Main visual conditions in adulthood

Astigmatism is a refractive error that causes blurred and distorted vision, both near and far vision, and that manifests itself when images are focused on several points on the retina. In contrast, in emmetropic (non-prescription) eyes, images focus on a single point on the retina.

People who suffer from astigmatism are characterized by alterations in their corneal curvature, that is, their cornea has an irregular curvature, instead of being symmetrical.

This visual anomaly does not always occur in isolation, as it is often associated with myopia or hyperopia.

Like nearsightedness and farsightedness, astigmatism can be genetically determined. It may also occur after trauma, injury, or illness, or as a consequence of eye surgery.

Astigmatism is the third most common visual problem among Spaniards (behind myopia and presbyopia or eyestrain), since more than a quarter of the population suffers from it.

The main symptom of astigmatism is blurred and distorted vision of near and distant objects, as well as difficulty perceiving small details at all distances.

When astigmatism is associated with hyperopia, it is common for the patient to present symptoms such as visual fatigue, redness, itching and stinging of the eyes, dizziness or occasional headache, due to the overexertion made by the eye to focus on images.

The symptoms that the patient may perceive are different depending on their age, type of astigmatism or prescription. However, in mild cases it is possible to miss any signs of astigmatism.

It consists of a micro-tear in the macula (central part of the retina), as a consequence of the tension generated by the vitreous gel when it naturally detaches from the retina, to which it is attached. In some cases, the vitreous gel does not separate completely from the retina and remains attached to some areas. These areas of vitreomacular adhesion exert a traction force on the macula that can eventually lead to the formation of a macular hole.

There are different types of macular holes depending on whether they totally or partially affect the thickness of the retina.

The macular hole is usually due to the aging process, although there are also other risk factors that may influence its appearance, such as myopia (in myopic patients it may lead to retinal detachment ), certain eye injuries or a long-lasting ocular inflammatory process.

The visual consequences of this progressive pathology will depend on the degree to which it is present. Although, at first there are no symptoms, it can cause a significant loss of vision.

In an initial phase, during the formation of the macular hole, there is an alteration of vision that results in mild blurred or hazy vision. If the macular hole evolves and enlarges, a dark spot may appear in the central vision, the size of which depends on the area that has been affected, as well as a distortion of the image.

It is very important to detect this disease early, when the formation of the macular hole is still in its initial stages, in order to achieve a better visual recovery. For this reason, if any of these symptoms occur, it is necessary to consult an ophthalmologist immediately for an in-depth study to rule out or confirm the diagnosis.

It is an inflammation at the edge of the eyelid (eyelid margin), mainly due to the glands located in this area of the eye producing too much fat. The accumulation of this fat favors the excessive proliferation of a series of bacteria (generally staphylococci), whose presence on the skin does not cause problems under normal conditions.

The most common symptoms include redness of the conjunctiva and/or eyelid margin, irritation of the eyelids or eyestrain. In more severe cases, the appearance of blepharitis may adversely affect vision.

Some of the ocular complications resulting from blepharitis are styes and chalazia.

They are caused by a displaced fat accumulation in the lower eyelid. This type of aesthetic defects associated with the natural aging of the skin can be corrected by a surgical treatment called blepharoplasty, which improves the patient’s aesthetic appearance, rejuvenating their look.

Conjunctivitis is the inflammation of the conjunctiva, a thin, transparent membrane that covers the inside of the eyelids and the white part of the eye (sclera). Being an external mucosa, it is exposed to agents that can irritate it. When this happens, the blood vessels become inflamed and the eye is reddened.

It is one of the most frequent pathologies in ophthalmology, both in adults and children. In most cases it does not usually compromise the patient’s visual health, evolving favorably as long as it is treated correctly.

The most frequent causes of conjunctivitis are bacterial or viral infections, as well as an allergic reaction due to exposure to an allergen (pollen, mites, etc.). Exposure to chemical substances or the presence of foreign bodies can also cause conjunctival irritation.

