Cycloplegic

Cycloplegia refers to the paralysis of the ciliary muscle hindering accommodation. Due to the paralysis of the ciliary muscle, the curve of the eye cannot focus on the objects or images nearby. The ciliary muscle is a ring of the smooth muscle in the eye, typically in the middle layer, which controls viewing of objects at different distances. Moreover, the ciliary muscle also regulates the flow of specific aqueous humour into the Schlemm’s canal.

Cycloplegic drugs are used also used in cycloplegic refraction to paralyze the ciliary muscle to help examine the actual refractive issue of the eye. Moreover, cycloplegics are also used to treat uveitis. Essentially, all cycloplegics are also pupil dilating agents and used for dilating pupils, enabling better visualisation of the retina. Cycloplegics are very frequently used during eye examinations.

When the cycloplegic drugs are used to dilate pupils during eye exams, the pupil regains its function upon the cycloplegic drugs being metabolized or taken away. However, in some cases, the cycloplegic drugs can leave the pupil dilated for some days even after the examination is done. The cycloplegic medications used by the doctors generally wear off in some hours after their application; however, the patient is advised to wear strong protective sunglasses for comfort.

Functioning of cycloplegics

Typically, cycloplegics obstruct the functioning of acetylcholine. Acetylcholine is a stimulatory neurotransmitter that is associated with the autonomic nervous system. In the human eye, the acetylcholine is situated in the iris sphincter, and also in the ciliary body. These acetylcholine receptors function to cause a contraction of the iris, along with the ciliary body. With the use of cycloplegics, the doctor can control this activity by causing the ciliary body to become temporarily paralysed.

Overall, cycloplegics are very useful in providing relief from pain because of ocular inflammation. These drugs paralyze the ciliary muscle, thereby, helping the ciliary spasm relax. Moreover, the cycloplegics decrease the area of the posterior iris, which helps to prevent posterior synechiae formation.

Cycloplegics also help to minimise the intensity of cell and flare reaction, which typically occurs in the anterior chamber of the eye. Because of these various advantages of cycloplegics, they have been used by doctors to manage patients with corneal injury and an eye condition, known as uveitis.

Side effects of cycloplegic

Cycloplegics can cause some local and systematic issues after their usage. However, these issues are temporary a generally get better with time. Some of the common side effects of cycloplegic drugs include:

  • Increased intraocular pressure
  • Blurry vision
  • Photophobia
  • A stinging feeling in the eye
  • Conjunctivitis
  • Dryness in the mouth and skin
  • Tachycardia
  • Rashes on the skin
  • Abnormal reactions
  • Behavioural issues
  • Increased sensitivity to glare
  • Reduced power to recognize hazards with low contrasts

That said, most cycloplegic agents do not any such issues. They are easy to apply, suppress much accommodation, wear of in-time, and do not have any side effects.

Overall, cycloplegic drugs are very useful in calming the ciliary muscle to enable the eye doctor to diagnose the eye condition properly or to carry out a treatment procedure. However, these drugs can have some side effects, which are temporary and fade away. But the usage of these drugs depends on the preference of the doctor and also on the general health of the condition.

Glaucoma

Glaucoma refers to a group of medical conditions, which harm and in most cases damage the optic nerve of the eye. The optic nerve is very critical for a good vision and is damaged mostly by intense pressure caused on the eye. Glaucoma worsens with time and can often cause blindness in people over the age of 60 years. Even though the condition is more common in elders, it can occur at any age.

In many cases, glaucoma is hereditary and runs in the family. Some forms of the condition do not have any warning signs and are thus, often detected when the condition has worsened. The overall impact may be noticeable only when the condition reaches an advanced stage.

Since a loss of vision caused due to glaucoma cannot be recovered it is advisable to have regular eye exams. These examinations should also include checking the eye pressure, to allow a diagnosis to be made in the earlier stages and hence, treated properly. If the condition is diagnosed early, the loss of vision can be prevented or caused to slow down. For patients that have glaucoma, the treatment can continue for the rest of their lives.

Types of Glaucoma

Different types of glaucoma include:

Open-angle glaucoma: This is the most common form of glaucoma.In this issue, the drainage works properly but the trabecular meshwork is temporarily blocked. This increases the pressure in the eyes, which further intensifies with time. The pressure further damages the optic nerve.

