2. Dry Eyes.
4. Eye allergy
What is pterygium?
It is a fleshly growth that appears on the medial(inner ) or temporal(outer) part of the conjunctiva of the eye .It can occur in one or both eyes. It is common to people living in the equatorial region with frequent exposure to sunlight , but people living in colder climates are not exempted. The age of onset tends to be in the second or third decades of life. Pterygium is not cancerous.
Exposure to ultraviolet radiation ( sunlight).
Exposure to dusty environment.
Dry and low humid environment
Chronic eye irritation
Írritation of the eye and feeling of dryness;it is usually painless.
Redness of the eye.
In severe cases , blurring of vision due to induced astigmatism
What can you do ?
Avoid prolonged exposure to sunlight.- wear sunglasses
Avoid dusty environment.
Instill lubricant eye drops to lubricate the eyes regularly.
When is surgery necessary.?
Usually when the pterygium is very small, surgery can be avoided. Lubricant drops can be instilled to prevent irritation and discomfort.
Surgery is indicated when :
it has encroached onto the cornea
it caused frequent irritation and redness.
For cosmetic reasons, especially in young people who do not wish to face the embarassment of frequent “red eye”
How is surgery done ?
Nowadays, the gold standard operation for pterygium is excision with autologous conjunctival transplantation ie the pterygium is excised out and a piece of healthy conjunctiva is obtained from another area of the eye and patched onto the excised bare area .Previously,the patching is secured with stitches, but this caused a lot of discomfort post operatively .
Since 2007, we have been using a special glue to patch the healthy piece of conjunctiva to the excised bare sclera, something which I call a ‘copy and paste’ technique. It is so much more soothing and faster than using stitches. The discomfort of post surgery irritation from stitches is greatly minimised .The surgery time last usually about 10 to 15minutes.
The recurrence rate is extremely rare with this method.
Post surgery, the eye will be patched up for usually 1 day. Pain medication will be prescribed to you in case you experience some pain, but this is rare.
You will be required to come for a review the next day and your eye cleaned up. You will then be instructed on how to instill your eye drops and ointment.
What is dry eyes.?
It is a condition whereby the eye does not produce enough tears properly or the tears evaporate too quickly.
Who is at risk?
Older people tend to get dry eyes more often and women are more prone to it.
However dry eyes can occur at any age.
Aging is the commonest cause of dry eyes.
Apart from that , there are other causes:
Local inflammatory eye condition
Systemic diseases like thyrotoxicosis, hypertension.
Prolonged use of medications like anti histamines and certain anti –hypertension medications.
Prolonged visual tasking eg computer work.
Arid and dry conditions.
Dusty and polluted environment
What are the symptoms?
Gritty sensation and foreign body sensation, worst in a dry ,low humidity environment like in a hypermarket.
Burning sensation and intolerance to contact lens wear.
Discharge when waking up in the morning.
Eye fatigue , heaviness of the eyelids and intolerance to prolonged visual task eg computer work
Occasionally, blurred vision
In severe cases, pain and redness.
Sometimes, paradoxically ,one can have excessive tearing as a result of dry eyes; this is due to reflex action
Treatment Options :
Articial tears or eye gels to lubricate the eyes; there are many types that can be purchased over the counter.
Wearing glasses or sunglasses.
Insertion of punctual plugs .
Avoidance of dry ,dusty and low humidity environment
Conjunctivitis( fig 3) or commonly called red eye is a fairly common eye condition. It is an inflammation caused by virus , bacteria or any irritant.
Symptoms include redness and watery eyes with eye discharge.
Most cases of infectious red eye is caused by virus and they don’t require antibiotics.
Antibiotics are prescribed to prevent secondary bacterial infection or in infectious bacterial conjunctivitis. They are very contagious and sometimes the whole family or a community can be infected with conjunctivitis. It is therefore very important to take measures to prevent spread of viral or bacterial infection like frequent washing of hands , avoid sharing of towels and voluntary isolation of the affected individual.
Rest at home.
Drink plenty of fluids.
Antibiotic medication in certain cases.
Eye allergy can be local or part of a systemic allergic condition.
Local causes include dust ,pollen and animal hairs. Systemic causes include drug or food induced or as part of a systemic disease eg psoriasis or dermatitis
Itching is the main symptom.Other symptoms include frequent rubbing of the eyes, swelling, redness and tearing .
