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COMPREHENSIVE EYE EXAMINATION

At our hospital we use a wide variety of tests & procedures to examine your eyes. The comprehensive eye examination provides the means to evaluate the function health of the eyes & visual system. It also provides the means to identify the presence of other ocular or systematic conditions that may exist without symptoms. Examination is a dynamic & interactive process. It involves collecting subjective data directly from the patient & obtaining objective data by observation, examination & testing. The nature of the eye examination is such that many conditions can produce the same or similar symptoms. For example blurred vision can be result from many causes including uncorrected refractive errors, systematic conditions such as diabetes mellitus or hypertension. In addition potentially blinding conditions such as glaucoma or diabetic retinopathy may cause no symptoms until they are far advanced & the ocular damage is irreparable.

The goals of the comprehensive eye & vision examination are-

a) To evaluate the functional status of the eyes & visual system taking into account special vision demands & needs.

b) Assess ocular health & related systematic health conditions.

c) Establish a diagnosis.

d) Formulate a treatment & management plan.

e) Counsel & educate the patient regarding his or her visual, ocular & related systematic health care status including recommendations for treatment, management & further care.

Some eye & vision tests that you are likely to encounter during eye exam-

Auto Refraction (AR)- We use AR to automatically estimate your eye glass prescription. A chinrest stabilizes your head while you look into the instrument at a pin point of light or a detailed image. It determines the power of your eye required to accurately focus light on your retina.

Non Contact Tonometer (NCT)- NCT is a test that helps detect glaucoma. By directing a quick puff of air onto the eye it can detect elevated eye pressure.  The test begins with you putting your chin on the machine’s chin rest. While you look at a light inside the machine, a puff of air will be blown at your open eye. It is completely painless and the tonometer does not touch your eye. Based on your eye’s resistance to the puff of air, the machine calculates your intraocular pressure (IOP). If you have high eye pressure, you may be at risk for or have glaucoma.

Visual Acuity Tests- In this test our optometrists measure the sharpness of your vision. These usually are performed using a projected eye chart to measure your distance visual acuity and a small, hand-held acuity chart to measure your near vision.

Dilated Eye Exam- Dilation is an important part of a comprehensive eye exam because it enables your eye care professional to view the inside of the eye. Drops placed in each eye widen the pupil, which is the opening in the center of the iris (the colored part of the eye). Dilating the pupil allows more light to enter the eye the same way opening a door allows light into a dark room. Once dilated, each eye is examined using a special magnifying lens that provides a clear view of important tissues at the back of the eye, including the retina, the macula, and the optic nerve.

Retinoscopy- In retinoscopy, the room lights will be dimmed and your eye doctor will shine a light at your eye and flip lenses in a machine in front of your eyes. This test estimates which lens powers will best correct your distance vision. Based on the way the light reflects from your eye, your doctor is able to “ballpark” your prescription. This test is especially useful for children and patients who are unable to accurately answer the doctor’s questions.

Slit Lamp Exam- A slit lamp is a binocular microscope (or “biomicroscope”) that your eye doctor uses to examine the structures of your eye under high magnification. It looks somewhat like a large, upright version of a microscope used in a science lab. During the slit lamp exam, you will be asked to place your forehead and chin securely against the rests on the front of the instrument and your doctor will begin by examining the structures of the front of your eyes — including your eyelids, cornea, conjunctiva, iris, and lens. With the help of a hand-held lens, your doctor may also use the slit lamp to examine structures located farther back in the eye, such as the retina and optic nerve.

A wide range of eye conditions and diseases can be detected with the slit lamp exam, including cataracts, macular degeneration, corneal ulcers and diabetic retinopathy, etc.

Glaucoma Test- Apart from NCT another type of glaucoma test is performed with an instrument called an Applanation Tonometer. For this test, your eye doctor will put yellow eye drops in your eye to numb it. Your eyes will feel slightly heavy when the drops start working. This is not a dilating drop, it is a numbing agent combined with a yellow dye that glows under a blue light. Then the doctor will have you stare straight ahead into the slit lamp while he or she gently touches the surface of your eye with the tonometer to measure your IOP. Like NCT, applanation tonometry is painless. At most, you may feel the tonometer probe tickle your eyelashes. The whole test takes just a few seconds. You typically have no warning signs of glaucoma until you already have significant vision loss. For this reason, routine eye exams that include tonometry are essential to rule out early signs of glaucoma and protect your eyesight.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

CATARACT

A Cataract is a clouding of the lens in the eye leading to a decrease in vision. It can affect one or both eyes. Often it develops slowly. Symptoms may include faded colors, blurry vision, halos around light, trouble with bright lights, and trouble seeing at night. This may result in trouble driving, reading, or recognizing faces. Poor vision may also result in an increased risk of falling and depression. Cataracts are the cause of half of blindness and 33% of visual impairment worldwide. Cataracts are most commonly due to aging, but may also occur due to trauma, radiation exposure, be present from birth, or occur following eye surgery for other problems.

Signs & Symptoms- Signs and symptoms vary depending on the type of cataract, though considerable overlap occurs. People with nuclear sclerotic or brunescent cataracts often notice a reduction of vision. Those with posterior subcapsular cataracts usually complain of glare as their major symptom. The severity of cataract formation, assuming no other eye disease is present, is judged primarily by a visual acuity test. The appropriateness of surgery depends on a patient’s particular functional and visual needs and other risk factors, all of which may vary widely.

Causes-

Age– Age is the most common cause. Lens proteins denature and degrade over time, and this process is accelerated by diseases such as diabetes mellitus and hypertension. Environmental factors, including toxins, radiation, and ultraviolet light, have cumulative effects, which are worsened by the loss of protective and restorative mechanisms due to alterations in gene expression and chemical processes within the eye.

Trauma- Blunt trauma causes swelling, thickening, and whitening of the lens fibers. While the swelling normally resolves with time, the white color may remain. In severe blunt trauma, or injuries which penetrate the eye, the capsule in which the lens sits can be damaged. This allows fluid from other parts of the eye to rapidly enter the lens leading to swelling and then whitening, obstructing light from reaching the retina at the back of the eye. Cataracts may develop in 0.7 to 8.0% of cases following electrical injuries.

Radiation- Ultraviolet light, specifically UVB, has been shown to cause cataracts, and some evidence indicates sunglasses worn at an early age can slow its development in later life. Microwave radiation has also been found to cause cataracts. The mechanism is unclear, but it may include changes in heat-sensitive enzymes that normally protect cell proteins in the lens. Another possible mechanism is direct damage to the lens from pressure waves induced in the aqueous humor. Cataracts have been associated with ionizing radiation such as X-rays. The addition of damage to the DNA of the lens cells has been considered. Finally, electric and heat injuries denature and whiten the lens as a result of direct protein coagulation. This same process makes the clear albumin of an egg become white and opaque after cooking. Cataracts of this type are often seen in glassblowers and furnace workers. Lasers of sufficient power output are known to damage the eyes and skin.

Genetics- The genetic component is strong in the development of cataracts, most commonly through mechanisms that protect and maintain the lens. The presence of cataracts in childhood or early life can occasionally be due to a particular syndrome. Examples of chromosome abnormalities associated with cataracts include deletion syndrome (part of chromosome gets deleted), cri-du-chat syndrome (rare genetic disorder due to missing part of chromosome), Down syndrome (presence of third copy of chromosome), Patau’s syndrome (chromosomal abnormality), trisomy 18 (Edward’s syndrome) and Turner’s syndrome (female misses all or part of X chromosome), and in the case of neurofibromatosis type 2 (an inherited disease), juvenile cataract on one or both sides may be noted. Examples of single-gene disorder include Alport’s syndrome, Conradi’s syndrome, myotonic dystrophy, and oculocerebrorenal syndrome or Lowe syndrome.

Skin Diseases- The skin and the lens have the same embryological origin and can be affected by similar diseases. Those with atopic dermatitis (inflammation of skin) and eczema occasionally develop shield ulcers cataracts. Ichthyosis (scaly skin) is an autosomal recessive disorder associated with cuneiform cataracts and nuclear sclerosis. Basal-cell nevus and pemphigus have similar associations.

Drug Use- Cigarette smoking & consumption of alcohol has been shown to double the rate of nuclear sclerotic cataracts and triple the rate of posterior subcapsular cataracts. Evidence is conflicting over the effect of alcohol. Some surveys have shown a link, but others which followed patients over longer terms have not.

Medications- Some drugs, such as corticosteroids (steroid hormones) can induce cataract development. People with schizophrenia (abnormal social disorder) often have risk factors for lens opacities (such as diabetes, hypertension, and poor nutrition) but antipsychotic medications (psychiatric medicines) are unlikely to contribute to cataract formation. Miotics (construction of excessive pupil) and triparanol may increase the risk.

Iatrogenic- Nearly every person who undergoes a vitrectomy — without ever having had cataract surgery — will experience progression of nuclear sclerosis at 6-months and 12-month after the operation. This may be because the native vitreous humor is significantly different from the solutions used to replace the vitreous (vitreous substitutes), such as BSS Plus. This may also be because the native vitreous humour contains ascorbic acid which helps neutralize oxidative damage to the lens and because traditional vitreous substitutes do not contain ascorbic acid. As such, for phakic patients requiring a vitrectomy it is becoming increasingly common for ophthalmologists to offer the vitrectomy with a combined prophylactic cataract surgeryprocedure to prophylactically prevent cataract formation.

