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Sudden loss of vision is a very important clinical feature and may require urgent treatment. In non-arteritic ischaemic optic neuropathy, field loss is often predominantly in the superior or inferior field, a pattern known as altitudinal.
If a branch of the retinal artery is affected, only a sector of the retina opacifies, producing only a partial loss of vision. Patients present with unilateral vision loss and fundoscopy will reveal haemorrhages in the affected part of the retina. Associated with trauma, retinal detachments, retinal tears and retinal neovascularisation (e.g.
Typically patients complain of photopsia followed by large number of floaters and then a shade over the vision. Multiple sclerosis - in optic neuritis, there is subacute loss of vision with afferent pupillary defect and painful eye movements. Chronic simple (open angle) glaucoma is an important cause of gradual vision loss as patients may be asymptomatic for years until vision is severly impaired and optic nerve damage is irreversible. Usually patients are asymptomatic but since it is the leading cause of blindness in the UK in those aged 20-65, it is important to look out for signs of retinopathy.
Features on fundoscopy include microaneurysms ('dots'), haemorrhages ('blots') and hard exudates - these are features seen in non-proliferative diabetic retinopathy.
The clinical features depend on the underlying cause of the atrophy - glaucoma, retinal artery occlusion, choroiditis, retinitis pigmentosa or toxins such as tobacco, methanol and lead. This malignant tumour can cause retinal detachment over the tumour growth and patients may be asymptomatic or present with features of retinal detachment or progressive visual field loss. Some causes of loss of vision such as retinal artery occlusion, ischaemic optic neuropathy and retinal detachment need urgent help and it is important to be familiar with the signs and symptoms of these conditions so there can be no delay in referral to a specialist. Tumor growth in the optic nerve sheath may compress the optic nerve and cause vision loss in the affected eye.
This optic nerve sheath is made of a fatty insulating substance that covers and protects nerves, arranged in the dura, arachnoid, and pia mater. As it is a major contributor to one's vision, it is important to note the injuries and ailments which might befall the optic nerve sheath. Any time the myelin sheath has been destroyed or severely compromised, the nerve is susceptible to direct damage. Research has been conducted for many years to develop techniques for detecting these issues early on and repairing the myelin sheaths.
Choroidal neovascularization and retinal detachment are common complication of high myopia that sometimes may be detected on the images. 1.2% of the entire population of Africa is blind, with cataract causing 36% of this blindness. In the UK 30% of persons of 65 years and over have visually impairing cataract in one or both eyes. An analysis of blind registration forms in the west of Scotland showed senile cataract as one of the 4 leading causes of blindness. Anatomy The lens is surrounded by a thick lens capsule which is the basement membrane of the lens epithelial cells.
Congenital cataract Present at birth or appear shortly thereafter These cataracts may show many different patterns. Secondary Cataract Develop as a direct effect of eye diseases – glaucoma, – iritis – eye tumors, – retinitis pigmentosa – retinal detachment. Assessment Vision acuity test Slit lamp Ophthalmoscopy In most cases, eye drops are used to dilate pupils before the exam. Treatment If symptoms from a cataract are mild, a change of glasses may be all that is needed for you to function more comfortably.
Extracapsular cataract extraction is the preferred method of cataract surgery It preserves the posterior portion of the lens capsule Posterior chamber IOL can be implanted in the capsular sac An IOL is a tiny, transparent, convex lens made of different materials which is inserted in the eye during surgery. Glaucoma A group of disorders in which there is eventual development of an optic neuropathy with characteristic changes at the optic nerve head.
Why is glaucoma important Glaucoma causes significant visual disability in the UK, accounting for 15% of registrable blindness In a white population, POAG occurs in approximately 1-2% of the population over 40, increasing with age to 4% or more of the over 80-year olds. Warning signs of eye troubleBlurry vision, spots, glare at night - these are common eye complaints that can be harmless annoyances or an early sign of disease. Causes include ischaemic optic neuropathy, retinal artery or vein occlusion, vitreous haemorrhage and optic neuritis. Observe the dilated, tortuous veins supero- and infero-temporally in the picture and the widespread superficial haemorrhages. In contrast to the extensive haemorrhages seen in central retinal vein occlusion, branch occlusion will show bleeding in one segment of the retina only. Blood vessels can appear to have breaks throughout their course as they emerge from the disc, disappear into the cup and are seen at the base again. The presence of engorged tortuous veins, cotton wool spots (areas of ischaemia) and large blot haemorrhages suggest significant ischaemia. The loss of vision is painless and patients may describe a "curtain falling over the vision".