It is the inflammation of the lacrimal sac, generally as a consequence of an acute or chronic infectious process, which causes the obstruction of the lacrimal-nasal duct. Other causes of this pathology are, although to a lesser extent, the existence of nasal trauma, nasal polyps or previous nasal surgery. Dacryocystitis is when tears accumulate in the lacrimal sac because they do not drain properly, and end up spilling to the outside of the eye.

The most frequent symptoms include constant tearing (epiphora), redness due to inflammation, painful edema in the inner part of the lower eyelid, i.e. in the area of the lacrimal sac which is swollen with fluid accumulation, and conjunctivitis. Occasionally, secretions through the lacrimal punctum and fever may also occur.

Dacryocystitis can affect newborn infants due to congenital obstruction of the tear duct, which hinders or prevents the drainage of tears.

When it manifests itself suddenly and acutely, the patient suffers a rather painful inflammation that should be treated urgently to avoid possible complications. On the contrary, when the infection is chronic, it presents milder but recurrent symptoms.

Retinal detachment occurs when the retina separates from the tissue to which it is attached (pigment epithelium) and which supports it, even if it is only a portion of its entire length. This separation can cause retinal tears or holes, through which the vitreous gel gradually seeps and can end up detaching the retina completely.

When this occurs, the affected area stops functioning properly and generates an abrupt loss of vision. In order to prevent the damage suffered from producing retinal atrophy, chronic ocular inflammation, or even causing severe visual limitation that is irreversible, this condition should be considered a medical emergency and should be treated immediately by an ophthalmologist.

Some of the risk factors that can trigger retinal detachment are family/personal predisposition to have a weak retina, myopia (high prescriptions) and diabetes (complication associated with advanced diabetic retinopathy). However, in healthy people, it can also occur as a consequence of ocular trauma.

Retinal detachment does not cause pain and its symptoms are always visual.

As a consequence of the inadequate functioning of the detached portion of the retina, in an initial phase, which is when the tear occurs, the first noticeable symptom felt by the patient is the sudden and intense appearance of floaters or dark spots that change position when the eye is moved.

These are shadows that are projected on the retina, due to the vitreous gel filtering through the first tears. The appearance of these spots in the vision does not necessarily imply any problem, but if they occur in a striking way, it is of vital importance to have an ophthalmologic evaluation immediately to determine their causes and rule out a possible case of retinal tear or hole in the retina.

As the retinal detachment progresses, the patient will notice flashes of light, distortion of images, as well as a veil or black cloth covering an area of his visual field, limiting his peripheral vision. In case of suffering from these symptoms, an urgent consultation with the ophthalmologist should be made.

It is a physiological process related to the aging of the eye that occurs when the vitreous humor, which is the transparent gel that fills the eyeball, modifies its consistency so that some areas liquefy and others condense. Over time, the vitreous degrades naturally, causing the hyaloid, the membrane that surrounds it, to spontaneously separate from its attachment points on the retina.

Among the causes that can cause the appearance of a posterior vitreous detachment, in addition to advanced age (it is more common around the age of 60), are high myopia, trauma or ocular inflammatory processes.

The most frequent symptoms when the vitreous is detached are the sudden sight of a multitude of dark spots that the patient perceives in the form of a spider web or web and that move from one place to another accompanying the movement of the eyes.

There are patients who also describe the appearance of flashes of light (photopsias) on one side of the visual field, mainly at night or in low light conditions, as well as a certain visual decrease.

Unlike vitreous detachment, the patient who suffers from floaters (floaters) should know that the main symptom to identify them is the vision of small, floating, translucent spots, which have been manifesting for a long time without suffering any change in their form of presentation. As long as they are detected in time, they do not constitute an emergency.

However, if the patient notices a sudden increase in the size and number of floaters that may be accompanied by the appearance of flashes of light, it is advisable to go to the ophthalmologist for an assessment that rules out retinal detachment or similar lesions.

Although vitreous detachment usually occurs without incident, it may exceptionally happen that, when the hyaloid separates from the retina, it causes a tear with light bleeding (vitreous hemorrhage), and even evolves to a retinal detachment.

Ectropion consists of the rotation of the lower eyelid outwards, away from the eyeball, the consequences of which are similar to those of entropion (constant tearing, irritating and stinging action on the ocular surface, etc.).

