Post operative care after Cataract Surgery

Precautions to be taken after surgery:

1. Use the eye drops and medicines as prescribed by the doctor. 
2. Avoid rubbing or squeezing your eye.

Protection: As advised by your doctor, you may wear the protective eye shield at night for first week. Dark eyeglasses may be worn during the daytime, especially outdoors, to avoid any discomfort that you may have from bright light and also to prevent any injury to eye.

Face wash: For the first few days, avoid splashing water directly into the eye. You may use a clean, soft, wet towel to wipe your face.

Shaving: Shaving of the beard is permitted after the operation.

Bathing: Body bath (below the neck) may be resumed after the first day, but avoids taking a shower or a bath in the bathtub for the first week after surgery.

Head bath: One may wash the hair with the head tilted backwards to avoid any water splashing into the eye.

Games: Normal daily activities including walking, reading and watching television may be resumed soon after the operation. However avoid strenuous activities like jogging, lifting weights, swimming, gardening, aerobics, contact sports etc. for 1-2 months.

Sex: You can resume your sex life a week or two after the operation after consulting your doctor.

Makeup: Avoid eye makeup for 6 weeks.

Diet: There are no dietary restrictions and you may take your routine diet. However, the restrictions as per you pre-existing medical problems, if any, are to continue. Avoid constipation by taking high fiber diet and plenty of fluids. Avoid excessively oily and spicy food.

Driving: Avoid driving unless the surgeon permits you.

Job: You may get back to your job in 1-4 weeks after surgery depending on your profession. Ask your surgeon about this.

Normal symptoms: The following symptoms are normal and are not a cause for alarm. These are slight redness, mild watering, mild irritation, glare and slight drooping of upper eyelid. These will remain to some extent for 6-8 weeks.

Alarming symptoms: In case of any pain, injury, decrease in vision or flashes of light in the operated eye, contact your surgeon immediately.

Procedure for cleaning the eye:

1. The operated eye needs to be cleaned at least twice a day.
2. The attendant performing this task should wash the hands with soap and water and dry them with a clean towel.
3. You may use the disposable tissue supplied at the hospital for this purpose. Alternately you may place cotton in a clean vessel cover it with a lid for 10 minutes, let it cool down, take the cotton out, squeeze the excess water and use the same to clean.
4. Cleaning the lower lid is done by asking the patient to look up and wiping all the secretions sticking to the lower lid margin.
5. Cleaning the upper lid is done by asking the patient to look down and doing similar procedure.
6. Similarly the outer and inner corners of the eye are cleaned.
7. Once the margins and corners are cleaned, the eye drops can be instilled and then the surrounding areas can also be cleaned.

General instructions for instilling medicines in the eye:

1. Always instill drops before ointment.
2. Leave a gap of 5 minutes between two medications.
3. Keep the eye closed for 5 minutes after applying the medication.
4. Once opened the eye drops are discarded after 10 days.
5. Replace the cap of the bottle immediately after use.
6. Make sure that the right drops are being used for the right number of times.
7. If similar medication is advised for both eyes, it is advisable to have separate bottles for the two eyes.
8. Unused eye medication, once opened is discarded and never used for other persons.

General instructions:

1. Do not rub the eyes
2. Do not lift heavy weights
3. Do not allow the eye to get injured- the eye shield is meant to protect the eye from physical hurt.
4. Avoid too many visitors for fear of contacting infection- especially avoids visitors with conjunctivitis, cold etc.
5. Do not play with children since there is possibility of getting hurt in the eye.
6. Do not strain at toilet. If needed please take laxative.
7. Avoid use of snuff.
8. Cigarette smoking should be avoided.
9. Alcoholic beverages are best avoided.
10. Avoid using handkerchief to mop the eye. Use sterile tissue only.

Conjunctivitis - Eye Flu or Pink Eye

What is Conjunctivitis?

Conjunctivitis (also called pink eye) is the most common eye infection. It causes soreness and swelling (inflammation) of the skin that lines the eyelid and the white part of eyeball (the conjunctiva). When small blood vessels in the conjunctiva becomes inflamed, they are more visible. This is what makes the eye appear reddish or pink.

Infectious conjunctivitis can be highly contagious and spread from one eye to the other and all around the family if precautions are not taken.

Types of Conjunctivitis

The four main types of conjunctivitis are:

1. Bacterial conjunctivitis usually infects both eyes and produces a heavy discharge of pus and mucus.
2. Viral conjunctivitis typically begins with one eye and causes lots of tears and a watery discharge.This is probably the most contagious form of pink eye.
3. Allergic conjunctivitis produces tearing, itching and redness in both eyes and sometimes an itchy, runny nose.
4. Giant papillary conjunctivitis is another form of pink eye. It is most frequently associated with the long term use of contact lenses.

