Hepatitis A

Key facts:

Hepatitis A is a viral liver disease that can cause mild to severe illness.
The hepatitis A virus is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person.
Almost everyone recovers fully from hepatitis A, but very small proportions die from fulminant hepatitis.
Hepatitis A infection risk is associated with a lack of safe water and poor sanitation.
Epidemics can be explosive and cause significant economic loss.
Improved sanitation and the hepatitis A vaccine are the most effective ways to combat the disease.

Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faces of an infected person. The disease is closely associated with unsafe water, inadequate sanitation and poor personal hygiene.

Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality.

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. The hepatitis A virus is one of the most frequent causes of foodborne infection. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000 people1. Hepatitis A viruses persist in the environment and can withstand food-production processes routinely used to inactivate and/or control bacterial pathogens.

The disease can lead to significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.
Geographical distribution

Geographical distribution areas can be characterized as having high, intermediate or low levels of hepatitis A infection.
Areas with high levels of infection

In developing countries with very poor sanitary conditions and hygienic practices, most children (90%) have been infected with the hepatitis A virus before the age of 10 years2. Those infected in childhood do not experience any noticeable symptoms. Epidemics are uncommon because older children and adults are generally immune. Symptomatic disease rates in these areas are low and outbreaks are rare.
Areas with intermediate levels of infection

In developing countries, countries with transitional economies and regions where sanitary conditions are variable, children often escape infection in early childhood. Ironically, these improved economic and sanitary conditions may lead to a higher susceptibility in older age groups and higher disease rates, as infections occur in adolescents and adults, and large outbreaks can occur.
Areas with low levels of infection

In developed countries with good sanitary and hygienic conditions, infection rates are low. Disease may occur among adolescents and adults in high-risk groups, such as injecting-drug users, men who have sex with men, people travelling to areas of high endemicity, and in isolated populations, such as closed religious communities.
Transmission

The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water.

The virus can also be transmitted through close physical contact with an infectious person, although casual contact among people does not spread the virus.
Symptoms

The incubation period of hepatitis A is usually 14–28 days.

Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms.

Adults have signs and symptoms of illness more often than children, and the severity of disease and mortality increases in older age groups. Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases.
Who is at risk?

Anyone who has not been vaccinated or previously infected can contract hepatitis A. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors include:

poor sanitation;
lack of safe water;
injecting drugs;
living in a household with an infected person;
being a sexual partner of someone with acute hepatitis A infection; and
travelling to areas of high endemicity without being immunized.

Diagnosis

Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific IgM and IgG antibodies in the blood. Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA, but may require specialised laboratory facilities.
Treatment

There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and may take several weeks or months. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.
Prevention

Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.

The spread of hepatitis A can be reduced by:

adequate supplies of safe drinking water;
proper disposal of sewage within communities; and
personal hygiene practices such as regular hand-washing with safe water.

Several hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than 1 year of age.

Nearly 100% of people develop protective levels of antibodies to the virus within 1 month after a single dose of the vaccine. Even after exposure to the virus, a single dose of the vaccine within 2 weeks of contact with the virus has protective effects. Still, manufacturers recommend two vaccine doses to ensure a longer-term protection of about 5 to 8 years after vaccination.

Millions of people have been immunized worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and also with other vaccines for travelers.
Immunization efforts

Vaccination against hepatitis A should be part of a comprehensive plan for the prevention and control of viral hepatitis. Planning for large-scale immunization programmes should involve careful economic evaluations and consider alternative or additional prevention methods, such as improved sanitation, and health education for improved hygiene practices.

Whether or not to include the vaccine in routine childhood immunizations depends on the local context. The proportion of susceptible people in the population and the level of exposure to the virus should be considered. Several countries, including Argentina, China, Israel, Turkey, and the United States of America have introduced the vaccine in routine childhood immunizations.

While the 2 dose regimen of inactivated hepatitis A vaccine is used in many countries, other countries may consider inclusion of a single-dose inactivated hepatitis A vaccine in their immunization schedules. Some countries also recommend the vaccine for people at increased risk of hepatitis A, including:

travellers to countries where the virus is endemic;
men who have sex with men; and
people with chronic liver disease (because of their increased risk of serious complications if they acquire hepatitis A infection).

Regarding immunization for outbreak response, recommendations for hepatitis A vaccination should also be site-specific. The feasibility of rapidly implementing a widespread immunization campaign needs to be included.

Vaccination to control community-wide outbreaks is most successful in small communities, when the campaign is started early and when high coverage of multiple age groups is achieved. Vaccination efforts should be supplemented by health education to improve sanitation, hygiene practices and food safety.
WHO response

WHO is working in the following areas to prevent and control viral hepatitis:

raising awareness, promoting partnerships and mobilizing resources;
formulating evidence-based policy and data for action;
preventing transmission; and
executing screening, care and treatment.

WHO also organizes World Hepatitis Day on July 28 every year to increase awareness and understanding of viral hepatitis.

What is Dengue?

Dengue is a mosquito-borne infectious disease caused by the dengue virus, which is mainly found in the tropical regions. The disease may produce such body pains as one feels when his/ her bones break; it is hence known as Dengue fever, or ‘Breakbone’ fever.

The major symptoms of dengue include fever, headache, muscle and joint pain and a typical skin rash that occurs all over the body, similar to measles. Rarely dengue may develop into a more life threatening form known as dengue hemorrhagic fever, which results in bleeding, decreased blood platelet count or thrombocytopenia, blood plasma leakage or the more fatal dengue shock syndrome, which causes dangerously low blood pressure.

