Lazy Eyes or (Amblyopia)

Lazy eye or amblyopia is a disturbance of eyesight in children, because the brain and eyes are not well connected, resulting in decreased vision.

The presence of lazy eyes in the child will cause the quality or focus of the vision produced by the two different eyes. In effect, the brain will only translate the vision of a good eye and ignore the vision of the eye that is experiencing interference (lazy eye). If not handled properly, lazy eyes may suffer blindness.

Lazy eyes generally occur from birth to age 7 years. In some rare cases, the disease can affect both eyes.

Symptoms of Lazy eye

Children rarely know that they suffer from impaired vision or cannot explain it, so lazy eyes include conditions that are difficult to detect. Therefore, parents should be aware of the following symptoms and clinical signs:

  • Visible eyes do not work at the same time.
  • One eye often moves towards the inside or outside (juling).
  • Children are difficult to estimate distances.
  • One eye looks more squinted than others.
  • The child often tilts the head to see more clearly.
  • Difficulty seeing 3-dimensional objects.
  • Poor vision test results.

If the parents are aware of the symptoms of lazy eyes, should immediately have a child checked into the ophthalmologist.

Causes of Lazy eyes

Lazy eyes occur when a nerve connection from one eye to the brain is not formed perfectly in childhood. Poor vision eyes will send a blurred or mistaken visual signal to the brain. Gradually, the performance of both eyes becomes out of sync and the brain ignores the signal from the bad eye.

Lazy eyes can happen to a child triggered by various things. Some of them are:

  • Eye squeal (strabismus). This is the most trigger of lazy eyes. This condition is often derived genetically in the family.
  • Refractive disorder, which is the presence of refractive differences in both eyes, so that the eyes with clearer vision will be dominant to see. Examples of refractive disorders are long-sightedness, near-sightedness, and astigmatism.
  • Cataract in children. Cataracts cause a blur in the lens of the eye, thus disrupting vision. If it occurs only in one eye, it can trigger a lazy eye in the child.
  • Wounds on the cornea of the eye. The wound in the front of the eyes (corneal ulcer) can cause visual impairment and trigger a lazy eye in the child.
  • Drooping eyelids, preventing

Besides the above triggers, there are several factors that could potentially increase the risk of lazy eyes on a child. Among them are:

  1. Premature births.
  2. Babies born with weight below normal.
  3. Hereditary factors, especially if there is a lazy eye history in
  4. Child developmental Disorders.

Lazy Eye Diagnosis

Most children who experience lazy eyes are unaware if one of their eyes is experiencing vision problems, especially early childhood. Parents can estimate whether the child is experiencing lazy eyes or not by observing the lazy eye symptoms mentioned above. Parents can also do simple tests to make sure that their children are suspected of suffering from lazy eyes or not, by closing one of their eyes in turns. The child will complain if the one covered is a good eye, and will not complain if the covered is a lazy eye. However, to determine whether or not the child is experiencing the disease, parents are strongly advised to have their children checked in to the doctor.

At the time the child is examined, the doctor will check to ensure the condition of the child’s eye and vision, namely that:

  • Both eyes can see equally well.
  • Nothing prevents the entry of light into the inside of the eye.
  • Both eyes move simultaneously and align with each other.

An eye exam can be done routinely when a child is 6 months old, 3 years, and at school age to ensure the development of his vision. If at the time of examination, the doctor suspects the child suffers from lazy eye, then the treatment will begin.

Lazy Eye Treatment

The severity of the lazy eye and its impact on child vision will determine the appropriate treatment step. Generally if the lazy eye is diagnosed as early as possible, the success rate is quite good. Treatment that begins at the age of children over 6 years has a lower success rate.

