COMMON EYE PROBLEMS

by Royal College of General Practitioners

Cataract (clouding of the lens of eye)

You should see an eye specialist if your poor vision disrupts daily activities or work. There are different types of cataract:

• Cortical cataracts are very slow growing and cause blurring and double vision in the affected eye.
• Nuclear sclerosis takes 3-5 years between diagnosis and surgery; it causes late onset myopia and blurred distance vision; near vision is preserved till late on.
• Posterior subcapsular cataract develops rapidly; surgery may be needed after only one year; it causes blurring for near and distance, and glare.

Glaucoma (raised pressure in the eye)

The usual simple (open angle) glaucoma takes several years to develop. It is only an urgent condition if the pressure in the eye is above 30 mmHg and some loss of vision is already present. Your optometrist can examine and test eye pressure, visual fields and optic disc appearances to help decide the urgency of treatment.

Age Related Macular Degeneration

The commoner 'dry' type of macular degeneration is very slowly progressive but unfortunatly is untreatable and therefore not urgent; An eye specialist can confirm the diagnosis and arrange low visual aid advice and partially sighted or blind registration. You may lose your central vision but peripheral vision is always preserved.

You should be sent to an eye specialist urgently if you have a sudden onset. This suggests a haemorrhagic or 'exudative' type of macular degeneration which can occasionally be arrested by prompt laser treatment.

Squint

If your child has a constant squint, he/she always needs referral to eye specialists and should not wait longer than three months. The risk is the development of amblyopia (blindness in the squinting eye) and the occasional underlying serious abnormality (like cataract). There is less urgency for intermittent squints.

If as an adult you have a sudden onset squint with double vision and no history of childhood squint you should be seen urgently by an eye specialist (although most are due to microvascular disease).

Retinal Vein Occlusion (blockage of a vein at the back of the eye)

This is not treatable but it may be associated with other condition like systemic hypertension, ocular hypertension and possibly diabetes, and these conditions need to be excluded. Specialists can confirm the diagnosis and predict, and limit with laser in appropriate cases, late complications such as chronic macular oedema, retinal and disc neovascularisation causing vitreous haemorrhage, and rubeotic glaucoma

Ectropion (lax eyelids)

This is not urgent unless the cornea is seriously exposed and especially if numbed.

Watering Eye (epiphora)

In babies most blocked nasolacrimal ducts will resolve spontaneously. Probing the duct to 'unblock' it is delayed until 12 months of age. It may be done earlier if a persistently sticky eye shows an undesirable bacteria like a haemolytic streptococcus.

If you have a watering eye you may be referred to eye specialists especially if discharge is present. A diagnostic probing of the nasolacrimal duct will indicate the level of the blockage; if in the common canaliculus, treatment is generally unsatisfactory and cures are short term; if in the nasolacrimal duct itself, cure by operation is more certain. Probing as a treatment is controversial. Syringing alone gives very little information and no relief.

If you are elderly and have intermittent symptoms (especially if there is no actual watering of the eye) you will not benefit from treatments.

Dry Eye

If you have dry eye problems you do not require hospital referral and can be treated with any artificial tear preparation (eg Hypromellose drops). Most sight-threatening dry eye problems are associated with other diseases such as Sjogrens syndrome and require hospital supervision.

Chalazion (lumps in the eyelids)

Most Meibomian cysts (chalazia) will disappear spontaneously although this may take many months. Early treatment with incision and curettage causes unnecessary procedures. You can be referred to an eye specialist if the cyst is large or infected and very persistent.

Blepharitis (inflammation of eyelashes and eyelid margin)

You treat this by thorough cleaning of the lid margins with cotton bud dipped in a weak solution of Sodium Bicarbonate (teaspoon to a pint of warm water or equivalent) morning and night - the alkaline residue discourages the growth of the bacteria responsible for the condition. Follow this cleaning with a smear of antibiotic/ hydrocortisone ointment for up to one month. This is a recurrent condition.