 |
 |
|
|
|
|
DESCRIPTION
Many different conditions can lead to a dimming or loss of vision. Among the most common are cataracts, glaucoma, and diabetic retinopathy. Macular degeneration and retinitis pigmentosa are less common, but do occur with some frequency. There are others as well.
RETINAL DETACHMENT
RETINAL DETACHMENT DESCRIPTION
This causes a loss of vision often compared to having a curtain drawn across one's field of vision. Loss of vision may be preceded by a shower of "sparks" or lightening-like flashes of light, or by a dramatic increase in the number of black floaters in the field of vision.
Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness. It is a medical emergency. The retina is a thin layer of light-sensitive tissue on the back wall of the eye. The optical system of the eye focuses light on the retina much like light is focused on the film in a camera. The retina translates that focused image into neural impulses and sends them to the brain via the optic nerve. Occasionally, posterior vitreous detachment, injury or trauma to the eye or head may cause a small tear in the retina. The tear allows vitreous fluid to seep through it under the retina, and peel it away like a bubble in wallpaper.
TYPES OF RETINAL DETACHMENT
Rhegmatogenous Retinal Detachment: A rhegmatogenous retinal detachment occurs due to a hole, tear, or break in the retina that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium.
Exudative, Serous, or Secondary Retinal Detachment: An exudative retinal detachment occurs due to inflammation, injury or vascular abnormalities that results in fluid accumulating underneath the retina without the presence of a hole, tear, or break.
Tractional Retinal Detachment; A tractional retinal detachment occurs when fibrovascular tissue, caused by an injury, inflammation or neovascularization, pulls the sensory retina from the retinal pigment epithelium.
FREQUENCY AND RISKS OF RETINAL DETACHMENT
The risk of retinal detachment in otherwise normal eyes is around 5 in 100,000 per year. Detachment is more frequent in the middle-aged or elderly population with rates of around 20 in 100,000 per year. The lifetime risk in normal eyes is about 1 in 300.
Retinal detachment is more common in those with severe or extreme myopia (above 5-6 diopters), as their eyes are longer and the retina is stretched thin. The lifetime risk increases to 1 in 20. Myopia is associated with 67 percent of retinal detachment cases. Patients suffering from a detachment related to myopia tend to be younger than non-myopic detachment patients.
Retinal detachment can occur more frequently after surgery for cataracts. The estimate of risk of retinal detachment after cataract surgery is 5 to 16 per 1000 cataract operations. The risk may be much higher in those who are highly myopic, with a frequency of 7 percent reported in one study. Young age at cataract removal further increased risk in this study. Long term risk of retinal detachment after extracapsular and phacoemulsification cataract surgery at 2, 5, and 10 years was estimated in one study to be 0.36 percent, 0.77 percent, and 1.29 percent, respectively.
Tractional retinal detachments can also occur in patients with proliferative diabetic retinopathy or those with proliferative retinopathy of sickle cell disease. In proliferative retinopathy, abnormal blood vessels (neovascularization) grow within the retina and extend into the vitreous. In advanced disease, the vessels can pull the retina away from the back wall of the eye causing a traction retinal detachment.
Although retinal detachment usually occurs in one eye, there is a 15 percent chance of developing it in the other eye, and this risk increases to 25-30 percent in patients who have had cataracts extracted from both eyes.
SYMPTOMS OF RETINAL DETACHMENT
A retinal detachment is commonly preceded by a posterior vitreous detachment which gives rise to these symptoms:
- Flashes of light (photopsia) - very brief in the extreme peripheral (outside of center) part of vision.
- A sudden dramatic increase in the number of floaters.
- A ring of floaters or hairs just to the temporal side of the central vision.
- A slight feeling of heaviness in the eye.
Although most posterior vitreous detachments do not progress to retinal detachments, those that do produce the following symptoms:
- A dense shadow that starts in the peripheral vision and slowly progresses towards the central vision.
- The impression that a veil or curtain was drawn over the field of vision.
- Straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved (positive Amsler grid test).
- central visual loss.
TREATMENT
There are several methods of treating a detached retina which all depend on finding and closing the holes (tears) which have formed in the retina.
- Cryopexy & Laser Photocoagulation: Cryotherapy (freezing) and laser photocoagulation are treatments used to create a scar/adhesion around the retinal hole to prevent fluid from entering the hole and accumulating behind the retina and exacerbating the retinal detachment. Cryopexy and photocoagulation are generally interchangeable. However, cryopexy is generally used in instances where there is a lot of fluid behind the hole; laser retinopexy will not take.
- Scleral Buckle Surgery: Scleral buckle surgery is an established treatment in which the eye surgeon sews one or more silicone bands (bands, tyres) to the outside of the eyeball. The bands push the wall of the eye inward against the retinal hole, closing the hole and allowing the retina to re-attach. The bands do not usually have to be removed. The most common side effect of a scleral operation is myopic shift. That is, the operated eye will be more short sighted after the operation. Radial scleral buckle indicated to U-shaped tears or Fishmouth tears and posterior breaks. Circumferential scleral buckle indicated to multiple breaks, anterior breaks and wide breaks. Encircling buckles indicated to breaks more than 2 quadrant of retinal area, lattice degeneration located on more than 2 quadrant of retinal area, undetectable breaks, proliferative vitreous retinopathy and inexperienced surgeon.
- Pneumatic Retinopexy: This operation is generally performed in the health care provider's office under local anesthesia. It is another method of repairing a retinal detachment in which a gas bubble (SF6 or C3F8 gas) is injected into the eye after which laser or freezing treatment is applied to the retinal hole. The patient's head is then positioned so that the bubble rests against the retinal hole. Patients may have to keep their heads tilted for several days to keep the gas bubble in contact with the retinal hole. The surface tension of the air/water interface seals the hole in the retina, and allows the retinal pigment epithelium to pump the subretinal space dry and pull the retina back into place. This strict positioning requirement makes the treatment of the retinal holes and detachments that occurs in the lower part of the eyeball impractical. This procedure is usually combined with cryopexy or laser photocoagulation.
