and C, zinc and selenium as well. These are called antioxidants. Instead of taking vitamin A supplements alone, it would be better to take a vitamin preparation with A,C,E, selenium and zinc. These are marketed as “antioxidants”.

    Antioxidants remove free radicals from our system and help “spare” retinal cells( and other body cells) from oxidative damage, and make metabolism more efficient. In this way they are good for not only for our eyes but for our entire body.

    Taking these vitamins will not stop myopia and myopic degenerative disease of the retina. In the right amounts (the AREDS formula) antioxidants have been shown to be effective for Age Related Macular Degeneration. Your ophthalmologist can prescribe the anti-oxidant preparation for you.

  • Will a baby’s prematurity cause blindness?

    What can be done to prevent blindness from Retinopathy of Prematurity? Not all prematurity results in blindness. A premature baby of a certain weight and birth age, defined as “high risk”, is open to the development of the disease during the first few weeks of life outside the womb. The definition of “ high risk” is a birthweight of 1500 grams and below, and age at birth of 32 weeks and below. Only 15% of “high risk” babies actually develop some form//stage of the disease, but only 5-6% of these go into the severely visually debilitating stages. Fortunately only about 1% of all “high risk” premature babies actually develop blinding disease.

    Prematurity is the greatest risk factor. The smaller the baby, and the more premature it is, the greater is the risk. Other risk factors are exposure to oxygen and the associated systemic problems after birth. Blood transfusions, infection, respiratory distress, etc, are definite negative factors that can increase risk and must be taken into consideration.

    When a baby fits into the “high risk” criteria, the retina must be screened by an ophthalmologist who will perform a dilated fundus examination. This means that drops will be instilled onto the baby’s eyes to dilate the pupil temporarily to allow the ophthalmologist to examine the retina. Babies that are found to have some form of the disease will require serial examinations and/or actual management. When the fundus findings fit the description of “threshold” disease, treatment in the form of laser or cryopexy must be instituted. Sometimes “prethreshold” treatment may be justified. Higher stages called ROP 4 A & B and ROP 5 will need vitreoretinal surgery which is a more invasive and delicate procedure. The visual prognosis for ROP 4 B is guarded, and is very bad for ROP 5.

  • Will I eventually become blind or poorly sighted later in life because of my nearsightedness?

    Those who have “high myopia” or nearsightedness of 6 Diopters ( “600” in common language) may have myopic retinal changes that have the potential to cause loss of vision of variable degrees. However, not everyone who is highly myopic has these problems. These myopic changes are collectively referred to as “myopic degeneration”. They come in the form of thinning of the peripheral retina ( lattice degeneration) , retinal tears and holes, staphylomatous changes (abnormal out-pouching) of the back of the eye, abnormal vessels under the macula ( choroidal neovascular membranes) , thinning of the retinal pigment epithelium.

    When there are lattice lesions, retinal tears and holes, retinal detachment can occur, causing sudden drop in vision. A retinal detachment is a separation of retina from the underlying retinal pigment epithelium and accumulation of fluid in the space. Retinal detachment will need surgery to close this retinal tear or hole to reattach the detached retina. Visual prognosis is always guarded, and vison is almost always subnormal compared to fellow eye in spite of successful surgical reattachment.

    Another cause of visial loss in high myopes is the growth of a submacular neovascular membrane. In this case there is a submacular hemorrhage and atrophy and scarring at the macula, the center of vision. When this happens the patient loses only central vision, not peripheral vision. These cases are managed with special pharmacologic and laser treatments. The eventual scar formation results in central visual loss of variable degrees.

    Thinning of the layers of the retina at the posterior pole (back portion of the eye) causes loss of vision of varying degrees, depending on the tissue loss and scarring. There is no treatment for this problem.

    Again, not everyone who is highly myopic will have these problems. And, patients who have myopic degenerative changes may have all of these at the same time, combinations of these, or perhaps only one.

Uveitis

  • What is Uveitis?

    The wall of the human eye is composed of three (3) layers. The outermost fibrous layer is made up of the cornea and sclera. The uvea is the middle vascular portion of the three layers. The innermost neural layer includes the retina. Located between the sclera and retina, the uvea is the pigmented tissue visible in the front of the eye as the iris, but it also extends all the way to the back of the eye as the ciliary body and choroid. When inflammation involves the uveal tract, the term "uveitis" is used. The general term “uveitis” is sometimes used by ophthalmologists to refer to most inflammations of the eye.

  • What are the symptoms of uveitis?

    Uveitis may present in a variety of ways. More commonly, the anterior form of uveitis may present with eye redness, tearing, mild eye pain, photophobia and in some cases blurring of vision. The posterior forms of uveitis typically present with floaters and/or painless blurring of vision, with a paucity of anterior eye findings.

  • What causes Uveitis?

    Uveitis may be caused by infectious and noninfectious processes. As such, there are many possible causes of uveitis and many more which science have not even discovered at present. It is estimated that 10% to 15% of the blindness in the United States is due to uveitis. Local collections of data on uveitis causing blindness in the Philippines are underway.

  • Is Uveitis contagious?

    You cannot contract uveitis from another person since uveitis is an inflammatory disorder of the eye. However, certain infections, like tuberculosis, which can cause uveitis, are transmissible from person to person. Patients and their relatives should discuss possible causes of their uveitis with their Ophthalmologist.

  • How is Uveitis treated?

    Since the causes of uveitis are many, the treatment of uveitis depends on each patient's situation. As such, there is no single correct answer to this question. Patients and their relatives are encouraged to discuss treatment options with their uveitis specialists.

  • Can Uveitis cause blindness?

    Again, since the etiologies of uveitis are multi-faceted, it is difficult to come up with a specific answer to this question. Disease severity, non-response and/or resistance to treatment, delay in therapy and secondary complications that may arise from the disease and its management are a few factors that can result in poor visual results, including blindness. With modern targeted treatments now available, few individuals with uveitis should suffer devastating visual outcomes, especially with informed, cooperative and compliant patients.

  • Where can we find a specialist in Uveitis?

    Uveitis can be diagnosed by a general ophthalmologist who may also manage the disease if it is mild. If the inflammation is severe, persistent, difficult to treat, unusual, or if the general ophthalmologist or the patient wishes, then a referral can and should be made to a specialist in Uveitis.

    The Philippine Academy of Ophthalmology or the Philippine Ocular Inflammation Society may be contacted to find a Uveitis specialist near you.

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