Eye Diseases

We are going to discuss common eye conditions in clinical practice

Conjunctivitis

It is the inflammation of conjunctiva associated with watery, mucoid or purulent discharge.

The common causes are infection such as bacterial, viral etc. or allergic reaction to change of season, dust mites etc.

A. Infective Conjunctivitis –

1. Bacterial Conjunctivitis – It is highly infectious disease occurs usually in dry hot climate because of poor hygienic conditions.

Patient usually presents with sudden onset of redness with discomfort in one eye, sticking of lid margins during sleep because of mucoid or purulent discharge. After 1-2 days infection may spread to another eye. The symptoms are at peak on 3^rd or 4^th day. The prognosis is still good without any treatment but may take long time (10 – 15 days) to resolve the infection. The chances of complications are rare but may pass into chronic catarrhal conjunctivitis stage.

2. Viral Conjunctivitis –

Most of the viral infections affect both conjunctivitis and cornea so it is also termed as Keratoconjunctivitis.

It is highly contagious and spreads through contact with contaminated finger.

Patients usually presents with similar but milder form of symptoms than bacterial conjunctivitis. There is sudden onset of redness of eyes with mucoid discharge. Eyelids are swollen in some cases.

B. Allergic Conjunctivitis –

It is the inflammation of conjunctiva due to hypersensitivity reaction may be immediate or delayed type.

Simple allergic conjunctivitis is relatively common in practice than any other type. It is either seasonal or perennial (throughout year). Seasonal allergic conjunctivitis (SAC) is very common and may be associated with allergic rhinitis.

Perennial allergic conjunctivitis (PAC) occurs because of allergens like house dust, mite etc. and the condition is chronic in nature, occurs all throughout the year. The patient usually presents with intense itching with watery of stringy discharge.

Phlyctenular Kerato Conjunctivitis – The patient presents with characteristic nodules on the conjunctiva as an allergic response.

Stye –

It is an acute suppurative inflammation of lash follicle. Patient presents with painful, localized firm or red swelling at the lid margin associated with oedema. In some cases, we find visible pus point on the lid margin. The patients of diabetes, chronic blepharitis are more prone to recurrent stye formation.

Chalazion –

It is a chronic non suppurative lipogranulomatous inflammation of the meibomian gland. Patients usually present with painless swelling in the eyelid gradually increasing in size. While examining firm to hard and non-tender nodule is noted away from the lid margin. In few cases complete spontaneous resolution occurs rarely. Slow increase in size is often seen in many cases.

In recurrent chalazion at old age malignancy should be ruled out.

Blepharitis –

It is subacute or chronic inflammation of the lid margins. It is commonly associated with bacterial infection or seborrhoic dermatitis. We can find yellow or whitish crust at the lid margin.

Cataract –

It means development of any opacity in the lens or its capsule. It occurs due to formation of opaque lens fibres or most commonly due to degenerative process leading to opacification of lens.

Senile cataract is commonest type of cataract affecting persons above age of 50.

In diabetes and smokers cataract develops at early age.

Many patients are asymptomatic. Some patient develops intolerance to bright light, black spots, blurred or deterioration of vision.

Cataract is usually diagnosed by ophthalmologist. Treatment of cataract is essentially surgical.

Retinal Detachment –

It is the separation of neurosensory retina proper from the pigment epithelium. Normally these two layers are loosely attached to each other with existing space in between. Therefore, the proper term should be retinal separation.

It is common at 40 to 60 yrs. age group. Patients usually complain of predominant symptoms like dark spots or sensation of flashes of light in front of eye. Afterwards, relative loss in field of vision is noted by patient in the early stage. Sudden painless loss of vision occurs when the detachment is large and central.

Ophthalmoscopy is required for the diagnosis.

Dacryocystitis –

It is the inflammation of the lacrimal sac. It occurs commonly because of stasis of secretion in the lacrimal sac due to blockage in the nasolacrimal duct. It is either congenital or adult dacryocystitis. Patient presents with copious mucopurulent discharge from eye. When pressure is applied over swelling of lacrimal sac, purulent discharge regurgitates from lower punctum.

Suggested further reading for Section IV

Medicine –

1. Kumar and Clark’s Clinical Medicine, Elsevier publication
2. Davidson’s Principles and Practice of Medicine, 23^rd edition, Elsevier publication
3. Harrison’s Principles of Internal Medicine, 20^th edition, publication- McGraw – Hill Education.