We have listed some common eye conditions that patients typically ask us about.
Tiny spots, lines, flashes or shapes in your vision are known as flashes and floaters. Lots of people experience them and they usually aren't cause for alarm. Below we explain what causes flashes and floaters and when you should be concerned.
WHAT ARE FLASHES?
Sometimes the jelly inside your eye shrinks a little and tugs on the retina (the light-sensitive layer) at the back of your eye. This can cause flashes of light at the edge of your vision. This is different from the disturbance of vision that can happen with a migraine.
WHAT ARE FLOATERS?
Often, people who have healthy eyes see floaters. They appear as spots, lines or cobweb effects, usually when you look at a plain surface such as a white wall, screen or a clear blue sky. They are usually caused by cells clumping together in the clear jelly in the main part of your eye and casting shadows on your retina – the light-sensitive layer of the eye. The sudden appearance of new floaters is different and may be caused by the jelly shrinking and can sometimes mean there is a tear in the retina.
When should I be concerned?
If you suddenly notice a shower of new floaters, or floaters along with flashes or a dark shadow or a ‘curtain’ in your vision, you should take urgent action. Follow the advice at the bottom of this page. These symptoms can mean that the retina is tearing.
What will happen if the retina tears?
The retina is the light-sensitive layer at the back of your eye which receives images and sends them to your brain. If the retina tears, it may come away from the back of the eye and can lead to a retinal detachment which can result in you losing part or all of your vision.
How is retinal detachment treated?
A tear may be treated by using a laser. If treated quickly you may have a better chance of full recovery. However, if your retina has become detached, you will need surgery. The operation may restore most of your vision but may come too late for a full recovery.
What to do if your symptoms change, Look out for the following:
If you notice any of these symptoms, arrange an urgent MECS appointment within 24 hours, or go to an Accident and Emergency department immediately.
The normal tears of the eye are made up of three layers – an oily (lipid) layer, a watery (aqueous) layer, and a sticky (mucous) layer. MGD is when the glands that make the oily layer of the tears are not working properly and this allows the watery layer of the tears to dry out.
The meibomian glands are inside the eyelids, and the openings are on the edge of the eyelids. The outer oily layer stops the watery layer of the tears from drying out. When the glands become blocked, the oily part of the tears cannot be released. This causes the watery tears to dry up more quickly which results in the eye becoming dry and can make it feel sore. It is not usually a serious condition, but can cause discomfort and sometimes blurry vision. If it is not treated, the glands may stop working permanently. MGD can cause dry eye. It is common to have a combination of MGD, dry eye and blepharitis.
MGD is a common condition and can affect anyone. However, it is more likely to happen after the age of 50, if you have diabetes or oily skin conditions and it is also more common in women.
The eyelids can become sore and swollen as the glands become blocked. As the eyes become dry, they can feel itchy or gritty, as if there’s something in the eye. The eyes may be red, and if they’re sore, may be watery, which can cause vision to become blurry.
Treatment involves releasing the oily tears from the glands using hot compresses. You need to get a face cloth, or cotton pads, soak them in hot (not boiling) water, close your eyes, and hold the hot cloth onto your eyelids. Wet the cloth again with hot water and keep applying the compress for at least five minutes. Repeat every day until the condition gets better. You can also use products known as ‘heat bags’ that are specifically designed for this condition. These bags make it easier to direct the heat and are much more effective than a hot cloth. As your optometrist, we can give you advice on these. To help stop the glands from blocking up again continue the treatment every day for a few minutes. Massaging your eyelids can also help to release tears.
If the hot compresses or heat bags don’t work, your optometrist may need to refer you for further treatment.
Glaucoma is the name given to a group of eye conditions where the optic nerve at the back of the eye is damaged. It is often linked with raised pressure within the eye, although the eye pressure can sometimes be normal. When the nerve is damaged, it can start to cause problems with the peripheral vision (side vision) and, if left untreated, can cause permanent damage. With early treatment, further damage to vision can be prevented. The condition often happens in both eyes, although sometimes it affects one eye more than the other. Glaucoma is one of the leading causes of severe sight impairment.
There are two main types of glaucoma – open-angle (chronic) glaucoma and closed-angle (acute) glaucoma. Even though there are many different causes of the disease, the outcomes are very similar. Glaucoma may not have symptoms and this is why it is very important to have regular sight tests.
Age is the biggest risk factor for glaucoma. However, your risk also increases if you have family members with glaucoma or if you’re of black African or black Caribbean ethnic origin. Other eye conditions can sometimes cause glaucoma as a side effect. If you are diagnosed with glaucoma, it is important to let your close relatives know as they may be at increased risk of developing the disease.
The danger with open-angle or chronic glaucoma (slow onset) is that, in the early stages, your eyesight may seem perfectly normal. There is no pain, but your peripheral vision (side vision) is being damaged. Eventually your central vision can be affected. This can be described as tunnel vision because it feels like looking down a long tube. It’s important to have regular sight tests as open-angle glaucoma often does not have symptoms.
