Acanthamoeba Keratitis

Although very rare, Acanthamoeba Keratitis is an extremely painful sight-threatening infection of the front part of the eye (the cornea) caused by an amoeba found in almost all soil, fresh water, sea water and even air. It is known to thrive where limescale and bacteria are present, but contact lens wearers are at highest risk if they clean their lenses or lens cases in tap water, or swim while wearing their lenses.

Therefore, lens wearers should never rinse the lenses or lens cases with tap water. Don't even use distilled water. You should always follow your optometrist's instructions on disinfection and clean lenses daily in the correct sterile solutions. When used and cared for properly contact lenses offer an extremely safe and effective form of vision correction

The pain associated with Acanthamoeba Keratitis is intense but often far worse than the inflammation of the eye that can accompany it. The condition requires immediate treatment so don't wait until visible signs appear. Contact lens wearers who experience any kind of unusual or intense pain in their eyes should contact Campbell Eyecare straight away.





Age Related Macular Degeneration

What is the macula?
Imagine that your eye is like a camera. There is a lens and an aperture (an opening) at the front, which both adjust to bring objects into focus on the retina at the back of your eye. The retina is made up of a delicate tissue that is sensitive to light, rather like the film in a camera.

The macula is found at the centre of the retina where the incoming rays of light are focused. The macula is very important and is responsible for:


•What we see straight in front of us

•The vision needed for detailed activities such as reading and writing

•Our ability to appreciate colour


What is macular degeneration?
Sometimes the delicate cells of the macula become damaged and stop working. We do not know why this is, although it tends to happen as people get older. This is called age-related macular degeneration. Because macular degeneration is an age-related process it usually involves both eyes, although they may not be affected at the same time. With many people the visual cells simply cease to function, like the colours fading in an old photograph - this is known as 'dry' degeneration. Sometimes there is scarring of the macula caused by leaking blood vessels and this is called disciform maculopathy. Children and young people can also suffer from an inherited form of macular degeneration called macular dystrophy. Sometimes several members of a family will suffer from this, and if this is the case in your family it is very important that you have your eyes examined regularly.

Is there any good news!?
Macular degeneration is not painful, and never leads to total blindness. It is the most common cause of poor sight in people over 60 but never leads to complete sight loss because it is only the central vision that is affected. Macular degeneration never affects vision at the outer edges of the eye. This means that almost everyone with macular degeneration will have enough side vision to get around and keep their independence.

What are the symptoms?
In the early stages your central vision may be blurred or distorted, with things looking an unusual size or shape. This may happen quickly or develop over several months. You may be very sensitive to light or actually see lights that are not there. The macula enables you to see fine detail and people with the advanced condition will often notice a blank patch or dark spot in the centre of their sight. This makes activities like reading, writing and recognising small objects or faces very difficult.

What should I do if I think I have macular degeneration?
If you suspect that you may have macular degeneration but there are no acute symptoms you should contact the practice who can refer you to the hospital if necessary. If you have acute symptoms then you should contact the practice immediately or the local casualty department if the practice is closed. There is a fast track system to refer patients with “Wet” macular degeneration to Raigmore Hospital for urgent treatment with the latest medication. If macular degeneration has already been diagnosed in one of your eyes, and your other eye is getting acute symptoms, then you should go to the hospital that usually looks after you, or your local casualty department, as soon as possible.

What does an examination involve?
Firstly there will be an assessment of your vision in both eyes. Then you will be given eye drops which enlarge your pupil so that your optometrist can look into your eyes. The drops take about 20 minutes to work although their effect may last for several hours. Your vision will become blurred for a while and your eyes will become very sensitive to light, but this is nothing to worry about.

What is fluorescein angiography?
In some cases your optometrist may decide to refer you to the hospital where a doctor may recommend a fluorescein angiogram. This involves taking a series of colour photographs of your retina with bright flashes of light. These photographs give an accurate map of the changes occurring in the macula and help your eye specialist to decide what is the best treatment for you. For the angiogram you will be given a small injection of special dye in your arm which then works its way around to your eye. This is not painful but you may feel a bit sick. A series of rapid pictures are then taken with a blue light over the next few minutes. There are few side effects, although some people find that they are dazzled for a while afterwards. You may also notice that the injection has left your skin with a faint yellow tinge from the fluorescein dye but this soon passes as it is excreted in your urine.

Can I be helped to see better?
Don't be discouraged - you can be helped to see better. With disciform degeneration laser treatment can help some people if the condition is diagnosed early enough. There are also a variety of optical aids which make use of the parts of the retina that are not affected. These range from brighter reading lights and simple magnifying glasses to more sophisticated equipment. Your optometrist can refer you you to the hospital low vision clinic.

What does laser treatment involve?
If you have disciform degeneration certain abnormalities on the macula can sometimes be treated by laser. This is usually done as an outpatient, and although it may cause some discomfort, is not painful. You will sit at a slit lamp and special contact lens are put into the eye to help focus the laser onto the macula.

Unfortunately, with most people the areas of degeneration are in the middle of the macula, at its focal point. This means that treatment cannot be given because the scars produced by the laser would make central vision worse rather than better. Laser treatment is useful for about 10 per cent of people with disciform degeneration, and this always where people have reported their symptoms early. If successful it can prevent things getting worse, and sometimes bring back sight that is already lost. 'Dry' degeneration cannot be treated by laser.

What research is going on?
There is a great deal of research that is looking into the causes of macular degeneration and how it can be treated. With 'dry' degeneration, there have been claims that certain types of medical therapy can halt the condition, but this remains uncertain.

You can find out more from the: Macular Disease Society,

PO Box 247, Haywards Heath, West Sussex RH17 5FF
Astigmatism

For normal undistorted vision, the cornea should be smooth and equally curved in all directions. When astigmatism is present, the cornea is warped and curves more in one direction than the other. In other words, the cornea is shaped more like the side of a rugby ball than a football where, in one direction, the surface is steeper (more curved) than the other.

Normally, light enters the eye and is focused precisely on the retina. With astigmatism, the warped cornea causes the light rays to bend improperly depending on where they strike the cornea. They are not refracted (bent) equally in all directions and so one focal point on the retina is not attained. Some light rays are not focused on the retina but are focused in front of or behind the retina. The result of multiple focal points is distorted vision. Objects appear somewhat indistinct and slanted. Vision with astigmatism can be compared to what one sees when looking through a glass bottle or seeing yourself in the Hall of Mirrors at the funfair, with images appearing too tall, too thin, too wide, or blurred.

Astigmatism is most often caused by a defect in the curvature of the cornea but may also occur from an unequal bending of light by the lens inside the eye. Astigmatism can occur in conjunction with short-sightedness (myopia) or long-sightedness (hyperopia) and usually remains unchanged through life despite natural changes in the amount of myopia or hyperopia.

Astigmatism can also result from corneal scars or surgery. Eye surgery may cause the cornea to scar and warp, changing the path of light as it enters the eye. Some patients experience surgically induced astigmatism after eye surgery. Tightly tied sutures can cause a slight wrinkling of the cornea. The patient will experience distorted vision or astigmatism until healing or loosening of the sutures relieves the problem.

Astigmatism is diagnosed during a routine eye examination. A visual acuity test is performed to determine the unaided ability of the eye to focus light correctly. A process called refraction is used to measure the refractive error of the eye (myopia or hyperopia) and includes specific test to detect, measure and correct astigmatism. The final result determines the prescription for corrective lenses that correct myopia, hyperopia and astigmatism as necessary

A small amount of astigmatism is common and usually does not need correction. However, in cases where the problem is more severe, glasses and contact lenses are used to correct vision. To correct astigmatism, glasses or contact lenses are ground to neutralise the defective curvature of the cornea. Hard or gas permeable contact lenses generally improve astigmatism better than soft contact lenses. But in many cases soft contact lenses can be helpful.

For a complete examination and professional advice regarding you vision correction needs, contact us to make an appointment.


Blepharitis

Blepharitis, or granulated eyelids, is a common problem that produces a red-rimmed appearance to the edge of the eyelids. This condition is often chronic and involves both the upper and lower lids.

Common symptoms include dandruff-like scales or grainy material adhering to the lashes and lid edges. The symptoms can include itching, burning, sticky, crusted eyelids on awakening, and a feeling of “something in the eye.”

