Causes of Tunnel Vision

The list of possible causes for loss of peripheral vision is a long one, so this article should by no means be taken as an exhaustive list. If you find you have experienced a decrease in your peripheral vision, it is important that you see an eye doctor as soon as possible in order to obtain a diagnosis and find out what treatment options may be available to you.

Glaucoma

Glaucoma is one of the leading medical causes of tunnel vision. This insidious disease is caused by a buildup of pressure inside the eye (which itself can have any number of causes), which eventually begins to cause damage to the optic nerve. When this happens, blind spots begin to appear on the affected person’s field of vision.

Open-angle glaucoma, the most common type, is also the form of glaucoma most likely to cause tunnel vision. This is because the blind areas in the visual field caused by open-angle glaucoma tend to appear first at the edge of the affected person’s range of sight.

If you believe you are experiencing any of the symptoms of glaucoma—which include (in addition to tunnel vision) cloudy or blurred vision, severe eye pain, halos around lights, and nausea/vomiting, it is important that you seek medical attention as soon as it is possible to do so.

Retinitis Pigmentosa

Retinitis pigmentosa is a progressive disease that causes the death of the rods and cones—the light-sensitive cells in your retina that pick up visual information and transmit it to your brain. This causes a gradual loss of vision, which often begins with peripheral vision loss.

Unfortunately, the cause of retinitis pigmentosa is not known (although it is suspected to be genetic), and there is no cure.

Blood Loss Due to Injury

Under certain circumstance, the rapid loss of a large amount of blood can result in a loss of peripheral vision.

Alcohol Intoxication

Drinking too much alcohol can cause a variety of visual symptoms, including blurred vision and double vision. While it is less common, alcohol intoxication can on occasion cause tunnel vision.

Of course, this is a subjective experience; in many cases of alcohol-induced peripheral vision loss, the likely explanation is that the intoxicated person is simply suffering from a decreased awareness of their surroundings, and a correspondingly decreased ability to react to them. In short, a drunk may have his peripheral vision and simply be too intoxicated to pay any attention to it.

Hallucinogenic Drugs

Hallucinogenic Drugs come in a great many varieties: LSD (aka “acid”), psilocybin (aka “magic mushrooms”), ecstasy, peyote buttons, Mexican Moonshot Capsules, Squid Juice, Midnight Deathtrap Music, Symbionese Liberation tablets—the list is endless.

What most of the chemical concoctions have in common is their ability to alter the user’s perceptions and cause visual hallucinations—which can sometimes include tunnel vision. One reason for this may be that a person who is “tripping” on psychedelic drugs may become intensely focused on whatever has captivated his attention—say, a pebble or an insect. This narrowing of mental focus creates the sensation that object being focused upon is the only thing in the world, a perception that may manifest itself as tunnel vision.

While experimenting with so-called “psychedelic” drugs may seem like fun, it is not a practice recommended by most mental health professionals. Your brain is not a toy; it is one of the more important organs in your body, and needs to be treated accordingly.

Medications

Leaving aside the effects of alcohol and recreational psychedelics, more mundane drugs can also sometimes cause tunnel vision. Medications such as brimonidine, nitroglycerin, and scopolamine, among many others, list peripheral vision loss among their side effects. Always consult with your doctor and your pharmacist about potential side effects before beginning any course of medication.

Concussion or Stroke

Over half a million Americans suffer strokes each year. The symptoms of a both conditions include dizziness, feelings of confusion, and various visual disturbances, including peripheral vision loss. The reason for this is that stroke and concussion are both negative events affecting the brain (a stroke occurs when blood flow to the brain is blocked, depriving the brain of oxygen and nutrients).

Choroideremia

Choroideremia is an extremely rare genetic condition that causes sufferers to slowly lose their vision. It affects men almost to the exclusion of women, and symptoms usually begin to manifest during childhood.

Sufferers of choroideremia find their vision slowly dimming over a period of years, and eventually their peripheral vision begins to disappear.

Retinal Detachment

Retinal detachment occurs when the retina—the layer of light-sensitive cells at the back of the eye—peels away from the back of the eye, in much the same way that an orange peel disengages from the fruit.

Visual symptoms of retinal detachment include flashes and floaters in the peripheral vision area, and the visual field can sometimes narrow, causing peripheral vision loss.

Retinal detachment is a serious, vision-threatening emergency. If you think you may be experiencing any of the symptoms of Retinal detachment, see an eye doctor as soon as you possibly can.

Panic Attack

Many people are subject to panic attacks. This is not a character weakness; it is a medical condition with both psychological and physiological causes.

Among the symptoms of panic attack are derealization, which is defined as a feeling of unreality, and depersonalization—a sense of detachment from oneself. With these sensations can come a range of vivid perceptions of altered reality, including tunnel vision.

Cataracts

A cataract occurs when some of the protein that makes up the lens of your eye begins to clump together, causing a cloudy area in your field of vision. Often cataracts form in the center of the lens (this is called a nuclear cataract), but in many cases cataracts form around the edges of the lens, causing peripheral vision loss.

Ocular Migraine

Ocular migraines are not the same as the migraine headaches that you or someone you know may experience from time to time. In fact, an ocular migraine is often painless.

A person who suffers an ocular migraine will, for ten to twenty minutes, experience shimmering “scintillations” in their visual field, possibly accompanied by halos around objects and a loss of peripheral vision.

Fortunately, ocular migraines are harmless, and the sensation of tunnel vision and other symptoms abate within minutes.

Mercury Poisoning

Mercury is a highly poisonous substance, and mercury poisoning can happen in a variety of ways. Industrial pollution is one of the more common causes of mercury poisoning, but equally common—and more widely known about—is overconsumption of mercury-contaminated fish or whale meat.

