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High myopia is a vision condition in which a person experiences blurred or unfocused vision of distant objects. It is a more severe form of myopia than mild or moderate myopia.
In high myopia, the eyeball is abnormally elongated or the cornea is excessively curved. This causes light rays to focus in front of the retina rather than directly on it. As a result, distant objects appear blurred, while nearby objects may be seen more clearly.
High myopia is characterised by a higher prescription in dioptres. A person is generally considered to have high myopia if their prescription exceeds -6.00 dioptres.
High myopia may be associated with a greater risk of developing eye complications, such as retinal detachment, myopic maculopathy, early cataracts and glaucoma. These complications can affect long-term vision quality, so people with high myopia usually require closer care and monitoring by a specialist.
Treatment for high myopia may include wearing glasses or contact lenses to improve vision. In some cases, surgical options such as laser refractive surgery or the implantation of intraocular lenses (ICL) may be considered to correct vision or reduce dependence on glasses or contact lenses. However, the specific treatment will depend on individual needs and the ophthalmologist's assessment.
ICL lenses: what are they?
ICL (Implantable Collamer Lens) lenses are medical devices used to correct vision problems such as myopia, hyperopia and astigmatism. Unlike conventional glasses or contact lenses, ICL lenses are implanted inside the eye, between the iris and the natural lens.
ICL lenses are made from a biocompatible material called collamer, which is a mixture of collagen and hyaluronic acid. They are transparent and flexible, allowing good visual quality and greater patient comfort.
Implanting ICL lenses is a surgical procedure, but it is generally quick and safe. It is performed under local anaesthesia and does not require stitches. The surgeon makes a small incision in the cornea to insert the folded ICL lens, which then unfolds inside the eye. The ICL lens is placed behind the iris and in front of the natural lens, without altering any eye structure.
Once in place, the ICL lens helps focus light correctly on the retina, correcting refractive errors and improving the patient's vision. The main advantage of ICL lenses is that they are reversible, meaning they can be removed or replaced if necessary in the future.
It is important to emphasise that ICL lens implantation must be performed by an experienced ophthalmologist following a thorough assessment of the patient's eye health. Each case is unique, so consulting a specialist is essential to determine whether ICL lenses are a suitable option in each situation.
What is a cataract?
The cataract in the eye is a common medical condition affecting the eye's natural lens, known as the crystalline lens. This lens lies just behind the pupil and is responsible for focusing light entering the eye onto the retina at the back of the eye. When a person develops a cataract, the lens becomes opaque or cloudy. This makes it difficult for light to pass through it and reach the retina, resulting in blurred or unfocused vision. A cataract can affect one or both eyes and generally develops slowly over time.
They tend to be more common in older people because of the natural ageing of the lens. However, they can also develop due to other factors, such as eye injuries, systemic diseases (such as diabetes), prolonged use of certain medicines, excessive exposure to the sun's ultraviolet radiation and genetic factors.
The symptoms may include blurred vision, sensitivity to light, difficulty seeing at night, faded or yellowish colours, and double vision in one eye. If you experience any of these symptoms, it is important to consult an ophthalmologist for an accurate diagnosis.
The treatment is surgery to remove the cloudy lens using PHACOEMULSIFICATION and replace it with a clear artificial lens, called an intraocular lens. Cataract surgery is safe and effective and is frequently performed around the world to restore vision affected by this condition.
Cataract surgery is generally performed as a day-case procedure and does not require a prolonged hospital stay. During the procedure, a small incision is made in the eye to access the lens. A technique called phacoemulsification is then used to break up and remove the cataract using ultrasound waves. Once the cataract has been removed, an artificial intraocular lens is placed in the same position to restore vision.
Artificial intraocular lenses may be monofocal, correcting vision at a specific distance, usually distance vision, or multifocal, allowing clear vision both near and far. The choice of lens depends on the patient's needs and preferences and is discussed with the ophthalmologist before surgery.
Vision may improve immediately after surgery, although it can take a few days or weeks to stabilise completely. Eye drops and medicines may be needed during recovery to prevent infection and help healing.
It is important to mention that there is no effective non-surgical treatment for cataracts. Glasses or medicines cannot remove cataracts or reverse their development. Surgery is the only definitive treatment for cataracts and is generally recommended when reduced vision significantly affects the patient's quality of life
What are monofocal lenses?
Monofocal lenses are intraocular lenses used in cataract surgery to replace the cloudy natural lens. They are called “monofocal” because they are designed to focus vision at a single focal point, usually for distance vision.
Once the cataract has been removed and the monofocal lens placed in the eye, the patient may have clear distance vision without needing glasses for that distance. However, because monofocal lenses focus at a single focal point, the patient will probably need glasses for near vision, such as reading or tasks requiring close focus.
Monofocal lenses are a popular and effective option for correcting vision after cataract surgery, especially in patients who do not have significant near-vision problems and prefer clear vision without glasses for distance activities.
It is important to emphasise that every patient is unique and intraocular lens options should be discussed with the ophthalmologist, who will assess each person's individual needs and preferences before cataract surgery
What are toric lenses?
Toric lenses are a special type of intraocular lens used in cataract surgery or refractive surgery to correct astigmatism. Astigmatism is a vision condition in which the cornea or the natural lens has an irregular shape rather than being completely spherical, resulting in blurred or distorted vision both near and far.
Toric lenses are designed with different refractive powers in different meridians of the eye to compensate for corneal irregularity and correct astigmatism. Unlike monofocal lenses, toric lenses have an asymmetrical shape to accommodate the shape of the cornea and align vision correctly.
