• Filiz KUZUM AKYOL, MD
• Safiye CAN KÜÇÜKGÜL, MD
• Fuat BOZKURT, MD
• İsmail KARDEŞLER, MD
• Sebahattin Hasan AZİZAĞAOĞLU, MD
It is a case characterized with fibrosis and abnormal vascular formation in retina layer of premature infants without developed intraocular veins. Since it has no symptom, infant born prior to 32 weeks and lighter than 1500 g should be examined by an experienced ophthalmologist in this sense. Treatment includes observation, laser, kriotherapy or operation.
Glaucoma- Eye Pressure
Liquid pressure in the eye increases and damages eye nerve in glaucoma disease known as eye pressure. It is observed in persons above 40 years old and in both eyes and it is a widespread eye disease. Especially it is one of the reasons of blindness in the advanced ages. Many patients notice glaucoma in advanced stage or when clear loss of vision occurs. Early diagnosis is very significant since there is no chance in the event of loss of vision.
3 types of glaucoma are as follows:
Open angle glaucoma: It is the most frequent glaucoma type seen in the society. It doesn’t have any symptom in early stage. It is insidious and progresses slowly. As the disease progresses, loss of vision and loss of visual field occurs and it is not possible to recover and improve eye nerve damage.
Closed-angle glaucoma: The angle zone where the ducts discharging eey fluid is structurally narrow in some persons. For some reasons, angle and ducts are closed fully and eye pressure rises suddenly. In this case, very severe eye pain may be felt, vomiting and nausea may occur. Eye becomes red, vision reduces. Patients see rings, colors like rainbow around the lights. In this case called as “acute glaucoma crisis”, you should consult the ophthalmologist immediately, if the treatment is delayed, vision will be lost.
Congenital glaucoma: It is a congenital disease. Since eye membrane is flexible in infants, increase of intraocular pressure results in dilation of eyes. Blur, sensitivity to the light and dilution are the other signs. Even if lachrymal duct obstruction is applicable more in infants with watering of eyes, these infants should be examined for glaucoma.
Amblyopi (lazy eye-amblyopia)
It occurs in early period of childhood. While an eye sees well, the other one doesn’t see at the same level and the eye seeing less is called as amblyopic. It is seen in one eye generally. Early diagnosis is significant. For this reason, families should follow their children and ignore eye examination.
Cataract is the loss of transparency of natural lens in the eye. It is called as “curtain” or “aksu” (cataract) by people. Lens transparency of which deteriorates becomes like sooty, mat or stained glass and complaints about vision begin. Objects are seen unshaped, blurred or weak. Eye strain and headache are experienced. It shouldn’t be forgotten that these changes constitute the risk of permanent loss of vision.
Cataract can’t be eliminated by medical treatment, medicine, eye drop, exercise or glasses. The treatment is the replacement of cataract lens with transparent intraocular lens by the surgical method. If visual defect is at advanced stage that hinders daily life of the person, cataract should be removed by operation. For congenital cataract, operation should be performed immediately in any cases that vision is prevented.
3 types of refraction defects for eye are as follows:
Myopia: It is the focalizing of beams in front of the retina for various reasons. Myopia is the eyes seeing close objects clearly not seeing far objects clearly. Myopic persons squint their eyes to see the far better. Myopia is generally genetic. Using eyes under less light or nutritional deficiency may result in myopia. It starts in 8-12 age group and there is also adult type myopia in the mid 20’s.
Hypermetropia: It is known as not seeing the close. Eyeball is shorter than usual in far-sighted persons. For this reason, focusing beams from objects near to eye lens on retina is difficult. In addition to this, flatness of cornea or thinness of eye lens may be the reason of hypermetropia.
Hypermetropic children generally see far and near well. The skill of focusing of eye lens is strong enough to compensate shortness of eye. Strabismus may be seen in hypermetropic children. Headache and indifference in reading may be the sign of hypermetropia.
Astigmatism: It generally occurs due to disorder or deviancy of cornea. While cornea should be smooth and have equal inclination for normal vision, inclination of cornea in astigmatism is more in one direction. It is genetic and remains lifelong.
Retinal Break And Retina Decollement
Retina being the nerve layer perceiving the vision in the eye is adhered to the internal wall of the eye. Vitreus in the gel consistence filling the posterior gap of the eye displays weak adhesion to retina layer. As a result of aging or some diseases, vitreus deteriorates and begins to break away from the retina layer. Photospy can be perceived by the patient during break-away. Retina break may occur during this process. The patient may perceive “soot raining” “shadow” in the front of the eye at this stage. Liquid behind the retina begins to break retine away from the eye wall. It is called as “tear retina recollement”. Myopic persons, persons with recollement history, persons having cataract operation, persons with retina recollement in the other eye constitute risk more. In non-tear retina decollement seen rarely, the reason may be tractional process of retina by membranes contracted or liquid accumulation (cereous) under the retina.
