Eye Care Blog

At the beginning of this century the most prominent cause of blindness was infections of the eye. The eye is exposed externally to infections because of the very delicate skin-lining of the lids and sensitive outer membrane of the eye itself. Other tissue areas of equal susceptibility to infection are the nose, mouth and genitalia. It is even possible for all these orifices to be infected by the same organism.

Since the the availability of antibiotics has drastically reduced the incidence of chronic consequences following an infection. Many serious infections, provided they are treated quickly, no longer inflict severe damage. Yet, at the extremes of the microbial organism spectrum, some trouble-spots remain. The larger organisms can be very selective in their reaction to antibiotics. Thus the yeast and fungus types of infection, common wherever there is necrotic (cell-dead) tissue, require very special toxic medications in their control and eradication. In the northern hemisphere fungus infection is relatively rare, but it can be found anywhere where there is stagnant water. It is just as well that fungus infection is relatively rare because the spores of this kind of disease are resistant to most drugs. It is also fortunate that the organisms one normally discovers as contaminants of food and vegetation do not generally cause infection of the human tissue. Indeed, the most common means of introducing fungal spores into the eye is by the use of already contaminated eye-drops, lotions and contact-lens solutions. However, poorly made cosmetics such as mascara may also be infected and, where clean water is scarce or not used in personal hygiene, may cause infection of the lids. A third route of infection involves small creatures such as nits and fleas. Just as they cling to the hairs of the scalp and pubic orifice regions, so they can attach themselves to the lashes of the lid. When they do this they cause severe irritation, and treatment usually means removing the parasites one by one and then applying soothing ointments and creams. In some cases, however, these creatures may bring microbial infections with them, in which case antibiotics will have to be used as well.

On the other hand, hygiene of the eyelids and eyes can become a fetish. Over-use of water or commercial medications about the eye will eventually produce irritation. The eye-surface normally has its own very good methods of keeping itself clean and infection-free, and it is generally prudent to interfere with these as little as possible. All that is usually required is the removal of surface dirt and debris from the lids and surrounding skin. When an abnormality does occur, skilled medical attention should be sought.

Women tend to play with the eye tissues much more than men. The lids are cleaned and various salves to remove make-up and apply fresh preparations are used daily. In general they are non-irritant. Nevertheless they are strictly abnormal and often cause the onset of toxic or allergic reactions. Thus the eyelashes are coated with a greasy adherent pigment to make the eyes look darker. The lid-skin is lined and painted with various dyes, and sometimes false plastic eyelashes are glued to the lash margin. Some women even paint the delicate tissue inside the lash margin — the very area where gland secretions discharge onto the eye’s surface! Set against these infection-hazards, however, is the fact that for some women the absence of make-up can result in a very real loss of confidence.

At the other end of the micro-organism scale are the very small organisms that even very high-power microscopes have difficulty in detecting. Some of them even have no nucleus, as normally seen in bacteria, and can only be controlled by special drugs. Unfortunately some of these infections actually thrive on medications successful in the fight against larger organisms. They love hormones such as the cortisone group — steroids, for example. Therefore if the eye develops an infection owing to one of these viruses, and is given the wrong treatment, the condition can worsen very quickly.

Viruses also like to inhabit nerve tissue, and the condition known as shingles can affect the nerves supplying sensation to the eye. Generally an attack of shingles causes half the face to erupt in blisters. If the eye becomes involved, serious complications can occur, though in the majority of cases shingles heals without any lasting problems other than a loss of sensation in the areas affected.

You are likely to be affected by minor infections of the lids and conjunctiva on several occasions during your lifetime. In most cases only a slight discharge is observed, together with some stickiness of the lids. An attack may last only a few days, and is often associated with irritation caused by wearing contact lenses or by a dusty atmosphere. Another form of common infection is a stye. This affects the lash follicles (base of the eyelash), and is most frequent among people with insufficient immunity against staphylococcus bacteria. (Other symptoms produced by staphylococci include boils and even septicaemia.) However, more serious infections of the conjunctiva and cornea do occur, especially in those countries where such conditions have been endemic for centuries. A good example is trachoma.

This virus- like infection is so severe that infection by bacteria nearly always follows. (Viruses are the very small micro-organisms, bacteria the larger ones. The trachoma organism is a chlamydia, which is intermediate between the two groups.) If it is not treated, severe scarring of the eye tissues occurs, and often blindness. In developing countries with poor standards of hygiene and education, it accounts for a very large percentage of child blindness. In riverine Africa there is also an infectious disease known as onchocerciasis. Here the parasite is transmitted by flies, and can affect humans in different stages of its development from larvae to the adult onchocerca vulvulus. At first it causes an itchiness on the skin (or cornea), but later, if the infection enters the globe of the eye, it will become apparent in the vision itself as a kind of falling ’snowstorm’ of small black larvae sinking through the optic fluid. As yet no effective cure has been discovered, perhaps again because the disease is restricted to parts of the world which enjoy little medical priority.

A more pressing, or universal, anxiety concerns venereal diseases, since these have become much more prevalent in recent years. While the venereal disease remains untreated, there is always a possibility that the adult’s eyes can be affected by transmission of the infection from the genitalia by the hands. In the initial stages such an infection is not serious (that is to say, it is treatable), but in the long term the eyes will suffer as much as any other part of the body. But whereas it used to be fairly common for babies to become infected with the bacteria of gonorrhoea (gonococci) during the process of birth, modern drugs have considerably reduced this risk, even where the mother has not already been cured of the venereal infection. However, there are parts of the world where health control is still elementary, even though transport and communications may not be, and cases of advanced gonorrhoea can still be found. The same is true of syphilis, a slightly more complicated disease which can also be transmitted from mother to child. But syphilis, even in its advanced terminal stages, does not usually affect the eyes.

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