Healthwise: Vision

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Monday, 2 December 2024

Five common eye infections and how to treat them

Sir Elton John has revealed that he has now lost his sight completely in one eye.

Story by Susanna Galton

• • 6 min read

Some eye infections will clear up of their own accord, others will need to be treated with medication such as antibiotics, in the form of eye drops or ointment, or antihistamines

He’s famous for his show-stopping glasses but, following a severe eye infection, Sir Elton John has revealed that he has now lost his sight completely in one eye. The Rocketman singer, 77, shared at the gala performance of The Devil Wears Prada: “I have lost my sight and I haven’t been able to see the performance.” He recently also revealed that his poor eyesight had put his new album on hold.

Eye infections are common and, like the flamboyant performer, easy to spot, while some can develop into something more serious. Symptoms vary from redness, itching and swelling to pain and blurred vision and can linger for a few days to several weeks. Some infections will need to be treated with medication such as antibiotics, in the form of eye drops or ointment, or antihistamines, while others may develop into something more acute and require expert medical care.

Following a severe eye infection, Sir Elton John has been left with 'limited eye vision' - Getty Images

Here are the five most common afflictions to affect our eyes.

Uveitis

Uveitis is inflammation of the uvea, the central layer of the eyeball that transports blood to the retina and transmits images to the brain. It can be caused by immune system conditions, infections, or eye injuries, and may be contagious, depending on the cause. There are also types that affect the back of your eye, called “posterior uveitis”, which may take longer to treat – up to several months if caused by an underlying condition.

While uveitis doesn’t usually cause any long-term problems, and it usually starts to improve after a few days to weeks of treatment, you can lose vision if a severe case isn’t treated.

“Complex or more severe symptoms need reviewing by an ophthalmologist,” says Hughes. “Never ignore deteriorating vision, especially in the context of a new red or painful eye, as infections can be sight-threatening and require prompt treatment.”

Treatments include: Wearing darkened glasses, eye drops that open up your pupil to relieve pain, corticosteroid eye drops or oral steroids that relieve inflammation, eye injections (ouch) or oral antibiotics for infections that have spread beyond your eye and – in severe cases – medications that subdue your immune system.

Blepharitis

This happens when the skin folds covering the eyes become inflamed. It is usually caused by bacteria clogging the oil glands inside the eyelid skin at the base of the eyelashes, but it may have non-infectious causes. Even when the cause is bacteria, it’s not contagious.

Treatments include: Cleaning the eyelids with clean water and applying a warm, wet towel to relieve swelling, along with corticosteroid eye drops or ointments to help with inflammation.

You may also need lubricating eye drops to moisten your eyes and prevent irritation from dryness, as well as antibiotics, which may be oral, topical, or eye drops. Depending on what causes it, it can become a chronic condition that needs continuous management.

As a general rule, when it comes to our delicate eyes, proceed with caution. “Itchy, gritty eyes or a short history of discharge or watering should be addressed by your GP or chemist,” says Laura Hughes. “If none of these treatments resolve it, it’s best to see an optician promptly for a diagnosis.”

Conjunctivitis (pink eye)

Infected eyes become pink or red and inflamed, and it can also result from allergies or exposure to chemicals, such as chlorine in swimming pools. Especially common in children, conjunctivitis produces sticky pus or makes eyes feel gritty and is extremely contagious. It happens when blood vessels in the conjunctiva (the thin outermost membrane surrounding your eyeball) become infected by bacteria or a virus. “Conjunctivitis symptoms often present as ‘sticky’ in the morning and most commonly, by far, it is caused by a virus,” says Alex Ionides, a consultant ophthalmologist at Moorfields Eye Hospital.

Treatments include: Antibiotic eye drops and over-the-counter (OTC) antihistamines. Sometimes, the only treatment is to wait it out and apply a clean, warm, wet cloth to your eyes to relieve discomfort. “Your chemist can suggest an over-the-counter antibiotic such as chloramphenicol, but may also suggest seeing an eye doctor to confirm the diagnosis, as other more sinister eye diseases, such as iritis, can appear as a red and inflamed eye. “Most viral conjunctivitis settles in two to three days, but some can last for two to three weeks.”