Allergy can also be inborn; there is a condition called vernal papillary conjunctivitis(VPC) (fig 4) that appears at a very young age .This condition usually waxes and wanes; sometimes it can get worsened , but as one grows,the good news is that this condition gradually improves. Other conditions associated with it are asthma and vasomotor rhinitis(VMR) which cause early morning nasal drip .
Treatment options .
Avoidance of the allergen; if you are aware that certain food or material causes the allergy, try to avoid them.
Anti histamine eye drops ( there are many now available and are very effective)
Artificial eye drops to dilute or wash off the allergen.
Stye can be divided into external and internal stye.
They are caused by bacterial infection.
Onset is usually acute and of short duration.
A external stye or hordeolum is a tender red lump that looks like a pimple on the edge of the eyelid. It is due to infection of the tiny glands of the eyelid. They usually point to the outside of the eyelids. They usually heal quite rapidly and can be hastened by a warm wet compress..
Internal stye( fig 5) is an infection of the larger sebaceous glands of the eyelids .They tend to point inside of the eyelids .
Antibiotic eye drops and ointment are necessary to speed up the healing .Systemic antibiotics may be necessary if there is marked surrounding inflammation( cellulitis) and the risk of infection spreading to the rest of the body, especially in young children.
Avoid contact lenses or eye makeups.
Surgery ( incision and curettage) is necessary when the stye does not resolve within a week.
Chalazion( fig 6) is a much larger lesion. It is a cyst of the eyelid that is caused by blockage of the larger Meibomiam glands of the eyelid.;the pores to the glands are blocked by infection.
Usually surgery( incision and curettage) is necessary to remove the lipo granulomatous material within the gland.
Surgery is usually done under local anaesthesia in adults; sometimes especially in young children ,it has to be done under general anaesthesia to ensure the patient stays still while the surgery is being performed and to avoid injury to other parts of the eye.
Under local anaesthesia, a small volume of anaesthetic is infiltrated around the eyelid region to numb the area. After a few minutes, an incision is made at the site of the swelling; a curette is introduced to scoop the contents within the lesion thoroughly. Stitches are not necessary.
The eye is then padded for 4-6hours; painkiller may be necessary to prevent post operative pain and discomfort.
There is no need for admission; it can be done as an outpatient or day care procedure.
Blepharitis ( fig 8)is a chronic inflammation of the border of the eye lids. It is a fairly common condition and is often neglected .It can occur in all ages .It can be acute, but generally is a long standing condition with varying severity. It is aggravated by hot ,humid conditions.
.Infection, usually bacterial.
.Redness and irritation of the eyelids
.Crusting and flaky skin at the margins of the eyelids.
.Itching and gritty sensation of the eye.
.Associated with styes .
.In severe cases, blurring of vision can occur due to involvement of the cornea.
The hallmark of treatment is lid hygiene. Daily cleaning of the eyelid margin with a mild soap or with those commercially available lid care wipes will go a long way in combating blepharitis. Sometimes , a broad spectrum topical antibiotic gel or systemic oral antibiotic may be necessary in severe cases to reduce the bacterial flora in the eyelids.
Common lid problems
Entropion is an inward turning of the eye lids .It is usually caused by aging, when the eyelid ( usually lower) become laxed (called involutional entropion).
Other cause include trauma to the eyelids and congenital cause.
Symptoms include discomfort and tearing of the eyes when the eyelashes hit onto the cornea.
Ectropion( fig 9) is an outward turning of the eyelids.It is also usually caused by laxity of the lower lids as a result of aging ( called involutional ectropion).
Ectropion can also be caused by other factors like damage to the &th cranial nerve ( paralytic ectropion ) and also trauma to the eyelids.
When symptoms are significant , example tearing and persistent irritation , surgery to correct the entropion or ectropion becomes necessary.
Ptosis( fig 10 ) is due to droopy upper eyelid. The majority is due to old age, also called involutional ptosis ; this is caused by weakness or dehiscence of the upper lid muscles that pull the upper eyelid.
Ptosis can also be congenital, meaning one is born with it; this is due to maldevelopment of the muscles that pull the upper eye lid.
It the visual axis is blocked, it is necessary for surgical correction of ptosis to be done.Ptosis is also sometimes done for cosmetic reasons.