Angle-closure glaucoma: This is also called closed-angle glaucoma.This condition occurs when the iris comes forward and blocks or narrows the drainage angle of the cornea and iris. This restricts the fluid circulation causing the pressure to intensify.

Normal-tension glaucoma: There is no specific reason for this type of glaucoma. In this problem, the optic nerve gets damaged even when the pressure of the eye is normal. Possible causes could be sensitive optic nerve or less blood supply to the nerve.

Pigmentary glaucoma: In this type of glaucoma, the granules of pigments of the iris accumulate in the drainage. This tends to block or slow down the fluid from exiting the eye. Jogging or other such related physical activities can cause the stirring of pigments.

That said, children can also have glaucoma, which could be present since birth or could develop in the first few years post-birth. This could be because of an underlying condition or drainage blockages.

Symptoms of Glaucoma

In most cases, glaucoma produces no symptoms and advances with age. Hence, the symptoms vary per the stage of the problem and the type of glaucoma.

Open-angle glaucoma: This condition can cause patch-like blind spots in the side or the central vision. Typically, this affects both eyes of the person.

Acute angle-closure glaucoma: If a person has this type of glaucoma, the following symptoms may appear:

  • Frequent and severe headache
  • Extreme pain in the eyes
  • Nausea
  • Vomiting
  • Blurry vision
  • Formations around the lights
  • Redness in the eyes

For patients left untreated, the condition can worsen over time to cause blindness.

Causes of Glaucoma

Glaucoma occurs when the optic nerve of the eye is damaged. When the nerve slowly deteriorates, the eye starts to witness the development of blind spots in the visual fields. One of the major causes of this problem is the increased pressure on the eyes.

The increased pressure causes fluid to build-up, which flows in the eyes. This fluid is generally drained via a tissue known as the trabecular meshwork, at the point where iris and cornea meet. However, when there is an excessive build-up of fluid in the body or if the drainage does not work well to remove the fluid, the eye pressure can increase, causing glaucoma. In most cases, the problem is related to the genes and runs in the family.

Risk Factors of Glaucoma

Severe forms of glaucoma can completely cause a complete loss of vision even before any warning signs appear. However, some risk factors that increase the risk of a person for this condition include:

  • High internal eye pressure
  • People above the age of 60
  • Asian, black or Hispanic race
  • Family history of glaucoma
  • Medical problems such as diabetes, heart problem, high blood pressure, etc.
  • People who have a cornea that is thinner in the centre
  • People who have high nearsightedness or farsightedness vision issues
  • Eye injury
  • Eye surgery
  • Continued usage of eye drops or other corticosteroid medications

Diagnosis of Glaucoma

To diagnose the problem, the doctor will conduct a comprehensive eye exam and also understand the medical history of the patient. For this purpose, the doctor may conduct several tests, such as:

  • Tonometry that measures the intraocular pressure
  • Dilated eye exam to test the optic nerve damage
  • Imaging tests
  • Visual field test to assess the extent of vision loss
  • Pachymetry exam to measure the thickness of the cornea
  • Gonioscopy to know the drainage functioning

Treatment of Glaucoma

Glaucoma cannot be reversed. However, some medications and regular eye exams can help to prevent complete vision loss or slow down the process. This is even more beneficial in cases where the problem is detected in its early stages.

Typically, glaucoma can be treated in its initial stages by reducing the eye pressure. Also, certain medications, eye drops, laser treatment, surgery or a combined approach of two or more methods, can be used to treat the condition.

Prevention of Glaucoma

Some self-eye care can help prevent glaucoma in the early stages. These include:

  • Regular dilated eye examinations
  • Knowing the family history and taking early precautions
  • Regular and moderate exercise can help reduce eye pressure
  • Taking prescribed medications and eyedrops regularly
  • Wearing eye protection in potentially harmful activities such as adventure sports, etc.

Overall, glaucoma is an irreversible problem. But the condition can be prevented with early diagnosis through regular eye check-ups and other medications, etc.

Keratoconus

The cornea is the clear, dome-like surface that is located in front of the eye. When this cornea becomes too thin and eventually protrudes outward into a cone-like structure. This cone-shaped cornea leads to blurry vision and can make the person extremely sensitive to light and glare. The condition often occurs in both eyes, but one is often more affected than the other.

Keratoconus tends to affect people mostly between the ages of 10 and 25 years and continues to worsen for another 10 years or probably longer. In the initial stages, the problem can be corrected with prescriptive glasses or soft contact lenses. In the later stages, the patient might need to be fixed with rigid, gas, porous contact lenses. In cases, where the condition advances to severe stages, the patient might need a cornea transplant.

