Eye Service | About us | What we treat
What we treat
The eye is a complex structure, and there are conditions that can affect the entire eye or one particular area of the eye.
The structure of the eye
At Barts and The London Eye Service we treat a wide range of eye conditions, and these include:
· Cataract
· Age-related macular degeneration (AMD)
· Dry eye
· Glaucoma
· Eye conditions associated with HIV and AIDS
· Neurological related eye disorders
Please click on the links above to find out more. For full details about the services on offer to treat these conditions, please click here.
A cataract is a clouding of the lens in the eye, and when it develops your vision becomes blurred; a cataract in your lens acts like a frosted glass, interfering with your sight. Patients with cataract complain of blurred or misty vision, that colours are washed out and faded, and that they are often dazzled by bright lights (particularly sunlight and car headlamps). Cataracts can form at any age – most develop as people get older, however in younger patients they can occur in patients with diabetes, patients on certain medications, and as a result of other longstanding eye problems. Many people develop cataracts and most can be successfully treated.
The only effective treatment for cataract is an operation to remove the cataract, and then replace the natural lens with an artificial lens.
For information about how we assess and treat cataract please click here.
We are a leading centre for treating patients with cancers of the eye. We monitor and treat a number of different types of cancer of the eye in our dedicated Ocular Oncology Service.
What we monitor
- Some benign tumours
- Congenital or acquired pigment on the surface or inside the eye - eg: conjunctival naevi (moles), iris/ choroidal naevi (moles), congenital hypertrophy of the retinal pigment epithelium, primary acquired melanosis and melanocytosis.
What we treat
1. All types of malignant and benign intraocular cancer (cancer originating from inside the eye).
Malignant intraocular tumours can spread to elsewhere in the body and therefore the primary goal of treatment is to improve patient survival. Malignant intraocular tumours include:
- Uveal melanoma
- Retinoblastoma
- Uveal tract or CNS lymphoma
Benign Tumours do not spread in the body and therefore do not affect patient survival. Some benign tumours may affect vision and in extreme cases produce a blind painful eye, therefore the primary goal of treatment is to preserve vision. Many benign tumours only require monitoring. Benign intraocular tumours include:
- Retinal capillary haemangioma
- Vasoproliferative tumour of the retina
- Retinal astrocytoma
- Choroidal haemangioma
Intraocular cancer that has spread to the eye from elsewhere in the body, also known as uveal metastases, are treated because they may affect vision.
This treatment is coordinated with the oncology department at St Bartholomew’s Hospital. The most common cancers to spread to the eye come from the breast or lung and are also known as ocular surface neoplasia.
Many of these conditions overlap with cancer of the eyelid. Malignant ocular surface neoplasia can spread to elsewhere in the body and therefore the primary goal of treatment is to improve patient survival. Malignant intraocular tumour includes:
- Conjunctival squamous cell carcinoma
- Conjunctival melanoma
- Sebaceous cell carcinoma
- Conjunctival lymphoma
Benign ocular surface neoplasia does not spread to elsewhere in the body and therefore does not affect patient survival.
We sometimes treat these benign conditions because they can cause a lot of irritation on the surface of the eye,and can affect vision and may result in an unsightly eye.
Many benign tumours only require monitoring. Benign ocular surface neoplasia includes:
- Conjunctival intraepithelial neoplasia
- Conjunctival papillom
There are many causes of corneal ulcers. Some are sterile and some are highly infectious which may lead to impaired vision if the ulcer is not treated promptly. Our eye experts will prescribe the right medication or keep patients in hospital if necessary for around the clock care.
Diabetes affects the eye in a number of ways. However the most common and serious condition is diabetic retinopathy. Diabetic retinopathy is a disease of the blood vessels of the retina. Diabetic retinopathy is graded according to its severity and location.
· Background retinopathy - At this stage of the disease the retinal blood vessels are only mildly affected, the blood vessels may swell slightly (microaneurysms) or they may leak blood causing haemorrhages or leak fluid leaving fatty deposits (exudates) on the retina.
· Maculopathy - This occurs when diabetic retinopathy progresses at the central area of the retina (the macula). Maculopathy causes a gradual deterioration in central vision and patients may complain of difficulty with fine detail and recognising faces.
