Eye Conditions FAQ
What are Cataracts?
What is a cataract?
A cataract happens when the lens within your eye becomes cloudy. It can happen to all of the lens or just part of it. There are different types of cataract, but the most common is age-related cataract, which is more common in people over 65. It can be found to some degree in almost all older people.
Age is the biggest risk factor for developing cataracts. Apart from age, smoking increases the risk of cataracts and often causes the cataract to develop earlier and more quickly. Excessive exposure to sunlight and ultraviolet light can increase the speed at which cataracts develop. Diabetes is also a common cause of early onset cataract. Other causes include certain drugs, such as steroids, or cataracts may form after an eye injury or surgery. In some cases, people are born with cataracts.
Cataracts can cause your vision to become misty and less clear. You may notice that you’re more easily dazzled by vehicle headlights, or that objects appear less colourful. You may need to change the prescription of your glasses more regularly than usual. Cataracts don’t cause eye pain or make your eyes red. If you experience blurred or misty vision, you should see your optometrist.
At first your optometrist may be able to prescribe new glasses that will help with changes to your vision caused by the cataract. When this no longer helps you to see well enough, the only effective treatment is surgery. Surgery is usually only recommended once the cataract is causing problems with everyday activities, such as driving, watching television and reading.
Cataract surgery improves the vision of nearly all patients and has one of the highest success rates of all surgery. Following surgery, the prescription of your glasses will change and you should see your optometrist after a few weeks for advice.
What is Blepharitis?
What is blepharitis?
Blepharitis causes eyelids to become red, swollen and inflamed. It doesn’t normally cause serious damage to the eyes, but it can be very uncomfortable. It tends to be a long-term condition, which means you’re likely to need ongoing treatment. Severe cases do have a risk of causing long-term damage, but fortunately these are quite rare.
Types of blepharitis
There are two main types of blepharitis – anterior and posterior.
When the front (anterior) part of the eyelids becomes sore, this can be caused by an infection, allergy or a general sensitivity to bacteria present on the eyelids. It can also be associated with some scalp conditions, such as very dry or oily skin and dandruff.
Also known as meibomian gland dysfunction (MGD) is when the glands that make the oily part of your tears become blocked. Both types of blepharitis can cause dry eye or make it worse if you already have it. Many people will have a combination of blepharitis, meibomian gland dysfunction and dry eye.
Blepharitis is more common in people over the age of 50, but anyone can develop it. This is often because the glands that make the normal tears, particularly the oily part of the tears, tend to become less effective as you get older.
Blepharitis can cause crusting and white scales may stick to the roots of eyelashes. Your eyelid edges may become red and your eyes will feel gritty, burning, sore or itchy. If you experience these symptoms, make an appointment with your optometrist.
There is a range of products designed especially for treating blepharitis, such as sterile pads, individual moist wipes and separate cleaning solutions.
Your optometrist will be able to advise you on where you can buy these products. Antibiotic ointment may be recommended in severe cases.
As part of the treatment, you need to remove all the crusting and debris from the edge of your eyelids and from between your eyelashes. You should use your cleaning product. If this is not available, you should use warm water and cotton balls or make-up removal pads. Treatment of blepharitis is a long-term procedure. You may not see any improvement for several weeks.
Continue the treatment twice a day for at least one month, then less often as it starts to get better. You will probably need to continue to clean your lids at least twice a week to help prevent the blepharitis from returning.
Blepharitis treatment method
Wash your hands before and after cleaning your eyelids
Rub the moistened pad or cotton ball firmly but gently along the eyelid edges to remove the crusts and debris
Take care to wipe between the eyelashes of both the upper and lower lids
Use a fresh pad or wipe each time
Dry your eyes gently
What is Age-related macular degeneration (AMD)?
Age-related macular degeneration (AMD) is the most common cause of visual loss in the UK affecting older people. Some types of AMD need to be treated quickly, so it’s important to see your optometrist urgently if you notice any sudden change in your vision.
What is age-related macular degeneration?