Many of the symptoms of mercury poisoning are neurological in nature—itching, burning, or the sensation of insects crawling on one’s skin—and visual disturbances such as tunnel vision can certainly accompany these types of symptoms.

Snake Bite

There are many, many different varieties of poisonous snake in the world, with many different types of venom. The type of snake venom that concerns us here is neurotoxic venom. This is any snake venom that acts on the nervous system. The neurotoxins in snake venom produce a number of unpleasant effects, including trouble swallowing, respiratory failure, and peripheral vision loss.

Which variety of snake is most likely to be armed with neurotoxic venom? Elapid snakes, i.e., cobras. There are exceptions, however—the venom of the Mojave rattlesnake is also highly neurotoxic. If you enjoy hiking or other such outdoor activity, it is important to exercise caution: always wear long pants and sturdy boots, and watch the trail carefully.

Risks Associated with Peripheral Vision Loss

The loss of one’s peripheral vision, even if temporary, can present immediate and long-term safety hazards. Without our peripheral vision, we are unable to perceive dangers that are not directly in front of us.

The most important thing to remember is that never, under any circumstances, should you drive a car if you are experiencing tunnel vision. This cannot be stressed enough. It is likewise important that you not ride a bicycle with tunnel vision, especially in vehicular traffic.

If you must go somewhere on foot, and your peripheral vision is impaired, the wisest and safest course of action is to ask a friend or family member to accompany you on your errand. Take your friend’s arm and hold firmly but loosely onto their elbow or bicep. Your companion will serve as an additional pair of eyes, ensuring that you are not blindsided by oncoming cars or bicycles that you are not able to see due to your tunnel vision.

Also, while this should go without saying, it bears mentioning that if you have a job that involves physical labor, especially if it requires you to use potentially dangerous tools or heavy machinery, you must take a leave of absence from that job until your normal peripheral vision has been restored. If your tunnel vision is permanent for any reason, a career change or an application for disability payment may be in order.

Likewise, if your hobbies include sporting activities such as baseball, basketball, boxing, or—most especially—target shooting, you must abstain from these activities until your tunnel vision has cleared up.

Treatment for Tunnel Vision

The correct treatment for a case of peripheral vision loss depends entirely on the cause of the condition. The articles on our site linked from the “Causes” section above can shed light on what (if anything) can be done to treat your particular case of tunnel vision.

Male Hormone Imbalance

Male hormone imbalance is a growing problem, I am testing more and more men with less than optimal testosterone results, often combined with high estrogen. There are some simple diet, lifestyle and supplement options that you can do to help optimise your hormonal health, but the first thing I recommend doing is testing your hormones.

Signs and Symptoms of Excess Estrogen

You do not need to have all of these symptoms if you have excess estrogen, these are the most common symptoms that men experience.

• Low testosterone and excess estrogen can cause similar symptoms in men

• Excess estrogen can cause excess weight, especially around the breasts, hips and abdomen and is the most common male hormone imbalance in overweight men.

• Excess estrogen can lead to low libido, infertility and erectile dysfunction

• Increased risk of stroke and heart attack because of an increased risk of clotting

• Increased risk of prostate cancer

Signs and Symptoms of Low Testosterone

Low testosterone has many similar symptoms to excess estrogen, with more muscle weakness and fatigue being the main difference.

• Similar to excess estrogen, low testosterone can cause low libido and erectile dysfunction.

• Muscle weakness and poor recovery from exercise.

• Fatigue and lack of energy, this can be caused by many things and low testosterone is one of them.

• Mood changes and depression.

• It can lead to weak bones and osteoporosis as you age.

 

What Causes Low Testosterone and Excess Estrogen

There are many different causes of hormonal imbalances in men and here is a list of the most common ones.

• Stress can cause many different health problems and hormone problems are no different, adrenal fatigue will upregulate an enzyme called aromatase leading to low testosterone and high estrogen.

• Diets high in refined carbohydrates will lead to insulin resistance and problems with the sex hormones.

• Excess weight leads to excess estrogen, many men with excess abdominal weight will be high in estrogen.

• Personal care products can be high in chemicals which contain xenoestrogens.

• Other chemicals in the environment and plastic containers also contain xenoestrogens leading to higher estrogen levels and lower testosterone levels.

• Excessive amounts of cardio/ endurance exercise will lead to a drop in testosterone and higher estrogen, strength and high intensity interval training is a better option.

• Excess alcohol will lead to lower testosterone.

Supplements

These are some of the supplements that I recommend and that I have seen client get good results with, the supplements that you need will depend on whether you have high estrogen levels or low testosterone. There are also different causes of the hormones going out of balance which is why I recommend the DUTCH hormone test to help identify exactly what is going wrong.

Eye dystonia (the medical term is Blepharospasm) is uncontrollable and often painful muscle contractions around the eye. Symptoms of eye dystonia may include excessive blinking and involuntary closure of the eyelids. The cause is believed to be incorrect messages from the brain to the muscles around the eye. Eye dystonia is a neurological movement disorder and should be diagnosed and treated by an ophthalmologist or a neurologist specialising in movement disorders.

Blepharospasm usually starts gradually. First symptoms may include eye irritation, sensitivity to light and increased blinking. The frequency and severity of the muscle spasms generally increases over a period of one to two years. Sometimes eye dystonia is experienced together with mouth, jaw or tongue dystonia (oromandibular). The medical term for this is Meige’s syndrome.

Causes:

The cause of dystonia is not fully understood. There appears to be a problem with the region of the brain called the basal ganglia. In most cases where dystonia appears in adults and some case where it appears in children, there is no clear explanation for why this problem arises.

