The eyes have it
I looked at Bruce, eye to eye.
“You have to stop doing it Bruce or you’ll go blind!”
“I know Bernie, my old man told me that when I was a little tacker, and he wasn’t referring to smoking,” Bruce replied.
Bruce suffered from diabetes, high blood pressure and an elevated cholesterol level which were all being controlled by various pills… but he had gone back to smoking. I had his latest report from his eye specialist in front of me and it wasn’t a good read. He had a moderate degree of eye damage caused by the effects of his diabetes called diabetic retinopathy. The cigarettes certainly weren’t helping the condition. When vision is lost for various medical reasons it is very difficult to get it back so prevention is important. And vision is such a cherished sense.
The anatomy of the eye
Basically the eye is a glorified camera. Light passes through the front glass or cornea. The shutter is called the iris and it allows variable amounts of light through to the lens that then focuses the light to the screen or retina at the back of the eye, especially to a small area called the macula. The macula has a concentrated number of nerve cells present which passes the information to the brain via the optic nerve.
What conditions do I see as a GP relating to the eyes? Probably the commonest would be infections. The thin covering of the eye is called the conjunctiva and various bugs such as viruses and bacteria can go splat against it and cause an infection called conjunctivitis.
Conjunctivitis occurs particularly when people have coughs and colds or when people around them cough and splutter all over them. The eyes get sore and gunky (discharge) especially in the morning and it may be hard to open them when you wake up as the lids stick together. Cleaning with some warm salty water may help but antibiotic drops or ointment may be required. It is a good idea to go and get the eyes checked as there are serious viral infections like a cold sore virus in the eye called herpes simplex keratitis that can cause ulcers and scarring on your cornea.
Shingles or herpes zoster infection may occur in the distribution of the nerve supplying the skin near your eye and can affect the eye seriously. It is caused by a reactivation of the chicken pox virus that you picked up as a kid which then lives in your nervous system for your entire life. It can be extremely painful. So, if you get pain near the eye followed by blisters in the same area, go and see your doctor pronto.
The conjunctiva can also be affected by allergies which cause the eyes to be very itchy, red and watery. This is termed allergic conjunctivitis and can settle with an antihistamine tablet and/or some anti-allergy drops from the chemist. It is the eye’s version of hayfever and any of the common allergens such as grasses, pollens and dust mite can be implicated. The wateriness comes from the eyes’ unique watering system that continually flushes the front of the eye including the cornea with fluid or tears in order to remove microscopic grit, grime and bugs hitting the eye from the environment. In some people, as they get older, this mechanism dries up and they end up with dry, gritty irritated eyes all the time. This is called dry eyes syndrome. Fortunately there are myriad drops available for this, effectively replacing your normal tears with artificial ones.
Ectropion is another common lid problem that occurs as we get older. It comes into play when the lower lid starts to sag, like everything else, and eventually everts itself. This disrupts the normal flow of tears and they continually drip down and over the everted lid which looks angry and red. The lid requires a bit of a tummy tuck to tighten it up and fix the problem.
Trauma to the eye is not uncommon and thankfully one of the serious mechanisms, a squash ball in the eye, has been lessened with the advent of wearing protective glasses when playing. Any direct blow to the eye should be checked out as the eye is quite a soft and intricate organ and serious things such as burst blood vessels inside the eye or a detached retina can be quite damaging.
Scratches to the cornea are quite common, particularly from sport or when blokes are out gardening. Getting something like a piece of grit in the eye on a windy day generally needs to be looked at as the foreign body can get stuck under the lid and be difficult to get out or it may even embed itself in the front of the eye in the cornea. Numbing (anaesthetic) eye drops and a deft hand are generally needed to remove these and in most instances your GP can do it or if difficult to find or remove, refer you to an eye specialist (ophthalmologist). A word of warning though: do not grind metal without safety goggles as bits of metal at high velocity flying up into the eye are very common and can be very difficult to remove.
Probably the scariest presentation with the least importance is when I see blokes who come in, or more than likely pushed in by their partner, because the white of the eye has suddenly turned blood red due to a burst blood vessel. It looks quite dramatic and scary and in most cases there is no obvious cause. It may happen if the person strains excessively or even coughs or sneezes violently. It is not a bad idea to get your blood pressure checked and if recurrent, a blood test to check your blood counts and clotting system. It will gradually dissolve like a bruise over a week and doesn’t damage the eye or vision.