Dengue and Dengue fever
How is it Caused and Spread?
Dengue is a serious infection especially among children; about two-fifths of the world’s population is at risk. Dengue and dengue haemorrhagic fever are spread from human-to-human by the bite of mosquitoes carrying the dengue virus. The dengue virus belongs to a group known as Flavivirus and can be typically divided into four viral serotypes, DEN-1, DEN-2, DEN-3, and DEN-4, which are closely related but differ in their antigens. Many species of mosquito under the genus Aedes transmit dengue; especially the Aedes aegypti species is involved in spreading the infection and is considered as the main cause of dengue. This species of mosquito breeds in stagnant water and usually bites during daylight hours. The virus circulates in the blood for 2-7 days after the human is affected, during which the mosquito may acquire the virus by biting the infected human and spread it to another unsuspecting victim.

The symptoms typically develop anywhere between 2 to 4 days from the time of the mosquito bite and may last up to a week. The dengue virus doesn’t have any detrimental effect on the mosquito, that carries it, and the mosquito remains infected for life. Dengue is rarely spread through person-to-person contact. Usually the disease is spread when a mosquito bites an infected person and becomes a carrier of the dengue virus. The mosquito then bites another healthy person and thus spreads the disease causing a possible epidemic breakout. A person infected with a single type of dengue virus serotype out of the four, develops resistant to that particular virus. However, they become much more susceptible to infection by other three serotypes.

Dengue Infection Cycle
Complications Involved with Dengue
Dengue causes the dengue fever, which sometimes may develop into more dangerous forms such as dengue hemorrhagic fever or dengue shock syndrome, which may lead to the development of life-threatening symptoms. Some of the complications caused due to the disease are:

Severe dehydration

Continuous bleeding

Low platelets, due to which clotting of blood doesn’t occur

Blood pressure may go dangerously low

Enlargement of liver and damage to it

Bradycardia (heart beating less than 60 counts per minute)

Damage to brain due to bleeding, seizures or encephalitis

Damage to the immune system

Diagnosis of Dengue
Diagnosis of dengue is considered when fever is accompanied by severe body pain. It is important to be evaluated when a person develops fever within two weeks of being in the tropics or sub-tropics. Dengue often causes symptoms that are similar to other diseases such as flu, measles, and typhoid fever etc. Hence investigations are always performed to exclude other disease conditions. Usually the blood of the patient is tested for the presence of antibodies and virus. Diagnosis of dengue infection can be done by the following methods:

Isolating the virus by collecting serum sample from patients within 5 days of appearance of symptoms

Detection of specific antibodies can be done by collecting serum within 6 days after onset of symptoms. The serum is tested for specific anti-dengue antibodies by Enzyme-linked Immunosorbent assay (ELISA). Titres of IgM and IgG antibodies increase four-fold in serum sample

Using Polymerase Chain Reaction (PCR) for detecting viral genomic sequence from Serum or Cerebro Spinal Fluid (CSF) samples collected from the patient, which is more expensive and complicated

Polymerase Chain Reaction (PCR)

In the case of more serious complications such as dengue hemorrhagic fever, the following diagnosis must be performed:

A tourniquet test is to be conducted, where a tourniquet is tied to the arm and if blood blotches tend to appear beyond the tourniquet, the patient may be suffering from increased bleeding, which may indicate Dengue Hemorrhagic Fever

Decreased in platelet count also known as Thrombocytopenia occurs when platelets are found to be 100 000 cells or less and this may be due to disease condition

Increase in hematocrit i.e., the volume percentage of Red Blood Cells (RBS), by 20% should be a caution as it occurs due to rise in the vascular permeability of the plasma. Signs of plasma leakage appears as increased fluid accumulation in the chest and abdominal cavity known as pleural effusion or ascites respectively

Treatment for Dengue:

There are actually no known antiviral drugs or injections available for the cure of dengue. However, the disease can be treated with plenty of supportive care and treatment that would eventually help save the patient’s life. Dengue is characterized by fever and intense body ache. The fever can be treated with antipyretic drugs such as paracetamol and the body ache can be treated with analgesics that help relieve the pain. Drugs such as aspirin and ibuprofen should be avoided as they may increase the risk of hemorrhage. The patient can also be treated with natural home remedies such as papaya leaves, kiwi and other food items that have been proven to help in the increase of platelet count, which gets affected during dengue.

In the case of more severe forms of dengue, such as dengue hemorrhagic disease or dengue shock syndrome, it a must for the patient to be admitted to a hospital and given proper care. The mortality rate of a dengue patient without hospitalisation increases about 50 percent. Treatments such as intra-venous fluid replacements should be administered to these patients to prevent shock. Patients should drink plenty of fluids, as dehydration is prevalent among those affected with Dengue. Vaccines for all of the serotypes are being developed, which will be the most effective way to cure the disease.
Prevention of Dengue
As there are no injections or vaccines available to cure dengue, prevention by following certain basic steps will be the most effective way to fight against the dreadful disease. Some of the ways to prevent the onset of dengue are stated as follows:

It is better to avoid stagnant water in flowerpots, buckets, barrels etc., in and around the house, as these are the favorite places for mosquitoes to lay eggs. Water should be stored in closed containers

Bleaching powder may be used in water sources that are not meant for drinking, as it prevents the development of mosquito eggs

The female mosquito feeds on blood as it requires the blood protein to produce eggs, hence it is better to use mosquito repellents, even when indoors

It is advised to reside in a well screened or air conditioned house. If not, mosquito nets may be attached to the windows