However, in a minority of cases, the dystonia does have a clear cause. These are:

Another Medical condition

Where dystonias appear in children, in more than 80% of cases the dystonia will be secondary to another condition. In the majority of cases, this will be cerebral palsy.

Some dystonias appearing in adults may caused by stroke or tumour.

Drugs

Some dystonias, called Tardive, are caused by certain drugs (especially dopamine blocking drugs used to treat psychiatric disorders).

Genetics

Some cases generalised primary dystonia may be inherited.

 

Symptoms:

• Blinking and eyelid problems
• Neck problems
• Hand problems
• Voice problems
• Muscle spasms
• Tremor
• Dystonic Storms

Treatment usually involves regular injections, using a tiny needle, administered either by neurology or ophthalmology professionals and/or oral medication can also be prescribed. Some people find relief by applying light pressure to particular points on their face; symptoms can also be reduced by wearing dark glasses or wearing a hat with a peak. It is very much an individual experience.

Unfortunately there is not currently a cure. However, in the vast majority of cases, dystonia does not shorten a person’s life span. Most people do manage to develop successful strategies for living with dystonia combining treatment with pain control and sensory tricks.

Although there is currently no cure for dystonia, there are several widely used treatments. Many treatments are very successful but depend particularly on the type of dystonia and the age of onset. Because dystonia is such a complex and ‘individual’ condition, the usefulness of all these treatment options can vary widely between patients. Treatment regimes should be determined by a consultant familiar with dystonia.

Adult dystonia

The usual treatment regime for common forms of adult onset dystonia such as cervical dystonia, facial dystonia, oromandibular dystonia and blepharospasm is regular injections of botulinum toxin, which are usually repeated every three months.

Various oral medications drug treatments are available to assist in the management of some types of dystonia. However, not all medications are suitable for all people with dystonia.

In rare cases where cervical dystonia does not respond to botulinum toxin, Deep Brain Stimulation (DBS) brain surgery may be considered. Other surgical treatments which aim to either remove the problematic muscles or cut (denervate) selective peripheral nerves leading to these muscles, have also been found to be helpful for people with blepharospasm and torticollis respectfully.

Physiotherapy can be helpful to correct dystonic postures and movements in neck and hand dystonia. Speech and language therapy can be helpful if dystonia is affecting speech.

Young-onset dystonia

Many physicians will prescribe an initial trial of Levodopa for young patients as it can be highly effective in cases of dopa-responsive dystonia

Unfortunately, in the majority of cases, other oral drugs will be required of which Trihexyphenidyl is the most widely used. However, there are a number of other drug treatments available.

DBS brain surgery, especially in cases of generalised dystonia, can be of sustained benefit to certain young patients. Assessment will be required to determine whether DBS is suitable for individual cases. Botulinum toxin has limited use in the case of generalised dystonia as there are too many diverse muscles groups to treat successfully. It is used most successfully in the treatment of specific muscle groups.

Physiotherapy can be helpful to find the most effective way of coping with the dystonic movement. Speech and language therapy can be helpful if dystonia is affecting speech. An occupational therapist can help make adaptations to your approach to everyday life and make it easier to cope.

Acquired dystonia

Treatment of dystonia secondary to brain injury is often similar to that of young-onset dystonia. DBS is reported to be less successful in managing cases of secondary dystonia, as is botulinum toxin, although it can be useful when targeting specific small areas of muscle.

Physiotherapy can be helpful to find the most effective way of coping with the dystonic movement. Speech and language therapy can be helpful if dystonia is affecting speech. An occupational therapist can help make adaptations to your approach to everyday life and make it easier to cope.

For people with tardive dystonia (dystonia, which is a side effect to certain medications), the use of further medications to treat the symptoms of dystonia, needs to be managed very carefully.

Eye Floaters appear as small spots that drift through your field of vision. They may stand out when you look at something bright, like white paper or a blue sky. They might annoy you, but they shouldn’t interfere with your sight.

If you have a large floater, it can cast a slight shadow over your vision. But this tends to happen only in certain types of light.

You can learn to live with floaters and ignore them. You may notice them less as time passes. Only rarely do they get bad enough to require treatment.

What Are the Symptoms?

Floaters earn their name by moving around in your eye. They tend to dart away when you try to focus on them.

They come in many different shapes:

• Black or gray dots
• Squiggly lines
• Threadlike strands, which can be knobby and almost see-through
• Cobwebs
• Rings

Once you get them, they usually don’t go away. But you usually notice them less over time.

What Causes Them?

Most floaters are small flecks of a protein called collagen. They’re part of a gel-like substance in the back of your eye called the vitreous.

As you age, the protein fibers that make up the vitreous shrink down to little shreds that clump together. The shadows they cast on your retina are floaters. If you see a flash, it’s because the vitreous has pulled away from the retina. If that happens, see your eye doctor ASAP.

These changes can happen at any age, but usually occur between 50 and 75. You’re more likely to have them if you’re nearsighted or have had cataract surgery.

It’s rare, but floaters can also result from:

• Eye disease
• Eye injury
• Diabetic retinopathy
• Crystal-like deposits that form in the vitreous
• Eye tumors

• Detached retina
• Torn retina
• Bleeding in your vitreous
• Inflamed vitreous or retina caused by infections or an autoimmune condition
• Eye tumors

Something that might resemble a floater is the visual aura that can come with a migraine headache. It could look like what you see when you put your eye to a kaleidoscope. It might even move. It’s different from the floaters and flashbulb type “flashes” that come with other eye problems. This usually lasts a few minutes and may involve the vision in both eyes.