The principle of treatment of lazy eye is two, which is between forcing the use of lazy eye to see, or treating the condition that causes the disease. Some of the treatments that doctors will advise are:

  • Use of glasses. In the early days, most children would refuse to use a special eye-specific eyewear, as it felt the vision was better without the tool. Parents are encouraged to always keep their children with lazy eye-specific spectacles, so that the treatment can work well.
  • Use of blindfold. This appliance is paired to a normal eye to stimulate lazy eyes, in order to develop a developmental look. Just like the use of glasses, in the early period of therapy, children sometimes refuse to use the blindfold, because it is uncomfortable in seeing. This is most effective for toddler sufferers, and the blindfold is generally worn for 2-6 hours per day. Eye-Cover therapy can be combined with the use of glasses.
  • Special eye drops, which can obscure the normal eye view. This will encourage children to use their lazy eye. However, eye drops like this could potentially trigger side effects of eye irritation, reddish skin, as well as headaches.
  • Operating. This procedure is recommended to deal with cataracts and squing eyes that trigger lazy eyes. Surgery is generally done in the case of unconscious children after being given total anaesthesia. After surgery, the child must undergo hospitalisation as part of the recovery. While it could not be a hundred percent improved visual ability, the eye would become more synchronous, so its performance increased.

Dry Eye Disease

Dry eye disease is a condition in which the eyes do not get adequate lubrication from tears. This condition prevents the eye from removing dust or foreign objects that irritate the eye. As a result, the eyes feel very uncomfortable.

Irritated and injured red eye.

In healthy eyes, the cornea will continue to flow through the tears as the eyes flicker, to nourish the corneal cells and protect the cornea from the outside. Tears are a compound of fat, water, mucus, and more than 1500 proteins that keep the surface of the eye smooth and protected from the surrounding environment, irritating elements, or germs that cause infection. When the glands around the eyes are unable to produce enough tears or when the composition of the tears changes, then the outer surface of the eye that plays a role in transmitting light into the eyes can also be disturbed.

Another name for dry eye disease is keratoconjunctivitis sicca or dry eye syndrome. Dry eyes are more common in women than in men, and the risk of dry eye is also increasing with age.

Dry Eye Symptoms

Common symptoms of dry eye disease include:

  • Red eye.
  • The eyes are hot.
  • The eyes are sandy and dry.
  • Eyes water because of the body’s response to dry eye irritation.
  • Sensitive to sunlight.
  • Blurred vision
  • It’s hard to open your eyes when you wake up, because the upper and lower eyelids are tight.
  • There is mucus in or around the eyes.
  • Have trouble wearing contact lenses or driving at night.
  • The eyes are tired quickly.

The degree of dryness of the eyes varies from mild to severe. But in most cases, the symptoms are still mild.

Dry eye symptoms can worsen when the patient is in certain conditions, such as working on a computer screen for hours, staying in a dry environment, or reading books for long periods of time. Dry eye conditions can cause inflammation on the surface of the eye, resulting in scar tissue in the cornea or bacterial infection.

Causes of Dry Eyes

Some conditions can cause dry eye, which is:

  • Tear production decreased. This condition can be due to old age, certain diseases (such as diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren syndrome, thyroid hormone disorders, vitamin A deficiency or xerophthalmia), consumption of certain drugs (such as antihistamines, decongestants, antidepressants, hypertension drugs, acne medicine, Parkinson’s disease, or hormone replacement therapy), tear gland damage or radiation.
  • Tears evaporate faster. These conditions can be due to weather (wind, smoke, or dry air), conditions that rarely blink (when reading or working too long in front of a computer screen), eyelids that turn outward (ectopion) or turn inward (entropion).
  • Unbalanced tear composition. Tears are made up of 3 compositions, namely oil, water, and mucus, with a specific composition. When this composition changes, for example due to oil gland blockage, blepharitis, or rosacea, it can cause dry eyes.

In addition to some of the causes of dry eye, the risk of having dry eyes on someone is also increased if:

  • Age over 50. As we grow older, tear production tends to decrease.
  • Experiencing hormone changes. This condition is most common in women who experience hormone changes due to pregnancy, family planning, pills, and menopause.
  • A diet with low vitamin A content.
  • Wear contact lenses.

Dry Eye Diagnosis

To determine the diagnosis of dry eye, the ophthalmologist will ask about the patient’s symptoms and history of their illness, before conducting a physical examination.

To measure the volume of a patient’s tears, the doctor will perform a Schirmer’s test. Through this test, the doctor will measure the degree of dryness in the eyes by sticking to a special piece of paper that can absorb the fluid in the lower eyelids for 5 minutes. Eyes are classified as dry if the wet paper size is less than 10 millimeters in 5 minutes.