Granulated lids cannot be cured, but the symptoms can be controlled with treatment.

Treatment may consist of cleaning and removing any scales from the lid edges, frequent shampooing of the scalp and eyebrows, and ointment applied at bedtime when indicated.

Follow these instructions:


1.Apply a warm, moist hand towel to the closed lids for five to 10 minutes in the morning and at bedtime.

2.Following the warm compresses at bedtime, use Lidcare applied to a cleaning patch, and gently scrub from side to side on the upper eyelids and lashes for 15 to 20 seconds.

3.Pull the lower lid down and away from the eyeball and gently scrub side to side along the edge of the lower eyelid and lashes for 15 to 20 seconds. Avoid scrubbing the eyeball.

4.Rinse the lids with clear, warm water.

5.If instructed by your optometrist, place a 1/4-inch strip of ointment under the lower lids at bedtime and rub the excess onto the lid edges.

6.If you have a problem with dandruff of the scalp and eyebrows, shampooing frequently with a shampoo containing selenium sulphide or pyrithione zinc (such as Head & Shoulders) will be helpful.

7.Continue this treatment for two to three weeks or until the problem is controlled. After an initial treatment period, it will most likely be necessary to continue to use warm compresses and lid scrubs from time to time to keep the lid scales under control.




Chalazion

A chalazion is an enlargement of a long, thin oil gland in the eyelid that results from an obstruction of the gland opening at the edge of the eyelid.

At first, a chalazion looks and feels like a stye, with swollen eyelid, pain, and irritation. However, after a few days the symptoms disappear, leaving a round, painless swelling in the eyelid that grows slowly for the first week. A red or gray area may develop underneath the eyelid.

Most chalazions disappear without treatment after a few months but always be sure to have any growths examined by a professional. Contact us to make an appointment.


Colour Vision Deficiency

What is colour vision deficiency?
Colour vision deficiency almost never means 'seeing in black and white'. The nerve cells which receive and process light at the back of the eye - the retina - are of two main types: the 'rods', which operate at night and the 'cones', which allow us to see fine detail and colours by day. Three different chemicals can be found within the cone nerve cells, so that each cone responds best to red, green or blue light in a similar manner to colour television. The fault of defective colour vision lies in one set of chemicals, usually those controlling principally either red or green colours.

It is not generally realised that defective colour vision can range from near- normal appreciation of hues, where the chemical within the "red" or "green" cones is only slightly altered, to a medium degree of confusion where the chemical is altered considerably. For the first group, pale colours will give most common difficulties in identification, and deep colours will be confused if the lighting is poor, or the person is tired or under pressure to make a quick decision of colour name.

Only a third of those with colour vision problems have the more severe form where one sort of chemical is completely lacking and very strong colours are frequently confused, though still within a limited range of up to ten main colours. Complete colour deficiency, where all colours are seen as varying shades of black and white is extremely rare.

Why are more men than women colour deficient?
Like many other medical conditions, defective colour vision may be inherited and carried through the mother (whose vision will be apparently normal) to the son. Frequently, brothers within the same family are affected, but this is not always the case as there is only a 50/50 chance the sons of "carriers" will have altered colour vision.

A female can only inherit defective colour vision if her father has the problem and her mother is a carrier or herself colour deficient. The pattern of inheritance is simple, so future generations of colour blind individuals can be easily predicted.

Will Inherited colour deficiency change with age?
No. The inherited alterations to colour vision involve both eyes and remain stable through life.

Can one develop colour deficiency?
Yes, but not in the inherited form. A whole range of prescribed drugs, systemic conditions such as diabetes, multiple sclerosis and cardiovascular diseases (including high blood pressure), some liver diseases and many eye diseases, can affect the cones or the nerve pathways from them to the brain. In these cases, colour vision may be temporarily or permanently altered, often in one eye at a time. Difficulty in colour discrimination may be noticed along with other visual problems, such as overall blurring of near or distance vision, or gaps in the field of vision. Women and men are equally at risk from this type of colour vision deficiency.

Drugs prescribed for arthritis, malaria, depression and heart disease can, on occasion, significantly impair colour vision. Even long-term use of aspirin can change colour perception. Tobacco and alcohol taken in excess can have similar effects. Many industrial chemicals can permanently alter appreciation of colours. Glaucoma, cataract and most eye problems affecting the retina or nerve pathways to the brain can give gradually worsening problems with many different colours, including blues and greens.

Since colour vision changes can be an early sign of disease or a side effect of prescribed medication, if you are aware that your appreciation of colours is changing, it is important to discuss it with your optometrist.

Can colour vision deficiency be a handicap?
Colour is relevant to many aspects of everyday life and some jobs and careers do involve some degree of colour identification. Colour coding is important in industry and for signal lights, so it is understandable that British Rail and the London Underground check for defective colour vision at a pre-employment medical. Many large companies involved with printing inks, textiles, paints and electronic components screen prospective employees and may refuse entry for certain jobs if colour perception is inadequate. Despite the introduction of instruments for colour matching, the human eye is still the most sensitive instrument of all. Restrictions in some branches of the Services, Police Force and Civil Service are often strongly enforced.

Although some people with abnormal colour vision are not denied a driving licence, there have been a few cases of death caused by people with faulty colour perception driving through a red traffic light. In some countries, law prohibits colour defective people from driving commercial vehicles.

Colour also has a special place in the child's world, being used as an aid to learning. Studies have failed to show any educational handicap resulting from faulty colour vision, but parents, GPs and teachers may not necessarily be well-informed on this subject. It is always sensible to inform teachers if a child is known to have difficulty in identifying colours.

Can anything be done to correct colour deficiency?
Although nothing can replace a faulty mechanism in the retina of the eye - which is essentially a part of the brain - many colour defective people do learn ways of compensating for their difficulty with experience and help from relatives and colleagues. It is important that good lighting is always available.

Many people find help, albeit limited, identifying certain colours that they would otherwise misname, with the aid of a small red or red-mauve filter of transparent plastics or glass held in front of the eye. Often red cellophane can help. This is best tried at home with a selection of transparent coloured materials, but it is not usual to prescribe tinted spectacles for this purpose, since only one eye must use the filter. A red tinted contact lens (branded the 'Chromagen' lens can be worn in one eye to help colour recognition, but the results cannot be guaranteed. There is no way of restoring the lost sensation or appreciation of colour.
How can I have my colour vision tested?
Straightforward clinical tests have been devised to screen for defective colour vision, most taking only a matter of minutes. These involve reading coloured numbers from a book or arranging coloured papers in order, or naming coloured lights. Campbell Eyecare can administer such a test as part of an eye examination if your optometrist believes it to be necessary or if you request it or . Some school medical examinations may include colour vision tests. But for the individual, the best advice is that if there is the slightest reason for doubt contact us to book a comprehensive eye examination that includes a test for colour vision.


Conjunctivitis

Conjunctivitis is inflammation of the conjunctiva, the thin, transparent layer that lines the inner eyelid and covers the white part of the eye.

The three main types of conjunctivitis are infectious, allergic and chemical. The infectious type, commonly called "pink eye" in the USA is caused by a contagious virus or bacteria. Your body's allergies to pollen, cosmetics, animals or fabrics often bring on allergic conjunctivitis. Irritants like air pollution, noxious fumes and chlorine in swimming pools may produce the chemical form of the condition.

Common symptoms of conjunctivitis are red watery eyes, inflamed inner eyelids, blurred vision, a scratchy feeling in the eyes and, sometimes, a pus-like or watery discharge. Conjunctivitis can sometimes develop into something that can harm vision so you should see your optometrist promptly for diagnosis and treatment.

A good way to treat allergic or chemical conjunctivitis is to avoid the cause. If that does not work after examination and diagnosis, your optometrist may prescribe certain eye drops which relieve discomfort and aid resolution. Infectious conjunctivitis, caused by bacteria, can be treated with antibiotic eye drops. Other forms, caused by viruses, cannot be treated with antibiotics. They must be fought off by your body's immune system.

To control the spread of infectious conjunctivitis, you should keep your hands away from your eyes, thoroughly wash your hands before applying eye medications and do not share towels, washcloths, cosmetics or eye drops with others.

