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Patient Education
Mucor mycosis and eyes
Mucor mycosis or black fungus can affect eyes. Who are susceptible? Covid positive patients admitted in ICU and have received oxygen. Those who are uncontrolled diabetics Those who received heavy doses of steroids. Those who received heavy doses of antivirals and antibiotics . Those who are immunocompromised, on immunosuppressants OR on chemotherapy. It can occur even few weeks after recovery from covid and it is found even in some non covid patients also.
How it starts? It starts from nose forming the crusts in the nose. Then it spreads in nasal sinuses and mouth (palate) and to orbit and eye.
This fungus blocks the blood vessels and that part of the fungus affected area becomes dead.
What are the early nasal symptoms.. ? Nasal watering, discharge Bleeding from the nose One sided facial pain, swelling of one side of the face,one sided headache.
Nose examination at this stage is very important and helps early diagnosis.
Early MRI helps detect the disease early.
If not diagnosed and treated, it may spread to mouth and eye.
Symptoms in the eyes-- Redness,watering and pain in the eye. Swelling of the eye. Sudden drop in vision Inability to move the eye leading to double vision. Drooping of eye lid. Popping out of the eye. (proptosis) Loss of sensation of and around the the eye. Facial swelling and pain around the eye. Colour changes of the skin on and around the eye. Sudden loss or drop of vision.
If diagnosed and treated in time, eye can be saved. Once the tissue is dead, the only treatment for mucor mycosis is surgical removal of all the part of nose, sinuses, palate and eye. If it is not treated in time, it can spread to the brain and patient can die. Some antifungals are useful to prevent the spread.
How to protect from mucor? Control the blood sugar. Avoid exposure if immunocompromised. Protect from covid by wearing mask, social distancing and sanitizer use. Betadine gargles, especially to high risk patients may have beneficial effect. Use clean, fresh mask. Early detection and treatment can save the eye and life.
Don't ignore eye symptoms during pandemic, especially if you are admitted for covid or you are in post covid state. See the ophthalmologists for eye problems.
We all know that our eyes are somewhat wet as compared to our skin of the body.
It is because of tears which are secreated by the tear gland. Tear gland is placed just above the eye behind the brow.
The tears formed in this gland come to the eye, get circulated between two eye lids and then flow to the nose.
When a person cries, there is excess secretion of tears and tears flow from the nose also. Eye drops put into the eye are felt in the nose and throat.
So there is connection between eyes, nose and throat.
Let's see how it happens.
There is a small sac inside, between the corner of the eye and root of the nose.
The excess tears in the eye are flown to this sac and stored there for a while.
There is a narrow tube starting from the end of the sac. The tube opens in the nose.The tears in this sac are flown from the sac to nose and then to throat through this narrow tube.
Now, if this tube gets blocked because of some reason, like old age, constant cold or nose problems, then tears remain accumulated in the sac. And once this sac gets filled, they come back in the eye.
That leads to constant watering of the eye.
Stagnated water in the sac gets infected. That leads to sticky, dirty discharge from the eye, which further adds to watering accompanied by redness, itching etc. Some times sudden pain, swelling may occur at sac area along with fever. This acute attack needs to be treated well with the medicine.
But the definitive treatment of this watering of the eye ( dacryocystitis) is surgical.
Surgically, the sac is opened. And a passage is made from sac to nasal skin. This new passage remains patent most of the time and carries the tears from eye to sac and then from sac to nose.
This solves the problem of watering of the eye. This operation is called Dacryocystorhinostomy (DCR).
Hundreds of DCR OPERATIONS have been done at Dr Aaphale Eye Hospital and we have excellent success rate of this difficult surgery.
Sometimes this sac is damaged or atrophied due to long term disease. In that case it has to be removed.Then, the sticky discharge stops but watering doesn't stop, though it reduces considerably.
If not treated in time, recurrent infections cause damage to cornea and vision.
This problem of constant watering can occur in newborn babies also.
The narrow tube carrying the tears from eye to nose should open up at the time of birth normally.
But,it doesn't open in some babies. Such babies start getting constant watering and sticky discharge from that eye.
This is treated with mild antibiotic drops and massage.
Massage is done at the Sac area from above down.
