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Acute Angle-Closure Glaucoma Acute angle-closure glaucoma is caused by a rapid or sudden increase in intraocular pressure (IOP), the pressure

inside the eye. Fluid is continually produced within, and drains out of, the normal eye. This fluid, called aqueous humor, is unrelated to the tears, which are only on the outside of the eye. High pressure inside the eye is caused by an imbalance in the production and drainage of fluid in the eye. If the channels within the eye that normally drain the fluid from inside the eye do not function properly or are blocked, the pressure within the eye will rise. In this case, more fluid is continually being produced but cannot be drained because of the improperly functioning or blocked drainage channels. This results in an increased amount of fluid inside the eye, which is a limited space, thus raising the intraocular pressure. The angle of the eye is the anatomical portion of the eye that contains the structures that allow fluid to drain out of the inside of the eye. The angle is located between the peripheral cornea and the peripheral iris. The angle contains the trabecular meshwork, which acts as a filtration system for the aqueous fluid draining from the eye. In angle-closure glaucoma, the iris (the colored part of the eye) is pushed or pulled up against the trabecular meshwork (or drainage channels) within the angle of the anterior chamber of the eye. When the iris is pushed or pulled up against the trabecular meshwork, the fluid (called aqueous humor) that normally flows out of the eye is blocked and cannot drain out, thereby increasing the IOP. See Multimedia files 1 to 2. If the angle closes suddenly, symptoms are severe and dramatic. Immediate treatment is essential to prevent optic nerve damage and vision loss. If the angle closes intermittently or gradually, angle-closure glaucoma may be confused with chronic open-angle glaucoma, another type of glaucoma. People who have farsightedness (called hyperopia) are at an increased risk for acute angle-closure glaucoma because their eyes are smaller, their anterior chambers are shallower, and their angles are narrower. Acute Angle-Closure Glaucoma Causes Angle closure may occur two ways:

The iris may be pushed forward up against the trabecular meshwork. The iris may be pulled up against the trabecular meshwork.

In either case, the position of the iris causes the normally open anterior chamber angle to close. Aqueous humor that should normally drain out of the anterior chamber is trapped inside the eye, thereby increasing the IOP. If the ensuing rise in pressure is sudden, pain, blurred vision, and nausea may occur. Optic nerve damage may also occur due to the increased IOP, either in a sudden attack or in intermittent episodes over a long period of time. Sometimes, the attack may be caused by dilation of the pupils, possibly during an eye examination. In eyes that are anatomically smaller, pupillary block may occur, causing acute angle closure glaucoma. In pupillary block, a brief episode of obstruction of aqueous fluid can occur by the pupil coming into contact with the structures behind it, usually the lens of the eye. This causes the pressure of the fluid behind the iris (in the posterior chamber) to be higher than the pressure of fluid in front of the iris (in the anterior chamber), causing the iris to be pushed forward, initiating closure of the angle.

Acute angle closure glaucoma may be primary or secondary. In primary acute angle closure glaucoma, there is no underlying eye disease that is causing the condition. Secondary acute angle closure glaucoma occurs because of another eye disease or condition, trauma, drugs, or a chronic medical condition. Acute Angle-Closure Glaucoma Symptoms With acute angle-closure glaucoma, because the rise in pressure is rapid, the symptoms also occur suddenly. Understandably, people who are experiencing acute angle-closure glaucoma are extremely uncomfortable and distressed. Dramatic symptoms of acute angle-closure glaucoma include the following:

Severe eye pain Nausea and vomiting Headache Blurred vision and/or seeing haloes around lights (Haloes and blurred vision occur because the cornea is swollen.) Profuse tearing

In acute attacks of angle-closure glaucoma, it is common for only one eye to be involved and for symptoms to worsen over a few hours. Acute Angle-Closure Glaucoma Diagnosis During an examination for angle-closure glaucoma, an ophthalmologist performs the following tests: gonioscopy, tonometry, biomicroscopy, and ophthalmoscopy. Each test is described below.

Gonioscopy is performed to examine the drainage angle of the eye; to do so, a special contact lens is placed on the eye. This test is important to determine if the angles are open, narrowed, or closed and to rule out any other conditions that could cause elevated IOP. If the intraocular pressure is elevated and the angle is open, acute angle-closure glaucoma is not possible.

Tonometry is a method used to measure the pressure inside the eye. Eye pressure is measured in millimeters of mercury (mm Hg). Normal eye pressure ranges from 10 to 21 mm Hg. In a case of acute angle-closure glaucoma, IOP may be as high as 40 to 80 mm Hg.

Biomicroscopy is a technique to examine the front of the eyes and uses a special microscope called a slit lamp. This examination may reveal a poorly reactive pupil, a shallow anterior chamber, corneal swelling, redness around the iris, and inflammation.

Ophthalmoscopy is used to examine the optic nerves for any damage or abnormalities; this may require dilation of the pupils to ensure an adequate examination of the optic nerves. If episodes of angle-closure glaucoma have been chronic (long term), this test may reveal excavation of the optic disk, which is a depression in the front surface of the optic nerve.

If an attack persists or if several milder incidents of angle closure have occurred in the past, the ophthalmologist looks for signs of previous attacks.

Peripheral anterior synechiae (scarring) and adhesions may be visible between the cornea and the iris. Peripheral anterior synechiae may destroy the trabecular meshwork.

Prior attacks may cause a poorly reactive pupil because of damage to the muscle of the iris.

Glaucoma flecks (also known as glaukomflecken) are spots on the lens of the eye. Glaucoma flecks may be seen if an acute attack of angle closure has occurred in the past.

Atrophy of the iris provides further evidence of a prior attack if it occurred 3 or more weeks prior to the eye examination. The atrophied part of the iris appears gray, rather than blue, brown, or green.

Acute Angle-Closure Glaucoma Medical Treatment There is no curative medical treatment for acute angle-closure glaucoma. An ophthalmologist must treat angle-closure glaucoma with either laser therapy or incisional surgical therapy (seeAcute Angle-Closure Glaucoma Surgical Treatment). The use of eyedrops, oral medications (osmotic agents such as glycerolor carbonic anhydrase inhibitors such as Diamox [acetazolamide]), or intravenous medication (mannitol, an osmotic drug) are temporizing measures designed to bring the pressure down prior to surgical therapy. Medicines that are used for acute angle-closure glaucoma prepare one to undergo either a laser iridotomy or a surgical iridotomy. They come in the form of medicated eyedrops. Prior to surgery, the ophthalmologist prescribes medicines to reduce the pressure inside the eye and to clear up the cloudiness of the cornea that occurs during an acute attack of angle-closure glaucoma. In acute angle-closure glaucoma, several drugs are used simultaneously to accelerate and maximize their pressure-lowering effects. The drugs lower IOP by increasing the outflow of the fluid (aqueous humor) from the eye or by decreasing the production of fluid in the eye. Medical Treatment