As with any problem with your eyes, no matter how seemingly minor, it must be investigated by an expert. If you have any problems with your eyes, don't wait or self medicate, contact us for an appointment where your optometrist will thoroughly investigate and manage the problem. If you are a contact lens wearer, remove your contact lenses immediately and keep them out until you have been seen by your optometrist.



Corneal Dystrophy

What is Corneal Dystrophy?
The globe of the eye is made of five layers and the cornea is the transparent front portion. It is also the most sensitive structure in the body because of the high number of nerve endings per square millimetre, even more so than the tips of your fingers.

The cornea owes its transparency to the presence of a regular lattice structure of collagen fibres. Anything which affects this regularity results in loss of the transparency which is essential for good corneal function and health.

Corneal dystrophies are a group of rare disorders which usually affect both eyes. They may be present at birth, but more frequently develop during adolescence and progress gradually throughout life. Some forms are mild, others severe.

What are the causes of Corneal Dystrophies?
This group of disorders tends to run in families and the causes of most corneal dystrophies will lie in individual genetic make-up.

What are the effects of a Corneal Dystrophy?
Although age of onset, symptoms and progression differ in the various dystrophies, most cases of corneal dystrophy fall into three types, classified by their inheritance pattern and appearance. These are Granular Dystrophies, Macular Dystrophy and Lattice-like Dystrophies.




1.Granular Dystrophy usually starts at around 5 years of age. This can be seen as small white dots in the centre of the cornea or may take the form of lines radiating from the centre. These signs can increase in size and number and by 50 years of age, opacities are visible to the naked eye.

2.Macular Dystrophy (not to be confused with macular degeneration which affects the retina at the back of the eye) usually starts in the first decade of life and appears as a thin superficial corneal veil with isolated opacities when seen with a slit lamp. It is the least common type of dystrophy. Acute, short lived, attacks may be experienced and there is increasing haziness of the central part of the cornea and increasing isolated opacities.

3.Lattice Dystrophy can develop in infancy but more usually during the second decade of life. This is seen as a cobweb of fine lines which develop into a lattice-like pattern. By 40 years of age onwards, the centre of the cornea can become irregular with ill-defined opacity. Although in some people the pattern of progress is less severe, acute attacks are experienced which can contribute to relatively early onset of sight loss.

Among the many other types, Map/Dot/Fingerprint Dystrophy, Fuch’s Dystrophy, Meesman Dystrophy and RET-Buckler Dystrophy are most encountered.

What are the genetics behind dystrophies?
Dominant, single gene diseases result from one of a pair of matched autosomal genes having a disease and the other being normal. With each pregnancy there is a 1 in 2 chance of the disease appearing in the offspring. Recessive single gene disease requires both parents to carry the condition and this results in a 1 in 4 inheritance risk in each pregnancy. Only siblings within a single generation are affected, unless members of that generation create offspring with another carrier of the specific gene.




It is valuable to seek genetic advice on all conditions, which have an hereditary cause in order to identify how this may affect individual family members.




What is the prognosis?
Although there are many more forms of corneal dystrophy, likely outcome varies with the type of dystrophy:




1.Granular dystrophies are usually mild and may be unnoticed by those with the condition. In some cases sight is not affected even in later years.

2.Macular Dystrophy is a severe dystrophy which may cause considerable damage by 30 years of age.

3.Lattice Dystrophies can be either mild or severe and from middle-age these may cause acute attacks, capable of causing serious sight loss.

Is there any treatment?
In some conditions corneal grafting offers a good prospect of visual improvement, but there is nothing that can be done to stop a dystrophy that has been diagnosed. If you or someone in your family has been diagnosed with a corneal dystrophy, contact us to make an appointment to discuss your condition.

At Campbell Eyecare, even a routine examination involves a thorough examination of all parts of the eye including a high magnification examination of the cornea and all its layers to detect even the earliest signs of corneal dystrophy.


Diabetes and your vision

What is diabetes?
Diabetes mellitus or `sugar diabetes' affects about one person in fifty in the UK. This means that the body cannot cope normally with sugar and other carbohydrates in the diet. Research indicates there may be up to half a million people who are undiagnosed.

Diabetes can start in childhood, but it often begins later in life. It can cause complications, which affect different parts of the body. There are two types of diabetes mellitus - one is controlled by insulin injections and the other by diet or tablets, but they both affect the eyes in the same way.

If you have diabetes this does not necessarily mean that your sight will be affected, but there is a higher risk. If your diabetes is well controlled then you are less likely to have problems, or they may be less serious. However if there are complications which affect the eyes then this can result in loss of sight.

Why are regular eye tests are important?
Most sight loss from diabetic retinopathy can be prevented. But it is vital that it is diagnosed early. You may not realise that there is anything wrong with your eyesight, and so regular eye checks are extremely important.

How can diabetes affect the eye?
Your eye has a lens and an aperture (opening) at the front, which adjust to bring objects into focus on the retina at the back of the eye. The retina is made up of a delicate tissue that is sensitive to light, rather like the film in a camera.

At the centre of the retina is the macula, which is a small area about the size of a pinhead. This is the most highly specialised part of the retina and it is vital because it enables you to see fine detail and read small print. The other parts of the retina give you side vision (peripheral vision). Filling the cavity of the eye in front of the retina is a clear jelly-like substance called the vitreous humour.

Diabetes can affect the eye in a number of ways. These usually involve the fine network of blood vessels in the retina - hence the term diabetic retinopathy.

Temporary blurring
Your vision may become blurred for a few days or weeks while your diabetes is first being controlled. This is due to the swelling of the lens of the eye and will soon clear without treatment soon after the diabetes is controlled.

Cataract
This can occur in two forms:


•Young people with diabetes very occasionally develop a special type of cataract. Although their vision gets worse, it can be restored by surgery;

•Older people with diabetes can be especially prone to developing cataracts. Cataracts can be successfully removed by surgery and usually it is possible to insert a lens implant. However this is unsuitable for some people and your optometrist will tell you if this is the case.

Diabetic retinopathy
The most serious diabetic eye condition involves the retina and is called diabetic retinopathy.

Background diabetic retinopathy
This condition is very common in people who have had diabetes for a long time. Your optometrist may be able to see abnormalities in your eyes, but there is no threat to your sight.

There are two types of diabetic retinopathy, which can damage your sight. Both involve the fine network of blood vessels in the retina. They are described below.

Maculopathy
This happens when the blood vessels in the retina start to leak.


•If the macula is affected, you will find that your central vision gradually gets worse. You may find it difficult to recognise people's faces in the distance or to see detail such as small print. The amount of central vision that is lost varies from person to person. However the vision which allows you to get around at home and outside (navigation vision) will be preserved.

•It is very rare for someone with maculopathy to lose all his or her sight.


Proliferative diabetic retinopathy
Sometimes diabetes can cause the blood vessels in the retina to become blocked. If this happens then new blood vessels form in the eye. This is nature's way of trying to repair the damage so that the retina has a new blood supply.

Unfortunately these new blood vessels are weak. They are also in the wrong place - growing on the surface of the retina and into the vitreous jelly. Consequently these blood vessels can bleed very easily and cause scar tissue to form in the eye. The scarring pulls and distorts the retina. When the retina is pulled out of position this is called retinal detachment.


•This condition is rarer than background retinopathy and is more often found in people who have been insulin dependent for many years.

•The new blood vessels will rarely affect your vision, but their consequences, such as bleeding or retinal detachment can cause your vision to get worse suddenly.

•Your eyesight may become blurred and patchy as the bleeding obscures part of your vision.

•Without treatment, total loss of vision can happen in proliferative retinopathy.

With treatment most sight-threatening diabetic problems can be prevented if caught early enough.

The importance of early treatment
Although your vision may be good, changes can be taking place to your retina that need treatment and because most sight loss in diabetes is preventable:


•Early diagnosis is vital

•Have an eye examination every year

•Do not wait until your vision has deteriorated to have an eye test.

Your optometrist can examine for diabetic retinopathy. Campbell Eyecare uses digital retinal photographs to detect abnormalities. If a problem is found you will be referred to an ophthalmologist at a hospital eye clinic.

Remember, however, that if your vision is getting worse, this does not necessarily mean you have diabetic retinopathy. It may simply be a problem that can be corrected by glasses.

