Melomed Articles

13 February 2019 - Dr. Michael  Djan

Eye health

The month of October is recognised globally as eye awareness month and this period draws attention to how precious these two organs really are. Flawless vision is essential in virtually every single daily activity we engage in and so the age-old adage the eyes are the window to the soul has never been more appropriate. As an ophthalmologist, I have been fortunate enough to be blessed with a profession I thoroughly enjoy and I am a perpetual advocate of eye health. There are a myriad of preventable eye conditions that affect the eyes, but for the sake of brevity I will focus my attention on 3 major conditions plaguing South Africa.

1. Glaucoma
Glaucoma comprises a group of diseases that damage the eye's optic nerve and can result in vision loss and blindness. It is commonly referred to as silent blindness' because of how often it worsons without the person being aware of any symptoms at all until it's late stages. However, with screening, early detection and treatment, you can often protect your eyes against serious vision loss. The optic nerve consists of more than 1 million nerve fibers that connect the retina to the brain. The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision. Several large studies have shown that eye pressure is a major risk factor for optic nerve damage. In the front of the eye is a chamber that contains an important fluid substance called aqueous. This clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. If too much of this fluid is produced or too little of it is drained from the chamber, the imbalance results in a build up of eye pressure causing gradual damage to the eye nerve. That is why controlling pressure inside the eye is absolutely vital. Another risk factor for optic nerve damage relates to blood pressure. Thus, it is important to also make sure that your blood pressure is at a proper level for your body by working with your medical doctor.

  • Who is at risk for glaucoma?
  • Anyone can develop glaucoma. Some people, listed below, are at higher risk than others:
    - Everyone over age 40
    - People with a family history of glaucoma
    - People with hypertension (high blood pressure)

  • How is glaucoma treated?
  • There are number of ways that glaucoma is successfully treated by the ophthalmologist and depends on the stage. These methods include medical eyedrops, laser eye therapy or glaucoma surgery.

    2. Squints
  • What is a Squint (cross-eyed)?
  • Strabismus, or squint eyes, refers to a condition of misalignment of the eyes i.e. cross-eyed. The misalignment can be
    horizontal, vertical or obliquely oriented.
  • What are the symptoms associated with a squint?
  • Children and adults adapt differently to squints and therefore experience squints differently. Young children will usually have no complaints but will have the temporary/persistent squint noted by the parents. This squinting may also be masked by one eye "winking" when exposed to excessive sunlight. In this age group, prompt intervention is required to prevent lazy eye(amblyopia) from setting in. Adults with a new squint will complain of double-vision(diplopia) and may adapt by closing one of the eyes to avoid seeing multiple images.
  • What are the causes of a squint?
  • Squints are broadly either due to an eye muscle weakness, an eye focusing weakness or a combination of the 2. Primary squints (Infantile squints and Accommodative) develop early and are different from the Secondary squints seen in adults that develop from vascular problems( Diabetes,Hypertension etc) & other neuro-ophthalmic diseases.
  • How are the various squints managed?
  • Each type of squint has a customized form of treatment for each person depending on the cause, the severity and the
    presence/degree of lazy eye(amblyopia). A thorough examination by the ophthalmologist helps classifying all of these
    factors and thereafter appropriating a treatment objective.
    - Amblyopia(lazy eye), if present, is treated with limited periods of eye-patching or special dilating eyedrops.
    - Significant refractive errors (long/short-sightedness,astigmatism) are treated with spectacles/contact lenses with/out prisms
    - Botox injections into muscles can also be performed to neutralize the squint. These injections offer a temporary solution and need to be repeated after 4-6 months as the effect slowly wears off
    - Surgical correction to muscles may also be performed to correct any squints.

    3. Pterygium
    A pterygium is a fleshy, pink growth of the conjunctiva (mucous membrane that covers the white part of the eye). It is a benign growth often shaped like a wedge.
  • What causes a pterygium?
  • The exact cause is unknown, but it is associated with excessive exposure to sunlight, wind or sand. Therefore, it is more likely to occur in populations that inhabit areas near the equator, as well as windy locations. In addition, pterygia (plural) are twice as likely to occur in men than women. Preventative measures include wearing protective sunglasses with side shields and/or wide brimmed hats and using artificial tears throughout the day may help prevent their formation or stop further growth. Surfers and other water-sport athletes should wear eye protection that blocks 100% of the UV rays from the water, as is often used by snow-sport athletes.
  • What are the symptoms?
  • A Pterygium isn't always symptomatic, but may cause eye irritation (itching, redness and tearing) and larger ones which
    expand can distort clear vision or all together obscure it. Early detection and intervention are pertinent before this late stage is reached.
  • How is a pterygium treated?
  • Treatment of an early symptomatic pterygium are limited to conservative use of eyedrops initially. Surgical intervention is normally warranted in cases where the pterygium has expanded across the cornea (clear window portion of the eye) or distorts it causing blurred vision. Surgery is also warranted for cosmetically unsightly pterygia and for persistent eye irritation symptoms despite adequate medical therapy. Surgical removal of the pterygia is performed in theatre under local anaesthesia. The pterygium is peeled off gently and synthetic graft tissue is used to seal the surgical site giving a pleasing cosmetic and functional result.


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