The tip of the finger kept on respective side of the nose near corner of that eye and it is pushed firmly below, towards lower end of the nose.
If done regularly, 5,6 times at a time in a day, the tube in the nose may open.
If it doesn't open till 2 years of age, then small procedure needs to be done to open the tube.
If not done till 2 years of age, major surgery of DCR may be needed.
This small procedure is called probing and has to be done under light GA.
It is done at Dr Aaphale Eye Hospital.
One of the reasons of sudden loss of vision is retinal detachment.
Eye ball is egg shapped and it's outer covering is white and tough sclera.
Sclera has inner lining of retina which is supported from inside by semisolid vitreous gel.
Retina is a sensory curtain in which image of the object is formed.
If this retina leaves it's natural place and falls in vitreous cavity it is called retinal detachment.
If examined carefully, tears, holes or degenerative spots may be seen on retina before it detaches.
Detachment can occur because of trauma like hitting of cricket ball on eye.
Vision may drop immediately or may be after a month. Trauma may occur to eye during fight. Hence, one should not neglect any trauma to eye and immediately see the eye surgeon. Because, if tear or hole is detected early it can be sealed with laser and major surgery can be avoided.
Spontaneous retinal detachment may occur in high myopes because retina is weak in high myopes. Such patients must get their retina checked in detail, once in a year.
Retinal detachment may occur in untreated diabetic retinopathy in late stage.
Aging and complicated cataract surgery are some of the other reasons of retinal detachment.
It can occur spontaneously also.
If retina is weak as seen in high myopes, they should avoid lifting heavy weight or any trauma to the eyes.
If one sees flashes of light in front of the eyes, black veil is seen or multiple floaters are seen in front of the eye, one should immediately rush to the eye surgeon. Because, these could be warning signals of retinal detachment.
If retina checked in time, simple welding like treatment with green laser can secure the retina.
But if neglected, retinal detachment may occur and major surgery may be needed.
Retinal detachment is a serious problem of eyes.Surgeries are not always successful. So it is better to prevent it.
At Dr Aaphale Eye Hospital, many patients have been diagnosed in time and treated with laser to prevent retinal detachment.
Retina is the curtain in the eye on which visual image is formed.
The central very important point on retina where sharpest image of the object is formed is called macula.
This tiny point gets adversely affected by the aging process. Then the image of the object is not formed properly. Obviously, person can't see properly. Since aging is the reason, this condition is called as "age related macular degeneration."
It is supposed to occur because of ultraviolet rays. Vision is reduced very slowly. Total blindness never occurs.
Some old people come for eye check up because they can't read properly and vision is reduced.
They expect that there must be cataract developing and surgery will cure them. But unfortunately, some of them have age related macular degeneration and surgery can not cure it. Operating for cataract doesn't improve their vision.
Diagnosis of this disease can be confirmed by OCT.
There is no satisfactory cure for this disease. In initial stages antioxidants can slow down the process.
If vision is reducing in spite of that, then intravitreal injection have to be given in the eye.
Some patients need multiple injections and many can be benefitted from them.
Sometimes,a layer comes on macula. In such cases operation may be needed.
Eating lot of vegetables and fruits and using UV filtering goggles/ spects, may prevent age related macular degeneration.
If vision worsens, magnifying glass can be used for reading.
Treatment of age related macular degeneration is done at Dr Aaphale Eye Hospital in the form of intravitreal injection.
When a child has unequal spectacle number in both eyes and it remains uncorrected for some time ,the eye which has higher number becomes lazy.
That means, even after giving perfect spectacle number for that eye, vision of that eye doesn't improve fully.
The reason of amblyopia is the brain centre of that eye becomes inactive.
There is competition between the eye which has less number and better vision (good eye) and the other eye which has higher number and subnormal vision. (bad or lazy eye).
The good eye does all the work of seeing, all the time,.In short it dominates the bad eye.So that eye becomes suppressed and lazy.
The treatment of amblyopia is giving correct spectacle number to both eyes and temporary closure of GOOD EYE.
This will force the lazy eye to see.It helps to activate the brain centre of that eye and improves the vision of lazy eye.
After patching the good eye, the patient is supposed to use the lazy eye as much as possible.
