Retina is a ten-layered delicate structure inside our eyes, it captures the visual images and send it to our Brain for visual perception. Retina gets damaged in various conditions which should be diagnosed and treated as early as possible.
Retinopathy of Prematurity Occurs in Pre term and Low birth weight babies (Has to be seen and treated less than 1 month of age)
Retinal Vascular Occlusions
Retinal Holes and Lattice degenerations
Age Related Macular Degeneration
Cystoid macular edema
Most of these conditions can be managed with Laser photocoagulation and injections into the eye which can be done in day care. Proper systemic control of Diabetes, Hypertension, Dyslipidemia is very important in prevention and control of many retinal diseases. Very few conditions require retina surgery. These conditions if not intervened properly will lead to gross and permanent visual loss.
Cataract is clouding of the lens in eye which leads to decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurring of vision, halos around light, trouble with bright lights, and trouble seeing at night. This may result in trouble for driving, reading, or recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts are the cause of half of blindness and 33% of visual impairment worldwide.
Cataracts are most commonly due to aging but may also occur due to trauma or radiation exposure, be present from birth, or occur following eye surgery for other problems.Risk factors
Either clumps of protein or yellow-brown pigment may be deposited in the lens reducing the transmission of light to the retina at the back of the eye.
Prevention includes wearing sunglasses and not smoking. If this does not help, surgery to remove the cloudy lens and replace it with an artificial lens is the only effective treatment. Surgery is needed only if the cataracts are causing problems and generally results in an improved quality of life.
About 20 million people are blind due to cataracts. Blindness from cataracts occur in about 10 to 40 per 100,000 children in the developing world, and 1 to 4 per 100,000 children in the developed world. Cataracts become more common with age. More than half the people in the United States had cataracts by the age of 80.
Glaucoma is the second-leading cause of blindness worldwide (behind cataracts).
Glaucoma is a group of related eye disorders that cause damage to the optic nerve that carries information from the eye to the brain.
Glaucoma often is called the silent thief of sight, because most types typically cause no pain and produce no symptoms until noticeable vision loss occurs, by the time patient notice problems with their sight, the disease has progressed to the point that irreversible vision loss has already occurred and additional loss may be difficult to stop.
In most cases, glaucoma is associated with higher-than-normal pressure inside the eye — a condition called ocular hypertension. But it also can occur when intraocular pressure (IOP) is normal. If untreated or uncontrolled, glaucoma first causes peripheral vision loss and eventually can lead to blindness.
And because most cases of glaucoma have few or no early symptoms, about half of patients with glaucoma don't know they have it.
The two major categories of glaucoma are open-angle glaucoma (OAG) and narrow angle glaucoma. The "angle" in both cases refers to the drainage angle inside the eye that controls the outflow of the watery fluid (aqueous) that is continually being produced inside the eye.
If the aqueous can access the drainage angle, the glaucoma is known as open angle glaucoma. If the drainage angle is blocked and the aqueous cannot reach it, the glaucoma is known as narrow angle glaucoma.
Primary open-angle glaucoma.
This common type of glaucoma gradually reduces your peripheral vision without other symptoms. By the time you notice it, permanent damage already has occurred.
If your IOP remains high, the destruction caused by POAG can progress until tunnel vision develops, and you will be able to see only objects that are straight ahead. Ultimately, all vision can be lost, causing blindness.
Acute angle-closure glaucoma.
Also called narrow-angle glaucoma, acute angle-closure glaucoma produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting.
These signs constitute a medical emergency. The attack may last for a few hours, and then return again for another round, or it may be continuous without relief. Each attack can cause progressively more vision loss.
Like POAG, normal-tension glaucoma (also called normal-pressure glaucoma, low-tension glaucoma or low-pressure glaucoma) is a type of open-angle glaucoma that can cause visual field loss due to optic nerve damage. But in normal-tension glaucoma, the eye's IOP remains in the normal range.
Also, pain is unlikely and permanent damage to the eye's optic nerve may not be noticed until symptoms such as tunnel vision occur.
