Eye Disorders and Treatments

Dry Eye

• Symptoms: Rainy, sandy, gritty feeling, typically worse as the day goes on.
• Diagnosis:
  • Schirmer's Test: Filter paper placed in the lower lid; normal results are 10-15 mm of wet paper after 5 minutes.
  • Drops: Dye disappears from the lacrimal cul-de-sac within one minute is considered normal.
• Medical Management:
  • Artificial Tears: Over-the-counter, doctor can recommend specific ones.
  • Cyclosporine: Increases tear production, reduces inflammation (takes 3-6 months for improvement).
• Environmental Factors: Dust, sprays, aerosols; advise filters.
• Surgical Repair: If other methods fail.

Ectropion and Entropion

• Non-infectious disorders of eyelid margins turning abnormally.
• Ectropion: Outward turning (EGG - Out).
  • Causes: Bell's palsy, birth defects, eye lacerations, injury.
• Entropion: Inward Turning (IN - In).
  • Causes: Atrophy of eyelid tissue and muscle, congenital conditions, trauma.
• Medical Management: Topical medications to reduce inflammation; surgery is preferred.
• Interventions: Monitor treatment, report progress; early diagnosis is better.

Cataracts

• Lens becomes cloudy or opaque, decreasing visual acuity.
• Causes: Aging, injury, congenital problems, diabetes, UV rays, corticosteroids, toxins, hypertension, smoking.
• Clinical Manifestations:
  • Painless, blurred vision, difficulty reading fine print, double vision, photosensitivity, glare (worse at night), abnormal color perception, hazy/fuzzy vision.
• Diagnostic Tests:
  • Slit lamp exam to see opaqueness.
  • Ophthalmoscope to look at the lens.
• Treatment:
  • Change eyewear prescription.
  • Surgical repair: Intracapsular (entire lens removal - not typical), extracapsular (preferred).
• Post-op Education:
  • Outpatient procedure.
  • Antibiotics and corticosteroid drops to prevent infection and decrease inflammation.
  • Avoid bending, stooping, coughing, lifting, straining (increase IOP).
    • Stool softeners and high-fiber diet recommended to avoid straining.
  • Use eye shield at night.
  • Notify doctor if continued irritation or pain.
  • Follow-up: Typically the next day.
• Visual field is hazy and fuzzy.

Diabetic Retinopathy

• Disorder of retinal blood vessels characterized by microaneurysms, hemorrhage, exudates, and new vessel formation.
• Common after 15 years of diabetes.
• Nearly all patients with type 1 and 80% with type 2 diabetes have some degree of retinal disease.
• Incidence increases with duration of diabetes and poor control.
• Initial stage can last several years.
• Clinical Manifestations: Microaneurysms, floaters, visual loss.
• Diagnosis: Ophthalmoscopy to see dilated and narrowed arteries.
• Surgical intervention:
  • Photocoagulation: Laser beam to destroy new blood vessels, seal leaking vessels, and prevent retinal edema.
  • Cryotherapy. Uses a topical anesthetic.
• Early detection is key

Age-Related Macular Degeneration (ARMD)

• Slow progressive loss of central and near vision.
• Genetic component and risk factors like UV light exposure, hyperopia, smoking, female gender, obesity, race, light-colored eyes.
• Dietary supplementation with vitamins C, E, A, copper, and zinc will slow development of advancing ARMD.
• Two types: Wet and Dry (dry is 90% of cases).
• Clinical Manifestations:
  • Drusen (yellow exudate beneath the retinal pigment).
  • Gradual bilateral loss of central vision.
  • Trouble distinguishing colors.
  • Distorted vision.
  • Dark empty area in the center of vision.
• Diagnosis: Fluorescein angiography.
• Treatment:
  • Injections of Avastin and Maccogen, and antibiotics to prevent infections.
  • Visual aids: Telescopic and microscopic lenses, magnifying glasses, electronic magnifiers.

Retinal Detachment

• Separation of the retina from the choroid, often due to a hole in the retina.
• May be caused by severe trauma to the eye.
• Clinical Manifestations:
  • Initially painless (only pain with initial trauma).
  • Floaters and flashes of light.
  • Feeling of a curtain or heaviness over the eye.