Entropion is the inversion of the lower eyelid inwards, that is, towards the eyeball, so that the eyelashes contact the cornea. This continuous contact causes irritation and eye itching that is very uncomfortable for the patient, excessive tear production, and can even cause more serious lesions such as erosions or ulcers.

Macular edema is a swelling of the retina at the level of the macula, which is the part responsible for central and detailed vision. This complication is due to irritation of the blood vessels that irrigate the retina and cause fluid leaks. As a result of these leaks, fluid accumulates in the macula and impairs its proper function. The result of this complication is a mild or severe loss of vision, although peripheral vision is maintained in many cases.

Although the causes of macular edema can be multiple, the risk of developing it is usually associated mainly with complications of ocular pathologies such as diabetic retinopathy, age-related macular degeneration (AMD), venous thrombosis (obstruction in the retinal veins) or uveitis. Occasionally, it may be a consequence of an ocular surgery procedure.

When macular edema develops, it can cause symptoms in central vision, such as blurred vision, distorted vision of straight lines, and a feeling of darkening of images in the center of the visual field.

Farsightedness is a refractive error that causes blurred and uncomfortable vision of nearby objects (and sometimes also distant objects). Unlike myopia, the images are focused behind the retina and not directly on it.

People who suffer from hyperopia are characterised by alterations in the different structures of the eye such as its corneal curvature, the optical power of its lens (low power) or the size of its eyeball (shorter than normal length).

Like myopia, farsightedness has an important hereditary component.

The main symptom of farsightedness is poor near vision. If the hyperopia is low, the patient will see well at a distance, although their effort to focus or accommodate will be greater. This can lead to other symptoms such as headache and eye strain.

In many cases, its effects are not noticed until, from the age of 40, the ability to accommodate is reduced.

The epiretinal membrane (ERM) is the proliferation of fibrous tissue that grows on the macular surface, forming a kind of mesh that alters its functionality. When this membrane, which is attached to the retina, contracts, it induces a certain degree of distortion in the retina.

Generally, the epiretinal membrane develops as a result of a posterior vitreous detachment. Over the years, the vitreous humor may separate from the retina, allowing the passage of cells through it, which stimulates the appearance of this tissue.

Other less frequent causes are intraocular inflammation, retinal detachment or severe ocular trauma.

These membranes are more common after the age of 50, but can appear at any age.

This pathology is usually asymptomatic when it is in an incipient stage or the symptoms may be very subtle. In fact, many people who have macular epiretinal membrane are unaware of it.

However, in some patients, sometimes there is a contraction of the membrane that wrinkles the retinal area to which it is attached, reducing their central vision. As the membrane progresses, the symptoms that appear are diverse: blurred vision, deformation of objects(metamorphopsia), appearance of a spot in the central vision, luminous flashes(photopsia), among other manifestations.

In case of any of the symptoms described above, it is very important to see an ophthalmologist for a fundus examination to determine the degree of opacity of the epiretinal membrane, as well as the distortion it is causing in the retina.

Myopia is a refractive error that manifests itself when distant objects are projected at a point in front of the retina, instead of on it. As a result, a distorted perception of the image occurs and, therefore, vision is blurred and poorly defined.

People who suffer from myopia are characterised by alterations in the different structures of the eye such as its corneal curvature, the optical power of its lens (excessive power) or the size of its eyeball (excessive length).

Myopia is the most common visual defect among people under the age of 45 and can be associated with other refractive errors, such as astigmatism (myopic astigmatism) and presbyopia or eyestrain.

The main symptom of the patient with myopia is that they have poor distance vision and yet optimal near vision. Other symptoms you may suffer from are eye strain, headache, difficulty concentrating, permanent dry/itchy eyes, etc.

It is the most common condition of this area of the eye and may be congenital (from birth) or develop during adulthood.

The lacrimal ducts consist of several anatomical parts. The lacrimal punctum, where they start, the upper and lower caniculi, also known as lacrimal ducts (they channel the tear into the lacrimal sac), the lacrimal sac, whose role is fundamental in the tear drainage system, and the nasolacrimal duct (duct that goes from the lacrimal sac to the nose).