These symptoms can develop very quickly. Your eye might become very red and painful, you can get headaches and feel sick, and you may notice coloured halos around lights. This is a medical emergency. If you notice any of these symptoms, you should go to an accident and emergency (A&E) department immediately.
Open-angle glaucoma is usually treated with eye drops which reduce the pressure in the eye. You will need to use these daily and you will be monitored regularly at the hospital. Occasionally people with open-angle glaucoma need surgery to control the pressure.
Closed-angle glaucoma can damage the eye quickly. It’s treated at first by drops and tablets and sometimes by drugs direct into the bloodstream to quickly reduce the pressure in the eye. Laser treatment is often needed later to allow the fluid to flow through the eye better. People with closed-angle glaucoma may need surgery if laser treatment is not successful.
The normal tear fluid that lubricates the eyes is made up of three layers – an oily (lipid) layer, a watery (aqueous) layer, and a sticky (mucous) layer – and these normal tears are what prevent our eyes from feeling dry.
You release extra tears when you cry. These are the same tears that are also triggered when something goes into or irritates the eye including chopping onions.
WHAT IS DRY EYE?
People with dry eye either don't make enough normal (lubricating) tears or the ones that they make are of poor quality, causing the tears to dry up too quickly and the front of the eye to become dry and irritated. As a result, dry eye can be uncomfortable and cause the eye to produce the watery type of tears. This only helps for a short time – leaving the eye uncomfortable and gritty.
If your eyelids are sore and red, you may also have another condition called blepharitis. Blepharitis is a condition that affects the eyelids making them sore and inflamed. If the eyelid glands become blocked, you may have a condition called meibomian gland dysfunction. It is quite common to have a combination of these conditions. Dry eye doesn't tend to cause serious damage to the eyes, but it can be very uncomfortable. Severe cases do have a risk of causing long-term damage, but fortunately these are rare.
Dry eye is much more common in people over the age of 50. This is often because the glands that make the normal tears, and particularly the oily part of the tears, tend to become less effective as you get older. Also the tears tend to spread across the eye less well with age. Some general health conditions can cause dry eye as a side effect, such as autoimmune diseases and hormonal changes. The condition is also more common in windy, cold, dry and dusty conditions. If you’re concentrating on your computer or smartphone for long periods of time without a break, this may also make your eyes feel dry. Air conditioning and central heating can make dry eye worse too, as can some medications and general health problems. Smoking has also been linked to dry eye as it may both cause the condition and make it worse.
People with dry eye may get some or all of the following symptoms.
Most cases of dry eye tend to be a long-term condition, meaning that you’ll need ongoing treatment.
There are lots of different types of drops and gels that can help your eyes feel more comfortable. The best ones don’t have preservatives in them, or if they do they contain very gentle preservatives, which helps to reduce irritation. They may also contain an ingredient called sodium hyaluronate, known to be very effective in treating the condition.
It’s important to use the correct type of drops. The wrong drops are unlikely to cause any harm, but they won’t help as much. If your drops aren’t working or you’re not sure which drops to use, your optometrist can advise you and may be able to offer other treatment options.
A cataract happens when the lens within your eye becomes cloudy. It can happen to all of the lens or just part of it. There are different types of cataract, but the most common is age-related cataract, which is more common in people over 65. It can be found to some degree in almost all older people.
Age is the biggest risk factor for developing cataracts. Apart from age, smoking increases the risk of cataracts and often causes the cataract to develop earlier and more quickly. Excessive exposure to sunlight and ultraviolet light can increase the speed at which cataracts develop. Diabetes is also a common cause of early onset cataract. Other causes include certain drugs, such as steroids, or cataracts may form after an eye injury or surgery. In some cases, people are born with cataracts.
Cataracts can cause your vision to become misty and less clear. You may notice that you’re more easily dazzled by vehicle headlights, or that objects appear less colourful. You may need to change the prescription of your glasses more regularly than usual. Cataracts don’t cause eye pain or make your eyes red. If you experience blurred or misty vision, you should see your optometrist.
At first your optometrist may be able to prescribe new glasses that will help with changes to your vision caused by the cataract. When this no longer helps you to see well enough, the only effective treatment is surgery. Surgery is usually only recommended once the cataract is causing problems with everyday activities, such as driving, watching television and reading.
Cataract surgery improves the vision of nearly all patients and has one of the highest success rates of all surgery. Following surgery, the prescription of your glasses will change and you should see your optometrist after a few weeks for advice.
Blepharitis causes eyelids to become red, swollen and inflamed. It doesn’t normally cause serious damage to the eyes, but it can be very uncomfortable. It tends to be a long-term condition, which means you’re likely to need ongoing treatment. Severe cases do have a risk of causing long-term damage, but fortunately these are quite rare.