Symptoms of Keratoconus

Signs and symptoms of this condition change with the advancement of the problem. Some of the common symptoms include:

  • Blurred or distorted vision
  • Intense sensitivity to bright light and glare
  • Problem with night driving
  • Consistently and frequently changing eye power
  • Sudden worsening of vision
  • Cloudy vision

For patients who experience rapidly worsening eye vision, immediate medical attention must be sought.

Causes of Keratoconus

There are no defined reasons for keratoconus. However, the problem can occur because of genetic and environmental factors, including hereditary conditions.

That said, some factors that increase the risk of keratoconus, include:

  • A family history of keratoconus
  • Vigorous rubbing of eyes
  • Some eye conditions, such as retinitis pigmentosa, hay fever, asthma, etc.

Complications of Keratoconus

In some cases, the cornea can become swollen too rapidly and cause sudden loss of vision and scarring of the cornea. This problem can break down the lining of the cornea, which allows the fluid to enter the cornea. The swelling goes off on its own but can lead to the formation of a scar that can hamper vision.

Moreover, advanced keratoconus can also cause the cornea to become scarred, especially in the area where the cone is most prominent. A scarred cornea can lead to severing vision issues that might need to be treated by a cornea transplant surgery.

Diagnosis of Keratoconus

To diagnose the condition, the optometrist or an ophthalmologist, will conduct an assessment of the medical history of the patient, and understand the symptoms. The doctor will also understand the family history and then conduct some tests to better understand the shape of the cornea. Some of the tests that can be used for this purpose include:

  • Eye refraction, where a special piece of equipment is used to measure the eyes to identify vision problems.
  • Slit-lamp exam, where the doctor directs a vertical beam into the patient’s eye surface and then uses a microscope (low-powered) to see the eye more clearly.
  • Keratometry, in this test the doctor leads a circle of light on the cornea and assess the reflection to understand the shape of the cornea.
  • Computerized corneal mapping, including corneal tomography and corneal topography, can be used to provide images to understand the shape of the cornea in deeper detail. This can help identify the keratoconus even before the disease shows any visible signs or is detected via other exams.

Treatment of Keratoconus

There is no one fixed treatment for this condition. The treatment depends on case-to-case and mostly varies per the severity of the problem and how quickly is the condition progressing. Typically, keratoconus can be treated in two ways – either by slowing the issue or by enhancing the vision.

If the condition is worsening, a new form of treatment that is called corneal collagen cross-linking can be used to treat the patient. This form of treatment has the power to minimize symptoms and reduce the chances of a cornea transplant. However, this form of treatment does not improvise vision or reverse the condition.

On the other hand, the severity of keratoconus affects the chances of vision treatment. Patient with a mild or moderate issue can be treated with the help of prescriptive eyeglasses or contact lenses. However, the treatment will take a long time before it starts to show improvement.

That said, in patients with extreme keratoconus the cornea can be too damaged and become scarred. Even wearing contact lenses for a prolonged period can cause damage to the cornea. In such cases, a cornea transplant surgery may be required.

Some lenses which can be used to treat keratoconus include:

  • Eyeglasses or soft contact lenses
  • Hard contact lenses
  • Piggyback lenses
  • Hybrid lenses
  • Scleral lenses

Overall, keratoconus can be very discomforting but with timely and preventive eye check-ups, precautions, and advice from the healthcare professional, the condition can be prevented. Moreover, it can also help to detect the condition at an early stage and avoid serious complications that might occur later.

Retinoblastoma

Retinoblastoma is a type of eye cancer, which primarily begins in the retina of the eye. The retina is the innermost, sensitive layer of tissue inside the eye. The retina comprises of nerve tissue which senses the light when it reaches the eye. The retina then sends signals to the brain via the optic nerve. The brain, in turn, understands the signals and interprets the images.

Retinoblastoma typically impacts children; however, it can also impact adults. It is a very uncommon form of cancer. But in children, it is the most common form of cancer. Cancer can occur in both or one eye.

Symptoms of retinoblastoma

As retinoblastoma generally impacts children and infants, the symptoms are often hard to understand. However, some possible signs will include:

  • Red eyes
  • Swelling in the eyes
  • An issue where the eyes appear to be focussed in different directions
  • A white dot in the centre of the eye (pupil), which is clear when the light is reflected upon it

However, if a parent notices any abnormal changes in the eyes of the child, immediate medical attention should be sought. Moreover, since retinoblastoma is a very rare form of cancer, the healthcare provider may examine other causes for the issue.