In case of retina decollement, partial or total loss of vision may occur. When thinning and deterioration areas to result in tear or retina break are determined before retina decollement occurs, laser or cryotherapy (freezing) can be applied to around this region. The purpose is to make retina layer around the break adhere to the eye wall more tightly and prevent retina recollement.
In case of retina decollement, surgical therapy will be necessary as soon as possible. Delay of operation will reduce the chance of success. Silicone bands can be inserted to external wall of the eye, gas may be injected to the eye (pneumatic retinopexy or vitrectomy methods can be used by the condition of the eye in the operation. Post-op recovery may last long and recovery may not be achieved fully. Operation may be necessary again for the patient that decollement has not improved completely.
“Diabetic retinopathy” due to diabetes mellitus is the main reason of loss of vision in the ages of 20-65. If not treated, risk of blindnes is 25 times more than non-diabetic patients. The main reason of the problems of retina layer is the deterioration of retina veins due to diabetes mellitus. As a result of it, micro aneurism in retina layer (small vascular bubbles), bleeding, edema, exudate (accumulation due to leakage from vein), formation of new veins in the eye and membranes are seen at early stage. Blindness occurs due to more significant results such as intraocular bleeding from these new veins, breaking retina layer away from eye wall by the membrane (retina decollement) at the final stage of the disease. For this reason, early diagnosis and proper follow-up and treatment is quite significant. Diabetes patients should be examined by an ophthalmologist when diagnosed and continue controls as recommended by the physician provided that they will not interrupt the controls more than one year.
The inflammation in the choroid is called as uveitis. It may sometimes repeat even treated. Inflammation in the front part of the eye called as iridocyclitis responds to treatment earlier and well. Inflammation behind the eye is called as “posterior uveitis” and may result in serious permanent loss of vision. Reasons of uveitis are not determined in most cases. In some cases, rheumatismal or infectious disease can be seen. Uveitis may occur with infectious diseases such as syphilis, tuberclosis, brucellosis, herpes and AIDS, systemic diseases described and collagen tissue and auto-immune originated (Behcet’s syndrome, sarcoidosis, anklylosing spondylitis, rheumatoid arthritis, etc.). Uveitis has the symptoms of redness of eye, not being able to look at the light, blurred vision or decrease of vision, pain around eye, fuzziness around eye. In the central region the symptom of decrease of vision is observed.
Persons due to aging may have difficulty in seeing the close objects. It is called as presbyopia. Reading is improved with glasses and it can’t be treated.
Nerve layer macula (yellow point) behind the eye enables us to see and read clearly, drive a car. When macula doesn’t function adequately, confusion is noted in the center of vision field. Words on the page become blurred while reading and straight line may seem as altered. Macula degeneration occurs due to age and it is widespread eye disease in the age group above 60.
Strabismus (cross-eye) is the case that eyes look at different directions. It is generally seen in children however, it may develop in adults. An eye may be cross-eye in strabismus or eyes may change and glances may shift. Since eyes cross, two different image perception may develop in the brain, sense of depth of vision and vision by both eyes will reduce. Adults have the complaint of double-vision.
Children having the strabismus or amblyopia history and infants with cross eye as of month 4 should be examined by an ophthalmologist. Moreover, routine eye examinations of the child as of 3 ages shouldn’t be ignored.
Oculoplastic surgery is a medical branch of eyelid, lachrymal ducts and orbita diseases. It includes diagnosis and treatment of lid spasm, entropium, ectropion, ptosis, entropium of eyelash, opening congenital or subsequent lachrymal duct obstruction, eye tumor operations and eyelid spasm.
Surgical procedures for correcting eyelid ptosis due to aging and hereditary factors are called as blepharoplasty.
Ptosis is the case that level of upper eyelid is lower than normal. Ptosis may occur as congenital, post-impact, post-eye operation and muscle weakness in the advanced ages. Hanger is used to lift the eyelid for congenital ptosis. In ptosis in advanced age, muscle lifting the eyelid is shortened and strengthened surgically.
The symptoms include turning of eyelash inward, scratch, sting, wetting, pain in superficial layers of the eye and also it may result in scar in cornea and loss of vision at advanced stage. In this case, eyelid and eyelash should be turned outward surgically.
Eye becomes open to external factors in the cases of facial palsy or entropium that lower eyelid turns outward and drying and then infection occurs. Symptoms may include wetting, sting and burning. Usual lid position is achieved by surgical procedure.
Blepharospasm of eyelids unintentionally is the spasm of muscles closing the eyelids excessively and involuntarily. It is seen after the age of 40. Botox is injected to eyelid and around in certain points for treatment and over spasm of eyelid muscles is prevented. Action time of medicine is generally 4-6 months. Treatment should be repeated periodically.