Blepharitis

opthalmology eyes bletharitis Dr Justin Lim Professor Yoland Lim Dr Selina Lim Eastern Wisdom skin

Blepharitis is an inflammatory condition of the eyelids most commonly caused by a bacterial infection, usually Staphylococcus[1]. However, in some individuals blepharitis may arise due to skin conditions such as dandruff on the scalp or rosacea.

Inflammation is typically found at the base of the eyelashes or in the glands of the eyelids. Common symptoms consist of:

itchiness
watery eyes
burning sensation in the eyes
enhanced sensitivity to light
crusty or sticky eyelashes
feeling that something is in your eye, and
redness on the eyelids.

When treating blepharitis, it is vital to ensure eyelid hygiene is maintained.

Common strategies to ensure eyelid hygiene typically involve three steps[2]:

1. Softening of the crusts around the eyelid and eyelashes using a warm face towel

2. Massaging the eyelid towards the lashes using either your pinky finger or a cotton bud

3. Cleaning the upper and lower eyelid edge with a cotton bud and baby shampoo

Treatments include ‘artificial tear’ eye drops/gels and antibiotic ointments and or tablets[3].

Additionally, it is important to cease using eye makeup such as eye-shadow and eyeliner during treatment. If you are experiencing any changes to vision, or your eye do not seem to be ok, you must seek the assistance of you GP or ophthalmologist.

References:

[1] Health Direct (2018, January) Blepharitis healthdirect.gov.au/blepharitis

[2] Children’s Health Queensland Hospital and Health Service. Fact sheet: Blepharitis childrens.health.qld.gov.au/fact-sheet-blepharitis/

[3] Better Health Channel (2015, April) Dry eye betterhealth.vic.gov.au/health/conditionsandtreatments/dry-eye#lp-h-5

Conjunctivitis

Conjunctivitis or pink eye is a highly contagious eye condition that affects everyone but predominantly children under the age of five[1]. This is where the sclera (the white part of the eye) becomes pink due to inflammation[2].

Conjunctivitis is spread through two ways:

1. Direct contact with eye secretions or

2. Indirectly by contact with towels, handkerchiefs or any other objects contaminated[3].

Common symptoms include:

eye irritation and redness
discharge with pus swelling of the eyelids,
excessive tears in the eye, and photophobia (sensitivity to light)[4]

As conjunctivitis can be caused by virus or by bacteria, treatment varies with bacterial infections requiring antibiotic eye drops or ointments. However, regardless of the cause, people with conjunctivitis should wash their hands regularly and avoid touching the eyes[2]. This will ensure not only a speedy recovery but also prevent spreading of the virus or bacteria.

References:

[1] The Royal Children’s Hospital (2018, February) Conjunctivitis. rch.org.au/kidsinfo/fact_sheets/conjunctivitis/

[2] Health Direct (2017, November) Conjunctivitis (pink eye). healthdirect.gov.au/conjunctivitis

[3] Government of South Australia – SA Health. Conjunctivitis – including symptoms, treatment and prevention. sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/conjunctivitis/conjunctivitis+-+including+symptoms+treatment+and+prevention

[4] Better Health Channel (2016, June) Conjunctivitis. betterhealth.vic.gov.au/health/ConditionsAndTreatments/Conjunctivitis

Diabetic Retinopathy

Diabetic retinopathy is an eye condition characterised by damage to blood vessels in the retina, which is the light-sensitive tissue at the back of the eye. When this is due to high blood sugar levels in diabetics[1], the term diabetic retinopathy is used by medical practitioners.

The high blood sugar levels in the blood causes the vessels in the retina to swell and leak or closes and stops blood from passing through causing vision loss and blindness[2]. There are three main types of diabetic retinopathy[3]:

1. Non-proliferative retinopathy or the early form of the condition

2. Macular oedema where the macula swells causing leakage of fluid from the blood vessels having potential consequence for central vision

3. Proliferative retinopathy. This is the advanced form of the disease where new fragile blood vessels replace previous blood vessels.