AMD is a condition that affects the central part of your vision. It is caused by damage to the macular region of the eye, which is the part of the retina that provides detailed, central vision. It doesn’t normally affect your peripheral (side) vision, so while objects in the centre of your vision may become difficult to see, the vision to the side and edges should not be affected.
There are two main types of AMD – dry and wet. Dry AMD, sometimes referred to as wear and tear, is caused by a build-up of waste within the cells of the eye that react to light – these are called drusen. Drusen stop the cells from reacting properly to light. This form of AMD usually develops slowly.
Wet AMD happens when new blood vessels grow behind the macula. These blood vessels can begin to leak and this can damage the cells in the macular region and stop them from working. This process can start very suddenly.
Age is the main risk factor for developing AMD and the disease is more common in people over 65. Smoking significantly increases the risk of getting macular degeneration. Stopping smoking is the greatest change you can make to protect yourself from AMD. Ultraviolet light may also increase the risk of AMD, so, it’s a good idea to wear glasses that block or absorb UV light, especially in bright light. Getting enough exercise and eating a healthy diet, with lots of fruit and vegetables, can help to protect your eyesight. Kale, spinach and broccoli all contain nutrients that have been shown to help keep the eyes healthy. If you have a close relative with AMD, your risk of developing the condition is higher. You are also more at risk if you already have AMD in the other eye.
To begin with, dry AMD may have little effect on your vision. If the disease develops, your central vision may gradually become more blurred and it may become difficult to recognise faces and read things directly in front of you. Wet AMD will normally cause distorted vision, with straight lines and edges such as door frames becoming wavy and distorted. Some people also see a sudden blank spot in their central vision. Sometimes these changes can happen quickly, so it’s important to see your optometrist urgently if you notice any sudden change in your vision.
At the moment, there is no effective treatment for dry AMD, but it may be possible to see better with the help of special magnifiers and good lighting. Advice from the National Institute for Health and Care Excellence (NICE) states that patients with dry AMD should not normally be referred to the hospital eye service, but should continue to regularly see their optometrist to monitor the condition. If you have dry AMD, you should also take steps to monitor your own vision and can use an Amsler chart to do this. Download an Amsler chart.
Wet AMD can often be treated with injections into the eye, as long as it is diagnosed quickly. The injections work by stopping the growth of new blood vessels and can help to save your vision and reduce the risk of the disease getting any worse. If you notice any recent change in symptoms, you should contact your optometrist immediately. They will arrange for you to be seen by the hospital eye service.
Living with AMD
If your vision is affected due to AMD, your optometrist can advise you on steps you can take to help you in your daily life. This may include referring you to a clinic which can offer help in the form of magnifiers, or putting you in touch with local support groups. You may be advised to register your sight loss with your local authority.
If you have lost vision through AMD, you may experience visual hallucinations. This is known as Charles Bonnet Syndrome. Many patients find it reassuring to know that this is a common experience after losing vision, and although it can be quite upsetting, it is unlikely to be a sign of mental illness. If you experience visual hallucinations, you may want to discuss it with your eye care practitioner.
If you drive, you should discuss your eyesight with your optometrist.
What are Flashes & Floaters?
Tiny spots, lines, flashes or shapes in your vision are known as flashes and floaters. Lots of people experience them and they usually aren't cause for alarm. Below we explain what causes flashes and floaters and when you should be concerned.
What are flashes?
Sometimes the jelly inside your eye shrinks a little and tugs on the retina (the light-sensitive layer) at the back of your eye. This can cause flashes of light at the edge of your vision. This is different from the disturbance of vision that can happen with a migraine.
What are floaters?
Often, people who have healthy eyes see floaters. They appear as spots, lines or cobweb effects, usually when you look at a plain surface such as a white wall, screen or a clear blue sky. They are usually caused by cells clumping together in the clear jelly in the main part of your eye and casting shadows on your retina – the light-sensitive layer of the eye. The sudden appearance of new floaters is different and may be caused by the jelly shrinking and can sometimes mean there is a tear in the retina.
When should I be concerned?