Keratitis

Our corneas are the clear, curved, outermost layer of the eye that covers our pupil and iris, and when this gets infected, keratitis (swelling) happens. It can be caused by an infection (bacterial, viral, fungal, or parasitic) or an eye injury.

“People who wear soft contact lenses are most at risk from bacterial keratitis,” explains Dr Ionides. “Wearers who get a red and inflamed eye should seek immediate advice as these contact lens-related infections can be blinding,” he warns.

Laura Hughes is a consultant ophthalmologist and oculoplastic surgeon who warns that contact lens wearers need to be especially careful. “Never swim, shower, sleep in lenses or rinse them under tap water,” she says. “As there is also risk of acanthomoeba infection (acanthomoeba keratitis) which is a very serious parasitic infection that can blind and it can be found in various environments including tap water.”

If you notice symptoms, see your doctor immediately in case an infection can be stopped.

Treatments include: Antibiotic eye drops, which should improve the symptoms in two to seven days after using them. Fungal infections can take many weeks. However, a viral infection cannot be fully eliminated, even with oral antiviral medications or eye drops, and symptoms may later return.

Styes

A stye is a pimple-like bump that develops from an oil gland on the outer edges of your eyelids. These glands can get clogged with dead skin, oils and other matter, allowing bacteria to overgrow in your gland. The resulting infection causes a stye (or “hordeolum”). Like blepharitis, styes are generally not contagious.

A stye should disappear in about seven to 10 days. Treatments include applying a clean, warm, damp cloth to your eyelids for five minutes at a time a few times a day and using mild, scent-free soap and water to clean your eyelids.

“Styes are caused by an infection of an eyelash follicle,” says Alex Ionides, “the infection can be drawn out by what your grandmother might have called ‘hot spoon bathing’, that is, stir your tea with a metal spoon and then apply it to the stye.”

Treatments include: Ionides doesn’t recommend using any spoon that’s been in tea, though bathing with a warm flannel can help. “If the skin starts to become infected and spreads, antibiotic tablets are needed, so see an eye doctor if in doubt. Moorfields has 24-hour eye A&E clinics.”

An antibiotic ointment might be prescribed to help kill the infectious overgrowth, along with over-the-counter tablets such as acetaminophen (Panadol, or paracetamol) to help with pain and swelling. While you’re being treated, you may need to stop using contact lenses or eye make-up.

Prevention

To help stop eye infections or keep viral infections from recurring:

Don’t touch your eyes or face with dirty hands
Bathe regularly and wash your hands frequently
Eat a balanced diet, as nutritional deficiencies are thought to be related to the development of various eye diseases, including infection
Use clean towels and tissues on your eyes
Don’t share eye and face make-up with anyone
Wash your bedsheets and pillowcases at least once a week
Wear contact lenses that fit well into your eye, and see your eye doctor regularly to check them
Use contact solution to disinfect lenses every day
Don’t touch anyone who has conjunctivitis
Replace any object that’s been in contact with an infected eye

The bottom line

Eye infections can be caused by germs from objects such as door handles, keyboards, phones and shopping baskets. Germs can also pass from your hands to your eyes, or from someone you shake hands with.

Eye infection symptoms often go away on their own in a few days. But seek emergency medical attention if you have severe symptoms such as pain or loss of vision. The earlier infections are treated, the less likely you are to experience any complications or loss of vision.

Eye cells can’t regenerate, so once they’re damaged or injured, they can’t be repaired or replaced.

Five common eye infections and how to treat them

Wednesday, 5 October 2022

Cabbage: Experts weigh in on health benefits, nutrition facts, and more

Cabbage is packed in nutrients as vitamins, fibers and minerals and also in micronutrients too as vitamin A, iron and riboflavin.