During cataract surgery or refractive surgery, the toric lens is placed in the eye to replace the cloudy natural lens or correct existing astigmatism. The choice of a toric lens depends on the degree and type of astigmatism the patient has and is determined in consultation with the ophthalmologist.
It is important to bear in mind that, although toric lenses are very effective at correcting astigmatism, some patients may still need glasses for near or distance activities, particularly if they have other refractive problems such as presbyopia (difficulty focusing close up due to ageing).
In any case, the ophthalmologist is best placed to assess and recommend the appropriate lens type for the patient's individual needs
What are multifocal lenses?
Multifocal lenses are a type of intraocular lens used in cataract surgery or refractive surgery to correct presbyopia, also known as age-related long-sightedness. Presbyopia is an age-related vision condition in which the eye gradually loses the ability to focus clearly on nearby objects.
Unlike monofocal lenses, which have a single focal point for distance vision, multifocal lenses have multiple focal points that allow clear vision at different distances. These lenses are designed with specific optical zones that allow patients to see both distant and nearby objects, reducing or eliminating the need for glasses for everyday activities.
Multifocal lenses work by using the principle of diffraction or refraction of light through different zones of the lens. This allows light rays to focus at different focal points within the eye, providing sharp vision for both distant and nearby objects.
It is important to emphasise that some patients may need a period of adjustment, as they may experience temporary side effects such as glare or slightly blurred vision in certain situations. However, most people adapt well to these lenses and enjoy clear vision without glasses both near and far.
As with any eye surgery, an ophthalmologist must carefully assess the patient's individual characteristics and needs to determine whether multifocal lenses are the right option.
Related article: How do I know if I have cataracts? - Clínica Castellote.
Presbyopia, also known as age-related long-sightedness, is a common vision disorder affecting many people as they age. It is characterised by difficulty focusing on nearby objects, such as small print or fine details, while distance vision may remain clear.
Presbyopia occurs because of age-related changes in the crystalline lens, the eye's natural lens behind the pupil. As we age, the lens becomes less flexible and loses its ability to change shape to focus on nearby objects. This makes it harder for the eye to focus light from close objects accurately on the retina, resulting in blurred vision.
Common symptoms of presbyopia include needing to hold objects further away to read them properly, difficulty focusing in low light, and eye strain after prolonged close-up activities. Presbyopia usually begins to become apparent around the age of 40 and continues to worsen gradually over time.
How is it treated?
There are different treatment options for presbyopia, depending on each person's individual needs and preferences. Some common treatment options include:
Reading glasses and magnifying lenses: these are specifically designed to correct presbyopia. Their lenses focus light from close objects, allowing clear near vision. They are mainly used when near vision is needed, such as for reading or detailed work.
Multifocal contact lenses: like varifocal glasses, multifocal contact lenses have different zones that correct both near and distance vision, and in some cases intermediate vision too. They allow clear vision at different distances without constantly having to change glasses.
Monovision with contact lenses: in this approach, a contact lens for near vision is placed in one eye and a contact lens for distance vision in the other. This allows the brain to adjust and use the appropriate eye to see nearby or distant objects.
Surgery. There are different techniques for correcting presbyopia.
One of these, and the most widely used today, is surgery with premium intraocular lenses.
It is important to bear in mind that each treatment option has its own advantages, disadvantages and individual considerations. Consulting an ophthalmologist or optometrist is recommended to assess each specific situation and determine the best treatment option.
Presbyopia surgery
Presbyopia surgery is also known as surgery to correct presbyopia or age-related long-sightedness.
Presbyopia is an age-related eye condition affecting the eye's ability to focus on nearby objects. As we age, the eye's natural lens becomes less flexible, making it harder to focus on nearby objects, such as when reading text or looking at fine details.
Presbyopia surgery aims to correct this problem by replacing the eye's natural lens. There are different surgical techniques for addressing presbyopia, including:
Monovision. One eye is adjusted for clear near vision and the other for clear distance vision. The brain adapts to this difference, allowing balanced vision overall.
Premium intraocular lenses: special lenses are implanted in the eye to correct presbyopia. These lenses have different focusing zones, allowing clear vision both near and far. Different lens types suit different patients, so it is necessary to see a specialist ophthalmologist to determine the right lens in each case.
What are premium intraocular lenses?
Premium intraocular lenses are a type of implantable lens used in cataract surgery or refractive surgery to correct vision. They are designed to offer better visual quality and a wider range of focus than conventional intraocular lenses.
Premium intraocular lenses are called “premium” because they offer additional features beyond simply replacing the cloudy natural lens during cataract surgery. They are designed to correct not only distance vision but also near vision and, in some cases, intermediate vision. Some features and options offered by premium intraocular lenses include:
Multifocal lenses: these lenses have different focusing zones, allowing sharp vision both near and far. Some multifocal lenses use simultaneous focus, while others use a “split vision” approach in which each eye focuses at different distances.
Extended depth of focus (EDOF) lenses: these lenses offer clear vision at multiple distances, including intermediate vision.
Accommodating lenses: these lenses are designed to imitate the natural focusing of the eye's crystalline lens. They allow variable focus at different distances as the eye muscles contract and relax.
Premium intraocular lenses offer the advantage of reducing or eliminating dependence on glasses or contact lenses after cataract surgery. However, it is important to bear in mind that they are not suitable for everyone. A prior assessment by an ophthalmologist is necessary to determine suitability and the appropriate options for each patient.
What are extended depth of focus lenses?