An ophthalmologist must treat angle-closure glaucoma with either laser therapy or surgical therapy (see Surgery). A laser iridotomy is the most commonly performed procedure. During a laser iridotomy, your eye doctor uses a laser beam to make a hole in the iris to reduce the pressure inside the eye. By making a hole in the iris, the fluid (aqueous humor) is better able to drain out from the posterior chamber to the anterior chamber of the eye. If the iris cannot be accessed with a laser beam for some reason, a surgical (or incisional) iridectomy is performed, wherein your eye doctor creates the hole in the iris by making surgical incisions. Prior to a laser iridotomy, your ophthalmologist uses medicines to reduce the pressure inside the eye and to clear up the cloudiness of the cornea that occur during an acute attack of angle-closure glaucoma. Also, because the pupil is often partially dilated (or enlarged), it is constricted (or made smaller) before laser surgery. See Medications. Medications

Medicines that are used for acute angle-closure glaucoma prepare you to undergo either a laser iridotomy or a surgical iridotomy. They come in the form of medicated eyedrops (see How to Instill Your Eyedrops). Prior to surgery, your ophthalmologist uses medicines to reduce the pressure inside the eye and to clear up the cloudiness of the cornea that occur during an acute attack of angle-closure glaucoma. In acute angle-closure glaucoma, several drugs are used simultaneously to accelerate and maximize their pressure-lowering effects. The drugs lower IOP by increasing the outflow of the fluid (aqueous humor) from the eye or by decreasing the production of fluid in the eye.

Surgery

Laser iridotomy Laser iridotomy is the treatment of choice for angle-closure glaucoma. Iridotomy is performed using either an argon laser or an Nd:YAG laser. The laser beam creates an opening in the iris through which the fluid (aqueous humor), which is trapped in the posterior chamber, can reach the anterior chamber and the trabecular meshwork (or drainage channels). As the fluid flows into the anterior chamber through this opening in the iris, the pressure behind the iris (ie, inside the eye) falls, allowing the iris to return to its normal position. This procedure opens the angle of the anterior chamber and relieves the blockage at the trabecular meshwork. If the cornea is extremely cloudy or if the person cannot cooperate, a surgical (or incisional) iridectomy may be performed instead of a laser procedure. With a surgical iridectomy, the ophthalmologist creates the hole in the iris by making surgical incisions. Laser gonioplasty Laser gonioplasty is sometimes used as a treatment of angle-closure glaucoma or as a temporary measure to open the angle until a laser iridotomy can be performed. During a laser gonioplasty, a laser beam is used to create burns in the iris. These burns cause the iris to contract and flatten, which, in turn, causes the angle of the anterior chamber to deepen (ie, opens the angle). Prevention

Regular eye examinations with an ophthalmologist may identify people who are at risk for acute angle-closure glaucoma. In some people who are at high risk, a laser iridotomy may be performed to prevent an attack of acute angle-closure glaucoma. Chronic Open Angle Glaucoma In chronic open angle glaucoma there is damage to the optic nerve at the back of your eye. It is usually caused by an increase in pressure within your eye. If it is not treated, glaucoma can lead to visual loss and even to blindness. Treatment can slow down glaucoma and help to prevent this. All adults aged over 35-40 should have a regular eye check which includes measurement of their eye pressure.. What happens in chronic open angle glaucoma? In chronic open angle glaucoma (just called glaucoma from now on) there is a partial blockage within the trabecular meshwork. This restricts the drainage of aqueous humour. The reason why the trabecular meshwork becomes blocked and does not drain well is not fully understood. The aqueous humour builds up if the drainage is faulty and this increases the pressure within your eye. The increased pressure in your eye can damage the optic nerve (the main nerve of sight) and the nerve fibres running towards it from the retina. The retina contains the seeing cells at the back of the eye. The damaged parts of the nerve and retina lead to permanent patches of vision loss. In some cases this can eventually lead to total blindness. Glaucoma can affect both of your eyes. However, it can often progress more quickly in one eye than in the other. What's the difference between increased eye pressure and glaucoma? Glaucoma means that part of the optic nerve is damaged, usually caused by increased eye pressure. Another term for eye pressure is intraocular pressure. However, about 1 in 5 people with glaucoma has eye pressures in the normal range. This is

called normal pressure glaucoma. In this condition the optic nerve is damaged by relatively low eye pressures. Other factors, such as a poor blood supply, may make the optic nerve sensitive even to modest pressure. In contrast, some people have an increased eye pressure with no ill effect to the optic nerve and no visual loss. Raised eye pressure without glaucoma is called ocular hypertension. However, as a rule, if your eye pressure is high, you have ocular hypertension and you have a much increased risk of developing glaucoma and visual loss. If you are found to have high intraocular pressure, you should discuss with your doctor about your individual risk of developing glaucoma. The results from a large study have been published recently. They showed that if you do have ocular hypertension, the higher your individual risk of developing glaucoma, the more likely you are to benefit from having treatment to lower your eye pressure. Who gets chronic open angle glaucoma? Glaucoma is common. In the UK. About 1 in 50 people aged over 40 has glaucoma. This rises to about 1 in 10 people over the age of 75. It is unusual in people under the age of 35. It becomes more common with increasing age. Glaucoma can affect anyone, but it is more common if you:

Have a family history of glaucoma. Have very short sight. Have diabetes. Are from African or Afro-Caribbean origin.

What are the symptoms of chronic open angle glaucoma? There are usually no symptoms at first. There is no pain or redness in the eye. Most people with glaucoma do not notice problems until quite a bit of visual loss has occurred. This is because the first part of the vision to go is the outer (peripheral) field of vision. Central vision, used to focus on an object such as when we read, is spared until relatively late in the disease. Also, although glaucoma usually affects both eyes, it may not affect them equally. The better eye may fill in for a while if the other eye starts to lose patches of visual field. Some elderly people with glaucoma put their gradually failing vision down to "just getting old". They might not have had their eyes checked for many years and may needlessly lose their sight. Untreated glaucoma is one of the world's leading causes of blindness. But, blindness can be prevented if glaucoma is diagnosed and treated early enough. Who should be tested for glaucoma? Everyone aged over 35 to 40 should have an eye check by an optometrist at least every five years. A check every 2 to 3 years is advised if you are aged over 50. Eye checks are particularly important if you are in any of the at-risk groups listed above. The eye check will detect early signs of glaucoma before any significant vision loss occurs. Most people with glaucoma have it detected at a routine eye check. Certain people are entitled to free eye tests. For example, people aged over 40 with a first-degree relative (mother, father, brother, or sister) with glaucoma. If you have been found to have glaucoma, you should tell your close family members so that they can be tested. What does an eye test for glaucoma involve? The eye test usually involves examining your eyes in detail using a special light and magnifier called a slit lamp. In particular, the back of your eye where the optic nerve leaves your eye (known as the optic disc) will be examined. There are specific changes that can be seen in this area in someone with glaucoma. The optic disc takes on a typical appearance and is said to be cupped. A special photograph may be taken of your optic disc. This photograph can be used to refer back to in the future when your eyes are checked. The pressure in your eyes (intraocular pressure) will also be measured. The thickness of your cornea may also be measured.