Leticia Soares, Postgraduate Degree in Public and Family Health/Bachelor Degree in
Nutrition and Dietetics and Carolina Castro, PhD Candidate (Health Services) -

Wednesday 05 Oct 2022

https://www.msn.com/en-my/health/nutrition/cabbage-experts-weigh-in-on-health-benefits-nutrition-facts-and-more/ar-AA12Assi

Cabbage image© Provided by Getty Images

Perspective from Leticia Soares

Benefits

Cabbage can help control high blood pressure. Cabbage is a source of fiber, folic acid and potassium. Potassium relaxes the walls of the blood vessels, lowering blood pressure and protecting cardiovascular system.
Cabbage may help in weight loss. The vegetable has few calories and it is rich in dietary fiber, which promotes the feeling of satiety for a longer time, helping in weight loss.
Cabbage regular consumption contributes to a healthy vision. Cabbage is rich in vitamin A, which is one of the most important nutrients to reduce the risk of macular degeneration and vision loss.
Cabbage can strengthen the immune system. Cabbage is a source of antioxidants compounds such as vitamin C, carotenoids and folate, which help prevent that free radical damage body cells and protect the body against infection.
Cabbage help prevent constipation. The high dietary fiber content of cabbage can help make your stools larger and softer and this can help lower the risk of constipation and diarrhea.
Cabbage has anti-inflammatory properties. The vegetable is a source of antioxidants that fight inflammation and prevent chronic diseases such as type 2 diabetes, heart disease, Alzheimer, cancer and depression.

Possible Side Effects

Excess consumption of cabbage can lead to increased gas, as it is high in sulphur and raffinose, which are substances that cause flatulence and gas.

→ Cabbage: How much should you eat? Experts weigh in.

→ Love Cabbage? Get nutritional facts, tips from health experts, and more

Perspective from Carolina Castro

Benefits

Cabbage is packed in nutrients as vitamins, fibers and minerals and also in micronutrients too as vitamin A, iron and riboflavin.
Cruciferous vegetables as cabbage are rich in antioxidants and may help avoid inflammation.
Cabbage has insoluble fibers, may improve digestive health and also feeds good bacteria known as probiotics.
Cabbage is rich in pigments as anthocyanins and may have a protection effects in heart diseases.

Possible Side Effects

Cabbage as a cruciferous vegetable can have medication interactions with blood thinners.
Excess of cabbage may also cause digestive symptoms as flatulence and diarrhea.

→ Cabbage: How much should you eat? Experts weigh in.

→ Love Cabbage? Get nutritional facts, tips from health experts, and more

This is for information purpose only, and should not be considered as a substitute for medical expertise. These are opinions from an external panel of individual doctors, and not to be considered as opinion of Microsoft. Please seek professional help regarding any health conditions or concerns.

https://www.msn.com/en-my/health/nutrition/cabbage-experts-weigh-in-on-health-benefits-nutrition-facts-and-more/ar-AA12Assi

Why short-sightedness is on the rise

Soaring rates of short-sightedness in children are alarming parents and doctors around the world. Can we turn the tide?

By Jessica Mudditt5th October 2022

https://www.bbc.com/future/article/20220927-can-you-prevent-short-sightedness-in-kids

In the late 1980s and 1990s, parents in Singapore began noticing a worrying change in their children. On the whole, people's lives in the small, tropical nation were improving hugely at the time. Access to education, in particular, was transforming a generation and opening the gates to prosperity. But there was a less positive trend, too: more and more children were becoming short-sighted.

Nobody was able to stop this national eyesight crisis. Rates of short-sightedness – also known as near-sightedness or myopia – continued to rise and rise. Today, Singapore has a myopia rate of around 80% in young adults, and has been called "the myopia capital of the world".

"We've been dealing with [this] issue for 20 years, so we're almost numb to it," says Audrey Chia, an associate professor and senior consultant at the Singapore National Eye Center (SNEC). "Almost everybody in Singapore is myopic now."

What happened in Singapore now appears to be happening all over the world. Countries with seemingly completely different lifestyles are unified by a startling phenomenon: rocketing rates of short-sightedness.