Extended depth of focus lenses, also known as EDOF lenses, are a type of intraocular lens used in cataract surgery or presbyopia surgery. They are designed to correct both distance and near vision, providing a broad intermediate focusing zone.
Unlike multifocal lenses, which have multiple well-defined focal points for different distances, extended depth of focus lenses use special optical technology to create a broader focusing zone extending from distance to near vision. This allows a smoother, more natural transition between different focusing distances without constantly having to change focus or experiencing halos or glare.
Extended depth of focus lenses use principles such as diffraction or phase modulation to extend the depth of focus and provide clear vision at multiple distances. Although they do not offer the same ability to focus at different distances as multifocal lenses, their main aim is to provide good visual quality across a range of intermediate distances, which can be beneficial for activities such as reading medium-sized text or using electronic devices.
It is important to emphasise that extended depth of focus lenses are not suitable for everyone and may not be the best option for specific visual needs. The choice of this lens type should be discussed and assessed with an ophthalmologist, who will determine whether it is appropriate for the patient's individual characteristics and needs.
Related article: What presbyopia is, why it develops and the best treatments.
Blepharochalasis is a medical condition affecting the eyelids. It is characterised by weakening or laxity of the skin and tissues of the upper eyelids. As a result, the eyelids may become redundant, with excess skin and muscle. This redundancy can affect the appearance of the eyes and, in some cases, cause functional problems such as difficulty opening and closing the eyes properly.
Blepharochalasis is commonly associated with ageing. In some cases, it may be related to underlying medical conditions such as autoimmune diseases or thyroid disorders. Typical symptoms include the appearance of drooping eyelids, swelling, eye irritation and difficulty seeing if the redundant eyelid tissue obstructs vision.
Treatment for blepharochalasis depends on the severity of symptoms and the patient's needs. In more severe cases, or when symptoms significantly interfere with vision, blepharoplasty surgery may be an option to remove excess skin and tissue from the eyelids.
What is upper blepharoplasty?
Upper blepharoplasty is a surgical procedure performed to correct drooping upper eyelids or excess skin and fat. It aims to improve the appearance of the eyes and correct functional problems caused by excess eyelid skin.
During upper blepharoplasty, an incision is made in the natural crease of the upper eyelid. Excess skin, fat and, in some cases, muscle tissue are removed through this incision. After the excess tissue has been removed, the incision is carefully stitched closed.
Upper blepharoplasty is generally performed under local anaesthesia. The procedure usually takes approximately one hour, depending on the extent of the correction required.
Swelling and ecchymosis (bruising) around the eyes are common after surgery, but these side effects usually decrease in the days and weeks following the procedure. Painkillers may be prescribed, and instructions will be provided on caring for and cleaning the eyes during recovery.
Upper blepharoplasty can offer significant benefits, improving the appearance of the eyes and making them look more rested. It can also help improve vision if excess upper eyelid skin obstructs the visual field.
It is important to emphasise that blepharoplasty is a surgical procedure and must therefore be performed by a surgeon specialising in eyelid surgery. Before undergoing this type of surgery, it is essential to consult a professional for a proper assessment and to discuss the specific risks and benefits in your case.
Related article: UPPER BLEPHAROPLASTY: EVERYTHING YOU NEED TO KNOW - Clínica Castellote.
Conditions
The vitreous (vitreous humour) is a clear, gel-like substance that fills the cavity of the eye and helps maintain its shape.
Posterior vitreous detachment, also known as vitreous gel detachment, occurs when the vitreous gel inside the eye separates from the retina.
As we age, the vitreous can change in consistency and undergo a process called syneresis, in which the gel shrinks and separates from the retina. This phenomenon is common and generally does not cause significant problems in most cases. However, in some cases vitreous detachment can have certain consequences.
When the vitreous detaches from the retina, symptoms such as floaters and flashes of light may occur. Floaters are small spots or floating particles that may appear in the visual field. They are actually shadows cast by particles or fibres within the vitreous. Intermittent flashes or streaks of light may also be seen, especially in peripheral vision. This happens when the vitreous separates from the retina and may temporarily stimulate the photoreceptors.
In most cases, posterior vitreous detachment is a benign process and requires no specific treatment. However, a comprehensive eye examination is important to rule out retinal tears or retinal detachment, as vitreous detachment can sometimes cause these complications.
Children's eye health is extremely important, as adequate vision is crucial for their development and learning.
Children should have regular eye examinations, even from an early age. These examinations can detect vision problems such as myopia, hyperopia, astigmatism or amblyopia (lazy eye). Early detection can help correct these problems and prevent future complications.
It is important for parents to look out for symptoms that may indicate a vision problem in their children. These may include frequent eye rubbing, narrowing the eyes, tilting the head when looking at objects, difficulty focusing, avoiding activities requiring near vision, or poor hand–eye coordination.
Children must protect their eyes from potential injuries. This means wearing safety glasses during sports or recreational activities that pose a risk, and avoiding direct contact with sharp objects or chemicals that could harm the eyes. It is important for children to use electronic devices appropriately.
Many children now spend time in front of electronic screens, such as mobile phones, tablets and computers. It is important to set time limits and encourage frequent breaks to rest the eyes. Maintaining an appropriate distance between the eyes and the screen and adjusting the devices' brightness and contrast to reduce eye strain are also recommended.
A healthy, balanced diet is also important for eye health. Foods rich in nutrients such as vitamins A, C and E, as well as omega-3 fatty acids, can contribute to eye health. Examples include carrots, spinach, citrus fruits, oily fish and nuts.