- Vitrectomy: Vitrectomy is an increasingly used treatment for retinal detachment in countries with modern healthcare systems. It involves the removal of the vitreous gel and is usually combined with filling the eye with a gas bubble (SF6 or C3F8 gas). Advantages of this operation is that there is no myopic shift after the operation. A disadvantage is that a vitrectomy always leads to more rapid progression of a cataract in the operated eye. In many places vitrectomy is the most commonly performed operation for the treatment of retinal detachment.
- Ignipuncture: Ignipuncture is an outdated procedure that involves cauterization of the retina with a very hot pointed instrument. It was pioneered and named by Jules Gonin in the early 1900s.
After treatment, patients gradually regain their vision over a period of a few weeks, although the visual acuity may not be as good as it was prior to the detachment, particularly if the macula was involved in the area of the detachment. However, if left untreated, total blindness could occur in a matter of days.
PREVENTION OF RETINAL DETACHMENT
Retinal detachment can be prevented in some. The most effective way of preventing retinal detachment is by educating people to seek ophthalmic medical attention if they suffer symptoms suggestive of a posterior vitreous detachment. Early examination allows detection of retinal tears which can be treated with laser or cryotherapy. This reduces the risk of retinal detachment in those who have tears from around 1 in 3 to 1 in 20 cases.
There are some known risk factors for retinal detachment. There are also many activities which at one time or another have been forbidden to those at risk of retinal detachment, with varying degrees of evidence supporting the restrictions.
- Cataract surgery is a major cause, and can result in detachment even a long time after the operation. The risk is increased if there are complications during cataract surgery, but remains even in apparently uncomplicated surgery. The increasing rates of cataract surgery, and decreasing age at cataract surgery, inevitably lead to an increased incidence of retinal detachment.
- Trauma is a less frequent cause. Activities which can cause direct trauma to the eye (boxing, kickboxing, karate, etc.) may cause a particular type of retinal tear called a retinal dialysis. This type of tear can be detected and treated before it develops into a retinal detachment. For this reason governing bodies in some of these sports require regular ophthalmic examination.
- Individuals prone to retinal detachment due to a high level of myopia are encouraged to avoid activities where there is a risk of shock to the head or eyes, although without direct trauma to the eye the evidence base for this may be unconvincing. Some health care providers recommend avoiding activities that increase pressure in the eye, including diving, skydiving, again with little supporting evidence. According to one medical website, retinal detachment does not happen as a result of straining your eyes, bending or, heavy lifting. Therefore, heavy weightlifting would appear to be fine. However, two recent scientific articles have noted cases of retinal detachment or maculopathy due to weightlifting (specifically with the Valsalva method), and a third documented an increase in blood pressure in the eye during weightlifting.
- Activities that involve sudden acceleration or deceleration also increase eye pressure and are discouraged by some health care providers. These include bungee jumping, Drag Racing and may also include rollercoaster rides.
MoonDragon's Health & Wellness: Eye Floaters
- Mayo Clinic: Retinal Detachment Treatment
- EyeMDLink: Retinal Detachment Repair
- The Retina source: Retinal Detachment
- All About Vision: Retinal Detachment
- MIB: Understanding Retinal Detachment
UVEITIS
DESCRIPTION
Uveitis is an inflammation in the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye. The middle layer consists of the iris, the ciliary body, and the choroid. Uveitis is most common in people ages 20 to 50. It can be serious, leading to permanent vision loss. Early diagnosis and treatment are important to prevent the complications of uveitis.
Uveitis is usually categorized anatomically into anterior, intermediate, posterior and panuveitic forms.
- Anterior Uveitis: Anywhere from two-thirds to 90 percent of uveitis cases are anterior in location, frequently termed iritis (inflammation of the iris and anterior chamber). This condition can occur as a single episode and subside with proper treatment or may take on a recurrent or chronic nature.
Anterior uveitis symptoms include red eye, injected conjunctiva, pain and decreased vision. Signs include dilated ciliary vessels, presence of cells and flare in the anterior chamber, and keratic precipitates ("KP") on the posterior surface of the cornea.
- Intermediate Uveitis: Intermediate uveitis consists of vitritis - inflammatory cells in the vitreous cavity, sometimes with snowbanking, or deposition of inflammatory material on the pars plana.
- Posterior Uveitis: Posterior uveitis is the inflammation of the retina and choroid.
- Pan-Uveitis: Pan-uveitis is the inflammation of all the layers of the uvea.
CAUSES
A variety of conditions can lead to the development of uveitis, including systemic diseases as well as syndromes confined to the eye. In anterior uveitis, no specific diagnosis is made in approximately one-half of cases. However, anterior uveitis is often one of the syndromes associated with HLA-B27.HLA-B27 (Human Leukocyte Antigen B27 [subtypes B2701-2724]) is a class I surface antigen encoded by the B locus in the major histocompatibility complex (MHC) on chromosome 6 and presents microbial antigens to T-cells. HLA-B27 strongly associated with a certain set of autoimmune diseases referred to as the "seronegative spondyloarthropathies". In the general population, about 8 percent Caucasian, 4 percent African, 2-9 percent Chinese, and 0.1-0.5 percent Japanese have the HLA-B27 antigen. In Northern Scandinavia (Lapland), 24 percent of people are HLA-B27 positive while 1.8 percent have ankylosing spondylitis (AS).
SYSTEMIC DISORDERS CAUSING UVEITIS
The cause of uveitis often cannot be determined. In many cases it is caused by an underlying systemic disease such as rheumatoid arthritis or infection. In some people, uveitis is associated with:
- Autoimmune disorders, such as rheumatoid arthritis or ankylosing spondylitis.
