Macular Degeneration (AMD)
What is age-related macular degeneration (AMD)?
Age-related maculopathy (ARM) and age-related macular degeneration (AMD) describe stages of a degenerative disorder of the central area of the retina (the macula) which is often associated with visual impairment and becomes more common over the age of 50.
The macula is a circular area located centrally in the retina which lines the inside of the eyeball. The retina is a complex multilayered structure composed of multiple cell types required for vision.
Adult Strabismus (or Squint)
What is Strabismus?
Strabismus is a condition in which the eyes are not pointing in the same direction. It has a prevalence of 4% (about half develop a squint in childhood).
Adults with strabismus may complain of diplopia (double vision), visual confusion or rivalry (overlapping images), discomfort or difficulty with reading and driving. Sometimes people have to adopt an unusual head posture or cover one eye to avoid double vision.
They may also find social situations embarrassing as they struggle to make direct eye contact while looking at people.
Uveitis
Uveitis (pronounced you-vee-EYE-tis) defined as inflammation of the uvea.
What is the Uvea?
The uvea consists of the middle, pigmented, vascular structures of the eye and includes the iris, ciliary body, and choroid. If you imagine the eye as a hollow ball, the innermost lining layer is the retina, which senses light and helps to send images to your brain. The outermost layer is the sclera, the strong white wall of the eye.The middle layer between the sclera and retina is called the uvea. The centre of the eye-ball is filled with a clear gel.
Uveitis requires an urgent referral and thorough examination by an ophthalmologist along with urgent treatment to control the inflammation.
The uvea contains blood vessels that carry oxygen to and from the eye.
Chalazion
This is a blocked and usually infected eyelid oil gland and is different from a stye (which is an infected eyelash follicle). A chalazion is within the cartilage at the back of the lid and can get quite large and sore, taking a long time to resolve. If it is very painful, inflamed and infected, the first step is to settle the infection and inflammation. Drainage is usually too uncomfortable at this stage and it’s worth waiting until most of the swelling has resolved before contemplating a procedure. Drops and ointment do not penetrate a chalazion so antibiotics must be taken orally. Good options are either one of:
· Doxycycline 100mg twice daily for 7-10 days
· Cefalexin 500mg twice daily for 7-10 days
Doxycycline has the advantage of being anti-inflammatory and it can be continued at a very low dose of 50mg daily for 12 weeks. This will treat the underlying condition if the chalazion is associated with acne or rosacea, if there are multiple chalazia or if the chalazion is persistent and red.
Ibuprofen (Nurofen) up to 400mg three times a day can be helpful for pain and inflammation.
Warm compresses can help a chalazion to resolve. If the chalazion is not infected (red and puffy) then antibiotics can be avoided. The key is to be patient, to do compresses at least once a day, and to persist until the lump is small and no longer causing symptoms. This can take months as can be the case for a bad pimple. A chalazion is a bad pimple of a large oil gland in an inconvenient place.
The chalazion should be heated to 40 degrees (as hot as the hand can bear) for 4 minutes, to melt the blocked up oils. A heat pack or hot flannel is ideal. The lump should then be compressed firmly towards the pore of the gland which is on the edge of the eyelid behind the eyelashes. The aim is to allow melted oils to drain.
Omega-3 fatty acids are anti-inflammatory and improve the quality of the oils in the eyelid glands. Good sources are chia or linseeds (at least 1tsp per day) or oily fish eaten 3 times a week (canned or fresh are both good).
Please see the YouTube video below from Dr Richards for information on how to do warm compresses. Warm compresses are helpful if you have blepharitis as well as when you have a blocked oil gland or chalazion
A chalazion can be drained, if necessary, as a minor procedure under local anaesthetic. Typical reasons people might decide to have a chalazion drained are:
· if it is very large e.g. 1cm
· if it is right in the centre of the eyelid and is causing blurry vision by pressing on the eye
· if there is a fleshy inflammatory reaction under the lid (pyogenic granuloma)
· for cosmetic reasons
Please see this YouTube video from Dr Richards for more information: https://youtu.be/9JjyEG2hsD8
Emergency Eye Care
Usually you will have presented to your Optometrist or your GP if you find yourself with an eye condition; these professionals will know immediately if you require urgent care by an Ophthalmologist and will generally call to arrange an appointment for you.
Please contact Western Eye (08 9383 5353) for advice if you are unsure as to your eye complaint. Outside of our business hours please attend your local emergency department or consult your after hours GP.