Premier Eye Hospital in India

Red Eye due to Allergy

Allergic Conjunctivitis is an inflammation in the conjunctiva which is the thin transparent membrane that covers the white of the eye and the inner surfaces of the eyelids.

As the name implies, this inflammation is caused due to Allergy which is essentially hypersensitivity of the body to a particular stimulus. The stimuli can be any trivial substance present in the internal or external environment. Usually, these are airborne.

The commonest triggers are pollen, grass, weeds, and moulds. These may cause seasonal symptoms. Smoke, fumes, dust, and dust mites can trigger an attack of Allergy. If you have a pet, the secretions, saliva or fur of the pet may cause Allergy. Skin or eye cosmetics and perfumes can act as a stimulus.

Allergy is mediated by a biogenic chemical entity called ‘histamine’ which is synthesized and stored in a special type of cells called ‘mast cells’ and is released upon contact with a potential trigger of Allergy. Histamine causes the small blood vessels to dilate and also causes itching.

The dilation of the blood vessels increases blood flow and causes redness. These vessels become leaky to cause accumulation of tissue fluids and hence swelling and heaviness in the eyes.

Symptoms

A few symptoms of Conjunctivitis are mentioned below:

During an episode of Allergic Conjunctivitis, contact with a trigger causes the release of histamine, and hence the consequent swelling, redness, itching, and watering in the eyes.

These may resolve when exposure to the stimulus is over and can recur upon a second and subsequent contact with the same or different stimulus. Allergy can be due to one or many stimuli. Allergy may run in your family.

Allergic Conjunctivitis may be a part of a generalized Allergy process like hay fever which is characterized by Allergic symptoms in the nose, called Allergic Rhinitis.

You may have other concurrent Allergic manifestations like Allergy in the windpipes, called Allergic  Asthma, or Allergy anywhere in the skin.

Red-eye Effect on eyesight

Allergic Conjunctivitis manifests as swollen red watery eyes that may itch. There may be a foreign body sensation and the distress may increase on exposure to light.

Allergic Conjunctivitis causes distress, pain and heaviness in the eyes. There are no deleterious effects on eyesight.

Once the contact with the trigger is over, the inflammation subsides, and the eyes get healthy again till a second contact with the same or another stimulus precipitates it.

Treating Allergic Conjunctivitis

Allergic Conjunctivitis treatment includes eye drops and sometimes oral medications, i.e., pills or syrups. Of these, eye drops are commonly used. Since histamine is the main cause of all the symptoms in Allergic Conjunctivitis, Allergic Conjunctivitis benefits from eye drops containing antihistamines. This treatment is also called the Pink eye treatment.

These will reduce the swelling and congestion in the eyes. Also, eye drops containing mast cell stabilizers can help prevent the release of histamine from mast cells. For symptom relief from pain, swelling and redness, a drop with anti-inflammatory agents may help.

An eye drop preparation may contain one or more of these medications. Since these agents are short-acting, the eye drops may need to be used multiple times in a day depending upon the severity of symptoms. In severe cases, oral therapy may be required.

Your doctor may advise you for any of these and prescribe you the same. You can also use artificial tears. These irrigate the eyes and wash off the irritants. These also soothe, moisten and give relief to the irritated eyes.

Adverse effects are possible with any of these eye drops or oral medications. The commonest adverse effect can be a stinging sensation or a feeling of burning in the eyes. Usually, these are self-limiting and subside over a short period. If severe, stop the medication and seek medical help.

Steroid eye drops can cause Glaucoma (increase in eye pressure), cataracts (opacity in the lens) or make eyes more susceptible to infections. Oral antihistamines may cause sedation, dizziness and reduced concentration.

If you have red eyes, take good care of your eyes. Avoid exposure to the substances you are allergic to. Wear sunglasses when you go out. Wash your eyes with plenty of cold water many times a day. Do not rub your eyes vigorously. You may use a soothing cool eye compress.

Avoiding Allergic Conjunctivitis

The best way to prevent another episode of Conjunctivitis is to avoid exposure to the stimulus that causes the symptoms.

• If you are allergic to dust, do not go out when there is a dusty storm.
• If you are allergic to pollen, avoid going out in seasons when pollens are high.
• Follow the weather forecasts to help you plan your day.
• Keep your environment clean and preferably air-conditioned.
• Clean your air conditioning units too.
• Control moisture and humidity to prevent the growth of moulds.
• Swab the floor with a wet rag.
• Avoid dusting or sweeping.
• Clean all air ducts of the house.
• Avoid using carpets; instead, select wood flooring or tiles.
• Use dehumidifiers at home, preferably in basements that have a higher likelihood of humidity.
• If you are allergic to some cosmetics or perfumes, avoid using them.
• If you have a pet, keep it clean and avoid any contact with possible secretions and fur.
• Keep the pet out of the bedroom and wash your hands immediately after you handle the pet.