- Inflammatory disorders, such as Crohn's disease or ulcerative colitis.
- Infections such as syphilis, toxoplasmosis or tuberculosis.
- Eye injury.
Certain cancers, such as lymphoma, that have an indirect effect on the eye.
Acute posterior multifocal placoid pigment epitheliopathy
Ankylosing spondylitis
Behçet's disease
Birdshot retinochoroidopathy
Brucellosis
Herpes simplex
Herpes zoster
Inflammatory bowel disease
Juvenile rheumatoid arthritis
Kawasaki's disease
Leptospirosis
Lyme disease
Multiple sclerosis Presumed ocular histoplasmosis syndrome
Psoriatic arthritis
Reiter's syndrome
Sarcoidosis
Syphilis
Systemic lupus erythematosus
Toxocariasis
Toxoplasmosis
Tuberculosis
Vogt-Koyanagi-Harada syndrome
Whipple disease
Polyarteritis nodosa
MASQUERADE SYNDROMES
Masquerade syndromes are ophthalmic disorders that clinically present as either an anterior or posterior uveitis, but are not primarily inflammatory. The following are some of the most common:
Anterior segment
Intraocular foreign body
Juvenile xanthogranuloma
Leukemia
Malignant melanoma
Retinoblastoma
Retinal detachment
Posterior segment
Lymphoma
Malignant melanoma
Multiple sclerosis
Reticulum cell sarcoma
Retinitis pigmentosa
Retinoblastoma
SYMPTOMS
Pain and redness may be present, but often symptoms consist primarily of diminished or hazy vision.
Redness of the eye.
Blurred vision.
Decreased vision.
Sensitivity to light (photophobia).
Dark, floating spots along the visual field (floaters).
Eye pain.
Sudden appearance and rapid worsening of symptoms.
Effects noticeable in one or both eyes.
Variable site of inflammation (sometimes only the front of the eye [anterior], or the back of the eye [posterior], and sometimes all three layers of the uvea [panuveitis]).
TREATMENT
When you visit an eye specialist (ophthalmologist), expect a complete eye exam and be prepared to answer questions related to your signs, symptoms and health history. If the ophthalmologist suspects an underlying condition to be the cause of your uveitis, he or she may refer you to another health care provider for a general medical examination and special laboratory tests. Often, it is difficult to find a specific cause for uveitis. However, your health care provider will make every effort to determine whether your uveitis has an infectious cause or results from some other disease.
If uveitis is caused by an underlying condition, treatment will focus on treating that specific condition. The goal of treatment is to reduce the inflammation of the eye.
Uveitis is a serious eye condition that may scar the eye and has to be treated as soon as possible. Eye drops such as steroids and pupil dilators can reduce inflammation and pain. For more severe inflammation, oral medications or injections may be necessary.
Treatment of uveitis may include:
- Anti-inflammatory medication. Your health care provider may prescribe anti-inflammatory medication, such as a corticosteroid, to treat your uveitis. This medication may be given as eyedrops. Your health care provider also could administer a corticosteroid by pill or by injection into the eye.
- Antibiotic or antiviral medication. If uveitis is caused by an infection, antibiotics, antiviral medications or some other medicine may be given with or without corticosteroids to bring the infection under control.
- Immunosuppressive or cytotoxic medication. Immunosuppressive or cytotoxic agents may become necessary if your uveitis responds poorly to corticosteroids or becomes severe enough to threaten your vision.
- Surgery. Vitrectomy (surgery to remove the jelly-like material in your eye [vitreous]) may sometimes be necessary for diagnosis and treatment of uveitis.
PROGNOSIS
The prognosis is generally good for those who receive prompt diagnosis and treatment, but serious complication (including cataracts, glaucoma, band keratopathy, retinal edema and permanent vision loss) may result if left untreated. The type of uveitis, as well as its severity, duration, and responsiveness to treatment or any associated illnesses, all factor in to the outlook.
The part of your eye affected by uveitis - either the front (anterior) or back (posterior) of the uvea - may determine the duration of the condition. With proper treatment, anterior uveitis can clear up in a matter of days to weeks. Posterior uveitis, on the other hand, may last several months or years and could permanently alter your vision.
MEDICATIONS
Uveitis is typically treated with glucocorticoid steroids, either as topical eye drops (such as betamethasone, dexamethasone or prednisolone) or oral therapy with prednisolone tablets. In addition topical cycloplegics, such as atropine or homatropine, may be used. In some cases an injection of PSTTA can also be given to reduce the swelling of the eye.
Antimetabolite medications, such as methotrexate are often used for recalcitrant or more aggressive cases of uveitis. Experimental treatment with Infliximab infusions may prove helpful.
COMPLICATIONS
Complications may occur if uveitis is left untreated. Uveitis can cause the following complications:
- Abnormally high pressure inside the eye (glaucoma).
- Damage to the optic nerve.
- Clouding of the lens (cataract) or cornea.
- Scar tissue inside the eye.
- Retinal problems, such as fluid within the retina or retinal detachment.
- Vision loss.
Uveitis is the third leading cause of blindness in the United States and is estimated to be responsible for approximately 10% of the blindness in the country. Uveitis requires an urgent referral and thorough examination by an ophthalmologist, along with urgent treatment to control the inflammation. A careful eye examination by an ophthalmologist is extremely important when symptoms occur since inflammation inside the eye can permanently affect sight or even lead to blindness if not adequately treated. Since uveitis can be associated with disease in the rest of the body, your ophthalmologist will want to know about your general health and may want to consult with your primary care health care provider or other medical specialists. If you have a "red eye" that does not clear up, see your ophthalmologist.
- Uveitis Service: Massachusetts Eye & Ear Infirmary
- Mayo Clinic: Uveitis
- All About Vision: Uveitis
- Prevent Blindness: Uveitis
- Uveitis Society Home Page
RETINAL BLOOD VESSEL OCCLUSION (BLOCKAGE)
DEFINITION
Retinal Vessel Occlusion is a blockage of blood supply to the retina, the light sensitive membrane if the back of the eye.