Examples of symptoms of diabetic retinopathy include[4]:

Blurred, distorted or patchy vision
Problems with balance, reading, watching television and recognising people
Difficulty seeing at night
Being overly sensitive to glare

The prevalence of being affected by diabetic retinopathy depends on how long you have had diabetes for. The longer you have had diabetes, the more likely it is that you will be affected by diabetic retinopathy1. It is important to seek regular eye checks (at least once a year) to detect early signs of the condition[5]. Furthermore, as individuals with diabetes are 25 times more likely to experience vision loss than people without diabetes3, it is important to control blood sugar levels to slow down the onset and progression of diabetic retinopathy. Strategies to help with this include[6]:

Exercising regularly
Avoiding alcohol and smoking
Adhering to your diet
Taking your prescribed medication

Treatment of diabetic retinopathy varies depending on the stage of the condition. For example, early stages of diabetic retinopathy involve regular monitoring whereas in more advanced stages ophthalmologists may use laser treatment to stop the leakage of blood and fluid into the retina[6].

References

[1] Health Direct (2018, August) Diabetic retinopathy healthdirect.gov.au/diabetic-retinopathy

[2] American Academy of Ophthalmology (2019, October) What Is Diabetic Retinopathy? aao.org/eye-health/diseases/what-is-diabetic-retinopathy

[3] Better Health Channel (2015, October) Diabetic retinopathy betterhealth.vic.gov.au/health/conditionsandtreatments/diabetic-retinopathy

[4] Diabetes Australia. Eye health diabetesaustralia.com.au/eye-health

[5] Centre for Eye Research Australia. Diabetic Retinopathy cera.org.au/community/your-eye-health/diabetic-retinopathy/

[6] American Optometric Association. Diabetic retinopathy aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/diabetic-retinopathy

Dry eyes

Dry eyes is a common condition caused when there is a low level of production of tears (lubricating the eye). Some of the most common signs and symptoms include:

stinging or scratchy sensation
mucus
redness
eye fatigue,
uncomfortable sensation in the eyes, and
blurred vision[1].

Factors and conditions which can cause or contribute to dry eye include infrequent or incomplete blinking, arthritis, climate conditions, medications, trauma to the eye and irritants in the air (including smoke, dust and chemical exposure)[2]. More recently the greater use of mobile phones and tablets has lead to more younger people being affected by dry eyes.

Although there is no cure for dry eye, there are effective management strategies to increase tear production and prevent the loss of excess tears. These include gentle eye massages, medication to increase tear production, adding artificial tears and warm compresses to the eye[3]. To reduce the symptoms of dry eyes, health care professionals suggest blinking regularly, wearing sunglasses outdoors, increasing the humidity in the air and drinking plenty of water each day[4].

Professor Yoland Lim Health Care uses JUVEFACE® management program utilizing Low Level Laser Therapy (LLLT)[5]which has “photobiomodulation effects on the lids and periorbital area”[6]. It is said to be a “strong metabolic enhancer that increases cellular action which emphasizes cell activity["7] of the meibomian glands.

70% of patients had severe eye disease before treatment, compared with only 30% after[8].

After treatment the mean Tear Break Up Time (TBUT) increases to an addiontal 3 sec in 60% of patients[9], meaning it takes longer for tears to disappear from eyes, keeping eyes lubricated for longer.

The index below demonstrates sensitivity and specificity in distinguishing between normal subjects and patients with dry eye disease[10]. This shows:

i) OSDI decreasing from 42 to 24 (the lower the better), and

ii) TBUT increasing from 4 seconds to 8 seconds on average (the higher the better).