What is the treatment?
Most sight-threatening diabetic problems can be prevented by laser treatment if it is given early enough. It is important to realise however that laser treatment aims to save the sight you have - not to make it better. The laser, a beam of high intensity light, can be focused with extreme precision. So the blood vessels that are leaking fluid into the retina can be sealed.

If new blood vessels are growing, more extensive laser treatment has to be carried out. In eight out of ten cases laser treatment causes the new blood vessels to disappear.

How is laser treatment carried out?
All treatment is carried out in an outpatient clinic and you will not have to stay in hospital. Eye drops are used to enlarge the pupils so that the doctor can look into your eye. The eye is then numbed with drops and a small contact lens is put onto your eye to stop it blinking. The eyes need to be moved in certain directions but this can easily be done with the contact lens in place.

Is it painful?
The treatment for sealing blood vessels doesn't usually cause any discomfort. However the treatment to remove new blood vessels can be a bit uncomfortable so you may be given a pain-relieving tablet at the same time as the eyedrops. If the treatment does become painful, then it is possible to have an injection around the eye to numb the pain. Don't be afraid to ask for this injection, especially if you have found a previous session of laser treatment distressing.

Does laser treatment have any side effects?
The treatment for sealing blood vessels has few side effects, although you may lose a little central vision or notice the laser burns as small blank spots.

The laser treatment to remove new blood vessels is more complicated and there may be more side effects. It is quite common to lose some vision to the sides (peripheral vision), and this may mean that you will not be able to drive in future. Night and colour vision may also be reduced. Occasionally your central vision may not be as good as before so that print isn't as easy to see. This is usually temporary but sometimes this doesn't improve. No treatment is possible without some side effects. But the risks of laser treatment are far less than the risks of not having treatment.

What if my eye becomes painful after treatment or if my vision gets worse?
The laser is very bright and causes a temporary reduction of sight, which may last an hour or two after the treatment. Most people have a headache after the more lengthy treatment and you can take a headache tablet for this. However if the pain is severe, or if your eyesight gets worse, you should contact your consultant straightaway.

If your eye condition becomes more severe, causing retinal detachment and scar tissue, it may be possible to perform vitreous surgery. This is highly specialised and you should discuss the various options with a consultant ophthalmologist.
Research is continuing into diabetes-related eye conditions, and their treatment is constantly improving.

Contact us to book an appointment for professional monitoring of your condition.


Double Vision

What is Double Vision?
If you see two of whatever you are looking at simultaneously, you may have a condition known as double vision, referred to medically as diplopia. Double and blurred vision are often thought to be the same, but they are not. In blurred vision, a single image appears unclear and fuzzy. In double vision, two images are seen at the same time, creating understandable confusion for anyone who has it.

What causes double vision?
There are 2 of possible causes.


1.Refractive - Light from an object is split into two images by a defect in the eye's optical system. Cataracts might, for example, cause such a defect.

2.Failure of both eyes to point at the object being viewed, a condition referred to as "strabismus" or "squint". In normal vision, both eyes look at the same object. The images seen by the two eyes are fused into a single picture by the brain. If the eyes do not point at the same object, the image seen by each eye is different and cannot be fused. The result is double vision possibly caused because of a defect in the muscles which control the movement of the eyes or in the control of these muscles through the nerves and brain.

What are its implications?
Double vision can be extremely discomforting. The brain acts to alleviate the discomfort by suppressing, or blanking out, one of the images. In young children, if this suppression persists over a continued length of time, it can lead to an impairment of the development of the visual system. The suppressed eye may get to the point where it is unable to see well, no matter how good the spectacle or contact lens correction, a condition called amblyopia or “lazy eye”. Since it is a result of a defect in the interpretative mechanisms of the eye and brain, it is more difficult to treat than a refractive condition (one having to do with the eye's ability to bend light).

How is it treated?
Treatment of double vision may consist of eye exercises, surgical straightening of the eye or a combination of the two. Therapy is aimed at re-aligning the squinting eye where possible without surgery and re-stimulating the part of the visual pathway to the brain, which is not working correctly.

Double vision can occasionally develop in a person who has never had the problem before due to trauma to the head or a problem with the nerve supply to the muscles around the eye. This type of 'sudden onset diplopia' can be a sign of a serious problems with the visual system so if you are experiencing double vision you should contact us immediately to have a thorough, professional investigation of the visual system.


What is dry eye?



Tears serve to lubricate the eye and they are produced around the clock, but when insufficient moisture is produced stinging, burning, scratchiness and other symptoms are experienced and may be referred to as Dry Eye, Keratitis Sicca, Keratoconjunctivitis Sicca (KCS) or Xerophthalmia.

When we blink, tears form a film that spreads over the eye, making the surface smooth and optically clear and enabling good vision. There are three layers in the thin film of tears: an oily layer, a watery layer and a layer of mucus, each with specific function. The outermost, oily layer is produced by small glands at the edge of the eyelid (meibomian glands) and the main purpose of this layer is to smooth the tear surface, aid lubrication and reduce evaporation.

The middle, watery layer, is produced by small glands scattered through the conjunctiva, (the delicate membrane lining the inside of the eyelid) and by the large lacrimal (tear) gland. This layer cleanses the eye and washes away foreign particles or irritants. The innermost layer consists of mucus that allows the water layer to spread evenly over the surface of the eye. Without mucus, tears would not adhere to the eye.

What causes it?
Dry eye is caused when the tear gland produces insufficient tears. This can happen as part of the normal ageing process, and is more common among women so although the condition is not common it tends to occur with increasing age when it is not always noticed because the effect of dry eye tends to balance another age-related change; poor tear drainage. The result of this is a balance between not making as much lacrimal fluid (tears) and not being able to drain away the lacrimal fluid efficiently.

The main causes of an insufficient film of tears are deterioration of lacrimal tissue, dysfunction of the Meibomian gland destabilising the film of tears or a blockage in the excretory ducts of the lacrimal gland. People with Sjogren's syndrome are at risk of dry eye as part of a more systemic problem involving salivary glands and other sites of mucous membrane. Salivary gland involvement produces a dry mouth as well. This syndrome and dry eyes generally, may be found in people with rheumatoid arthritis.

What are the effects of the condition?
In the early stages there is an increase in mucus strands and as the tear film breaks down, the mucin layer becomes contaminated. Where this contaminated matter cannot be dispersed it tends to move with blinking. Mucin is a substance that dries very quickly and rehydrates very slowly.

People with dry eye rarely have a sensation that the eye is dry but instead experience irritation, burning, a sensation of having a foreign body in the eye, mucus discharge and possible temporary blurring of vision.

Blinking may cause pain to people with severe forms of keratitis.

What is the treatment?
There is a series of tests designed to identify the cause and type of dry eye and these include Rose Bengal staining where a dye is used to identify problems and the Phenol Red test, which involves measuring the amount of wetting of a special coloured thread which is placed under the lower eyelid for 15 seconds.
The aim of treatment will be to relieve discomfort and prevent corneal damage.

In some situations relief may be found by blinking consciously when doing close or continuous work. It is also helpful to close the eyes for a spell from time to time.

Eye drops may be prescribed or purchased over the counter and since there is a variety, it may be helpful to try others if your present product does not suit you.

Some drops contain preservative that means they are safe to use for a month after opening, but although these drops are cheap and suitable for most sufferers, some people do not tolerate the preservative and may need to get prescription from the hospital pharmacy for a preservative free medication.

Lubricant ointments are also helpful, particularly at night. These are also available without preservative.

Some women benefit from hormone replacement therapy (HRT), especially those whose dry eye problems began around or after the menopause.

Antihistamines or certain types of travel sickness pills, inhibit tear secretion and symptoms can vary from day to day and be affected by general health.




In severe cases permanent or semi-permanent or short acting occlusion of the drainage channels of the eye (puncta) can help to keep the eye lubricated and provide relief from symptoms.




Surgical procedures may be indicated if punctum plugs are helping to relieve symptoms and patients require a more permanent solution. It involves closing the tear drainage holes in the eyelids permanently. It is a minor operation that is suitable for some patients.




How can I avoid Dry Eye?
Avoiding the following situations will minimise your risk of Dry Eye.