CAUSES
The blockage occurs in a retinal vein (retinal vein occlusion) or artery (retinal artery occlusion), a condition that can lead to loss of vision and is usually a blood clot or a substance, such as fat or plaque, that get stuck in the blood vessels. In adults, there are two main reasons that the retina's artery would become blocked: a thrombus or an embolus.
A thrombus (blood clot) - Inside the retinal artery, a blood clot typically develops at a site where the artery's lining has already been damaged by a chronic illness, such as high blood pressure (hypertension), diabetes or atherosclerosis. Atherosclerosis is a common cardiovascular problem that produces cholesterol deposits called plaques along the walls of arteries, decreasing blood flow.
An embolus (floating blood clot or debris in the bloodstream) - In the retinal artery, an embolus is usually a tiny blood clot or a piece of atherosclerotic plaque that has been carried through the bloodstream from a damaged area of the heart, aorta or carotid artery (in the neck). For this reason, the embolus is often interpreted as a warning sign of cardiovascular disease elsewhere, especially in the carotid artery.
Retinal vessel occlusion usually caused by an underlying disorder such as atherosclerosis, diabetes, hypertension, glaucoma, coagulation disorders or hyperlipidemia.Retinal Artery Occlusion: Less often, a retinal artery occlusion may be caused by vasculitis (inflammation of the artery's wall), trauma, blood clots from injections of medication into the eye, sickle cell disease, clotting disorders, oral contraceptives or damage from radiation treatments. Overall, retinal artery occlusion is a rare illness that is responsible for only one out of every 10,000 visits to ophthalmologists (physicians who specialize in eye problems) in the United States. The average person with the illness is between 50 and 70 years old and has a history of heart disease, high blood pressure or diabetes. In almost all cases, only one eye is affected.
Retinal Vein Occlusion: The retinal vein carries blood away from the retina. When the vein is blocked, blood flow backs up and causes tiny hemorrhages, areas of swelling, and other pressure-related damage in portions of the retina that are located near the blocked blood vessels. This can cause minimal or substantial loss of vision, depending on the extent of this retinal damage. Some common risk factors for this form of retinal vessel occlusion include high blood pressure, diabetes, open-angle glaucoma, lymphoma, leukemia, multiple myeloma, syphilis and use of oral contraceptives.
Visual loss is generally sudden if the affected blood vessel is an artery, but it may be less rapid if the blocked vessel is a vein. Usually only one eye is affected. Vision loss after retinal vein occlusion varies. Hemorrhage (bleeding) may be present, and the person may be at risk for developing glaucoma, However, in retinal artery occlusion, there is considerable visual loss. The degree of loss is partially related to the location of the occlusion.
Retinal vessel occlusion more frequently affects older individuals. People with retinal vessel occlusion have a risk of stroke because the source of the clot(s), or emboli, affecting the eye could also send blood clots to the brain. Risk factors are related to the possible disorders that cause the blockage.
SYMPTOMS
The primary symptoms of a retinal artery occlusion is a sudden, painless, persistent, substantial loss or blurring of vision in all or part of one eye. In about 10 percent of those affected, this loss of vision is preceded by one or more episodes of a condition called amaurosis fugax. Amaurosis fugax is a temporary episode of decreased vision, usually lasting no more than 10 to 15 minutes, this is sometimes described as a "closing of a curtain" on one eye.
Although retinal vein occlusion also causes painless loss of vision, this vision loss sometimes develops gradually over several days or weeks rather than suddenly. Also, depending on the extent of retinal damage, some people have only minimal blurring of vision, while others experience more substantial vision loss.
DIAGNOSIS
After reviewing your symptoms, your health care provider will ask you questions about your medical history, especially any history of high blood pressure, heart disease, diabetes, glaucoma, eye trauma or amaurosis fugax. A thorough eye exam will be given. You will be give eye drops to dilate your eyes. Using an ophthalmoscope, your health care provider can see whether your retina's blood supply appears to be normal, or whether there are areas of whiteness (a sign of arterial occlusion), hemorrhage, a visible embolus lodged in a retinal vessel, or other eye problems. Tests to determine retinal integrity may include:
- Visual acuity.
- Refraction test.
- Color defectiveness determination.
- Pupillary reflex response.
- Slit lamp examination.
- Intraocular pressure determination.
- Ultrasound of the eye.
- Retinal photography.
- Fluorescein angiography, a test that uses an injected dye to analyze blood flow in the eye.
- Electroretinogram (a record of the action currents of the retina produced by visual or light stimuli).
For some people, especially the elderly, retinal artery occlusion may be caused by a form of blood vessel inflammation, called temporal arteritis, rather than an embolus or thrombus. A special blood test called an erythrocyte sedimentation rate may help to confirm this diagnosis. Treatment for this inflammation involves long-term treatment with high-dose corticosteroid medications.
In addition, if your health care provider suspects that your eye problem is being caused by emboli from undiagnosed cardiovascular illness, you may need diagnostic tests to evaluate the blood flow in your heart and carotid arteries. Also, blood tests may be necessary to determine your cholesterol levels or to check for blood clotting disorders, especially in very young people.
TREATMENT
Whenever the retina's circulation is blocked, loss of vision may be permanent if the blockage is not removed within 24 hours. Ideally, the problem should be treated within 2 hours or less. Treatment focuses on increasing blood flow to the retina, while trying to safely dislodge the thrombus or embolus from the blocked artery. Some treatment techniques for retinal arterial occlusion include:
Inhalation (rebreathing) of a carbon dioxide/oxygen mixture has been used to treat arterial blockages. This treatment causes the retinal vessels to widen (dilate), increase blood flow and may allow the clot to move down the vessel, which reduces the area of the retina that is affected. If carbogen (95 percent oxygen and 5 percent carbon dioxide used to increase the flow of blood and oxygen to the retina) is not available, you may be asked to breathe into a paper bag to increase the amount of carbon dioxide in your blood.