Usage of long-sleeved shirts, boots, socks and long pants is advised when outdoors

It is healthier to avoid being outdoors during dawn, dusk or early evenings when mosquitoes tend to roam around in the open

Mosquitoes are attracted to dark colored clothing hence it is better to wear bright and light colored clothes

Avoid strong perfumes, as mosquitoes are drawn towards strong body odours

Pediatric Onco Surgery:

Surgery in children with cancer has a major role in same tumors like Wilms Tumor, Neuroblastoma, Bone Tumor, Soft Tissue Sarcoma, Gonadal Malignancies, Brain Tumor etc and it has a supportive role in Leukemias and Lymphomas where mainstay of treatment is Chemotherapy. All surgical procedures are performed by surgeons who are specifically trained in the field of Pediatric Oncosurgery. Pediatric Cancers are potentially curable and in the modern era. The focus is to formulate treatment plans with minimum complication and suffering. Pediatric Oncosurgery plays a major role in decreasing the morbidities of cancer treatment.

Initially the treatment of long bone tumors was amputation of the limb but now most of the tumors can be resected without sacrificing limb especially if tumor is detected in early stage. We want to cure, but not by performing mutilating surgery. This is made possible by multimodality approach and working in close association with Pediatric Oncologist, Orthopedic Surgeons and Radiation Therapist.

While treating a pediatric cancer patient a lot of stress is laid down on maintaining the reproductive abilities of these patients. Pelvic tumor like PNET, Rhabdmyosarcomas which require Radiation Therapy to pelvis, may impair the ovarian functions and minimally invasive surgery can be undertaken, to move the ovaries out of the radiation field and thereby saving the ovaries from radiation.

Most of the pediatric patients are afraid of needle sticks. We deal with this problem by placement of central vascular access devices like PICC line, Hickman Line and Portacath. These devices make the oncology treatment acceptable and to a great extent painless. All the blood sampling can be done through these devices and all the IV medications can be given through these devices.

We work as a team throughout the treatment. Whenever the patient goes to operation theatre, an experienced Anesthesiologist provides Anesthesia to the patient. One of the parents is allowed to come with the patient to Operation Theatre, after wearing OT clothes. This process alleviated the anxiety of the patient to a great extent.

Category based treatment of tuberculosis in children:

Abstract:

Childhood tuberculosis is treated with multiple regimens for different clinical manifestations. World Health Organization has suggested a category-based treatment of tuberculosis that focuses on adult type of illness. To include children as DOTS beneficiaries, there is a need to assess the feasibility of classification and treatment of various types of childhood tuberculosis in different categories.

METHODS:

The study was conducted in the Pediatric Tuberculosis (TB) Clinic of a tertiary care hospital in North India. All children registered in the TB clinic were classified in four categories, similar to the categorization in World Health Organization’s guidelines for treatment of tuberculosis in adults. All children with freshly diagnosed serious form of tuberculosis were included in category I. Category II included patients who had treatment failure, had interrupted treatment, relapse cases and those who were suspected to have drug resistant tuberculosis. Patients with primary pulmonary complex (PPC), single lymph node tuberculosis, minimal pleural effusion and isolated skin tuberculosis were included in category III. Category IV included patients who did not improve or deteriorated despite administration of 5 drugs (as per Category II) for at least 2 months.
RESULTS:

A total of 459 patients were started on antituberculosis drugs and were available for analysis. Pulmonary tuberculosis was the commonest followed by lymph node tuberculosis. Identification of AFB was possible only in 52 (11 percent) of the patients and was more commonly seen in lymph node tuberculosis. The mean age of the children was 93 months and sex distribution was almost equal. 323 patients were in category I, 12 in category II, 120 in category III and 4 in category IV. 365 (80 percent) children completed the treatment. Of these, 302 (82.7 percent) were cured with the primary regimen assigned to them in the beginning, 54 (14.8 percent) required extension of treatment for 3 months and 9 (2.5 percent) patients required change in the treatment regimen. Side effect in form of hepatotoxicity was observed in 12 (2.6 percent) patients and was significantly more in patients who were getting category IV treatment.
CONCLUSION:

It is feasible to classify and manage various types of tuberculosis in children in different categories similar to WHO guidelines for adult tuberculosis.

Glaucoma :

Glaucoma is a group of eye diseases in which the normal fluid pressure inside the eyes slowly rises, leading to damage to the eye’s optic nerve resulting in vision loss or even blindness.

What causes Glaucoma?

At the front of the eye, there is a small space called the anterior chamber. Clear fluid flows in and out of the chamber to bathe and nourish nearby tissues. In Glaucoma, for still unknown reasons, the fluid drains too slowly out of the eye. As the fluid builds up, the pressure inside the eye rises. Unless this pressure is controlled, it may cause damage to the optic nerve and other parts of the eye and loss of vision.

How is it detected?

To detect Glaucoma the following tests are done:

Tonometry: This standard test determines the fluid pressure inside the eye. There are many types of Tonometry. One type is the “air puff,” test, which measures the resistance of the eye to a puff of air.

Visual Field: This test measures your side (peripheral) vision. It helps your doctor to find out if you have lost side vision, a sign of Glaucoma.

Pupil dilation: This examination provides your doctor with a better view of the optic nerve to check for signs of damage. To do this, drops are placed in the eye to dilate (widen) the pupil.