Wearing contact lenses

Avoid wearing your contact lenses when you have inflamed eyes. Contact lenses can irritate and can worsen the symptoms. Prefer using glasses.

If you have used contact lenses anytime when you have used contact lenses anytime you had symptoms, clean them well before you use them again.

Complications

Cataract: Clouding of the lens of the eye leads to blurred vision. Cataracts may develop at an early age in people with Diabetes.

Glaucoma: Increased fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with Diabetes is nearly twice as likely to get Glaucoma than other adults.

Causes

An elevated blood glucose level is the main factor for retinopathy. These high levels of sugar can cause swelling in the lens leading to blurred vision. Apart from this, high levels of cholesterol and tobacco use also lead to Diabetic Retinopathy.

Symptoms

• Blurred vision.
• The new blood vessels growing on the surface of the retina can bleed into the eye and block vision.

Diagnosis

• Visual test
• Dilated eye exam
• Tonometry (to assess the pressure)

Who is at risk of Diabetic Retinopathy?

People with Diabetes are at high risk. Every Diabetic individual must have an eye check done at least once a year to avoid or detect eye complications.

During pregnancy, Diabetic Retinopathy might be a problem for women with Diabetes. To protect vision, every pregnant woman with Diabetes must have a dilated eye exam done.

Symptoms

• Nearby objects appear blurry
• You need to squint to see the objects clearly
• Eyestrain, painful and burning of eyes
• A Headache or discomfort in the eyes when you read, write or work on the computer

Causes

Farsightedness mainly occurs when your cornea is curved too little or if your eye is shorter than normal. Instead of light focusing on the retina, it focuses behind the retina resulting in the blurry appearance of close-up objects.

Other causes of Farsightedness include:

• Abnormal shape of the cornea
• Abnormal location of the lens
• Rarely, tumours of the eye and Retinopathy disease of the retina

Many children are born with Farsightedness. Moreover, Farsightedness tends to be hereditary.

Does it worsen over time?

Though it begins in childhood, with normal growth and development of the child, the problem is rectified. But, after the cessation of development of the eye, if the child is still farsighted, he or she may be given glasses or contact lenses to wear.

Prevention

You can’t prevent Farsightedness, but you can protect your eyes and vision by following these tips:

• Have your eyes checked regularly
• Know the symptoms and seek immediate care
• Protect your eyes from UV light by wearing sunglasses
• Eat plenty of fruits and vegetables to keep your retina healthy
• Use proper lighting that helps you see better

Diagnosis

Your doctor performs a complete eye examination that includes a series of tests along with a slit-lamp test to check if you have Farsightedness.

Things to do before seeing an eye specialist

• Carry the contact lenses box, if you wear them.
• Make sure you carry your old glasses, if you have one.
• Share the experiences which bother you when you use your eye.

How is Farsightedness treated?

Generally, Farsightedness does not require treatment, especially if you are young because the lenses are so flexible that they can adjust accordingly. As the person ages, the flexibility is lost. So, one needs to wear corrective lenses such as eyeglasses and contact lenses.

Surgical treatment: Surgery for Farsightedness may be required in some cases, which works by correcting the curvature of the cornea, thereby improving the refractivity of the light.

Examples of surgeries are:

• Laser-assisted In-situ Keratomileusis (LASIK)
• Laser-assisted Subepithelial Keratectomy (LASEK)
• Photorefractive Keratectomy (PRK)
• Conductive Keratoplasty (CK)

Post-procedural complications

• Dry eyes
• Blindness
• Risk of infections

Types of Glaucoma

Glaucoma is of two types: Primary open angle Glaucoma, and Acute angle closure Glaucoma, both of these have different symptoms.

In Primary Angle Glaucoma, there is a loss of peripheral vision in both eyes that takes place gradually. In the advanced stages, tunnel vision occurs.

In Acute Angle Closure Glaucoma, there is severe eye pain which is accompanied by nausea and vomiting. The vision is blurred, and the eyes look red. One can see halos around lights.