This is because the thickness of your cornea can affect your intraocular pressure reading. A special lens may also be used to examine the drainage area (or trabecular meshwork area) of your eye. This examination is called gonioscopy. Your field of vision may also be tested. This is essentially how much you can see whilst you are looking forward. As mentioned above, in glaucoma, it is usually the periphery (outside) of your field of vision that is affected first. Glaucoma Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve. This nerve carries visual information from the eye to the brain. In most cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP). Causes Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma:

Open-angle (chronic) glaucoma Angle-closure (acute) glaucoma Congenital glaucoma Secondary glaucoma

The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always being made behind the colored part of the eye (the iris). It leaves the eye through channels in the front of the eye in an area called the anterior chamber angle, or simply the angle. Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build up in the eye. This pressure is called intraocular pressure (IOP). In most cases of glaucoma, this pressure is high and causes damage to the optic nerve. Open-angle (chronic) glaucoma is the most common type of glaucoma.

The cause is unknown. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve. Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are at particularly high risk for this disease.

Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure in the eye.

Angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision. If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment. Dilating eye drops and certain medications may trigger an acute glaucoma attack.

Congenital glaucoma is seen in babies. It often runs in families (is inherited).


It is present at birth. It is caused by abnormal eye development.

Secondary glaucoma is caused by:


Drugs such as corticosteroids Eye diseases such as uveitis Systemic diseases Trauma

Symptoms

OPEN-ANGLE GLAUCOMA

Most people have no symptoms Once vision loss occurs, the damage is already severe There is a slow loss of side (peripheral) vision (also called tunnel vision) Advanced glaucoma can lead to blindness

ANGLE-CLOSURE GLAUCOMA

Symptoms may come and go at first, or steadily become worse Sudden, severe pain in one eye Decreased or cloudy vision, often called "steamy" vision Nausea and vomiting Rainbow-like halos around lights Red eye Eye feels swollen

CONGENITAL GLAUCOMA

Symptoms are usually noticed when the child is a few months old Cloudiness of the front of the eye Enlargement of one eye or both eyes Red eye Sensitivity to light Tearing

Exams and Tests A complete eye exam is needed to diagnose glaucoma. You may be given eye drop to widen (dilate) your pupil. The eye doctor can look at the inside of the eye when the pupil is dilated. A test called (tonometry) is done to check eye pressure. However, eye pressure always changes. Eye pressure can be normal in some people with glaucoma. This is called normal-tension glaucoma. Your doctor will need to run other tests to confirm glaucoma. Some of the tests your doctor may do can include:

Using a special lens to look at the eye (gonioscopy) Photographs or laser scanning images of the inside of the eye (optic nerve imaging) Examination of the retina in the back of the eye Slit lamp examination Visual acuity Visual field measurement

Treatment The goal of treatment is to reduce eye pressure. Treatment depends on the type of glaucoma that you have. If you have open-angle glaucoma, you will probably be given eye drops. You may need more than one type. Most people can be treated successfully with eye drops. Most of the eye drops used today have fewer side effects than those used in the past. You may also be given pills to lower pressure in the eye. Other treatments may involve:

Laser therapy called an iridotomy Eye surgery if other treatments do not work

Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated. If you have angleclosure glaucoma, you will receive:

Eye drops Medicines to lower eye pressure, given by mouth and through a vein (by IV)

Some people also need an emergency operation, called an iridotomy. This procedure uses a laser to open a new pathway in the colored part of the eye. This relieves pressure and prevents another attack. Congenital glaucoma is almost always treated with surgery. This is done using general anesthesia. This means the patient is asleep and feels no pain. If you have secondary glaucoma, treatment of the underlying disease may help your symptoms go away. Other treatments may be needed. Nursing Intervention Remember to administer cycloplegic eyedrops in the affected eye only. In the affected eye, these drops may precipitate an attack of angle-closure glaucoma and threaten the patients residual vision. After trabeculectomy, give medications as ordered to dilate pupila. Apply topical corticostroids as ordered to rest the pupil. After surgery, protect the affected eye by applying an eye patch and eye shield. Position the patient on his back or unaffected side, and following general safety measures. Administer pain medications as ordered. Encourage ambulation immediately after surgery. Encourage the patient to express his concerns related to having a chronic condition. Monitor the patients ability to see clearly. Question the patient regularly about the occurrence of visual changes. Monitor the patients intra-occular pressures. Stress the importance of meticulous compliance with prescribeddrug therapy. Instruct the patients family how to modify the patients environment for safety. Teach the patient the signs and symptoms that require immediate medical attention, such as sudden vision change or eye pain.

Detached Retina A detached retina is a serious and sight-threatening event, occurring when the retina becomes separated from its underlying supportive tissue. The retina cannot function when these layers are detached. And unless the retina is reattached soon, permanent vision loss may result.

Detached Retina Symptoms and Signs If you suddenly notice spots, floaters and flashes of light, you may be experiencing the warning signs of a detached retina. Your vision might become blurry, or you might have poor vision. Another sign is seeing a shadow or a curtain descending from the top of the eye or across from the side. These signs can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches immediately. About one in seven people with sudden onset of flashes and floaters will have a retinal tear or detachment, according to a study reported in late 2009 in the Journal of the American Medical Association. Up to 50 percent of people who experience a retinal tear will have a subsequent detachment. No pain is associated with retinal detachment. If you experience any of the signs, consult your eye doctor right away. Immediate treatment increases your odds of regaining lost vision.

What Causes Retinal Detachments?

An injury to the eye or face can cause a detached retina, as can very high levels ofnearsightedness. Extremely nearsighted people have longer eyeballs with thinner retinas that are more prone to detaching.

On rare occasions, a detached retina may occur after LASIK surgery in highly nearsighted people. In a study of more than 1,500 LASIK patients, just four suffered retinal detachment; their pre-LASIK prescriptions ranged from -8.00 D to -27.50 D. Cataract surgery, tumors, eye disease and systemic diseases such as diabetes and sickle cell disease also may cause retinal detachments. New blood vessels growing under the retina which can happen in diseases such as diabetic retinopathy may push the retina away from its support network as well. Sometimes fluid movement in the eye pulls the retina away. Treatment for Detached Retina Surgery is required to repair a detached retina. The procedure usually is performed by a retinal specialist an ophthalmologist who has undergone advanced training in the medical and surgical treatment of retinal disorders. Generally, the sooner the retina is reattached, the better the chances that vision can be restored. Surgical procedures used to treat a retinal detachment include:

Scleral buckling surgery. This is the most common retinal detachment surgery, and consists of attaching a small band of silicone or plastic to the outside of the eye (sclera). This band compresses (buckles) the eye inward, reducing the pulling (traction) of the retina and thereby allowing the retina to reattach to the interior wall of the eye. The scleral buckle is attached to the posterior portion of the eye and is invisible after surgery.