When to See the Doctor

If you only have a few eye floaters that don’t change over time, don’t sweat it.

Go to the doctor ASAP if you notice:

• A sudden increase in the number of floaters
• Flashes of light
• A loss of side vision
• Changes that come on quickly and get worse over time
• Floaters after eye surgery or eye trauma
• Eye pain

Choose a doctor who has experience with retina problems. If you don’t get help right away, you could lose your sight.

How Are Floaters Treated?

Benign ones almost never require medical treatment.

If they annoy you, try to get them out of your field of vision. Move your eyes — this shifts the fluid around. Look up and down, that usually works better than side to side.

If you have so many that they block your vision, your eye doctor may suggest surgery called a vitrectomy. He’ll remove the vitreous and replace it with a salt solution.

You might have complications like:

• Detached retina
• Torn retina
• Cataracts

The risk is low, but if these problems happen, they can permanently damage your vision.

What are styes and chalazia?

Styes and chalazia are lumps in or along the edge of an eyelid. They may be painful or annoying, but they are rarely serious. Most will go away on their own without treatment.

• A stye  is an infection that causes a tender red lump on the eyelid. Most styes occur along the edge of the eyelid. When a stye occurs inside the eyelid, it is called an internal hordeolum (say “hor-dee-OH-lum”).
• A chalazion  (say “kuh-LAY-zee-on”) is a lump in the eyelid. Chalazia (plural) may look like styes, but they are usually larger and may not hurt.

Styes and chalazia may be related to blepharitis, a common problem that causes inflammation of the eyelids.

    

 

 

What causes a stye or chalazion?

Styes are caused by a bacterial infection. Usually the bacteria grow in the root (follicle) of an eyelash. An internal hordeolum is caused by infection in one of the tiny oil glands inside the eyelid.

A chalazion forms when an oil gland in the eyelid becomes blocked. If an internal hordeolum doesn’t drain and heal, it can turn into a chalazion.

What are the symptoms?

A stye usually starts as a red bump that looks like a pimple along the edge of the eyelid.

• As the stye grows, the eyelid becomes swollen and painful, and the eye may water.
• Most styes swell for about 3 days before they break open and drain.
• Styes usually heal in about a week.

A chalazion starts as a firm lump or cyst under the skin of the eyelid.

• Unlike styes, chalazia often don’t hurt.
• Chalazia grow more slowly than styes. If a chalazion gets large enough, it may affect your vision.
• The inflammation and swelling may spread to the area surrounding the eye.
• Chalazia often go away in a few months without treatment.

How is a stye or chalazion diagnosed?

Doctors diagnose these problems by closely examining the eyelid. It may be hard to tell the difference between a stye and a chalazion. If there is a hard lump inside the eyelid, the doctor will probably diagnose it as a chalazion.

How are they treated?

Home treatment is all that is needed for most styes and chalazia.

• Apply warm, wet compresses for 5 to 10 minutes, 3 to 6 times a day. This usually helps the area heal faster. It may also help open a blocked pore so that it can drain and start to heal.
• Use an over-the-counter treatment. Try an ointment (such as Stye), solution (such as Bausch and Lomb Eye Wash), or medicated pads (such as Ocusoft Lid Scrub).
• Let the stye or chalazion open on its own. Don’t squeeze or open it.
• Don’t wear eye makeup or contact lenses until the area has healed.

If a stye is not getting better with home treatment, talk to your doctor. You may need a prescription for antibiotic eye ointment or eyedrops. You may need to take antibiotic pills if infection has spread to the eyelid or eye.

If a stye or chalazion gets very large, the doctor may need to pierce (lance) it so it can drain and heal. Do not try to lance it yourself.

How can you prevent styes and chalazia?

• Don’t rub your eyes. This can irritate your eyes and let in bacteria. If you need to touch your eyes, wash your hands first.
• Protect your eyes from dust and air pollution when you can. For example, wear safety glasses when you do dusty chores like raking or mowing the lawn.
• Replace eye makeup, especially mascara, at least every 6 months. Bacteria can grow in makeup.
• If you get styes or chalazia often, wash your eyelids regularly with a little bit of baby shampoo mixed in warm water.
• Treat any inflammation or infection of the eyelid promptly.

Ocular, or eye, melanoma is the most common type of eye cancer. It normally affects the uvea, the vascular layer of the eye between the retina and the white of the eye.

It is also known as uveal melanoma. Tumors develop in the melanocytes, the pigment-producing cells within the uvea that give color to the eye.

Most melanomas affect the skin, but some develop in other parts of the body, including the eye.

If cancer starts in the eye, this is primary eye cancer. If the eye melanoma starts elsewhere in the body and spreads to the eye, it is called secondary eye cancer.

Eye cancer is usually secondary, and 9 out of 10 eye melanomas start in the skin.

Signs and symptoms

Some patients may experience no symptoms, while others may have light flashes, blurring of vision, or see dark spots in their field of vision.

The following signs and symptoms are possible:

• a dark spot in the iris that gets bigger
• a displacement of the eye within the eye socket
• seeing flashing lights
• watery eyes>
• poor or blurry vision or loss of peripheral vision in one eye

There may also be floaters, or small specks or squiggles that move about in the patient’s field of vision. Floaters may be seen more clearly when looking at a plain background, such as a blank wall. They may appear as tiny dots, circles, lines, clouds, or cobwebs.

Floaters are common, especially as people age, and they do not necessarily indicate cancer.

Rarely, pain in or around the eye can be a sign of eye melanoma.

Causes and risk factors

Experts are not sure what the exact cause of ocular melanoma is, but genetic factors are believed to play a role in cells becoming cancerous.

