Don't be blind to Macular Degeneration

With Macular Degeneration Awareness Week coming up from the 25 June to 1 July this year, it is disturbing to note that the majority of the people have never had their macular checked. Macular degeneration (progressive damage to the retina) is currently the leading cause of blindness, but inmany cases it can be prevented.

Reduce the risk of blindness due to MD by:

• Wearing sunglasses
• Not smoking
• Eating fish, dark green leafy vegetables and fresh fruits
• Having regular eye-checks every two years
• Eating foods that contain zinc
• Exercising regularly

TO REMOVE A SOFT LENS

Never use forceps

1. Wash hands carefully.
2. Check that the lens is on the cornea.
3. With patient looking up, place the index finger on the lower edge of the lens and slide it laterally.
4. Pinch the lens between thumb and index finger - this allows air beneath the lens so that it can be withdrawn.

5. Clean the lens with normal saline by placing it in one palm and gently massaging with the other index finger.

6. Place in the carrying case in saline, or in a vial or bowl with saline. Soft lenses must not be stored dry.

TO CHECK WHETHER A SOFT LENS IS INSIDE OUT

Place the lens concave side up on an index finger. If the lens is correct, the edges turn in slightly.

If the lens is inside out, the edges turn out. If the lens is inside out, it should be pressed to reverse the surfaces, then rechecked to make sure it is correct.

Insertion of Soft Lens - the correct way

1. Wash the hands thoroughly, soft lenses are readily contaminated.
2. Remove the holder of the lenses from the solution in the carrying case, and identify
the lenses for the right and left eye.
3. Lenses that have been soaking in germicide must be washed thoroughly in saline-
not over a basin without a plug.
4. Wipe the right lens off the holder onto the pulp of the index finger of the right hand.
5. Check that the lens is right side out. If it is very floppy, wait about a minute for it
to dry a little.
6. Retract the lower lid with the middle finger (same hand as holding the lens).
7. Looking up, roll the lens onto the lower conjunctiva and express any air,
8. Close the eyelids, then massage the closed upper eyelid to help center the lens.
9. Repeat for left eye.

CONTACT LENSES - The correct way to wear them

Hard contact lenses are smaller than the cornea. Sorft contact lenses cover the cornea or extend onto the sclera. Hard lenses are firm while soft lenses are like a tiny sponge. Their management is different.

If a lens is lost under the upper lid, reassure the person that it can cause no harm. Gently press over the upper lid to move it down. If it is stuck, irrigate with saline.

Never use forceps on a contact lens.
Never instill fluorescein eye drop in an eye wearing a soft lens.
Never wash a contact lens over a basin without a plug.

HOW TO INSERT A HARD LENS:

1. Wash the hands.
2. Check which is the right and which is the left lens.
3. Place the lens in the palm of one had and apply contact lenses wetting solution.
4. Place the lens concave, or bowl side upwards on the pulp of the index finger of the master hand.
5. Have the patient look down, retract the upper lid with fingers of the other hand.
6. Place the lens above or to the side of the cornea and move it centrally. Blinking should then center the lens.

Instead of insertion with a finger, a small suction cup holder may be used. Moisten the tip with saline to obtain a good grip.

HOW TO REMOVE A HARD LENS - 3 methods:

Method 1

Squeeze the lens off the eye by placing one thumb on the upper lid and one on the lower lid. Apply some pressure and bring the lids together. The lens should be displaced onto the lower eyelid or onto the hand.

Method 2

1. Wash the hands.
2. Place an index finger at the outer canthus and cup the other hand just below the eye.
3. Have the patient open the eyes widely.
4. Don't blink hard and at the same time, you pull the eyelids back in the direction of the top of the ear.
5. The lens should pop out into the cupped hand.

Method 3

The lens may be removed with a moistened suction cup holder.

How to insert Soft Lens?.....to be cont'd.