Scleral buckling surgery often is combined with one of the following procedures to fuse the retina to its underlying supporting tissue (called the retinal pigment epithelium, or RPE). Vitrectomy. In this procedure, the clear jelly-like fluid is removed from the posterior chamber of the eye (vitreous body) and replaced with clear silicone oil to push the detached portion of the retina back onto the RPE. Pneumatic retinopexy. In this procedure, the surgeon injects a small bubble of gas into the vitreous body to push the detached portion of the retina onto the RPE. If the detachment is caused by a tear in the retina, the surgeon usually uses a laser or a freezing probe to "spot weld" the retina firmly onto the RPE and underlying tissues and thereby seal the tear. If a laser is used, this is called laser photocoagulation; use of a freezing probe is called cryopexy. Surgical reattachment of the retina isn't always successful. The odds for success depend on the location, cause, and extent of the retinal detachment, along with other factors. Also, successful reattachment of the retina doesn't guarantee normal vision. Generally, visual outcomes are better after surgery if the detachment is limited to the peripheral retina and the macula is not affected.

Nursing Interventions: 1. Prepare the patient for surgery. Instruct the patient to remain quiet in prescribed (dependent) position, to keep the detached area of the retina in dependent position. Patch both eyes. Wash the patients face with antibacterial solution. Instruct the patient not to touch the eyes to avoid contamination. Administer preoperative medications as ordered. 2. Take measures to prevent postoperative complications. Caution the patient to avoid bumping head.

Encourage the patient no to cough or sneeze or to perform other strain-inducing activities that will increase intraocular pressure. 3. Encourage ambulation and independence as tolerated. 4. Administer medication for pain, nausea, and vomiting as directed. 5. Provide quiet diversional activities, such as listening to a radio or audio books. 6. Teach proper technique in giving eye medications. 7. Advise patient to avoid rapid eye movements for several weeks as well as straining or bending the head below the waist. 8. Advise patient that driving is restricted until cleared by ophthalmologist. 9. Teach the patient to recognize and immediately report symptoms that indicate recurring detachment, such as floating spots, flashing lights, and progressive shadows. 10. Advise patient to follow up.

Uveitis Iritis; Pars planitis; Choroiditis; Chorioretinitis; Anterior uveitis; Posterior uveitis Uveitis is swelling and irritation of the uvea, the middle layer of the eye. The uvea provides most of the blood supply to the retina.

Uveitis is inflammation of the uveal tract: the iris, ciliary body and choroid. It is classified according to the part of the uveal tract that it affects and symptoms also vary according to this. Uveitis can be acute (sudden onset), chronic (long-lasting) or recurrent (relapsing). Treatment, often with steroid eye drops, can usually reduce inflammation and ease symptoms. If treatment is not started promptly and/or complications occur, it can be serious and may lead to permanent loss of vision. What is uveitis? Uveitis is inflammation of the uveal tract. The uveal tract is the name given to the part of your eye that is made up of:

The iris: the part of your eye that gives it colour. The ciliary body: a small ring-like muscle that sits behind your iris. The choroid: the layer of tissue between your retina and your sclera, containing blood vessels and a pigment that absorbs excess light.

Parts of your eye next to the uveal tract can also be affected. These include:

The retina: the light-sensitive layer lining the interior of your eye. The optic nerve: the nerve responsible for vision. The vitreous humour: the jelly-like material that fills the chamber behind your lens. The sclera: the white outer layer of your eyeball.

What are the different types of uveitis? Uveitis is classified according to the part of the uveal tract that the inflammation affects:

Anterior uveitis is when the inflammation affects the anterior part of the uveal tract at the front of the eye. This can include the iris (iritis) or the iris and the ciliary body (iridocyclitis). It is the most common type of uveitis. Intermediate uveitis is when the inflammation affects the middle part of the uveal tract or eye, mainly the vitreous humour. It can also affect the underlying retina. Posterior uveitis is when the inflammation affects the back of the eye. It can affect the choroid, the head of the optic nerve, and the retina (or any combination of these structures). It includes chorioretinitis, retinitis and neuroretinitis. Panuveitis is when the inflammation affects the whole of the uveal tract.

Uveitis can also be:

Acute: the uveitis is of sudden onset and tends not to last very long (less than three months but usually around six weeks). Chronic: which means it is persistent. The uveitis lasts for more than three months and also relapses (comes back) within three months of stopping treatment. Recurrent: the disease can flare up (relapse) and, at other times, it settles down.

The reason why some people develop chronic uveitis is not known. However, it is not thought to be due to inadequate treatment. Causes, incidence, and risk factors Uveitis can be caused by autoimmune disorders such as rheumatoid arthritis or ankylosing spondylitis, infection, or exposure to toxins. However, in many cases the cause is unknown. The most common form of uveitis is anterior uveitis, which involves inflammation in the front part of the eye. It is often called iritis because it usually only affects the iris, the colored part of the eye. The inflammation may be associated with autoimmune diseases, but most cases occur in healthy people. The disorder may affect only one eye. It is most common in young and middle-aged people. Posterior uveitis affects the back part of the uvea, and involves primarily the choroid, a layer of blood vessels and connective tissue in the middle part of the eye. This type of uveitis is called choroiditis. If the retina is also involved, it is called chorioretinitis. You may develop this condition if you have had a body-wide (systemic) infection or if you have an autoimmune disease. Another form of uveitis is pars planitis. This inflammation affects the narrowed area (pars plana) between the colored part of the eye (iris) and the choroid. Pars planitis usually occurs in young men and is generally not associated with any other disease. However, some evidence suggests it may be linked to Crohn's disease and possibly multiple sclerosis. Uveitis can be associated with any of the following: AIDS Ankylosing spondylitis Behcet syndrome CMV retinitis Herpes zoster infection Histoplasmosis Injury Kawasaki disease Psoriasis Reactive arthritis Rheumatoid arthritis Sarcoidosis Syphilis Toxoplasmosis Tuberculosis Ulcerative colitis

Symptoms Uveitis can affect one or both eyes. Symptoms may develop rapidly and can include: Blurred vision Dark, floating spots in the vision Eye pain Redness of the eye Sensitivity to light

How is uveitis diagnosed? Uveitis is usually suspected on the basis of the symptoms that you have. If your doctor suspects that you have uveitis, you will usually be referred to an eye specialist for further examination and confirmation. The doctor may start by testing your vision. This allows them to assess any differences in vision between your eyes. It also means that they can tell if the uveitis is causing

your vision to worsen. The doctor examining your eye will usually use an ophthalmoscope (a hand-held instrument) to examine the interior of your eye. This directs a beam of light into your eye and allows the doctor to examine the inside of your eye where the beam falls. The doctor will usually put in some eye-drops just before the examination. These make your pupils wider so that they can see into your eye more easily. The doctor may also use a special microscope called a slit-lamp to examine your eye. If you have uveitis, the doctor will see some specific changes in your eye that allows them to make the diagnosis. You may also need some other investigations depending on what the doctor thinks is the likely cause of your uveitis. These can include blood tests and X-rays. What is the treatment for uveitis? Treatment for uveitis aims to help relieve pain and discomfort in the eye(s), treat any underlying cause (if possible), and to reduce the inflammation. This may prevent permanent loss of vision or other complications. Treatment usually includes the following: Treatment to relieve pain and discomfort

Cycloplegic eye drops: these are special eye drops that can be used to relieve pain by causing the pupil in your eye to dilate (widen). The drops cause your pupil to dilate by relaxing the muscle in the ciliary body. As a result, pain reduces and the inflamed iris is able to rest and recover. Examples include atropine and cyclopentolate eye drops. However, they can have some side-effects. They can make your pupil appear large, can cause temporary blurred vision and also difficulty with focusing. When the effect of the drops wears off, these side-effects will disappear. The drops need to be used as frequently as every hour when uveitis is first diagnosed. If the drops are not used, the inflammation in the iris may cause it to become 'stuck' to the lens causing permanent scarring.