In the United States, about 40% of adults are short-sighted, up from 25% in 1971. Rates have similarly soared in the UK. But their situation pales in comparison with that of teens and young adults in South Korea, Taiwan and mainland China, whose prevalence rates are between 84% and 97%. If current trends continue, half the world's population will be short-sighted by 2050. And the problem seems to be spreading at a faster rate than ever.

Myopia has risen dramatically among children in China to reach 76%-90% among older school children. "It has been an extremely steep rise," says Chia.

At first glance, the idea of a short-sighted world may not seem like a major problem. After all, when someone struggles to see things at a distance, we have a proven fix: glasses. But researchers warn that myopia is not a benign quirk. It is one of the leading causes of vision impairment and blindness, for example.

And in children, where it may take some time to spot the problem and correct it, it can hurt their ability to learn in school and enjoy daily life – and set them up for future eye health problems.

A classroom in China, where short-sightedness has been on the rise among children and teens (Credit: Getty Images)

To make matters worse, while the typical age for a child to develop myopia is between eight and 12 years old, children are becoming myopic at a younger age. The earlier a child develops myopia, the more likely it is that they will have severe myopia in adulthood that can ultimately threaten their eyesight, by causing problems related to different parts of the eye such as glaucoma, retinal detachment, cataracts, and myopic maculopathy.

What explains this global eyesight crisis?

Genetics play only a small part. While a family history of myopia raises the risk of a child developing it, a purely genetic case of myopia is rare, says Neema Ghorbani-Mojarrad, a lecturer at the University of Bradford in the UK and a registered optometrist.

Instead, lifestyle factors are thought to be more significant, in particular, a lack of time outdoors, and focusing on close objects for an extended period through an activity like reading. These factors help explain why one otherwise thoroughly positive trend in children's lives has unintentionally worsened the spread of myopia: education.

Of course, education in itself – in the sense of discovering the world, and empowering oneself through knowledge and skills – does not cause poor eye health. In fact, education is associated with many positive, measureable health effects. But the way children obtain an education in the modern world, with the emphasis on long hours spent in classrooms, appears to be consistently hurting their eye health.

"Education has been shown to cause short-sightedness," says Ghorbani-Mojarrad, referring to education as measured by school years. "We don't know what it is about education – we suspect it is reading and spending more time indoors. Every year of education completed increases the expected amount of short-sightedness."

The education paradox

Ghorbani-Mojarrad and his colleagues studied the effect of education, as measured by school years, on myopia, by investigating the impact of the UK's raising of the school leaving age from 15 to 16, in the 1970s. "There's literally a bump in the chart for the extra year of school. Now that the leaving age is 18 in the UK, I wonder whether we will find the same thing again," he says.

To understand this surprising link, it helps to parse how myopia develops in the first place. Most newborn babies begin life long-sighted. Within the first year of life, the eyes naturally develop and the long-sightedness reduces to the point of their vision becoming almost perfect. However, in some cases the eyes do not stop growing and short-sightedness develops. The eyeball is too elongated to be able to make out objects at a distance without the help of a corrective measure such as glasses.

"Everyone has a finite amount of retina, and if the eye continues to grow, it's like trying to scrape the same amount of butter on a larger piece of bread," says Ghorbani-Mojarrad. "The retina becomes really thin and is more prone to tearing."

It appears that being indoors may worsen this problem, perhaps because of the way indoor lighting differs from natural light.

My father's generation spent a lot of time outdoors. But then urbanisation came to Singapore and there was a great push for academic excellence. It drove all the children indoors - Audrey Chia

In Singapore, which has undertaken some of the longest-running research on childhood myopia, experts have reached a similar conclusion.

"My father's generation spent a lot of time outdoors fishing and things," says Chia. "But then urbanisation came to Singapore and there was a great push for academic excellence. Parents wanted their kids to get into the best school and go to university. It drove all the children indoors for more reading, because reading was supposed to be good for you."

The paradox is, of course, that reading is good for children – measurably so. Literacy, and schooling more generally, is crucial for children's wellbeing, and missing out on them can cause lasting damage.

But pursuit of educational excellence to the exclusion of other aspects of life, such as spending time outside, can be detrimental to eye health, says Nathan Congdon, professor of global eye health at the Centre for Public Health at Queen’s University Belfast.

