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B-55
CHAPTER
The Eyes
This is a reprint from
WAme / Aere Is No Docior
(Indian adaptation)
published by the
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
259
CHAPTER
The Eyes
tear gland-
pupil
iris
-the conjunctiva is the
thin layer that covers
the white of the eye
-the cornea is the clear or
transparent layer that
covers the iris and the pupil
the tear tube----from eye to nose
HOW TO TAKE GOOD CARE OF THE EYES
The eyes are delicate and need good care. Infections of the eye
spread very easily, if proper care is not taken.
1.
Keep eyes clean by washing them with
clean water. Washing eyes at bedtime.is very
good as it removes the dirt and dust collected
throughout the day.
2.
Always use a clean cloth to wipe eyes. Do not
use saris, dhotis, or sleeves of clothes to wipe
eyes These may cause serious infection in the eyes.
Trachoma (p.,264) and conjunctivitis (p.263) spread 1
3.
Each person should use a separate cloth, towel o
handkerchief for wiping eyes. If one eye is already infected, use a
separate clean cloth for each eye.
4.
When applying "kajal" or "surma".
use a separate finger or applicator for each
person. Keep the tin closed after use. so
that dust does not collect on it.
260
5.
Show any eye infection to a health worker. Do not use medicines
given by roadside medicine sellers. These may not help and may
even cause blindness.
6. Eat dark green leafy vegetables like amarnth, agathi. spinach.
drumstick leaves and fruits like papaya and mangoes. These
contain vitamin A which is very good for eyes. They prevent
night blindness (p.271)
DANGER SIGNS
The eyes are delicate and need good care. Get medical help fast when any of
the following danger signs occurs:
1.
2.
Any wound that cuts or ruptures (goes through) the eyeball.
A painful, grayish spot on the cornea, with redness around the cornea
(corneal ulcer).
3.
Great pain inside the eye (possibly iritis or glaucoma).
4.
Difference in the size of the pupils when there is pain in the eye or thehead.
A difference in the size of the pupils
may come from brain damage, stroke,
injury to the eye, glaucoma, or iritis.
(Some difference is normal in a few
people.)
5.
6.
If vision begins to fail in one or both eyes.
Any eye infection or inflammation that does not get better after 5 or 6 days
of treatment with an antibiotic eye ointment.
INJURIES TO THE EYE
All injuries to the eyeball must be considered dangerous, for they may cause
blindness.
Even small cuts on the cornea (the transparent layer covering the pupil and iris)
may get infected and harm the vision if not cared for correctly.
If a wound to the eyeball is so deep that it reaches the black layer beneath the
outer white layer, this is especially dangerous.
261
If a blunt injury (as with a fist) causes the eyeball to fill with blood, the eye is
in danger (see p.27O). Danger is especially great if pain suddenly gets much worse
after a few days, for this is probably acute glaucoma (p.267).
Injuries may be caused by:
*
fireworks used carelesslv can injure the eye and cause permanent damage
•
"gulli danda" which is a verypopular game, can be dangerous: the "gulli” with its
two sharp ends might damage the eye.
bows and arrows can cause permanent damage if handled carelessly.
•
'
’
*
sparks during welding can damage the eyes if the eyes are not protected with
special dark glasses.
careless handling of chemicals can also damage the eyes.
blunt injuries as with a fist
Treatment:
♦ If the person still sees well with the injured
eye, put an antibiotic eye ointment (p.413)
262
in the eye and cover it with a soft, thick
bandage. If the eye is not better in a day or
two, get medical help.
If the person cannot see well with the injured
eye, if the wound is deep, or if there is blood
inside the eye behind the cornea (p.270),
cover the eye with a clean bandage and go for
medical help at once.
Do not try to remove thorns or splinters that
are tightly stuck in the eyeball. Get medical help.
Prevention of injuries:
• Sit far from fire when cooking.
• Use special dark glasses while welding.
• Wash hands carefully after handling chemicals
• In places where children play, cut off the
lower branches of trees so that the:hildren
may not injure their eyes.
HOW TO REMOVE A SPECK OF DIRT FROM THE EYE
Often you can get a bit of dirt or sand out of the eye by flooding the eye with
clean water (p. 58) or by using the corner of a clean cloth or the tip of some
moist cotton.
263
If you cannot get the particle out easily, use an antibiotic eye ointment, cover
the eye with a bandage, and go for medical help.
