Dr. Cyres Mehta ::: Consulting Ophthalmic Surgeon

Dear Dr. Cyres a close friend underwent an umcomplicated cataract operation few months ago. Today he can see black spots moving in front of his eyes. They first appeared a few days after the surgery and then disappeared but now they are back. Why?

So what are floaters what causes them and is there any treatment ?

Sometimes I find a cloud in front of my vision which goes away for a few seconds and them comes back. It moves with the movement of my eyeballs much like the black spots. Whats this due to?

-- Prof. Randeria - Chowpatty

The eye is divided into 2 parts by the human lens. The front part which includes the brown colour of the eye and the cornea(the clear front window) is called the anterior chamber.

The anterior chamber of the eye contains a watery clear fluid described by the ancients as “Aqueous Humour”

The back part of the eye which houses the retina has a jelly called “vitreous humour”. This jelly is clear and in one piece when the person is young. It consists of a matrix containing molecules of hyaluronic acid and collagen and loosely resembles the jelly that we eat.

With time the jelly forms pockets of fluid in it much like a jelly taken out of the fridge for an hour or two. Now the vitreous consists of fluid and jelly which mix and move along

Many conditions can cause this to occur:

	Age - After the age of 30 everyones vitreous jelly develops a little degeneration. By 60 everyone's has at least 50% liquid.
	Surgery - Any eye surgery howsoever minor can cause this.
	High minus number - Always have vitreous degeneration.
	Injury to the eye.
	Bleeding in the eye.
	Diabetes causes it as well.

This pieces of formed jelly swirl around with the movements of the eye and cast Shadows on the retina. The patient sees this a a “black spot” and feels its floating around.

Also few blood cells can leak out of capillaries in the retina These move around in the vitreous and cause the patient to see floaters. This is common in diabetics hypertensives and those who are on blood thinners for heart diseases, like asprin or warfarin

Any inflammation (uveitis) or infection of the eye also causes inflammatory white cells to move around at the back of the eye causing floaters.

Just having Floaters is Harmless, But if you notice the following see the eye doctor immediately

	Sudden increase in the number of floaters.Could be a sign of early bleeding
	Flashes of light like lightning streaks or diwali sparkles - This means the jelly is detaching from the retina and is pulling on it. This is called posterior vitreous detachment and is harmless in 95 % of cases. In the other 5% a small retinal tear forms which may in the future lead to retinal detachments
	Dark curtain over a part of the vision - Early sign of Retinal detachment

Treatment: Just floaters need no treatment. Just a visit to the eye doctor where he will take a peep at the retina is enough. Floaters and flashes need detailed investigation as do the other symptoms like sudden increase in the number and the dark curtain, to rule out retinal detachment.

If the persons job involves very fine work and floaters keep bothering them we can insert a small needle less than half a millimeter into the eye and suck the jelly out.This is called sutureless 25G vitrectomy.

In conclusion if your friends floaters keep returning ask him to visit the eye doctor who will take a look at the retina.

Why does a persons eye pain. How to treat it?

-- Prof Randeria-Chowpatty

The eye like any of the other organs of the body has a rich supply of nerves which feel pain.

Causes for pain in the eye:

	Increased pressure - Could be Glaucoma. This can cause only a dull ache or a sharp pain moving upto the head. Check eye pressure to rule this out
	Conjuctivitis or “pink eye”- this can cause a sore feeling of the eyes.
	Inflammation of the eyes - UVEITIS - Deep stinging type of pain.
	Optic neuritis - Inflammation of the optic nerve of the eye can lead to pain at the top part of the eye.
	Sceritis is inflammation of the white of the eye - Piercing type of pain.

Finally just a tired eyeache- Due to wrong spectacles number, too much computer use or near activity in a wrong posture with bad lighting.

Treating the cause will solve the problem

Remember - Cataract & Retina Detachment are causes of Painless loss of Vision

Are cataracts occuring after vitrectomy, difficult to operate, due to vitreous support loss?

-- Mr AP Mehta

In the olden days the eye was cut open and the lens pushed out of the eye with pressure. After vitrectomy (removal of vitreous jelly from the eye) this was more difficult as the eye was not stiff enough. It led to collapse of the eye, bleeding etc.

Today the most modern cataract systems use powerful computers to determine flow in and out of the eye to keep the eye inflated with saline during surgery. As well we only go in through an incision less than 2 mm and sometimes only 0.7 mm depending on the case. Specialised settings are used to ensure safety.

To answer it succinctly - No, there is no problem nowadays and very little danger to the eye.

To know more or to have a question answered write to –

Dr Cyres Mehta
Mehta International Eye Institute;
Sea Side building, 147 Colaba Road,
Mumbai -400005.

email at cyresmehta@yahoo.com

contact 9892736692/9819850971