He points out that countries like Japan, Korea, Vietnam, China, Hong Kong and Singapore that have very high rates of myopia: "They've also got huge educational success. It is a complicated cultural phenomenon."

In China, trials have been conducted in classrooms that mimic learning in the outdoors. Children and teachers in a 2017 study by Zhongshan Ophthalmic Center, where Congdon also works, preferred the bright classrooms that resemble a glasshouse, as compared with a traditional classroom. However in summer and on sunny days, the light intensity was at the "practical upper limit for routine use". The bright classroom is also twice as expensive to build as a regular classroom, partly because cooling mechanisms are required.

This complex problem – myopia as a bad side effect of an otherwise positive trend – also shows up in another area: income levels.

Like education, a higher income is generally associated with greater wellbeing in children – but not when it comes to eye health. Instead, myopia is associated with higher socioeconomic status.

As Congdon explains: "The richer we get, the better we are at protecting our children from ever going outdoors, because they've got more things to do. They've got to play the piano and learn saxophone and watch TV, and so forth."

The literacy effect

In low- and middle-income countries, myopia rates still tend to be lower – Bangladesh and India for example report rates of about 20-30% in adults – but this is changing. In Africa, for example, myopia used to be comparatively uncommon, but over the past ten years the prevalence of childhood myopia has been rising fast. In addition, lower-income countries may lack the resources to diagnose and correct short-sightedness in children, with a massive impact on their lives and education. Some communities in Africa have reported having no access to spectacles at all, and very little access to eye care. Being unable to see properly means children can't follow what their teacher writes on the board, and may also find it hard to participate in other routine school activities.

As literacy rates improve in those countries – an otherwise welcome development – that problem could grow, unless there is a big effort to also provide eye tests and glasses, experts warn.

"We can expect myopia rates to continue to climb because countries like India are getting more kids into school," says Congdon. "And if kids are spending more time in school, they're spending more time reading and less time outdoors."

School time in itself is, however, not necessarily the root of the problem, as the Covid-19 pandemic lockdowns have shown. It is staying indoors that appears to be. During the lockdowns, schools shut down all over the world – but children's eye health became even worse. Typically, they stayed inside during the lockdowns, and spent hours staring at screens, either following classes or watching TV, as other forms of learning and entertainment disappeared.

Singaporean children play by the harbour in the early 1960s. As the country became wealthier, children began spending more and more time indoors (Credit: Getty Images)

Lockdown vision

Because of the legacy of the lockdowns, Chia's biggest concern at the moment is for children aged between four and six. "We're worried that due to Covid-19, children were spending even more time indoors and that rates have gone up," says Chia. "We're waiting for our data to find out."

Data from China already shows that the lockdowns did in fact deal a blow to young children's eye health. One study compared myopia rates among children, measured by annual screenings. Before the pandemic, in the years from 2015-19, the highest myopia rate measured among six-year-old children was 5.7%. In June 2020, after 5 months of home confinement, researchers measured children's eyesight in that age group and found that the rate that shot up to 21.5%, says David C. Musch, one of the study's co-authors and a professor of ophthalmology and visual sciences, and epidemiology, at the University of Michigan.

Researchers have referred to this effect as "quarantine myopia" – basically, lockdown-induced short-sightedness.

Due to pandemic lockdowns, myopia is also becoming a concern in countries that were not much troubled by it before. This can be particularly noticeable in countries where children generally roamed outdoors before the pandemic – but found themselves suddenly confined.

"In countries with outdoor lifestyles, there may be a dramatic increase in myopia rates due to pandemic lockdowns," says Chia. "In countries like Singapore, where we don't go outdoors much, the change caused by the pandemic may not be as big."

IN BRIEF: CAN YOU PREVENT SHORT-SIGHTEDNESS IN CHILDREN?

Short-sightedness rates in children and young people are soaring around the world, with some countries reporting rates of more than 80% or even 90%. The causes are complex, and researchers are still investigating a range of different factors. But one known factor is too much time spent indoors – whereas time spent outdoors, in natural light, is thought to benefit eye health. If you have any specific concerns over your child's eyesight, it is important to ask your health care provider for advice.