Symptoms of Conjunctivitis?

1. Eye redness
2. Something in the eye
3. Drainage from the eye
4. Swollen , red eyelids
5. Itchy or burning eyes
6. Crusty eyelids
7. Lots of tears
8. Sensitivity to light 

What you should not do—Don’ts

1. People with conjunctivitis should avoid public places and handshakes, sharing their clothing, bedding or sunglasses.
2. Do not rub your eyes
3. Temporarily avoid the usage of contact lenses.
4. Do not share your eye drops- it can cause cross contamination.
5. Do not use steroid eye drops or over the counter medicines from the chemist without consulting an ophthalmologist.

What you should do—Do’s

1. Frequent washing of hands with soap and water or sanitizer should be ensured by patient and everybody else around them.
2. Frequent eye wash with cold filter water and cold compresses with ice packs helps in relieving the symptoms.
3. To wipe eyes, use tissue paper and dispose it properly in the dustbin.
4. Wear sunglasses to avoid glare and accidental eye contact with fingers.
5. Antibiotic and anti-inflammatory eye drops to be used as prescribed by the eye specialist preferably have a separate set of eye drops for each eye. 

If you are suffering from Conjunctivitis, Meet our eye specialist today for a free consultation and eye checkup. - Click here Book an appointment now! (it's FREE)

Trachoma

Trachoma is one of the oldest infectious diseases known to mankind. It is caused by Chlamydia trachomatis – a microorganism which spreads through contact with eye discharge from the infected person (on towels, handkerchiefs, fingers, etc.) and through transmission by eye-seeking flies. After years of repeated infection, the inside of the eyelid may be scarred so severely that the eyelid turns inward and the lashes rub on the eyeball, scarring the cornea (the front of the eye). If untreated, this condition leads to the formation of irreversible corneal opacities and blindness.

It is responsible, at present, for more than 3% of the world’s blindness. Trachoma continues to be hyper endemic in many of the poorest and most remote poor rural areas of Africa, Asia, Central and South America, Australia and the Middle East. The sequels of active trachoma appear in young adulthood and in middle-aged persons. In hyper endemic areas active disease is most common in pre-school children with prevalence rates as high as 60-90%. It often strikes the most vulnerable members of communities-women and children. Adult women are at much greater risk of developing the blinding complication of trachoma than are adult men. This increased risk has been explained by the fact that women generally spend a greater time in close contact with small children, who are the main reservoir of infection.

The development of trachoma is quite slow and there are five stages of this development that are designed by the World Health Organization.

1. Follicular Inflammation – It is the first stage of the trachoma condition in which five or more than five follicles become visible in the inner surface of the upper eyelids.
2. Intense Inflammation – In this second phase of the development of trachoma, the irritation of the eyes beings and the eye becomes highly infectious. The swelling of the upper eyelids also begins in the second phase.
3. Scarring of the eyelids – Due to the infectious eyes the inner eyelids show scars on it. These scars appear like white lines and this will distort the eyelids.
4. Ingrown eyelashes – Due to the scarring of the inner lining of the eyelids, the eyelashes starts turning in and touches the transparent outer surface of the cornea. But only one among 100 affected people shows this painful symptom.
5. Clouding of the cornea – Due to the inflammation of the upper eyelids, the cornea gets affected severally. The ingrown eyelashes lead to clouding of the cornea. This can also result in ulcers on cornea and thus causes partial or complete blindness. 

Prevention and Treatment of Trachoma

Environmental risk factors are water shortage, flies, poor hygiene conditions, and crowded households. A prolonged exposure to infection throughout childhood and young adulthood appears to be necessary to produce the complications seen in later life. A single episode of acute Chlamydia conjunctivitis is not considered sight threatening as there is virtually no risk of prolonged inflammation or blinding complications.

It is easily treatable , all that is required is awareness, hygiene and a good eye checkup.

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फिट दिल्‍ली: कैसे दें गर्मी की उमस को मात: AAJ TAK: Fit Delhi

फिट दिल्‍ली: कैसे दें गर्मी की उमस को मात: AAJ TAK: Fit Delhi

Age related macular degeneration ARMD (AMD)

ARMD stands for Age Related Macular Degeneration. These are aging changes occurring in the macular area, which affects our vision. Since macula is the area responsible for main or central vision, even small changes can cause major visual problem. It affects one eye followed by the involvement of the second eye.