There are exercises also for that.
Time period of closing the eye depends upon the age of the patient and vision .
Younger the child faster the improvement.
Even adults can try the treatment.
If child has squint, it also improves after the amblyopia treatment.
Lazy eyes of many children and even adults have been treated by Dr Kshipra Aphale in last 20 years and their vision improved to normal after they have taken treatment at Dr Aaphale Eye Hospital.
Infection of the outer thin layer of the eye, conjunctiva, is called conjunctivitis.
It is mainly of two types. Bacterial and viral.
Symptoms of conjunctivitis are redness, pain and discharge from the eye or eyes. (it can affect one or both eyes).
Some people develop sudden foreign body sensation in the eye.
If it's mild, then there is mild redness, itching and stickiness in the morning only.
Bacterial type has lot of discharge while viral may have no or minimal discharge. Viral type is more painful.
Mostly,conjunctivitis doesn't affect vision but viral type may affect cornea causing small opacities on it, which reduce the vision.
Treatment of bacterial conjunctivitis is in the form of plain antibiotic eye drops. Many people buy eye drops from chemists without consulting the doctor. They get steroid antibiotic combination drops,which may give temporary relief but prevents complete cure of the disease.
Depending on the severity of the problem, expert ophthalmologist prescribed correct antibiotic drops which cure the infection quickly if put in proper frequncy.
Oral antibiotic is rarely needed.
There is no specific treatment for viral conjunctivitis. It is self limiting and takes time depending on immune status of the patient.
The treatment is supportive as no broad spectrum antiviral eye drops are available.
We have to give some time to our body to develop antibodies against the virus.If steroid eye drops given during this stage, they interfere in this process and cure is delayed. Steroid drops in acute stage of viral conjunctivitis leads to corneal spots and vision problem.
Dr. Aphale at Dr Aaphale Eye Hospital gives safe treatment for conjunctivitis which cure it without complications.
Conjunctivitis spreads via things touched by the affected individual. Tears, eye discharge contain germs.
Viral conjunctivitis spreads fast through air.
So, to avoid spread, the affected individual should use goggles, should not touch eyes, wash eyes and hands frequently.
Patient should keep their soap, napkins etc separate to prevent the spread.
Person suffering from conjunctivitis should avoid going to public places, swimming pools, schools and crowded places.
>>What is LASIK operation?
This is the operation on the surface of the eye. With the help of eximer lasers, reshaping of the front part of the eye is done ,so that the patient's refractive error is corrected. (spect number is abolished).
>>Can anyone undergo this surgery?
No. It depends upon various tests we do at Dr Aaphale Eye Hospital on the patient's eye.
>>What is the age when we can do Lasik surgery?
Normally, by the age of 19 to 21 years ,spectacle number becomes stable. So after that age,once number becomes stable ,one can do Lasik surgery. It can be done up-to the age of 45 to 50 yrs.
>>How much number gets corrected?
It depends upon corneal thickness. But if thickness permits -2 to -9/10 spherical and -3.5/4 cylindrical and +1 to +4 spherical can be corrected. ( vary with the individual eye).
>>What anaesthecia is used?
Topical anaestecia ( in the form of eye drops) is used.
>>Does it pain?
Little discomfort may be there but no severe pain.
>>How long the surgery takes?
15 to 20 mins.
>>Are both eyes operated at the same time?.
Yes, one by one immediately.
>>When to stop using contact lenses?
Ideally 15 days before lasik surgery.
>>What precautions need to be taken after surgery?
Basically, touching the eyes and rubbing the eyes is prohibited for 1 week.
Washing the face, hair bath avoided for a week.
>>Does it pain afterwards?
Not much..
>>What about dark goggles?
No dark goggles needed.
Transperent protective spects will be provided.
>>When the normal work can be started?
Watching TV, reading PC can be started from next day.
Routine studies, office work can be started after 3 days.
>>How much holidays are needed?
3 to 4 days are enough.
>>When cooking can be started?
From 3rd or 4 th day.
>>Is there any dietary restriction?
No.
>>Does the number goes permanently?
Yes.
>>Does near number goes?
No. In fact after the age of 40 yrs LASIK operated patient may need near glasses like the normal persons.