The cause of normal-tension glaucoma is not known. But many doctors believe it is related to poor blood flow to the optic nerve. Normal-tension glaucoma is more common in those who are Japanese, are female and/or have a history of vascular disease.
This rare form of glaucoma is caused by clogging of the drainage angle of the eye by pigment that has broken loose from the iris, reducing the rate of aqueous outflow from the eye. Over time, an inflammatory response to the blocked angle damages the drainage system.
You are unlikely to notice any symptoms with pigmentary glaucoma, though some pain and blurry vision may occur after exercise. Pigmentary glaucoma most frequently affects white males in their mid-30s to mid-40s.
Symptoms of chronic glaucoma following eye injury could indicate secondary glaucoma, which also may develop with presence of eye infection, inflammation, a tumor or enlargement of the lens due to a cataract.
This inherited form of glaucoma is present at birth, with 80 percent of cases diagnosed by age one. These children are born with narrow angles or some other defect in the drainage system of the eye.
It's difficult to spot signs of congenital glaucoma, because children are too young to understand what is happening to them. If you notice a cloudy, white, hazy, enlarged or protruding eye in your child, consult your eye doctor. Congenital glaucoma typically occurs more in boys than in girls.
During routine eye exams, a tonometer is used to measure your intraocular pressure, or IOP. Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers send a puff of air onto your eye's surface. An abnormally high IOP reading indicates a problem with the amount of fluid (aqueous humor) in the eye. Either the eye is producing too much fluid, or it's not draining properly. Normally, IOP should be below 20 mmHg .
If your IOP is higher than 30 mmHg, your risk of vision loss from glaucoma is 40 times greater than someone with intraocular pressure of 15 mmHg or lower. This is why glaucoma treatments such as eye drops are designed to keep IOP low.
Other methods of monitoring glaucoma involve the use of sophisticated imaging technology — such as scanning laser polarimetry (SLP), optical coherence tomography (OCT) and confocal scanning laser ophthalmoscopy — to create baseline images and measurements of the eye's optic nerve and internal structures.
Visual field testing is a way for your eye doctor to determine if you are experiencing vision loss from glaucoma. The visual field test may be repeated at regular intervals to make sure you are not developing blind spots from damage to the optic nerve or to determine the extent or progression of vision loss from glaucoma.
Gonioscopy also may be performed to make sure the aqueous humor (or "aqueous") can drain freely from the eye. In gonioscopy, special lenses are used with a biomicroscope to enable your eye doctor to see the structure inside the eye (called the drainage angle) that controls the outflow of aqueous and thereby affects intraocular pressure. Ultrasound biomicroscopy is another technique that may be used to evaluate the drainage angle.
Treatment can involve lasers, medication, glaucoma surgery, depending on the severity. Eye drops with medication aimed at lowering IOP usually are tried first to control glaucoma.
Because glaucoma often is painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage.
Non-compliance with a program of prescribed glaucoma medication is a major reason for blindness caused by glaucoma.
If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.
The uvea is the pigmented middle layer of the eyeball. It has three segments: iris, ciliary body and choroid.
ris- Iris is a thin, circular structure made of connective tissue and muscle that surrounds the pupil. Colour of our eyes is determined by the amount of pigment in the iris.
Ciliary body- The second part of uvea is ciliary body. It surrounds the iris and cannot be seen because it's located behind the opaque sclera (white of the eye). It secretes the transparent liquid (aqueous humour) into the eye.
Choroid- The posterior portion of uvea is choroid, which is a layer of blood vessels and connective tissue sandwiched between the tough outer sclera of the eyeball and the retina in the back of the eye.
Uveitis occurs when the middle layer of the eyeball gets inflamed (red and swollen). This layer, called the uvea, has many blood vessels that nourish the eye. Uveitis can damage vital eye tissue, leading to permanent vision loss.
There are 3 types of uveitis. They are based on which part of the uvea is affected.
Swelling of the uvea near the front of the eye is called anterior uveitis. It starts suddenly and symptoms can last up to 8 weeks. Some forms of anterior uveitis are ongoing, while others go away but keep coming back.