•Reduce the dry atmosphere caused by central heating by using a humidifier;

•Avoid car heaters, particularly at face level;

•Sit away from direct heat such as gas or electric fire s;

•Use eyedrops just before activities which cause additional pain or discomfort such as television, reading, sewing and writing;

•Remember to blink regularly, particularly when doing close or concentrated work. Blink properly with full lid closure, not "half" blinking;

•Avoid smoky atmospheres.

What is the prognosis?
Prognosis varies considerably and may depend in part upon individual lifestyle choices and overall health as well as the severity and cause of the condition. There is no definite cure, but people can usually be made more comfortable.




Contact us at the practice if you are experiencing any symptoms of dry eye for a thorough examination and expert advice and treatment.


Dyslexia and vision

What is Dyslexia?
People with specific learning difficulties have problems with certain areas of academic performance, yet do well in other subjects and are generally intelligent. The most common type of specific learning difficulty is specific reading difficulty; and this is often called dyslexia.

Dyslexic children are usually poor at spelling and may seem intelligent in conversation but have trouble with written language. Leonardo da Vinci and Einstein are both thought to have been dyslexic.

Dyslexia can only be diagnosed with certainty by a psychologist who, in addition to other tests, will calculate a person's expected reading age from their IQ and age. The difference between this and the actual reading age as measured with a reading test, gives a measure of the reading difficulty. The term dyslexia is usually reserved for a severe degree of reading difficulty.

The psychologist would also ensure that the poor reading was not secondary to another problem, such as inadequate schooling or low intelligence. Psychological assessments can be arranged through your school or privately through a local Dyslexia Institute

Visual Factors in Dyslexia
Most experts agree that problems with sight are not usually a main cause of dyslexia. Certain visual problems however do occur more often in dyslexia and these may, in some cases contribute to the reading difficulty.

These visual problems would not normally be detected in a school eye test. The most common visual anomalies in dyslexia are a reduced ability to focus close to and poor or unstable co-ordination of the two eyes binocular instability). Several simple tests can detect binocular instability.

These visual problems can cause eyestrain, visual stress, or visual distortions. This may slow reading and discourage children from prolonged reading.

Not all dyslexic people have these visual problems, but some have visual anomalies without realising it. People with a mild specific learning difficulty, perhaps not bad enough to be called dyslexia, can also have these visual problems. The visual problems may be treated with simple eye exercises or corrective glasses may be prescribed.


Coloured Overlays and Specific Tinted Lenses


At Campbell Eyecare, we can assess the possible benefits of coloured plastic overlays to aid reading. Professor Arnold Wilkins, a child psychologist, has developed The Wilkins Rate of Reading Test which utilises different colours of overlays placed on top of a page of print or on the computer screen. This allows us to measure the patient’s ability to read normal black print on a white background compared to the preferred overlay. If there appears to be an improvement, the patient is given an overlay to use at home and in the classroom, plus instructions to change the computer settings to produce the same colour as a background on the computer screen for word processing.


The parent(s) and teacher are requested to monitor the use of the overlay, without prompting, by the patient. If there is an improvement in reading and reduction in symptoms over a period of a month or so, the patient is assessed for specific tinted lenses using the Intuitive Colorimeter. This allows us to measure the exact colour and density of tint to suit the individual, which are then manufactured by Cerium Visual Technology Ltd. The final tint normally does not match the colour of the overlay.


This service is not currently funded under the NHS, although almost 10% of the population are known to have a reading difficulty of some sort.


Entropion

Entropion is a condition that commonly affects the lower eyelid, causing it to turn inwards, resulting in the eyelashes rubbing on the front of the eye. This causes discomfort, redness and sometimes a sticky eye. If left untreated, it can lead to corneal ulcers.

Entropion is the medical term used to describe rolling inward of the lower eyelid and eyelashes towards the eye. The skin of the eyelid and the eyelashes rub against the cornea (the front part of the eye) and conjunctiva (the mucous membrane that protects the eye). This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge, a feeling that something is in the eye, irritation of the cornea, and impaired vision.

Most cases of entropion are due to relaxation of the tissues of the eyelid because of ageing. Some cases result from scarring of the inner surface of the eyelid caused by chemical and thermal burns, inflammatory diseases such as ocular pemphigoid, or allergic reactions. Rarely entropion can be present at birth if the eyelids do not form properly.

Entropion should be repaired surgically before the rubbing damages the cornea by causing infection and scarring. Prior to surgery, taping the lower lid down and using lubricating drops and ointment can protect the eye. In some cases, sutures (stitches) can be placed through the lower eyelid until more definitive surgery can be performed.

The surgery to repair entropion is usually performed under local anaesthesia as an outpatient. In most cases, the doctor will tighten the eyelid and its attachments. Following the surgery a patch is worn overnight used in conjunction with antibiotic ointment for about a week. After the eyelids have healed, the eye should feel comfortable and no longer have the risk of corneal scarring, infection, and loss of vision.


Episcleritis

Episcleritis is an inflammation of the episclera, a membrane covering the sclera of the eye.

The sclera is composed of collagenous fibres to form a white, hollow ball. It is the 'skeleton' of the eyeball and is covered by the episclera, a thin layer of tissue containing many blood vessels that nourish the sclera. On the front of the eye, the episclera is covered by the conjunctiva. Inflammation of the episclera is usually mild and usually does not progress to the more serious, scleritis. The cause is unknown, but certain diseases such as rheumatoid arthritis, Sjogren's syndrome, syphilis, herpes zoster, and tuberculosis have been associated with episcleritis. It is a common condition.

Although usually self limiting, episcleritis can progress into a more serious condition so it is important to have any red or sore eyes examined by a professional. Contact us to make an appointment.



Eyelids and the tear film

The eyelids play a key role in protecting the eyes. They help spread moisture (tears) over the surface of the eyes when they close (for example, while blinking); thus, they help prevent the eyes from becoming dry. The eyelids also provide a mechanical barrier against injury, closing reflexively when an object comes too close to the eye. The reflex is triggered by the sight of an approaching object, the touch of an object on the surface of the eye, or the eyelashes being exposed to wind or small particles such as dust or sand.

Tears are a salty fluid that continuously bathes the surface of the eye to keep it moist. This fluid also contains antibodies that help protect the eye from infection. Tears are produced by the lacrimal (tear) glands, located near the outer corner of the eye. The fluid flows over the eye and exits through two small openings in the eyelids (lacrimal ducts); these openings lead to the nasolacrimal duct, a channel that empties into the nose.

If the lacrimal glands don't produce enough tears, the eyes can become painfully dry and can be damaged. A rare cause of inadequate tear production is Sjögren's syndrome. The eyes can also become dry when evaporation causes an excessive loss of tears, for example, if the eyelids don't close properly.

Fuch's Endothelial Dystrophy

What is Fuchs Dystrophy?
Fuchs endothelial dystrophy (FED) is a slowly progressing disease that usually affects both eyes and is slightly more common in women than in men. Although your optometrist can often see early signs of Fuchs dystrophy in people in their 30s and 40s, the disease rarely affects vision until a person reaches their 50s and 60s. It is one of a number of corneal dystrophies (conditions that affect the cornea - the clear, front layer of the eye).

What causes it?
Fuchs dystrophy occurs when endothelial cells (the back layer of the cornea) gradually deteriorate without any apparent reason, such as trauma or inflammation. As more endothelial cells are lost over the years, the cornea becomes less efficient at pumping water out of the stroma (the middle layers of the cornea). This causes the cornea to swell and to distort vision. Eventually, the epithelium (the front layer of the cornea) also takes on water, resulting in great pain and severe visual impairment.

Epithelial swelling damages vision in two ways:




1.Changing the cornea's normal curvature

2.Causing a sight-impairing haze to appear in the tissue.

Epithelial swelling will also produce tiny blisters on the corneal surface. When the blisters burst, they are extremely painful.

What are the symptoms?
At first, a person with Fuchs dystrophy will awaken with blurred vision that will gradually clear during the day. This occurs because the cornea is normally thicker in the morning, and it retains fluids during sleep that evaporate in the tear film while we are awake. But as the disease worsens, this swelling will remain constant and reduce vision throughout the day.