>>Is there any implantation of lens in LASIK surgery?
No.
>>Is there any other option if LASIK surgery is not safe for particular eyes?
Yes. PRK, Intraocular contact lenses, lens exchange are other options,which Dr Aphale will reccomend after thorough eye check up.
>>When the person starts seeing after surgery?
From the next day.
>>Is it a safe surgery?
If done on properly examined eye and proper care is taken, it is as safe as any other surgery.
>>Can a patient loose vision after surgery?
In todays technology, it is very rare to lose vision.
Retina, the inner curtain of the eye ,of a diabetic patient gets damaged. This disease is called diabetic retinopathy.
There is no pain or discomfort during the damage and patient comes to know only after vision is lost completely. That is why it is called silent killer of the eye.
Retina is made up of visually sensitive nerve calls. These cells are maximum at the center point of retina called macula.
Retinal cells get oxygen through micro blood vessels present in retina.
In diabetes, for some reasons, these blood vessels get blocked.
This leads to bleeding and leakages of fat on retina. This causes damage to vision. If these bleeding and fat deposits are on macula, there is severe loss of vision.
Blockage of blood vessels leads to lack of oxygen to retinal nerve cells. This leads to formation of fragile new blood vessels.
These vessels break and bleed frequently and lead to sudden or gradual loss of vision in a diabetic patient.
Things to remember
There is loss of vision in diabetes.
It can occur even if sugar is controlled .
It is painless loss of vision.
It is very slow loss of vision and patient may not realise that damage is being done on retina.
Even if patient has good vision, there might be lot of damages, like bleeding and leakages, on retina.
When these damages cause loss of vision, it might be too late to save the vision or reverse it.
The only way to diagnose and save the vision is regular eye check up, including dilated retinal examination, from eye surgeon. Dr Aphale at Aaphale Eye Hospital does detailed retinal check up for every diabetic patient visiting the hospital.
Not every diabetic patient develops retinopathy.
The treatment to diabetic retinopathy which has reached a vision threatening stage is in the form of green lasers or intravitreal injection. Aaphale eye hospital had first green laser of Thane and now it is well equipped with even more advanced green laser. Laser does photocoagulation of bleeding and leaking new vessels, just like welding.
Laser treatment is painless, done under topical ( eye drop) anaestecia in sitting position. Sugar may or may not be controlled.
Intravitreal injections are of different types .2 of 3 injections may be needed. They need to be given in strict aseptic operation theatre. Aaphale Eye Hospital has one of it's best.
If diabetic retinopathy is timely diagnosed and treated, vision can be saved.
The only way to save the vision from diabetec retinopathy is ROUTINE RETINAL CHECK UP and timely treatment of retinopathy.
For long time computer users, dryness is the main problem of eyes. To prevent dryness of eyes frequent blinking of eyes is very important as continuously looking at the screen reduces the normal blinking rate of eyes leading to evaporation of the tears and dryness of eyes.
Looking at a distant object for 20 seconds after every 20 min. This will relax the eye muscles.
Avoid direct blow of AC air - this will also reduce the evaporation of tears and drying of the eyes.
Adjust the distance ( eye to screen distance should be 15 to 18 inches) and height of the sceen comfortable to your eyes and neck.
Adjust the font size and illumination comfortable to the eyes.
Take a walk after 2 hours of continuous work.
Drink enough fluid which keep you hydrated.
Eat home made, nutritious food as brain and eyes need proper nutrition to work efficiently.
Check eyes yearly, use proper number spects.
Tailor-made,customised progressive glasses can make you comfortable. Dr Kshipra Aphale at Aaphale Eye Hospital gives special, customised spectacle number for progressive glasses for patients above 40 years.
This makes them very comfortable while working on desktop or laptop.
Redness, gritty sensation, frequent feeling of washing the eyes, eye ache, brow pain,intolerence to light are some of the symptoms which should not be neglected and one should consult the eye surgeon.
Routine general exercise, square diet, fruits and vegetables improve the efficiency of eyes which get tired after long working hours.
No medicine can do it.
No specific eye exercises reccomended but moving the eyes on all directions and rotating them may be done.