Optical Coherence Tomography: This is a newer diagnosis imaging technique which does high resolution cross sectional or tomographic imaging of biological tissues and hence helps in the early detection of glaucomatous optic nerve damage

SYMPTOMS:

Most types of Glaucoma cause no symptoms. Vision stays normal, and there is no pain. If Glaucoma remains untreated, people may notice that although they see things clearly in front of them, they miss objects to the side and out of the corner of their eye. Without treatment, people with Glaucoma may find that they suddenly have no side vision. It seems as though they are looking through tunnel. Over time, the remaining forward vision may decrease until there is no vision left. Some forms however cause pain, redness, vomiting, decrease in vision and colored rings around bulbs.

Treatments:

Patients benefit from our state-of-the-art Glaucoma testing capabilities and specially trained Glaucoma staff who have expertise in the diagnosis and the medical and surgical management of primary, secondary and complicated Glaucoma.

Although Glaucoma cannot be cured, it can usually be controlled. The loss of vision that already exists cannot be recovered. This makes early diagnosis and treatment important to protect vision.

Glaucoma treatments include:

Medications: These may be either in the form of eye drops or pills. For most people with Glaucoma, regular use of medications will control the increased fluid pressure. But, these drugs may stop working overtime. Or they may cause side effects. If a problem occurs, your doctor may select other drugs, change the dose, or suggest other ways to deal with the problem.

Laser Surgery: During laser surgery, a strong beam of light is focused on the part of the interior chamber where the fluid leaves the eye. This results in a series of small changes, which makes it easier for fluid to exist the eye. Overtime, the effect of laser surgery may wear off. Patients who have this form of surgery may need to keep taking Glaucoma drugs.

Surgery: Surgery can also help fluid escape from the eye and thereby reduce the pressure. However, surgery is usually reserved for patients whose pressure cannot be controlled with eye drops, pills or laser surgery.

FAQs:

Who is most likely to get it?

Glaucoma is one of the leading causes of blindness in India. Although anyone can get Glaucoma, some people are at higher risk. They include:

People over age of 45: While Glaucoma can develop in younger patients, it occurs more frequently as we get older.

People who have a family history of Glaucoma: Glaucoma appears to ‘run’ in families. The tendency for developing Glaucoma may be inherited. However, just because someone in your family has Glaucoma does not mean that you will necessarily develop the disease.

People with abnormally high intraocular pressure (IOP): High IOP is the most important risk factor for Glaucomatous damage.

People who have Diabetes, Myopia, Regular, long-term Steroid/Cortisone use and a previous eye injury.

Article by

Sankara Eye care.

Retinal Detachment:

Retinal detachment is separation of the retina from the underlying layers that line the inner wall of the eye. Through the retinal tear, liquid from the vitreous may pass through the tear, and detach the retina. As the fluid accumulates, more and more of the retina detach. Detached retina loses its function; hence the person with retinal detachment loses vision suddenly or gradually. more…

Although anyone can develop a retinal detachment, some people are at a high risk. Myopic patients (nearsighted people), those who have ‘weak areas’ in the retina, known as lattice degeneration, those who have had significant eye injuries, and those with a family history of retinal detachment are at higher risk of retinal detachment. Retinal detachment can also occur following cataract surgery.

Retinal Detachment is an emergency; Earlier the treatment better the vision.

What is Retina?

The retina is a thin sheet of light sensitive nerve tissue lining the inner aspect of the eye. The light that enters the eye passes through the cornea and lens and is focused on the retina. It is this layer of the eye that turns into light into the visual signal transmitted to the brain, allowing one to see. If the retina is damaged, spectacles alone cannot improve one’s vision.

What is Vitreous?

The vitreous is a clear jelly-like material that fills most of the space inside the eye. As we age, the vitreous often liquefies and the gel structure may collapse.

What is a Retinal Tear?

In most people, the vitreous gel separates from the retina easily without any problems. In some people, the gel may be strongly adherent to the retina and when gel separates it may tear the retina as well. When this happens, one may perceive “flashes of light” even if there is no light in the room or even if the eye is closed.

What causes retinal detachment?

The vitreous-a gel like material is present is maximum areas of eye. Meanwhile, the presences of retinal tear allow gel from vitreous space to pass through the hole and flow between the retina and the back wall of the eye. As a result the retina detaches from its underlying layer of support tissue at the back of the eye. The detached area of the retina will not function properly and if not treated initially the whole retina will peel off and the person may lose his/her vision.

Why do Retinal detachments occur?

Retinal detachment can occur for a number of reasons, some of these reasons include:

Shrinkage of the vitreous: The gel-like material that is present inside the maximum area of eye that may generate tugging on the retina and a retinal tear, leading to a retinal detachment.
Injury
Advanced diabetes
High Myopia

SYMPTOMS :

Most people notice floaters and flashes before the retina detaches. As the detachment increases a gradually enlarging dark shadow engulfs vision. It may appear as a curtain or a shade drawn slowly across the field of vision. Central retina is the area that helps one see fine detail also allowing one to read small print. When retinal detachment progresses to involve the central retina, the reading ability is lost. In complete retinal detachment, one may just see light and no other details.

TREATMENTS:

Retinal tears with minimal or no detachment can be treated on an out-patient basis using laser therapy or cryopexy (freezing) procedures. These treatments decrease the risk of a retinal detachment. Retinal detachment may rarely occur even after these treatments; it is hence essential that the patient is on regular follow-up after the treatment.

Once the retina is detached, surgery to reposition the separated retina is required. Scleral buckling or vitrectomy operation will be necessary to reattach the retina. Surgical treatment of retinal detachment requires admission to the hospital and a day’s stay. The patient may be allowed to go home in the evening. Surgery is usually performed under local anesthesia, by making the eye and area around it numb by giving an injection.