RED, PAINFUL EYES-DIFFERENT CAUSES
Many different problems cause red, painful eyes. This chart may help you find
the cause:
foreign matter (bit of dirt, etc.)
in the eye (p.262)
usually affects one eye only;
redness and pain variable
burns or harmful liquids
(p. 58)
one or both eyes;
redness and pain variable
'sore eye'(conjunctivitis,
p. 263)
\
j
usually both eyes (may start
or be worse in one)
hay fever (allergic conjunctivitis,
p. 202)
(
>
trachoma (p. 264)
\
usually
reddest
at outer
edge
measles (p. 358)
/
acute glaucoma (p.267)
\
iritis (p. 266)
f
scratch or ulcer on the
cornea (p. 269)
\
)
'
'burning' pain, usually mild
usually one eye only;
reddest
_■ 'SHfETr.
■next to
the cornea
pain often great
The correct treatment of red, painful eyes often depends on finding out the
cause. Be sure to check carefully for signs of each possibility.
SORE EYES (Conjunctivitis) Sometimes called 'Pink Eyes'
This infection causes redness, pus and mild burning in one or both eyes. The
eyes are usually reddest at the outer edge. There is watering of the eyes. The
lids often stick together after sleep.
Treatment:
To clean pus from the eyes:
Boil one glass of water with a pinch of salt, and then let it cool. Boil a few pieces of
clean cloth in a small cup or 'katori' separately.and let them cool.
Ask the person to lie down with the normal eye near the ground. Wash your hands
with soap and water. Take the boiled water in a cup and pour gently into the corner
of the normal eye near the nose. Collect the dirty water in a vessel kept below the eye.
264
Close the eye. Take a piece of boiled cloth and wipe the eye gently with one stroke.
starting from near the nose towards the ear. Do not use the same cloth again for the
other eye. Throw away the dirty water.
Then turn the head so that the infected eye is near the ground. Open the eyelids
wide. If they are stuck together, do not force them open. Wet the eyes with the boiled
salt water The pus will become loose and can easily be removed.Then wash the eye
in the same way as the normal eye Wipe with a separate piece of boiled cloth.
Pull down the lower eyelid and put in 2 to 3 drops of 20% sulfacetamide eye
drops. Put the drops inside the lower eyelid like shown in the above illustration.
Putting them outside the eye does no good. Put these drops'every 10 minutes till the
eye becomes normal. Put the drops in the normal eye also once or twice a day.
Prevention:
Conjunctivitis is easily spread from one person to another if proper care is not
taken. To avoid spreading conjunctivitis:
' do not let a child with 'sore eyes' play or sleep with others
• use a separate towel or handkerchief for each person; it is very important that
others do not use the infected person's towel or handkerchief.
* wash hands after touching eyes
if you have conjunctivitis.
•
•
•
avoid bathing in canal or pond water
avoid meeting others in crowded places
if possible, try and use dark glasses
TRACHOMA
Trachoma is a chronic form of conjunctivitis that slowly gets worse. It may last
for months or many years. If not treated early, it sometimes causes blindness. It is
spread by touch or by flies, and is most common where people live in poor,
crowded conditions.
265
Signs:
• Trachoma begins with red, watery eyes, like
ordinary conjunctivitis.
• After a month or more, small, pinkish gray
lumps, called follicles, form inside the upper
lids. To see these, turn back the lid as shown
on p.262.
• The white of the eye is mildly inflamed.
» If you look very carefully, or with a
magnifying glass, you may see that the top
edge of the cornea looks grayish, because it
has many tiny new blood vessels in it (pannus).
• The combination of both follicles and pannus
is almost certainly trachoma.
• After several years, the follicles begin to
disappear, leaving whitish scars.-----------------------
These scars make the eyelids thick and
may keep them from opening all the way.
z">rrVV-rct
Or they may pull the eyelashes down into
the eye, scratching the cornea and causing'
blindness.
Treatment of trachoma:
Put 20% sulfacetamide eyedrops inside the eyes three times a day for a month.
If it does not become better, put tetracycline eye ointment inside the eyes three
times a day for a month. For complete cure, also take a sulfonamide or tetracycline
by mouth for 10 days to 2 weeks (p. 400. 402)
Prevention:
Early and complete treatment of trachoma helps prevent its spread to others.
All persons living with someone who has trachoma, especially children, should
have their eyes examined often and if signs appear, they should be treated early.
Also, it is very important to follow the Guidelines of Cleanliness, explained
earlier in this chapter.
Cleanliness helps prevent trachoma.
266
INFECTED EYES IN NEWBORN BABIES
(NEONATAL CONJUNCTIVITIS)
In the first 2 days of life, if a newborn baby's eyes get
red, swell, and have a lot of pus in them, this is probably
gonorrhea (p. 280). The baby has picked up the disease
from his mother at birth. It must be treated at once to
prevent the baby from going blind.
Treatment:
♦ Inject .crystalline penicillin (p. 398) or give 250 mg. (half a 500 mg
tablet) of triple sulfa, ground up and mixed wttn breast milk or boned
water, 4 times a day tor a week, for dosage see P 413.