While looking at the condition of the eyes, tests using eye drops containing a special dye (fluorescein dye test) can be done. After giving the eye drops to the patient, the doctor can see the color change pattern on the eyes to see how quickly the eyes can dry. This fluorescein dye test can also show areas that have damaged the surface of the eye.

To see the damage to eyebrows can also be seen through a lissamine green test or a special dye on a piece of paper. Next, the paper is washed with saline solution and applied to the surface of the eye. Through a color pattern that attaches to the surface of the eyeball, the doctor can see the early signs of damage to the eye. In addition to eye examination, physical examination will also be done to find out the cause of dry eye,

Dry Eye Treatment

Dry eye treatment is intended to help the patient alleviate symptoms and resolve the cause of dry eye. If the cause of the dry eye is related to a medical factor, the first step to take is to address the cause. For example, if the cause is a side effect of the medication, then the doctor may recommend that the patient replace the drug that does not cause side effects.

For dry eyes that are light or occasional, patients may use eye drops or known as artificial tears, in the form of eye drops, gels, or ointments that are sold free in pharmacies. These medications can moisturize the eyes and act as a substitute for tears.

In addition, other efforts can be made at home to relieve symptoms or prevent dry eye syndrome, namely:

  • Protects the eye from environments that cause dry eyes, such as windy, hot, smelly, or dusty weather. Avoid the environment or use glasses as a protective device, and use an indoor moisturizer or filter.
  • Avoid wearing makeup on the eyes.
  • Stop smoking.
  • Set the length of your work in front of your computer screen.
  • Maintain eye hygiene by applying warm compression to the glands in the eye area, and removing dirt or oil on the eyelids.
  • Many take omega-3 fatty acids which can improve dry eye condition. Omega-3 is found in many types of fish, such as mackerel, tuna, sardines, or salmon.

If home remedies do not work, then doctors can make several therapeutic options, including:

  • Medicines. One of the most commonly prescribed medications to treat dry eye is an antibiotic to relieve inflammation at the ends of the eyelids and over-the-counter painkillers (such as ciclosporine or corticosteroids) that reduce inflammation in the cornea of ​​the eye. However, long term consumption of corticosteroids may have side effects. In order to encourage tears production, doctors can prescribe cholinergic drugs, such as pilocarpine. If the dry eye is still intact, the doctor may recommend using eye drops made and processed from the person’s blood (autologous serum eye drops).
  • LipiFlow thermal pulsation. This tool aims to break down the oil glands that cause dry eyes. During this therapy, tools such as bowls are inserted into the eyes, giving a gentle, warm massage to the lower eyelids,
  • Intensed-pulsed light therapy. Light therapy followed by a massage on the eyelids can help severely dry eye patients.
  • Custom contact lens. These contact lenses called scleral lenses are recommended for patients to protect the surface of the eye and maintain eye moisture.
  • Surgery. This procedure can be done in cases of severe dry eye and cannot be remedied by other therapies. The operation is done by clogging the tear duct permanently, so that the surface of the eye is always moist. Another operation is gastric gland autotransplantation. In this procedure, the saliva gland from the bottom of the lip is raised to be placed in the skin around the eyes to act as a replacement for the tears gland.

In general, dry eye symptoms can be controlled post-treatment. However, there are some patients who still suffer from dry eye syndrome after treatment, even if the complaint lasts a lifetime.

Dry Eye Complications

The possible complications of dry eye disease include increasing the risk of eye infections due to a lack of tears, loss of surface area due to dry eye conditions that are left untreated to cause conjunctivitis, corneal surface damage, open corneal injury, and vision impairment. Dry eye syndrome also causes problems for the sufferer to perform daily activities, such as reading or driving a vehicle.

Eye Cancer

Eye cancer is a disease in which cells in the surrounding eye or tissue organs grow rapidly, uncontrolled, malignant, and can spread to other parts or organs of the body. As it grows and spreads, the cancerous cells may damage the surrounding normal cells.

Eye cancer is a rare disease. Eye cancer can occur in three main parts of the eye, i.e. eyeballs (globe), Orbita (the tissues surrounding the eyeball), and eye accessories (eyebrows, tear glands, and eyelids).