Swelling of the uvea in the middle of the eye is called intermediate uveitis. Symptoms can last for a few weeks to many years. This form can go through cycles of getting better, then getting worse.
Swelling of the uvea toward the back of the eye is called posterior uveitis. Symptoms can develop gradually and last for many years.
In severe cases, all layers may be involved (Panuveitis)
Doctors do not always know what causes uveitis. You are more likely to get uveitis if you have or have had:
Infections such as Tuberculosis, Shingles virus, Herpes simplex virus, Syphilis, Lyme disease, and Parasites such as Toxoplasmosis.
A systemic inflammatory disease such as inflammatory bowel disease (IBS), rheumatoid arthritis or lupus
An eye injury
Smoking (cigarettes, cigars or pipes) also increases your risk of getting uveitis.
Uveitis can develop suddenly. Symptoms can include:
having a red eye with or without pain
being very sensitive to bright light
having blurry vision
seeing “floaters” (specks or moving clouds in your vision) all of a sudden
Your ophthalmologist will examine the inside of your eye. Since uveitis is often connected with other diseases or conditions, some tests may be needed. They may include a physical exam, blood or skin tests, examination of eye fluids, and imaging tests, such as X-rays. Your ophthalmologist may ask about other diseases or health problems you have had.
ROP occurs due to abnormal growth of blood vessels in the eyes of pre-term babies. The process of normal development of blood vessels which is from the central part of the retina outwards is completed few weeks before the time of full term delivery. If blood vessels grow normally ROP doesn’t occur. On the contrary if they grow and branch abnormally the baby develops ROP. ROP is an increasingly important cause of visual impairment and blindness in children. A recent estimate suggests that in the year 2010, 32,200 infants developed visual loss from ROP in both eyes, with the highest incidence being in East, Southeast Asia and the Pacific region. Incidence of ROP in India is between 38-51% and it is high as 80% in infants weighing < 900 Gms at birth or < 25 wks gestational age. In the absence of an effective screening strategy number of children going irreversibly blind is increasing as the disease affects both the eyes simultaneously and if left untreated can lead to blindness.
Pre Term babies
Low Birth Weight
Anemia needing blood transfusion
Apnea (Respiratory distress)
Birth weight of 2000 gms or less. Gestational age of 34 weeks or less. Heavier or older babies can be included depending on attending risk factors.
A good rule to remember is first screening at 1 month of birth in babies born at more than 28 weeks of gestation age. 2-3 wks after birth in very low birth weight babies(1200 gms) and age less than 28wks.
Retina specialist can detect ROP by dilated fundus examination. Indirect ophthalmoscopy is done to scan the entire retina and grade the stage of maturity.
Chances of unfavourable disease outcomes can be reduced with above procedures. Mild forms of ROP may resolve without any active intervention. Surgical intervention is necessary once the disease reaches stage 4 & 5.
Once treated, lifelong follow up (yearly) is mandatory. All other premature infants irrespective of having ROP , yearly follow up till the age of 5 yrs is advisable to rule out sequelae.
Presence of Plus disease explains the severe nature of the disease and needs to be addressed without further delay.
Get a Retina evaluation for pre-term and risk babies. Follow the 30 Day strategy. Your awareness could save the babies from becoming blind.
Ocular trauma is an emergency which needs to be handled as early as possible. Trauma can happen accidentally, road traffic accidents, iatrogenic, sports injuries and various other means.
Open globe injury
Close globe injury
Sub macular or intraretinal haemorrhage
Ocular infections can be extraocular over the eye, periocular around the eye and intraocular which is inside the eye.
Infections to eye can occur after direct exposure of the infective organism to the eye from environment, as a sequelae to ocular trauma or it can spread from other structures of our body through blood. Infection very rarely can spread from eye to other structures also.
It is very important to identify the source of infection and treat them with appropriate antibiotics at the earliest.
Refractive errors (Myopia, hyperopia, presbyopia)
Discharge from the eyes
Ocular emergencies are the conditions to eye which needs immediate intervention in order to protect and prevent from getting the condition worse.
Central retinal artery occlusion
Drug induced eye reaction