· Proliferative retinopathy - As background retinopathy progresses blood vessels in the retina can become blocked, and new blood vessels grow to replace the blocked ones. Unfortunately new blood vessels are much weaker and grow on top of the retina, rather than inside the retina. This can lead to further bleeding inside the eye, and retinal detachment.
All forms of diabetic eye disease can occur without symptoms. If left untreated it can lead to permanent blindness. For this reason it is recommended that all patients with diabetes have yearly diabetic eye screening. Your GP or practice nurse can arrange diabetic eye screening in your local area.
For details of how we assess and treat diabetic retinopathy please click here.
Age-related macular degeneration (AMD)
Macular degeneration is a condition whereby the cells of the retina (in the macular region) become damaged or stop working. As the name suggests, it occurs later in life, and occurs more frequently in older people. There are two types of macular degeneration - wet and dry.
- Dry AMD is the most common form of the condition. It is caused by the gradual loss of function in the cells of the macular region and is characterised by a gradual loss of central vision. Unfortunately there is no treatment available currently for this condition, although patients often benefit from optical aids.
- Wet AMD occurs from a build-up of fluid under the retina that causes bleeding and scarring, and is characterised by a rapid loss of central vision. There are treatments now available for this type of AMD, although these may not be appropriate in all cases. Your consultant will tell you if treatment may help you.
For details of how we assess and treat AMD please click here.
Patients with dry eye experience symptoms such as a scratchy or sandy feeling, heaviness, burning or blurred vision. Dry eyes can be associated with other medical conditions. Dry eye may cause chronic discomfort and treatment includes lubricating drops (artificial tears), there are many different types available on prescription or purchased over the counter. Our eye specialists will recommend the best type for you and how often you should use the treatment. For patients experiencing severe cases of dry eye, surgery may be recommended.
Glaucoma is a diverse group of eye conditions, in which the optic nerve is damaged. The major risk factor is raised pressure inside in the eye.
Most cases of glaucoma in the UK are open angle glaucoma, and the majority of cases will be detected by community opticians (optometrists), who screen for the disease with sight testing. Many patients have no symptoms.
Less common forms of glaucoma include acute angle closure glaucoma, which can be characterised by a sudden onset of pain, blurring of vision, and a severely raised eye pressure. This occurs when the drainage channels (angle) become acutely blocked. The rapid rise in eye pressure can result in eye pain and redness. Finally, secondary glaucoma occurs as the pressure inside the eye is raised following another eye condition.
Common disorders of the eyelid include ptosis (droopy eye lid), blepharitis, chalazions, styes and cysts.
Keratoconus is a disease of the cornea that causes it to gradually thin and bulge. As the disease progresses, the cone becomes more pronounced and the patient becomes very nearsighted which cannot be corrected with glasses. Patients are referred to the contact lens clinic for fitting of rigid gas permeable contact lenses. If the vision has deteriorated to the point that contact lenses are no longer helpful, your consultant may suggest a corneal transplant to retain your vision.
Eye conditions associated with HIV and AIDS
There are some less common eye disorders that occur frequently in patients who have HIV and AIDS. Patients with HIV and AIDS can be referred by their physicians directly to our Ocular Immunology Clinic for investigation and treatment.
Neurological related eye disorders
Whilst the eyes are at the front of the head, the section of the brain that processes vision is at the back of the head, and the two are connected by nerves. Due to this tortuous course through the brain, the nerves are often susceptible to damage from trauma, stroke, and brain tumour or bleeding.
If the nerves communicating between the eyes and the brain become damaged, a patient’s vision and/or their peripheral vision can be affected. Patients are often referred from the neurologist, neuro-surgeon or endocrinologist for assessment and management in our neuro-squint clinic.
Strabismus, commonly referred to as squint is condition in which the visual axes of the eyes are not parallel and the eyes appear to be looking in different directions.
In divergent strabismus, or exotropia, one eye turns outward, whilst in convergent strabismus or esotropia, one eye turns inward.
These generally develop in childhood and if left untreated can have serious consequences on the child’s vision.
For more information on how we assess and treat strabismus/squint in children, please click here.