Vision is the prime role of our eyes and problems with vision can certainly indicate serious underlying issues. Any change in vision should be checked out by your GP or optometrist if you have one. Sudden loss of vision in one eye for a variable length of time may be due to a mini stroke caused by a clot going to the back of the eye. Clots are more prevalent if you have medical conditions such as diabetes, high blood pressure, high cholesterol or if you are a smoker. Get it checked, even if it is transient and goes away.
As we get older our vision may deteriorate due to problems with the lens. This mainly occurs due to changes in the shape of the lens which make it difficult to bend the light to exactly where it is needed onto the screen or retina at the back of the eye. This can be corrected by the wearing of glasses which has the correct lens to compensate for the deficiency in the natural lens. I am very much aware of this as I wear glasses for both distant and near vision, the latter being noted when I gradually had to hold the newspaper further and further away to read it until my arms weren’t long enough. This is a condition called presbyopia and generally starts in the forties as the lens starts to stiffen and the little muscles that can alter the shape of the lens aren’t strong enough to do the increased work required. Thus it was reading glasses for me as well.
The other very common condition affecting the lens is cataract formation. Normally the lens is clear like glass but for various reasons the lens starts to develop a foggy or cloudiness within it. The vision may gradually deteriorate and blur and there may be sensitivity to light. Cataracts tend to run in families and are more prevalent in people with diabetes. Smokers are more at risk and the prolonged glare from the sun without the use of sunglasses may also predispose the eyes to cataract development. Stronger glasses and better lighting may initially help but the cataract frequently needs to be removed and often an artificial lens may be implanted to take over the role of the diseased lens.
Glaucoma is another very common condition that may affect your vision. The eye is not hollow but fluid filled and that fluid imparts a pressure within the eye. The fluid at the front of the eye is called the aqueous humor and is watery while the fluid at the back of the eye is jelly like and called the vitreous humor. The aqueous humor is continually circulating and if it gets blocked the pressure in the eye builds up which prevents the blood getting into the eye to nourish it and give it oxygen. The main nerve, the optic nerve that transmits the visual images we see back to the brain, may die off. Fortunately there are very good drops that reduce the pressure but it is important to get the diagnosis as early as possible. In very acute cases, sometimes laser surgery is required to clear the blockage. Your friendly neighbourhood optometrist is able to check your eye pressure as part of a general eye check-up and there is no need to get a referral from your GP and Medicare covers most of, if not all, of the check-up cost.
Like cataracts, glaucoma runs in families and is also a complication of diabetes which further emphasises the important need for people with diabetes to get a regular eye check-up. Trauma to the eye may lead to glaucoma and it may be brought on by drugs such as cortisone which may be used for various inflammatory conditions.
Macular degeneration is a chronic eye condition that has certainly come to the forefront of eye concerns in our ageing population. It is estimated that one in seven Australians will suffer from it and it is the main cause of blindness in Australia, contributing to 50% of cases of blindness. The macular is an area in the centre of the retina or screen which has the most concentrated number of nerve cells and hence we tend to focus what we see onto the macular for clarity and colour. For various reasons this area becomes diseased and the nerve cells are lost along with vision.
Aged over 50, smoking, diabetes, obesity and a poor diet particularly lacking in fruit and vegetables are implicated in causing it. The visual loss tends to be central and straight lines such as steps become distorted. There is no cure but diet, along with smoking cessation, are critical in lessening its impact. The diet recommended should contain daily fruit and green leafy vegetables along with fish 2-3 times per week. Nuts have also been shown to be of benefit. Sometimes injections into the eyeball are required to keep the condition under control and to save vision.
Diabetes is a very prominent risk factor for many of these conditions, especially cataracts and glaucoma, and if that isn’t enough it has its own unique eye problem called diabetic retinopathy. A healthy retina is so important for normal vision. In diabetic retinopathy the high blood sugar levels from the diabetes cause damage to the little blood vessels supplying blood to the retina. The arteries get blocked, leak fluid and blood and form little swellings called micro aneurysms. The end result is a damaged retina and a visual loss which is mostly gradual but may be sudden. It is critical that people with diabetes get a regular eye check-up. It can be prevented if the diabetes is well controlled along with proper blood pressure and cholesterol levels… and no smoking, Bruce!
Probably the worst eye condition known to man and peculiar to the AFL is a condition called the One Eyed Collingwood supporter. Not a lot is known in regards to how the good eye is lost but perhaps they didn’t listen to the wise words of their fathers! Now, where did I put my glasses?
Stay happy and healthy