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Vasculitis is an autoimmune condition where the blood vessels are inflamed. This inflammation narrows the blood vessels thereby making circulation difficult. This causes the vessels to stretch and weaken leading to a chance of internal bleeding. In some situations, the blood vessels might weaken and form a bulge or aneurysm. This can be life-threatening. Typical symptoms of Vasculitis include fever, swelling and pain in affected tissues. While some persons suffer few symptoms, others are badly affected.

Chronic vasculitis can only be controlled with long-term medications but it remains active. When vasculitis affects the skin, a person develops bruises, hives or itchy red spots. For persons who suffer vasculitis in the joints, arthritis or joint aches are common. Vasculitis can affect the gastrointestinal tract, lungs, sinuses, eyes or throat. Those who suffer vasculitis in the brain experience headaches, paralysis and muscle weakness. Urine tests for raised protein levels and RBCs might help in identifying vasculitis. X-rays and ultrasounds of affected organs are done to detect inflamed blood vessels. Steroids might be prescribed to control inflammation. Immunosuppresant drugs or cytotoxic drugs are also used to treat vasculitis.

Alpha Blockers

The muscles of our blood vessels contain alpha receptors and muscles tend to tighten when these alpha receptors are stimulated. The blood does not flow smoothly when the muscles of the blood vessels contract leading to hypertension. Alpha blockers or α-blockers also called alpha adrenergic antagonists reduce the nerve impulses and keep the small blood vessels open.

They work by blocking peripheral alpha receptors that are present in blood vessels. Alpha blocker drugs attach themselves to the alpha-adrenergic receptors and thus stop the stimulation. Thus blood vessels remain relaxed and open and allow the blood to flow through them lowering blood pressure. The generic names of alpha blockers are Doxazosin, Phenoxybenzamine, Prazosin, Terazosin. Alpha blockers do not cure high blood pressure but help to keep it under check. These medications are most often prescribed to patients suffering hypertension, peripheral vascular disease and hyperplasia.

Some of the common side effects produced by the α blockers are orthostatic hypotension, dizziness, tiredness, retrograde ejaculation, rhinitis, poor vision, headache, lightheadedness and peripheral swelling.

α-Adrenoceptor Antagonists: Long term use of Alpha blockers may result in tachyphylaxis (sudden loss of response) with other side effects as mentioned above - for some patients. Cataractectomy in patients using α-blockers can be complicated by the Floppy Iris Syndrome. The operating ophthalmologist should be alerted to the use of Alpha blockers.

Macular degeneration

Macular degeneration is the predominant cause of vision loss in the elderly. However, the word senile macular degeneration is often misinterpreted with respect to age-related macular degeneration (AMD or ARMD). The macula of the eye enables the central vision process. Macular degeneration occurs in dry and wet forms respectively. The dry form is the non-exudative form where as the wet form is the exudative form. In some instances, the advance of AMD is so slow that people may even fail to notice a little change in their vision. Whereas, in others the disease spreads faster and may lead to loss of vision in both the eyes.

Non-exudative Macular degeneration

The extra cellular deposits which are called drusen accumulate under the retinal pigment lead to the dry form. Although they appear pleomorphic, under ophthalmoscopy they generally tend to appear as discrete yellow lesions which are clustered in the macula referred to as pseudo papilledema. The symptoms of macular degeneration include difficulty in reading, recognizing faces etc. The peripheral vision remains but deteriorates gradually.

These lesions gradually become larger leading to multiple conditions such as retinal epithelial atrophy and also loss of photoreceptor function which causes vision loss. The enlargement of these lesions also results in retinal vein occlusion. Treatment with vitamins such as beta carotene, vitamin C and also zinc may slow down the process of dry macular degeneration.

Exudative Macular degeneration

The wet form or the exudative macular degeneration is a rare form of the disease. It occurs when the neovascular vessels arising from the choroid grow through defects in Bruch's membrane into the potential space of the retinal pigment epithelium. When these blood vessels leak, the retina is elevated along with the pigment epithelium leading to distorted or blurred form of vision. The symptoms resulting are generally gradual. However bleeding resulting from the sub retinal choroidal neovascular membranes may lead to acute vision loss. The exudative changes in the eye include hemorrhages, hard exudates, sub retinal / intraretinal fluid. Atrophy caused may be both incipient and geographic in nature. In addition to this, there is also a condition called central scotomas which is generally noticed as the missing areas of vision.

The neovascular membrane is difficult to locate by fundus examination since the locus of the membrane is beneath the retina. Angiography pertaining to the use of fluorescein or indocyanine may yield good diagnostic results. Laser ablation followed by the Angiography may prevent the onset of exudative macular degeneration.

Signs and symptoms of Macular degeneration

In gradual muscular degeneration, vision change is noticed slowly. The symptoms usually developed are:

  • Difficulty in adapting to low light levels. This could be exhibited even while entering any dimly lit restaurants.
  • Need for brighter light while reading or doing any other close work.
  • Printed words could increasingly blur.
  • Increase in haziness of central or overall vision.
  • Difficulty in recognizing faces.
  • The intensity or brightness of colors could decrease.
  • Central vision could get crooked.
  • A blind spot in the center of her field of vision.
  • Hallucinations of geometric shapes of people can occur in case of advanced macular degeneration.

Treatment of Macular degeneration

The wet from of macular degeneration is more likely to cause significant vision loss than the dry from and therefore different treatments for wet forms are available. These could help decrease the amount of vision lost. Laser treatment may stop or lesson vision loss in early stages of the disease. This is performed with specific wavelength designed to cauterize the abnormal blood vessels. A laser beam destroys blood vessels and may stop the growth of new ones. A scar forms after the treatment and this produces a permanent vision loss in that area of retina sacrificed to preserve the rest of the eye layer. Only a small number of people qualify for laser treatment and for many, vision may not improve after laser treatment. Photo dynamic therapy uses a light activated drug called verteportin given intravenously to the patient. A special laser is used to close the abnormal vessels while the retina is left intact. As closed blood vessels can reopen within a treated area, this may be necessary for one or two years. Exposure to light/sunlight should be avoided for five days after treatment. There are a number of drugs that block vascular endothelial growth factor and thus used as a treatment option. These have shown improvement in vision and not just delay or arrest the loss of vision due to macular degeneration.

Although macular degeneration is associated with age, genes related to the degeneration process of the macula have much significance. Factors such as obesity, hypertension, and oxidative stress may cause macular degeneration. Cardiovascular disease may increase the risk of macular degeneration. Among all the risk factors, smoking is considered as the most potent cause of macular degeneration. The risk of this disease in smokers is three times more than the other factors.

Tags: #Vasculitis #Alpha Blockers #Macular degeneration
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Collection of Pages - Last revised Date: June 25, 2024