Ocular massage is when your health care provider uses his or her finger to apply pressure on your eye through your closed eyelid.
Anterior chamber paracentesis is a procedure that involves the health care provider using a needle to remove a few drops of fluid from inside your eye to decrease the pressure within the eye, making it easier for blood to flow through the retinal artery.
In retinal artery occlusion, the cause of the blockage should be investigated. These blockages may reflect life-threatening medical situations. Patients with retinal artery occlusions should be screened for valvular heart disease, hypertension, or carotid artery blockage.
Treatment for retinal vein occlusions can include aspirin, clot-dissolving medication injections directly into the eye's circulation, administration of vasodilators (medications that widen blood vessels), exposure to hyperbaric oxygen and laser therapy used for the destruction of retinal emboli.
Retinal vein occlusion treatment depends on the extent of blockage. For a partial blockage in which only a small branch of the central retinal vein is blocked, sealing the damaged area with a laser (laser photocoagulation) may improve vision. A total blockage is when the entire central retinal vein is blocked, there is no effective treatment. However, laser photocoagulation may be used to prevent complications, such as glaucoma.
In patients under 40, blood tests should be done to check for a clotting problem. It is important that any blockage be closely monitored for several months, since many harmful effects take 3 or more months to develop.
PROGNOSIS
The outcome varies. Retinal arterial blockages have a poor prognosis for visual recovery, while patients with retinal vein occlusions often regain excellent sight.
COMPLICATION CONCERNS
- Complete or partial loss of vision in the affected eye.
- Stroke.
- Glaucoma.
PREVENTION
The prevention measures useful in other vascular (blood vessel) diseases, such as coronary artery disease, may decrease the risk of retinal artery occlusion. Controlling your blood pressure, cholesterol levels and blood glucose (sugar) are helpful preventative measures. Include exercise, positive lifestyle choices and a low-fat diet. Aspirin is commonly used to prevent additional attacks of vessel blockage once one has occurred.
To prevent retinal artery occlusion related to traumatic eye injuries, always wear appropriate protective gear, such as goggles, face shields, face masks, and helmets (if required) at work, while playing sports or riding recreational vehicles. Use a seat belt when you ride in a car to prevent your face and eyes from hitting the dashboard or the windshield during a collision.
Oral contraceptives have been linked to some cases of retinal vessel occlusion. Ask your health care provider or midwife about your risk of this rare side effect before you begin taking birth control pills or other hormonally based contraception.
Call your health care provider if sudden blurring or loss of vision occurs.
OPTIC NERVE INFLAMMATION (OPTIC NEURITIS)
Inflammation of the Optic Nerve (Optic Neuritis) is a vision disorder and another possible cause of vision loss. Such inflammation may occur as a result of a systemic illness or infection, but in many cases the cause cannot be determined. This condition usually affects only one eye but it may affect both, causing varying degrees of vision loss over the course of a few days.
DESCRIPTION
Optic neuritis, sometimes called retrobulbar neuritis, occurs when the optic nerve, the pathway that transmits visual information to the brain, becomes inflamed and the myelin sheath that surrounds the nerve is destroyed (a process known as demyelination). It typically occurs in one eye at a time (70 percent), and the resulting vision loss is rapid and progressive, but only temporary. Thirty percent of patients experience occurrence in both eyes. Optic neuritis tends to afflict young adults with an average age in their 30s. Seventy-five percent of patients with optic neuritis are women.
Nerve damage that occurs in the section of the optic nerve located behind the eyeball, is called retrobulbar neuritis, and is most often associated with multiple sclerosis. Up to 50 percent of patients with MS will develop an episode of optic neuritis, and 20 percent of the time optic neuritis is the presenting sign of MS. Optic nerve inflammation and edema (swelling) caused by intracranial pressure at the place where the nerve enters the eyeball is termed papillitis.
OPTIC NEURITIS CAUSES
Optic neuritis is most commonly associated with multiple sclerosis (MS). Other causes include viral-bacterial or fungal infections (such as herpes zoster), encephalomyelitis, autoimmune diseases (such as lupus), or pressure on the nerve from tumors or vascular diseases (such as temporal arteritis) and inflammation of vessels (vasculitis) nourishing the optic nerve. Ethambutol, and antitubercular drug, can also cause optic neuritis. Some toxins, such as methanol and lead, can also damage the optic nerve, as can long-term abuse of alcohol and tobacco. Patients with non-MS related optic neuritis are usually immunocompromised in some way.
OPTIC NEURITIS SYMPTOMS
Symptoms of optic neuritis include one or more of the following:
- Sudden blurred, "foggy" or dimmed vision.
- Blind spots, particularly with central vision. Sudden loss of vision (partial or complete).
- Pain with eye movement in the affected eye. A study found that 92.2 percent of patients experienced pain, which actually preceded the visual loss in 39.5 percent of cases.
- Sudden color blindness. Loss of some color vision in the affected eye, with colors appearing subtly washed out compared to the other eye.
- Impaired night vision.
- Headache.
- Impaired contrast sensitivity
DIAGNOSIS
An ophthalmologist, a health care provider trained in diseases of the eye, will typically make a diagnosis of optic neuritis. A complete visual exam, including a visual acuity test, color vision test, and examination of the retina and optic disc with an ophthalmoscope, will be performed. The head of the optic nerve can be easily visualized by an ophthalmoscope, however frequently there is no abnormal appearance of the nerve head in optic neuritis, though it may be swollen in some patients. Clinical signs such as impaired pupil response may be apparent during an eye exam, but in some cases the eye may appear normal. In many cases, only one eye is affected and patients may not be aware of the loss of color vision until the health care provider asks them to close or cover the healthy eye. A medical history will also be performed to determine if exposure to toxins such as lead may have caused the optic neuritis.