These childhood squints can often remain in adulthood, or re-occur after being treated in childhood – and patients become concerned about the appearance of their eyes.
Strabismus can also occur in adult patients as a result of cranial nerve palsy. The muscles around the eyes, which control eye movements, work as pairs and are controlled by three pairs of cranial nerves.
If one of these nerves is damaged in any way (i.e. aneurysm, high blood pressure, diabetes, lesion in the brain) then it affects the supply to one or more of these muscles and creates an imbalance between the two eyes causing a squint and double vision (diplopia).
To find out more about diplopia click here.
It is likely these patients will be followed up in our Neuro-squint clinic, our specialty clinic for adult patients with squint or neurological problems.
In adult and paediatric squints, surgery is often the final treatment method to either alleviate double vision or to improve the cosmetic appearance of the eyes. This generally involves tightening one muscle (increasing tension) and loosening (decreasing tension) another to restore the balance between the eyes.
If your consultant is considering surgery for your condition they will discuss the proposed procedure with you.
A refractive error is a need for glasses. There are three types of refractive error – hypermetropia (long-sightedness), myopia (short-sightedness) and astigmatism.
Hypermetropia occurs from a short-length eye and causes blurred near vision, and if the amount of hypermetropia is large it may also cause blurred distance vision.
Myopia occurs when the eye is too long and causes blurred distance vision. Astigmatism arises from an abnormal curvature of the eye and causes blurred vision at all distances.
Patients with refractive errors have decreased vision that improves when lenses are placed in front of the eye.
For more information on how we assess and manage refractive errors please click here.
Diplopia is classified as being either binocular or monocular.
Binocular Diplopia
If the two eyes are misaligned and aim at different targets, two non-matching images will be sent to the viewer's brain.
When the brain accepts and uses two non-matching images at the same time, double vision results. Diplopia can be vertical, horizontal or torsional (tilted) and can arise as a result of a number of different causes.
Some of the common causes are cranial nerve palsies (leading to squints), trauma to the muscles around the eye and orbit, from medical conditions such as thyroid dysfunction and myasthenia gravis and de-compensating squints (squints which were once controlled and the patient is no longer able to). Patients with diplopia are initially assessed and managed by the orthoptists.
Diplopia can be very debilitating and we try to alleviate the problem as soon as possible and treat the cause.
There are different methods used to treat diplopia and different methods are better suited to certain problems. In patients who have a squint with diplopia, we try to join the two images by using prisms to fuse the two separated images into one.
The prisms shift the light entering the deviated eye to re-align the two images. These prisms can be fitted to the lens of a pair of plain glasses and when the condition and squint is stable this/these prisms can be incorporated into a pair of glasses for a more permanent solution.
If we are unable to join the two images we occlude one of the eyes (generally the one deviated the most or with the worst vision) we do this by “frosting” one lens of a pair of glasses so the patient is unable to see through it and thus stopping the diplopia.
In both of these treatments the patient is regularly reviewed to ensure they are comfortable with the prism/ occlusion and it is still helping to alleviate the symptoms.
In many cases of cranial nerve palsies there is partial or full recovery and therefore the patient can re-gain single vision with little intervention, this recovery varies greatly in time, from approximately 1-9 months.
If the patient has had very little recovery from their problem, and is unhappy or unable to manage with a prism or frosting of a lens, then surgery for the strabismus may be an option to alleviate the diplopia.
Monocular diplopia
More rarely, diplopia can also occur when viewing with only one eye; this is called monocular diplopia, or, where the patient perceives more than two images, monocular polyopia.
In this case, the differential diagnosis of multiple image perception includes a structural defect within the eye, a lesion in the anterior visual cortex (rarely cause diplopia, more commonly polyopia) or non–organic conditions.
Unfortunately there are some eye conditions that glasses, laser or surgery cannot cure, and as such the patient has a permanent visual impairment. With patients such as this we provide ongoing care with the aim of preventing further loss of vision. In these cases, patients are referred to our low vision clinic for specialised assessment and management.
Our paediatric patients are seen in the Children’s Eye Service which has services dedicated to treating and caring for our young patients with eye conditions. To find out more about this service please visit our dedicated website for Barts and The London Children's Eye Service.