Apart from these there are many factors or diseases which cause cataract such as-

  • Diabetes
  • Hypertension
  • Obesity
  • Prolonged use of corticosteroid medications
  • Medicines used to reduce cholesterol
  • Previous eye injury or inflammation
  • Previous eye surgery
  • Hormone replacement therapy
  • High myopia
  • Family history

Treatment- Cataract removal can be performed at any stage and no longer requires ripening of the lens. Surgery is usually ‘outpatient’ and performed using local anesthesia. Almost all patients can achieve all good vision  after surgery.

Phacoemulsification or Phaco is the most widely used cataract surgery. This procedure uses ultrasonic energy to emulsify the cataract lens. Phacoemulsification typically comprises six steps:

Anaesthetic – The eye is numbed with either a subtenon injection around the eye or using simple eye drops.

Corneal incision – Two cuts are made through the clear cornea to allow insertion of instruments into the eye.

Capsulorhexis – A needle or small pair of forceps is used to create a circular hole in the capsule in which the lens sits.

Phacoemulsification – A handheld probe is used to break up and emulsify the lens into liquid using the energy of ultrasound waves. The resulting ’emulsion’ is sucked away.

Irrigation and Aspiration – The cortex, which is the soft outer layer of the cataract, is aspirated or sucked away. Fluid removed is continually replaced with a saline solution to prevent collapse of the structure of the anterior chamber (the front part of the eye).

Lens insertion – A plastic, foldable lens is inserted into the capsular bag that formerly contained the natural lens. Some surgeons also inject an antibiotic into the eye to reduce the risk of infection. The final step is to inject salt water into the corneal wounds to cause the area to swell and seal the incision.

Extracapsular Cataract Extraction (ECCE) consists of removing the lens manually, but leaving the majority of the capsule intact. The lens is expressed through a 10- to 12-mm incision which is closed with sutures at the end of surgery. ECCE is less frequently performed than phacoemulsification, but can be useful when dealing with very hard cataracts or other situations where emulsification is problematic. Manual Small Incision Cataract Surgery (MSICS) has evolved from ECCE. In MSICS, the lens is removed through a self-sealing scleral tunnel wound in the sclera which, ideally, is watertight and does not require suturing. Although “small”, the incision is still markedly larger than the portal in phacoemulsion. Microincision Cataract Surgery (MICS) is an approach to cataract surgery through incision less than 1.8 mm with the purpose of reducing surgical invasiveness, improving at the same time surgical outcomes. Phacoemulsification requires expensive instrumentation which may not be available at all centres, whereas manual. Small Incision Cataract Surgery (SICS) requires only a minimum addition to the standard cataract surgery instrument armamentarium. Capsulorrhexis is mandatory for phacoemulsification, whereas manual SICS can be comfortably done with the envelope capsulotomy skills acquired previously.

Post-operative Care- The postoperative recovery period (after removing the cataract) is usually short. The patient is usually admitted only on the day of surgery, but is advised to move cautiously and avoid straining or heavy lifting for about a month. The eye is usually patched on the day of surgery and use of an eye shield at night is often suggested for several days after surgery. In all types of surgery, the cataractous lens is removed and replaced with an artificial lens, known as an Intraocular Lens (IOL), which stays in the eye permanently. Intraocular lenses are usually Monofocal correcting for either distance or near vision. Multifocal lenses may be implanted to improve near and distance vision simultaneously.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

REFRACTIVE SURGERY ( LASIK )

Refractive Eye Surgery is any eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea or cataract surgery. The most common methods today use excimer lasers to reshape the curvature of the cornea. Successful refractive eye surgery can reduce or cure common vision disorders such as myopia (near sightedness), hyperopia (farsightedness) presbyopia (aging eye) and astigmatism (eye defect in which vision gets blurred), as well as degenerative disorders like keratoconus (cornea in conical shape). The most widely performed type of refractive surgery is LASIK (laser-assisted in situ keratomileusis), where a laser is used to reshape the cornea. For people who are nearsighted, certain refractive surgery techniques will reduce the curvature of a cornea that is too steep so that the eye’s focusing power is lessened. Images that are focused in front of the retina, due to a longer eye or steep corneal curve, are pushed closer to or directly onto the retina following surgery. Farsighted people will have refractive surgery procedures that achieve a steeper cornea to increase the eye’s focusing power. Images that are focused beyond the retina, due to a short eye or flat cornea, will be pulled closer to or directly onto the retina after surgery. Astigmatism can be corrected with refractive surgery techniques that selectively reshape portions of an irregular cornea to make it smooth and symmetrical. The result is that images focus clearly on the retina rather than being distorted due to light scattering through an irregularly shaped cornea.

Refractive surgery might be a good option for you if you:

a) Want to decrease your dependence on glasses or contact lenses

b) Are free of eye disease

c) Understand that you could still need glasses or contacts after the procedure to achieve your best vision

d) Have an appropriate refractive error

There is no universally-accepted, best method for correcting refractive errors. The best option for you should be decided after a thorough examination and discussion with your ophthalmologist. If you are considering refractive surgery, you and your eye doctor can discuss your lifestyle and vision needs to determine the most appropriate procedure for you.

Techniques-

1)Flap Procedures-

Laser-assisted in situ Keratomileusis (LASIK): The surgeon uses either a microkeratome (precision surgical instrument) or a femtosecond laser (type of laser) to cut a flap of the corneal tissue (usually with a thickness of 100–180 micrometers). The flap is lifted like a hinged door, but in contrast to ALK, the targeted tissue is removed from the corneal stroma with an excimer laser. The flap is subsequently replaced. When the flap is created using an IntraLase brand femtosecond laser, the method is called IntraLASIK; other femtosecond lasers such as the Ziemer create a flap similarly.

2) Surface Procedures-.

Photorefractive Keratectomy (PRK)- is an outpatient procedure generally performed with local anesthetic eye drops. It is a type of refractive surgery which reshapes the cornea by removing microscopic amounts of tissue from the corneal stroma, using a computer-controlled beam of light (excimer laser). The difference from LASIK is that the top layer of the epithelium is removed (and a bandage contact lens is used), so no flap is created. Recovery time is longer with PRK than with LASIK, though the final outcome (after 3 months) is about the same (very good).

Transepithelial Photorefractive Keratectomy (TransPRK)-  is a laser-assisted eye surgery to correct refraction errors of human eye cornea. It employs excimer laser to ablate outer layer of cornea, epithelium, as well its connective tissue, stroma, to correct eye optical power.

Radial Keratotomy (RK)- developed by Russian ophthalmologist Svyatoslav Fyodorov in 1974, uses spoke-shaped incisions, always made with a diamond knife, to alter the shape of the cornea and reduce myopia or astigmatism; this technique is in medium to high diopters, usually replaced by other refractive methods

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

RETINA, VITREOUS & UVEA

Retina (rɛtini from Latin rēte meaning “net”) is a light-sensitive layer at the back of the eye that covers about 65 percent of its interior surface. It is the third and inner coat of the eye which is a light-sensitive layer of tissue. The optics of the eye create an image of the visual world on the retina (through the cornea and lens), which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical events that ultimately trigger nerve impulses. These are sent to various visual centres of the brain through the fibers of the optic nerve. The retina is a layered structure with several layers of neurons interconnected by synapses. The only neurons that are directly sensitive to light are the photoreceptor cells. These are mainly of two types: the rods and cones. Rods function mainly in dim light and provide black-and-white vision, while cones support daytime vision and the perception of colour. A third, much rarer type of photoreceptor, the intrinsically photosensitive ganglion cell, is important for reflexive responses to bright daylight. Neural signals from the rods and cones undergo processing by other neurons of the retina. The output takes the form of action potentials in retinal ganglion cells whose axons form the optic nerve. Several important features of visual perception can be traced to the retinal encoding and processing of light.

The retina has ten distinct layers-
a) Inner Limiting Membrane – basement membrane elaborated by Müller cells (retinal cells)

b) Nerve Fibre Layer – axons of the ganglion cell (neuron located in inner retina) nuclei (note that a thin layer of Müller cell footplates exists between this layer and the inner limiting membrane)

c) Ganglion Cell Layer – contains nuclei of ganglion cells, the axons of which become the optic nerve fibres for messages and some displaced amacrine cells (interneurons in the retina).

d) Inner Plexiform Layer – contains the synapse between the bipolar cell axons and the dendrites of the ganglion and amacrine cells.

e) Inner Nuclear Layer – contains the nuclei and surrounding cell bodies (perikarya) of the amacrine cells, bipolar cells and horizontal cells.

f) Outer Plexiform Layer – projections of rods and cones ending in the rod spherule and cone pedicle, respectively. These make synapses with dendrites of bipolar cells.[1] In the macular region, this is known as the Fiber layer of Henle.

g) Outer Nuclear Layer – cell bodies of rods and cones

h) External Limiting Membrane – layer that separates the inner segment portions of the photoreceptors from their cell nucleus

i) Layer of Rods and Cones – layer of rod cells and cone cells

j) Retinal Pigment Epithelium – single layer of cuboidal cells (with extrusions not shown in diagram). This is closest to the choroid. These can be simplified into 4 main processing stages: photoreception, transmission to bipolar cells (exiss between photoreceptors, act to transmit signals from photoreceptors to ganglion cells), transmission to ganglion cells (neuron located near the inner surface) which also contain photoreceptors, the photosensitive ganglion cells (neuon located in retina), and transmission along the optic nerve. At each synaptic stage there are also laterally connecting horizontal (interconnecting neurons) and amacrine cells (interneurons in retina). The optic nerve is a central tract of many axons of ganglion cells connecting primarily to the lateral geniculate body (relay cetre in the thalamus), a visual relay station in the diencephalon (the rear of the forebrain). It also projects to the superior colliculus (paired structure of the midbrain), the suprachiasmatic nucleus (tiny region in the hypothalamus), and the nucleus of the optic tract. It passes through the other layers creating the optic disc in primates.