♦ Also make penicillin eyedrops. Boil half a teaspoon of salt in half a cup of
water. After cooling, add 10 lakh units of injectable (crystalline) penicillin.
Put a drop of this mixture in the baby's eyes every 10 minutes for an hour,
then every hour for 6 hours, then every 2 or 3 hours for 3 days.
♦ Before using drops, clean out pus as described on page263.
Prevention:
All babies' eyes should be protected against gonorrhea, especially the eyes of
babies whose mothers may have gonorrhea or whose fathers have pain when
passing urine. (Mothers may have gonorrhea without knowing it.)
Put a drop of 1% silver nitrate solution once only in each eye at birth. If you
do not have silver nitrate drops, use a tetracycline eye ointment 3 times a day for
3 days.
If a baby develops gonorrhea of the eyes, both parents should be treated for
gonorrhea.
IRITIS (INFLAMMATION OF THE IRIS)
Signs:
NORMAL EYE
EYE WITH IRITIS
pupil small,
often irregular
redness around iris
severe pain
Pain may begin suddenly or gradually. The eye waters a lot. It hurts more in
bright light. There is no pus as in conjunctivitis. Vision is usually blurred.
This is a medical emergency. Antibiotic ointments do not help. Get medical help.
267
GLAUCOMA
This dangerous disease is the result of too much pressure in the eye. It usually
begins after the age of 40 and is a common cause of blindness. To prevent
blindness, it is important to recognize the signs of glaucoma and get medical help
fast.
There are 2 forms of glaucoma.
Acute glaucoma:
This starts suddenly with a headache or severe pain in the eye. The eye
becomes red, the vision blurred. The eyeball feels hard to the touch, like a marble.
There may be vomiting. The pupil of the bad eye is bigger than that of the good
eye. When a person with glaucoma looks at ,the light, he may see colored rings
around the light. This is a very serious sign.
If not treated very soon, acute glaucoma will cause blindness within a few days.
Surgery is often needed. Get medical help fast.
Chronic glaucoma:
The pressure in the eye rises slowly. Usually.there is no pain. Vision is lost
slowly, starting from the side, and often the person does not notice the loss.
Testing the side vision may help detect the disease.
Have the person cover one
eye, and with the other look at
an object straight ahead of him.
Note when he can first see
moving fingers coming from
behind on each side of the head.
Normally fingers are first seen
here.
In glaucoma, finger
movement is first seen more
toward the front.
268
Glaucoma can also be detected by
testing the pressure in ,he eye
Ask the person to look toward his feet. Place the index fingers of both your hands
side by side on the eye. Like this. Keep one finger still and gently press upon the eye
through the lid with the other finger.If the pressure is high, the eye feels hard like a
marble, (to be certain, compare the pressure with your own eye.)
If discovered early, treatment with special eyedrops (pilocarpine) may prevent •
blindness. Dosage should be determined by a doctor or health worker who can
measure the eye pressure periodically. Drops must be used for the rest of one's life.
Prevention:
Persons who are over 40 years old or have relatives with glaucoma should have
their eye pressure checked once a year.
INFECTION OF THE TEAR SAC (DACRYOCYSTITIS)
Signs:
Redness, pain, and swelling beneath the
eye, next to the nose. The eye waters a lot.
drop of pus may appear in the corner of the
eye when the swelling is gently pressed. Treatment:
Apply hot compresses.
Put antibiotic eye drops or ointment in the eye.
Take penicillin (p. 397).
TROUBLE SEEING CLEARLY
Children who have trouble seeing clearly or who get headaches or eye pain
when they read may need glasses. Have their eyes examined.
In older persons, it is normal that, with
passing years, it becomes more difficult to see
close things clearly. Reading glasses often help.
If possible, they should be carefully
prescribed, so as to prevent eye strain and
headache.
CROSS-EYES AND WANDERING EYES
If a baby or young child has one eye that turns in (cross-eye) or out (wall-eye)
or that sometimes looks the wrong way (wanders), try covering the good eye with
a patch.
269
If possible, do this when the child is 6 months old. Keep the good eye covered
until the other eye stays straight. For a 6-month-old baby this may only take a
week or two. Older children take longer—up to a year for a 7-year-old, so for an
older child discuss this with a health worker first.
Early patching of-the good eye often prevents a child from staying cross-eyed
or wall-eyed for life.
If one eye is always turned the wrong way, it is less likely that covering
the good eye will help. Special glasses sometimes help. The eyes can perhaps be
straightened by surgery, but this does not usually help the person see better.
STY (HORDEOLUM)
A red, swollen lump on the eyelid, usually
near its edge. To treat, apply warm, moist
compresses with a little salt in the water. Use
of an antibiotic eye ointment 3 times a day
will help prevent more sties from occurring.