Further diagnostic testing such as magnetic resonance imaging (MRI) may be necessary to confirm a diagnosis of optic neuritis. An MRI can also reveal signs of multiple sclerosis. The presence of demyelinating white matter lesions on brain MRI at the time of presentation of optic neuritis is the strongest predictor for developing clinically definite MS. At 5 years follow-up, the overall risk of developing MS is 30 percent, with or without MRI lesions. Patients with a normal MRI still develop MS (16 percent), but at a lower rate compared to those patients with 3 or more MRI lesions (51 percent). From another perspective, almost half (44 percent) of patients with any demyelinating lesions on MRI at presentation will not have developed MS 10 years later.
TREATMENT OF OPTIC NEURITIS
Treatment of optic neuritis depends on the underlying cause of the condition. Vision loss resulting from a viral condition usually resolves itself once the virus is treated, and optic neuritis resulting from toxin damage may improve once the source of the toxin is removed.
A course of intravenous corticosteroids (steroids) followed by oral steroids has been found to be helpful in restoring vision quickly to patients with MS-related episodes of optic neuritis, but its efficacy in preventing relapse is debatable. It does not have a significant effect on the visual acuity at one year, when compared against placebo. The Optic Neuritis Treatment Trial (ONTT) has shown that IV steroids may be effective in reducing the onset of MS for up to two years in those patients who have MRI lesions, but this effect disappears by the third year of follow up. Further studies are necessary. Oral prednisone (corticosteriods) has been found to increase the likelihood of recurrent episodes of optic neuritis than in non-treated patients (though oral steroids are generally prescribed after the IV course, to wean the patient off of the medication). This effect of corticosteroids seems to be limited to optic neuritis and has not been observed in other diseases treated with corticosteroids. Oral corticosteroids are not recommended for treating the disorder.
When optic neuritis is associated with MRI lesions suggestive of multiple sclerosis, then general immunosuppressive therapy for MS is most often prescribed (IV methyleprednisolone may shorten attacks, oral prednisone may increase relapse rate).
PROGNOSIS
The vision loss associated with optic neuritis is usually temporary. Spontaneous remission occurs in two to eight weeks. In most cases, visual functions return to near normal within 8 to 10 weeks, but they may also advance to a complete and permanent state of visual loss. Sixty-five to eighty percent of patients can expect 20/30 or better vision after recovery. Long-term prognosis depends on the underlying cause of the condition. If a viral infection has triggered the episode, it frequently resolves itself with no after effects. If optic neuritis is associated with multiple sclerosis, future episodes are not uncommon. Thirty-three percent of optic neuritis cases recur within five years. Each recurrence results in less recovery and worsening vision. There is a strong association between optic neuritis and MS. In those without multiple sclerosis, half who experience an episode of vision loss related to optic neuritis will develop the disease within 15 years.
PREVENTIVE MEASURES
Regular annual eye exams are critical to maintaining healthy vision. Early treatment of vision problems can prevent permanent optic nerve damage (atrophy). Optic neuritis typically affects young adults ranging from 18 to 45 years of age, with a mean age of 30 to 35 years. There is a strong female predominance. The annual incidence is approximately 5 in 100,000 people, with a prevalence estimated to be 115 in 100,000.
TOXIC AMBLYOPIA
Toxic Amblyopia: This is a condition in which a toxic reaction damages the optic nerve, creating a small "hole" in the field of vision that enlarges over a period of time and may even lead to blindness. In most cases, both eyes are affected. It is caused by multiple toxic and nutritional factors and probably other unknown factors. It is also known as nutritional amblyopia. This disorder is most common in people who smoke - in fact, it is sometimes referred to as tobacco amblyopia - and is seen most often in pipe smokers. It may also occur in those who consume excessive amounts of alcohol or who come into contact with lead, methanol, chloramphenicol, digitalis, ethambutol, and other chemicals.
TYPES OF AMBLYOPIA
Amblyopia, or lazy eye is the result of strabismus that has gone untreated. A child who has strabismus will eventually learn to focus on the vision produced by the stronger eye and ignore the vision of the weaker, or lazy, one. This causes the vision in the weaker eye not to develop fully and can result in reduced sight in that eye. Amblyopia can be caused by a condition called ptosis, which is a drooping of the eyelid. An impairment of color vision is usually the result of toxic or some other influence.
Nutritional amblyopia as the name suggests, occurs as a result of vitamin and mineral deficiencies. It is often seen in alcoholics and those with severe nutritional deficiencies, especially in pernicious anemia, which is caused by a vitamin B-12 deficiency. Lack of vitamin A in the diet leads to blindness. A lack of zinc prevents the body from using adequate amounts of vitamin A stored in the body. Thiamine (B-1) and B-12 deficiencies may cause optic neuropathy and vision loss. Generally, intensive vitamin therapy and proper nutrition can restore lost vision. Complete recovery is possible with an improvement in diet and nutritional supplementation, but a prolonged deficiency can result in permanent loss of central vision. It is estimated that about two to three percent of children in the US have amblyopia.
Alcohol amblyopia is a visual condition unique to those who have a history of chronic, severe drinking problems. The disorder involves lost vision, including scotomas (blind spots) and decreased visual acuity within the central portion of the visual field. The painless, bilateral sight loss gradually worsens. The disorder is caused by the toxic effects of alcohol on the optic nerve causing optic neuropathy, a condition in which the optic nerve swells. Because alcohol depletes the entire body system of nutrients, alcohol amblyopia is easily linked to a thiamine (vitamin B-1) deficiency, a condition that can lead to optic-nerve damage. The condition can be treated with proper diet and vitamin supplementation. It is generally reversible, but may lead to permanent vision loss if untreated.