If there is severe dryness, lubricating drops may be prescribed but one should improve the habits rather than becoming dependent on medicine. Dr Kshipra Aphale believe in minimum medication.
If in spite of above all care one gets headache, while working on PC, one should look for other causes of headache like anaemia, migraine, acidity, sinusitis, hypertension, nutrition problem and lack of exercise
If used with all above proper care, computer does not harm the eyes.
Glaucoma is called as silent killer of the vision. Because many times, there is no much pain or discomfort to the eye of the patient even if he /she has glaucoma, damaging the vision.
Patient comes to know only when there is severe damage to both eyes and vision is both eyes is drastically impaired.
Many times glaucoma is diagnosed by eye surgeon only on routine eye examination.
What is glaucoma?
Just like we have blood pressure, we also have certain eye pressure.
If it increases above certain level, it harms the optic nerve.optic nerve is a nerve carrying visual signals to the brain from eye. Once it is damaged it can not be repaired.
So, this increased eye pressure leading to optic nerve damage is called glaucoma.
But blood pressure or mental tension has nothing to do with this eye pressure.
Who are at risk?
Patients having family history of glaucoma, patients having plus or minus high number need to keep watch on their eye pressure.
What is central and peripheral vision of the eye?
Interestingly there is certain pattern about this optic nerve damage.
Typically, the damage occurs in such a way that the central vision is preserved but peripheral vision is lost first and slowly over months and years.
When we look or focus at particular object, it is central vision that comes into play. And we see that object very clearly. But while looking at that particular object, we can also see few things around that object. Those things are not very clearly seen but it is important to notice that for all our routine activities like walking, driving, eating etc. This ability to see things around the subject of interest is peripheral vision.
And this is damaged first in glaucoma. So patient does not notice this early. Unless there is severe loss, patient is in wrong impression that he can see the things in front and his vision is fine.
Slowly, along with peripheral vision, central vision is also lost. And then suddenly patient realises the problem. But as said above, it is too late and vision can not be recovered.
Then how to protect the vision from glaucoma?
The only way is early diagnosis and treatment.
How to diagnose glaucoma ?
On routine examination, Dr Aphale at Aaphale Eye Hospital, always check eye pressure. If it is higher than normal, we check for other parameters. Aaphale Eye Hospital is well equipped with all the necessary teats for early diagnosis of glaucoma.
Most important test for glaucoma is perimetry which measures the peripheral vision.
Here, on this test we can find if there is glaucoma damage to optic nerve at very early stage and start the treatment .
Other important tests is gonioscopy.
We also see the Optic nerve staring point directly with an ophthalmoscope.
What is the treatment of glaucoma?
Aim of the reatment of glaucoma is to reduce the eye pressure to normal level.
This is done by 3 ways.
1) Eye drops.- Certain eye drops reduce eye pressure very well and vision remains intact.
A, The drop have to be put regularly without failure as skipping the drops causes increase in eye pressure and damage to optic nerve
B Never stop the eye drop without doctor's advice.
Doctor may change the drops if there is allergy to the drop or drops have stopped giving effect or they are insufficient to control the pressure.
But mostly, antiglaucoma drops have to be put life long.
One has to visit the doctor as per advice to check the eye pressure regularly as some drops may become ineffective and vision damage may continue without patient's knowledge
.
2, Laser,- some types of glaucoma can be cured by timely laser treatment.(narrow angle glaucoma)
3.surgery -.Glaucoma surgery is rarerly needed.
Here the fluid in the eye is bypassed out of the eye by making a separate channel. It is called trabeculectomy. It is done when combination of 2 to 3 eye drops fail to control glaucoma damage.
Acute glaucoma attack - generally, glaucoma is painless ,slowly progressing disease but sometimes patient develops severe pain, redness of eye,headache vommiting, browpain.
In such cases,severe visual damage occurs if patient doesn't go to ophthalmologist in time.
Patient needs to be treated urgently and eye pressure which is very high has to be reduced fast.
Various medication reduce the eye pressure quickly.
How to prevent vision damage by glaucoma ?
Regular eye check up from ophthamologist which includes eye pressure measurement and optic nerve visualisations.
If diagnosed to have glaucoma, regular medication,regular follow up and repeated perimetry (which only can tell us early if drops are working properly or not) can save the vision of the eye.