In Scleral buckling surgery, a flexible silicone rubber piece is sewn to the sclera (white of the eye) to close the hole. This surgery is performed on the outer wall of the eye.

Vitrectomy is performed by placing three micro incisions on the white of the eye and is performed within the eye ball.

An oil or gas may be placed within the eye to close the hole. If oil is placed inside the eye for reattaching the retina a minor surgery will be required 4-6 months later for removing the oil.

A simple technique of injection a gas bubble and doing laser or cryopexy may reattach the retina in a small group of patients. This technique is called Pneumoretinopexy.

FAQs :
Will I get my vision back if I have detached retina?

Retinal detachment is serious problem that needs early, highly specialized treatment. Despite surgery, one out of 10 people on an average may develop recurrence of the disease necessitating re-operation.

Retina being nerve tissue, some loss of function always occurs after retinal detachment. After successful attachment of the retina, vision will improve but not to normal levels. Visual recovery varies and depends on factors such as how soon after the detachment operation is performed and whether the central retina is detached or not, among others.

Article by
Sankara Eye care.

Computer Vision Syndrome:

Computer Vision Syndrome is the complex of eye and vision problems related to near work which are experienced during or related to computer use.” Computer Vision Syndrome results from focusing eyes on a computer display for protracted, uninterrupted periods of time. American Optometric Association studies indicate that 50% to 90% of computer users suffer from visual symptoms of computer vision syndrome.

Regular use of computers for more than 3 hours in a day is known to predispose to Computer Vision Syndrome in the presence of one or a combination of the following factors:

Uncorrected vision problems
Poor lighting
Improper viewing distances
Glare from the computer screen
Poor seating posture

Pixels in a computer are brightest at the centre and become dim towards the edges. Due to this, the eye muscles have to adjust constantly to maintain focus. The computer can make the eye focus nearly 25,000 times in a single day, as a result of which eye muscles work 3 times harder and blinking reduces by 70%.

All these factors add to the burden placed on the visual demands while working on the computers and thus contribute to the problem.

SYMPTOMS:

The vision problems due to computer vision syndrome result in visual inefficiencies and in eye-related symptoms. The symptoms occur whenever the visual demands of the task exceed the visual abilities of the individual over time.

The symptoms of Computer Vision Syndrome can be one or all of the following:

Eye Strain
Headaches
Blurred Vision
Dry Eyes
Temporary Blurring of Near or Distance vision
Light sensitivity
Red and Watering eyes
Neck and Back pain

The symptoms associated with Computer Vision Syndrome result in a gradual deterioration in the quality of life of an individual due to the fatigue associated with them.

Studies have shown that Computer Vision Syndrome negatively impacts productivity of Computer workers.

Treatments:

Computer Vision Clinic at Sankara Eye Hospital:

Many aspects of computers and the work environment in which they are used are likely to cause or contribute to the development of eye or vision difficulties. The symptoms associated with Computer Vision Syndrome can largely be resolved with right diagnosis, proper management of environment and by providing proper visual care for computer workers.

Sankara Eye Hospital offers holistic, specialized treatment for Computer Vision Syndrome at the Computer Vision Clinic.

Treatment of Computer Vision Syndrome is achieved by:

Glasses: Normal or specially designed for computer eye
Vision Therapy: included various exercise of the eyes that help the eyes to focus, move and to work together.
Eye Care: to prevent the recurrence of the symptoms of computer Vision Syndrome
Artificial tears: to reduce dryness of eyes
Altering ergonomics

FAQs:
Who is most likely to get it?

50% to 90% of computer users suffer from visual symptoms of computer vision syndrome.

What are the services offered by Computer Vision Clinic at Sankara Eye Hospital?

The services offered at the in-house clinic are:

Evaluation and consultation by experts in the field of Computer Vision Syndrome
Screening and diagnostic software that helps in through screening of Computer vision syndrome
Holistic treatment of Computer Vision Syndrome including Vision Therapy
Home Therapy System: With the help of this system, the client can undergo vision therapy at either his/her home/office
Option between Home therapy system or hospital sessions
Please note that the duration of the treatment will depend on the severity of the problem.

Article By
Sankara eye care.

Orbit & Oculoplasty :

Oculoplasty is a special discipline in ophthalmology that deals with plastic and reconstructive surgery of the peri-orbital and facial tissues which include the eyelids, orbit and lacrimal system. Services available include management of abnormal eyelid position (entropion, ptosis ), removal of eyelid tumors, lid reconstruction, lacrimal surgery, medical management of orbital infections & inflammations, medical & surgical management of thyroid eye disease, orbitotomy, repair of orbital fractures as well as rehabilitation of anophthalmic socket with orbital implants, BOTOX treatment for various therapeutic purposes and cosmetic enhancement of age related changes in facial skin (orbital fat prolapse, brow ptosis, wrinkles) to a more youthful appearance by a wide variety of cosmetic and functional surgical intervention (Blepharoplasty, brow lift, botox injections).
more…

Facilities available in Orbit and Oculoplasty department
Surgical and therapeutic

Well-equipped ophthalmic plastic operating rooms.
Radio Frequency Surgical unit
Endoscopy for transnasal procedures
LASER dacryocystorhinostomy
Custom made ocular and facial prosthesis

Eyelid and Eyebrow

Ptosis correction
Entropion and Ectropion correction
Eyelid tumor removal and reconstruction
Blepharoplasty and Brow lift
Botox injections

Lacrimal system

Dacryocystorhinostomy, external, laser and endoscopic endonasal
Management of congenital dacryocystitis

Socket

Enucleation with orbital mplant
Cosmetic evisceration with orbital implant
Socket reconstruction
Custom made artificial eye and facial prosthesis

Orbit

Orbitotomy
Decompression

Trauma

Eyelid trauma repair
Repair of Lacrimal Canalicular Laceration
Orbital fracture repair

BOTOX injections & Cosmetic lid surgeries

What is Orbit?