Function – An image is produced by the patterned excitation of the cones and rods in the retina. The excitation is processed by the neuronal system and various parts of the brain working in parallel to form a representation of the external environment in the brain. The cones respond to bright light and mediate high-resolution colour vision during daylight illumination (also called photopic vision). The rods are saturated at daylight levels and don’t contribute to pattern vision. However, rods do respond to dim light and mediate lower-resolution, monochromatic vision under very low levels of illumination (called scotopic vision). The response of cones to various wavelengths of light is called their spectral sensitivity. In normal human vision, the spectral sensitivity of a cone falls into one of three subgroups. These are often called blue, green, and red cones but more accurately are short, medium, and long wavelength sensitive cone subgroups. It is a lack of one or more of the cone subtypes that causes individuals to have deficiencies in colour vision or various kinds of colour blindness. These individuals are not blind to objects of a particular colour but experience the inability to distinguish between two groups of colours that can be distinguished by people with normal vision.

Retinal Diseases & Disorders- There are many inherited and acquired diseases or disorders that may affect the retina. Some of them include:-
a) Retinitis Pigmentosa- It is a group of genetic diseases that affect the retina and cause the loss of night vision and peripheral vision.

b) Macular Degeneration describes a group of diseases characterized by loss of central vision because of death or impairment of the cells in the macula.

c) Cone-Rod Dystrophy (CORD) describes a number of diseases where vision loss is caused by deterioration of the cones and/or rods in the retina.

d) Retinal Separation/Retinal Detachment- The retina detaches from the back of the eyeball.  The term retinal detachment is used to describe a separation of the neurosensory retina from the retinal pigment epithelium (pigmented cell layer just outside the neurosensory retina).

e) Both Hypertension and Diabetes Mellitus can cause damage to the tiny blood vessels that supply the retina, leading to Hypertensive Retinopathy and Diabetic Retinopathy.

f) Hypertensive Retinopathy- It is damage to the retina & retinal circulation due to high blood pressure (Hypertension). High blood pressure can cause damage to the retina’s blood vessels, limit the retina’s function & put pressure on optic nerve causing vision problems.

g) Diabetic Retinopathy- is a complication of diabetes that causes damage to the blood vessels of the retina. There are generally 2 types of causes of vision loss from diabetic retinopathy-
Diabetic Macular Edema- is the term used for swelling in the central part of the retina. The macula or the central part of the retina is used for sharp, straight-ahead vision. It is nourished by blood vessels that are weakened or begin to leak as a result of diabetes. This causes the central part of the retina to become thickened or swollen & can lead to decreased vision.

Proliferative Diabetic Retinopathy – also called PDR, in this poor circulation of blood in retina may lead to the development of growth factors that can cause new blood vessels & scar tissue to grow on the surface of the retina.

h) Retinoblastoma- is a cancer of the retina. It is a rare form of cancer that rapidly develops from the immature cells of a retina, the light-detecting tissue of the eye. It is the most common malignant cancer of the eye in children, and it is almost exclusively found in young children.

i) Lipemia Retinalis- It is a white appearance of the retina, and can occur by lipid deposition in lipoprotein lipase deficiency.

j) Retinal Prosthesis- In this a microelectronic chip is used to convert light rays to neuronal impulses that can be conveyed to the brain via the preserved connections.

k) AMD (Age-related Macular Degeneration)- In normal aging yellowish deposits called drusen form under the retina. As drusen increases it can affect normal functioning of the retina damaging its cells. This type of AMD is called Dry AMD. Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. Afterwards these blood vessels leak blood & fluid damaging the cells of the retina.

l) Central Retinal Vein Occlusion- also known as CRVO is a condition in which the main vein that drains blood from the retina closes of partially or completely. This can cause blurred vision & other vision problems.

m) Central Serous Chorioretinopathy- commonly referred as CSC is a condition in which fluid accumulates under the retina causing a serous (fluid-filled) detachment & vision loss.

n) Choroidal Detachment- is a spongy layer of blood vessels that lines the back wall of eye between the retina & the sclera. It plays an important role in delivering oxygen & nutrients to the outer half of the retina. The choroid is normally directly next to sclera, but can be displaced by fluid or blood leading to a choroidal detachment (separation).

o) Congenital X-Linked Retinoschisis- also known as CXLRS is an early onset hereditary retinal disease characterized by splitting of retinal layers, particularly in the center of vision (fovea) and/or in the peripheral retina.

p) Epiretinal Membranes- also commonly known as Cellophane Maculopathy or Macular Puckers, are avascular (having few or no blood vessels), semitranslucent fibro cellular membrane that form on the inner surface of the retina. They most commonly cause minimal symptoms & can be simply observed but in some cases they can cause painless loss of vision & metamorphosia (visual distortion).

q) Familial Exudative Vitreoretinopathy- called FEVR, is a hereditary condition where the retinal blood vessels do not develop normally. As a result, scar tissue may develop which as it contracts can detach the retina & result in vision loss.

r) Infectious Retinitis- is an inflammation of the retina resulting from infection by bacteria, viruses, fugi or parasites. These pathogens affect patients differentially depending on characteristics like age, location & immune status.

s) Macular Hole- Macula is situated in the centre of the retina. When a full thickness defect develops in the macula the condition is referred as Macular Hole.

t) Floaters- are those tiny spots, specks, flecks & cobwebs that drift aimlessly around in your field of vision. Floaters occur when the vitreous (gel like substance in eye) slowly shrinks & it becomes stingy & the strands can cast tiny shadows.

u) Persistent Fetal Vasculature- or PFV also known as Persistent Hyperplastic Primary Vitreous (PHPV) is a congenital developmental disorder that occurs when the vascular structures present during the development of the eye fail to wither or regress as they should. The resulting structural abnormalities may lead to impairment of vision.

v) Posterior Vitreous Detachment- as PVD is a natural change that occurs during adulthood when the vitreous gel that fills the eye, separates from the retina.

w) Presumed Ocular Histoplasmosis Syndrome- or POHS causes atropy (wasting) around the optic nerve & multiple scars called histo spots in the choroid. These symptoms are accompanied by new blood vessel growth that starts adjacent to a histo spot.

x) Retinopathy of Prematurity- or ROP is a condition affecting premature infants of low birthweight & young gestational age. It occurs when the development of normal retinal blood vessels which typically require a full term pregnancy for completion is interrupted by premature birth. If the disease progresses, scar tissue can grow. This can lead retinal detachment & vision loss.

y) River Blindness- or Onchocerciasis is a disease caused by infection with the parasitic worm Onchocerca volvulus.  Symptoms include severe itching, bumps under the skin, and blindness. It is the second most common cause of blindness due to infection, after trachoma. Infection can cause intense itching, skin discoloration, rashes, and eye disease that often leads to permanent blindness. It is spread by the bites of infected black flies that breed in rapidly flowing rivers.

z) Vitreomacular Traction Syndrome- The vitreous humor is a transparent, gel-like material that fills the space within the eye between the lens and the retina. The vitreous is encapsulated in a thin shell called the Vitreous Cortex and the cortex in young, healthy eyes is usually sealed to the retina. As the eye ages, or in certain pathologic conditions, the vitreous cortex can pull away from the retina, leading to a condition known as Posterior Vitreous Detachment (PVD). This detachment usually occurs as part of the normal aging process. There are instances where a PVD is incomplete, leaving the vitreous partially attached to the retina, and causing tractional (pulling) forces that can cause anatomical damage. The resulting condition is called Vitreomacular Traction (VMT) syndrome.

Treatment-
Torn Retina Surgery- Most retinal tears need to be treated by sealing the retina to the back wall of the eye with laser surgery or cryotherapy (a freezing treatment). Both of these procedures create a scar that helps seal the retina to the back of the eye. This prevents fluid from traveling through the tear and under the retina, which usually prevents the retina from detaching. These treatments cause little or no discomfort.

Laser Surgery (Photocogulation) – With laser surgery, your ophthalmologist uses a laser to make small burns around the retinal tear. The scarring that results seals the retina to the underlying tissue, helping to prevent a retinal detachment.

Freezing Treatment (Cryopexy)- Your eye surgeon uses a special freezing probe to apply intense cold and freeze the retina around the retinal tear. The result is a scar that helps secure the retina to the eye wall.

Detached Retina Surgery – Almost all patients with retinal detachments must have surgery to place the retina back in its proper position. Otherwise, the retina will lose the ability to function, possibly permanently, and blindness can result. The method for fixing retinal detachment depends on the characteristics of the detachment. In each of the following methods, doctor will locate the retinal tears and use laser surgery or cryotherapy to seal the tear.

Scleral Buckle – This treatment involves placing a flexible band (scleral buckle) around the eye to counteract the force pulling the retina out of place. The doctor often drains the fluid under the detached retina, allowing the retina to settle back into its normal position against the back wall of the eye. This procedure is performed in an operating room.

Pneumatic Retinopexy – In this procedure, a gas bubble is injected into the vitreous space inside the eye in combination with laser surgery or cryotherapy. The gas bubble pushes the retinal tear into place against the back wall of the eye. The doctor will ask you to constantly maintain a certain head position for several days. The gas bubble will gradually disappear.

