In our series on practical guides to common health conditions, this issue we focus on eye conditions that you might experience from infections to those that affect vision – both related and unrelated to diabetes. By Angela Coffey.
We all need to take care of our eyes and have regular tests to check our vision. Of course, with diabetes, you’ll know that extra measures are in place to make sure any problems that might occur are found as soon as possible and managed accordingly.
First off, when you have diabetes, you need to have regular diabetes eye screening (see ‘Keeping your eyes in check’). Plus, everyone should aim to get an eye test with an optician every two years. These are free to people with diabetes and check your overall eye health, as well as check for common vision problems, such as whether you’re long- or short-sighted.
Common eye conditions
This is more common in people over the age of 40, but it can occur at any age. It can affect you differently; for example, some people have trouble focusing on nearby objects only, while others may be affected to see clearly at any distance. Some symptoms include:
- nearby objects appear fuzzy and out of focus, but distant objects are clear
- squinting to see clearly
- tired or strained eyes after reading, writing or using the computer.
This is much more common and has the opposite symptoms of long-sightedness – where you can see nearby objects clearly, but things in the distance will appear blurred. In the UK, it affects around one in three people and can range from mild to severe. Other symptoms include:
- eye strain
- feeling fatigued when driving or playing sports.
For either long- or short-sightedness, you can get a prescription for glasses or contact lenses to help you see more clearly. Laser surgery is also an option.
Conjunctivitis (pink eye)
Eye infections are common – the most obvious ones being styes and pink eye (conjunctivitis). They have similar symptoms, but the causes and treatments are completely different. Conjunctivitis and styes can look similar, but the reasons differ. Viruses, bacteria, or allergens commonly cause conjunctivitis. But environmental factors like smoke or dust, dirt, or simply irritation caused by your contact lenses can also cause the infection.
Symptoms of conjunctivitis include:
- blurred vision
- swelling and redness on your eyelid
- eye pus and tearing
- red on the whites of your eyes or inner eyelid
You can do some things at home to help treat conjunctivitis – place a cold compress on your eye, wash your hands before touching your eyes and using over-the-counter drops or cream available from your pharmacist. If symptoms continue, visit your GP, who can prescribe antibiotic treatment.
A stye is the result of an infection of the oil glands on your eyelid. A red lump – a bit like a spot – around the affected gland or lash follicle is visible. Sleeping with make-up on, often rubbing your eyes or using your disposable contacts for longer than recommended can cause a stye. Symptoms include:
- pain in or around the eye
- a raised, red lump on your eyelid or swollen eyelid
- sensitivity to light
- eye pus or tearing
- a gritty feeling when you blink.
Don’t try to squeeze or pop a stye. Apply a clean, warm compress to the area for around 15 minutes up to five times a day. See your GP if it hasn’t gone away after a few days. They may prescribe an antibiotic, or occasionally, the stye may need draining.
Diabetes-specific eye conditions
Diabetic retinopathy is a type of eye disease caused by damage to blood vessels in the eyes, leading to blindness if left untreated. When blood vessels are damaged, they can become blocked, leak or grow irregularly, and affect your vision.
Keeping your blood glucose and blood pressure in your target range will help lower your risk of developing serious eye problems. And, the good news is that if complications do occur, there are treatments to help your long-term vision when issues are diagnosed in time. That’s why your eyes will be screened for diabetic retinopathy regularly, at least annually.
Retinopathy often develops in stages:
Stage one – background retinopathy: This is when your vision hasn’t yet been affected, but action will be needed to contain the problem. See ‘Keeping your eyes in check’, xxxx.
Stage two – non-proliferative retinopathy: This is more serious damage to your eyes, and you will have more regular screenings to monitor any changes.
Stage three – proliferative retinopathy: This requires treatment to help avoid the risk of sight loss. Depending on the severity, there are various options:
• Laser treatment. This, alongside well-managed blood glucose levels, can prevent damage from worsening, but it doesn’t usually improve sight. The session lasts around 30 minutes, and you may need more than one. A local anaesthetic numbs the eyes, and eye drops enlarge the pupils. Next, a special contact lens holds the eyelids open while the small bursts of laser beams are given. Afterwards, you may experience some swelling, but this should improve within a few weeks. More than one session carries more risks of side effects to your overall vision but will still be better than no treatment at all.
- Eye injections.A type of drug – called anti-VEGF – is given into the eye (usually once a month over a few sessions) to help slow down any damage when you have eye swelling, and you should notice results generally within a month. After the injection, your eye pressure will be monitored to make sure there are no problems.
- Steroids. If other treatments aren’t successful, steroid injections can help if you have severe eye damage. The injection administers a tiny implant that releases the steroid treatment over three years.
- Eye surgery (vitreoretinal surgery). This is performed under general anaesthetic requires an overnight hospital stay. Your eye specialist will explain how well it is likely to work for you and the risks involved.
Diabetic maculopathy oedema (DMO)
This is a complication of diabetic retinopathy when leaky vessels cause fluid to build up in the macula at the centre of the retina. The damage occurs over several years and may affect the whole retina or only small bulges in the blood vessels of the retina. However, when the blood vessels in or close to the macula become damaged, or blood or fluid leaks into the macula, vision can deteriorate dramatically. You may notice:
- dark spots, particularly first thing in the morning
- objects changing shape, size or colour or even seem to move or disappear
- colours fading
- bright light or glare hard to tolerate
- difficulty reading.
DMO can be treated if caught early, usually with eye injections – Lucentis (ranibizumab) or Eylea (aflibercept) – to stop fluid leaking from the blood vessels. As with some other types of diabetic retinopathy, steroid injections and laser treatment can also be a treatment option for some people.
Other eye conditions
Other eye conditions – such as cataracts and glaucoma – can happen to anyone, particularly as we age. However, according to Diabetes UK, having diabetes can put you at a higher risk: two times more likely to develop cataracts, and one-and-a-half times more likely to develop glaucoma.
A cataract is when cloudy patches forms in the lens of the eye. It’s caused by proteins in the eye forming clumps and mainly affects older adults getting worse over time, resulting in blurry vision and eventually blindness. Symptoms include cloudy or blurry vision, lights seeming too bright or glaring, colour fading and finding it harder to see in low light.
As well as age, your risk of developing cataracts may increase if you:
- have diabetes
- have a family history of cataracts
- have injured your eye
- take steroids long term
- drink too much alcohol.
Cataracts don’t usually hurt and, in early, mild cases, stronger glasses may help for a while. As time goes on, cataract surgery – which involves replacing the cloudy lens – is the only way to improve your vision.
Glaucoma is a condition that damages the optic nerve, usually caused by fluid building up in the front part of the eyes. If it’s not diagnosed and treated early, glaucoma can lead to blindness; however, it doesn’t usually cause any symptoms at first. The most common type – primary open-angle glaucoma – can develop slowly over many years and is often discovered during a routine eye test.
If you do experience symptoms, they might be blurred vision or seeing rainbow-coloured circles around bright lights.
There are various risk factors for developing glaucoma, including:
- age – glaucoma becomes more common as you get older, particularly in your 70s and 80s
- ethnicity – if you’re of African, Caribbean or Asian origin
- family history
- other medical conditions, eg short- or long-sightedness and diabetes.
In rare cases, glaucoma can develop suddenly and cause:
- intense eye pain
- nausea and vomiting
- red eye
- eye tenderness
- seeing rings around lights
- blurred vision
If you suddenly develop glaucoma symptoms, go to your nearest eye clinic or A&E as soon as possible. This is a medical emergency.