References

[1] healthdirect.gov.au/dry-eye-syndrome

[2] Better Health Channel (2015, April). Dry eye. betterhealth.vic.gov.au/health/conditionsandtreatments/dry-eye

[3] Harvard Health Blog (2017, February). The fix for dry eyes. health.harvard.edu/blog/the-fix-for-dry-eyes-2017021011090

[4] American Optometric Association. Dry Eye. aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/dry-eye

[5] Combined low level light therapy and intense pulsed light therapy for the treatment of meibomian gland dysfunction. Authors Stonecipher K, Abell TG, Chotiner B, Chotiner E, Potvin R. Received 27 April 2019. Accepted for publication 21 May 2019. Published 11 June 2019 Volume 2019:13 Pages 993—999. DOI doi.org/10.2147/OPTH.S213664

[6] Kim WS, Calderhead RG. Is light-emitting diode phototherapy (LED-LLLT) really effective? Laser Ther. 2011;20(3):205–215. Review. PubMed PMID: 24155530; PubMed Central PMCID: PMC3799034.

[7] topcon-medical.co.uk/uk/products/485-eye-light-simple-but-effective-treatment-for-dry-eye.html#description

[8] dovepress.com/combined-low-level-light-therapy-and-intense-pulsed-light-therapy-for--peer-reviewed-fulltext-article-OPTH#CIT0013

[9]dovepress.com/combined-low-level-light-therapy-and-intense-pulsed-light-therapy-for--peer-reviewed-fulltext-article-OPTH#CIT0013

[10] dovepress.com/combined-low-level-light-therapy-and-intense-pulsed-light-therapy-for--peer-reviewed-fulltext-article-OPTH#CIT0013

Macular Degeneration

Macular degeneration or age related macular degeneration (AMD) is a condition affecting the eye causing loss of eyesight, often with the vision in the middle of your visual field being blurred and darkened. Responsible for 50% of all cases of blindness, AMD is caused by damage to the nerves in the eye[1].

Although susceptible to all individuals, risk factors include[2]:

family history of AMD
age over 75 years
smoking.

Typically as AMD causes blurred vision in the centre of your field of vision, individuals affected find difficulty in driving, reading and seeing people’s faces[3]. There are two types of AMD[4]:

1. Dry AMD. The commonest kind which develops slowly and causes gradual vision loss.

2. Wet AMD. Develops more rapidly and occurs when abnormal blood vessels grow under the macular.

Currently there is no cure for AMD.

Treatment strategies are directed at maintaining the central vision for as long as possible. These efforts are primarily targeted at wet AMD cases and include[5]:

Pharmaceutical drugs that are injected into the cavity of the eye to reduce leakage from blood vessels
Photodynamic Therapy (PDT). A combination of laser therapy and drug therapy
Laser Photocoagulation or a high energy laser light used to seal leaky blood vessels.

References

[1] Macular Disease Foundation Australia. Macular Disease. mdfoundation.com.au/content/macular-degeneration-about

[2] Vision Australia. Age Related Macular Degeneration visionaustralia.org/information/eye-conditions/Aged-Related-Macular-Degeneration

[3] Health Direct (2018, February) Macular degeneration healthdirect.gov.au/macular-degeneration

[4] Better Health Channel (2015, July) Eyes – age-related macular degeneration betterhealth.vic.gov.au/health/conditionsandtreatments/age-related-macular-degeneration

[5] Lions Eye Institute. Macular Degeneration. lei.org.au/services/eye-health-information/macular-degeneration/

Tired Eyes

Many people spend long hours at a time using a computer, smartphones or watching television. These acts can result in your eyes becoming tired and your vision blurred. In medical terms, this is known as asthenopia or eye strain[1].

Symptoms of asthenopia can include[2]:

Sensitivity to light
Headache
Dry or watery eyes
Burning, sore or tired eyes
Difficulty keeping your eyes open
Pain around the eyes

In many cases asthenopia isn’t serious and resolves itself once you rest your eyes. Asthenopia can be treated and managed through changes in environment and lifestyle. These can consist of[3]:

Positioning your screen about an arm’s length away
Finding the right light
Using eye drops
Checking the air
Reduce the time spent on a single activity.

References

[1] Better Health Channel (2015, April) Eyes – common problems betterhealth.vic.gov.au/health/conditionsandtreatments/eyes-common-problems

[2] Santos-Longhurst (2018, December) Getting Relief for Asthenopia healthline.com/health/asthenopia

[3] Silver (2017, January) 8 Tips to Prevent Eyestrain healthline.com/health/eye-health/eye-strain