Causes of retinoblastoma

This form of cancer develops when the nerve cells in the retina form abnormal genetic mutations. These mutations lead to a condition where the cells continue to grow and multiply when ideally, they should die. This abnormal number of cells form a mass, known as a tumour.

Retinoblastoma can also spread to other parts of the eyes or the nearby structures. It can also impact other areas of the body, such as the brain and spine. In most cases, the actual cause of mutations is not clear. However, children can inherit an abnormal genetic mutation from their parents.

In the case of inherited gene mutation, it is possible to pass it on to children, even if one parent has the issue. Each parent carries a 50 per cent chance to increase the risk of genetic mutation in the child. Children that have this inherited condition, tend to develop this condition at an early age. Moreover, hereditary retinoblastoma impacts both the eyes, rather than just one.

Complications of retinoblastoma

Children with an inherited form of retinoblastoma, are more prone to develop other types of cancer in other body parts. This can happen even after the retinoblastoma is treated. This could be prevented by regular medical examinations to diagnose any other types of cancer or issue.

Prevention of retinoblastoma

Since the actual cause of retinoblastoma is not known, there is no definitive way to prevent this issue. However, some measures can help prevent retinoblastoma.

For families that have a risk of retinoblastoma, prevention may not be possible. But genetic testing can provide an advantage to families to know which child is at a higher risk of developing the issue. The parents can then resort to regular eye exams to help diagnose the condition early. This can help to treat the issue and minimise complications.

Diagnosis of retinoblastoma

The doctor will conduct a few exams to diagnose retinoblastoma. These tests include:

  • Eye exam: The doctor will conduct an exhaustive eye exam to understand the symptoms and underlying causes. For a clearer picture, the child could be placed under the influence of mild anaesthetics to keep the child still.

Imaging tests: Imaging tests such as ultrasound, CT scans or MRI can be used by doctors to understand the retinoblastoma has grown to impact other structuresnearby the eyes.In some cases, the doctor may also refer the patient to other specialists, such as an oncologist, or a genetic counsellor for diagnosis or confirmation of condition.

Treatment of retinoblastoma

The treatment for retinoblastoma depends on the general health of the patient, the cause of retinoblastoma, the size and location of the tumour, and if cancer has spread to other structures. The main objective of the treatment is to cure cancer. However, the procedure could impact the vision.

Some treatments for retinoblastoma include:

Chemotherapy: Chemotherapy through blood vessels or pill can be used to kill the cancer cells. The drug used in chemotherapy travels through the body to attack the cancer cells. Specifically, for children, chemotherapy may be used to shrink the size of the tumour. Once, the tumour has shrunk, another form of treatment such as radiation therapy, cryotherapy, laser therapy, etc. can be used to eliminate other cancer cells. Chemotherapy is very useful in cases, where cancer has spread to nearby structures.

Radiation therapy: In radiation therapy, X-rays, protons, and other high-energy beams can be used to destroy cancer. Radiation therapy is of two kinds:

  • Internal radiation is also known as brachytherapy where the device is placed near or in the tumour. This minimises damage to nearby tissues.
  • External beam radiation directs high-powered beams to the tumour from an external device. This can have side effects since the radiation can also impact nearby tissues.

Laser therapy: In this form of treatment, a laser is used to damage blood vessels, which provide the primary supply of oxygen and nutrients to the tumour.

Cryotherapy: This form of treatment uses an extremely cold temperature to kill cancer cells.

Surgery: When all other non-invasive or minimally invasive formsof treatment fail to provide any relief or if the tumour is too large, the doctor may recommend surgery to cure cancer. This could involve removing the affected eye, an eye implant, or placing an artificial eye.

Overall, retinoblastoma is rare but cannot be prevented. However, it is possible to reduce complications and improve the quality of life through regular eye exams.

Corneal Ulcer

The cornea is the front layer of eye tissue, which is clear and allows the light to enter the eye. The cornea is protected from bacterial infections, viruses and other problems by the tears.

A corneal ulcer is an open sore, which develops on the clear surface of the cornea, typically because of an infection. Moreover, wearing contact lenses for a prolonged period and small injuries to the eye can cause the cornea to form an ulcer.