Vitrectomy – This surgery is commonly used to fix a retinal detachment and is performed in an operating room. The vitreous gel, which is pulling on the retina, is removed from the eye and usually replaced with a gas bubble. Sometimes an oil bubble is used (instead of a gas bubble) to keep the retina in place. Your body’s own fluids will gradually replace a gas bubble. An oil bubble will need to be removed from the eye at a later date with another surgical procedure. Sometimes vitrectomy is combined with a scleral buckle.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

CORNEAL

The cornea is the eye’s outermost layer. It is the clear, dome-shaped surface that covers the front of the eye. Although the cornea is clear and seems to lack substance, it is actually a highly organized group of cells and proteins. Unlike most tissues in the body, the cornea contains no blood vessels to nourish or protect it against infection. Instead, the cornea receives its nourishment from the tears and aqueous humor (a fluid in the anterior portion of the eye) that fills the chamber behind it. The cornea must remain transparent to refract light properly, and the presence of even the tiniest blood vessels can interfere with this process. To see well, all layers of the cornea must be free of any cloudy or opaque areas.

Structure – The corneal tissue is arranged in five basic layers, each having an important function. These five layers are:-
Epithelium- The epithelium is the cornea’s outermost region, comprising about 10 percent of the tissue’s thickness. The epithelium functions primarily to: (1) block the passage of foreign material, such as dust, water, and bacteria, into the eye and other layers of the cornea; and (2) provide a smooth surface that absorbs oxygen and cell nutrients from tears, then distributes these nutrients to the rest of the cornea. The epithelium is filled with thousands of tiny nerve endings that make the cornea extremely sensitive to pain when rubbed or scratched. The part of the epithelium that serves as the foundation on which the epithelial cells anchor and organize themselves is called the basement membrane.

Bowman’s Layer – Lying directly below the basement membrane of the epithelium is a transparent sheet of tissue known as Bowman’s layer. It is composed of strong layered protein fibers called collagen. Once injured, Bowman’s layer can form a scar as it heals. If these scars are large and centrally located, some vision loss can occur.

Stroma – Beneath Bowman’s layer is the stroma, which comprises about 90 percent of the cornea’s thickness. It consists primarily of water (78 percent) and collagen (16 percent), and does not contain any blood vessels. Collagen gives the cornea its strength, elasticity, and form. The collagen’s unique shape, arrangement, and spacing are essential in producing the cornea’s light-conducting transparency.
Descemet’s Membrane- Under the stroma is Descemet’s membrane, a thin but strong sheet of tissue that serves as a protective barrier against infection and injuries. Descemet’s membrane is composed of collagen fibers (different from those of the stroma) and is made by the endothelial cells that lie below it. Descemet’s membrane is regenerated readily after injury.

Endothelium – The endothelium is the extremely thin, innermost layer of the cornea. Endothelial cells are essential in keeping the cornea clear. Normally, fluid leaks slowly from inside the eye into the middle corneal layer (stroma). The endothelium’s primary task is to pump this excess fluid out of the stroma. Without this pumping action, the stroma would swell with water, become hazy, and ultimately opaque. In a healthy eye, a perfect balance is maintained between the fluid moving into the cornea and fluid being pumped out of the cornea. Once endothelium cells are destroyed by disease or trauma, they are lost forever. If too many endothelial cells are destroyed, corneal edema and blindness ensue, with corneal transplantation the only available therapy.

Function – Because the cornea is as smooth and clear as glass, but is strong and durable, it helps the eye in two ways:
1.    It helps to shield the rest of the eye from germs, dust, and other harmful matter. The cornea shares this protective task with the eyelids, the eye socket, tears, and the white part of the eye (sclera).
2.    The cornea acts as the eye’s outermost lens. It functions like a window that controls and focuses the entry of light into the eye. The cornea contributes between 65-75 percent of the eye’s total focusing power.
When light strikes the cornea, it bends–or refracts–the incoming light onto the lens. The lens further refocuses that light onto the retina. For you to see clearly, light rays must be focused by the cornea and lens to fall precisely on the retina. The retina converts the light rays into impulses that are sent through the optic nerve to the brain, which interprets them as images.

Disease & Disorders- Some diseases and disorders of the cornea are:-
a) Allergies- Allergies affecting the eye are fairly common. The most common allergies are those related to pollen, particularly when the weather is warm and dry. Symptoms can include redness, itching, tearing, burning, stinging, and watery discharge

b) Conjunctivitis (Pink Eye)- This term describes a group of diseases that cause swelling, itching, burning, and redness of the conjunctiva, the protective membrane that lines the eyelids and covers exposed areas of the sclera, or white of the eye. Conjunctivitis can spread from one person to another. Conjunctivitis can be caused by a bacterial or viral infection, allergy, environmental irritants, a contact lens product, eye drops, or eye ointments. At its onset, conjunctivitis is usually painless and does not harm vision. The infection will clear in most cases without requiring medical care. But for some forms of conjunctivitis, treatment will be needed.

c) Corneal Infections- Sometimes the cornea is damaged after a foreign object has entered the tissue, such as from a poke in the eye. At other times, bacteria or fungi from a contaminated contact lens can pass into the cornea. Situations like these can cause painful inflammation and corneal infections called Keratitis. These infections can reduce visual clarity, produce corneal discharges, and perhaps erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant.

d) Dry Eye- The continuous production and drainage of tears is important to the eye’s health. Tears keep the eye moist, help wounds heal, and protect against eye infection. In people with dry eye, the eye produces fewer or less quality tears and is unable to keep its surface lubricated and comfortable. As we age, the eyes usually produce fewer tears. Also, in some cases, the lipid and mucin layers produced by the eye are of such poor quality that tears cannot remain in the eye long enough to keep the eye sufficiently lubricated.

e) Fuchs’ Dystrophy- Fuchs’ dystrophy is a slowly progressing disease that usually affects both eyes and is slightly more common in women than in men. Although doctors can often see early signs of Fuchs’ dystrophy in people in their 30s and 40s, the disease rarely affects vision until people reach their 50s and 60s. Fuchs’ dystrophy occurs when endothelial cells gradually deteriorate without any apparent reason. As more endothelial cells are lost over the years, the endothelium becomes less efficient at pumping water out of the stroma. This causes the cornea to swell and distort vision. Eventually, the epithelium also takes on water, resulting in pain and severe visual impairment.

f) Corneal Dystrophies- A corneal dystrophy is a condition in which one or more parts of the cornea lose their normal clarity due to a buildup of cloudy material. There are over 20 corneal dystrophies that affect all parts of the cornea. Corneal dystrophies affect vision in widely differing ways. Some cause severe visual impairment, while a few cause no vision problems and are discovered during a routine eye examination. Other dystrophies may cause repeated episodes of pain without leading to permanent loss of vision.

g) Herpes Zoster (Shingles)- This infection is produced by the varicella-zoster virus, the same virus that causes chickenpox. After an initial outbreak of chickenpox (often during childhood), the virus remains inactive within the nerve cells of the central nervous system. But in some people, the varicella-zoster virus will reactivate at another time in their lives. When this occurs, the virus travels down long nerve fibers and infects some part of the body, producing a blistering rash (shingles), fever, painful inflammations of the affected nerve fibers, and a general feeling of sluggishness. Varicella-zoster virus may travel to the head and neck, perhaps involving an eye, part of the nose, cheek, and forehead. In about 40 percent of those with shingles in these areas, the virus infects the cornea.

h) Iridocorneal Endothelial Syndrome- More common in women and usually diagnosed between ages 30-50, iridocorneal endothelial (ICE) syndrome has three main features: (1) visible changes in the iris, the colored part of the eye that regulates the amount of light entering the eye; (2) swelling of the cornea; and (3) the development of glaucoma, a disease that can cause severe vision loss when normal fluid inside the eye cannot drain properly. ICE is usually present in only one eye.ICE syndrome is actually a grouping of three closely linked conditions: iris nevus (or Cogan-Reese) syndrome; Chandler’s syndrome; and essential (progressive) iris atrophy (hence the acronym ICE).

i) Keratoconus- This disorder–a progressive thinning of the cornea–is the most common corneal dystrophy in the U.S., affecting one in every 2,000 Americans. It is more prevalent in teenagers and adults in their 20s. Keratoconus arises when the middle of the cornea thins and gradually bulges outward, forming a rounded cone shape. This abnormal curvature changes the cornea’s refractive power, producing moderate to severe distortion (astigmatism) and blurriness (nearsightedness) of vision. Keratoconus may also cause swelling and a sight-impairing scarring of the tissue.

j) Lattice Dystrophy- Lattice dystrophy gets its name from an accumulation of amyloid deposits, or abnormal protein fibers, throughout the middle and anterior stroma. During an eye examination, the doctor sees these deposits in the stroma as clear, comma-shaped overlapping dots and branching filaments, creating a lattice effect. Over time, the lattice lines will grow opaque and involve more of the stroma. They will also gradually converge, giving the cornea a cloudiness that may also reduce vision. In some people, these abnormal protein fibers can accumulate under the cornea’s outer layer–the epithelium. This can cause erosion of the epithelium. This condition is known as recurrent epithelial erosion. These erosions: (1) alter the cornea’s normal curvature, resulting in temporary vision problems; and (2) expose the nerves that line the cornea, causing severe pain. Even the involuntary act of blinking can be painful.

k) Map-Dot-Fingerprint Dystrophy- This dystrophy occurs when the epithelium’s basement membrane develops abnormally (the basement membrane serves as the foundation on which the epithelial cells, which absorb nutrients from tears, anchor and organize themselves). When the basement membrane develops abnormally, the epithelial cells cannot properly adhere to it. This, in turn, causes recurrent epithelial erosions, in which the epithelium’s outermost layer rises slightly, exposing a small gap between the outermost layer and the rest of the cornea. Epithelial erosions can be a chronic problem. They may alter the cornea’s normal curvature, causing periodic blurred vision. They may also expose the nerve endings that line the tissue, resulting in moderate to severe pain lasting as long as several days. Generally, the pain will be worse on awakening in the morning. Other symptoms include sensitivity to light, excessive tearing, and foreign body sensation in the eye.