Recent onset retinal vein occlusion, showing extensive haemorrhages in the posterior pole and giving the "blood and thunder" appearance. Patient with nonischaemic retinal vein occlusion presented with dialted, tortuous veins and superficial haemorrhages. Demyelination is one such condition and refers to the destruction or loss of the myelin sheath. Optic neuropathy is a general term used to describe any conditions that result in damage to the optic nerve. One option to patients might be the surgical implanting of oligodendrocyte precursor cells.
Age-related cataract is responsible for 48% of world blindness, which represents about 18 million people, according to the World Health Organization (WHO). Epithelial cells at the lens equator continue to be produced throughout life Older lens fibres are compressed into a central nucleus Younger fibres around the nucleus make up the cortex.

The opacity may be confined to the area of the embryonic or fetal nucleus with clear cortex surrounding this.
It is intended for general information purposes only and does not address individual circumstances. In this picture, there is a focal area of bleeding found lateral or temporal to the optic disc, suggesting branch retinal vein occlusion. Optic neuritis is an inflammation of the optic nerve which can cause severe pressure, pain and headaches and may result in the destruction of the protective myelin sheath that covers the optic nerve.
Symptoms would include blurred vision in only one eye, double vision, difficulty in coordination and fatigue.
Other times, the condition is so progressed or acute that there may not be a cure, only medications and treatments to deal with pain or slow the condition's progress. At least 5-10 million new visually disabling cataracts occur yearly, with modern surgical techniques resulting in 100,000-200,000 irreversibly blind eyes. Cataract surgery should be considered when cataracts cause enough loss of vision to interfere with daily activities. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Areas of localised infarction due to arteriolar vasoconstriction can create cotton wool spots and flame-shaped haemorrhages. This particular sheath is responsible for insulating the optic nerve, which is the primary structure that connects the eye to the brain.
These conditions are usually the result of an autoimmune reaction or disorder in which the body mistakes its own oligodendrocytes for a pathogen and essentially attacks them. Never ignore professional medical advice in seeking treatment because of something you have read on the BootsWebMD Site. Although it is called the optic nerve, this structure is actually made of many nerve axons that originate in the retina of the eye and carry visual information from the retina to the primary visual cortex of the brain.
If it's a "5", you may be have colour vision deficiency – also known as being colour blind. Short-sightedness (myopia)At least five million people in the UK are short-sighted, and about 200,000 of them have a high degree of myopia. Long-sightedness (hyperopia)Most of us are born with mild long-sightedness also known as far-sightedness, but normal growth in childhood often corrects the problem. When it persists, you may see distant objects well, but books, knitting and other close objects are a blur. The eyes' lenses become less flexible and can't change shape to focus on objects at reading distance. Short-sightedness: What happensTypically, an eyeball that's too long causes short-sightedness, or myopia, but an abnormally shaped cornea or lens can also be responsible. This sensitive membrane lines the back of the eye (seen in yellow) and sends signals to the brain through the optic nerve. Short-sightedness often develops in school children and teenagers, who need to change glasses or contacts frequently as they grow.
Long-sightedness: What happensIn long-sightedness, or hyperopia, the cause is often an eyeball that is too short.
Children with significant hyperopia are more likely to have crossed eyes (strabismus) and may have difficulty reading.
AstigmatismYour vision may be out of focus at any distance with astigmatism in one or both eyes. It occurs when the cornea, the clear "window" that covers the front of the eye, is not a perfectly curved shape. Light rays can be scattered in different points on the retina, rather than focusing on a single point.
Surgery to reshape the cornea can correct short-sightedness, long-sightedness or astigmatism with a success rate of better than 90%.
People with severe dry eye, thin corneas or severe vision problems may not be good candidates. Laser surgery is available on the NHS for eye conditions that can lead to loss of vision if they are left untreated. GlaucomaYou can't feel it, but rising pressure in the eye can silently steal your sight, a condition called glaucoma. There may be no symptoms until some peripheral vision is lost, so regular eye tests are critical to detect it early.
Regular eye tests every one to two years after the age of 40 – or earlier if recommended – can help identify it early. Glaucoma: What happensIn the most common form of glaucoma, too much fluid builds up inside the eye. That increases pressure and damages the optic nerve at the back - the bundle of one million nerve fibres that carry information to the brain.
Without treatment, glaucoma can cause total blindness. The bright yellow circle shows an optic nerve head that is damaged by glaucoma. Macular degenerationAge-related macular degeneration (AMD) damages, then destroys, the eye's finely-detailed central vision, making it difficult to read or drive. Being over 60, a family history of AMD, and smoking increase the risk, as may sunlight exposure and excessive alcohol consumption. Macular degeneration: What happensIn age-related macular degeneration (AMD), the central part of the retina, called the macula, deteriorates.
As dry AMD progresses, the macular tissue deteriorates, gradually shutting down the delivery of images to the brain.