Reason for corneal ulcer

The primary cause of corneal ulcer is an infection. Some of the most common eye infections that can lead to the formation of a corneal ulcer are:

Acanthamoeba Keratitis: This type of infection mostly occurs in people who wear contact lenses.This is a type of amoebic infection and in some rare cases; the worsening of this infection can also cause blindness.

Herpes Simplex Keratitis: This a form of viral infection which leads to viral lesion flare-ups or causes sores in the eyes. This can be due to stress, excessive exposure to the sunlight, or a problem that impacts the body’s immune system.

Fungal Keratitis: This kind of infection develops post an injury to the cornea of the eye. This injury is typically caused because of a plant or a related material. This condition is most common in people who have a weak immune system.

Apart from these infections, there are several other reasons, which can cause to formation of a corneal ulcer. These include:

  • Dry eyes
  • Inflammatory problems
  • Injury to the eye
  • Deficiency of Vitamin A
  • Unsterilised contact lenses

Moreover, people who wear disposable contact lenses for a long period, including overnight, are at a higher risk of corneal ulcer. Moreover, expired soft lenses can also lead to the formation of ulcers.

Symptoms of corneal ulcer

The corneal ulcer first produces signs of infection, which can further be related to a corneal ulcer. Some symptoms of a corneal ulcer include:

  • Itchy eyes
  • Watery eyes
  • Pus-like discharge from the eyes
  • Extreme sensitivity to light
  • Red or pink eye
  • Burning or a stinging sensation in the eyes

That said, symptoms of the corneal ulcer itself include:

  • Inflammation in the eyes
  • Sore eyes
  • Consistent tearing
  • Blurred vision
  • White spots on the cornea
  • Swelling in the eyelids
  • Pus or discharge from the eyes
  • Sensitivity to light
  • The feeling of a unfamiliar particle in the eye

No matter the intensity of symptoms, all signs of corneal ulcers should be treated immediately to avoid the risk of blindness.

Diagnosis of corneal ulcer

A corneal ulcer is diagnosed by an eye doctor through an eye exam. A particular test to examine the ulcer is called fluorescein eye stain. In this test, the doctor puts an orange dye on top of the blotting paper. This dye is then transferred to the eye by touching the blotting paper to the eye surface only slightly.

Once done, the doctor uses a microscope known as slit-lamp to direct violet light into the eye. This helps the doctor assess any damaged areas of the cornea. The damaged or affected areas will appear green upon being directed with violet light. If an ulcer is found on the cornea, the doctor will further investigate the cause of the problem. This will be done by scraping a thin layer of the ulcer by placing the numbing eye drops in the patient’s eyes. This will help the doctor know if the ulcer is caused due to bacteria, fungi or a virus.

Treatment of corneal ulcer

After the exact cause of corneal ulcer is diagnosed, the doctor will recommend antibacterial, antifungal or antiviral eye medications to treat the issue. In case of severe infections, the patient may be advised to take antibacterial eye drops until the cause of the infection is determined. Moreover, the doctor may recommend corticosteroid eye drops to check for the inflammation and swelling.

During treatment, the doctor will advise the patient to avoid:

  • Wearing contact lenses
  • Applying makeup
  • Taking other medications
  • Avoid touching the eyes regularly

In some severe cases, the doctor can also suggest a corneal transplant. A corneal transplant involves removing the corneal tissue through surgery and replacing it with donor tissue. This is a fairly safe procedure to correct the corneal ulcer. However, it still has some risks and complications, such as:

  • Rejection of the donor cornea tissue
  • Glaucoma (excessive pressure in the eye)
  • Eye infection
  • Clouding of eye’s lens, called cataract
  • Swelling in the cornea

Preventing a corneal ulcer

Foremost, it is important to treat the ulcer as soon as a symptom appears. This helps to minimise future risks and complications. Moreover, in case of an eye infection or eye injury, the person should get checked for a corneal ulcer too.

Some other tips that can help prevent corneal ulcers include:

  • Avoid sleeping with contact lenses
  • Wearing contact lenses after sterilising them or cleaning them
  • Rinsing the eyes to remove any foreign object
  • Washing handing before touching the eyes

That said, overall a corneal ulcer can easily be treated but can cause a reduction in the eye ulcer. However, for patients that are not treated with the right care, the corneal ulcer can cause a loss of vision, visual obstruction because of scarring of the retina. In rare cases, the problem intensifies to damage the entire eye.

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