l) Ocular Herpes- Herpes of the eye, or ocular herpes, is a recurrent viral infection that is caused by the herpes simplex virus and is the most common infectious cause of corneal blindness in the U.S. Previous studies show that once people develop ocular herpes, they have up to a 50 percent chance of having a recurrence. This second flare-up could come weeks or even years after the initial occurrence. Ocular herpes can produce a painful sore on the eyelid or surface of the eye and cause inflammation of the cornea. Prompt treatment with anti-viral drugs helps to stop the herpes virus from multiplying and destroying epithelial cells. However, the infection may spread deeper into the cornea and develop into a more severe infection called stromal keratitis, which causes the body’s immune system to attack and destroy stromal cells. Stromal keratitis is more difficult to treat than less severe ocular herpes infections. Recurrent episodes of stromal keratitis can cause scarring of the cornea, which can lead to loss of vision and possibly blindness.

m) Pterygium- A pterygium is a pinkish, triangular-shaped tissue growth on the cornea. Some pterygia grow slowly throughout a person’s life, while others stop growing after a certain point. A pterygium rarely grows so large that it begins to cover the pupil of the eye. Pterygia are more common in sunny climates and in the 20-40 age group. Scientists do not know what causes pterygia to develop. However, since people who have pterygia usually have spent a significant time outdoors, many doctors believe ultraviolet (UV) light from the sun may be a factor. In areas where sunlight is strong, wearing protective eyeglasses, sunglasses, and/or hats with brims are suggested. While some studies report a higher prevalence of pterygia in men than in women, this may reflect different rates of exposure to UV light.

n) Refractive Errors – About 120 million people in the United States wear eyeglasses or contact lenses to correct nearsightedness, farsightedness, or astigmatism. These vision disorders–called refractive errors– affect the cornea and are the most common of all vision problems in this country. Refractive errors are usually corrected by eyeglasses or contact lenses. Although eyeglasses or contact lenses are safe and effective methods for treating refractive errors, refractive surgeries are becoming an increasingly popular option. Read more about refractive errors.

o) Stevens –Johnson Syndrome. Stevens-Johnson Syndrome (SJS), also called erythema multiforme major, is a disorder of the skin that can also affect the eyes. SJS is characterized by painful, blistery lesions on the skin and the mucous membranes (the thin, moist tissues that line body cavities) of the mouth, throat, genital region, and eyelids. SJS can cause serious eye problems, such as severe conjunctivitis; iritis, an inflammation inside the eye; corneal blisters and erosions; and corneal holes. In some cases, the ocular complications from SJS can be disabling and lead to severe vision loss.

Treatment – A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light-sensitive retina. Poor vision or blindness may result. In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea, usually donated through an eye bank. A trephine, an instrument like a cookie cutter, is used to remove the cloudy cornea. The surgeon places the new cornea in the opening and sews it with a very fine thread. The thread stays in for months or even years until the eye heals properly (removing the thread is quite simple and can easily be done in an ophthalmologist’s office). Following surgery, eye drops to help promote healing will be needed for several months.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

GLAUCOMA

Glaucoma is a disease that damages your eye’s optic nerve. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure in your eye, damaging the optic nerve. Glaucoma is a condition that causes damage to your eye’s optic nerve and gets worse over time. It’s often associated with a buildup of pressure inside the eye. Glaucoma is the second-leading cause of blindness in the U.S. (behind macular degeneration), and the second-leading cause of blindness worldwide (behind cataracts). The increased pressure, called intraocular pressure, can damage the optic nerve, which transmits images to the brain. If damage to the optic nerve from high eye pressure continues, glaucoma will cause permanent loss of vision. Without treatment, glaucoma can cause total permanent blindness within a few years. Because most people with glaucoma have no early symptoms or pain from this increased pressure, it is important to see your eye doctor regularly so that glaucoma can be diagnosed and treated before long-term visual loss occurs.
Detection- Glaucoma is detected through a comprehensive dilated eye exam that includes the following:-

a) Visual acuity test- This eye chart test measures how well you see at various distances.

b) Visual field test- This test measures your peripheral (side vision). It helps your eye care professional tell if you have lost peripheral vision, a sign of glaucoma.

c) Dilated eye exam- In this exam, drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.

d) Tonometry- is the measurement of pressure inside the eye by using an instrument called a tonometer. Numbing drops may be applied to your eye for this test. A tonometer measures pressure inside the eye to detect glaucoma.

e) Pachymetry- is the measurement of the thickness of your cornea. Your eye care professional applies a numbing drop to your eye and uses an ultrasonic wave instrument to measure the thickness of your cornea.

Treatment – Immediate treatment for early-stage, open-angle glaucoma can delay progression of the disease. That’s why early diagnosis is very important. Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.

a) Medicines- Medicines, in the form of eyedrops or pills, are the most common early treatment for glaucoma. Taken regularly, these eyedrops lower eye pressure. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye. Glaucoma medicines need to be taken regularly as directed by your eye care professional. Most people have no problems. However, some medicines can cause headaches or other side effects.

b) Laser trabeculoplasty- Laser trabeculoplasty helps fluid drain out of the eye. Your doctor may suggest this step at any time. In many cases, you will need to keep taking glaucoma medicines after this procedure. Before the surgery, numbing drops are applied to your eye. As you sit facing the laser machine, your doctor holds a special lens to your eye. A high-intensity beam of light is aimed through the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This allows the fluid to drain better.

c) Conventional surgery- Conventional surgery makes a new opening for the fluid to leave the eye. Conventional surgery, called Trabeculectomy, is performed in an operating room. Doctor makes small injections around the eye to numb it. A small piece of tissue is removed to create a new channel for the fluid to drain from the eye. This fluid will drain between the eye tissue layers and create a blister-like “filtration bleb.”

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

NEURO OPTHALMOLOGY

Neuro ophthalmology is the speciality that deals with ophthalmicdiseases with neurological problems and various optic nerve disorders. Objectives of the Department. To offer facilities for the investigations and treatment for patients with neuro-ophthalmic disorders. Neuro-ophthalmology is the branch of Ophthalmology that deals with diseases of the eye in relation to the nervous system. These fall into two main groups-
1) Disease affecting Optic Nerve
2) Disease affecting Eye Movement

Disease affecting Optic Nerve- The optic nerve is the only nerve in the body that can be directly examined by a doctor. It connects the eye to the brain. The optic nerve can be affected by:

a) Inflammation is normally indicated by the rapid onset of the loss of vision and colour vision associated with pain behind the eyes occurring especially during eye movements. Blood investigations and a MRI may be necessary to rule out connective tissue disease and multiple sclerosis. Treatment is with steroids.

b) Ischaemia (a stroke of the optic nerve) manifests with the rapid onset of painless visual loss. It is most commonly related to hypertension, diabetes, hyperlipidaemia and smoking and treatment is usually directed at controlling them

c) Compression occurs due to a growth and exhibits slow, progressive, painless visual loss which is usually apparent on CT scan or MRI.

e) Raised intracranial pressure can occur as a headache with early morning nausea or vomiting, transient loss of vision, or weakness or loss of balance. A CT Scan or MRI imaging and a lumbar puncture to obtain cerebrospinal fluid is usually necessary for analysis

f) Trauma

Disease affecting Eye Movement- These disorders present as double vision, blurred vision or ‘Unstable’ (shaky) vision and usually occurs due to the following
a) Local (orbital) disease causing restriction of movement.
b) Disease affecting the nerves to the muscles causing weakness.
c) Diseases affecting the transmission of signals between nerve and muscle.
d) Diseases of the muscle.
e) Diseases affecting portions of the brain that control movement.

The vision in each eye (when tested separately) is often normal but abnormal when both eyes are used. The patients will also have giddiness, unsteady gait, headaches or weakness involving other parts of the body. Eye movement disorders that occur suddenly require urgent medical attention to rule out serious conditions such as a rupture of blood vessels supplying the brain. Investigation and treatment is directed at the cause of the eye movement disorder.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

PEDIATRIC OPTHALMOLOGY

Pediatric ophthalmology is a sub-specialty of ophthalmology concerned with eye diseases, visual development, and vision care in children. Pediatric ophthalmologists focus on the development of the visual system and the various diseases that disrupt visual development in children. Pediatric ophthalmologists also have expertise in managing the various ocular diseases that affect children. Pediatric ophthalmologists are qualified to perform complex eye surgery as well as to manage children’s eye problems using glasses and medications. Children may not complain if they do not see out of one or both eyes. Sometimes the only clue may be poor performance in School, as well viewing the blackboard at a very close distance. Hence all children need an eye exam at the time of starting Schooling. Of the eye problems in children, the most important are Refractive Errors, Squint and Amblyopia.