Macular degeneration: TestCover one eye and stare at the centre dot in this Amsler Grid, from a distance of 30 to 40 cm. Macular degeneration: SignsAs seen here, the Amsler Grid can look quite distorted to someone with significant macular degeneration and may include a central dark area.
Straight lines that appear wavy are also cause for concern, as they can be an early symptom of "wet" AMD, the more serious and fast-moving type of macular degeneration.
Your optometrist will want to evaluate you right away, starting with a thorough dilated eye examination.

Diabetic retinopathyType 1 and type 2 diabetes can cause partial vision loss (seen here) and lead to blindness.
The damage involves tiny blood vessels in the retina and can often be treated - but don't wait for symptoms.
By the time they occur - blurry vision, spots, shadows or pain - the disease may be severe.
For those with diabetes, an annual examination of the retina can detect early warning signs. Diabetic retinopathy: What happensWhen high blood sugar levels go unchecked, it can damage the tiny blood vessels that support the retina. In some cases, dozens of new, abnormal blood vessels grow, a condition called proliferative retinopathy. These processes gradually damage the retina, causing blurred vision, blind spots or blindness. By the time we're 80 years old, more than half of us will have a cataract, or clouding of the lens. Vision gradually gets foggy and makes it hard to read, drive and see at night.  Diabetes, smoking or prolonged sunlight exposure may increase the risk. Cataracts: What happensIn good health, the lens focuses light into a sharp, clear image on the retina, which captures the image like film in a camera. As we age, protein builds up in the lens, clouding it and sending scattered rays of light to the retina, instead of one sharp clear image. The result can be blurred vision, changes in colour vision, and glare, especially at night. Advanced cataracts are visible to the naked eye - the muddy-coloured circle at the centre of this picture. Retinitis pigmentosaRetinitis pigmentosa (RP) is an inherited disorder that often begins with night vision problems, followed by a gradual loss of side vision, developing into tunnel vision, and finally, in some cases, blindness.
There is no cure yet for retinitis pigmentosa, but researchers are working to develop treatments for RP and other inherited retinal diseases. Retinitis pigmentosa (RP): What happensThe light-sensitive tissue of the retina slowly deteriorates over many years in people with RP. Eye tests show abnormal dark spots (pigments) sprinkled around the retina, called bone spicules.
Early cataracts can also occur, as well as a swelling of the retina called macular oedema (the central orange mass seen here). Floaters and specksBlurry spots or specks that move may be floaters - debris in the eye's vitreous gel. Floaters are common and usually harmless, but if they change suddenly, or are accompanied by light flashes, you should seek medical advice. Vision abnormalities that tend to be more serious include persistent white or black spots or a sudden shadow or loss of peripheral vision. Lazy eye (ambylopia)Ambylopia, or lazy eye, may stem from a misalignment of the eyes (strabismus or crossed eyes) or poorer vision in one eye.
A patch or drops that blur the vision in the "good" eye can force the brain to use the other eye.
Eye care: Object in the eyeMany nerve endings lurk just beneath the surface or your cornea, so a tiny speck can be surprisingly painful.
When not enough flow, perhaps due to dry air, ageing or other health conditions, the eyes can become painful and itchy. Eye drops called artificial tears may help, but some people will need other medication or a procedure to plug the tear ducts. Eye Care: ConjunctivitisConjunctivitis is an inflammation caused by a virus, bacteria, irritant or allergy.
Along with the telltale redness, you might have an itching or burning sensation and a discharge. Both types are very contagious, so wash your hands frequently while you wait for it to clear up. Styes usually heal in a week, but using a warm, wet compress three to six times a day can speed the healing. Watery, itchy eyes are commonly triggered by allergens such as pollen, dust, weeds and pet fur.
Eye care: Regular eye testsEveryone should have regular eye tests as often as advised by their optometrist or doctor. Beyond vision issues, the eyes can reveal underlying health problems, such as diabetes and high blood pressure. Abnormalities in an eye test can help reveal a stroke, brain tumour or other serious disorder.
Bulging eyes can be a sign of thyroid disease, and a yellow tint of the sclera (white of the eye) may indicate liver problems. Regular overexposure to sun can cause cataracts 8 to 10 years earlier than normal, and a single lengthy exposure can actually burn your corneas. More significant light sensitivity - getting headaches or nausea from light exposure - could be a symptom of other eye disorders. Eye protection: Everyday hazardsGrease splatters from a frying pan, garden debris flies up from the lawn mower, cleaning solution splashes in a bucket.
Some of the greatest hazards to the eyes are in the home, so consider using eye protection for some DIY tasks. So are spinach, nuts, oranges, beef, fish, whole grains and many other foods in a healthy diet.

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