7 Eye Symptoms You Shouldn’t Ignore
Lifestyle

7 Eye Symptoms You Shouldn’t Ignore

doctor giving warning

Sight is one of the most important of our five senses. Yet, considering the complexity of the eye and how it works perfectly to enable us to see well, we often take good vision for granted. We get out of bed, take a fleeting glance at our phones, rush into the bathroom, head out to go to work, and move on with life.

Sometimes, we get a jolt in life, when something happens all of a sudden with our eyes or sight. When these are quite severe and significant, our whole lives and schedules are put on hold.

When are eye problems so urgent that we absolutely need to have an eye check as soon as possible? Here Dr Errol Chan highlights and discusses some of these emergency eye symptoms that every individual should be aware of. These should prompt a visit to an eye specialist on an emergency basis as soon as possible.

Symptom #1: Floaters and flashing lights

flashes

Floaters are a fairly common symptom, and most individuals learn to live with them. They resemble dots, flying insects, squiggly lines, rings, or cobweb-like particles floating in your field of vision. They are more common in those above 50 years old, and in those who are highly short-sighted.

Floaters can develop rather rapidly, or very slowly and stay more or less the same for some time. The issue with floaters is that they may indicate a retinal tear, which can be identified on a retinal examination by an ophthalmologist. A retinal tear needs to be taken care of as soon as possible with a laser procedure in the clinic.

Acutely developing floaters, versus floaters which have developed slowly over time, are often accompanied by flashes of light (often described as streaks of lightning appearing in one’s side vision). These acute floaters often cause some misting of vision, as if you are looking through smoke. Anyone experiencing these symptoms absolutely needs an eye examination by an ophthalmologist as soon as possible, to exclude a retinal tear.

Why should you be concerned?

What happens in the very rapid development of floaters is that the back layer of the vitreous gel peels away from the retina, a process which is termed medically as a posterior vitreous detachment (PVD). As the gel peels away, it tugs on to the retina; so if too much force is involved, there is a high likelihood that it would cause a retinal tear.

If retinal tears are left for too long, for even more than a few hours, this may lead to a retinal detachment. A darkening shadow developing across your field of vision, like a curtain being pulled down, may suggest a detaching retina. A retinal detachment is sight-threatening and requires retinal reattachment surgery in the operating theater as soon as possible.

There is however a silver lining in the cloud — more than 80% of individuals with a PVD do not have retinal tears after the initial examination. There will be some getting used to the misty vision, but the fogginess will eventually reduce significantly after a couple of weeks or so. If no retinal tear is found, you may simply be followed-up in the clinic over the next few weeks, to ensure that you do not develop new retinal tears.

Symptom #2: Red, teary and painful eyes (for contact lens wearers)

contact lense at a fingertip

Most of us experience red eyes from time to time, for example, from overuse of our phones or from prolonged screen time. So when do red, teary and painful eyes warrant a prompt visit to the eye specialist?

You absolutely need to see an eye specialist immediately if you wear contact lenses and develop a red painful eye. While micro-trauma to the corneal surface from contact lens overuse is a common cause of red eye in contact lens wearers, these symptoms may well indicate a corneal infection by bacterial or fungal agents.

Why should you be concerned?

A corneal infection represents an eye emergency which should be expediently attended to and treated promptly. Every minute counts. Bacterial infections associated with contact lens use are well-known to be very devastating, which can destroy significant amounts of corneal tissue. Infections can be very deep-seated and difficult to eradicate.

Even after treatment, the residual scar can permanently reduce your vision, to the extent that it cannot be fully corrected with glasses. In severe cases, corneal transplants may be required either to remove the infection, or clear the scar in the cornea.

A strong awareness of symptoms is therefore important so that you can seek treatment quickly!

Symptom #3: Sudden development of double vision in both eyes WITH a headache

double vision symptoms

Double vision can occur in one or both eyes. If one has double vision when viewing through either the right or left eye (e.g. the edges of an object appear slightly more blurry or fuzzy, or a fainter ghost image by the side is seen), this is uni-ocular double vision, and less of a concern. However, if you have double vision which is only present when you use both eyes, this is more sinister and indicates that the nerve or muscular control of eye movements is not coordinated between the 2 eyes. There are only 3 nerves in the brain which control eye movement, and these are the 3rd, 4th and 6th nerves. Any pressure on, or damage of these nerves in the brain will lead to these symptoms.

Why should you be concerned?

The sudden development of such symptoms, especially if these are worsening and accompanied by a significant headache, is an important warning sign, as this may indicate life-threatening neurological disease. For instance, rapidly developing leaks from large blood vessels in the brain, or expanding brain tumours. Both of these conditions can very quickly increase the pressure in the skull to dangerous levels.

In this situation, a CT or MRI scan of the brain is absolutely needed. Thus, time is of the utmost essence and you should avoid further delay before seeking out assessment by an ophthalmologist at an emergency service. If necessary, call an ambulance.

Symptom #4: Significant eye pain and headache, nausea and vomiting

a man having headache

In this part of the world, we are predisposed to a particular subtype of glaucoma termed angle closure glaucoma. Why is this so? Asian eyes are structured in such a way that the drainage outflow pathway within the eyeball is much more narrow, and thus pressure tends to build up more easily in the eye.

One form of angle closure glaucoma, commonly referred to as an “acute angle closure attack”, can be quite frightening. It may develop over the course of hours to days, and the symptoms get progressively worse as time goes by. It typically starts with an eye ache, associated with headache on the same side, then misty or blurry vision, and halos around lights, as well as glare symptoms (with lights being more uncomfortable). When full blown, nausea and vomiting can occur as well.