In summary, caring for and maintaining children's eye health is essential. Regular examinations, appropriate protection, responsible use of electronic devices, a balanced diet and early detection of vision problems can promote good eye health and support children's development and wellbeing.
Related article: Do you know what amblyopia, or lazy eye, is? - Clínica Castellote.
Diabetic retinopathy is an eye complication that can develop in people with diabetes mellitus. It is characterised by progressive damage to the blood vessels supplying the retina, the light-sensitive layer at the back of the eye. Chronic diabetes can affect and damage blood vessels, leading to diabetic retinopathy.
There are two main types of diabetic retinopathy:
1. Non-proliferative diabetic retinopathy: at this early stage, the retinal blood vessels are damaged, which can cause fluid and blood to leak. As the disease progresses, small bulges known as microaneurysms may form in the blood vessels.
2. Proliferative diabetic retinopathy: at this advanced stage, the damaged blood vessels cause a lack of blood supply to the retina, stimulating the growth of abnormal new blood vessels.
These new blood vessels are fragile and prone to leaking blood, which can affect vision and lead to more serious complications such as vitreous haemorrhage, preretinal fibrosis and, in more severe cases, retinal detachment.
Diabetic retinopathy generally causes no symptoms in its early stages, so regular eye examinations are important for people with diabetes to detect it in time. Maintaining a healthy lifestyle, with proper control of blood glucose levels and blood pressure and good overall diabetes care, can help reduce the risk and progression of diabetic retinopathy.
In advanced cases of eye disease, treatments such as laser photocoagulation, injections of medicine into the eye or surgery may be necessary.
It is important to emphasise that early diagnosis and timely treatment can help prevent or delay vision loss caused by diabetic retinopathy. If you have diabetes, regular ophthalmic examinations are essential to detect and treat any eye problems early.
Related article: Diabetic retinopathy and macular oedema: what they are and how to treat them.
Pinguecula is a common eye condition affecting the conjunctiva, the thin, transparent membrane covering the white of the eye (sclera). It appears as a yellowish or white deposit on the conjunctiva, usually on the side nearest the nose. Pinguecula is seen more frequently in people who spend a lot of time outdoors, particularly in sunny environments.
The exact cause is not known for certain, but it is thought to be associated with prolonged exposure to the sun's ultraviolet (UV) radiation and other environmental factors. Chronic irritation and dry eye can also contribute to its development. Pinguecula is more common in older adults, although it can affect people of all ages.
Generally, it causes no problems and requires no treatment unless it becomes inflamed or causes discomfort. Artificial tears or lubricating eye drops can help relieve dryness and irritation. In some cases, if it becomes significantly inflamed or causes persistent symptoms, an ophthalmologist may recommend anti-inflammatory eye drops.
It is important to distinguish pinguecula from another condition called pterygium, a fleshy growth extending over the cornea. Pterygium can cause more severe symptoms and, in some cases, may need surgical removal if it affects vision or causes significant discomfort.
If you suspect you have a pinguecula or another eye condition, it is always best to consult an eye care professional for an accurate diagnosis and appropriate treatment recommendations.
Dry eye syndrome occurs when the eye cannot keep itself properly hydrated. In general, at least one of three problems is usually present: not enough tears are produced, the tears do not have the right composition, or an eyelid abnormality prevents their proper distribution.
The symptoms most frequently experienced are eye discomfort, a gritty sensation, excessive watering, burning or itching, red eye and, in some cases, reduced visual acuity.
Dry eye syndrome becomes more common with age, contact lens use and prolonged screen use. It can worsen in polluted environments, on windy days, and with air conditioning and heating; it can also be triggered by immune-related diseases such as Sjögren's syndrome or by certain medicines.
The treatment of dry eye can vary according to the cause and severity of the condition. It may include medicines such as artificial tears in drops or gel, anti-inflammatory eye drops, topical corticosteroids or immunomodulatory medicines. Other approaches to dry eye treatment include punctal plugs, treatment of the meibomian glands, avoiding triggers and keeping the environment humidified.
If compatible symptoms are present, an ophthalmic assessment is important to evaluate each case and provide fully individualised treatment according to the patient's characteristics.
Related article: Keep your eyes hydrated! Understanding and treating dry eye - Clínica Castellote.
Blepharitis is a condition mainly affecting the eyelids and causing inflammation and redness. Patients notice that their eyes become irritated very easily and may also experience itching, watering and a gritty sensation. It is one of the most common causes of eye discomfort.
Blepharitis may present with crusts or scales at the eyelid margins, known as anterior blepharitis, associated with secondary Staphylococcus infection or seborrhoeic dermatitis. Or it may present as… The causes of blepharitis are not always clear, but may include:
- Bacterial infections: bacterial infections, particularly Staphylococcus.
- Meibomian gland dysfunction: problems with the glands that produce the oily part of the tear film.
- Skin conditions: seborrhoeic dermatitis, rosacea and other dermatological conditions.
- Allergies: allergic reactions to cosmetics or environmental substances.
As we can see, many of these causes are chronic, so the priority in blepharitis is to control the abnormalities, as a definitive cure is not always possible. However, with the right treatment, symptoms subside and patients regain their quality of life. Treatment is based on long-term eyelid hygiene and hydration with artificial tears, and short courses of antibiotics and/or anti-inflammatory treatments.
The macula is the central part of the retina, responsible for central vision and providing the greatest precision. When it becomes oedematous, fluid accumulates and its layers thicken. The macula is very delicate and depends on the surrounding blood vessels being in perfect condition; it is therefore prone to inflammation in many conditions, both confined to the eye and systemic: diabetic retinopathy, venous thrombosis, uveitis, macular degeneration, epiretinal membrane and even the postoperative period following uncomplicated eye surgery.