Protecting children's eyesight

Faced with these facts, many parents may be wondering what they can do to protect their child's eyesight. And since eye health if a global issue, many countries have made it a priority, too. China, for example, is pursuing a slew of different strategies, warning that widespread near-sightedness could cause labour shortages in a slew of industries.

"A majority of the interventions that exist to stop short-sightedness getting worse were developed or tested in China," says Ghorbani-Mojarrad.

The results have been mixed. Eye exercises, which were previously recommended as a low-cost health strategy, were found to be insufficient in preventing myopia in the long-term. China has limited children's video gaming to a set amount of time per week – but this was largely directed at concerns over the perceived negative influence of gaming, rather than screen time itself. As for the potential link between screen time and myopia, the evidence is not conclusive.

If your child really likes screentime, just sit them outside while they do it – Neema Ghorbani-Mojarrad

"There are many different types of screens and so many variables, so it is difficult to get accurate risk data," says Ghorbani-Mojarrad. "As a parent, it's probably worth being cautious about screens particularly because the evidence shows that it might be a factor. If your child really likes screentime, just sit them outside while they do it."

Other solutions hinge on technological advances. Singapore's myopia strategy, for example, includes special contact lenses or glasses. Its researchers have found no evidence to suggest that treatments such as oral supplements, eye exercises, eye relax machines, acupressure or magnetic therapy, are effective. Simple eye drops, however, may help.

A new red-light therapy may also hold promise. "The machine emits a red light into a child's eye for a few minutes a day for five days a week. It has been shown to slow the amount of short-sightedness developing. But we do not fully understand why," Ghorbani-Mojarrad says.

Ultimately, the right treatment depends on the child, experts say. If parents are worried, they should speak to an optometrist.

But for now, some of the most powerful solutions – be it to manage or prevent myopia – are surprisingly simple.

A girl plays in a conservatory in Singapore. Natural light and outdoor play can benefit children's eye health and general wellbeing (Credit: Getty Images)

Healthy lives, healthy eyes

In many parts of the world, providing an ordinary pair of glasses can be life-changing. Congdon has been working in China since the early 1980s, together with ORBIS International, a charity that has provided low-cost glasses to 2.5 million children in China and India. He undertook the first trial to find out whether glasses would improve educational outcomes. His study of 20,000 children in Guangdong, China found that the impact of giving a $4 (£3.70) pair of glasses outstripped the impact of parental education or family income.

"It means that a simple, low-cost intervention can reverse a lot of the disadvantages that a kid might come into the world having vis-a-vis their parent's education or a low family income. We found this exciting," adds Congdon.

The most effective, evidence-based prevention strategy is also surprisingly low-tech, and applies to all countries regardless of their wealth or resources: more time outdoors.

Researchers are still investigating exactly why being outdoors, and being in natural light, helps prevent myopia – but for now, their perhaps most important conclusion is that it does. The challenge is to ensure that children make use of this natural boost.

In Singapore, outdoors time at preschools was doubled to one hour as part of the broader national myopia-fighting strategy. Exams for the youngest students have been scrapped, to reduce the time spent doing homework.

"We want to increase outdoor time for older students, but the curriculum is quite packed," says Chia. "We're a small island, so some schools don't have the room for the kids to go out and they're not close to a park or anything." While many uncertainties remain about myopia, she is encouraged by the progress made during decades of research: "Three years ago, we did not know how important sunlight is."

Ultimately, a child's eyesight is part of their general wellbeing, she says: "We don't just want the focus to be on the eyes: it's about the whole body and good mental health. We want our kids to lead healthy lives."

FAMILY TREE

This article is part of Family Tree, a series that explores the issues and opportunities families face today – and how they'll shape tomorrow. You might also be interested in other stories in the series:

Climb other branches of the family tree with BBC Culture and Worklife.

https://www.bbc.com/future/article/20220927-can-you-prevent-short-sightedness-in-kids