Can it be treated?
When treating the disease, doctors will try first to reduce the swelling with ointments or soft contact lenses. They may also instruct a person to use a hair dryer, held at arm's length or directed across the face, to dry out the epithelial blisters. This can be done two or three times per day.

But when the disease makes even the simplest tasks hard to complete, a person may need to consider having a corneal transplant to restore sight. The short-term success rate of corneal transplantation is quite good for people with Fuchs dystrophy. But, some studies do suggest that the long-term survival of the donor cornea can be a problem.




If you have been diagnosed with Fuch's Dystrophy or are concerned about this or any other eye condition, contact us to book an appointment.











Glaucoma

What is glaucoma?
Glaucoma is the name for a group of eye conditions in which the optic nerve is damaged at the point where it leaves the eye. This nerve carries information from the light sensitive layer in your eye, the retina, to the brain where it is perceived as a picture. Your eye needs a certain amount of pressure to keep the eyeball in shape so that it can work properly. In some people, the damage is caused by raised eye pressure. Others may have an eye pressure within normal limits but damage occurs because there is a weakness in the optic nerve. In most cases both factors are involved but to a varying extent. Eye pressure is largely independent of blood pressure.

What controls pressure in the eye?
A layer of cells behind the iris (the coloured part of the eye) produces a watery fluid, called aqueous, which nourishes the focussing lens and the cornea. The fluid passes over the front of the lens, out through a hole in the centre of the iris (called the pupil) and over the back surface of the cornea to leave the eye through tiny drainage channels. These channels are in the angle between the front of the eye (the cornea) and the iris and return the fluid to the blood stream. Normally the fluid produced is balanced by the fluid draining out, but if it cannot escape, or too much is produced, then your eye pressure will rise. (The aqueous fluid has nothing to do with tears.)

Why can increased eye pressure be serious?
If the optic nerve comes under too much pressure then it can be damaged. How much damage there is will depend on how much pressure there is and how long it has lasted, and whether there is a poor blood supply or other weakness of the optic nerve. A really high pressure will damage the optic nerve immediately. A lower level of pressure can cause damage more slowly, and then you would gradually lose your sight if it is not treated.

Are there different types of glaucoma?
Yes. There are four main types:




•The most common is chronic glaucoma (chronic = slow) in which the aqueous fluid can get to the drainage channels (open angle) but they slowly become blocked over many years. The eye pressure rises very slowly and there is no pain to show there is a problem, but the field of vision gradually becomes impaired.

•Acute glaucoma (acute = sudden) is much less common in western countries. This happens when there is a sudden and more complete blockage to the flow of aqueous fluid to the eye. This is because a narrow 'angle' closes to prevent fluid ever getting to the drainage channels. This can be quite painful and will cause permanent damage to your sight if not treated promptly.

•There are two other main types of glaucoma. When a rise in eye pressure is caused by another eye condition this is called secondary glaucoma.

•There is also a rare but sometimes serious condition in babies called developmental glaucoma, which is caused by a malformation in the eye. This page focuses on the chronic and acute glaucoma.

How common is glaucoma?
In the UK some form of glaucoma affects about 2 in 100 people over the age of 40.

Are some people particularly at risk of chronic glaucoma?
Yes. There are several factors which increase the risk.




•Age - Chronic glaucoma becomes much more common with increasing age. It is uncommon below the age of 40 but affects one per cent of people over this age and five per cent over 65.

•Race - If you are of African origin you are more at risk of chronic glaucoma and it may come on somewhat earlier and be more severe. So make sure that you have regular tests.

•Family - If you have a close relative who has chronic glaucoma then you should have eye tests at intervals. You should advise other members of your family to do the same. This is especially important if you are aged over 40 when tests should be done every two years.

•Short sight - People with a high degree of short sight are more prone to chronic glaucoma.

•Diabetes is believed to increase the risk of developing this condition.

Why can chronic glaucoma be a serious risk to sight?
The danger with chronic glaucoma is that your eye may seem perfectly normal. There is no pain and your eyesight will seem to be unchanged, but your vision is being damaged. Some people do seek advice because they notice that their sight is less good in one eye than the other.

The early loss in the field of vision is usually in the shape of an arc a little above and/or below the centre when looking 'straight ahead'. This blank area, if the glaucoma is untreated, spreads both outwards and inwards. The centre of the field is last affected so that eventually it becomes like looking through a long tube, so-called 'tunnel vision'. In time even this sight would be lost.

How is chronic glaucoma detected?
As glaucoma becomes much more common over the age of forty you should have eye tests at least every two years. There are 3 main tests for detecting glaucoma of which your optometrist may only need to do 1 or 2 to confirm that you don't have it.




1.Viewing your optic nerve either with digital retinal photographs or using a special lens and microscope designed to give a 3D view of the back of the eye

2.Measuring the pressure in the eye using a special instrument

3.Visual field test - where you are shown a sequence of spots of light on a screen and asked to say which ones you can see.

All these tests are very straightforward, don't hurt and can all be carried out at Campbell Eyecare.

How is chronic glaucoma treated?
The main treatment for chronic glaucoma aims to reduce the pressure in your eye. Some treatments also aim to improve the blood supply of the optic nerve. You will need to go to hospital for treatment and have regular check-ups afterwards. Treatment to lower the pressure is usually started with eyedrops. These act by reducing the amount of fluid produced in the eye or by opening up the drainage channels so that excess liquid can drain away. If this does not help, your specialist may suggest either laser treatment or an operation called a trabeculectomy to improve the drainage of fluids from your eye. Your specialist will discuss with you which is the best method in your particular case.

Can chronic glaucoma be cured?
Although damage already done cannot be repaired, with early diagnosis and careful regular observation and treatment, damage can usually be kept to a minimum, and good vision can be enjoyed indefinitely.

What is acute glaucoma?
In acute glaucoma the pressure in the eye rises rapidly. This is because the periphery of the iris and the front of the eye (cornea) come into contact so that aqueous is not able to reach the tiny drainage channels in the angle between them. This is sometimes called closed angle glaucoma.

What are the symptoms of acute glaucoma?
The sudden increase in eye pressure can be very painful. The affected eye becomes red, the sight deteriorates and may even black out. There may also be nausea and vomiting. In the early stages you may see misty rainbow coloured rings around white lights.

Is acute glaucoma always severe?
Sometimes people have a series of mild attacks, often in the evening. Vision may seem 'misty' with coloured rings seen around white lights and there may be some discomfort in the eye. If you think that you are having mild attacks you should contact your optometrist without delay. In routine examinations the structure of the eye may make the examiner suspect a risk of acute glaucoma and advise further tests.

What is the treatment?
If you have an acute attack you will need to go into hospital immediately so that the pain and the pressure in the eye can be relieved. Drugs will be given which both reduce the production of aqueous liquid in the eye and improve its drainage.

An acute attack, if treated early, can usually be brought under control in a few hours. Your eye will become more comfortable and sight starts to return. When the pain and inflammation have gone down, your surgeon will advise making a small hole in the outer border of the iris to relieve the obstruction, allowing the fluid to drain away. This is usually done by laser treatment or by a small operation.

Usually the surgeon will also advise you to have the same treatment on the other eye, because there is a high risk that it will develop the same problem. The treatment is not painful. Depending on circumstances and the response to treatment, it may not require admission to hospital. Sometimes a short stay in hospital may be advised.

Can acute glaucoma be cured?
If diagnosed without delay and treated promptly and effectively there may be almost complete and permanent recovery of vision. Delay may cause loss of sight in the affected eye. Occasionally the eye pressure may remain a little raised and treatment is required as for chronic glaucoma.

Will I be able to drive?
Most people can still drive if the loss of visual field is not advanced. To assess possible damage to your peripheral vision you will need a special test to see whether your sight meets the standards of the Driver and Vehicle Licensing Authority. Ask your specialist about this. The IGA leaflet about driving may also be helpful. Campbell Eyecare has the special equipment to carry out this test in the Alness practice and are registered with DVLA.

What if my sight cannot be fully restored?
Early detection and treatment will usually prevent or retard further damage by glaucoma. Much can be done to help you use your remaining vision as fully as possible. You should ask your optician or optometrist about low vision aids and whether you are eligible to register as partially sighted or blind. Registration opens the door to expert help and sometimes to financial benefits.

