OPHTHALMOLOGY FOR THE CLINICAL PRACTITONER
Dr. Manuel John, MS, DO, DNB, M.Phil, PGDMLE, Associate Professor, Consultant, Alexander Eye Centre
The eyes are windows, to the soul (Leonardo daVinci). It is a
tragedy that one person goes blind every 5 seconds. This accounts for over 70
million people going blind worldwide and the number is increasing day by day.
India has more than 10 million blind people. Cataract is the leading cause of
blindness accounting for more
than 60%. This can easily be picked up by shining a torch and checking visual acuity. Surgical management includes implantation of an intraocular lens. Refractive
errors account for the next segment approximately 20%. A history from people who complain of either decreased distance or near acuity can be elicited in these cases. What needs to be done here is refraction (under cycloplegia if appropriate) and assessment of deviations (if present). Glaucoma with or without cupping and corneal blindness stand next in the hierarchy of blindness. The Humphrey field analyser and the optical coherence tomography (OCT) are important adjunctive tools
in early diagnosis and follow up of disease. Posterior segment problems are documented to be the least in the major groups causing blindness but in the light of advancing technology and better diagnostic capabilities they are on the rise. Some of the diseases commonly seen are stye. The acute inflammation is treated with oral antibiotics and anti-inflammatory tablets. Hot fomentation brings relief. Foreign bodies if very small or coloured as the iris may be missed on torchlight examination. Hence a slit lamp examination is suggested. One must remember to evert the eyelids and examine for retained particles. High velocity missiles can end up on the retina too. Uveitis may also present as red eye. Cells and flare in the anterior chamber and endothelial dusting with keratic precipitates are seen on slit lamp examination. Corneal ulceration is an emergency. A small bacterial (pseudomonas) ulcer can progress overnight to devastate the cornea. In viral ulceration, dendrites and punctuate keratitis may be seen. Any discharge and watering of the eyes within the first 3 months after birth should be regarded with due suspicion. Neonatal conjunctivitis has many causes and blanket therapy is avoided. A lot of color and designer contact lenses are available off the shelf. Prescription of contact lenses is advisable after doctors consultation and due care of the lenses should be taken after purchase. Contact lens related corneal ulcers can blind the patient
within 24 hours!! The WHO Guidelines For Primary Eye Care (PEC) are as follows: 1. Conditions to be recognized and treated by a trained health care worker
" Allergic conjunctivitis " Bacterial conjunctivitis " Blunt trauma " SCH " Superficial foreign bodies " Stye, Chalazion 2. Conditions to be recognized and referred after treatment has been initiated " Corneal ulcers " Lacerating / penetrating injuries to the eyeball " Burns, chemical 3. Conditions to be recognized and referred for treatment " Cataract " Painful red eye with visual loss " Visual loss < 6/18 in either eye.