Eye cancer can be derived from eye cells as well as from cancer in organs or other body parts that spread to the eyes. Eye cancer derived from the eye part is called primary eye cancer, while the eye cancer of other organs is called secondary eye cancer.

Types of eye cancer

Based on the original network, eye cancer can be divided into several types, namely:

  • Intraocular melanoma

Intraocular melanoma is the most common type of eye cancer. The melanoma can of pigment-producing cells (dyestuffs) or melanocytes located in the uvea tissues. Intraocular melanoma appears most often in the coroid, but it can also occur in the iris (rainbow membrane) tissues.

  • Intraocular lymphoma

Intraocular lymphoma is a type of eye cancer derived from cells in the lymph nodes in the eye. Intraocular lymphoma belongs to the non-Hodgkin lymphoma group.

Patients with intraocular lymphoma generally have a disease that causes weak immune system, such as HIV/AIDS. Intraocular lymphoma also often appears in conjunction with lymphoma in the central nervous system called primary central nervous system (PCNSL).

Retinoblastoma

Retinoblastoma is an eye cancer in children. Retinoblastoma arises from the occurrence of gene mutation in the retina causing the retinal cells to divide rapidly and spread to the eye tissues and other parts of the body. Retinoblastoma can occur in either one or both eyes.

In addition to the three types of eye cancer above that occur in the eyeball, eye cancer can also occur in the Orbita and the Eye accessories section. Some types of cancer in the Orbita network and the eye Accessories network, among others:

Eyelid cancer, a variant of skin cancer, such as basal cell carcinoma or squamous cell carcinoma
The Orbita cancer, which is a cancer that occurs in the muscles of the eyeball and connective tissue around the eyeball (rhabdomyosarcoma)
Conjunctival melanoma, which is the cancer that occurs in the conjunctival membrane that lines the eyelids and eyeballs, usually this cancer looks like a black stain in the eyes
Tear gland cancer (malignant mixed ephitelial tumors), which is a tear gland cancer derived from the cells of the gland that can spread to other parts of the body

Causes of eye cancer

Not known for certain causes of eye cancer. However, suspected eye cancer arises as a result of gene mutation in the eye tissues, especially the genes regulating cell growth.

Despite the unknown cause, there are factors that can increase the risk of eye cancer, namely:

  • Age over 50 years old
  • White-skinned
  • Has a bright eye color, such as blue or green
  • Having a family with an intraocular melanoma history
  • Have abnormalities or a history of certain abnormalities, such as having a lot of moles (dysplastic nevus syndrome) or black patches on the eyes (nevus of Ota)

Some studies have stated that exposure to harmful chemicals, exposure to sunlight, or exposure to ultraviolet lamps is also related to the occurrence of eye cancer. In addition, some types of work, such as welders, are also thought to increase the risk of a person being affected by melanoma.

Eye Cancer Symptoms

The symptoms of eye cancer differ depending on the type of cancer suffered. Symptoms may resemble symptoms of other eye conditions or diseases. Sometimes, eye cancer may also not cause any symptoms at first.

However, in general there are some symptoms that can signify eye cancer, namely:

  • There are dark spots on the iris
  • Vision Disorders
  • Field Refinement
  • See things like flying floaters, stripes, or freckles.
  • See Flashes of light
  • Changes in pupil size and shape
  • Strabismus or squint
  • One eye looks more prominent
  • A bump on the surface of the eye, eyelid, or around the eyes
  • Eye pain
  • Red Eye or irritation
  • Conjunctivitis

In children with retinoblastoma, they will look like “cat eyes” or white patches when their eyes are exposed to light.

When to go to a doctor

Since the symptoms of eye cancer are not specific and can resemble symptoms of other eye conditions or diseases, it is advisable to conduct a doctor’s examination if you experience symptoms such as those mentioned above, especially if the symptoms do not subside after 2 weeks.

Routine examination to the doctor is highly recommended if you have any factors that may increase the risk of developing eye cancer. The examination should be done once a year, so that eye cancer can be detected as early as possible.