Orbit is the bony socket in the skull which houses the eyeball and other structures. It is akin to the jewel box which keeps the jewels safe and protected. Apart from housing the eyeball there are a lot of structures in the orbit. The extra ocular muscles, blood vessels, nerves and fat pads and connective tissues make the major contributors to the orbital contents apart from the eyeball.

What is Oculoplasty?

Oculoplasty refers to a subspecialty of ophthalmology which deals with the plastic reconstruction around the orbital region of the face. Conditions which warrant an oculoplastic surgeon intervention is an abnormal rotation or position of the lids, a swelling of the lids, a tumour of the lids, tearing of the eyes and orbital conditions such as fractures and orbital tumours.

What is Ptosis?

Ptosis is the medical term for droopy eyelids. Droopy upper lids may be present in children since birth or present in the early years of life. This condition can obstruct the visual axis in children and cause amblyopia (“lazy eye”). Early intervention usually surgery is imperative in such a condition. Adults can develop ptosis as a consequence of trauma, prior surgery, chronic lid inflammation, long term contact lens use or aging. There are various methods of correcting ptosis depending on the type, degree and severity of ptosis. Recovery from ptosis surgery is usually quite rapid, and patients find themselves returning back to work within a few days.

Tearing from the eye

Tearing eyes is a very common symptom. The causes may vary from emotional tearing to a problem in the ocular surface or swellings causing blockage of the drainage system to a frank block of the lacrimal drainage system of the eye. It is important to consult an oculoplastic surgeon to assess the cause of the block and the tearing. Treatment is generally medical but in some cases surgical procedures may need to be done to correct the drainage system abnormalities and diseases.

What are the abnormal rotational problems of the lids? (Entropion and Ectropion)

The eyelids maintain a close apposition to the globe. The close apposition of the lid margin with the globe maintains a delicate film of the tears known as the tear film. Any malposition of the lids can cause irritation resulting in tearing, pain, discharge and reduction in vision due to corneal surface irregularity. Entropion is a condition in which the eyelid is “turned in” toward the eye. Ectropion is a condition where the lower eyelid is “turned out” away from the eye. Both these conditions need to be surgically corrected to bring the lid back to its normal natural position.
TREATMENT
FAQs

Orbital Surgery

Orbital tumors: The orbit can have all different varieties of tumors. Tumors may arise from the bone, periosteum, blood vessels, nerves, fat and the connective tissues of the orbit. Most tumors mandate surgical removal and histopathological examination to know the nature and characteristics of the tumor and also to know whether it is a benign or a malignant tumor. Aggressive tumors may require coordination with other surgical specialists and oncologists.
Thyroid Decompression: Thyroid Eye Disease or Thyroid Related Orbitopathy (also known as Graves’ disease) is an autoimmune inflammatory disorder that affects the tissues of the orbit (i.e. eyelids, eye muscles and other soft tissues around the eyes.) Thyroid Eye Disease can develop and affect patients with varying degrees of severity. Surgical and non-surgical treatments exist to manage the complications of this condition including eyelid malposition or retraction, ocular proptosis (bulging eyes), and double vision.
Evisceration & Enucleation (removing blind painful eyes): In spite of all ophthalmic endeavors to save the eye and vision there may be situations when the eye may have to be removed. Removal of the eye results in an unacceptable cosmetic deformity which is corrected by the placement of an orbital implant followed later by prosthesis. “Enucleation “is the surgery where the eyeball is removed in entirety and “Evisceration” refers to removal of the contents of the eyeball but leaving the outer coat of the eyeball intact.
Orbital Trauma & Fractures: Trauma to the orbit can result fractures of bones of the orbit. When these fractures cause symptoms such as double vision or when the fracture is large, surgical repair is normally recommended. The surgical repair is typically performed within a few weeks of the injury.

What is DCR Surgery?

DCR (Dacryocystorhinostomy) refers to a surgical procedure to correct tearing of the eyes due to a block in the drainage system of the eyes. There are various ways to do a DCR procedure. It may be done from the nose (Nasal endoscopic DCR)or from the skin or external approach. There are lasers to assist in the procedure as well. The oculoplastic surgeon will discuss and decide on the best option for the patient.

What is BOTOX?

Botox or Botulinum Toxin A is a toxin derived from the bacteria Clostridium botulinum manufactured by Allergan, USA. BOTOX is injected into muscles and used to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (Blepharospasm) and face ( hemifacial spasm)in people 12 years and older. Blepharospasm (BLEH-far-o-spaz-em) is a muscle disorder that causes involuntary spasms of the muscles around your eye. Botox is a US FDA approved drug for the treatment of Blepharospasm and millions of patients have benefitted from the drug worldwide. Botox injection is an outpatient procedure and the results will be discussed by the oculoplastic surgeon.

What is Artificial eye (Prosthesis)?

Following removal of an eye the orbital socket is “empty”, or devoid of the eye. The deficiency of volume is corrected by the placement of an orbital implant. This though corrects volume it does not provide adequate cosmesis. An artificial eye or prosthesis is the cosmetic answer to the problem.