If you suddenly notice a shower of new floaters, or floaters along with flashes or a dark shadow or a ‘curtain’ in your vision, you should take urgent action. Follow the advice at the bottom of this page. These symptoms can mean that the retina is tearing.
What will happen if the retina tears?
The retina is the light-sensitive layer at the back of your eye which receives images and sends them to your brain. If the retina tears, it may come away from the back of the eye and can lead to a retinal detachment which can result in you losing part or all of your vision.
How is retinal detachment treated?
A tear may be treated by using a laser. If treated quickly you may have a better chance of full recovery. However, if your retina has become detached, you will need surgery. The operation may restore most of your vision but may come too late for a full recovery.
What to do if your symptoms change
Look out for the following:
Flashes or floaters getting worse
A black shadow in your vision
A sudden cloud of spots
A curtain or veil over your vision
Any change in vision
If you notice any of these symptoms, go to an Accident and Emergency department immediately.
What is Allergic Conjunctivitis?
Allergic conjunctivitis is an inflammation that affects the thin layer of tissue that covers part of the front of the eye and the inside of the eyelids (conjunctiva). It is not normally serious, and is sometimes referred to as pink or red eye.
There are two other forms of conjunctivitis – bacterial and viral. This leaflet looks at allergic conjunctivitis only. We have produced a separate leaflet on bacterial and viral conjunctivitis.
Allergic conjunctivitis is commonly caused by a sensitivity to grass and tree pollen, dust mites or animals. It is far more common in those with a history of allergies or those who have a family history of allergies.
Allergic conjunctivitis usually causes pink or red itchy eyes. The eyes are normally watery and other allergy symptoms such as sneezing and a runny nose may be present.
The seasonal type of allergic conjunctivitis will vary with the time of year and weather conditions. Those with more general allergies, such as an allergy to dust mites, will most likely have symptoms throughout the year.
You can treat allergic conjunctivitis by:
There is also a range of medicines that may help. Some are available over the counter at the pharmacy and other stronger medicines need a prescription.
Mast-cell stabiliser eye drops such as sodium cromoglicate (Opticrom) do not work straight away. Instead, they take a few days to start to work. These drops are good if you know when you are likely to develop an allergy and so you can use them to prevent symptoms. Mast cells are a type of white blood cell which are part of the immune system.
Antihistamine eye drops such as antazoline sulphate (Otrivine-Antistin) provide a more immediate effect. They won’t prevent an allergic reaction, but instead treat the symptoms once the allergy has started.
Combined eye drops have both types of medicine (mast-cell stabiliser and antihistamine) and so can work in the two ways shown above. They are only available on prescription.
Antihistamine tablets work in the same way as the eye drops, but will also treat other allergy symptoms such as a runny nose and sneezing that is caused by the allergy.
You should not wear contact lenses if your symptoms are severe or if you have been told that your cornea is affected. Do not put drops in your eyes while wearing contact lenses.
Occasionally you may need to be referred to an allergy specialist if the condition does not get better with treatment or the symptoms are very severe, but this is rare.
Avoiding the cause of the allergy (if possible)
Using cold compresses (such as clean cotton wool balls soaked in cold water) to soothe the eyes
Avoiding rubbing your eyes as this will make the symptoms worse
Wearing glasses or sunglasses may help to shield your eyes from pollen
Avoid rubbing your eyes, as this may make your symptoms worse
Use a cold compress to soothe your eyes
What is Dry Eye Syndrome?
The normal tear fluid that lubricates the eyes is made up of three layers – an oily (lipid) layer, a watery (aqueous) layer, and a sticky (mucous) layer – and these normal tears are what prevent our eyes from feeling dry.
You release extra tears when you cry. These are the same tears that are also triggered when something goes into or irritates the eye including chopping onions.
What is dry eye?
People with dry eye either don't make enough normal (lubricating) tears or the ones that they make are of poor quality, causing the tears to dry up too quickly and the front of the eye to become dry and irritated. As a result, dry eye can be uncomfortable and cause the eye to produce the watery type of tears. This only helps for a short time – leaving the eye uncomfortable and gritty.