When it is affected, patients may notice reduced visual acuity, distorted images, altered colour perception, difficulty reading…
Different treatments are available depending on the cause, the patient and the severity of the oedema. In some cases, anti-inflammatory eye drops or an injection of a depot anti-inflammatory around the eye are sufficient; in others, intraocular injections, laser photocoagulation or even surgery must be considered.
For the reasons mentioned, prevention through examination of the back of the eye and optical coherence tomography of the macula is paramount.
Retinitis pigmentosa is a genetic disease, meaning people are born with it and it can be passed down through generations. It affects the retina and is progressive, with the cells slowly deteriorating. Symptoms generally appear in childhood or young adulthood and progress with age.
Initially, the most typical symptom is loss of night vision or difficulty moving around in dark environments. Loss of peripheral vision, altered colour perception and sensitivity to bright light are also common. The disease progresses differently in each patient, but all usually go on to lose central vision.
To diagnose the disease, an ophthalmic examination is performed, including examination of the back of the eye with dilated pupils. A series of additional tests is requested, such as a multifocal electroretinogram, but confirmation comes from genetic tests, which look for changes in the genes known to be responsible using a sample of the patient's blood.
There is no cure for RP, but low-vision aids can help patients make the most of their vision.
Keratitis affects the surface of the cornea. In contact lens wearers, there are two main groups: non-infectious and infectious.
In the first group, there is a lack of hydration, perhaps from overusing contact lenses or reduced tolerance to them. Inflammation and small wounds on the cornea cause a gritty sensation, discomfort and possibly reduced visual acuity. This is a less serious condition, and patients generally recover with artificial tears and by avoiding contact lenses until the problem resolves.
In the second group, microorganisms colonise the cornea, causing more severe symptoms and making treatment more complicated. Poor hygiene when handling contact lenses and exposure to water increase the risk of infectious keratitis. Patients experience marked discomfort in light, even pain, and an intensely red eye is typical. It is advisable to take a sample from the corneal lesion; the contact lens solution will typically also be cultured (neither the contact lenses nor their case should be discarded). Treatment begins with broad-spectrum antibiotic drops and, in some cases, antifungals, until culture results are available and treatment can be targeted more specifically to the microorganism.
Infectious keratitis leaves significant lasting damage, which is why so much emphasis is placed on handling contact lenses correctly, maintaining the highest standards of hygiene, not wearing lenses beyond their recommended period and avoiding exposure to water.
This is involvement of the cornea by herpes simplex virus type 1 (different from the virus affecting the genitals, which is herpes simplex type 2).
Herpes virus type 1 can cause a wide range of eye conditions, from more benign to more serious. The first eye infection usually causes conjunctivitis with red eye, watering and discomfort… The virus then remains dormant in our nervous system and can reactivate in certain circumstances, such as sun exposure, stress or reduced immunity.
When it reactivates, the severity of the condition depends on how deeply the cornea is affected:
- Epithelial keratitis: branching lesions called “dendritic” lesions appear in the outermost layer and must be treated with antiviral ointment to prevent scarring.
- Immune stromal keratitis: an inflammatory reaction occurs in response to residual virus particles, although the virus is usually no longer active.
- Necrotising stromal keratitis: the virus infiltrates this layer of the cornea and the reaction is much more intense.
- Endotheliitis: the innermost layer is affected, resulting in an inflammatory reaction in the anterior chamber of the eye.
It should be emphasised that herpes can cause corneal anaesthesia, so sometimes the main symptoms are red eye and reduced visual acuity, without pain.
Another herpes virus that can cause similar conditions is herpes zoster, which we usually encounter in childhood, when it manifests as chickenpox, and which can reactivate later. Its particular feature is that it is generally accompanied by herpetic blisters on the skin following a specific distribution.
Uveitis is inflammation of the uvea. The uvea is the middle layer of the eye and includes the iris (the coloured part), the ciliary body (behind the iris, changing the shape of the natural lens when it focuses) and the choroid (a layer filled with blood vessels between the retina and sclera).
Uveitis can have various causes, such as infections or autoimmune diseases, although the most common cause is idiopathic, meaning of unknown origin.
There are several types of uveitis, classified according to the specific part of the uvea affected and the characteristics of the inflammation:
- Anterior uveitis: mainly affects the iris and ciliary body. It is one of the most common types and is characterised by eye redness, pain, sensitivity to light and blurred vision.
- Intermediate uveitis: characterised by inflammation in the ciliary body, specifically in the vitreous gel (the gel-like substance filling the eye cavity). Symptoms may include blurred vision, myodesopsia (the perception of floaters) and variable vision loss.
- Posterior uveitis: mainly affects the choroid. It can cause blurred vision, reduced vision and dark spots in central vision.
- Panuveitis: inflammation of all parts of the uvea (anterior, intermediate and posterior). It can cause a wide range of symptoms, including eye redness, pain, blurred vision and vision loss.
Uveitis can affect one or both eyes and may be acute (sudden onset and limited duration) or chronic (persistent with relapses).
The symptoms can vary depending on the part of the uvea affected, but commonly include eye redness, pain, sensitivity to light, blurred vision and visual disturbances.
As for the treatment of uveitis, it depends on the underlying cause and the severity of the inflammation, and may include topical medicines (drops), injections around or inside the eye, systemic medicines (oral or injectable), immunosuppressive therapy or surgery in severe cases.