Symptoms

If a person suffers from the following symptoms, he/she must seek medical help. The symptoms of Glaucoma are:

• Vision loss
• Nausea
• Vomiting
• Redness of the eye
• Pain in the eye

Risk factors

The risk factors of Glaucoma include:

• High pressure in the eyes
• Diabetes
• High Blood Pressure
• Heart Disease
• Hypothyroidism
• Latino and black races
• Nearsightedness

Complications

An early diagnosis and treatment will reduce a range of complications. These include:

• Chronic Epididymitis
• Formation of abscess in the scrotum
• Permanent damage to your Epididymitis
• Reduced fertility

Diagnosis

To measure the intraocular pressure, a painless diagnostic procedure known as Tonometry is done.

Special tests are done to evaluate the amount of Optic Nerve Damage and visual field. A test known as Pachymetry is done to measure the thickness of the cornea.

A test known as Gonioscopy is done to inspect the angle of drainage of fluid.

Another test known as Tonography is done to check how quickly the fluid is draining.

Treatment

There is no complete cure for Glaucoma, but Glaucoma treatment helps in reducing intraocular pressure and prevents the increase in vision loss. Medicated eye drops are prescribed to improve the symptoms, these include Prostaglandin like compounds (bimatoprost, latanoprost); Beta blockers (metipranolol, betaxolol, timolol); Alpha agonists (brimonidine, dorzalamide); cholinergic agents ( carbachol, pilocarpine); carbonic anhydrase inhibitors (brinzolamide, dorzolamide); epinephrine compounds (dipivefrin). Oral medication that can be given in the form of pills is carbonic anhydrase.

If medications are not effective, then surgery for Glaucoma needs to be performed. To open the clogged drain canals in the eyes and allow the fluid to drain out, a procedure known as Trabeculoplasty is done in which beams of laser are used. The other surgical procedures that may be done include drainage implants and filtering surgery. If a patient comes with a severe form of Glaucoma known as Acute angle closure Glaucoma, then it is treated as a medical emergency.

Prevention

Certain lifestyle changes would help to ease pain and discomfort. These include:

• Regular eye care check-up is necessary every year after 60 years of age.
• Eye drops prescribed by the doctor should be taken regularly to prevent further damage.
• People who are Diabetics and have High Blood Pressure should regularly check their blood sugar and blood pressure levels and keep them at normal values. It is very important to protect the eyes from any injury especially when playing sports as severe injuries lead to Glaucoma. Protective eyewear should be worn to safeguard eyes from any injury.

Symptoms

Horner Syndrome shows a combination of signs and symptoms. It is characterized by a triad of symptoms namely

• Miosis: constricted pupil which persists
• Anhidrosis: loss or decrease of hemifacial sweating (on the affected side)
• Partial ptosis: drooping eyelids

The other symptoms include:

• The difference in the pupil size (black part of the eye) between the two eyes
• Delayed or inadequate opening of the affected pupil in dim light
• Sunken eyeballs into the face

Causes and Risk Factors

Horner Syndrome occurs as a consequence of the interruption of the nervous supply from the Brain to the face and eye on one side of the body. The following are the causes of Horner Syndrome:

Nerve fibre injury can occur due to:

• Injury to the main artery of the Brain
• Injury to the nerves supplying the base of the neck
• Tumour in the top of the lung
• Stroke or tumour or any other damage to a part of the Brain
• Migraine or cluster Headache
• Surgery of the nerve fibres to relieve pain

Rarely, Horner Syndrome can be congenital, i.e., it is present at the time of birth. Such cases are detected by a lack of pigment in the iris of the eye.

Treatment

Treatment is based on the cause of the condition. There is no treatment for Horner Syndrome. Treatment is focused on the underlying condition which has caused the Horner Syndrome.

In the case of tumours of the nervous or endocrine system, surgical removal of the tumours, Chemotherapy or Radiotherapy may be beneficial.

Complications

Horner Syndrome does not produce any direct complications. However, complications can arise from the underlying cause or its treatment.

Diagnosis

For a proper diagnosis of Horner Syndrome, your doctor initially will conduct a thorough physical examination of the eye. The medical history of the patient is also taken to get a clue of the underlying cause.

Pharmacological testing is done by putting drops of drugs such as epinephrine, phenylephrine, or hydroxyamphetamine into the suspected eye to check for the reaction of the pupil size to these dilation-causing drugs. By comparing this with the reaction of the normal eye, the physician confirms if the patient has Horner Syndrome associated with nerve damage.

Additional tests are conducted to identify the location of nerve damage. One or more of the below tests may be required to detect the site of abnormality in the nerve:

In the case of children, blood tests may be required to diagnose the presence of Tumours of the nervous or the endocrine system (hormonal system).