Eye problems in Children- Children experience a variety of eye problems, many quite distinct from adult eye diseases. Pediatric ophthalmologists are specially trained to manage the following disorders:-

a) Infections (Conjunctivitis)- Conjunctivitis, also known as Pink Eye, is inflammation of the outermost layer of the white part of the eye and the inner surface of the eyelid. It makes the eye appear pink or reddish. There may also be pain, burning, scratchiness, or itchiness. The affected eye may have increased tears or be “stuck shut” in the morning. Swelling of the white part of the eye may also occur. Itching of the eye is more common in cases due to allergies. Conjunctivitis can affect one or both eyes.

b) Strabismus- is a misalignment of the eyes that affects 2-4% of the population; it is often associated with amblyopia. The inward turning gaze commonly referred to as “crossed-eyes” is an example of strabismus. The term strabismus applies to other types of misalignments, including an upward, downward, or outward turning eye.

c) Amblyopia (Lazy Eye)- occurs when the vision of one eye is significantly better than the other eye, and the brain begins to rely on the better eye and ignore the weaker one. Amblyopia affects 4% of the population and is clinically diagnosed when the refractive error of one eye is more than 1.5 diopters different from the other eye (anisometropia) or one of the eye is misaligned for a long period of time (Strabismus). The management of amblyopia involves correcting of significant refractive errors and using techniques that encourage the brain to pay attention to the weaker eye such as patching the stronger eye (occlusion therapy).

d) Ptosis- is a drooping or falling of the upper eyelid. The drooping may be worse after being awake longer, when the individual’s muscles are tired. This condition is sometimes called “lazy eye”, but that term normally refers toamblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism. This is why it is especially important for this disorder to be treated in children at a young age, before it can interfere with vision development.

e) Retinopathy of prematurity (ROP)- or Terry syndromeis a disease of the eye affectingprematurely-born babies generally having received intensive neonatal care, in which oxygen therapy is used on them due to the premature development of their lungs. It is thought to be caused by disorganized growth of retinal blood vessels which may result in scarring and retinal detachment. ROP can be mild and may resolve spontaneously, but it may lead to blindness in serious cases. As such, all preterm babies are at risk for ROP, and very low birth weight is an additional risk factor. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP.

f) Nystagmus- is a condition of involuntary (or voluntary, in rare cases) eye movement, acquired in infancy or later in life, that may result in reduced or limited vision. Due to the involuntary movement of the eye, it is often called “dancing eyes”. In a normal condition, while the head rotates about any axis, distant visual images are sustained by rotating eyes in the opposite direction on the respective axis. The semicircular canals in the vestibule sense angular acceleration. These send signals to the nuclei for eye movement in the brain. From here, a signal is relayed to the extraocular muscles to allow one’s gaze to fixate on one object as the head moves. Nystagmus occurs when the semicircular canals are being stimulated while the head is not in motion. The direction of ocular movement is related to the semicircular canal that is being stimulated.

g) Paediatric Glaucoma- is glaucoma that develops due to ocular hypertension and is evident either at birth or within the first few years of life. It is caused due to abnormalities in the anterior chamber angle development that obstruct aqueous outflow in the absence of systemic anomalies or other ocular malformation. The typical infant who has congenital glaucoma usually is initially referred to an ophthalmologist because of apparent corneal edema. The commonly described triad of epiphora (excessive tearing), blepharospasm and photophobia may be missed until the corneal edema becomes apparent.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

STRABISMUS

Strabismus also called as Cross Eye or Wall Eye is a condition that interferes with binocular vision because it prevents a person from directing both eyes simultaneously towards the same fixation point; the eyes do not properly align with each other. It is a vision condition in which a person cannot align both eyes simultaneously under normal conditions. One or both of the eyes may turn in, out, up or down. If you have strabismus, one eye looks directly at the object you are viewing, while the other eye is misaligned inward (esotropia, “crossed eyes” or “cross-eyed”), outward (exotropia or “wall-eyed”), upward (hypertropia) or downward (hypotropia). Strabismus can be constant or intermittent. The misalignment also might always affect the same eye (unilateral strabismus), or the two eyes may take turns being misaligned (alternating strabismus).

Signs & Symptoms- When the misalignment of the eyes is large and obvious, the strabismus is called “large-angle” referring to the angle of deviation between the line of sight of the straight eye and that of the misaligned eye. Less obvious eye turns are called small-angle strabismus. Typically, constant

Large – angle strabismus does not cause symptoms such as eye strain and headaches because there is virtually no attempt by the brain to straighten the eyes. Because of this, large-angle strabismus usually causes severe amblyopia in the turned eye if left untreated. Less noticeable cases of small-angle strabismus are more likely to cause disruptive visual symptoms, especially if the strabismus is intermittent or alternating. In addition to headaches and eye strain, symptoms may include an inability to read comfortably, fatigue when reading and unstable or “jittery” vision. If small-angle strabismus is constant and unilateral, it can lead to significant amblyopia in the misaligned eye. Both large-angle and small-angle strabismus can be psychologically damaging and affect the self-esteem of children and adults with the condition, as it interferes with normal eye contact with others, often causing embarrassment and awkwardness.

Cause – Each eye has six external muscles (called the extraocular muscles) that control eye position and movement. For normal binocular vision, the position, neurological control and functioning of these muscles for both eyes must be coordinated perfectly. Strabismus occurs when there are neurological or anatomical problems that interfere with the control and function of the extraocular muscles. The problem may originate in the muscles themselves, or in the nerves or vision centers in the brain that control binocular vision. Genetics also may play a role: If you or your spouse has strabismus, your children have a greater risk of developing strabismus as well.

Tratment-

a) Surgery- In most cases, the only effective treatment for a constant eye turn is strabismus surgery. The success of strabismus surgery depends on many factors, including the direction and magnitude of the eye turn. In some cases, more than one surgery may be required. The strabismus surgeon can give you more information about this during a pre-surgical consultation. Strabismus surgery also can effectively align the eyes of adults with long-standing strabismus. In many cases of adult strabismus, however, a significant degree of amblyopia may remain even after the affected eye is properly aligned. This is why early treatment of strabismus is so important.

b) Vision Therapy- Sometimes, a strabismus surgeon may recommend a program of vision therapy for a period of time after strabismus surgery to treat amblyopia and minor binocular vision problems that might remain after surgery. In these cases, the term “orthoptics” (“ortho” = straight; “optics” = eyes) rather than “vision therapy” might be used to describe this treatment, which may be provided by an orthoptistworking closely with the surgeon rather than by an optometrist.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

ORBIT & OCULOPLASTY

In anatomy, the orbit is the cavity or socket of the skull in which the eye and its appendages are situated. “Orbit” can refer to the bony socket or it can also be used to imply the contents. The orbital contents comprise the eye, the orbital and retrobulbar fascia, extraocular muscles, cranial nerves II, III, IV, V, and VI, blood vessels, fat, the lacrimal gland with its sac and nasolacrimal duct, the eyelids, medial and lateral palpebral ligaments, check ligaments, the suspensory ligament,septum, ciliary ganglion and short ciliary nerves. In addition to the eyeball itself, the orbit contains the muscles that move the eye, blood vessels, and nerves. The orbit also contains the lacrimal gland that is located underneath the outer portion of the upper eyelid. The lacrimal gland produces tears that help lubricate and moisten the eye, as well as flush away any foreign matter that may enter the eye. The tears drain away from the eye through the nasolacrimal duct, which is located at the inner corner of the eye.

Borders and Anatomical Relations

The orbit can be thought of as a pyramidal structure, with the apex pointing posteriorly and the base situated anteriorly. The boundaries of the orbit are formed by seven bones.
It is also important to consider the anatomical relations of the orbital cavity – this is clinically relevant in the spread of infection, and in cases of trauma.
The borders and anatomical relations of the bony orbit are as follows:
a) Roof (superior wall) – Formed by the frontal bone and the lesser wing of the sphenoid. The frontal bone separates the orbit from the anterior cranial fossa.
b) Floor (inferior wall) – Formed by the maxilla, palatine and zygomatic bones. The maxilla separates the orbit from the underlying maxillary sinus.
c) Medial wall – Formed by the ethmoid, maxilla, lacrimal and sphenoid bones. The ethmoid bone separates the orbit from the ethmoid sinus.
d) Lateral wall – Formed by the zygomatic bone and greater wing of the sphenoid.
e) Apex – Located at the opening to the optic canal, the optic foramen.
f) Base – Opens out into the face, and is bounded by the eyelids. It is also known as the orbital rim.

Orbital fissures & Optic Canal
The major nerves and vessels to the orbit and globe enter through 3 openings. The superior orbital fissure is bounded by the lesser and greater wings of the sphenoid. The greater wing of the sphenoid, the maxilla, and the palatine bones of the orbit form the boundaries of the inferior orbital fissure. The optic canal is at the apex of the orbit and lies within the sphenoid bone. The structures entering through the optic canal are as follows:-
a) Optic nerve
b) Ophthalmic artery
c) Central retinal vein

The bony orbit contains the eyeballs and their associated structures:-

a) Extra-ocular muscles – These muscles are separate from the eye. They are responsible for the movement of the eyeball and superior eyelid.
b) Eyelids – These cover the orbits anteriorly.
c) Nerves: Several cranial nerves supply the eye and its structures; optic, oculomotor, trochlear, trigeminal and abducens nerves.
d) Blood vessels: The eye receives blood primarily from the ophthalmic artery. Venous drainage is via the superior and inferior ophthalmic veins.

OCULOPLASTY
Oculoplasty is the art and science of plastic surgery around the eye. The eyeball is a delicate structure, protected from harm by eyelids in front and the bony cup (socket) behind. Behind the eyeball run the nerves , arteries and muscles, which carry messages to the brain, move the eyeball, and provide nutrition to the eye. Oculoplasty deals with all these structures surrounding the eyeball. Oculoplastic surgeons first train as ophthalmologists, when they learn in details about the eye. During further higher training, they start to handle plastic surgery. They have the best knowledge about the eye and its surrounding; as eye surgeons, they are also ready to handle the most delicate of structures. This combination of skills makes the oculoplastic surgeons the best to do plastic surgery around the eye.