Scientists have found links between eye cancer and some genetic changes, but it remains unclear exactly where these changes occur, or if they cause cancer to develop.

Risk factors

The following factors increase the chance of developing eye melanoma:

Eye color: People with blue eyes have a higher risk of developing melanoma of the eye than those with brown eyes.

Exposure to ultraviolet (UV) light: Exposure to UV light, for example from sunshine, may increase the risk, but research has not confirmed this.

Dysplastic nevus syndrome: In this condition, a person develops atypical moles, known as dysplastic nevi, which look different from ordinary moles. They have irregular borders, may be mixed in color, and appear in clusters. Dysplastic nevi are more likely to develop into malignant melanoma than ordinary moles.

Genetic factors: Some chromosomal abnormalities, such as those found on chromosome 3, increase the risk of melanoma spreading from the eye to other parts of the body.

 

Treatment and prevention

Treatment depends on several factors, including where and what type of tumor it is, the size of the tumor, and the patient’s general health.

If there is a small lesion, a doctor may suggest monitoring it rather than treating it straight away, as treatment can lead to some vision loss.

Surgery

A number of surgical options are possible.

Iridectomy removes parts of the iris with small melanomas that have not spread to other parts of the eye.

Iridotrabeculectomy removes parts of the iris and the supporting tissues where melanomas may have spread.

Iridocyclectomy removes part of the iris and ciliary body. The ciliary body is a thin layer between the white of the eye and the retina that contains blood vessels.

Choroidectomy removes part of the choroid, and sometimes part of the wall of the eye as well. The choroid is the pigmented, vascular part of the eye. The operation may be followed by a course of radiation therapy.

Enucleation removes the whole eye, in cases where the tumor is large, and any other treatment would result in the loss of most of the eye. It may also be recommended if there is eye pain.

The surgeon will implant an ocular prosthesis, or artificial eye. This does not provide vision. It is a cosmetic substitute.

Radiation and other targeted therapy

Radiation therapy can destroy the genetic material of cancer cells and stop them from reproducing. The radiation is carefully targeted to destroy the cancer cells while limiting damage to healthy cells. The doctor can deliver radiation from inside or outside the eye.

Two types of radiation treatment are teletherapy and brachytherapy.

Teletherapy generates radiation from outside of the patient’s body. It targets the malignant cells in the eye.

Brachytherapy temporarily anchors small radioactive seeds into the eye to shrink the tumor. The ophthalmologist or oncologist will stitch a plaque, or small implant, containing several iodine-125 seeds to the wall of the eye, near the tumor. It remains there for 4 to 5 days. The doctor carefully monitors the size of the tumor.

Transpupillary thermotherapy (TTT) is a type of infrared laser therapy that uses heat in the form of a laser to shrink smaller tumors.

Cryotherapy can freeze the cancerous cells.

Outlook and prevention

Treatment of eye melanoma is effective if it is detected and treated early enough. if the cancer only affects the eye, 80 percent of people will survive at least 5 years after diagnosis. If the cancer has spread to other parts of the body, around 15 percent will live for at least another 5 years.

Prevention

To reduce the risk of skin cancer and eye cancer, the American Cancer Society recommends using protection from strong sunlight, including sunglasses with UVA and UVB protection, sunblock, and a hat.

Sunshine and outdoor work have not been proven to cause eye cancer, but they may increase the risk.

Lumbar Puncture

Liver disease severe enough to require a liver transplant can come from many causes. Doctors have developed various systems to determine the need for the surgery. Two commonly used methods are by specific disease process or a combination of laboratory abnormalities and clinical conditions that arise from the liver disease. Ultimately, the transplantation team takes into account the type of liver disease, the person’s blood test results, and the person’s health problems in order to determine who is a suitable candidate for transplantation.

In adults, cirrhosis from alcoholism, hepatitis C, biliary disease, or other causes are the most common diseases requiring transplantation. In children, and in adolescents younger than 18 years, the most common reason for liver transplantation is biliary atresia, which is an incomplete development of the bile ducts.

Laboratory test values and clinical or health problems are used to determine a person’s eligibility for a liver transplant.

• For certain clinical reasons, doctors may decide that a person needs a liver transplant. These reasons may be health problems that the person reports, or they may be signs that the doctor notices while examining the potential recipient. These signs usually occur when the liver becomes severely damaged and forms scar tissue, a condition known as cirrhosis.
  • Common clinical and quality-of-life indications for a liver transplant include ascites, or fluid in the belly due to liver failure.
  • In the early stage of this problem, ascites may be controlled with medicines (diuretics) to increase urine output and with dietary modifications (limiting salt intake).
  • Another serious consequence of liver disease is hepatic encephalopathy. This is mental confusion, drowsiness, and inappropriate behavior due to liver damage.
• Several other clinical problems may arise from liver disease.
  • Infection in the abdomen, known as bacterial peritonitis, is a life-threatening problem. It occurs when bacteria or other organisms grow in the ascites fluid.
  • Liver disease causes scarring, which makes blood flow through the liver difficult and may increase the blood pressure in one of the major blood vessels that supply it. This process may result in serious bleeding.
  • Blood may also back up into the spleen and cause it to increase in size and to destroy blood cells.
  • Blood may also go to the stomach and esophagus(swallowing tube). The veins in those areas may grow and are known as varices. Sometimes, the veins bleed and may require a gastroenterologist to pass a scope down a person’s throat to evaluate them and to stop them from bleeding.
• These problems may become very difficult to control with medicines and can be a serious threat to life. A liver transplant may be the next step recommended by the doctor. 