The obstruction of the lacrimal duct is manifested by the difficulty in the elimination of tears, whose functions of protection, hydration and lubrication of the eyeball are essential in the visual system. This difficulty is due to the alteration of its natural drainage system.

The main symptoms derived from this pathology are constant tearing (epiphora), which can be quite annoying and uncomfortable for the patient depending on the amount of tears produced and the degree of obstruction of the tear duct (partial or total), secretion (eye discharge), eye redness and even infections in the lacrimal sac(dacryocystitis).

These are total or partial obstructions of the retinal blood vessels that hinder the flow of blood through them. Depending on the location of these obstructions, two types can be differentiated: occlusions in the central vein and occlusions in the branch vein, which is the area where arteries and veins cross.

In the case of venous occlusions, the venous return is interrupted and the retinal area becomes flooded. This type of obstruction is usually due to the presence of a thrombus, so any disease that favors thrombus formation may contribute to this ocular pathology.

In the case of arterial occlusions, the main consequence is the lack of blood supply to the retinal tissue, which no longer receives an adequate supply of nutrients, especially oxygen, which can lead to infarction (ischemia). It is important to bear in mind that sometimes the arterial obstruction is caused by a thrombus coming from another part of the body.

Diabetes, hypertension, cholesterol and tobaccoconsumption, as well as cardiovascular diseases that favor thrombus formation, constitute the main risk factors for these cardiovascular accidents.

Retinal venous occlusion represents the most frequent vascular condition causing vision loss after diabetic retinopathy. It occurs in adulthood and usually affects men and women equally.

Venous and arterial obstructions in the retina cause a sudden and painless visual decrease or loss. Depending on the area of the retina where they are located, this pathology may be asymptomatic for the patient.

The degree of visual impairment will depend on whether it is a venous or arterial occlusion. In the latter case, the obstructions cause an infarction of the tissue and, therefore, an irreversible loss.

Another determining factor is the caliber of the obstructed vessel. The visual alteration that the patient may suffer differs notably when the obstruction is located in the central vein or in a peripheral vessel.

Finally, if the central area of the retina (the macula) is involved in this vascular complication, the visual loss will be even greater, even if it is a mild arterial or venous occlusion.

Although this symptomatology is almost imperceptible at a very early stage, in a short period of time it can become more serious and irreversible. For this reason, it is essential to identify and manage possible complications as soon as possible.

The appearance of these symptoms should lead the patient to make an appointment with the retina specialist as soon as possible. A complete examination will allow you to diagnose whether there is an artery or vein obstruction, assess the extent of retinal damage and determine the treatment to be followed.

Dry eye, also known as dry eye syndrome, is one of the main causes of consultation to the eye specialist. In fact, it is a common eye disease caused by inadequate lubrication of the ocular surface.

In other words, the eye is not sufficiently hydrated, either because of a shortage of tears or because their quality is not optimal. This abnormal functioning of the tear film affects more and more people, to the point that about 30% of ophthalmology patients have this condition.

As a consequence of dry eye, inflammation occurs on the surface of the eye that can cause different discomforts such as mild irritation, dry and gritty sensation, burning, itching, intolerance to contact lenses and heaviness of the eyelids.

Some of the main causes of dry eye are related to age (the older you are, the greater the possibility of developing it), gender (women are more prone to this disease), contact lens use, prolonged exposure to screens and electronic devices that require fixing the eyes and reducing the frequency of blinking, and environments with low humidity.

In these cases, the treatment indicated by the specialist involves controlling the inflammation of the eye and restoring the ocular surface by means of an adequate hydration and lubrication regimen.

It is an autoimmune disorder that affects to varying degrees the tissues of the eye socket, which is the bony cavity into which the eye is inserted and is associated with a dysfunction of the thyroid gland, fundamentally, hyperthyroidism, although not always.

This disease is characterized by the immune system acting against soft tissues of the orbit and periorbital region, such as the extraocular muscles, the eyelids or the fat located behind the eye, causing inflammation of these structures.