What Your Eyes Reveal

DIABETES:
- Your optometrist may identify subtle changes in your eyes caused by unstable
blood sugar levels. With severe untreated diabetes, there's the risk of diabetic
retinopathy. The blood vessels inside the retina, become damaged and this can
lead to permanent blindness. A healthy retina is needed for good vision.

HEART DISEASE AND STROKE RISK:
- High blood pressure affects 3 in 10 adults, and many don't even know they have
it. It's a major risk factor for heart attack and stroke. Looking directly at the blood
vessels in your eyes an optometrist can identify haemorrhages and leaking vessels,
as well as changes such as hardening of the arteries.

BRAIN TUMOUR:
- An eye test can show a bulging optic nerve caused by increased pressure inside the
skull - one symptoms of a brain tumour.

DARK UNDER-EYE CIRCLES

THE CAUSE: While a lack of sleep can worsen the appearance of dark under-eye
circles, their most likely cause is kidney function: If the kidneys aren't eliminating
the body's waste products as they should be, it can contribute to a dark colouring
beneath the eyes.

THE SOLUTION: Help kidneys by drinking enough water 0 at least one liter per day
and start eating phosphorus-rich foods. Phosphorus is found in wholegrain foods,
chicken, eggs, seeds and nuts.

BEAUTY FIX: An eye cream containing vitamin K can help strengthen delicate
under-eye capillaries. Vitamins K and A in a gradual, controlled manner, helping
the vitamins to repair blood vessels and reduce pigmentation without causing irritation.

OPHTHALMIA NEONATORUM

OPHTHALMIA NEONATORUM - previously an important cause of impaired vision or blindness, now rare due to better hygiene, good antenatal supervision and efficient treatment of venereal disease; but it may occur when these factors are deficient. Forms for a "Notifiable Disease" need completion.

The most severe cases occurred from Neiseria gonorrhoea; the more moderate from chlamycia (TRIC), and common bacteria.

These cases can be highly infectious and extreme care must be taken. Be most careful lest splashes of pus occur when the eyelids are opened. Corneas may be ruptured by forcibly opening the eyelids.

SIGNS:

• Swollen eyelids
• Purulent discharge
• Corneal clouding or ulceration

TREATMENT:

Smear and culture, but begin intensive treatment while awaiting results.

Benzylpenicillin extemporaneous irrigation with Normal Saline (irrigate freely and

frequently until pus stops forming, continue 4 to 6 hours, then use eyedrops as indicated.

The mother will need investigation and treatment.

ROUTINE EYE CARE AFTER BIRTH - cleansing the eyelids only with sterile water and

swabs.

CATARACTS

CATARACTS happen when the crystalline lenses inside the eye become
cloudy as part of the ageing process. If left untreated, they can sometimes lead
to blindness.

We will all have cataracts eventually,however, not everyone gets to where they need
to do anything about it. Where treatment is necessary, it's very effective - it involves
surgery to replace the lens with a plastic implant, often as day surgery.

SIGHT TIPS:
Although cataracts are inevitable if you live long enough, early on, you can slow the
progression and minimise the damage. Not smoking, protecting your eyes from UV
rays, and a healthy diet are all helpful.

GLAUCOMA

GLAUCOMA - this condition is the result of increased pressure in the eye
causing damage to nerves in the retina (the eye's inner lining). It usually
has no symptoms, so it often robs people of their slight slowly and painlessly.

SIGHT TIPS:
Glaucoma can be treated if picked up early. People who have risk factors
for glaucoma (family history is a key contributor) should be regularly assessed
by an optometrist.

Glaucoma can affect people of all ages but becomes more prevalent as you get
older, so anyone over 40 should have a full eye check at least every two years
even if they don't have any obvious problems.

SUNBURN - A Cause of Eye Damage?

One of the most common causes of eye damage is sunburn.

We need to remember that sun protection means slip, slop, slap and slide on your
sunglasses. UV damage can cause serious eye problems, including pterygium, which
is tissue damage involved in the development of cataracts.