 

People who have liver disease may have many of the following problems:

• Jaundice – Yellowing of the skin or eyes
• Itching
• Dark, tea-colored urine
• Gray- or clay-colored bowel movements
• Ascites – An abnormal buildup of fluid in the abdomen
• Vomiting of blood
• Blood in the stool
• Tendency to bleed
• Mental confusion, forgetfulness

When Should I Call the Doctor About Liver Transplant Complications?

Call the transplant team whenever a patient with a newly transplanted liver feels unwell or has concerns about his or her medications. The patient should also call the transplant doctor if new symptoms arise. These problems may commonly occur before liver transplantation and indicate that a patient’s liver disease is worsening. They may also occur after transplantation and be a possible sign that the liver is being rejected. The doctor may recommend that the patient be taken to a hospital emergency department for further evaluation.

Acute rejection usually occurs in the first 1-2 months after the transplantation. It is common for the patient to require 1 admission to the hospital for either rejection or infection. The following are just a few examples of when to call the doctor:

• A patient may bleed after surgery, which may be detected by an increase in the amount of blood put out in what are called Jackson-Pratt (JP) drains, rather than by a decrease of blood over time. This may indicate that one of the blood vessels going to the liver is bleeding.
• The patient’s belly is more tender than usual, and he or she has a fever. Infection of the fluid in the belly can be a serious complication. Infection is diagnosed by removing a small amount of fluid from the abdomen and sending it to the laboratory for testing. If infection is present, antibiotics are usually prescribed, and the patient is admitted to the hospital. Infection in liver transplant recipients is usually seen 1-2 months after transplantation.
• After surgery, the patient’s belly is more tender and the skin is turning yellow. This may indicate that bile is backing up and not draining from the liver properly. The doctor may need to evaluate this problem by doing tests, such as a CT scan, ultrasound, or cholangiography. If a major problem exists, the doctor may reoperate (exploratory surgery), use nonoperative treatment, or list for urgent retransplantation.

If a patient comes to the hospital or an emergency department, the doctor will obtain blood tests, liver function tests, blood clotting tests, electrolytes, and kidney function tests. The doctor may also draw blood levels of certain immunosuppressive medications to make sure they are in the right range. If an infection is considered possible, cultures for viruses, bacteria, fungi, and other organisms may be grown. These may be checked for in the urine, sputum, bile, and blood.

Pretransplant tests are done to evaluate the severity of the liver disease and to determine when the patient should be placed on the waiting list. Once this initial evaluation is complete, the case is presented to a review committee of physicians and other staff members of the hospital. If the person is accepted as a candidate, he or she is placed on the waiting list for a liver transplant. A recipient may undergo some of the following tests before the transplantation:

• CT scan of the abdomen: This is a computerized picture of the liver that allows the doctor to determine the liver size and to identify any abnormalities, including liver tumors, that may interfere with the success of a liver transplantation.
• Ultrasound of the liver: This is a study that uses sound waves to create a picture of the liver and the surrounding organs. It also determines how well the blood vessels that carry blood to and from the liver are working.
• ECG: Short for electrocardiogram, this is a study that shows the electrical activity of the heart.
• Blood tests: These include blood type, blood cell count, blood chemistries, and viral studies.
• Dental clearance: A person’s regular dentist may fill out the form. Immunosuppressive medications may increase the chance of infection and if the teeth have cavities or periodontal disease, this can lead to infection. Therefore, a dental evaluation is important before beginning these medicines.
• Gynecological clearance: The patient’s gynecologist may provide clearance.
• Purified protein derivative (PPD) skin test: The PPD test is performed on the arm to check for any exposure to tuberculosis.

What Is Self-Care at Home When Healing from a Liver Transplant?

Home care involves building up endurance to carry out daily life activities and recovering to the level of health that the patient had before surgery. This can be a long, slow process that includes simple activities. Walking may require assistance at first. Coughing and deep breathing are very important to help the lungs stay healthy and to prevent pneumonia. Diet in the hospital may at first consist of ice chips, then clear liquids, and, finally, solids. It is important to eat well-balanced meals with all food groups. After about 3-6 months, a person may return to work if he or she feels ready and it is approved by the primary transplant doctor.

Preventing rejection: Home care also involves taking several medications to help the liver survive and to prevent the patient’s own body from rejecting the new liver. A person with a new liver must take medications for the rest of his or her life. The immune system works to protect the body from invading bacteria, viruses, and foreign organisms.

Unfortunately, the body cannot determine that the newly transplanted liver serves a helpful purpose. It simply recognizes it as something foreign and tries to destroy it. In rejection, the body’s immune system attempts to destroy the newly transplanted liver. Without the intervention of immunosuppressive drugs, the patient’s body would reject the newly transplanted liver. Although the medications used to prevent rejection act specifically to prevent the new liver from being destroyed, they also have a general weakening effect on the immune system. This is why transplant patients are more likely to get certain infections. To prevent infections, the patient must also take preventive medications. There are 2 general types of rejection, as follows:

• Immediate, or hyperacute, rejection occurs just after surgery, when the body immediately recognizes the liver as foreign and attempts to destroy it. Hyperacute rejection occurs in about 2% of patients.
• Acute rejection usually occurs in the first two months after transplant and is usually treatable with medication adjustments. About 25% of patients have at least one acute rejection episode.
• Delayed, or chronic, rejection can occur years after surgery, when the body attacks the new liver over time and gradually reduces its function. This occurs in 2-5% of patients.

The incision on the belly is in the shape of an upside-down Y. Small, plastic, bulb-shaped drains are placed near the incision to drain blood and fluid from around the liver. These are called Jackson-Pratt (JP) drains and may remain in place for several days until the drainage significantly decreases. A tube called a T-tube may be placed in the patient’s bile duct to allow it to drain outside the body into a small pouch called a bile bag. The bile may vary from deep gold to dark green, and the amount produced is measured frequently. The tube remains in place for about 3 months after surgery. Bile production early after the surgery is a good sign and is one of the indicators surgeons look for to determine if the liver transplant is being “accepted” by the patient’s body.