Dark glasses: if your symptoms include photophobia (sensitivity to bright light), wearing dark glasses may be helpful.

Painkillers: painkillers, such as paracetamol, taken by mouth may also help. Steroid eye drops

Steroid eye drops are used to reduce the inflammation in uveitis. They are usually the main treatment. Although steroid eye drops usually work well, in some cases side-effects occur, which are sometimes serious. Therefore, steroid eye drops are usually only prescribed by an ophthalmologist (an eye specialist) who can monitor the situation. Possible side-effects that sometimes occur include ulcers on the cornea of the eye which can be very painful and affect your vision. If steroid eye drops are used for long periods of time, they can lead to cataracts or glaucoma. Steroids by mouth or injection In severe uveitis, steroids are sometimes given by injection into or around your eye. They can also be given by mouth. Again, these can have side-effects if used in the long-term. The main side-effects from steroids taken by mouth occur when they are used for more than a few weeks. These include thinning of the bones (osteoporosis), thinning of the skin, weight gain, muscle wasting and an increased risk of serious infection. Immunosuppressive drugs If steroid treatment is needed in the longer term to treat uveitis, a second drug known as an immunosuppressive drug may be used. This can help to reduce the amount of steroids needed and/or help to control the uveitis if steroids are not working. Treatment of underlying conditions and causes Any underlying cause of your uveitis also needs to be treated (if possible). This means treating any underlying infection, inflammatory disease or autoimmune disease. Surgery Occasionally, surgery is needed to treat uveitis (usually chronic uveitis). For example, if someone has persistent floaters that are affecting their ability to see, the vitreous humour in the eye can be removed. Floaters tend to develop because of

inflammation causing damage to the vitreous humour. Surgery may also be used to treat the complication of cataracts that can occur (see below). Newer treatments There are a number of new treatments for uveitis that are currently being investigated. These include drugs called TNF-alpha blockers such as etanercept and infliximab. What are the complications of uveitis? If uveitis is not treated quickly, it can have serious effects and can lead to permanent loss of vision. It may also lead to complications that can affect your eyesight. If complications are not detected early, they can sometimes have a more detrimental effect on your eyesight than the underlying uveitis. The complications of uveitis may be caused by the effects of the inflammation inside the eye. However, some of them may also be caused by the steroid treatment used to control the inflammation. Despite this, as a general rule, using enough steroids to control the uveitis will generally give a better outcome than using too few steroids and not controlling the inflammation. Complications that can sometimes occur with uveitis include:

Formation of synechiae: synechiae are the name given to the 'bands' of tissue that can form between the iris and the lens due to inflammation if uveitis is not treated promptly. Dilating eye drops can sometimes help to prevent synechiae. Glaucoma: the synechiae that form mean that fluid is not able to drain normally within the eye. This can lead to a buildup of pressure within your eye which can lead to glaucoma. If glaucoma is not treated, it can lead to visual loss. Glaucoma can also be a side-effect of long-term steroid treatment. See separate leaflet called 'Glaucoma (Primary Open Angle)' for more information.

Macula oedema: this is when fluid builds up in the back of your eye around your macula on your retina. It may cause permanent visual loss. Cataract formation: the inflammation can cause changes in the lens of your eye, and cataract formation. Cataracts may also be caused by long-term steroid treatment. If a cataract worsens and is not treated, it can lead to visual loss. See separate leaflet called 'Cataracts' for more information.

Retinal detachment: the inflammation can cause 'pulling' on your retina so that it 'comes away' or is detached. This can cause you to experience flashing lights, floaters and problems with your vision. If you suspect that you have a retinal detachment, contact your doctor immediately as urgent surgery is often needed.

Keratitis What Is It? Keratitis is an inflammation of the cornea, the outermost part of the eye that covers the pupil and iris (the colored ring around the pupil). The most common causes of keratitis are infection and injury. Bacterial, viral, parasitic and fungal infections can cause keratitis. An infectious keratitis can happen after an injury to the cornea. But an injury can inflame the cornea without a secondary infection occurring. Viral keratitis occurs quite commonly and the types of viruses include:

Adenovirus, which is one of the causes of upper respiratory infections. Herpes simplex type 1, the same virus that causes cold sores. Varicella zoster (also a herpes virus), which is associated with chickenpox and shingles.

Bacterial keratitis occurs less often than viral keratitis. Parasitic and fungal keratitis is rarely seen in developed countries. Infectious keratitis usually begins by affecting the outer layer of the cornea, but it can go deeper into the cornea, increasing the risk of impaired vision. Non-infectious keratitis is a feature of some autoimmune diseases, such as rheumatoid arthritis and Sjogren's syndrome.

Trauma to the front of the eye, as may occur with poorly fitting contact lenses, surgery on the cornea (including LASIK surgery), or any other injury to the cornea may lead to keratitis. People who wear contact lenses are at increased risk for infectious keratitis. Lens wear should stop immediately if a person suspects that he or she is developing an eye infection. Symptoms Symptoms of keratitis include: Red eye Sensation of something, like sand, in the eye Pain Sensitivity to light Watery eye Blurred vision Difficulty keeping the eyelids open

When caused by an injury or infection, such as herpes simplex virus, keratitis usually affects only one eye, but both eyes may be affected when keratitis is due to other causes. Diagnosis Your health care professional will ask you about your symptoms, your vision, and your health in general. Your doctor, or an eye specialist, will use an instrument that magnifies the surface of the cornea to look for a tiny ulcer caused by viral infection. This ulcer when due to herpes simplex tends to send out star-like branches, and is best seen after a dye is used to stain the cornea temporarily. Herpes simplex infection of the cornea may be accompanied by infection of the eyelid. In this case, tiny, painful blisters resembling cold sores of the lips may appear on the eyelid. Your doctor also may:

Test your visual sharpness and clearness (visual acuity) Test of how well your pupil responds to light Examine your eye using a special instrument called a slit lamp Gently swab inside the eyelid to get a sample to send to the laboratory for culture

Expected Duration Keratitis caused by a virus or bacterium tends to get better relatively quickly. Herpes keratitis and bacterial keratitis are treated with antiviral medication or antibiotics. Keratitis caused by other viruses usually gets better on their own within a few days. If keratitis is related only to contact lenses, the duration tends to be brief. Keratitis caused by autoimmune disease, some parasites or prior injury can be difficult to treat and may be long lasting (chronic). In these cases, permanent damage to the cornea with impaired vision may occur despite intense treatment.