Initially, symptoms are mild and include dryness, eye redness, a feeling of pressure around the eyeball, and heaviness of the eyelids. However, as the inflammation evolves, the patient may present a retraction of the eyelid (eyelid retraction), exaggerated opening and displacement of the eye outwards (exophthalmos or bulging eye disease), alterations in vision such as permanent double vision (diplopia) or strabismus, and even loss of visual acuity due to compression of the optic nerve.

These are two types of eyelid disorders, very frequent in any age group, which are often confused as they have a similar appearance. However, their origin and the way they are treated are different.

Orzuelos

A stye is a small, reddish, usually painful bump that grows at the base of the eyelash (external stye) or on the inside of the eyelid (internal stye). People with oily skin (seborrheic dermatitis) or other skin diseases such as acne, psoriasis or rosacea are more prone to styes.

The appearance of both types of styes has an infectious origin in most cases, either from the hair follicle of the eyelash, in the case of an external stye, or from the oil-producing gland of the eyelid (Zeiss gland), in the case of internal styes. Although it is an acute infection, it generally does not pose any serious risk to vision.

Stress, hormonal changes or blepharitis are some of the preconditions that can trigger these types of visual conditions.

Chalazions

Chalazion is an inflammatory lesion similar to a cyst, with a hard consistency, which appears in the upper or lower eyelid as a consequence of the obstruction of the Meibomian glands, which are sebaceous glands located inside the eyelids. Unlike the stye, its origin is not infectious and it is usually painless to the touch.

However, in very specific cases, a large chalazion on the upper eyelid may cause blurred vision and astigmatism, due to the pressure it exerts on the eyeball.

Presbyopia, better known as eyestrain, is the progressive decrease in the focusing capacity of the lens, a structure that works in a similar way to the zoom of a camera.

The normal eye, at rest, is adapted for distance vision. When vision of nearby objects is required, the eye must change focus, making an effort known as accommodation. This effort of accommodation is made by the crystalline lens, which is the natural lens of the human eye.

As we age, our quality of vision worsens with age. Usually, between the ages of 40 and 45, the lens loses its elasticity, becomes stiffer, and the muscles and ligaments that control it weaken. This makes everyday tasks such as reading or using the mobile phone difficult and, inevitably, causes the appearance of presbyopia or eyestrain.

The evolution and progression of presbyopia varies, from its onset around the age of 40 to approximately 60, at which time presbyopia usually stabilizes.

It is estimated that 81% of the Spanish population over 45 years of age and 98% of those over 65 years of age suffer from presbyopia. The incidence of this condition is increasing due to the progressive aging of the population, the increase in life expectancy, the improvement of health conditions, as well as the intensive use of electronic devices that generates an overexertion of the eye.

The main symptom of presbyopia is poor near vision, which manifests itself by difficulty focusing on objects that are at a short distance, usually less than one meter, or performing precision tasks. To compensate, patients with presbyopia tend to intuitively move such objects away in order to obtain a sharper image.

If this visual condition is not corrected properly, it can lead to visual fatigue, redness, stinging and heaviness of the eyes, headache, etc.

In case of any of the above mentioned symptoms, it is advisable to visit your ophthalmologist for a complete examination.

These are abnormal growths of tissue on the ocular surface due to the effect of ultraviolet (UVB) rays. They are triangular in shape and extend from the conjunctiva to the cornea. They can cause irritation, a foreign body sensation and even impede vision. In the case of pterygium, surgical intervention is usually indicated, unlike pinguecula, a minor variant of this pathology.

It is the drooping of the upper eyelid that partially or totally covers the eye. This alteration of its normal position causes an unsightly effect of tiredness or sleepiness, sometimes very pronounced, and can also affect the visual field, seriously interfering with the patient’s vision.

Keratoconus is a degenerative pathology of the cornea that causes a slow and progressive thinning of this outer layer of the eye, as well as its deformity. This loss of corneal thickness results in the modification of its usual spherical shape to an abnormal conical shape. This causes an astigmatism that distorts images, as well as a decrease in vision that makes it difficult to perform daily activities.