SIDE TIPS:
Whenever in the sun, both adults and children should wear sunglasses. If you wear
glasses, there are tinted lenses available, although most prescription lenses absorb
a large amount of UV light.

Age Related Macular Degeneration (ARMD)

ARMD - is the result of progressive and often painless damage to the retina.
The problem starts with damage or breakdown of the macula - the part of the
retina responsible for central vision. If you smoke, you're about four times
more likely to develop ARMD and can expect it to happen up to 10 years
earlier.

SIGHT TIPS:
Besides giving up smoking, diet and UV protection also offer some preventive
help, especially if good habits adopted in early life. The dietary indications
are similar to those for cardiovascular health.

Eat less saturated fats and plenty of vegetables - particularly brightly coloured
vegetables, fruits, nuts and fish.

SCREEN STRAIN

SCREEN STRAIN

The effect of staring at your TV or computer is more tiring than damaging.

SIGHT TIPS:
Take regular breaks, look away from the screen often and remember to blink.
To avoid screen fatigue during a movie, sit at least two metres away from your
TV. The best distance to have between your eyes and your computer screen
depends on the type of monitor, but in general, try for at least 40 centimetres.

Dry Eye Syndrome

by: Bluntish

Dry Eye Syndrome - is caused by a reduced quantity or quality of the tears that
your body produces to lubricate your eyes.

It is more likely to affect older women. Besides air-conditioning and forgetting to
blink when at a computer, certain medications, smoking, poor diet and anything
that alters the body's fluid balance can also contribute.

• SIGHT TRIPS:

Ocular lubricant drops are available at your pharmacy, but be careful to choose

lubricants rather than decongestant drops. Make sure you're not having air blown

at your face fron an airconditioner or fan in your office or car, and only apply make-

up to the outer (not inner) edge of your eyelid.

Viral Conjunctivitis

Viral Conjunctivitis can be caused by many different viruses.

- Adenoviruses
- Herpes simplex virus
- Herpes zoster virus
- General intercurrent viral infections - measles, mumps, rubella.

Epidemic viral conjunctivitis is usually bilateral, with marked redness, follicular
reaction, chemosis and copious lacrimation. There is little serous discharge
and pus is generally absent. The cornea is likely to be involved.

Acute Infective Conjunctivitis

Conjunctivitis means inflammation of the conjunctiva. Most important
conjunctivitis is caused by infection, milder conjunctivitis may be allergic
or from physical irritants such as foreign bodies, sunlight or wind. Rarely,
systemic disease or parasites may be the cause. Conjunctivitis may be
acute, subacute, or chronic.

Bacterial Conjunctivitis - may be caused by a wide range of organisms:

• Staphylococcus aureus
• Streptococcus pneumoniae
• Streptococcus pyogenes
• Haemophilus influenzae
• Koch-Weeks bacillus
• Morax-Axenfield bacillus
• Pseudomonas pyocynaea
• Neisseria gonorrhoea

Symptoms of Bacterial Conjunctivitis

1. gritty, foreign body sensation
2. photophobia
3. lacrimation
4. eyelids sealed together with discharge on wakening
5. vision is clear and cornea is bright

Signs

1. - diffuse redness of the conjunctiva of the eyeball and the eyelids
2. - purulent discharge - but milder cases are free from discharge
3. - possible corneal complications

Treatment

• Do not pad a discharging eye as by closing the conjunctival sac

conditions are favoured for bacterial proliferation.

• Sunglasses to diminish photophobia.
• Removal of discharges or secretions by the frequent instillation of

antibiotic eye drops.

• Eye ointment applied at bedtime has longer action then eyedrops

prevents sealing of lid margins by discharge.

• Awareness of the danger of spreading the infection to the other eye

or other people.

• Maintain a good personal hygiene.

Chronic conjunctivitis may follow an acute conjunctivitis that has been

inadequately or ineffectively treated, but failure to respond may be due to

some other lesion - viral corneal ulcer, foreign body, infected tear sac.