Prevention The best way to prevent keratitis is to avoid eye injury by wearing sunglasses and appropriate eye gear as needed. If you have a cold sore, do not put your fingers to your eyes, because that could spread the infection. If there is any suspicion that you have herpes simplex virus, steroid eye drops may be dangerous because they can make this infection worse. Routine contact lens hygiene, a balanced diet and moisturizing eye drops may help prevent other causes of keratitis. Treatment Treatment of keratitis depends upon the cause. If there is mild injury to the cornea, such as a scratched cornea, no specific treatment is necessary. An antibiotic ointment might be prescribed. This is done mostly for comfort.

If the keratitis is caused by herpes simplex or the herpes zoster virus that causes shingles, your doctor will prescribe antiviral eye drops or an antiviral oral medication or both. Bacterial keratitis needs to be treated with antibiotics. Depending on the severity of the infection, an oral antibiotic may be prescribed along with an antibiotic ointment or eye drops. Artificial tears for lubrication usually are effective for keratitis related to ocular dryness. Keratitis caused by an autoimmune disease is often treated with topical corticosteroid eye drops. Also treating the underlying disease helps the keratitis heal with less chance of recurrence. Blepharitis Email this page to a friendShare on facebookShare on twitterBookmark & SharePrinter-friendly version Blepharitis is swelling or inflammation of the eyelids, usually where the eyelash hair follicles are located. Causes In people with blepharitis, too much oil is produced by the glands near the eyelid. The exact reason for this problem is not known. Blepharitis is more likely to be seen with:

A skin condition called seborrheic dermatitis or seborrhea, which often involves the scalp, eyebrows, eyelids, behind the ears, and creases of the nose Allergies and lice that affect the eyelashes (less common) Excess growth of the bacteria that are normally found on the skin Rosacea -- a skin condition that makes the face turn red

Blepharitis may be linked to repeated styes and chalazia. Symptoms The eyelids appear red and irritated, with scales that stick to the base of the eyelashes. The eyelids may be: Burning Crusty Itching Reddened Swollen

You may feel like you have sand or dust in your eye when you blink. Sometimes, the eyelashes may fall out and the eyelids may become scarred. Exams and Tests An examination of the eyelids during an eye examination is usually enough to diagnose blepharitis. Treatment Careful daily cleansing of the eyelid edges helps remove the skin oils that cause bacteria to grow too much. Your health care provider might recommend using baby shampoo or special cleansers. Antibiotic ointments may also be helpful. If you have blepharitis:

Apply warm compresses to your eyes for 5 minutes, at least two times per day. Using a cotton swab, gently rub a solution of warm water and no-tears baby shampoo along your eyelid where the lash meets the lid. Do this in the morning and before you go to bed.

Prevention

Cleaning eyelids carefully will help prevent blepharitis. If a specific skin condition is present, it should be treated.

Blunt Contusion Definition An eye contusion is a bruise around the eye, commonly called a black eye. It may occur when a blow is sustained in or near the eye socket. If a bruise appears, it will usually do so within 24 hours of the injury.

Causes After being struck in the eye or nose, blood leaks into the area surrounding the eye. Risk Factors Participation in high impact sports such as basketball, football, hockey, and boxing Occupations that expose the eye to potential injury, such as manufacturing, construction, and athletics Violence Symptoms A black and blue or purple mark will appear following the injury. There may also be redness, swelling, and tenderness or pain. Once it begins to heal, the contusion may turn yellow. Diagnosis Eye contusions are diagnosed visually. Healthcare providers assume that the eye has been struck in some way or another. Most people are able to self-diagnose a contusion, but a doctor may confirm the diagnosis. Treatment First-aid Treatment It is important to apply first-aid treatment immediately upon receiving an eye injury.

Seek emergency medical attention immediately. Immediately apply ice or a cold compress for 15 minutes to reduce swelling and minimize pain. Do not press on the eye itself. Repeat every 1 to 2 hours for the first 48 hours. If there is still tenderness after 48 hours, apply a warm compress every 1-2 hours. For pain, take acetaminophen. Do not take aspirin or nonsteroidal anti-inflammatory medications like ibuprofen because these drugs can cause or increase bleeding.

Medical Treatment While many eye injuries are fairly minor and will heal within two weeks with basic first-aid, there is always the risk of more serious consequences, so you should still see an eye doctor immediately, even if you have no symptoms. This is especially urgent if a blow to the eye causes blood to appear in your eye, loss or change in vision, double vision, inability to move the eye normally, or severe pain in your eyeball. Depending on the extent of your injury, your doctor may provide further medical treatment. For instance:

If the skin around your eye is cut, you may need stitches. If there was any damage to the eye itself, you may need antibiotic eye drops to prevent infection. Your doctor may prescribe eye drops to minimize inflammation. If there is suspicion of damage to the bones, such as a fracture, x-rays or other imaging may be performed If you are diagnosed with an eye contusion, follow your doctor's instructions . Prevention To help reduce your chance of an eye contusion, take the following steps:

Wear protective eye covering like safety goggles whenever the eye is exposed to potential injury at work or play. The best type of goggles are those that are snug up against the skin so that no foreign objects can get underneath the goggle and into the eye. Avoid fighting.

Hyphema (Bleeding in Eye) Overview Trauma to the eye can cause bleeding in the front (or anterior chamber) of the eye between the cornea and the iris. This bleeding into the anterior chamber of the eye is called a hyphema. The anterior chamber of the eye contains a clear liquid fluid called aqueous humor. The aqueous humor is secreted by the ciliary processes in the posterior chamber of the eye. The aqueous humor passes through the pupil into the anterior chamber.

Hyphema Causes Trauma to the eye may initially cause a small hyphema. More severe bleeding may follow in 3-5 days. This trauma is usually blunt or closed trauma, and it may be the result of an athletic injury from a flying object, a stick, a ball, or another player's elbow. Other causes include industrial accidents, falls, and fights. Hyphema Symptoms A person with a hyphema may have had a recent incident of eye trauma, might feel pain in the injured eye, and may have blurred vision. If the hyphema is large, the eye itself may look as if it is filled with blood. Smaller hyphemas are not readily visible to the naked eye. Exams and Tests Your ophthalmologist asks about any history of eye injury, when the injury may have happened, and how it happened. It is important for your ophthalmologist to know if, for example, you were hit in the eye with a baseball or you ran into a lowhanging branch on a tree. A complete eye examination is performed. A visual acuity test checks for how well you can see. The intraocular pressure (pressure inside the eye) must be checked. A special microscope, called a slit lamp, is used to look inside the structures of the eye. A hyphema can be seen as a clot or layered blood in the anterior chamber of the eye. The condition called "eight ball" or "black hyphema" occurs when the entire anterior chamber is filled with blood. Smaller hyphemas may appear layered in the anterior chamber. A microhyphema may also be seen. This appears as a haziness of suspended red blood cells in the anterior chamber. If you have experienced severe trauma, the doctor may order a CT scan to look at the eye sockets themselves and other facial structures. African Americans and those of Mediterranean descent should be screened forsickle cell disease or thalassemia, which can lead to serious complications. In these cases, surgery may be considered an early option.