Corticosteroids are usually the basis of treatment in the acute phase. Depending on the origin, treatment may range from an antibiotic for infectious causes to an immunomodulator for immune-related or chronic cases, or those with complications from corticosteroid use.
It is essential for an ophthalmologist or specialist in inflammatory eye diseases to assess and treat uveitis properly to prevent complications and preserve eye health.
Scleritis is inflammation affecting the sclera (the tough, white layer covering the outside of the eye). It is a relatively rare eye disease ranging from a trivial, self-limiting condition (resolving on its own over time without significant complications) to a necrotising process that can affect adjacent tissues and threaten vision.
It should not be confused with episcleritis, inflammation affecting the outermost layer of the sclera (episclera), which is generally considered more benign because it tends to be shorter in duration, self-limiting and typically idiopathic (of unknown origin).
The symptoms commonly associated with scleritis include intense, constant eye pain, eye redness, sensitivity to light (photophobia) and affected vision.
In many cases, scleritis is associated with autoimmune diseases such as rheumatoid arthritis. Other less common possible causes include infections such as herpes zoster or tuberculosis, previous eye injuries such as trauma or eye surgery, or an unknown origin.
There are different types of scleritis:
- Anterior scleritis: the most common type. It affects the front, visible portion of the sclera.
- Posterior scleritis: this type affects the back portion of the sclera, which is not visible, so there will be no obvious redness.
- Necrotising scleritis: a severe form that can cause necrosis (tissue death) of the sclera. It usually causes severe pain, marked inflammation and significant eye damage.
The treatment of scleritis is based on the severity of the disease and the underlying cause. It may include non-steroidal anti-inflammatory medicines, corticosteroids (typically oral or intravenous), immunosuppressants, biological therapy or surgery in severe cases.
It is important to seek medical care from an ophthalmologist for an accurate diagnosis and an appropriate treatment plan, as scleritis can cause serious complications and affect eye health.
Optic neuropathy is a disorder in which the optic nerve, responsible for transmitting visual signals from the eye to the brain, is damaged. This damage can occur anywhere along the optic nerve, from the eye to the point where the nerve connects to the brain.
The symptoms of optic neuropathy can vary depending on the cause and severity of the damage to the optic nerve. Common symptoms include blurred vision, painless partial or complete loss of vision in one or both eyes, changes in colour perception and loss of the visual field.
There are several types of optic neuropathy, depending on the cause of the damage:
- Ischaemic optic neuropathy: caused by reduced blood flow to the optic nerve.
- Non-arteritic (NA-AION): the most common form of optic neuropathy, associated with reduced blood flow to the optic nerve. It usually affects older people and may be caused by factors such as high blood pressure, diabetes, smoking or coronary artery disease.
- Arteritic (AAION): this form of optic neuropathy is caused by inflammation of the blood vessels supplying the optic nerve. It is associated with giant cell arteritis, an inflammatory disease of the blood vessels.
- Hereditary optic neuropathy: caused by genetic mutations, it is uncommon and encompasses various conditions.
- Traumatic optic neuropathy: occurs as a result of direct injury or trauma to the optic nerve, such as a skull fracture, a blow to the eye or radiation injury.
- Toxic/nutritional optic neuropathy: caused by exposure to toxic substances that damage the optic nerve, such as certain medicines, including chemotherapy medicines, or excessive alcohol or tobacco use. It also affects patients with poor diets and mainly results from deficiencies in B vitamins.
As for the treatment of optic neuropathy depends on the underlying cause and may include measures to control blood pressure, reduce inflammation, improve blood flow or treat underlying diseases. In some cases, vision may improve over time, but in others, vision loss may be permanent.
An early ophthalmic assessment is necessary to identify the possible type of optic neuropathy and act accordingly.
Optic neuritis is inflammation of the optic nerve, which is responsible for transmitting visual signals from the eye to the brain.
The symptoms of optic neuritis may vary but generally include rapid loss of vision in one or both eyes, changes in colour perception and loss of the visual field. Some patients may also experience pain when moving the affected eye, particularly from side to side.
There are several types of optic neuritis, depending on the cause of the inflammation:
- Demyelinating: the most common cause. A process in which the nerve fibres of the optic nerve lose their insulating layer, impairing nerve conduction. Although it includes several diseases, the most common is multiple sclerosis.
- Infectious: may be associated with sinusitis or other infections such as cat-scratch disease, syphilis, Lyme disease or herpes zoster.
- Non-infectious: due to sarcoidosis or autoimmune diseases such as systemic lupus erythematosus.
Optic neuritis can also be classified by the location of the inflammation within the optic nerve. In retrobulbar optic neuritis, the inflammation is behind the eyeball, before the nerve enters the eye. In anterior optic neuritis, or papillitis, the inflammation affects the optic nerve head, the part inside the eye (called the optic disc).
For treatment of optic neuritis, the underlying cause is generally taken into account. If optic neuritis is suspected to be related to multiple sclerosis or another autoimmune disorder, medicines may be prescribed to control inflammation and modulate the immune response.
An early ophthalmic assessment is necessary to identify the possible type of optic neuritis and act accordingly.
Age-related macular degeneration (AMD) is a degenerative disease that mainly affects older people and causes reduced central vision. AMD affects the macula, a small area in the centre of the retina responsible for the central vision needed for activities such as reading, recognising faces and seeing fine details.
It is one of the leading causes of vision loss in older adults.
The exact cause of AMD is not fully understood, but genetic and environmental factors such as age, smoking and exposure to ultraviolet light are thought to play a role in its development.
The symptoms may include blurred vision, distortion, difficulty reading or seeing detailed objects, and a dark or blind spot in the centre of vision.