Ocular prosthesis is made of a very fine medical grade plastic that is molded, colored and polished to create a realistic and comfortable artificial eye. The plastic is lightweight, yet tough enough to resist breakage if dropped. Each artificial eye is custom made and designed to specifically fit the individual eye socket. The ocular prosthetic is hand painted using the patient’s companion eye as a model and guide for matching. Our methods and technique allow us to create a custom prosthetic eye with the best possible cosmetic results.

What are the cosmetic lid surgeries?

Cosmetic surgeries can be performed around the lids, both upper and lower lids, for facial enhancement. Surgeries involved are upper and lower lid blepharoplasty and brow lifts. Surgery is done to correct “puffy” upper lids and lower lid “bags”. The “puffy lids” and lid “bags” occur due prolapse of orbital fat following a defect or thinning of the orbital septum. The incisions given for the procedures are either given subconjunctivally or masked along the existing lid folds to give an excellent cosmetic result. The excess or prolapsed fat is either removed or readjusted over the face to correct cosmetic blemishes. Recovery from the surgery generally takes about 7 to 14 days.

Brow ptosis is a droop of the brow giving rise to a “tired aged” look. Conversely brow ptosis may exist along with ptosis of the lids. There are many different ways to correct brow ptosis, your surgeon will discuss the options and pros and cons of each procedure before planning the surgery. When there is an additional ptosis of the lids along with brow ptosis, both the problems can be addressed together.

Some patients may have “crow’s feet” appearance at the outer aspect of the eye lids. Crows feet give rise to an aged appearance and are usually prominent when patients smile or laugh and are also known as dynamic wrinkles. These are corrected using a combination of BOTOX injections and filler injections. The cosmetic acceptance following these procedures is very high.

FAQs:

Why are eyelid swellings important to consult an oculoplastic surgeon?

There are many types of eyelid swellings, some can be observed safely while others should be biopsied or completely excised. Depending on the location and other general characteristics of the swelling a decision will be taken whether to biopsy the swelling or to completely remove the lesion. Some of the most common benign eyelid lesions are chalazion (stye), cysts, skin tags, and nevi (moles).

Facial weakness and the oculoplastic surgeon

Weakness of the facial nerve will lead to weakness on one side of the face. Depending on the severity of the weakness, the eyelids and eye itself can be affected. There can be weakness in blinking and closing the eyelids that can result in irritation, pain, and a potential risk for infection. Surgical and non-surgical techniques are available to protect the eye and provide symptomatic relief and functional improvement.

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Sankara eye care

Squint:

A Squint (Strabismus) is a condition of the eye that causes one of the eyes to turn inwards (converge), outwards (diverge) or sometimes upwards, while the other eye looks forward. The cause, severity, and direction of a squint vary from person to person. It is usually spotted in childhood, sometimes within weeks of a baby being born, and affects 5-8% of children (1-2 in every 30).
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A squint can occur for a number of reasons, these include:

Poor vision in one or both eyes
A need for glasses
Poor development of the eye muscle control centres in the brain
Damage to the nerves controlling eye muscles

What causes a Squint?

There are six muscles attached to the outside of each eye that are responsible for eye movements. When there is an imbalance of these muscles, a Squint occurs. The cause of the squint may not be obvious but can include a family history, long or short sightedness, injury or viral illness.

SYMPTOMS:

The most common symptom of a Squint is one of the eyes not looking straight ahead. In newborn babies it is quite normal for their eyes to ‘cross’ occasionally, particularly if they are tired. However, if you notice that this happens to your child beyond three months of age, it is advisable to talk to your ophthalmologist.

Your child may also look at you with one eye closed, or with the head turned to one side. These may be clues that they are experiencing double vision, and could be a sign that they have a Squint.

TREATMENTS:

A Squint is a condition that should be treated as soon as possible after it’s detected. Treatment is most effective in very young children.

A Squint will not disappear as the child gets older, and in fact the sight in the affected eye will gradually get worse.

There are several types of treatment available:

If your child is long sighted, glasses may be prescribed which can often correct the long sight and squint.
Alternatively, a patch may be needed to be worn over the good eye, to encourage the eye with the squint to work harder and become trained to work properly.
In some cases, the Squint can be treated with special eye drops, or with eye exercises.

If none of these treatments helps, then surgery may be required. Surgery for Squint involves moving the muscles attached to the outside of the eye to a new position. It may sometimes be necessary to operate on both eyes in order to ‘balance’ them effectively, even if the Squint is only in one eye.

If your child is long sighted, glasses may be prescribed which can often correct the long sight and the Squint.

Non-Surgical treatment modalities

Prisms, refractive lenses and pharmacologic measures have been used to help patient achieve fusion (alignment of the eyes) and alleviate diplopia, in addition to surgery. Some patients will adapt by suppressing the vision of one eye to eliminate their diplopia. An additional technique is the use of Botulinum toxin.

FAQS:

If my child needs an operation what happens next?

Your child will be sent an appointment for pre-assessment where we will measure the size of the Squint. The surgeon will see you and your child to discuss the details of the surgery. Our anesthetist would examine the child and advise any laboratory investigations for fitness for the surgery.

Are there any risks?

Although most Squint operations successfully straighten the eyes all surgery carries risks and Squint surgery is no different. The following are recognize

There may be some bruising on the eye, which can make it look red for a few weeks.
There may be under or over correction of the Squint.
There may get some double vision although this often settles.