Symptoms of Age related macular degeneration

• Blurry distance and/or reading vision
• Dark areas or distorted central vision ----straight lines will appear bent, crooked or irregular
• Need for increasingly bright light to see up close
• Colors appear less vivid or bright
• Hazy vision
• Difficulty seeing when going from bright light to low light (such as entering a dimly lit room from the bright outdoors)
• Trouble or inability to recognize people's faces
• Dark gray spots or blank spots in your vision
• Loss of central vision
• Size of objects may appear different for each eye

You may not notice vision changes if only one eye is affected, as your unaffected eye will compensate for vision loss in the other eye.
  
If you think you are suffering from Age related macular degeneration (ARMD), Meet our eye specialist today for a free consultation and eye checkup. - Click here Book an appointment now (it's FREE)!

Risk factors for macular degeneration

• Genetic predisposition-family history present in closely related family members.
• Aging-Incidence increases from2% in 50’s to 30% in 70’s.
• Approximately 1 in 3 Caucasians have genetic changes that make them more prone to damage from oxidative stress, which can lead to macular degeneration.
• Smoking and high blood pressure are associated with the wet form of macular degeneration.
• There may be a link between being obese and having early or intermediate-stage macular degeneration develop into the advanced (wet) form.
• Another risk factor for developing macular degeneration may include having abnormal cholesterol levels.
• An overactive immune system with its associated inflammation may be a risk factor for macular degeneration.

Diagnosis of Age related macular degeneration

• Complete eye check up with dilated fundus examination by a eye specialist.
• Amsler Grid test for each eye with near correction/glasses, where patients suffering from ARMD see lines as wavy, dark or blur.
• Fundus fluorsceine angiography (F.F.A)
• Optical coherence tomography (O.C.T)

Types of macular degeneration

Dry macular degeneration
With dry macular degeneration, vision loss is usually gradual. People who develop dry macular degeneration must carefully and constantly monitor their central vision. If you notice any changes in your vision, you should tell your ophthalmologist right away, as the dry form can change into the more damaging form of macular degeneration called wet (exudative) macular degeneration. While there is no treatment for dry macular degeneration some people may benefit from a vitamin and antioxidant therapy regimen.

Wet (exudative) macular degeneration also called neovascular macular degeneration
About 10-15 percent of people who have macular degeneration have the wet form, but it can cause more damage to your central or detail vision than the dry form.

Wet macular degeneration occurs when abnormal blood vessels begin to grow underneath the retina. This blood vessel growth is called choroidal neovascularization (CNV) because these vessels grow from the layer under the retina called the choroid. These new blood vessels may leak fluid or blood, blurring or distorting central vision. Vision loss from this form of macular degeneration may be faster and more noticeable than that from dry macular degeneration.

The longer these abnormal vessels leak or grow, the more risk you have of losing more of your detailed vision. Also, if abnormal blood vessel growth happens in one eye, there is a risk that it will occur in the other eye. The earlier that wet macular degeneration is diagnosed and treated, the better chance you have of preserving some or much of your central vision. That is why it is so important that you and your ophthalmologist monitor your vision in each eye carefully.

Treatment for Age related macular degeneration

The AREDS –age related eye disease study that among people at high risk for developing late-stage, or wet, macular degeneration (such as those who have large amounts of drusen or who have significant vision loss in at least one eye), taking a dietary supplement of vitamin C, vitamin E and beta carotene, along with zinc, lowered the risk of macular degeneration progressing to advanced stages by about 25 percent. The daily supplements also reduced the risk of vision loss for those at risk by about 19 percent. The supplements did not appear to provide a benefit for people with minimal macular degeneration or people without evidence of the disease during the course of the study.

Following is the nutrient supplementation shown to be beneficial in lowering the risk of macular degeneration progressing to advanced stages:

• Vitamin C – 500 mg
• Vitamin E – 400 IU
• Beta carotene – 15 mg (25,000 IU)
• Zinc oxide – 80 mg
• Copper (as cupric oxide) – 2 mg (to prevent copper deficiency, which may be associated with taking high amounts of zinc)

Another large study in women showed a benefit from taking folic acid and vitamins B6 and B12. And a large study evaluating the possible benefits of lutein and fish oil (omega-3) is ongoing. Other studies have shown that eating dark leafy greens, and yellow, orange and other colorful fruits and vegetables, rich in lutein and zeaxanthin, may reduce your risk for developing macular degeneration.

