Month: November 2017

There are many tiny glands along the eyelids, their main function is to produce the lipid of the tear film which helps to reduce its evaporation. Under normal condition, these glands are unobstructed, however any blockage of them will cause stye or chalazion. As kids have a higher chance of getting stye or chalazion, parents should pay more attention of their lid hygiene. The following will talk about the difference between stye and chalazion, their causes, treatment options and preventive measures.

The difference between stye and chalazion

Those who have stye or chalazion will have a lump at the edge of the affecting eyelid. From the pathological point of view, the cause of stye and chalazion is different. Stye is an acute bacterial infection of the glands of the eyelids, which leads to pus inside the glands. Patients with stye usually will feel pain. On the other hand, chalazion is a chronic inflammation of the glands of the eyelids, which leads to metabolic waste being accumulated inside the glands. Patients with chalazion usually will not feel very strong pain, but some discomfort around the lump. The chance of having chalazion is generally higher than stye.

Causes of stye and chalazion

1. Irregular sleep cycle and staying up late, causing excessive tiredness of eyes
2. Stressful lifestyle causing hormone imbalance
3. Using unclean hands to rub eyes
4. Having too much oily food
5. Active gland secretion during puberty may increase the chance of gland blockage

Treatment

Treatment options for both stye and chalazion are similar and are as follows:

1. Patients with mild and early symptoms can try warm compression. Hot clean towel or boiled egg covered with clean towel can be used to cover the affecting area for 10-15 mins, do it 2-3 times per day and persist for 1-2 weeks. Warm compression can usually cure the diseases with mild symptoms. One thing to remind is that the temperature of the towel should not be too high, otherwise it will burn your skin.
2. Those with severe symptoms should seek help from ophthalmologists. They will prescribe antibiotics to kill the bacteria and to prevent infection from happening, and/or prescribe steroid for relieving the inflammation. Steroid must be used under medical supervision, long term use of steroid will lead to severe complications.
3. If both warm compression and pharmaceutical treatment are unable to resolve the disease. Ophthalmologist may have to perform a minor surgery to remove the pus or deposits accumulated inside the gland. It is a minor procedure and takes about 15 mins to finish.

Preventive Measures

1. Having a good lifestyle, and regular sleep cycle
2. Having less oily food
3. Keeping good personal hygiene, and avoid using hands to rub eyes
4. For those kids with frequent recurrence, parents can use Q-tips which are soaked with some diluted baby shampoo (as they are not irritable to eyes) to scrub the upper and lower eyelids daily, so as to ensure good hygiene at and around the eyelids.

High myopia (shortsightedness) is usually defined as having myopia of -6.00D or stronger. The prevalence of young adults with high myopia in Asia was found to be 6.8% to 21.6%.1 The prevalence is far higher in urban than in rural area, it could be inferred that the amount of high myopic population in Hong Kong should be not less than 15%. Vision of high myopic patients can be easily corrected by glasses, however, there are some complications of high myopia that can cause irreversible visual impairment. The following entry will discuss some of the common complications of high myopia.

Pathologic Myopia

The eyeball length of high myopic patients is far longer than those without myopia. Due to such elongation, the retina, macula (centre part of the retina) and choroid (back part of the retina) are susceptible to pathological changes. A recent research from Singapore found that out of 100 high myopic young adults, there were about 8 of them had pathologic myopia. 2 Such figure indicated that the incidence of pathologic myopia is not low. Pathologic myopia can be classified into 5 categories based on different clinical characteristics, among them “myopic choroidal neovascularization” (myopic CNV) is the one that can cause fast vision loss. Patients with myopic CNV will be referred to ophthalmologists immediately for intraocular Anti-Vascular Endothelial Growth Factor injections in a bid to preserve vision and regain some vision loss. High myopic patients should also pay attention to sudden drop of vision and seeing distorted straight lines, and perform annual eye check for ruling out are any early pathological changes.

Retinal Detachment

The vitreous gel inside the eyeball of high myopic patients becomes liquefied and detaches from the retina at a younger age than those without myopia,3 this should be the most probable cause that makes the patients with high myopia more prone to retinal breaks and detachment. A research showed that the risk of high myopic patients to have retinal detachment was 20-fold higher than those without.4 Therefore, if there is any sudden onset of flashes and floaters (which are the classical symptoms of retinal detachment), dilated fundus examination must be performed immediately to rule out retinal detachment.

