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Amblyopia

Also known as lazy eye, amblyopia commonly develops in children and is a condition where vision does not properly develop in one eye. It indicates decreased vision due to abnormal visual development in infancy and early childhood. This condition generally affects one eye, however may affect both. In children, lazy eye is the major cause of vision loss and if left untreated may result in severe damage. Lazy eyes generally develop before the age of 6. This condition develops only in children.


The condition of amblyopia may not look to be obviously abnormal. However if left untreated, vision impairment becomes permanent. As the brain matures, it will begin ignoring the messages coming from the eye with poor vision. The healthy eye is subject to trauma thus causing vision loss in that eye. When the nerve pathways between the brain and eye are not completely stimulated, it leads to lazy eye or amblyopia. Due to this reason the brain favors the strong eye as the other eye has poor vision. The weaker eye keeps wandering and thus the brain ignores the signal received from the lazy eye.

Lazy eye is usually treated with an eye patch, eye drops, glasses and contact lens. In a few cases surgical intervention may be essential. A child has to be treated when around 7-9 years of age. It is important to remember that lazy eye does not go away naturally, it needs to be treated.


Amblyopia types

Depending on the cause of the condition, amblyopia is classified into three types:

Refractive amblyopia: Significant difference between the vision in each eye causes lazy eye. Near sightedness, far sightedness or imperfection in the eye surface can cause this problem. These vision problems can be corrected with the help of glasses.

Strabismic amblyopia: An imbalance in the muscles of the eye that position each eye. This causes the eye to cross in or turn out, this muscle imbalance may not allow the eyes to synchronize and look at things.

Deprivation amblyopia: If one of the eyes has a cloudy area, then this problem may show up. This condition deprives the child from normal vision.


Symptoms of Amblyopia


  • Eyes may not seem to move together.
  • Eye wanders inwards and outwards.
  • Depth perception may not be appropriate.

Diagnosis of Amblyopia

The physician generally checks for lazy eye through:


  • Physical examination
  • Checking for wandering eyes.
  • Checking for difference in vision in the eyes.
  • Checking for poor vision in the eyes.
  • Tests like red reflex test help identify the condition in kids.

Treatment for the condition depends upon the severity of the condition. Based on the severity the following treatment options are available.

Eye patches: Eye patch is used over the strong eye so as to stimulate the weaker eye. Children aged above 4 years benefit from wearing this patch for 3-6 hours a day. Wearing the patch helps in developing the part of the brain that manages the vision development.

Corrective eyewear: If conditions like far sightedness, near sightedness or imperfection in the eye surface contribute to lazy eye, they can be corrected using corrective glasses or contact lenses.

Surgery: In extreme cases surgery is recommended to repair the eye muscles.

Eye drops: Eye drops are prescribed to blur the vision of the strong eye thereby encouraging the child to use the weaker better.


If left untreated, amblyopia can lead to permanent visual defect in the affected eye, visual defect in normal eye and loss of depth perception.

Hyphema

A Hyphema is an eye condition that refers to pooling or collection of blood inside the anterior chamber of the eye (between the cornea and the iris). The blood may cover the iris partially or totally including the pupil and thereby blocking the vision partly or completely. Trauma to the eye is the most common cause of Hyphema. Injury may take the form of blunt trauma, laceration trauma or abrasion.


Some of other conditions that cause Hyphema are:


  • Tumors in the eye
  • Abnormal blood vessels on the surface of the iris
  • Herpes virus(eye infection)
  • Intra-ocular lens problems (artificial lens implants)
  • Severe diabetes
  • Blood disorders such as sickle cell anemia

Signs and symptoms of the Hyphema vary according to the severity of the condition. Mild Hyphema may not even be visible to the naked eye or a tiny spot of blood may show up which normally gets absorbed on its own. As the condition progresses, the patient experiences the following symptoms.


  • Impaired vision
  • Eye pain, blurring or loss of vision
  • Bleeding in the anterior chamber of the eye
  • Light sensitivity or photophobia

Treatment

Vision and ocular pressure are checked and dilation is done to examine the fundus for retinal detachment or blood elsewhere in the eye. Visual acuity test and slit lamp test allow the eye doctor to check the internal structure of the eye for any other damage. The eye sockets and facial structures might need to be examined with a CT scan in case of severe trauma.

Mild cases of Hyphema heal on their own. When the bleeding is not severe, doctor may recommend certain guidelines to be practiced at home along with sedatives and pain relieving medications. These guidelines include covering the affected eye, elevating the head of the patient to help drain the fluid, bed rest and frequent monitoring of the eye condition. Avoid any medicines containing aspirin, arthritis and non-steroidal medication as it promotes bleeding.

Steroid eye drops are prescribed to control inflammation and pain. Severe cases of Hyphema require an aggressive approach. You can use an eye shield or protective eyewear to prevent the eye from any further injury. If elevated is noticed, blood is drained through surgical intervention to prevent glaucoma or cornea damage.



Bleeding in the Eye

Bleeding in the eyes is associated with many underlying conditions like hyphema, blood vessel damage (subconjuctival hemorrhage), diabetic retinopathy and vitreous hemorrhage.


The conditions for diabetic retinopathy occur because of long term diabetics. Prolonged high blood sugar levels can damage the blood vessels associated with the retina of the eye. These blood vessels become leaky or clogged. The leaky blood vessels initiate the process of hemorrhages which are visualized as spots of bleeding. In some instances the clogged blood vessels obstruct the supply of oxygen to the retina causing ischemic condition. Maintaining proper blood sugar levels along with controlled pressure is essential.

Subconjuctival hemorrhage occurs due to damage caused to the sclera or the white portion of the eye. The blood released because of the damaged blood vessel is trapped under the conjunctiva. Subconjuctival hemorrhage associated eye bleeding is often painless. It is mainly caused because of high blood pressure and also triggered by cough, vomiting and sneezing. The blood spots disappear gradually. Medical attention is required if symptoms such as blurred vision, pain and recurrent hemorrhages occur. The choice of medication given for subconjunctival hemorrhage are blood thinners like heparin and Coumadin.


Hyphema is caused due to injury to the eye. The trauma caused in the eye can be of blunt or closed types depending upon the intensity of the damage. Most of these traumas which result in the bleeding of the eye are because of external sources such sharp objects, industrial chemicals, fumes, injuries associated with boxing and martial arts. Smaller hyphemas are associated with bleeding and swelling of the eye and extreme hyphemas are associated with pain, bleeding, swelling and reddening of the entire eye. The diagnosis for hyphema is usually performed by an ophthalmologist evaluating the entire history of the case followed by series of visual acuity tests. A CT scan is also recommended if there is a suspicion of bone damage in the eye region caused because of trauma.


Vitreous hemorrhage is another predominant cause for eye bleeding. Other factors include tumors adjacent to the vitreous humor of the eye and macro aneurysms. The treatment options for vitreous hemorrhages include vitrectomy and through Krypton laser therapy.

Rare causes for bleeding in the eye

Apart from the common factors that are associated with the hemorrhages caused in the eye, some rare conditions such cancers and iritis also cause bleeding in the eyes. Cancers of the eye are usually diagnosed by biopsy and also by careful visual examination. Since the symptoms of the bleeding eye disease may mask the diagnosis of underlying cancer or tumor, malignancy is confirmed by pathologic determination. Iritis is caused because of the inflammation in the iris of the eye. It may be the result of a trauma caused to the eye or underlying systemic conditions such as sarcoidosis and tuberculosis. Analgesics are recommended for common iritis. Patients are advised to wear dark sunglasses.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019