Further help and information




•The International Glaucoma Association supports patients by providing information, so that they can co operate fully in their treatment and prevent sight loss. It also promotes awareness and early detection of glaucoma, and supports and carries out research. The International Glaucoma Association (IGA), Woodcote House, 15 Highpoint Business Village, Henwood, Ashford, Kent, TN24 8DH. Telephone 01233 64 81 70 Available for advice by letter or by telephone 10am - 5pm from Monday to Friday.

•The Partially Sighted Society offers information and advice, publications, aids to vision, enlargement services and local support to help you make the most of your vision. Contact: The Partially Sighted Society, The Sight Centre 9 Plato Place,
72-74 St Dionis Road, London SW6 4TU
. Telephone 0207 371 0289

•Royal National Institute for the Blind,
224 Great Portland Street, London W1N 6AA


Herpes Simplex Infection

When a corneal herpes simplex infection (herpes simplex keratoconjunctivitis or keratitis) begins, it may resemble a mild bacterial infection because the eyes are slightly painful, watery, red, and sensitive to light. Corneal swelling makes vision hazy. However, the herpes infection doesn't respond to antibiotics, as a bacterial infection would, and often it continues to worsen.

Most often, the infection produces only mild changes in the cornea and goes away without treatment. Rarely, the virus deeply penetrates the cornea, destroying its surface. The infection may recur, further damaging the surface of the cornea. Several recurrences may result in ulceration, permanent scarring, and a loss of feeling when the eye is touched. The herpes simplex virus can also cause an increased growth of blood vessels, visual impairment, or total loss of vision.

An ophthalmologist may prescribe an antiviral drug as an ointment or a solution to be applied to the eye several times a day. However, they're not always effective; sometimes, other drugs must be taken by mouth. Sometimes, to help speed healing, an ophthalmologist may have to gently swab the cornea with a soft cotton-tipped applicator to remove dead and damaged cells.

Cold sores are the usually the cause of the extremely infectious Herpes simplex virus, which can also cause Corneal ulcer and genital herpes, so do not touch eyes or genitals after touching cold sores.

In first stage of infection, blisters and then ulcers form inside the mouth or on the face, accompanied by red, swollen gums, a furry tongue, mild fever, and feeling generally under par. Though these symptoms clear up within a few days, the virus may not be destroyed, so whenever immunity is at a low ebb infection tends to reappear around mouth and lips, causing blisters which weep and then become encrusted; these usually clear up within 5-7 days. As with any eye condition, be sure to contact us if your eye is ever red or painful.







Herpes Zoster Infection

What is Herpes Zoster?
Herpes zoster is the medical name for shingles. It is caused by reactivation in the adult years of the chicken pox virus that occurred during childhood (the varicalla-zoster virus). The virus can be reactivated when the body's immunity to the virus breaks down. This may happen due to normal aging, or the body's immune system may become weakened due to stress from illness, physical or emotional stress, fatigue, poor nutrition, certain medications, chemotherapy, radiation therapy, or other factors.

Once reactivated, the virus travels along nerve fibers, usually settling in fairly isolated areas of skin on one side of the body. The infected area of the body usually has severe pain, itching, redness, numbness, and the development of a rash. The rash on the skin develops into small, fluid-filled blisters called vesicles. Within a few days of their appearance on the skin, the vesicles break open and form scabs. In severe cases, the rash can leave permanent scars, long standing pain, numbness, and skin discoloration.

How does Herpes Zoster affect the eyes?
The eyes are sometimes affected by herpes zoster. This is due to the fact that the eyes are connected to nerves that may be infected with the herpes zoster virus.

The usual shingles rash can spread from an involved area of the forehead or cheek to the upper or lower eyelids. Shingles may cause redness of the conjunctiva (the mucous membrane covering the white of the eye). It can also cause small scratches or scarring of the cornea. The scratches on the cornea may increase the risk of bacterial infection in the eye. Shingles may also cause inflammation inside the eye, known as iritis or uveitis. It can also affect the optic nerve or the retina.

Herpes zoster infections of the eye can lead to redness, swelling, pain, sensitivity to light, and blurred vision. Severe or repeated episodes of herpes zoster infection are associated with other eye conditions, including glaucoma, scarring inside the eye, and cataract formation.

Are Herpes Zoster infections contagious?
Shingles caused by herpes zoster is not contagious and should not be confused with herpes simplex virus (HSV) infections. At the time the herpes zoster or varicella zoster virus first infects the body causing chickenpox, the infection is contagious. The outbreak of shingles later in life is not a new infection, but rather a reactivation of the dormant virus. For this reason, shingles is not contagious.

How are Herpes Zoster eye infections treated?
Treatment of the symptoms of shingles through compresses and pain relievers is usually recommended by your optometrist. Lubricating eyedrops or antibiotic eye drops may aso be prescribed.

The use of antiviral medications may be recommended by an ophthalmologist. The medication most commonly prescribed is acyclovir. Occasionally, steroids may be prescribed to reduce inflammation.

By its very nature, herpes zoster infections are prone to return from time to time, especially when the immune system is weakened. Early diagnosis and treatment is important to minimize the symptoms and reduce the risk of complications that may compromise vision so contact us if you are concerned.


Iritis

What is iritis?
Iritis is the inflammation of the iris, the coloured portion of the eye. It can cause extreme pain, light sensitivity and sight loss, and is often the result of a disease in another part of the body. Most cases of iritis recur in small attacks. Once treated the attack will usually respond to various medications. However, the condition may become sight threatening when left untreated. Medication for iritis varies, treatment that works for one will not always work with another.

What is the iris?
The iris is a circular muscle near the front of the eye. Besides giving colour to the eye, the iris controls the amount of light that enters the eye through the pupil. The iris is located behind the cornea (the clear protective layer of the eye) and just in front of the focusing lens. To see clearly, the proper amount of light must enter the eye. Just as the shutter controls the amount of light that enters a camera, the iris regulates the amount of light that enters the eye. The iris contains two muscles that control the size of the pupil opening. When too much light is present, the muscles cause the pupil to become smaller to reduce excessive light and glare. In dim light or at night, the muscles make the pupil larger to increase the amount of light entering the eye.

Is it serious?
Since iritis is an inflammation inside the eye, the condition is potentially sight threatening. Proper diagnosis and prompt treatment of iritis are essential. To minimise any loss of vision, you should have a complete eye examination as soon as symptoms occur. If diagnosed in the early stages, iritis can usually be controlled with the use of eye drops before vision loss occurs. If you are experiencing the symptoms of iritis or have other vision problems, you should have a full eye examination.
What causes iritis?
In many cases, iritis is related to a disease or infection in another part of the body. Diseases such as arthritis, tuberculosis, or syphilis can contribute to the development of iritis. Infection of some parts of the body (tonsils, sinus, kidney, gallbladder and teeth) can also cause inflammation of the iris. In other cases, iritis may follow injury to the eye or accompany an ulcer or foreign body on the cornea. Often, the exact cause of the disorder remains unknown.

What are the symptoms of iritis?
The symptoms of iritis usually appear suddenly and develop rapidly over a few hours or days. Iritis commonly causes pain, tearing, light sensitivity and blurred vision. A red eye often occurs as a result of iritis. Some patients may experience floaters, small specks or dots moving in the field of vision. In addition, the pupil may become smaller in the eye affected by iritis.

How is iritis diagnosed?
A careful eye exam is extremely important when the symptoms of iritis occur, as inflammation inside the eye can affect sight and could lead to blindness. A slit lamp, which illuminates and magnifies the structures of the eye, is used to detect any signs of inflammation. A diagnosis is often made on the basis of an eye examination. Since iritis can be associated with another disease, an evaluation of your overall health is sometimes necessary for proper diagnosis and treatment. In some cases, blood tests, skin tests, and x-rays may be conducted and other specialists may be consulted to determine the cause of the inflammation.