Tobacco amblyopia is a condition in which the vision is lost because of the use of tobacco. The toxic effects of tobacco constrict the vessels of the body and interfere with circulation. The optic nerve is very sensitive to tobacco and can be easily irritated by excessive smoke. As a result, the optic nerve swells, a condition known as optic neuritis. Early symptoms of tobacco amblyopia include painless blurring or loss of central vision that may be accompanied by numbness or tingling in the fingers. If allowed to progress, the blurring may spread to the peripheral visual fields, and optic nerve damage may result. Reduction or elimination of tobacco usage in conjunction with proper nutrition usually restores sight. Alcohol and tobacco amblyopia are common conditions. Overuse of either compound affects the optic nerve and optic disc, causing optic atrophy. A slow, progressive loss of central vision and, often, color vision follow. Both conditions are associated with poor nutrition and diet, which also affects ocular function. Treatment with vitamins and minerals, especially that of vitamins B-1 and B-12, as well as the reduction in the use of both substances often restores sight.
Toxic amblyopia is a condition in which vision is lost as a result of the absorption of toxic agents. The condition is usually bilateral, and except in the case of wood alcohol and arsenic poisoning when the vision loss is irreparable, generally tends not to be permanent. Some poisons induce a central vision blurring or scotoma, a blind spot. These include tobacco, ethyl alcohol, methyl alcohol, carbon disulphide, halogenated hydrocarbons, aromatic amino and nitro-compounds, such sedatives as barbiturates, opium, and morphine, anti-infective compounds and other drugs, and such heavy metals as lead and thallium. Other compounds produce a reduction of the peripheral field, or tunnel vision. These include organic arsenic, quinine, carbon tetrachloride, methyl iodide, and the drugs salicylic acid, hydrocupreine derivatives, ergot, and aspidium.
- Net Healthbook: Toxic Amblyopia
- Smoking & Eye sight
- Preventing Tobacco-caused Blindness
- Eye Care Basics: Amblyopia Treatments
- Health A-Z: Amblyopia
RECOMMENDATIONS
If any of the above symptoms develop, consult a health care provider. For most of these conditions, prompt treatment may help to preserve sight or at least slow vision loss.
Do not smoke, and avoid those who do. Even people who have already developed toxic amblyopia as a result of smoking can have their vision improve if they quit.
CONSIDERATION
The syndromes discussed here are usually painless. Physical discomfort is not a reliable indicator of visual health. Regular ophthalmic examinations are recommended for everyone over 35 years of age.
See also:
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member (such as a child) is having problems distinguishing colors or find colors confusing. This member may need to be tested for color blindness.
You or a family member are having problems with vision and/or you suspect an infection. Call your health care provider immediately if you experience severe eye pain or a sudden change in your vision, such as loss of vision or double vision.
You have any increase of symptoms. You may need frequent changes in your eyeglass prescription. If you have blurred or double vision that develops slowly; are having a problem seeing because of daytime glare or have difficulty driving at night because of glare from headlights, you need to see your health care provider.
You have any unexpected or unusual symptoms. There may be underlying health issues that need to be addressed.
Are having vision problems that are affecting your ability to perform daily activities.
Call your child's health care provider if your baby does not look directly at or respond readily to faces or large, colorful objects by age 2 to 3 months or if your child scowls, squints, or shields his or her eyes more than expected when in sunlight, or light seems to hurt your child's eyes.
You and your family members should have your eyesight checked regularly by your health care provider to rule out any problems and to receive a prescription for contacts or eyeglasses, if they are needed. Preserve you vision... it is very important.
NUTRITIONAL SUPPLEMENT RECOMMENDATIONS FOR EYE HEALTH
The following nutrients are important for healing once appropriate local treatment has been administered. Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments Vitamin A 25,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily. Promotes healthy skin and hair.
Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 Softgels,Plus
Natural Beta-Carotene
Or
Carotenoid ComplexAs directed on label. Needed for all eye disorders.
Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels,
Multi-Carotene Antioxidant, Nature's Way, 60 SoftgelsPlus
LuteinAs directed on label. Lutein can help protect the retina from harmful ultraviolet (UV) light and free radicals. Needed for all eye disorders.
Lutein Supplement, Nature's Way, 20 mg, 60 Softgels,
Lutein Esters, 20 mg, 60 SoftgelsAnd
ZeaxanthinAs directed on label. Needed for all eye disorders.
Visi Clear With Lutein, Bilberry, Zeaxanthin & Lycopene,Vitamin B Complex 50-100 mg daily. The B Vitamins help prevent loss of eyelashes.
Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 CapsPlus Extra
Vitamin B-2 (Riboflavin)As directed on label. The B vitamins help prevent loss of eyelashes.
Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps,
Vitamin B-2 (Riboflavin), 100% Natural, 100 mg, 100 CapsPlus Extra
Vitamin B-3 (Niacin)As directed on label. The B Vitamins help prevent loss of eyelashes. Caution: Do not take niacin if you have a liver disorder, gout, or high blood pressure.
Niacin Supplement (Vitamin B-3), 100% Natural, Nature's Way, 100 mg, 100 CapsPlus
Brewer's Yeast2 Tablespoons daily. An excellent source of protein and a good source of B-vitamins.
Brewer's Yeast, Debittered, NOW Foods, 1 lb.,
Brewer's Yeast, NOW Foods, 650 mg, 200 Tabs
EYE CARE SUPPLEMENTS & PRODUCTS
Information, supplements and products for eye-related problems.
