Free Resources

  • Prevention against Conjunctivitis
  • Nutritional Blindness
  • Retinopathy of Prematurity (ROP)
  • Diabetic Retinopathy

Any inflammation of conjunctiva (the outermost layer of the eye) is referred to as conjunctivitis.

There are two main types of conjunctivitis namely Infective Conjunctivitis and Allergic Conjunctivitis.

Infective Conjunctivitis:

This type of conjunctivitis is seen round the year but sometimes becomes epidemic. The infection can be bacterial or viral. The person may have symptoms such as acute redness, watering and discharge from both or one eye. He or she may also experience irritation, pricking and swelling of eyelids. Some individual may also have body ache, malaise and throat pain.

Treatment:
Usually, broad spectrum antibiotic eye drops and ointments are advised. The frequency of application of these eye drops and ointments depend upon the severity of illness. Patient should be explained and made aware about the contagious nature of the disease, should be checked at the earliest and sent back home to prevent spreading of conjunctivitis.

Prevention

To prevent spread of infection, patients must follow these advices:

  • Avoid going to work or school
  • Avoid close contact with family members and children at home
  • Wash hands frequently or use hand sanitisers after touching the eye
  • Use separate towels, soap, pillows etc.
  • You can go back to work once watering and discharge has stopped.

Remember
Normally, this does not cause any drop in vision, but if you notice any defect in vision, you should visit the doctor again!

Allergic Conjunctivitis
The fast pace of development in a city with increased building work, road works and motor vehicles on the road does not help either! Allergic conjunctivitis is mainly caused by pollens and dust. Patients come with symptoms of itching, redness and watering of eyes. They may also have a thready discharge. This condition can be acute or chronic. Recurrence and seasonal variations are common and can be associated with asthma and skin allergies etc.

Treatment

  • Use anti allergic eye drops and tear substitutes.
  • Use mild to strong steroid eye drops in recurrent cases.
  • Systemic anti allergic treatment in conjunction helps.
  • Counselling is extremely important because of the recurrent nature of the disease.
  • Parents should be explained that a child with chronic recurrent conjunctivitis usually outgrows this by puberty. Complications are seen due to over medication with steroids.
  • Patient should avoid exposure to dust and pollens. Wearing dark or clear glasses helps

Myth Busters (Click on myth to know the fact)

Myth: You can have conjunctivitis by looking at an infected persons eyes.

Fact: Conjunctivitis is not an air borne disease and its germs never flows. Infective conjunctivitis spreads by touch and direct contact and NOT by looking at a red eye!

Myth: Conjunctivitis is no contagious if the infected person uses antibiotic eye drops.

Fact: Conjunctivitis is always contagious, with or without eye drops. So, even after using the eye drops, it will affect the person who comes in physical contact with its infections. One should never mistake the eye drop as a remedy for making the disease non-infectious.

Myth: Pink Eye can cause permanent blindness.

Fact: A pink eye or infectious conjunctivitis's symptoms (itching, tear formation, burning sensation) are more intense, when compared to a non infectious one, which can make the vision blurred in the initial days. But the infection has nothing to do with blindness.

Myth: Sunglasses help a person recover faster.

Fact: Sunglasses do not prevent or cure the infection, but rather to protect oneself against the social stigma of pink eyes. Sunglasses only protect the eyes against the sun's rays and dust.

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Nutritional blindness is loss of useful vision resulting from Vitamin A deficiency It is a combination of:-

  • Xerophthalmia (dry or inflamed eye)
  • Keratomalacia (corneal necrosis)

Nutritional blindness remains the leading single cause of blindness among children worldwide. Xerophthalmia and keratomalacia are only one aspect of a more complex deficiency disease, known as the vitamin A deficiency disorders, that includes anaemia, growth retardation, immune suppression, inflammation, and increased morbidity and mortality from infectious diseases. Nutritional blindness is best understood in the context of the larger syndrome of the vitamin A deficiency disorders, as the factors that may precipitate nutritional blindness are intricately tied to the problems of infectious diseases, hygiene, poor nutrition, and poverty. Young children and women of reproductive age are at the highest risk of vitamin A deficiency.

Risk Factors:

  • Malnutrition in children, especially Vitamin A deficiency
  • Recent measles, malaria or other infections that deplete the child's Vitamin A stores and affect the eyes, nose and mouth
  • Extreme poverty

Symptoms of Nutritional Blindness

  • Difficulty in night vision
  • Dryness of the eye
  • Whitish foamy membrane called Bitots on the eye

Is your child malnourished and frequently falls sick?