If your eyelids are sore and red, you may also have another condition called blepharitis. Blepharitis is a condition that affects the eyelids making them sore and inflamed. If the eyelid glands become blocked, you may have a condition called meibomian gland dysfunction. It is quite common to have a combination of these conditions.
Dry eye doesn't tend to cause serious damage to the eyes, but it can be very uncomfortable. Severe cases do have a risk of causing long-term damage, but fortunately these are rare.
Dry eye is much more common in people over the age of 50. This is often because the glands that make the normal tears, and particularly the oily part of the tears, tend to become less effective as you get older. Also the tears tend to spread across the eye less well with age.
Some general health conditions can cause dry eye as a side effect, such as autoimmune diseases and hormonal changes. The condition is also more common in windy, cold, dry and dusty conditions.
If you’re concentrating on your computer or smartphone for long periods of time without a break, this may also make your eyes feel dry.
Air conditioning and central heating can make dry eye worse too, as can some medications and general health problems.
Smoking has also been linked to dry eye as it may both cause the condition and make it worse.
Most cases of dry eye tend to be a long-term condition, meaning that you’ll need ongoing. There are lots of different types of drops and gels that can help your eyes feel more comfortable. The best ones don’t have preservatives in them, or if they do they contain very gentle preservatives, which helps to reduce irritation. They may also contain an ingredient called sodium hyaluronate, known to be very effective in treating the condition.
It’s important to use the correct type of drops. The wrong drops are unlikely to cause any harm, but they won’t help as much. If your drops aren’t working or you’re not sure which drops to use, your local optometrist can advise you and may be able to offer other treatment options.
People with dry eye may get some or all of the following symptoms.
A sandy or gritty feeling
Uncomfortable and sometimes painful eyes
An itching or burning sensation
Short-term blurred vision
Watery eyes, as if you are crying (having watery eyes can mean you are producing poor-quality tears and actually have dry eyes)
What is Glaucoma?
Glaucoma is the name given to a group of eye conditions where the optic nerve at the back of the eye is damaged. It is often linked with raised pressure within the eye, although the eye pressure can sometimes be normal. When the nerve is damaged, it can start to cause problems with the peripheral vision (side vision) and, if left untreated, can cause permanent damage. With early treatment, further damage to vision can be prevented. The condition often happens in both eyes, although sometimes it affects one eye more than the other. Glaucoma is one of the leading causes of severe sight impairment.
There are two main types of glaucoma – open-angle (chronic) glaucoma and closed-angle (acute) glaucoma. Even though there are many different causes of the disease, the outcomes are very similar. Glaucoma may not have symptoms and this is why it is very important to have regular sight tests.
Age is the biggest risk factor for glaucoma. However, your risk also increases if you have family members with glaucoma or if you’re of black African or black Caribbean ethnic origin. Other eye conditions can sometimes cause glaucoma as a side effect. If you are diagnosed with glaucoma, it is important to let your close relatives know as they may be at increased risk of developing the disease.
The danger with open-angle or chronic glaucoma (slow onset) is that, in the early stages, your eyesight may seem perfectly normal. There is no pain, but your peripheral vision (side vision) is being damaged. Eventually your central vision can be affected. This can be described as tunnel vision because it feels like looking down a long tube. It’s important to have regular sight tests as open-angle glaucoma often does not have symptoms.
These symptoms can develop very quickly. Your eye might become very red and painful, you can get headaches and feel sick, and you may notice coloured halos around lights. This is a medical emergency. If you notice any of these symptoms, you should go to an accident and emergency (A&E) department immediately.
Open-angle glaucoma is usually treated with eye drops which reduce the pressure in the eye. You will need to use these daily and you will be monitored regularly at the hospital. Occasionally people with open-angle glaucoma need surgery to control the pressure.
Closed-angle glaucoma can damage the eye quickly. It’s treated at first by drops and tablets and sometimes by drugs direct into the bloodstream to quickly reduce the pressure in the eye. Laser treatment is often needed later to allow the fluid to flow through the eye better. People with closed-angle glaucoma may need surgery if laser treatment is not successful.