Thursday, April 19, 2007

Glaucoma - a thief in the night

This is an eye disease which is little understood by the general public. It's a disease of the optic nerve, which usually affects the peripheral vision first then gradually going centrally. A rise in intraocular pressure is usually but not always noted.

Glaucoma may be acute or chronic.

In acute glaucoma, there is a sudden increase in intraocular pressure (the pressure inside the eyeball), causing severe eye pain, headache, nausea, vomiting, blurring of vision and iridescent vision (seeing rainbows around lights). This is considered as a relative ophthalmologic emergency, and it is imperative to see an ophthalmologist at this point so that management of the glaucoma can be instituted immediately.

In chronic glaucoma, there is no sudden increase in intraocular pressure, hence, the signs and symptoms are a lot more subtle. There may be occasional headaches or eye pain, but generally the patient does not really feel a pressing need to see a doctor because these symptoms are not that severe or get relieved with minor measures like over the counter medications. Or they may not even feel any symptoms at all. The tragedy of chronic glaucoma is that patients do not know that they have this disease until they have already lost a significant amount of peripheral vision.

It is important to remember that since the optic nerve gradually loses axons in this disease, any vision loss is considered permanent. That's why an early diagnosis is important so that early intervention can be done and the progression of the disease can be minimized.

Current recommendations for people less than 45 years old and without risk factors for glaucoma to have an eye check at least every 4 years, and those above 45, at least every 2 years. If you have known risk factors for glaucoma, it's recommended that an eye exam should be done at least every 2 years if you're under 45 and every year if you're above 45. The following are considered as risk factors: Family history, myopia (nearsightedness), previous eye injury, low blood pressure, African descent, diabetes, long exposure to cortisone. (Previous info from The Glaucoma Foundation, website .)

It is also important to note that glaucoma is a disease that is controlled, not cured. That means that patients should visit their eye doctors at periodic intervals so that the treatment regimen can be reassessed accordingly.

How is diagnosis made? The ophthalmologist screens for glaucoma by looking at the optic nerve through an ophthalmoscope or through a special lens and a slit lamp. He also measures the intraocular pressure using a tonometer. Then gonioscopy, which allows him to see the "angles" of the eye is done to determine if it's an open angle or an angle closure type of glaucoma. This is important because the type of treatment is dictated by the type of glaucoma. Perimetry is then done to assess the peripheral visual function.

There are 3 basic treatment options available for glaucoma. These include medical treatment - with use of eyedrops and sometimes oral or IV medications, laser treatment and surgical treatment. The type of treatment is dependent upon the stage and the type of glaucoma.

It is important that patients undergoing glaucoma treatment understand that a careful and periodic monitoring of their disease by a qualified ophthalmolgist is a must in order that treatment plans are reevaluated and updated as needed, for maximum suppression of disease progression.

Should you have further questions, please do not hesitate to leave a comment and an email.

Saturday, April 14, 2007

The Red Eye

A common eye complaint is usually the red eye (or sometimes, pink eye). The most common cause of the red eye is an infection, and the infection is usually viral in origin (acute viral conjunctivitis).

Acute viral conjunctivitis also shows the following symptoms: tearing, discharge, slight pain, slight swelling of the eyelids, itchiness. This is a contagious condition, spread by direct contact.

What to do:
- HANDWASHING especially when you have touched your eyes. This would greatly cut down on the spread of conjunctivitis. You don't want to start an epidemic of conjunctivitis.
- Use tissue to wipe off any tearing, and throw the tissue afterwards.
- Use sterile or boiled water to clean off any crusting or discharge.
- it's best to just stay home, especially for children, in order to avoid spreading the infection.

What NOT to do:

- use just any eyedrop without a doctor's prescription. For that matter, don't just put anything into the eye, especially unclean water, urine, plant extracts etc. You might just be worsening the situation.

When you must ABSOLUTELY see an eye doctor (ophthalmologist)
- There was trauma involved, or a chemical substance has been introduced prior to the symptoms.
- When the redness has not subsided in 3 days
- There is very copious discharge.
- There is blurring of vision noted.
- Eyes are very swollen.
- There is eye pain, headache, dizziness or other symptoms.
- There is accompanying fever.
- The patient is either very young or very old.

Other possible cause of red eyes: Acute onset glaucoma, corneal abrasions, blepharitis, bacterial conjunctivitis, keratitis (bacterial or herpes), chemical burns or injury, etc.

Also published in and by the same author.

Why I decided to start this blog

I realized that a lot of people have some problems with their health, and want some helpful, practical advice. I would like to point out, though, that this is no substitute for seeing a doctor.

I am a doctor with a specialty in ophthalmology and a subspecialty in glaucoma. I am also mom to an active toddler. I believe that who I am gives me an edge as I've been on both sides of the health care relationship more times than I could count.

I hope that, in some way, I would be able to help people out.