Causes

The exact cause of Iritis is undetermined. It can be due to systemic conditions or genetic factors. Some of the conditions that may lead to Iritis include:

• Injury of the Eye: A penetrating injury blunt trauma, or burn due to chemical or fire
• Infections: Infections such as shingles, syphilis, tuberculosis, toxoplasmosis, and Lyme disease
• Genetic Predisposition: Autoimmune Diseases such as Ankylosing Spondylitis, Reiter’s Syndrome, and Psoriatic Arthritis can alter the immune system
• Juvenile Rheumatoid Arthritis: Children with juvenile Rheumatoid Arthritis are more likely to develop Chronic Iritis.
• Sarcoidosis: It is an Autoimmune Disease that leads to Granulomas in the eyes which in turn cause Iritis.
• Medications: Medications such as rifabutin, and cidofovir also cause Iritis

Signs and Symptoms

Iritis develops suddenly and may become chronic if untreated. The signs and symptoms of Iritis include red eyes, discomfort in the eye, blurred vision, sensitivity to light, pain in the eyes, spots in vision, Headache, and small pupils.

Complications associated with Iritis

If Iritis is not treated properly, it can lead to cataracts, irregular pupils, Keratopathy (calcium deposits on the cornea), Glaucoma, and Cystoid Macular Edema.

Diagnosis

First, the doctor performs an external eye examination by using a penlight to look at the pupil and observe the redness, inflammation, and discharge from the eyes. If Iritis is suspected, the doctor would suggest further tests like:

• Visual Acuity: This test is performed to determine the vision power of the eye. The doctor displays a chart of alphabets or numbers and asks the patient to read aloud.
• Biomicroscope examination: This is a special microscope with a slit-light attached to it which is used to examine and identify the inflammatory cells in the front part of the eye.
• Glaucoma Test: The intraocular pressure of the eyes is measured by this test. Elevated pressure levels indicate Glaucoma.

Treatment

The treatment for Iritis aims mainly at reducing pain, and inflammation and preserving the vision. The treatment includes:

• Steroid Eyedrops: These are given to reduce the inflammation of the eyes. Glucocorticoid medications are given as eye drops.
• Dilating Eyedrops: Dilation of the pupil can reduce the pain and inflammation caused by Iritis. Dilating eyedrops are given to reduce the complications that are associated with Iritis.

If the symptoms worsen, the doctors may suggest oral anti-inflammatory drugs and steroids.

Causes

Retinoblastoma can be hereditary and non-hereditary. It occurs when the retinal layer of the eye undergoes genetic mutations. These genetic alterations lead to rapid growth of the cells in the retina leading to the formation of an abnormal mass called the Tumour. The Retinal Tumour can spread to nearby tissues such as the Brain and spine. Hereditary Retinoblastoma may occur in an autosomal dominant pattern, where, if one parent carries the gene for Retinoblastoma, then each child has a 50 per cent chance of inheriting the condition.

Symptoms

Following are the signs and symptoms of Retinoblastoma

• Pain in the eye
• Diminished vision
• Redness in the eye
• Swelling of the eye
• Formation of the white-coloured circle in the pupil of the eye

Complications

In children who are treated for Retinoblastoma, there might be a risk of recurrence. Therefore, regular check-ups will help to reduce the severity and recurrence of the disease. Children with hereditary Retinoblastoma have a higher risk of developing other types of Cancer.

• Chronic Epididymitis
• Formation of abscess in the scrotum
• Permanent damage to your epididymitis
• Reduced fertility

Diagnosis

Your doctor might order any of the following tests:

• Eye examination: Your doctor dilates the pupil by instilling anaesthetic eye drops. This helps to check the signs of Retinoblastoma. Other eye examinations include ophthalmoscopy, Slit-lamp Biomicroscope, and Fluorescein Angiography.
• Imaging tests: Ultrasound, Computerised Tomography, and Magnetic Resonance Imaging studies provide a detailed view of your eye and help to confirm the diagnosis.

Treatment

Your doctor would recommend the treatment based on the size, location of the Tumour, overall health, and extent or severity of the Tumour. Your doctor might recommend any of the following treatments.

Chemotherapy: Chemotherapy uses chemicals to destroy the Cancer cells. Sometimes, chemotherapy is prescribed in combination with Radiation Therapy, Cryotherapy, Laser Therapy, or Thermotherapy.