  • These symptoms can be due to nutritional deficiency especially of vitamin A leading to nutritional blindness.
  • Nutritional blindness is the 5th major cause of blindness in the world. It can occur at any age but is most frequently seen in underprivileged young children in the developing countries in whom measles diarrhoea protein-energy malnutrition and other febrile illnesses are more common.
  • It also occurs in affluent communities as well in relation to diseases such as liver cirrhosis or in elderly with a poor diet. This is a preventable disease.
  • Early detection and treatment plays a vital role inventing nutritional blindness.

Steps taken are

  • Prophylactic vitamin A administration
  • Health education
  • Dietary advice

Pro Vitamin A Food - Vitamin A is a natural substance that the body needs for a healthy immune system (to fight infections), and for normal healing and growth. Children need it more than adults. Eating animal products such as Eggs, Fish, Meat or eating Rich coloured fruits such as Papaya, Mango, Dark green Leafy Vegetable and Milk & whole Milk Products is good for them. Oil must be added to the diet to allow the child to absorb Vitamin A and for brain growth.

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What is Retina?

Retina is a thin sensitive layer at the back of eye. It is like the film at the back of the camera. The image of an object that a person sees is formed on the retina, from where it is transmitted to the brain.

What is retinopathy of prematurity?

Premature babies are born with a growing retina. Normally, the development of the retina is complete at full term of pregnancy - however as the baby is premature, the retina is yet to fully develop. In majority of premature babies, the development of the retina usually proceeds without any problems. However in a small group of babies, the blood vessels in the retina develop abnormally. This abnormal development is called retinopathy of prematurity or ROP.

Why examine the baby's eye now - why not later?

The ROP can be effectively treated only if it is detected and diagnosed at an early stage. Hence it is very important to examine the eyes of the premature baby during the few weeks after birth. Delay in the detection could mean a permanent loss of vision of the baby.

When should the baby's eye be first examined?

The first eye examination is usually done about 4 weeks after birth. This could be earlier if the baby was very premature or the birth weight is extremely low.

How often should the baby's eye be examined?

This would depend on the condition of the retina at first examination. In general an eye examination in a premature baby is required every 1-2 weeks till the retina is fully developed.

How is the baby's eye examined?

For examining the retina of the babies' eyes, the pupils need to be dilated without which it is not possible to see the retina. The pupils are dilated by using eye drops which are instilled two to three times in the eyes. During the examination, the assistant holds the child while the retinal specialist does examination. A speculum is used to separate the eyelids of the baby. A sclera depressor is used to move the eyes of the baby. An instrument called the 'indirect ophthalmoscope' is used by the retinal specialist to see the retina of the baby. With a trained examiner, the entire examination will take just a couple of minutes and is not painful at all. There may be slight swelling of the eyelids of the baby after the examination. This becomes alright in a day or so. The child can be fed immediately after the examination.

Do all babies who develop ROP require treatment?

No. If the ROP is mild, it does not require any treatment except for a close follow up check. The ROP may go away by itself. Only if the ROP crosses a certain stage is laser treatment recommended. This is because, beyond this stage, a significant proportion of babies can develop severe vision problems if left untreated.

What are the treatments available if the baby develops ROP?

The currently preferred treatment modality for ROP is laser. Laser is applied to the peripheral non developed retina so as to preserve the central retina which is developed. This treatment is usually done in the neonatal ICU. However no anaesthesia or injections are required for the treatment. Only eye drops are used. The heart rate and the breathing of the baby are continuously monitored during the treatment. The procedure usually takes 30-45 minutes. The baby can be discharged after the treatment.

What are the treatments available if the baby develops ROP?

No specific medication or precaution is required after the laser. Eye drops if prescribed by your retinal specialist are to be used as advised.

What is the follow up schedule after the laser treatment?

The baby needs to be brought for a check a week after the treatment. Lithe response has been good then subsequent check up would be after 3 weeks.

What if the baby does not respond to laser treatment?

This can occur in a very small percentage of babies. If the response to laser treatment is not satisfactory, then depending on the status of the retina additional laser treatment or a surgery may be required. The surgery could be either a sclera buckle surgery or a Vitrectomy. Vitrectomy is the surgical remove of the vitreous gel from the middle of the eyes. These are required in a very small subgroup of babies. Majority of the babies do very well with laser treatment itself.