After surgery, the patient is taken to the intensive care unit, is monitored very closely with several machines. The patient will be on a respirator, a machine that breathes for the patient, and will have a tube in the trachea (the body’s natural breathing tube) bringing oxygen to the lungs. Once the patient wakes up enough and can breathe alone, the tube and respirator are removed. The patient will have several blood tests, X-ray films, and ECGs during the hospital stay. Blood transfusions may be necessary. The patient leaves the intensive care unit once he or she is fully awake, able to breathe effectively, and has a normal temperature, blood pressure, and pulse, usually after about 1-2 days. The patient is then moved to a room with fewer monitoring devices for a few days longer before going home. The average hospital stay after surgery is about 2 weeks.

 

After liver transplantation, the patient must visit the transplant surgeon or hepatologist frequently, about 1-2 times a week over about 3 months. After this time, the primary doctor may also see the patient, but the transplant doctor the patient about once a month for the remainder of the first year after transplantation.

Ideally, the transplant surgeon and hepatologist monitor the patient’s progress through blood tests and contact with the primary doctor. One year after transplantation, follow-up care is individualized. If a patient ever requires a visit to an emergency department, and is discharged from there, he or she should generally follow up with his or her primary transplant doctor in 1-2 days.

 

Before undergoing liver transplantation, people who have liver disease should avoid medications that may further damage the liver.

• Large amounts of acetaminophen (Tylenol) may be harmful and can damage the liver. (Acetaminophen is contained in many over-the-counter drugs; therefore, patients with liver disease must be particularly watchful.) Sleeping pills and benzodiazepines (Valium and similar medicines) can build up faster in the blood when the liver doesn’t work well. They can make a person confused, worsen existing confusion, and, in some cases, cause coma. If possible, try to avoid taking these medicines.
• Alcohol is an ingredient in some cough syrups and other medications. Alcohol can severely damage the liver, so it is best to avoid alcohol-containing medications.
• The female transplantation patient should not take oral contraceptives because of the increased risk of blood clot formation.
• No transplant recipient should receive live virus vaccines (especially polio), and no household contacts should receive these either.
• Pregnancy should be avoided by transplant recipients until at least 1 year after transplantation. If a woman wants to become pregnant, she should speak with her transplantation team regarding any special risks, as the immunosuppressive medications may need to be changed. In many cases, women successfully become pregnant and give birth normally after transplantation, but they should be carefully monitored because of the higher incidence of premature births. Mothers should avoid breastfeeding because of the risk of the baby’s exposure to the immunosuppressive medicines through the milk.

 

The 1-year survival rate after liver transplantation is about 88% for all patients, but will vary depending on whether the patient was at home when transplated or critically in the intensive care unit. At 5 years, the survival rate is about 75%. Survival rates are improving with the use of better immunosuppressive medications and more experience with the procedure. The patient’s willingness to stick to the recommended posttransplantation plan is essential to a good outcome.

Generally, anyone who develops a fever within a year of receiving a liver transplant is admitted to the hospital. Patients who cannot take their immunosuppressive medicines because they are vomiting should also be admitted. Patients who develop a fever more than a year after receiving a liver transplant and who are no longer on high levels of immunosuppression may be considered for management as an outpatient on an individual basis.

Complications are problems that may arise after liver transplantation. Many should be recognizable by the patient, who should call the transplantation team to inform them of the changes.

Possible complications after liver transplantation:

• Infection of the T-tube site: This tube drains bile to the outside of the body into a bile bag. Not all patients require such a tube. The site may become infected. This can be recognized if the patient notices warmth around the T-tube site, redness of the skin around the site, or discharge from the site.
• Dislodgement of the T-tube: The tube may come out of place, which may be recognized by breakage of the stitch on the outside of the skin that holds the tube in place or by an increase in the length of the tube outside the body.
• Bile leak: This may occur when bile leaks outside of the ducts. The patient may experience nausea, pain over the liver (the right upper side of the abdomen), or fever.
• Biliary stenosis: This is narrowing of the duct, which may result in blockage. The bile may back up in the body and result in yellowing of the skin.

• Infections: Infections may result from being on the immunosuppressive medications. Although these medications are meant to prevent rejection of the liver, they also decrease the ability of the body to fight off certain viruses, bacteria, and fungi. The organisms that most commonly affect patients are covered with preventive medications. Notify the transplantation team if any of the following infections arise:

• Viruses
  • Herpes simplex viruses (types I and II): These viruses most commonly infect the skin but may occur in the eyes and lungs. Type I causes painful, fluid-filled blisters around the mouth, and type II causes blisters in the genital area. Women may have an unusual vaginal discharge.
  • Herpes zoster virus (shingles): This is a herpesvirus that is a reactivated form of chickenpox. The virus appears as a wide pattern of blisters almost anywhere on the body. The rash is often painful and causes a burning sensation.
  • Cytomegalovirus: This is one of the most common infections affecting transplant recipients and most often develops in the first months after transplantation. Symptoms include excessive tiredness, high temperature, aching joints, headaches, abdominal problems, visual changes, and pneumonia.
• Fungal infections: Candida (yeast) is an infection that may affect the mouth, esophagus (swallowing tube), vaginal areas, or bloodstream. In the mouth, the yeast appears white, often on the tongue as a patchy area. It may spread to the esophagus and interfere with swallowing. In the vagina, a white discharge that looks like cottage cheese may be present. To identify yeast in the blood, the doctor will obtain blood cultures if the person has a fever.
• Bacterial infections: If a wound (including the incision site) has drainage and is tender, red, and swollen, it may be infected by bacteria. The patient may or may not have a fever. A wound culture (test for the organism) will be obtained and appropriate antibiotics given.
• Other infections: Pneumocystis carinii is similar to a fungus and may cause pneumonia. The patient may have a mild, dry cough and a fever. This infection is prevented with sulfamethoxazole-trimethoprim (Bactrim, Septra). If the patient develops this infection, it may be necessary to give higher doses or intravenous antibiotics.
• Diabetes: Diabetes is a condition in which blood sugar levels are too high. This may be caused by the medications the person takes. Patients may experience increased thirst, increased appetite, blurred vision, confusion, and frequent, large volumes of urination. The transplantation team should be notified if these problems occur. They can perform a quick blood test (a fingerstick glucose test) to see if the blood sugar level is elevated. If it is, they may start the patient on medications to prevent it and recommend diet and exercise.
• High blood pressure: This may be a side effect of the medications. The patient’s doctor will monitor the blood pressure with each clinic visit and, if it is elevated, may start medications to lower blood pressure.
• High Cholesterol: This may be a side effect of the medications, the patient’s doctor will monitor the cholesterol levels periodically with blood tests and may recommend diet changes or start medications if necessary.

A kidney transplant  is surgery to put a healthy (donor) kidney into your body. There are two types of donors:

• Living donors. A living donor may be a family member, a friend, a coworker, or any person who is willing to give a kidney to someone in need. A person only needs one healthy kidney to live.
• Deceased donors. A deceased donor is someone who has recently died.

You may need to have tests to see how well the donor kidney matches your tissue type and blood type. A close tissue match reduces the chances that your body will reject the new kidney. You will also be evaluated to make sure that you do not have significant heart or lung disease or other diseases, such as cancer, which might decrease your life span.

Kidney transplant surgery takes about 3 hours. During surgery, the donor kidney will be placed in your lower abdomen, blood vessels from the donor kidney will be connected to arteries and veins in your body, and the ureter from the donor kidney will be connected to your bladder. Blood is then able to flow through the new kidney, and the kidney will begin to filter and remove wastes and to produce urine.

The new kidney usually begins to function right away. In most cases, diseased or damaged kidneys are not removed unless you have a severe infection of the kidney (pyelonephritis), kidney cancer, nephrotic syndrome, or extremely large polycystic kidneys.

What To Expect After Surgery

You will have to stay in the hospital for several days after you receive your new kidney. In some cases, it may take time for your new kidney to produce urine. So you may have to receive dialysis and take medicines, such as diuretics, that help your new kidney get rid of excess water and salt from your body.

After the surgery you will have to take medicines to suppress your immune system. These medicines are used to help keep your body from rejecting your new kidney. You will need to take these medicines for the rest of your life.

During the first weeks to months after your surgery, your body may try to reject your new kidney. This is called acute rejection and occurs in less than 20 out of 100 people after transplant. Most of the time, acute rejection can be treated with antirejection (immunosuppressive) medicines.¹

Chronic rejection (also called chronic allograft failure) is a process of gradual, progressive loss of kidney function and can occur many months to several years after your surgery. Experts don’t fully understand what causes chronic rejection. There is no treatment for chronic rejection. Most people go back on dialysis or have another transplant.

Why It Is Done

Kidney transplant surgery is done so that a healthy kidney (donor kidney) can do what your diseased kidney can no longer do. Kidney transplant is used when you have severe chronic kidney disease (renal failure) that cannot be reversed by another treatment method. You will not be able to have this surgery if you have an active infection, another life-threatening disease such as cancer, or severe heart or lung disease.

How Well It Works

If you have severe chronic kidney disease and choose to have a kidney transplant, you may live longer than if you choose only to treat your kidney disease with dialysis alone.

In the past, transplants using a kidney from a first-degree relative, such as your father, mother, brother, or sister, were the most successful. But with modern antirejection drugs, kidneys from people you are not related to work well, too. Transplants from living donors or from deceased donors can succeed.

Risks

The risks of having a kidney transplant include:

• Rejection of the new kidney.
• Severe infection.
• Bleeding.
• Reaction to the anesthesia used for surgery.
• Failure of the donor kidney.

What To Think About

Kidney transplant may be a better treatment for you than dialysis, because survival rates are better after transplant. You will also be able to live a more normal life, because you won’t have to have dialysis. Although a kidney transplant is an expensive procedure, it may actually be less costly than long-term dialysis treatments.

There is often a long wait before you receive a donor kidney. And there is no guarantee that the transplant will be successful. Fewer complications occur in people who are good candidates for surgery and who do not have other serious medical conditions, such as unstable coronary artery disease or cancer, that may limit their life expectancy.

Not everyone is able to have a kidney transplant. You will not usually have a kidney transplant if you have an active infection or another life-threatening disease, such as cancer or significant heart or lung disease.

After having a kidney transplant, you will have to take medicines that suppress your immune system (antirejection or immunosuppressive medicines) to help prevent your body from rejecting the new kidney. You will need to take these medicines for the rest of your life. Because these medicines weaken your immune system, you will have an increased risk for serious infections. There is also the chance that your body may still reject your new kidney even if you take these medicines. If this happens, you will have to start dialysis and possibly wait for another kidney transplant.

Immunosuppressive medicines also increase your risk of other diseases, such as skin cancer and lymphoma. You have a greater risk for diabetes, high blood pressure, heart disease, cataracts, and inflammation of the liver (cirrhosis) if you are taking these medicines.