Glaucoma

Elongation of the eyeball not only causes higher risk of macular degeneration, but also causes stretching effect to the optic nerve head, which in turn may lead to higher risk of glaucoma. A recent research from Beijing found that under similar intraocular pressure, high myopic eyes are with about 7.5 times more risk of developing glaucoma than those without any prescription.5 There is no obvious symptom of early glaucoma, retinal examination is necessary to detect early changes.

Cataract

It is still controversial of whether there is an association between high myopia and age-related cataract, some research did find an association, but some did not.6 However, it should be noted that the incidence of retinal detachment after cataract surgery is slightly higher for patients with high myopia than general population (2.2% for high myopia vs 0.93% for general population). 7,8

By Paco Chan, Registered (Part I) Optometrist

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Eyecare information by SWISSCOAT Vision Centre

Address : 23/F Whole Floor, One Midtown, 11 Hoi Shing Rd, Tsuen Wan, N.T., HK

Appointment : +852 2751 8491

Website : www.swisscoat.com

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References:

1. Wong YL, Saw SM. Epidemiology of Pathologic Myopia in Asia and Worldwide. Asia-Pacific journal of ophthalmology (Philadelphia, Pa) 2016; 5(6): 394-402.
2. Koh V, Tan C, Tan PT, et al. Myopic Maculopathy and Optic Disc Changes in Highly Myopic Young Asian Eyes and Impact on Visual Acuity. American journal of ophthalmology 2016; 164: 69-79.
3. Akiba J. Prevalence of posterior vitreous detachment in high myopia. Ophthalmology 1993; 100(9): 1384-8.
4. Pierro L, Camesasca FI, Mischi M, Brancato R. Peripheral retinal changes and axial myopia. Retina (Philadelphia, Pa) 1992; 12(1): 12-7.
5. Xu L, Wang Y, Wang S, Wang Y, Jonas JB. High myopia and glaucoma susceptibility the Beijing Eye Study. Ophthalmology 2007; 114(2): 216-20.
6. Pan CW, Cheng CY, Saw SM, Wang JJ, Wong TY. Myopia and age-related cataract: a systematic review and meta-analysis. American journal of ophthalmology 2013; 156(5): 1021-33.e1.
7. Neuhann IM, Neuhann TF, Heimann H, Schmickler S, Gerl RH, Foerster MH. Retinal detachment after phacoemulsification in high myopia: analysis of 2356 cases. Journal of cataract and refractive surgery 2008; 34(10): 1644-57.
8. Norregaard JC, Thoning H, Andersen TF, Bernth-Petersen P, Javitt JC, Anderson GF. Risk of retinal detachment following cataract extraction: results from the International Cataract Surgery Outcomes Study. The British journal of ophthalmology 1996; 80(8): 689-93.

Falling is a serious health-related issue for elderly. According to statistics, one-third of the elderly living in the community would fall at least once a year. The seniors may not only lose mobility and cause depression, the study showed that elderly had hip fracture after falling could lead to a higher death rate in the next 6 months. Poor vision is one of the significant risk factors causing falling. According to studies, 12-20% elderly aged 75 years or above have visual problem. Visual problem that increasing falling risk is not only about visual acuity, which means the resolution of the eye, but also contrast sensitivity, depth perception and visual field. Here I am going to introduce few common conditions which can impair elderly’s visual functions.

1. Uncorrected Refractive Error and Inappropriate Glasses

Elderlies who were used to have good eyesight when they were young may have longsightedness, shortsightedness or astigmatism when getting old. In the Chinese elderly population, more than 10% of them have uncorrected refractive error. The uncorrected refractive error impairs their visual acuity to ≤50% of a normal adult’s vision. Besides uncorrected refractive error, sometimes new glasses that have dramatic changes in refractive correction can also increases risk of fall. Large changes in refractive correction alters the image magnification and difficult for elderly to get used to. Some elderly who are inexperienced in using progressive lenses and bifocals may increase falling risk when walking. When prescribing glasses to elderly, optometrists will take all these considerations and give the most suitable prescription to meet the requirement of both vision and ease adaptation.