Beta carotene has been shown to increase the risk of lung cancer in smokers or recent past smokers, so this supplement should not be used by people who currently smoke or recently quit smoking.

It is very important to remember that vitamin supplements are not a cure for neither macular degeneration, nor will they give you back vision that you may have already lost from the disease. However, specific amounts of these supplements do play a key role in helping some people at high risk for developing advanced (wet) AMD to maintain their vision.

Talk with your ophthalmologist to find out if you are at risk for developing advanced macular degeneration, and to learn if supplements are recommended for you.

Wet macular degeneration treatment

Treating the wet form of macular degeneration may involve the use of anti-VEGF treatment, thermal laser treatment or photodynamic therapy (PDT).There are many effective anti-VEGF drugs available in market, but mostly multiple injections are required. Thermal laser treatment and PDT too may require multiple sittings. All of them can be performed as outpatient procedure. It is very important to monitor your vision on Amsler grid routinely. Treatment of wet macular degeneration generally reduces—but does not eliminate-- the risk of severe vision loss.

People with wet or dry ARMD who cannot be treated will not become blind, as they will still have peripheral, or side, vision.

If you have untreatable macular degeneration, you can make the most of remaining vision by learning to “see again” with the vision you do have and with the help of special low-vision rehabilitation, devices and services. People with low vision can learn new strategies to accomplish daily activities. These skills, including mastering new techniques and devices, help people with advanced AMD regain their confidence and live independently despite loss of central vision.

While there is little that can be done to improve the eyesight of someone who has AMD, with early detection, the rate of vision loss can be slowed. The keys to slowing vision loss are to understand macular degeneration, monitor your symptoms and visit your ophthalmologist regularly to test your vision. Even with macular degeneration, you can still maintain an enjoyable lifestyle. 

If you are suffering from Age related macular degeneration (ARMD), Meet our eye specialist today for a free consultation and eye checkup. - Click here Book an appointment now! (it's FREE)

Eye Care Tips for Diabetics

Diabetic is a very well known disease and everyone knows that the diabetic patients have high blood sugar levels. Insulin present in the body converts the sugar level in blood into energy that is required for day-to-day work. This insulin reduces the blood sugar levels but with diabetic people there is either low insulin or lack of insulin that prevents the sugar in blood from getting converted into energy. Diabetic patients are prone to getting various eye diseases.

Eye care is especially important for people with diabetes, because they are at increased risk of developing eye complications from the disease. In fact, diabetes is the leading cause of blindness in adults age 20 to 74.

All people with diabetes should take precautions to help reduce their risk of developing eye problems. Various presentations of diabetes in eyes are given in the previous article. Here are some eye care tips:

1. Schedule regular appointments with your eye doctor so that any eye problem can be detected early and treated.
2. Maintain control of your blood glucose levels.
3. Keep your blood pressure under control. High blood pressure by itself can lead to eye disease, so if you have high blood pressure as well as diabetes, it is especially important that you take steps to control both conditions.
4. Get your blood cholesterol levels under control.
5. Eat a healthy diet.
6. Avoid smoking.
7. Exercise regularly.

When should I see eye doctor?

When you are diagnosed with diabetes one complete eye check up is advisable. You should make an appointment to see your eye doctor if you experience any visual problems or notice any changes in your vision. You should seek medical care for your eyes immediately if you experience any of the following symptoms:

• Blurring of vision
• Black spots
• Flashes of light
• Partial or complete loss of vision, in one or both eyes.

What are diabetes problems?

Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. You can do a lot to prevent or slow down diabetes problems.

High blood glucose can cause eye problems.

What should I do each day to stay healthy with diabetes?

1. Follow the healthy eating plan that you and your doctor or dietician have worked out. Antioxidant rich diet can slow down diabetic damage in the eye.
2. Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
3. Take your medicines as directed.
4. Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book.
5. Control your blood pressure and cholesterol.
6. Don't smoke.

Go for regular and complete eye checkups with eye doctor.

What can I do to prevent diabetes eye problems?

You can do a lot to prevent diabetes eye problems.

Keep your blood glucose and blood pressure as close to normal as you can.

Have an eye care professional examine your eyes once a year. Have this exam even if your vision is OK. The eye care professional will use drops to make the black part of your eyes-pupils-bigger. This process is called dilating your pupil, which allows the eye care professional to see the back of your eye. You experience mild blurring of vision as eye dilates; it recovers back to normal as the effect of eye drops wears out. Finding eye problems early and getting treatment right away will help prevent more serious problems later on.