Types of blepharitis
There are two main types of blepharitis – anterior and posterior.
When the front (anterior) part of the eyelids becomes sore, this can be caused by an infection, allergy or a general sensitivity to bacteria present on the eyelids. It can also be associated with some scalp conditions, such as very dry or oily skin and dandruff.
Also known as meibomian gland dysfunction (MGD) is when the glands that make the oily part of your tears become blocked. Both types of blepharitis can cause dry eye or make it worse if you already have it. Many people will have a combination of blepharitis, meibomian gland dysfunction and dry eye.
Blepharitis is more common in people over the age of 50, but anyone can develop it. This is often because the glands that make the normal tears, particularly the oily part of the tears, tend to become less effective as you get older.
Blepharitis can cause crusting and white scales may stick to the roots of eyelashes. Your eyelid edges may become red and your eyes will feel gritty, burning, sore or itchy. If you experience these symptoms, make an appointment with your optometrist.
There is a range of products designed especially for treating blepharitis, such as sterile pads, individual moist wipes and separate cleaning solutions.
Your optometrist will be able to advise you on where you can buy these products. Antibiotic ointment may be recommended in severe cases.
As part of the treatment, you need to remove all the crusting and debris from the edge of your eyelids and from between your eyelashes. You should use your cleaning product. If this is not available, you should use warm water and cotton balls or make-up removal pads. Treatment of blepharitis is a long-term procedure. You may not see any improvement for several weeks.
Continue the treatment twice a day for at least one month, then less often as it starts to get better. You will probably need to continue to clean your lids at least twice a week to help prevent the blepharitis from returning.
Blepharitis treatment method
AMD is a condition that affects the central part of your vision. It is caused by damage to the macular region of the eye, which is the part of the retina that provides detailed, central vision. It doesn’t normally affect your peripheral (side) vision, so while objects in the centre of your vision may become difficult to see, the vision to the side and edges should not be affected.
There are two main types of AMD – dry and wet. Dry AMD, sometimes referred to as wear and tear, is caused by a build-up of waste within the cells of the eye that react to light – these are called drusen. Drusen stop the cells from reacting properly to light. This form of AMD usually develops slowly.
Wet AMD happens when new blood vessels grow behind the macula. These blood vessels can begin to leak and this can damage the cells in the macular region and stop them from working. This process can start very suddenly.
Age is the main risk factor for developing AMD and the disease is more common in people over 65. Smoking significantly increases the risk of getting macular degeneration. Stopping smoking is the greatest change you can make to protect yourself from AMD. Ultraviolet light may also increase the risk of AMD, so, it’s a good idea to wear glasses that block or absorb UV light, especially in bright light. Getting enough exercise and eating a healthy diet, with lots of fruit and vegetables, can help to protect your eyesight. Kale, spinach and broccoli all contain nutrients that have been shown to help keep the eyes healthy. If you have a close relative with AMD, your risk of developing the condition is higher. You are also more at risk if you already have AMD in the other eye.
To begin with, dry AMD may have little effect on your vision. If the disease develops, your central vision may gradually become more blurred and it may become difficult to recognise faces and read things directly in front of you. Wet AMD will normally cause distorted vision, with straight lines and edges such as door frames becoming wavy and distorted. Some people also see a sudden blank spot in their central vision. Sometimes these changes can happen quickly, so it’s important to see your optometrist urgently if you notice any sudden change in your vision.
At the moment, there is no effective treatment for dry AMD, but it may be possible to see better with the help of special magnifiers and good lighting. Advice from the National Institute for Health and Care Excellence (NICE) states that patients with dry AMD should not normally be referred to the hospital eye service, but should continue to regularly see their optometrist to monitor the condition. If you have dry AMD, you should also take steps to monitor your own vision and can use an Amsler chart to do this. Download an Amsler chart.
Wet AMD can often be treated with injections into the eye, as long as it is diagnosed quickly. The injections work by stopping the growth of new blood vessels and can help to save your vision and reduce the risk of the disease getting any worse. If you notice any recent change in symptoms, you should contact your optometrist immediately. They will arrange for you to be seen by the hospital eye service.
Living with AMD
If your vision is affected due to AMD, your optometrist can advise you on steps you can take to help you in your daily life. This may include referring you to a clinic which can offer help in the form of magnifiers, or putting you in touch with local support groups. You may be advised to register your sight loss with your local authority.
If you have lost vision through AMD, you may experience visual hallucinations. This is known as Charles Bonnet Syndrome. Many patients find it reassuring to know that this is a common experience after losing vision, and although it can be quite upsetting, it is unlikely to be a sign of mental illness.
If you experience visual hallucinations, you may want to discuss it with your eye care practitioner.
If you drive, you should discuss your eyesight with your optometrist.