PTERYGIUM
A fleshy thickening on the eye surface that
slowly grows out from the edge of the eye
and onto the cornea; caused in part by sun
light, wind, and dust. Dark glasses may help
calm irritation and slow the growth of a
pterygium. It should be removed by surgery
before it reaches the pupil.
Folk treatments using powdered shells do
more harm that good.
A SCRAPE, ULCER, OR SCAR ON THE CORNEA
■ When the very thin, delicate surface of the
cornea has been scraped, or damaged by
infection, a painful corneal ulcer may result.
If you look hard in a good light, you may see
270
a grayish or less shiny patch on the surface of
the cornea.
If not well cared for, a corneal ulcer can
cause blindness. Apply antibiotic eye ointment,
give penicillin, and cover the eye with a patch.
Seek medical help.
A corneal scar is a painless, white patch on
the cornea. It may result from a corneal ulcer,
burn or other injury to the eye. Surgery
(corneal transplant) is the only treatment.
This is expensive and does not always give
good results. Surgery should only be done if
the person is blind but can still see light.
BLEEDING IN THE WHITE OF THE EYE
A painless, blood-red patch in the white
part of the eye occasionally appears after
lifting something heavy, coughing hard (as
with whooping cough), or being hit on the
eye. The condition results from the bursting
of a small blood vessel. It is harmless and will
slowly disappear without treatment.
Small red patches are common on the eyes
of newborn babies. No treatment is needed.
CATARACT
The lens of the eye, behind the pupil,
becomes cloudy, making the pupil look gray
or white when you shine a light into it.
Cataract is common in older persons, but also
occurs, rarely, in babies. If a blind person
with cataracts can still- tell light from dark
and notice motion, surgery may let him see
again. However, he will need strong glasses
afterward, which take time to get used to.
Medicines do not help cataracts.
271
NIGHT BLINDNESS AND XEROSIS
(VITAMIN A DEFICIENCY)
This eye disease is most common in children
between 2 and 5 years of age. It comes from not
eating enough foods with vitamin A. If not
recognized and treated early, it can make the child
blind.
Signs:
At first, the child may have night blindness. He can
not see as well in the dark as other people can.
Later, he develops dr/ eyes (xerosis). The white
of the eyes loses.its shine and begins to wrinkle.
Patches of little gray bubbles (Bitot's spots) may
form in the eyes.
As the disease gets worse, the cornea also becomes
dry and dull, and may develop little pits.----------- ?—
Then the cornea may quickly grow soft, bulge, or
even burst. Usually there is no pain. Blindness may
result from infection, scarring, or other damage.
Xerosis often begins, or gets worse, when a child is
sick with another illness like diarrhea, whooping
cough, or tuberculosis. Examine the eyes of all sick
and underweight children.
Prevention and treatment:
Xerosis can easily be prevented by eating foods that contain vitamin A. Do the
following:
♦ Breast feed the baby-up to 2 years, if possible.
♦ After the first 6 months, begin giving the child
foods rich in vitamin A, such as dark green leafy
vegetables and yellow or red fruits and
vegetables. Whole milk, eggs, liver, and kidneys
are also rich in vitamin A.
♦ If the child is not likely to get these foods, or if
he is developing signs of night blindness or
xerosis, give him a capsule of vitamin A,
once every 6 months (p.424) ■ Do not give to
babies under 6 months of age.
272
♦ If the condition is already fairly severe, give the child a 200,000 unit capsule
of vitamin A. (p. 424) If the eyes are not well in a week, give another capsule.
WARNING: Too much vitamin A is poisonous.
If the condition of the child's eyes is severe, with a dull, pitted, or bulging
cornea, get medical help. The child's eyes should be bandaged, and he should
receive vitamin A at once, preferably an injection of 100,000 units.
Dark green or yellow vegetables prevent blindness in children.
SPOTS OR 'FLIES' BEFORE THE EYES
(MOUCHES VOLANTES)
Sometimes older persons complain of small moving spots when they look at a
bright surface (wall, sky). The spots move when the eyes move and look like tiny
flies.
These spots are usually harmless and need no treatment. However, if they
appear suddenly in large numbers and vision begins to fail from one side, this
could be a medical emergency (detached retin?). Medical help is needed at once.
DOUBLE VISION
Seeing double can have many causes.
If double vision comes suddenly, is chronic, or
gradually gets worse, it is probably a sign of a serious
problem. Seek medical help.
If double vision occurs only from time to time, it may
be a sign of weakness or exhaustion, perhaps from malnutrition.
Read Chapter 11 on good nutrition and try to eat as well as possible. If sight
does not improve, get medical help..
The book V/hcrc ~Thcrc Is No Doctor is available
at Rs 29/- plus postage. Multiple copies of reprints
of various chapters are also available.
Please write to:
Publications Officer
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
Rs.
1.50
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