How is iritis treated?
Treatment of iritis is often directed at finding and removing the cause of the inflammation. In addition, eye drops and ointments are used to relieve pain, quiet the inflammation, dilate the pupil, and reduce any scarring which may occur. Both steroids and antibiotics may be used. The application of hot packs may also provide relief from the symptoms of iritis. In severe cases, oral medications and injections may be necessary to treat the condition. A case of iritis usually lasts 6 to 8 weeks. During this time, you must be observed carefully to monitor potential side effects from medications and any complications which may occur. Cataracts, glaucoma, corneal changes, and secondary inflammation of the retina may occur as a result of iritis and the medications used to treat the disorder.







Keratoconus

Keratoconus is a vision disorder that occurs when the normally spherical cornea (the front part of the eye) becomes thin and irregularly (cone) shaped. This abnormal shape prevents the light entering the eye from being focused correctly on the retina and causes distortion of vision.

In its earliest stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to glare and light. These symptoms usually appear in the late teens or late twenties. Keratoconus may progress for 10-20 years and then slow in its progression. Each eye may be affected differently. As keratoconus progresses, the cornea bulges more and vision may become more distorted. In a small number of cases, the cornea will swell and cause a sudden and significant decrease in vision. The swelling occurs when the strain of the cornea's protruding cone-like shape causes a tiny crack to develop. The swelling may last for weeks or months as the crack heals and is gradually replaced by scar tissue. If this sudden swelling does occur, your optometrist can prescribe eye drops for temporary relief, but there are no medicines that can prevent the disorder from progressing.

Glasses or soft contact lenses may be used to correct the mild short-sightedness and astigmatism that is caused by the early stages for keratoconus. As the disorder progresses and cornea continues to thin and change shape, rigid gas permeable contact lenses can be prescribed to correct vision adequately. In most cases, this is adequate. The contact lenses must be carefully fitted by a specialist, and frequent check-ups and lens changes may be needed to achieve and maintain good vision.

In a few cases, a corneal transplant is necessary. However, even after a corneal transplant, glasses or contact lenses are often still needed to correct vision.








Long-sightedness (Farsightedness or Hyperopia)

What is Long-sightedness?
If you can see objects at a distance clearly but have trouble focusing well on objects close up, you may be long-sighted.

Your optometrist may refer to long-sightedness as farsightedness, or by its medical names, hypermetropia or hyperopia. Hypermetropia causes the eyes to exert extra effort to see close up. After viewing nearby objects for an extended period, you may experience blurred vision, headaches and eyestrain. Children who are long-sighted may find reading difficult.

Hypermetropia is not a disease, nor does it mean that you have "bad eyes." It simply means that you have a variation in the shape of your eyeball. The degree of variation will determine whether you will need corrective lenses.

What causes long-sightedness?
Hypermetropia most commonly occurs because the eyeball is too short; that is, shorter from front to back than is normal. In some cases, the cornea having too little curvature may cause hypermetropia. Exactly why eyeball shape varies is not known, but the tendency for long-sightedness is inherited. Other factors may be involved too, but to a lesser degree than heredity.

How does long-sightedness affect sight?
Our ability to "see" starts when light enters the eye through the cornea. The shape of the cornea, lens and eyeball help bend (refract) light rays in such a manner that light is focused into a point precisely on the retina.

If, as in long-sightedness, the eyeball is too short, the "point of light" focuses on a location behind the retina, instead of on the correct area of the retina, known as the fovea. Consequently, at the point on the retina where a fine point of light should be focused, there is instead a disk-shaped area of light. Since light is not focused when it hits the retina, vision is blurred.

Convex lenses are prescribed to bend light rays more sharply and bring them to focus on the retina.

Who is affected by long-sightedness?
Many people have a degree of long-sightedness, yet it is only a problem if it significantly affects our ability to see well or causes headaches or eyestrain.

How is it diagnosed?
Hypermetropia is seldom diagnosed in school eye-screening tests, which typically test only the ability to see objects at a distance. A comprehensive eye health examination that checks both near and far vision is necessary to diagnose long-sightedness. Contact us to book an appointment.

How is it treated?
Convex lenses as glasses or contact lenses are usually prescribed. They bend light more sharply and bring the light rays into focus on the retina. If you do not have other vision problems such as astigmatism, you may only need glasses for reading or other tasks done at a close range.

To determine the best avenue of treatment, your optometrist will ask a number of questions about your lifestyle, occupation, daily activities and general health status. For instance, you may be asked whether you frequently need good near vision. Providing candid, considered answers to the questions and working with your optometrist will help assure that your corrective lenses contribute to clear sight and general comfort.




How will hypermetropia affect your lifestyle?
If glasses or contact lenses are prescribed, it may take a few days to adjust to them. After that, long-sightedness probably will not significantly affect your lifestyle.

Campbell Eyecare recommends a comprehensive eye examination regularly to ensure that minor changes in vision are diagnosed and treated so that your vision will remain as clear and comfortable as possible Contact us to book an appointment.








Short-Sightedness or Myopia

What is Shortsightedness?
If you can see objects close up clearly but have trouble focusing well on objects further away, you may be short-sighted.

Your optometrist may refer to short-sightedness by its medical name myopia. Myopia means that the focussing system within the eye cannot clearly focus distant objects.

Myopia is not a disease, nor does it mean that you have "bad eyes." It simply means that you have a variation in the shape of your eyeball. The degree of variation will determine whether you will need corrective lenses.

What causes shortsightedness?
Myopia most commonly occurs because the eyeball is too long; that is, longer from front to back than is normal. In some cases, the cornea having too steep a curvature may cause myopia. Exactly why eyeball shape varies is not known, but the tendency for shortsightedness is inherited. Other factors may be involved too, but to a lesser degree than heredity.

How does shortsightedness affect sight?
Our ability to "see" starts when light enters the eye through the cornea. The shape of the cornea, lens and eyeball help bend (refract) light rays in such a manner that light is focused into a point precisely on the retina.

If, as in short-sightedness, the eyeball is too long, the "point of light" focuses on a location in front of the retina, instead of on the correct area of the retina, known as the fovea. Consequently, at the point on the retina where a fine point of light should be focused, there is instead a disk-shaped area of light. Since light is not focused when it hits the retina, vision is blurred.

Concave lenses are prescribed to bend light rays and bring them to focus on the retina.

Who is affected by shortsightedness?
Many people have a degree of shortsightedness, yet it is only a problem if it significantly affects our ability to see well or causes headaches or eyestrain.

How is it diagnosed?
Myopia may be diagnosed in school eye-screening tests or parents may notice their child sits closer to the television or the teacher moves them closer to the board in class. Contact us to book an appointment.

How is it treated?
Concave lenses as glasses or contact lenses are usually prescribed. They bend light and bring the light rays into focus on the retina.

To determine the best avenue of treatment, your optometrist will ask a number of questions about your lifestyle, occupation, daily activities and general health status. For instance, you may be asked whether you frequently need good distance vision. Providing candid, considered answers to the questions and working with your optometrist will help assure that your corrective lenses contribute to clear sight and general comfort.




How will myopia affect your lifestyle?
If glasses or contact lenses are prescribed, it may take a few days to adjust to them. After that, shortsightedness probably will not significantly affect your lifestyle.

Campbell Eyecare recommends a comprehensive eye examination regularly to ensure that minor changes in vision are diagnosed and treated so that your vision will remain as clear and comfortable as possible Contact us to book an appointment.












Vernal Keratoconjunctivitis

Vernal keratoconjunctivitis is a recurring inflammation of the conjunctiva, usually in both eyes, that may damage the surface of the cornea. Because the condition is typically caused by allergies, it tends to recur in the spring and summer. Vernal keratoconjunctivitis is most common in children; it usually begins before puberty and resolves before age 20.

Symptoms include intense itching; red, watery eyes; sensitivity to sunlight; and a thick, sticky discharge. In one form of the condition, the conjunctiva under the upper lids is most affected, becoming swollen and pale pink to greyish, while the rest of the conjunctiva becomes milky white. In another form, the conjunctiva covering the eyeball is thick and greyish. Sometimes a small area of the cornea is damaged, causing pain and extreme sensitivity to light. All symptoms usually disappear in cold weather and become milder over the years.

Antiallergy eye drops such as cromolyn, lodoxamide, ketorolac, and levocabastine are the safest treatments. Oral antihistamines may also help. Steroids may be given by a doctor and are more potent so must be used under close supervision of the hospital to avoid increased pressure in the eyes, cataracts, and opportunistic infections which may result from their use.