Eye Cancer Diagnosis

The doctor will do the question and answer about the complaints and symptoms of the patient, including from when the symptoms arise and what can trigger or relieve symptoms, as well as the general medical history of the patient.

The doctor will also perform an eye exam with the help of tools, such as ophthalmology, slit lamp, and lens gonioscopy, to see eye conditions. This examination aims to determine the ability of eye vision, the movement of the eyeball, and the condition of the eye veins.

If the results of the examination indicate the possibility of eye cancer, some supporting examinations can be done to confirm the diagnosis, among others:

  • Scans, such as eye ULTRASOUND, CT scans, or MRI to determine the location and size of cancer cells
  • Biopsy, to sample a cancer-eye tissue that is suspected to be examined in a laboratory
  • Lumbar puncture, to detect whether intraocular lymphoma cancer has spread to the brain or spinal cord.

Eye Cancer Treatment

The chance of eye cancer cure depends on the size of the tumor, the severity of the condition, and the area and the cancer eye parts. In some patients, relapse can also occur after treatment and is declared cured.

Treatment of eye cancer aims to maintain the function of the eye, preventing the occurrence of the spread of cancer cells to other parts of the body, and prevent recurrence after treatment. Some methods that can be done include:

1. Operation

The type of operation performed depends on the location and size of the existing cancer network. During surgery, patients are usually given total anaesthesia. Specifically, the types of surgery that can be done to treat cancer are:

  • Iridectomy, which is the removal of part of the iris to treat small-sized iris melanoma
    Iridotrabulectomy, which is the removal of the part of the iris along with a small portion of the eyeball to treat the melanoma
    Iridosikletomy, which is the removal of the iris and part of the ciliary to treat Iris melanoma
    Transkleral resection, which is the removal of melanoma cancer that occurs in the choroid or the body of the ciliary
  • Enukleation, which is the removal of the entire eyeball in large melanoma or in patients who have lost sight
  • Eye excitation, i.e. eyeballs and some other parts around it, such as eyelids, muscles, nerves, and other tissues in the eye cavity

2. Radiotherapy

Radiotherapy is a treatment done by firing high-energy X-rays in cancer tissues. With radiotherapy the risk of losing or eyeball damage and vision loss can be reduced. The two types of radiotherapy that can be administered are:

  • Briterated, this procedure is carried out by inserting a small-sized radioactive plate in the surrounding eye area close to the cancer tissues
  • External radiotherapy, this procedure is performed by firing X-rays to the eye, but at risk of damaging other healthy tissues around the cancer

3. Laser Therapy

Laser therapy serves to destroy cancer tissues using laser beams. Laser therapy is usually used in patients with intraocular melanoma and small retinoblastoma, but is not recommended for people with intraocular lymphoma.

4. Chemotherapy

Chemotherapy is a method of eye cancer treatment using chemical medicines. Chemotherapy can be injected directly into the eye area (intraocular), into the cerebrospinal fluid (intrathecal), or administered through an infusion. Chemotherapy can be administered to patients with retinoblastoma, or intraocular lymphoma.

5. Medicine

Some drug immunotherapy and targeted therapeutic medications can be a treatment option, especially if chemotherapy drugs are not effective for this type of eye cancer that is handled. Immunotherapy drugs, which are pembrolizumab and ipilimumab, have been shown to overcome melanoma.

6. Cryotherapy

Cryotherapy is a method of cancer treatment by freezing the cancer tissue. Cryotherapy can be given to small retinoblastoma sufferers.

Eye Cancer Complications

Complications that can occur due to eye cancer include:

  • Vision or blind loss
  • Glaucoma
  • Spread of cancer cells to other parts of the body (metastases)

Eye Cancer Prevention

Because not all types of eye cancer are known for the exact cause, it is quite difficult to prevent the occurrence of eye cancer. The best thing that can be done is to avoid factors that can increase the risk of this condition. Some of the things that can be done are:

  • Avoid exposure to sunlight or ultraviolet rays by wearing UV-protected glasses when the sun is blazing
  • Preventing the occurrence of HIV infection, which is one of the factors that can increase the risk of intraocular lymphoma
  • Conducting early examination in children if a family member has a history of retinoblastoma