Hyphema Treatment - Self-Care at Home Hyphema should not be treated at home without seeing your ophthalmologist. Make no attempts to cover the eye, because, if done incorrectly, you may do more harm than good. Medical Treatment Treatment of hyphema depends on how readily you comply with instructions. Following directions for care is important. About 15-20% of people with a hyphema have further bleeding in 3-5 days. This is why compliance with care is so important. Blood usually reabsorbs, but the doctor must make sure the process is resolving as expected. If intraocular pressure increases or if bleeding reoccurs, you may be hospitalized. You will be instructed to do the following as part of home follow-up care: o o o Rest in bed with the head of the bed elevated as much as you can tolerate. Do not engage in any strenuous activity. Do not take any medicines containing aspirin. It promotes bleeding. This also includes nonsteroidal medications, such as naproxen (Aleve), ibuprofen (Motrin), or many other arthritis medications. You may take a mild pain reliever, such as acetaminophen (Tylenol), but do not take too much. You want to know if eye pain occurs, because it may be related to an increase in pressure in the eye. If eye pain increases, return to the doctor immediately. Place drops in your eye 3-4 times a day or exactly as prescribed by your doctor. Drops of 1% atropine may be prescribed. Cover the eye with a shield to protect it from further injury.

If you have a microhyphema or a small, layered hyphema, you might be asked to see your ophthalmologist every day for 5 days and then a week after that. A 1-month follow-up appointment may also be required. Your ophthalmologist checks your vision, intraocular pressure, and anterior chamber of the eye. Children and elderly persons may not be able to follow the home treatment plan. They and others who have complications may be admitted to the hospital for close observation. Treatment is similar to that suggested for home follow-up care. o Medicine may be given to prevent you from vomiting; such activity that involves straining increases pressure in the eye. If eye pressure increases, certain medicine, such as a beta-blocker, may be delivered through eyedrops into the eye. An occasional increase in pressure can be caused by the red blood cells obstructing the meshwork of the eye. When the meshwork is obstructed, the normal flow of liquid through the eye is interrupted. This increase of fluid in the eye increases the pressure in the eye.

Hyperopia Defined What is hyperopia? Hyperopia, also known as farsightedness, is a common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience hyperopia differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant hyperopia, vision can be blurry for objects at any distance, near or far.

What is refraction? Refraction is the bending of light as it passes through one object to another. Vision occurs when light rays are bent (refracted) as they pass through the cornea and the lens. The light is then focused on the retina. The retina converts the light-rays into messages that are sent through the optic nerve to the brain. The brain interprets these messages into the images we see.

What are refractive errors? In refractive errors, the shape of the eye prevents light from focusing on the retina. The length of the eyeball (longer or shorter), changes in the shape of the cornea, or aging of the lens can cause refractive errors.

How does hyperopia develop? Hyperopia develops in eyes that focus images behind the retina instead of on the retina, which can result in blurred vision. This occurs when the eyeball is too short, which prevents incoming light from focusing directly on the retina. It may also be caused by an abnormal shape of the cornea or lens.

Who is at risk for hyperopia? Hyperopia can affect both children and adults. It affects about 5 to 10 percent of Americans. People whose parents have hyperopia may also be more likely to get the condition.

What are the signs and symptoms of hyperopia? The symptoms of hyperopia vary from person to person. Your eye care professional can help you understand how the condition affects you. Common signs and symptoms of hyperopia include: Headaches Eyestrain Squinting Blurry vision, especially for close objects

How is hyperopia diagnosed? An eye care professional can diagnose hyperopia and other refractive errors during a comprehensive dilated eye examination. People with this condition often visit their eye care professional with complaints of visual discomfort or blurred vision.

How is hyperopia corrected? Hyperopia can be corrected with eyeglasses, contact lenses, or surgery. Eyeglasses are the simplest and safest way to correct hyperopia. Your eye care professional can prescribe lenses that will help correct the problem and help you see your best. Contact Lenses work by becoming the first refractive surface for light rays entering the eye, causing a more precise refraction or focus. In many cases, contact lenses provide clearer vision, a wider field of vision, and greater comfort. They are a safe and effective option if fitted and used properly. However, contact lenses are not right for everyone. Discuss this with your eye care professional. Refractive Surgery aims to permanently change the shape of the cornea which will improve refractive vision. Surgery can decrease or eliminate dependency on wearing eyeglasses and contact lenses. There are many types of refractive surgeries and surgical options should be discussed with an eye care professional.

Myopia Nearsightedness, or myopia, is the most common refractive error of the eye, and it has become more prevalent in recent years. Though the exact cause for this increase in nearsightedness among Americans is unknown, many eye doctors feel it has something to do with eye fatigue from computer use and other extended near vision tasks, coupled with a genetic predisposition for myopia. Myopia Symptoms and Signs If you are nearsighted, you typically will have difficulty reading road signs and seeing distant objects clearly, but will be able to see well for close-up tasks such as reading and computer use. Other signs and symptoms of myopia include squinting, eye strain and headaches. Feeling fatigued when driving or playing sports also can be a symptom of uncorrected nearsightedness. If you experience these signs or symptoms while wearing your glasses or contact lenses, schedule a comprehensive eye examination with your optometrist or ophthalmologist to see if you need a stronger prescription. What Causes Myopia? Myopia occurs when the eyeball is too long, relative to the focusing power of the cornea and lens of the eye. This causes light rays to focus at a point in front of the retina, rather than directly on its surface. Nearsightedness also can be caused by thecornea and/or lens being too curved for the length of the eyeball. In some cases, myopia is due to a combination of these factors. Myopia typically begins in childhood and you may have a higher risk if your parents are nearsighted. In most cases, nearsightedness stabilizes in early adulthood but sometimes it continues to progress with age. Myopia Treatment Nearsightedness can be corrected with glasses, contact lenses or refractive surgery. Depending on the degree of your myopia, you may need to wear your glasses or contact lenses all the time or only when you need very clear distance vision, like when driving, seeing a chalkboard or watching a movie. If you're nearsighted, the first number ("sphere") on your eyeglasses prescription orcontact lens prescription will be preceded by a minus sign (). The higher the number, the more nearsighted you are. Refractive surgery can reduce or even eliminate your need for glasses or contacts. The most common procedures are performed with an excimer laser. In PRK the laser removes a layer of corneal tissue, which flattens the cornea and allows light rays to focus more accurately on the retina. In LASIK the most common refractive procedure a thin flap is created on the surface of the cornea, a laser removes some corneal tissue, and then the flap is returned to its original position.

Then there'sorthokeratology, a non-surgical procedure where you wear special rigid gas permeable (RGP or GP) contact lenses at night that reshape your cornea while you sleep. When you remove the lenses in the morning, your cornea temporarily retains the new shape, so you can see clearly during the day without glasses or contact lenses. Orthokeratology and a related GP contact lens procedure called corneal refractive therapy (CRT) have been proven effective at temporarily correcting mild to moderate amounts of myopia. Both procedures are good alternatives to surgery for individuals who are too young for LASIK or are not good candidates for refractive surgery for other reasons. Implantable lenses known as phakic IOLs are another surgical option for correcting nearsightedness, particularly for individuals with high amounts of myopia or thinner-than-normal corneas that could increase their risk of complications from LASIK or other laser vision correction procedures. Phakic IOLs work like contact lenses, except they are surgically placed within the eye and typically are permanent, which means no maintenance is needed. Unlike IOLs used incataract surgery, phakic IOLs do not replace the eye's natural lens, which is left intact.