Is a follow up required once the child grows older?

Yes, follow up is important, as any premature child, with our without ROP can develop some refractive errors or strabismus. These need to be corrected at an early age as it can lead to a 'lazy eye'. A check up at 8 months to one year of age is recommended. Thereafter a yearly retina checkup is advisable.

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What is Diabetic Retinopathy?

Involvement of the retina due to diabetes is called Diabetic Retinopathy. If left untreated, it can lead to loss of vision.

What is retinopathy of prematurity?

Premature babies are born with a growing retina. Normally, the development of the retina is complete at full term of pregnancy - however as the baby is premature, the retina is yet to fully develop. In majority of premature babies, the development of the retina usually proceeds without any problems. However in a small group of babies, the blood vessels in the retina develop abnormally. This abnormal development is called retinopathy of prematurity or ROP.

People at risk

Anyone with diabetes can develop Diabetic Retinopathy. Longer the duration of diabetes, more are the chances of developing Diabetic Retinopathy. Persons with uncontrolled diabetes and those having hypertension have an increased chance of developing Diabetic Retinopathy.

Prevention

It is not possible to prevent Diabetic Retinopathy. However a strict control of diabetes and blood pressure can delay the onset and reduce the severity of Diabetic Retinopathy.

When should an eye checkup be done in diabetic persons?

In Type II diabetes patients or the adult onset type of diabetes, the first checkup should be at the time of diagnosis of diabetes. Thereafter, the frequency of checkup depends on the severity of diabetes; in general a checkup every four to six months is advisable. It is important to follow the advice of your ophthalmologist regarding this.

Test Required

In selected cases, a Fluorescein Angiogram (FFA) (an eye test that uses a special dye and camera to look at blood flow in the retina and choroid, the two layers in the back of the eye) or an ultrasound test may be done in cases of Diabetic Retinopathy.

Symptoms of Diabetic Retinopathy

In the early stages majority of the patients with Diabetic Retinopathy may not have any symptoms. Symptoms like: blurring of vision, loss of vision, seeing black's spots in front of the eye suggest severe retina affection. Patients with diabetes need "dilated" eye examination.

Treatments

Very mild Diabetic Retinopathy may not require any treatment. More advanced Diabetic Retinopathy requires laser treatment. Severe Diabetic Retinopathy requires surgery - i.e. Vitrectomy (Vitrectomy is the surgical remove of the vitreous gel from the middle of the eyes) surgery.

Important Facts for diabetic patients
  • A third of people with diabetes never know that they have diabetes: just two - thirds of diabetics go for medical attention.
  • Diabetic Retinopathy can occur without the patient having any symptoms
  • Diabetic Retinopathy is an important cause of blindness in working age group
  • A diabetic is 25 times more likely to go blind than a person in the general population
  • Diabetic Retinopathy is a preventable cause of blindness
  • Patients with diabetes need "dilated" eye examination
  • Annual examination is a must
  • In diabetics, during pregnancy, it is important to have early retinal examination
  • Good control of diabetes, blood pressure and anaemia are important for controlling progression of Diabetic Retinopathy
Things to remember about laser treatment

Laser treatment is done to try maintaining the existing vision. Vision may not improve after the laser.

  • Laser reduces the risk of severe vision loss by 50%.
  • Sometimes vision may get slightly blurred immediately after laser. This usually recovers in 1-2 weeks' time.
  • Despite doing laser treatment, vision can deteriorate.
  • Multiple sittings of laser are usually required.
  • Laser is a painless outpatient procedure and does not usually require any anaesthesia.
Things to remember about Vitrectomy

Vitrectomy is the surgical remove of the vitreous gel from the middle of the eyes. It is done for eyes already having very severe Diabetic Retinopathy. This procedure needs to be done under local or general anaesthesia. In some cases bleeding can recur even after surgery. This may recover by itself or may need a re-surgery.

Facilities available in the department:

  • Digital Imaging System
  • B-Scan Ultrasound
  • A-Scan Ultrasound
  • Visual Field Analyser
  • Slit lamp. Indirect and Endo Laser delivery system
  • Nd-YAG Laser
  • Colour vision and Contrast sensitivity estimation VEP

Remember - Diabetes can cause blindness. Early diagnosis and prompt treatment can prevent blindness due to diabetes

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