Treatment is effective in breaking the attack and lowering the pressure, as well as the symptoms of vomiting.

Why should you be concerned?

Early attention and medical treatment is extremely important to rapidly lower the pressure within the eye, to avoid the detrimental impact of sustained high pressures on the optic nerve. If left for too long, initial treatments to break the attack of angle closure are often more difficult, and it is more likely that permanent damage to the nerve can occur.

Symptom #5: Any form of trauma, injury or chemical splash to the eye

Trauma to the eye can come in many forms — it may be a child’s finger grazing the eye, but sufficient to cause a very painful loss of the top-most epithelial layer of the cornea, known as a corneal abrasion. This almost absolutely brings the parent to emergency attention!

Or, it may be a blow to the eye socket, from a tennis ball for instance. Although there may not be any clear outward signs (the eye still appears white to the layman), or vision may appear fairly normal initially, damage to the fine structures in the eye may have already occurred due to the impact. For instance, there may be tiny retinal breaks or small retinal detachments, or damage to the fine drainage pathways of fluid in the eye. The latter can result in secondary glaucoma many years later if this is not diagnosed early and not having the eye pressure continually monitored over years.

Those who have had LASIK before and suffered any kind of trauma to the eye need to have the eye examined, as the LASIK flap may shift with even minor trauma.

These are notwithstanding the possibility of fractures of the bones making up the eye socket. In children and young adults, bony fracture splints catching tightly onto the muscles of the eyeball can be extremely subtle, with a normal outward appearance. If left undetected, the muscle eventually develops scar tissue and is unable to work normally to move the eyeball.

And retinal detachments in children are known to occur from even seemingly minor trauma not involving the eyes, such as heading a soccer ball!

It is widely known that very tiny foreign bodies entering the eye (for e.g. metal splinters from hammering), cause almost no signs from the external appearance. Yet, these have in fact penetrated the walls of the eye and lodged themselves within the tissues of the eye. A very thorough examination by an eye specialist, who also uses specialized diagnostic and imaging tools to locate the foreign body, is of importance. Metallic foreign bodies left within the eye are toxic and can result in total loss of vision years later.

Finally, chemical splash injuries most commonly experienced after accidental soap or detergent splashes into the eye. Or they may arise from fumes or aerosol inoculation into the eye. These are usually very painful. The most important immediate action would be to wash the eye with copious amounts of water to flush the chemical out. Often immediate medical attention by an eye specialist is important, as the pH disturbances and damage these chemicals do to the eye and corneal surfaces require prompt treatment.

Why should you be concerned?

Early treatment of acute eye injuries limits the amount of damage done. There is also good reason to see an eye specialist after any kind of trauma, no matter how minor it is perceived to be. Seemingly minor injuries may actually mask more serious underlying issues which should be addressed early on, rather than later!

Symptom #6: A sudden and significant loss of vision

vision loss

A sudden loss of vision usually indicates an acute curtailment of blood supply to the retina or optic nerve.

This may occur with a sudden blockade of the main supplying artery or draining vein in the eye, termed a central retinal artery or central retinal vein occlusion, respectively. Or it may occur with an acute loss of blood supply to the optic nerve, where the darkened vision involves either the upper or lower half of the visual field in one eye, but usually not both. This is an ischemic optic neuropathy.

Giant cell arteritis, which is a rare but important form of ischemic optic neuropathy, requires urgent medical assessment and diagnosis, because of the need to start steroid treatment to prevent the condition from affecting the other eye as well! Patients with blood vessel issues in the eyes often have underlying medical disease affecting the blood vessels elsewhere in the body, e.g. high blood pressure or cholesterol issues, or diabetes.

Apart from these causes, a retinal detachment also causes sudden loss of vision, but usually preceded by numerous floaters and flashing lights, and the darkening of vision occurs as if a curtain is being drawn in from the side.

Why should you be concerned?

These represent eye emergencies, and assessment by an eye specialist is important to obtain a rapid evaluation of the problem. In the case of retinal detachments, prompt treatment with surgery, whilst the macula remains attached, undoubtedly preserves vision.

Symptom #7: Eyelid swelling in a child

Eyelid swelling in children, especially if occurring in both eyes, is most commonly caused by an allergic reaction of some sort. These may occur with consumption of specific food substances, or local contact with a contact or aerosol allergic agent around the eyelid skin.

Why should you be concerned?

Eyelid swelling may also indicate an underlying infection of the soft tissues in the eyelid (preseptal cellulitis), or even a more deep-seated infection involving the eyelids and the soft tissues around the eyeball in the bony eye socket (orbital cellulitis). The latter is certainly more severe, as it may cause vision loss, high eye pressures, or even spread to the brain in severe cases.

Both conditions need medical assessment, as it can sometimes not be clear which of these the child has, and because antibiotic treatment is absolutely needed in both cases.

LSC Eye Clinic offers an emergency service for patients with urgent eye problems requiring immediate medical attention. Call to obtain an appointment today to safeguard your sight!

About the Author

Dr Errol Chan

Dr Errol Chan
Consultant
MBBS, MMed(Ophth), MRCSEd,
FRCSEd, FRCOphth, FRCS(Glasg), FAMS, FRCS(Canada)

Dr Errol Chan has international experience in caring for patients with eye diseases, having worked at various eye centres in the world. To date, he has performed thousands of cataract and vitreoretinal surgery procedures.

His practice centers on all aspects of general and emergency ophthalmology, with special expertise in cataract surgery, the medical and surgical treatment of retinal diseases, and uveitis. Dr Chan’s meticulous approach emphasizes quality care, safety, honesty, and empathy. His personal ethos is to provide the most appropriate treatment for every patient to achieve the best possible vision.

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