Oculoplastic procedures-
Eyelid Surgery-

a) Blepharoplasty (eyelift) is plastic surgery of the eyelids to remove excessive skin or subcutaneous fat
b) Asian blepharoplasty
c) Ptosis repair for droopy eyelid.
d) Ectropion repair
e) Entropion repair
f) Canthal resection
g) A Canthectomy is the surgical removal of tissue at the junction of the upper and lower eyelids
h) Cantholysis is the surgical division of the canthus
i) A Canthoplasty is plastic surgery at the canthus
j) A Canthorrhaphy is suturing of the outer canthus to shorten the palpebral fissure
k) A Canthotomy is the surgical division of the canthus, usually the outer canthus
l) A Lateral Canthotomy is the surgical division of the outer canthus.
m) Tarsorrhaphy is a procedure in which the eyelids are partially sewn together to narrow the opening (i.e. palpebral fissure).

Surgery involving the lacrimal apparatus

a) DCR (Dacryocystorhinostomy) for Tearing
b) Canaliculodacryocystostomy is a surgical correction for a congenitally blocked tear duct in which the closed segment is excised and the open end is joined to the lacrimal sac
c) Canaliculotomy involves slitting of the lacrimal punctum and canaliculus for the relief of epiphora
d) A Dacryoadenectomy is the surgical removal of a lacrimal gland
e) A Dacryocystectomy is the surgical removal of a part of the lacrimal sac
f) A Dacryocystorhinostomy (DCR) or dacryocystorhinotomy is a procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

LOW VISION CARE CLINIC

Patients with low vision require different approaches to care because the causes of low vision of each individual may vary. Some people develop low vision over time due to aging or a certain genetic condition. As we age, our eyes change too. Many of these changes in vision can be corrected by glasses or contact lenses. However, if your eye doctor tells you that your vision cannot be fully corrected with ordinary prescription lenses, medical treatment, or surgery, and you still have some usable vision, you have what is called “low vision.” Having low vision means that even with regular glasses, contact lenses, medication, or surgery, you may find it difficult to perform everyday tasks, such as reading your mail, shopping, preparing meals, and signing your name. There are many signs that can indicate low vision. For example, even with your regular glasses, do you have difficulty:
a) Recognizing faces of your friends and relatives
b) Performing tasks that require you to see well up close, such as reading, cooking, crafting, fixing things around the house, or picking out and matching the color of your clothing
c) Performing tasks at work or home because lights now seem dimmer
d) Reading street and bus signs, or the names of stores

Vision changes like these could be early warning signs of eye disease. Usually, the earlier your problem is diagnosed, the better are your chances of undergoing successful treatment and keeping your remaining vision. Regular dilated eye exams should be part of your routine health care
Cause- Among older persons, low vision can result from specific eye conditions such as macular degeneration, glaucoma, and diabetic retinopathy, from a stroke, or from a range of other eye conditions. Low vision may affect your ability to see people’s faces or watch television, to read, to drive, and even to match colors. It is important to discuss your vision with your eye care professional because many causes of decreased vision can be treatable with medicine or surgery.

Low Vision Services- Low vision services can include any or all of the following:-
a) training to use optical and electronic devices correctly
b) training to help you use your remaining vision more effectively
c) improving lighting and enhancing contrast in each area of your home
d) providing a link with a counselor or a support group to help you deal with your feelings related to your changed vision
e) learning about other helpful resources in the community and state, such as vision rehabilitation services or free Library for the Blind services.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

CONTACT LENS CLINIC

While contact lenses can improve your vision as well as your appearance, they are medical devices and require expert fitting and careful instruction, as well as conscientious after care. Before you are fitted for contact lenses, you have a complete eye examination to be sure your eyes are healthy and to rule out any conditions that may prevent you from getting contact lenses. Once contact lenses have been prescribed, our clinic experts work with you to find the best contact lens for you from the variety of types, styles, materials, sizes, and colors available.

Types of Contact Lenses
a) Bifocal Contact Lenses-  can provide clear vision at all distances after age 40
b) Bifocal Contact Lenses for Astigmatism-  correct both presbyopia and astigmatism
c) Color Contact Lenses-  give your eyes a subtle or dramatic new look
d) Custom Contact Lenses- are an option for hard-to-correct vision problems
e) Daily Disposable Contact Lenses- offer convenience and a healthy wearing experience
f) Extended Wear Contact Lenses- are approved for overnight wear or naps
g) Gas Permeable (GP) Contact Lenses- often provide sharper vision than soft lenses
h) Monovision- is a good alternative to bifocal contact lenses if you have presbyopia
i) Orthokeratology Lenses- enable correction-free vision during the day
j) Prosthetic Contact Lenses- mask eye injuries or disfigurements
g) Scleral Contacts- for irregular corneas, dry eyes and more
h) Silicone Hydrogel Contacts- transmit more oxygen to your eyes
i) Special-Effect Contact Lenses- vampire, Goth, monster and anime looks
j) Toric Contact Lenses-  and other contacts that correct astigmatism

Contacts can also be described by replacement interval — that is, how often you discard the lenses and replace them with a fresh pair. Daily disposable contact lenses are discarded nightly and therefore require no care, cleaning or lens case. Other common replacement intervals are weekly, bi-weekly, monthly or quarterly; any of those lenses can be called “disposable.” Traditional, non-disposable lenses are usually replaced once a year, but these lenses are generally limited to unusual or difficult-to-manufacture prescriptions.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

OPTICAL SERVICES

Netradarshan Eye Hospital provides a one-stop solution Optical Services for all patients. Our Optical Services Department helps in the following:-
a) Provide quality service and products at an ongoing basis
b) Increase the conversion rate
c) Train optometry students in the art of dispensing
d) Provide solutions for difficult case

Services provided-
a) Dispensing of Single Vision Lenses, Bifocal Lenses and Progressive Addition Lenses.
b) Dispensing of Glass or Plastic Lenses
c) Dispensing lenses with tint, anti reflection coating, hard coat
d) Dispensing of frames and reading glasses

A large stock of plastic lenses is readily available with our Optical Services. Finished spectacles are sent by courier to out-station patients.

Netra Darshan Eye Hospital

One of the most sublime experiences we can ever have is to wake up feeling healthy after we have been unwell.

CTS No. 2678/2679
Khanapur Road
Opp. Big Bazar, Tilakwadi
Belgaum - 590006
Phone: 0831-2404111
Fax: 0831-2404111
Lines: 7 Lines
  • Emergency Case

    If you need a doctor urgently outside of medicenter opening hours, call emergency appointment number for emergency service.
    Read more
  • Doctors Timetable

    Here at medicenter we have individual doctor's lists. Click read more below to see services and current timetable for our doctors.
    Read more
  • Opening Hours

    • Monday - Friday
      8.00 - 17.00
    • Saturday
      9.30 - 17.30
    • Sunday
      9.30 - 15.00

The cornea is the eye’s outermost layer. It is the clear, dome-shaped surface that covers the front of the eye. Although the cornea is clear and seems to lack substance, it is actually a highly organized group of cells and proteins. Unlike most tissues in the body, the cornea contains no blood vessels to nourish or protect it against infection. Instead, the cornea receives its nourishment from the tears and aqueous humor (a fluid in the anterior portion of the eye) that fills the chamber behind it. The cornea must remain transparent to refract light properly, and the presence of even the tiniest blood vessels can interfere with this process. To see well, all layers of the cornea must be free of any cloudy or opaque areas.

Structure- The corneal tissue is arranged in five basic layers, each having an important function. These five layers are:-
Epithelium- The epithelium is the cornea’s outermost region, comprising about 10 percent of the tissue’s thickness. The epithelium functions primarily to: (1) block the passage of foreign material, such as dust, water, and bacteria, into the eye and other layers of the cornea; and (2) provide a smooth surface that absorbs oxygen and cell nutrients from tears, then distributes these nutrients to the rest of the cornea. The epithelium is filled with thousands of tiny nerve endings that make the cornea extremely sensitive to pain when rubbed or scratched. The part of the epithelium that serves as the foundation on which the epithelial cells anchor and organize themselves is called the basement membrane.

Bowman’s Layer- Lying directly below the basement membrane of the epithelium is a transparent sheet of tissue known as Bowman’s layer. It is composed of strong layered protein fibers called collagen. Once injured, Bowman’s layer can form a scar as it heals. If these scars are large and centrally located, some vision loss can occur.

Stroma- Beneath Bowman’s layer is the stroma, which comprises about 90 percent of the cornea’s thickness. It consists primarily of water (78 percent) and collagen (16 percent), and does not contain any blood vessels. Collagen gives the cornea its strength, elasticity, and form. The collagen’s unique shape, arrangement, and spacing are essential in producing the cornea’s light-conducting transparency.
Descemet’s Membrane- Under the stroma is Descemet’s membrane, a thin but strong sheet of tissue that serves as a protective barrier against infection and injuries. Descemet’s membrane is composed of collagen fibers (different from those of the stroma) and is made by the endothelial cells that lie below it. Descemet’s membrane is regenerated readily after injury.

Endothelium- The endothelium is the extremely thin, innermost layer of the cornea. Endothelial cells are essential in keeping the cornea clear. Normally, fluid leaks slowly from inside the eye into the middle corneal layer (stroma). The endothelium’s primary task is to pump this excess fluid out of the stroma. Without this pumping action, the stroma would swell with water, become hazy, and ultimately opaque. In a healthy eye, a perfect balance is maintained between the fluid moving into the cornea and fluid being pumped out of the cornea. Once endothelium cells are destroyed by disease or trauma, they are lost forever. If too many endothelial cells are destroyed, corneal edema and blindness ensue, with corneal transplantation the only available therapy.