It is usually detected in adolescence, although it tends to stabilize between 30 and 40 years of age. In 25 percent of cases, it is a hereditary disease.

Although keratoconus cannot be prevented, there are specific treatments that slow its development.

Keratitis is an inflammation that mainly affects the outer part of the cornea (corneal epithelium) and heals without complications. On the other hand, it can also affect deeper layers, although the incidence of this type of ulcerative keratitis is lower. When these lesions are not treated in a timely and inadequate manner, they can have important consequences.

The causes of keratitis are diverse, being more common those that have their origin in some type of infection, either viral(herpetic keratitis and keratoconjunctivitis) or bacterial(bacterial keratitis). Other factors that can cause corneal lesions are dry eye(dry eye syndrome), irritating and/or toxic substances, allergic processes, trauma or abnormal closure of the eyelids.

It is the most common hereditary disease of the retina. It consists of the progressive degeneration of light-sensitive cells (photoreceptors), leading to a gradual decrease in vision. In advanced stages, it can lead to blindness.

There are two types of photoreceptor cells that can be affected in retinitis pigmentosa: peripheral vision cells (rods) and central vision cells (cones).

Rods, which are located in the peripheral zone of the retina, are activated when light intensity is low and are therefore used for night vision. In contrast, cones are concentrated in the central area of the retina or macula and are stimulated when light intensity is high. These cells provide greater visual acuity and allow color vision.

Although retinitis pigmentosa has a genetic origin, in half of the cases it may appear sporadically without any family history.

Retinitis pigmentosa appears silently and causes a slow but progressive loss of visual acuity.

The initial symptoms of the disease to pay attention to are decreased night vision and progressive reduction of the visual field, which starts affecting only the peripheral vision.

On the one hand, loss of night vision manifests itself through poor vision in low-light environments and an inability to adapt to changes in the environment (light-dark).

On the other hand, the decrease in the visual field means that the patient begins to lose peripheral vision (side vision), although central vision is preserved.

As the disease progresses over the years, the symptoms worsen and it is then that color perception begins to be altered, glare (photopsias) and tunnel vision appear, because the central vision has also been affected.

Once symptoms begin, retinitis pigmentosa will continue to progress more or less rapidly, although the development of the disease does not affect everyone equally, even within the same family. Its prognosis can vary greatly from one person to another, as it depends on the genes affected, the mutations, the form of inheritance and the age of presentation. Hence the difficulty in predicting the evolution of this pathology.

Preferably, this disease occurs between the ages of 25 and 40. However, less frequently, there may be cases of patients younger than 20 and older than 50.

The eye contour is the most delicate area of the face and, like the rest of the body, it also suffers from the effects of natural aging. The loss of firmness and elasticity of the skin in the periocular region is manifested by the appearance of “crow’s feet” and wrinkles between the eyebrows and forehead.

In addition to the inevitable passage of time, genetic inheritance, poor eating habits, stress or lack of adequate rest are some of the factors that can accelerate its presence.

To satisfactorily eliminate the wrinkles that appear in the upper half of the face due to gesticulation and to look younger without the need for surgery, treatment with Botox®( botulinumtoxin) can be used. This aesthetic treatment allows the patient to recover a toned and smooth skin, revitalizing the expression of his face.

A corneal ulcer is an injury to the corneal epithelium, a tissue that lines the front of the eye, which can severely impair vision if not treated in time.

This eye condition may be due in most cases to an eye infection. There are also other causes such as dry eye (dry eye syndrome) or ocular trauma as a result of a sudden blow to the eye.

The most common symptoms of an ulcer are pain and discomfort in the eye, redness, discomfort or intolerance to light (photophobia), foreign body sensation, tearing, among others.

In the particular case of people who habitually wear contact lenses, it is important to follow a strict hygiene and conservation routine to reduce the risk of suffering a corneal ulcer.

Xanthelasmas are small benign lesions that accumulate fatty substances inside and grow around the eyelids, near the tear duct. These yellowish deposits are more frequent in adults with metabolic disorders such as hypercholesterolemia, diabetes and biliary cirrhosis, although they can also appear without being related to any disease.