Follow up for glaucoma
It is very important to diagnose glaucoma in time and it is also equally important to do follow up regularly.
Follow up mainly includes checking of eye pressure, optic disc examination and perimetry.
Regular perimetry can tell us about progression of the disease early.
6 monthly perimetry is necessary
Usually, children between the age of 3 to 14 years develope itching, redness, stickiness of the eyes which is more in the evening.
These are symptoms of allergy most of the times.
Allergy is abnormal reaction of the body to normal particles in the air ,food etc ( allergens). Body of the normal person does not react to such things,.But, person who is allergic to them, gets problem when he or she comes in contact with the allergen. The response in the eye is in the form of itching, redness etc of the eyes. It may start suddenly as an attack.
Usually the allergy in these children is of dust or pollen grains or house mites.
Allergic attack may come every year in same season or it may continue throughout the year.
Since it is abnormal body responds, it can be controlled but may not be completely cured.
There are very good medicines which can make child comfortable.
Medicines need to be used strictly as per instructions and should not be continued or repeatedly used on your own.
The allergy in most of the cases doesn't harm the eye or vision .But prolonged treatment without medical advice can cause glaucoma or cataract in children.
So for every attack, one should see the ophthalmologists. If it is not possible, let the eyes be red but self treatment or treatment from the chemist's advice should not be done. That is the strong advice Dr Kshipra Aphale gives to her patients of allergy.
It is difficult to find which allergy it is, without actual testing.
So simple measures to avoid the entry of allergens into the eye and reduce the severity of allergy can help.
Like
Frequent washing of eyes.
Avoid going in sun, dust.
Avoid dusting in front of the patient at home.
Washing the bed sheets and covers.
Using clean mattress and pillows.
Using goggles while going out to avoid entry of dust.
Cold application helps a lot
Rubbing of the eyes should be strictly avoided. It may damage the delicate structures of eye and lead to vision problem.
The allergy is associated with spectacle number problem and it is to be checked and proper spects have to be used.
Usually the allergy resolves on its own by the age of 14,15 years.
We have treatment protocol for eye allergy at Dr Aaphale Eye Hospital, depending upon the severity of allergy. And the response is good.
Our eye is like an egg. The length of the normal eyeball is 24 mm. Those who have perfect length of eyeball are fortunate to see things without glasses. But many people have either shorter or longer eyeballs constitutionally. If the eye eyeball is not of perfect size and shape, the rays of light don’t fall perfectly on visually sensitive retina. Hence objects are seen blurred. In case of longer eyeball, it is called myopia and if eyeball is shorter it is called hypermetropia. Some people have this abnormality only in one axis of spherical eyeball, which is called astigmatism. Almost everyone progressively reduces the ability to see near things clearly, and need near glasses. But purchasing them without checking the eyes is dangerous. The number doesn’t come because of too much reading, studying, or computer use, or because of watching television. Rather those people, who do lot of such eye work, need their existing number while other people like housewives or farmers can afford to go without using glasses. Constant use of glasses doesn’t reduce the number neither prevents its progress. Spectacle is an aid not the treatment. Frequent check up of spectacle number is necessary, as it tends to change. Though it looks very simple to check spectacle number and prescribe glasses, in this era of computer, where constant intensive eye work is involved, it’s very very important to find suitable and perfect spectacle number. It’s not only important to see things clearly, but they should be seen comfortably also. Various innovative ideas have to be found while prescribing glasses, depending upon person’s age, computer distance, and his work style and neck problem. We give tailor made design of glasses to spectacle shop people depending upon patients job requirement. Apart from prescribing glasses, it is also important to know how to use the glasses, how to adjust with the new glasses, how much should be the height of lenses, the distance between centre of 2 glasses, material of the glasses etc. Special care needs to be taken while prescribing glasses. At many places, this job of spectacle number checking is not given due importance and left for the ophthalmic assistant. This leads to incurable headaches, eye aches and various discomforts. Nothing is found in CT and MRI. We have saved many of our patients from all these expensive investigations and cured them of their so called migraines and headaches, because we believe that no work is small or unimportant and giving comfortable vision is equally important as performing the operation, which is our prime job.