There are two main forms of AMD:
- Dry, non-exudative or atrophic AMD: the most common form of AMD (85–90% of cases). It is characterised by progressive thinning of the macula due to the accumulation of deposits called drusen in the retina. Central vision is gradually affected and progression is slow (years).
- Wet or exudative AMD: the more severe and less common form of AMD (10–15% of cases). It is characterised by the abnormal growth of fragile new blood vessels beneath the retina that can leak fluid or blood, causing scarring and damage to the macula. Central vision is affected severely and rapidly (days or weeks).
In the case of dry or non-exudative AMD there is no curative treatment available. Some studies have shown that certain vitamin supplements and a healthy diet, as well as avoiding smoking and limiting sun exposure, may help reduce the risk of progression.
In the case of Wet or exudative AMD, treatment does not always restore lost vision but can help preserve existing vision and slow or even stop the progression of the disease. It is treated with intravitreal injections (injections into the vitreous gel inside the eye) of anti-angiogenic medicines (ranibizumab, aflibercept, brolucizumab or faricimab) to stop abnormal blood vessel growth. For greater safety, these injections must be administered under strictly sterile conditions. Complications associated with this technique are unusual.
As a disease associated with ageing, it cannot be prevented, although early diagnosis and treatment will lead to a better visual prognosis.
If any warning symptoms arise, seeing an ophthalmologist is recommended so that assessment and treatment can take place as quickly as possible, in an attempt to limit the irreversible visual damage caused by AMD. These symptoms include:
- Blurred central vision
- Straight lines appearing wavy
- Objects appearing distorted or crooked
- A central spot
Treatments
A chalazion is a swelling or lump that forms in the eyelid due to inflammation of an oil gland called a meibomian gland. These glands are in the eyelids and produce oils that help lubricate and keep the surface of the eye moist. When a meibomian gland becomes blocked, the oil cannot drain properly and accumulates inside the gland, forming a lump in the eyelid. This lump is painless in most cases, but it may cause discomfort if it grows larger or becomes inflamed.
It usually appears as a small nodule in the eyelid, near its margin. Chalazia can vary in size, from barely noticeable to the size of a pea. Although they do not cause serious problems in most cases, they can affect the appearance of the eye and, rarely, vision if they press on the cornea.
Treatment for a chalazion may include applying warm compresses to the affected area to help reduce inflammation and encourage drainage of the blocked gland. In some cases, surgical removal may be needed if it does not go away on its own or causes significant discomfort. If you have a chalazion, consulting an ophthalmologist for a proper diagnosis and appropriate treatment is recommended.
It is important to emphasise that surgical treatment is generally reserved for cases in which the chalazion does not respond to other conservative treatments.
If you have a chalazion and are considering surgery, please book an appointment so we can assess your specific situation and recommend the best treatment and appropriate medical care for your case.
Peripheral retinal degenerations are conditions or abnormal changes occurring in the peripheral retina, the outer part of the retina away from the centre of vision.
There are different types of peripheral retinal degeneration. Particularly important among them is lattice degeneration, characterised by thinning and weakness of the retina that can increase the risk of retinal detachment, especially if tears or holes develop.
These peripheral retinal degenerations are generally detected during a routine eye examination and are usually asymptomatic. However, in some cases they can increase the risk of complications such as retinal detachment, which can cause severe vision loss if not treated promptly.
Retinal tears are breaks in a section of the retina resulting from various causes.
Symptoms of a retinal tear may include the sudden appearance of flashes of light and floating spots in the visual field (called floaters). Sometimes symptoms may progress to seeing a curtain or dark shadow that appears to cover part of the visual field. These symptoms may indicate retinal detachment and require urgent medical attention.
Treatment for an uncomplicated retinal tear requires a procedure to seal the break and reposition the retina correctly. Treatment options may include laser therapy or cryotherapy (freezing) to seal the tear. If bleeding into the vitreous or retinal detachment occurs, a surgical procedure called vitrectomy will be necessary to remove the vitreous gel and repair the retinal detachment.
It is important to seek immediate medical attention if you experience symptoms of a retinal tear to prevent progression of retinal detachment and preserve vision.
Refractive errors are conditions in which the eye cannot focus light properly, resulting in blurred or distorted vision. The main refractive errors include:
Myopia: myopia makes nearby objects appear clear but distant objects blurred. It occurs when the eye is too long or the cornea too curved, causing light to focus in front of the retina rather than directly on it.
Hyperopia: Patients with hyperopia see nearby objects blurred, while distant objects may be seen more clearly. Hyperopia occurs when the eye is shorter than normal or the cornea less curved, causing light to focus behind the retina rather than on it.
Astigmatism: Astigmatism is characterised by irregular curvature of the cornea or natural lens, resulting in distorted vision both near and far. Objects may appear blurred, elongated or misshapen. Astigmatism can occur alongside myopia or hyperopia.
Presbyopia: Also known as age-related long-sightedness, presbyopia is a refractive error that develops with ageing. As the eye's natural lens loses its elasticity, focusing on nearby objects becomes more difficult. Presbyopia usually becomes apparent after the age of 40 and may require reading glasses.
Each refractive error can be corrected with glasses, contact lenses or refractive surgery, according to the patient's preference and the eye care professional's recommendation. Regular eye examinations are important to detect and correct any refractive error and maintain optimal eye health.
A pterygium is an abnormal growth of tissue on the conjunctiva, the transparent membrane covering the eye's surface and the inside of the eyelids.
It appears as a fleshy mass extending from the sclera (the white of the eye) towards the cornea, the clear outermost part of the eye.