Beta Carotene (Natural Dunaliella Salina), 100% Natural, Nature's Way, 25,000 IU, 100 Softgels
Nature's Way Beta Carotene is 100% all natural from Dunaliella Salina.CamoClear Soothing Eye Wash, Herbal Eye Wash, CamoCare, 10 Single Use Droppers
CamoClear Soothing Herbal Eye wash gives you instant, natural and long lasting relief for dry, tired or irritated eyes, due to dust, pollen, pollution, smoke irritants, sun glare, wind, swimming, air conditioning/heating and computer work.Clear Eye Herbal Tea, 20 Tea Bags
To nurture the eye and pacify the nervous system, protect retina, and improve eyesight.Clear Eye & Sharp Ear, TCM Formula, Shanze Xiaozhi, 60 Caps
Clear Eye & Sharp Ear Chinese Formulas are made of extracts from astragalus root, pueraria root, seashore vitex, common peony root, cimicifuge, phellodendron, licorice, cnidium, Chinese angelica root (Dong Quai) and ginseng.Digestive Enzymes, 750 mg, 100 Caps
Since cooking destroys many of the digestive enzymes in food, taking plant fiber-based digestive enzymes aids in digesting even the heaviest meal.Dry Eye Relief Eye Drops, Homeopathic, 0.33 fl. oz.
Eye Doctor recommended Similasan Eye Drops for dry, red eyes stimulate the eye's natural ability to fight dryness and clear redness due to smog, stress, age, contact lens wear, etc.Essential Fatty Acids, By Deborah Lee
"Woodland Health Series". Describes the benefits and functions of the three essential fatty acids, linoleic acid, linolenic acid and arachidonic acid.EyeFactor HAÖ for Healthy Vision with HA, Hyalogic, 120 Count
Hyaluronic acid makes up 95% of the fluid inside the eye. Acts as a shock absorber for the eye and also serves to transport nutrients into the eye.Eye Support Formula With Bilberry, Lutein & Antioxidants, NOW Foods, 60 Caps
NOW "Health Care Provider Recommended" Eye Support Formula eye supplement offers a full range of antioxidant nutrients which may aid in maintaining some visual functions with Lutein and Bilberry.Fisol Fish Oil Supplement, EPA DHA, Enteric Coated, Nature's Way, 500 mg, 90 Softgels
Fisol, enteric coated, fish oil supplement delivers 30% EPA and 20% DHA. The unique coating withstands stomach acid so Fisol dissolves in the small intestine and maximizes the body's absorption of Omega-3 Essential Fatty Acids.Magnesium Citrate Complex, Nature's Way, 250 mg, 100 Caps
Nature's Way Magnesium Citrate is an advanced chelate from which enhances absorption of magnesium by providing excellent solubility.Nature's Way Ginkgold Eyes Plus Lutein, 20 mg, Vegetarian, Eye Supplement, 60 Caps
Nature's Way Ginkgold eye supplement supports visual function and is the only Ginkgo extract shown to stimulate activity in all areas of the brainNeuromins DHA Supplement (Docosahexaenoic Acid), Nature's Way, 100 mg, 60 Softgels
Neuromins brand high quality DHA Supplement is sourced from microalgae and fortified with Vitamin C and E.Once Daily Multi-Vitamin With Iron, All Natural, Lactose Free, Nature's Way, 100 Tabs
Nature's Way Daily Multi Vitamin with Iron provides many of the essential nutrients that modern diets may lack. They are useful for protection, growth and maintenance of body systems as they age.Selenium, 100% Natural, 200 mcg, 100 Caps
Selenium is an essential component of glutathione, the body's most potent natural antioxidant system. It is a popular choice in many antioxidant regimens.Synthovial Seven, Pure Hyaluronic Acid, Hyalogic, 1 oz.
Hyaluronic Acid (HA) has been proven by numerous medical studies to alleviate pain and suffering from arthritis of the knee and other joints.Taurine, Free Form, NOW Foods, 500 mg, 100 Caps
Taurine is a conditionally essential amino acid which is not utilized in protein synthesis, but is mainly found free in most tissues, especially throughout the nervous system.Visi Clear With Lutein, Bilberry, Zeaxanthin & Lycopene, 60 Caps
Visi Clear Eye Vitamin with Lutein and Bilberry is one of the few products that provide both lutein and whole kale and Zeaxanthin, another powerful carotenoid, to maximize antioxidant activity.Vision Formula With Lutein & Bilberry, Eye Supplement, 60 Caps
Vision formula with Lutein & Bilberry Eye Supplement supports normal eye function by utilizing Lutein, a key carotenoid found in fruits and vegetables, which protects the retina by blocking harmful blue light.Vitamin A, 100% Natural, Nature's Way, 100 Softgels
Nature's Way Vitamin A is 100% natural from fish liver oil. It contains no artificial ingredients or preservatives.Vitamin B-12 Supplements & Products
An assortment of various B-12 products.Zinc Chelate, 100% Natural, Zinc Supplement, Nature's Way, 30 mg, 100 Caps
Nature's Way chelated Zinc supplement is 100% natural chelated with an advanced amino acid complex for superior absorption.
HerbalRemedies: Eye Problem Information
TYPES OF EYE PROBLEMS & DISORDERS
Maintaining Healthy Eyes
HELPFUL RELATED LINKS
For a full list of available products from Mountain Rose Herbs, click on banner below:
HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
This is only a small sample of educational materials and products available through Amazon.com. Use the search box provided below to search for a particular item.
HERBS, OILS, & SUPPLIES
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Click Here To Visit Herbal Remedies Product Page
A Source For Medicinal & Ritual Herbs & Supplies
Aphrodisiacs Aromatherapy Bath & Body Care Bulk Herbs By The Pound Capsules, Tablets & Extracts Chinese Herbals Electronics Extracts First Aid Products Food Products, Mixes, Seeds, Snacks & More! Hair Care Products & Supplies Herbs & Oils, Kilo & Ton Hydroponics & Gardening Kava Products Kitchen & Housewares Mushrooms Musical Instruments Oral Care & Dental Products PC & IT - Computer Supplies & Assessories Skin Care, Cosmetics, & Gift Sets Smokes, Seeds, Cacti Spices, Salts, Sweeteners, & Seasonings Sports, Toys & Games Sweets, Candy, Chips & Snacks Stimulants Sedatives Teas & Coffees
Shaman Shop Home Page
