EYES AT RISK - Full extract 

Mollie Fogarty loves her tennis. At 55 years of age she still plays in two midweek competitions. In recent months she felt that she wasn't seeing the ball as well as she used to. She wasn't sure, but it seemed as if the outer part of her vision was missing. 

She noticed the same thing on one occasion when she went to a movie. She covered one eye then the other. Yes, there was definitely something wrong with her right eye. She was a bit caught up with family commitments and decided to leave it until she came down for a Pap smear later that month. 

" It's about time I had my glasses checked again," she said. " This right eye of mine has been playing up for a while." With further questioning it was evident that she had been progressively losing vision in her right eye for several months. I was able to confirm this with a simple test of her fields of vision. With the ophthalmoscope I couldn't get a very clear view of the back of her eyes. However, there was no evidence of lens problems such as cataracts, or any other reason why her vision had deteriorated. When I asked about family history, she said that her mother had glaucoma for some years before she died. 

I rang one of our ophthalmologists and arranged an appointment for Mollie later that day. A diagnosis of glaucoma was made and she was immediately started on special eye drops. The pressure in her eye is no longer elevated and there has been no further loss of vision. Unfortunately, the vision that Mollie had lost has shown no sign of returning. 

 Glaucoma affects about 2% of Australians over the age of 40 and is a major cause of blindness. It occurs when there is an increase in pressure within the eye. Sometimes glaucoma can be acute and cause symptoms such as a painful red eye and foggy vision. More often it is gradual in onset and there may be no symptoms at all. For this reason, everyone over the age of 40 should have a simple glaucoma test. This is especially important if there is a family history. With early detection and treatment, and regular review by the eye specialist, loss of vision can be prevented. 

There are a number of other conditions that can lead to permanent loss of vision. Fortunately, there are clues to alert us. Any of these symptoms requires an urgent check with your GP, and in some cases referral to an eye specialist. 

A painful red eye.  This might be caused by acute glaucoma, injury to the eye, a foreign body, and various eye infections. It can also be caused when the coloured part of the eye, or iris, becomes acutely inflamed. Because these conditions can all be serious, a painful red eye must always be checked. 

Loss of vision.  This is probably the most important symptom of all. Sometimes the loss of vision can be very sudden, as with a clot in a blood vessel at the back of the eye. It may also be gradual as with diabetes, chronic glaucoma, and cataracts. It may be a central loss of vision or it can involve just one part of the visual field, such as the lower half of one eye. Any loss of vision needs to be urgently checked with your doctor. 

Odd visual disturbances  can point to a serious eye problem. The retina is like a satellite dish at the back of the eye. In its centre is the optic nerve. Images of light travel through the pupil and are focussed by the lens onto the retina. This information is then relayed by nerve impulses to the optic nerve and then to the brain. 

With a detached retina, part of it buckles and lifts up. Crazy flashes of light occur, sometimes described as being like hundreds of flashlights going off in rapid succession. Early diagnosis is essential if the retina is going to be satisfactorily repaired. These visual disturbances are very different to the common zig-zags and shimmering vision that can accompany migraine. 

A blocked blood vessel may produce loss of vision or an effect like looking through a lace cloth. Any of these symptoms need urgent sorting out. 

Headaches  can occur with acute glaucoma and with some eye infections. With another condition called temporal arteritis, the artery that runs up the side of the temple becomes acutely inflamed and tender. Early diagnosis is essential because the blood vessels that supply the optic nerve can also be inflamed, and permanent loss of vision can occur without proper treatment. 

A foreign body in the eye  is always potentially serious. Special care is required if there is any possibility of a penetrating eye injury, for instance from a piece of metal flying into the eye while someone is using a grinder. Severe eye infection with loss of vision can occur if the condition goes undetected or treatment is delayed. With some jobs protective goggles are absolutely essential. 

Trauma to the eye  is another area of concern. Double vision may suggest a fracture in the roof of the space behind the eye, something that may warrant early treatment. Likewise, reduced vision after a blow to the eye may be a clue to an underlying haemorrhage in the eye or some other injury. A significant blow to the eye always requires a full assessment. 

Health Tip:
* If there is the slightest suspicion that your eyesight is at risk, see your doctor urgently for a full assessment.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001