The exact causes are not known for certain, but they are thought to be related to chronic exposure to ultraviolet sunlight, dust, wind and other environmental irritants. These factors can trigger an inflammatory response in the conjunctiva, leading to excessive tissue growth.
Common symptoms include eye redness, a foreign-body or burning sensation, irritation, itching and blurred vision if the growth affects the cornea. In some cases, a pterygium may cause no significant symptoms and require no treatment.
However, treatment may be recommended if it causes discomfort or affects vision. This may include artificial tears to relieve symptoms, anti-inflammatory medicines to reduce inflammation and tissue growth, and, in more severe cases, surgery to remove the tissue.
The most appropriate surgical treatment for pterygium is conjunctival autograft or transplant surgery. This procedure involves removing the pterygium and using healthy tissue from the patient (an autograft) to cover the affected area.
One of the most common complications after surgery is recurrence of the lesion, so using the autograft technique is vitally important in some patients.
Each case is unique, and the surgical approach may vary according to the severity of the growth and the surgeon's preferences. It is essential for the patient to consult a specialist ophthalmologist for an assessment and personalised recommendations.
YAG capsulotomy is a procedure used to treat a common complication after cataract surgery called posterior capsule opacification (PCO). PCO occurs when the lens capsule, left in place to support the intraocular lens implanted during cataract surgery, becomes cloudy over time, affecting vision.
Treatment restores transparency by making a small opening in the posterior capsule of the lens bag with an Nd:YAG laser. It is painless, non-invasive and takes only a few minutes. It is performed in the consulting room as follows:
- Dilating eye drops are instilled.
- The patient sits in a chair facing a slit lamp, a device similar to the one used during routine eye examinations.
- The doctor uses the YAG laser to create a small opening in the posterior lens capsule
No preparation is required from the patient, although anti-inflammatory eye drops may commonly be needed for a few days afterwards.
It is a fairly safe technique; nevertheless, some unwanted side effects are possible, although unlikely, such as increased intraocular pressure or inflammation inside the eye.
In summary, YAG capsulotomy is a safe and effective procedure for treating posterior capsule opacification, significantly improving the quality of life of patients who experience this complication after cataract surgery. If your vision loses clarity after cataract surgery, please consult your ophthalmologist.
This is an established ophthalmic treatment involving the application of a beam of light concentrated at a single high-energy point, with the aim of generating heat that leads to scar formation. In general, there are two main uses for laser treatment:
- Conditions involving retinal ischaemia in which oxygen requirements need to be reduced: diabetic retinopathy, venous thrombosis, arterial occlusions… In all of these, laser treatment helps control the retina and prevent serious consequences such as bleeding or neovascular glaucoma.
- Retinal tears, in which the scar created by the laser seals the retina and prevents it from detaching.
After dilating drops are applied, anaesthetic drops are added. Using a small lens in contact with the cornea, laser treatment is performed non-invasively in the consulting room, in sessions lasting a few minutes.
Following up patients with systemic conditions (diabetes, high blood pressure) and those prone to retinal tears (people with myopia) allows their needs to be monitored and, where necessary, laser treatment to be applied at the right time to prevent their conditions from worsening.
An intravitreal injection is a medical procedure in which a medicine is administered directly into the vitreous humour (the clear, gel-like substance in the centre of the eye, behind the natural lens and in front of the retina).
Medicines administered by other routes, such as orally or intravenously, do not reach sufficient concentrations in certain structures inside the eye, such as the retina or vitreous, so local administration is necessary for some diseases.
It is mainly used to administer medicines for the treatment of retinal or vitreous conditions.
Currently, the most frequently administered injections are anti-angiogenic medicines (ranibizumab, aflibercept, brolucizumab or faricimab) for conditions such as wet age-related macular degeneration (AMD), diabetic retinopathy, central retinal vein occlusion and myopic neovascular membranes.
Other injected medicines include intravitreal corticosteroids (dexamethasone or fluocinolone) for macular oedema of vascular or inflammatory origin, such as uveitic oedema or oedema after intraocular surgery, and antibiotics for endophthalmitis (infection of the contents of the eye).
The procedure is performed in a sterile setting, usually a clean room, and generally takes only a few minutes. No preoperative assessment is required; it is performed under topical anaesthesia (anaesthetic drops) and is well tolerated by patients.
It is carried out as follows:
- Antiseptic and anaesthetic drops are applied to the eye before the procedure to numb it and minimise any discomfort.
- The patient lies on an examination couch or reclining chair, and the area around the eye is cleaned with an antiseptic to prevent infection.
- The medicine is carefully administered into the vitreous humour through a very fine needle in the sclera (the tough, white layer covering the outside of the eye).
After the injection, it is recommended not to cover the eye, to avoid rubbing it, and to avoid swimming in the sea or a pool. The technique is virtually painless, although a gritty sensation, stinging and mild redness are normal in the days following the injection. The doctor will provide specific instructions on postoperative care and follow-up appointments.
What are the possible risks?
Intravitreal injections carry potential risks such as infection, bleeding inside the eye or retinal detachment, although these risks are relatively low.
The most feared complication, although very rare, is endophthalmitis (infection of the contents of the eye). Preventing it requires meticulous hygiene and following the specific instructions provided by your ophthalmologist.
Occasionally, a small reddish patch may appear at the injection site or spread across the sclera (the white of the eye), and is reabsorbed spontaneously over the following days. Seeing black bubbles after the injection may be due to residual air, which will disappear within 24–48 hours without affecting the treatment's effectiveness.