Ask your eye care professional to check for signs of cataract and glaucoma. See what other eye problems can happen to people with diabetes see article eye presentations in Diabetes? Learn more about cataracts and glaucoma.

If you are planning to get pregnant soon, ask your doctor if you should have an eye exam.

If you are pregnant and have diabetes, see an eye care professional during your first 3 months of pregnancy.

Don't smoke.

How can diabetes hurt my eyes?

High blood glucose and high blood pressure from diabetes can hurt four parts of your eye:

1. Retina - The retina is the lining at the back of the eye. The retina's job is to sense light coming into the eye.
2. Vitreous - The vitreous is a jelly-like fluid that fills the back of the eye.
3. Lens - The lens is at the front of the eye. The lens focuses light on the retina.
4. Optic nerve - The optic nerve is the eye's main nerve to the brain.

A side view of the eye. Antioxidant rich diet or supplements can help slow down diabetic damage, as guided by your doctor.

More about Eye presentation in Diabetes

How can diabetes hurt the retina of my eyes?

Retina damage happens slowly. Your retinas have tiny blood vessels that are easy to damage. Having high blood glucose and high blood pressure for a long time can damage these tiny blood vessels.

First, these tiny blood vessels swell and weaken. Some blood vessels then become clogged and do not let enough blood through. At first, you might not have any loss of sight from these changes. Have a dilated eye exam once a year even if your sight seems fine.

One of your eyes may be damaged more than the other. Or both eyes may have the same amount of damage.

Diabetic retinopathy is the medical term for the most common diabetes eye problem.

What happens as diabetes retina problems get worse?

As diabetes retina problems get worse, new blood vessels grow. These new blood vessels are weak. They break easily and leak blood into the vitreous of your eye. The leaking blood keeps light from reaching the retina.

You may see floating spots or almost total darkness. Sometimes the blood will clear out by itself. But you might need surgery to remove it.

Over the years, the swollen and weak blood vessels can form scar tissue and pull the retina away from the back of the eye. If the retina becomes detached, you may see floating spots or flashing lights.

You may feel as if a curtain has been pulled over part of what you are looking at. A detached retina can cause loss of sight or blindness if you don't take care of it right away.

Call our eye care professional right away if you are having any vision problems or if you have had a sudden change in your vision.

Eye Presentations in Diabetes

Ocular (eye) involvement in diabetes is very common. Since diabetes is a very common condition found in every part of world.
Structure-wise eye lesions with symptoms & presentations (simplified) are as follows:

1. Lids. Xanthelasma (yellow whitish lesion found most commonly on upper eyelid) and recurrent  style (small lid nodules) or internal hordeolum.
2. Conjunctiva. Telangiectasia, sludging of the blood in conjunctival vessels (pink or bleary eyes) and subconjunctival hemorrhage (fresh bloody red irregular spots noted in the white area of eye).
3. Cornea. Pigment dispersal at back of cornea, decreased corneal sensations (due to trigeminal neuropathy), punctate kerotapathy, Descemet’s folds, higher incidence of infective corneal ulcers and delayed epithelial healing due to abnormality in epithelial basement membrane (presenting as watering , pain and blurring of vision)
4. Iris. Rubeosis iridis (neovascularization i.e new leaky vessels of iris)
5. Lens. Snow-flake cataract in patients with IDDM (insulin dependent diabetes mellitus). Posterior sub capsular cataract.  Early onset and early maturation of senile cataract.
6. Vitreous. Vitreous haemorrhage (sudden dimension of vision, multiple floaters) and fibre- vascular proliferation secondary to diabetic retinopathy.
7. Retina. Diabetic retinopathy and lipaemia retinalis (painless progressive visual loss).
8. Intraocular pressure. Increased incidence of POAG (primary open angle glaucoma), neovascular glaucoma. Hypotony(low Intraocular pressure IOP) in diabetic ketoacidosis (due to increased plasma bicarbonate levels)
9. Optic nerve. Optic neuritis(sudden decrease of vision over few days).
10. Extraocular muscles. Ophthalmoplegia(weakness or paralysis of eye muscles) due to diabetic neuropathy(visual doubling, lid drop, pupil dilatation & squint).
11. Changes in refraction. Hypermetropic (increased plus number in glasses) shift in hypoglycemia(low blood sugar levels), myopic shift(increased minus number in glasses) in hyperglycemia(high blood sugar level) and decreased accommodation(difficulty in near work or  reading).

Regular & complete eye check up by an ophthalmologist is sincerely advised to all diabetic patients.