Function – Because the cornea is as smooth and clear as glass, but is strong and durable, it helps the eye in two ways:
1.    It helps to shield the rest of the eye from germs, dust, and other harmful matter. The cornea shares this protective task with the eyelids, the eye socket, tears, and the white part of the eye (sclera).
2.    The cornea acts as the eye’s outermost lens. It functions like a window that controls and focuses the entry of light into the eye. The cornea contributes between 65-75 percent of the eye’s total focusing power.
When light strikes the cornea, it bends–or refracts–the incoming light onto the lens. The lens further refocuses that light onto the retina. For you to see clearly, light rays must be focused by the cornea and lens to fall precisely on the retina. The retina converts the light rays into impulses that are sent through the optic nerve to the brain, which interprets them as images.

Disease & Disorders- Some diseases and disorders of the cornea are:-
a) Allergies- Allergies affecting the eye are fairly common. The most common allergies are those related to pollen, particularly when the weather is warm and dry. Symptoms can include redness, itching, tearing, burning, stinging, and watery discharge

b) Conjunctivitis (Pink Eye)- This term describes a group of diseases that cause swelling, itching, burning, and redness of the conjunctiva, the protective membrane that lines the eyelids and covers exposed areas of the sclera, or white of the eye. Conjunctivitis can spread from one person to another. Conjunctivitis can be caused by a bacterial or viral infection, allergy, environmental irritants, a contact lens product, eye drops, or eye ointments. At its onset, conjunctivitis is usually painless and does not harm vision. The infection will clear in most cases without requiring medical care. But for some forms of conjunctivitis, treatment will be needed.

c) Corneal Infections- Sometimes the cornea is damaged after a foreign object has entered the tissue, such as from a poke in the eye. At other times, bacteria or fungi from a contaminated contact lens can pass into the cornea. Situations like these can cause painful inflammation and corneal infections called Keratitis. These infections can reduce visual clarity, produce corneal discharges, and perhaps erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant.

d) Dry Eye- The continuous production and drainage of tears is important to the eye’s health. Tears keep the eye moist, help wounds heal, and protect against eye infection. In people with dry eye, the eye produces fewer or less quality tears and is unable to keep its surface lubricated and comfortable. As we age, the eyes usually produce fewer tears. Also, in some cases, the lipid and mucin layers produced by the eye are of such poor quality that tears cannot remain in the eye long enough to keep the eye sufficiently lubricated.

e) Fuchs’ Dystrophy- Fuchs’ dystrophy is a slowly progressing disease that usually affects both eyes and is slightly more common in women than in men. Although doctors can often see early signs of Fuchs’ dystrophy in people in their 30s and 40s, the disease rarely affects vision until people reach their 50s and 60s. Fuchs’ dystrophy occurs when endothelial cells gradually deteriorate without any apparent reason. As more endothelial cells are lost over the years, the endothelium becomes less efficient at pumping water out of the stroma. This causes the cornea to swell and distort vision. Eventually, the epithelium also takes on water, resulting in pain and severe visual impairment.

f) Corneal Dystrophies- A corneal dystrophy is a condition in which one or more parts of the cornea lose their normal clarity due to a buildup of cloudy material. There are over 20 corneal dystrophies that affect all parts of the cornea. Corneal dystrophies affect vision in widely differing ways. Some cause severe visual impairment, while a few cause no vision problems and are discovered during a routine eye examination. Other dystrophies may cause repeated episodes of pain without leading to permanent loss of vision.

g) Herpes Zoster (Shingles)- This infection is produced by the varicella-zoster virus, the same virus that causes chickenpox. After an initial outbreak of chickenpox (often during childhood), the virus remains inactive within the nerve cells of the central nervous system. But in some people, the varicella-zoster virus will reactivate at another time in their lives. When this occurs, the virus travels down long nerve fibers and infects some part of the body, producing a blistering rash (shingles), fever, painful inflammations of the affected nerve fibers, and a general feeling of sluggishness. Varicella-zoster virus may travel to the head and neck, perhaps involving an eye, part of the nose, cheek, and forehead. In about 40 percent of those with shingles in these areas, the virus infects the cornea.

h) Iridocorneal Endothelial Syndrome- More common in women and usually diagnosed between ages 30-50, iridocorneal endothelial (ICE) syndrome has three main features: (1) visible changes in the iris, the colored part of the eye that regulates the amount of light entering the eye; (2) swelling of the cornea; and (3) the development of glaucoma, a disease that can cause severe vision loss when normal fluid inside the eye cannot drain properly. ICE is usually present in only one eye.ICE syndrome is actually a grouping of three closely linked conditions: iris nevus (or Cogan-Reese) syndrome; Chandler’s syndrome; and essential (progressive) iris atrophy (hence the acronym ICE).

i) Keratoconus- This disorder–a progressive thinning of the cornea–is the most common corneal dystrophy in the U.S., affecting one in every 2,000 Americans. It is more prevalent in teenagers and adults in their 20s. Keratoconus arises when the middle of the cornea thins and gradually bulges outward, forming a rounded cone shape. This abnormal curvature changes the cornea’s refractive power, producing moderate to severe distortion (astigmatism) and blurriness (nearsightedness) of vision. Keratoconus may also cause swelling and a sight-impairing scarring of the tissue.

j) Lattice Dystrophy- Lattice dystrophy gets its name from an accumulation of amyloid deposits, or abnormal protein fibers, throughout the middle and anterior stroma. During an eye examination, the doctor sees these deposits in the stroma as clear, comma-shaped overlapping dots and branching filaments, creating a lattice effect. Over time, the lattice lines will grow opaque and involve more of the stroma. They will also gradually converge, giving the cornea a cloudiness that may also reduce vision. In some people, these abnormal protein fibers can accumulate under the cornea’s outer layer–the epithelium. This can cause erosion of the epithelium. This condition is known as recurrent epithelial erosion. These erosions: (1) alter the cornea’s normal curvature, resulting in temporary vision problems; and (2) expose the nerves that line the cornea, causing severe pain. Even the involuntary act of blinking can be painful.

k) Map-Dot-Fingerprint Dystrophy- This dystrophy occurs when the epithelium’s basement membrane develops abnormally (the basement membrane serves as the foundation on which the epithelial cells, which absorb nutrients from tears, anchor and organize themselves). When the basement membrane develops abnormally, the epithelial cells cannot properly adhere to it. This, in turn, causes recurrent epithelial erosions, in which the epithelium’s outermost layer rises slightly, exposing a small gap between the outermost layer and the rest of the cornea. Epithelial erosions can be a chronic problem. They may alter the cornea’s normal curvature, causing periodic blurred vision. They may also expose the nerve endings that line the tissue, resulting in moderate to severe pain lasting as long as several days. Generally, the pain will be worse on awakening in the morning. Other symptoms include sensitivity to light, excessive tearing, and foreign body sensation in the eye.

l) Ocular Herpes- Herpes of the eye, or ocular herpes, is a recurrent viral infection that is caused by the herpes simplex virus and is the most common infectious cause of corneal blindness in the U.S. Previous studies show that once people develop ocular herpes, they have up to a 50 percent chance of having a recurrence. This second flare-up could come weeks or even years after the initial occurrence. Ocular herpes can produce a painful sore on the eyelid or surface of the eye and cause inflammation of the cornea. Prompt treatment with anti-viral drugs helps to stop the herpes virus from multiplying and destroying epithelial cells. However, the infection may spread deeper into the cornea and develop into a more severe infection called stromal keratitis, which causes the body’s immune system to attack and destroy stromal cells. Stromal keratitis is more difficult to treat than less severe ocular herpes infections. Recurrent episodes of stromal keratitis can cause scarring of the cornea, which can lead to loss of vision and possibly blindness.

m) Pterygium – A pterygium is a pinkish, triangular-shaped tissue growth on the cornea. Some pterygia grow slowly throughout a person’s life, while others stop growing after a certain point. A pterygium rarely grows so large that it begins to cover the pupil of the eye. Pterygia are more common in sunny climates and in the 20-40 age group. Scientists do not know what causes pterygia to develop. However, since people who have pterygia usually have spent a significant time outdoors, many doctors believe ultraviolet (UV) light from the sun may be a factor. In areas where sunlight is strong, wearing protective eyeglasses, sunglasses, and/or hats with brims are suggested. While some studies report a higher prevalence of pterygia in men than in women, this may reflect different rates of exposure to UV light.

n) Refractive Errors – About 120 million people in the United States wear eyeglasses or contact lenses to correct nearsightedness, farsightedness, or astigmatism. These vision disorders–called refractive errors– affect the cornea and are the most common of all vision problems in this country. Refractive errors are usually corrected by eyeglasses or contact lenses. Although eyeglasses or contact lenses are safe and effective methods for treating refractive errors, refractive surgeries are becoming an increasingly popular option. Read more about refractive errors.

o) Stevens – Johnson Syndrome. Stevens-Johnson Syndrome (SJS), also called erythema multiforme major, is a disorder of the skin that can also affect the eyes. SJS is characterized by painful, blistery lesions on the skin and the mucous membranes (the thin, moist tissues that line body cavities) of the mouth, throat, genital region, and eyelids. SJS can cause serious eye problems, such as severe conjunctivitis; iritis, an inflammation inside the eye; corneal blisters and erosions; and corneal holes. In some cases, the ocular complications from SJS can be disabling and lead to severe vision loss.

Treatment- A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light-sensitive retina. Poor vision or blindness may result. In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea, usually donated through an eye bank. A trephine, an instrument like a cookie cutter, is used to remove the cloudy cornea. The surgeon places the new cornea in the opening and sews it with a very fine thread. The thread stays in for months or even years until the eye heals properly (removing the thread is quite simple and can easily be done in an ophthalmologist’s office). Following surgery, eye drops to help promote healing will be needed for several months.