The result of Squint surgery is not completely predictable as the healing and the brain-eye coordination are variable. If the eye is not quite straight after the operation it may settle by the three month post-op appointment. If it does not then we may need to prescribe prisms or do a further operation to improve the position of the eyes.

Adjustable Stitches

In some adults who undergo Squint surgery a better surgical outcome may be achieved by using adjustable stitches. The doctor will tell you if this is an option. The operation is performed under general anaesthesia and the stitches are tied in a bow at the end of the operation. You are then woken up and the eyes position measured.

If the eye position has not been altered enough we can tighten up the bow to adjust the position, using some drops to numb the eye. This makes the operation more precise , especially, when there has already been previous surgery.

Post Operation

The eye will be mildly sore after the operation for a few week days. Redness will last for two to four weeks, but will get better each day.
Covering the eye is not necessary
Your child’s tears will appear a little blood stained for few days. This is normal.
The stitches used in Squint surgery are dissolving, so will not require removal.
You will need to use eye drops or ointment as per doctor advice.
If your child wears glasses, he can continue to wear them after the operation unless told otherwise by your consultant.
Your child’s eye may be little sticky after the operation, and the lids may be stuck together with mucus after sleep. This can be cleaned by using cooled boiled water and cotton.
If the stickiness and redness do not improve each day or gets worse contact your ophthalmologist.

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Sankara eye care

Amblyopia

Amblyopia is reduced vision in an eye that has not received adequate use during early childhood. Amblyopia, or “lazy eye,” has many causes. Most often it results from either a misalignment of a child’s eyes, such as crossed eyes, or a difference in image quality between the two eyes (one eye focusing better than the other). Amblyopia is the most common cause of visual impairment in childhood. The condition affects approximately 2 to 3 out of every 100 children.
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What causes an Amblyopia?

Amblyopia mainly occurs during childhood when the nerve pathway from one eye to the brain does not develop.Generally, when the eyes are not working together send a wrong or blurred image to the brain. As a result, brain confuses and may start to ignore the image from the weaker eye resulting in amblyopia.

Strabismus is one of the most common causes of amblyopia. However, amblyopia can occur with or without strabismus and vice versa.

Other causes include Farsightedness, nearsightedness, astigmatism or childhood cataracts, especially if it is more in one eye.
SYMPTOMS:

Amblyopia mainly develops in the child of age group below 6. The signs mention below may not necessarily indicatethat the child has amblyopia. In most of the cases, good eye and the brain make up for the problem so well that the child does not notice he/she has Amblyopia. Due to this reason, it is advised that children should get full eye check-up at 6 months, and again at 3 years.

The symptoms of Amblyopia include:

Eyes do not appear to work together
Dual vision
Significant favoring of one eye
Blurred vision
Poor depth perception
Poor vision in one eye
A squint (either upwards, downwards, outwards, or inwards).

Tratments:
The goal of amblyopia treatment is to improve the visual acuity of the poorer eye, so that it equated to the acuity values of the preferred eye, or to get the patient within one or two lines of the target acuity.With early diagnosis and treatment, the sight in the “lazy eye” can be restored. A recent NEI report suggests that older children can also benefit from amblyopia treatment.

Before treating amblyopia, it may be necessary to first treat the underlying cause.

Glasses are usually prescribe to improve focusing or misalignment of the eyes.Surgery may be performed on the eye muscles to straighten the eyes and for allowing them to work together better. Eye exercises may be recommended either before or after surgery to correct faulty visual habits associated with strabismus and also to teach comfortable use of the eyes.
Patching or covering one eye may be required for a period of time ranging from a few weeks to as long as a year. The better-seeing eye is patched, forcing the “lazy” one to work, thereby strengthening its vision. Any prescription glasses would need to be worn over the patch.

Help your child understand why the patch is needed. Rewards, support, and reassure your child. This will help your child comply with the patching treatment so that he or she can develop the best vision possible.

Here are some of the things you can do to help your child wear the patch and make the treatment more effective.

Talk to your child before treatment begins. Explain that the patch is needed to help make vision in the affected eye stronger.
Explain to family and friends why your child is wearing patch and how important it is that the patch stays on. Ask them to be supportive.
If your child is in day care school, talk with the caregivers and teachers. Often they will be glad to explain to your child’s classmates why he or she is wearing the patch and how they can help your child’s treatment be successful. This can help your child feel more comfortable in school.
Some parents have had success with a reward calendar, marking each time the child wears the patch as prescribed. Consider providing rewards when your child wears the patch without complaints and difficulties.
Schedule the times when your child wear the patch. It may be possible to wear the patch only at home. Then your child can avoid any teasing comments that may hurt because of the patch.
Try to minimize skin irritation when using hypo-allergic adhesive patches. This kind of patch occludes sight better than those with elastic bands or patches glasses. If your child is wearing adhesive-type patches, let him or her decorate them.
Spend time with your child just after the patch is put on. It takes a short time-about 10 or 15 minutes – for the brain to adjust to having the dominant eye covered. Doing something funny during this time can make the transition smoother.
Give your child as much attention while he or she is wearing the patch. Your child will enjoy the time spend you spend together, and this will help take his or her mind off the patch. Find the game & activities that capture your child’s attention and make the affected eye work harder.
Patching treatment for amblyopia will be more effective if your child’s weak eye has to work harder while the normal eye is patched. Games and activities that require visual acuity and eye-hand coordination work well.
Ensure your child wears the prescription glasses over the patch.
Include one hour of near work while the child is being patched.
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sankara Eye care