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2. Cataract

Cataract accounts for almost 50% of visual impairment in elderly. Besides decreasing visual acuity, cataract also decreases contrast and glare tolerance. Elderly with cataract may also found difficulty in night vision. To help patients with cataract, optometrists can monitor the disease changes and give opinions on performing cataract surgery, wearing prescription sunglasses to slow down cataract progression and prescribe tinted lenses to improve the visual functions.

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3. Glaucoma

Glaucoma contributes more than 12% of visual impairment in elderly population. Glaucoma is frequently remained undiagnosed because the patients are unaware of the painless vision loss. Their central vision is generally unaffected, however the peripheral vision will gradually shrink until leaving tunnel vision. When losing peripheral vision, elderly become prone to bump into obstacles and the worst case is falling from staircase because they lost the inferior visual field. Study showed glaucoma increases falling risk of a year for 3-4 times. Optometrists can conduct comprehensive eye examinations to diagnose glaucoma before functional vision loss takes place.

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4. Age-related Macular Degeneration (AMD)

AMD is the leading cause of severe vision loss in the elderly in developed regions. It deprives the central vision and greatly hinders the mobility of elderly. Similar to glacuoma, patients can be symptom-free in early stages. Study showed ⅔ of elderly with AMD have trouble in balancing which results in clumsiness and falling risk. Optometrists play an important role to diagnose, manage and monitor AMD in the community elderly population.

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5. Diabetic Retinopathy

Diabetic retinopathy is the ocular complication of diabetes mellitus. It decreases almost all visual parameters including visual acuity, contrast sensitivity, glare tolerance, colour vision and visual field. The patient’s vision may appear blurry and being dotted with black spots. Diabetes itself also damages peripheral nerves and causes motor disorders. Patients have to note that early stages diabetic retinopathy does not have any symptoms and they are reminded to have comprehensive eye examination at least once per year.

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All in all, elderly are susceptible to eye conditions that can result in visual impairment and increase the risk of fall. Optometrists are capable of assessing their visual functions and diagnosing ocular conditions. Elderly should receive comprehensive eye examination at least in a yearly basis to ensure their vision is safe to walk.

By Jeff Tang, Registered (Part I) Optometrist

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Eyecare information by SWISSCOAT Vision Centre

Address : 23/F Whole Floor, One Midtown, 11 Hoi Shing Rd, Tsuen Wan, N.T., HK

Appointment :+852 2751 8491

Website : www.swisscoat.com

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References:

Baril, F. (2013). Prevention of falls among seniors with a visual impairment.

Brundle, C., Waterman, H. A., Ballinger, C., Olleveant, N., Skelton, D. A., Stanford, P., & Todd, C. (2015). The causes of falls: views of older people with visual impairment. Health Expectations, 18(6), 2021-2031.

Dhital, A., Pey, T., & Stanford, M. R. (2010). Visual loss and falls: a review. Eye, 24(9), 1437-1446.

Elliott, D. B. (2014). The Glenn A. Fry award lecture 2013: blurred vision, spectacle correction, and falls in older adults. Optometry and vision science, 91(6), 593-601.

Fong, D. S., Barton, F. B., Bresnick, G. H., & Early Treatment Diabetic Retinopathy Study Research Group. (1999). Impaired color vision associated with diabetic retinopathy: Early Treatment Diabetic Retinopathy Study report no. 15. American journal of ophthalmology, 128(5), 612-617.

Freeman, E. E., Munoz, B., Rubin, G., & West, S. K. (2007). Visual field loss increases the risk of falls in older adults: the Salisbury eye evaluation. Investigative ophthalmology & visual science, 48(10), 4445-4450.

Kuang, T. M., Tsai, S. Y., Liu, C. J., Ko, Y. C., Lee, S. M., & Chou, P. (2016). Seven-year incidence of uncorrected refractive error among an elderly Chinese population in Shihpai, Taiwan: The Shihpai Eye Study. Eye, 30(4), 570-576.

Lamoreux, E. L., Chong, E., Wang, J. J., Saw, S. M., Aung, T., Mitchell, P., & Wong, T. Y. (2008). Visual impairment, causes of vision loss, and falls: the Singapore Malay Eye Study. Investigative Ophthalmology & Visual Science, 49(2), 528-533.