Astigmatism Astigmatism is an eye condition with blurred vision as its main symptom. The front surface of the eye (cornea) of a person with astigmatism is not curved properly - the curve is irregular - usually one half is flatter than the other - sometimes one area is steeper than it should be. When light rays enter the eye they do not focus correctly on the retina, resulting in a blurred image. Astigmatism may also be caused by an irregularly shaped lens, which is located behind the cornea. Astigmatism may occur in children and adults; it is fairly common and is not contagious. It is usually congenital - is present at birth - but can develop after an eye operation or an injury to the eye. It belongs to a group of eye conditions calledrefractive errors. Myopia (short-sightedness), hypermetropia (long-sightedness) and presbyopia (aging of the lens in the eye) are types of refractive errors. A refractive error means that the shape of the eye does not bend light properly, resulting in a blurred image. Light has to be bent (refracted) by the lens and the cornea correctly before it reaches the retina in order to see things clearly. The two most common types of astigmatism are:

Corneal astigmatism - the cornea has an irregular shape Lenticular astigmatism - the lens has an irregular shape What are the symptoms of astigmatism?

Blurred or distorted vision at all distances. Photophobia - sensitivity to light. Headaches. Excessive squinting. The person is constantly closing his/her eyes. Eye strain - occurs more often when the eye has to focus for long periods, as in reading from paper or a computer monitor. How is astigmatism diagnosed? The ophthalmologist, optometrist, or orthoptist may use the following tools to examine the eyes: Visual acuity test - this involves reading letters on a chart. The letters become progressively smaller on each line. Astigmatic dial - this is a chart showing a series of lines which make up a semi-circle. People with perfect vision will see the lines clearly, while those with astigmatism will see some more clearly than others.

Keratometer - also known as an ophthalmometer. This device measures the reflected light from the surface of the cornea. It measures the radius of the curvature of the cornea and can assess the degree of abnormal curvature of the cornea. Keratoscope - also known as Placido's disk - this device is marked with lines or circles and observes corneal reflex. It uses light to project rings on the cornea. By measuring the spacing between the rings it calculates the variations of curvature, which in turn calculates the degree of astigmatism. A videokeratoscope is a keratoscope fitted with a video.

The importance of regular eye tests Astigmatism is very common - experts say most of us are born with a degree of astigmatism. Most children who are born with astigmatism will not realize they have it until they have an eye test. Reading and concentrating at school may be affected if a child has undiagnosed astigmatism. Therefore, regular eye tests are important. In the UK babies have an eye test soon after they are born. They have a follow-up test about six weeks later. Doctors recommend that children receive a comprehensive eye test when they are four years old; and then every year up to the age of 16. Adults should have an eye test every couple of years. What are the treatments for astigmatism? If the astigmatism is very mild the health care professional will suggest no treatment at all. Corrective lenses Corrective lenses bend the income light rays in a way that compensates for the error caused by faulty refraction so that images are properly received onto the retina. Whether the corrective lenses are in glasses or contact lenses is up to the patient - they are equally effective. Experts say children can wear contact lenses as long as they are careful about using them properly. This includes not wearing them for too long and cleaning them properly. This may be difficult to achieve if the child is under the age of twelve. People of any age who use contact lenses need to be aware of good lens hygiene. Otherwise there is a significant risk of eye infection. There are three types of contact lenses. 1. Rigid contact lenses. 2. Gas permeable contact lenses. 3. Soft contact lenses. Rigid contact lenses - these are usually made of a combination of glass and plastic. The eye is more likely to produce new blood vessels which may eventually affect vision. This happens because rigid contact lenses stop oxygen from getting into the eye, so it produces new blood vessels which feed oxygen into those areas which had a drop in oxygen supply caused by the lens. Gas permeable contact lenses (oxygen permeable contact lenses) - these use polymers; a type of plastic. Polymers are permeable - they do not stop oxygen from getting into the eye - and prevent the risk of new blood vessels appearing in the eye and obscuring vision. Soft contact lenses - these are made of hydrogel, a combination of water and polymer. Soft lenses also allow oxygen to move through the lens and into the eye. The water in them lets the oxygen through, not the plastic. As the water soon evaporates soft lenses can only be worn for one day, and then discarded. Soft lenses made of silicone gel may be worn for longer.

Laser eye surgery Photorefractive keratectomy (PRK) - some of the outer protective layer of the cornea is removed. An excimer laser changes the shape of the cornea by removing tissue. When the cornea heals it usually has a more even and spherical curve. This procedure can be moderately to very painful. It can take up to one month for vision to recover. An excimer laser is a laser device that does not produce heat.

LASEK (Laser epithelial keratomileusis) - alcohol is used to loosen the surface of the cornea, which is then removed a much thinner layer is affected, making the eye less vulnerable to damage or injury, compared to PRK. A laser is then used to change the shape of the cornea. The cornea is then placed back. LASEK may be a better option for a patient whose cornea is thin. This procedure is usually less painful than PRK, but slightly more painful than LASIK, and can take up to one week for vision to recover. Laser in situ keratectomy (LASIK) - the doctor uses a device called a keratome to make a thin, round hinged cut into the cornea. This can also be done using a special cutting laser. The flap is then lifted and an excimer laser sculpts the shape of the cornea under the flap. LASIK causes less pain than the other procedures, and the patient will recover his/her vision within a few days. Hence, LASIK is usually the preferred laser treatment option. Even so, vision won't completely stabilize for about one month.

LASEK and PRK are better procedures than LASIK if the cornea is thin. Laser eye surgery is not suitable if: The patient is under the age of 21 - The structures of the eyes of people under 21 are still changing and should not be altered. The minimum age in different countries varies from 21 to 18. Vision is still changing - the vision of some older people may still be changing. Experts say that a person's vision should be stable for at least three years before undergoing laser surgery. Patients with diabetes - in some cases laser surgery may worsen abnormalities in the eye caused by diabetes. Pregnant or breastfeeding mothers - during pregnancy and breastfeeding hormone fluctuations still exist within the eye, making it more difficult to carry out surgery accurately. People with some immune conditions - people with rheumatoid arthritis, lupus, or HIV, for example, may find it harder to recover after surgery. People with other existing eye conditions - people other eye conditions will need to have those treated first, before becoming eligible candidates for laser eye surgery. Examples are cataracts and glaucoma. People taking certain medications - if the patient is taking medications, such as Accutane or oral prednisone, he/she should not undergo laser eye surgery.

What are the risks of laser surgery? Correction error - the surgeon may have taken out the wrong amount of tissue and the patient's vision worsens. Epithelial in-growth - the surface of the cornea starts growing into the cornea itself. This can cause vision problems and may need further surgery. Ectasia - the cornea becomes too thin. This can result in worse vision. Sometimes the deterioration of vision may be severe. Keratitis - the cornea becomes infected.