Radiation Therapy: Radiation therapy uses high-energy beams to destroy the Cancer cells. There are two types of radiation therapies used to treat Retinoblastoma which includes:

• Internal radiation therapy uses a small disc of a radioactive substance which is left in the place of the Tumour for a few days and kills the Cancer cells.
• External beam radiation therapy uses high-energy beams that are delivered into the eye to destroy the Tumour.

Laser Therapy: The laser beam is used to destroy the blood vessels that supply oxygen and nutrients to the cells.

Cryotherapy: Cryotherapy uses liquid nitrogen to kill the Cancer cells.

Thermotherapy: During Thermotherapy, extreme heat is used to kill the Cancer cells, which is guided by ultrasound, microwaves, or lasers.

Surgical management: Your doctor might suggest surgery if your child does not respond to the other treatment options.

• Surgical removal of the affected eye
• Surgery to place an eye implant
• Surgery that involves fitting an artificial eye

Causes

For both eyes to align normally and look at the same object at the same time, there are 6 muscles attached to each eye, which function together to control the movement of the eye. The Brain sends a signal to these muscles and controls their movement.

In people suffering from Strabismus, all these muscles do not work together, therefore, when one eye is looking at an object the other eye turns towards another object. In such cases, a double vision is sent to the Brain, initially, the Brain gets confused, and over time it starts to ignore the image from the weaker eye. Other predicted causes of Strabismus are;

• Family history, if one of the parents or sibling has Strabismus then the risk increases for the next kid
• Refractive error, long-term un-corrected far-sightedness
• Kids with Down syndrome and cerebral palsy who have suffered a Stroke or head injury might develop Strabismus
• Diabetes can cause Acquired Paralytic Strabismus
• High Blood Pressure
• Multiple Sclerosis
• Thyroid Disease
• Retinal damage in premature babies
• Injury to the eye
• Tumour in the Brain or eye
• Loss of vision due to disease or injury

Symptoms

Symptoms of Strabismus can be noticed either around the clock or only when the kid is tired or sick.

• The child may have crossed eyes, which do not move together or misaligned eyes.
• The child may complain of double vision or reduced vision.
• The parents may notice that the child lacks depth perception, and blinks or squints often in bright sunlight.
• They may also notice that the child tilts his head to one side while looking at an object.

Diagnosis

Physical examination and previous medical history are examined to check the alignment of both eyes.

The doctor also asks for symptoms that parents observe, any other medical condition, any medications taken recently or environmental factors that may have contributed to the condition.

A visual acuity test is done to determine the extent to which the vision is damaged.

A refraction test may be conducted to check the range of refraction (Far-sightedness and near-sightedness) and to determine the appropriate power of the lens needed to correct any refractive error.

Alignment and focus testing assess how focused and aligned the eyes move. This test will focus on looking for the exact problem that is keeping the eye from working in unison.

A test called Cover-uncover may be done. It is performed by making the kid look at a particular object, while the doctor observes his eye movement by covering and uncovering the object. The eye structure will be studied to rule out any other problem that is causing Strabismus. Both internal and external eyes will be assessed.

Treatment

Children with Strabismus have several options to correct their Crossed-eye.

• Contact lenses or eyeglasses may be prescribed for kids with uncorrected Far-sightedness. Wearing glass may help them to focus effortlessly and this may alone correct Strabismus in many. Prism lenses are a special type of glasses that reduce the amount of light entering the eyes, and they reduce the amount of turning the eye does while looking at an object.
• Vision therapy is a visual activity program that improves eye coordination and focusing ability. It trains the eye and Brain to work efficiently together.
• Strabismus Surgery is done to correct the length and position of the eye muscle for better alignment. After surgery vision therapy may be required to improve eye coordination.

As in every health complication same is the case with Strabismus, the earlier the Strabismus treatment starts the easier it is to fix the problem. Usually, treatment for correcting the eye may go on for many years, requiring fewer eye drops as time goes by. Sometimes, a single surgery may not correct the problem.

The kid may require many surgeries. As the treatment focuses on aiming for the weaker eye to work effectively to have proper vision, parents must learn every step to take care of their kid and follow the doctor’s instructions carefully.

Complications

As said above for normal vision both eyes must concentrate on the same object at the same time, but in Strabismus each eye focuses on different objects and sends two images to the Brain, Initially, the Brain gets confused but later it ignores the image from the weaker eye.

If this is continuous and is not fixed when the child is young, then it might result in a condition called Amblyopia, a type of vision loss where the Brain starts to always reject images from the weaker eye.