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Pain
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Sensitivity to light
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Tearing
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Eyelid twitch
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Ciliary hyperaemia
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Corneal opacification, infiltrates or ulcer
A pterygium is a triangular fibrovascular growth on the cornea of the eye. It is generally developed from bulbar conjunctiva. A new enlarging tissue from the conjunctiva slowly grows over the cornea and is shaped like a wedge. Pterygium will grow larger gradually. In serious case, it may change the corneal curvature and result in astigmatism; or the pterygium may grow too large (> 3mm) and block the pupil that affects patient’s visual function. Pterygium occurs more common in tropical regions, which is associated with excessive exposure to sunlight.
Genetic factors
Nutritional deficiencies, insufficient tear secretion
Allergy
Environmental factors and external stimuli such as the eyes have been excessively stimulated by wind, sand, dust, heat, sunlight, pollen, etc., especially long-term outdoor workers such as fishermen, farmers, seafarers and gravel workers
Pterygium is generally small in size and does not lead to any effects. Sometimes patients will experience eye redness, itchiness, burning sensation or have appearance problem.
Larger pterygium can change the corneal curvature and result in astigmatism and blurred vision. Some pterygia may spread to the central cornea and lead to vision loss.
The treatment to prevent progression of pterygium is to avoid chronic irritation. Treatment is not required if pterygium is small and does not further grow.
If apparent symptoms or severe hyperemia is experienced, patients can use corticosteroids under medical supervision to reduce inflammation.
If eyesight is affected or pterygium becomes larger, pterygium removal can be considered.
In some cases, a pterygium can return after being surgically removed. The ways to lower the recurrence rate include conjunctival autograft and anti-metabolite drugs.
Blepharitis refers to chalazion or is called as stye. Blepharitis is an inflammation of the eyelashes and the margin of eyelids. It is caused by inflammation or bacterial infection. Chalazion is usually caused by staphylococcus such as staphylococcus aureus, which is the most common external stimuli.
Bacteria enters eyelid from gland openings and results in inflection due to eyes rubbing
Food allergy, such as seafood and chocolate etc.
When infection recurs, it is needed to check if it is related to systemic disease such as diabetes etc.
Long hours of overnight work without enough rest can cause eye fatigue and weak immunity
Have diabetes and/ or have the eating habit of consuming food high in sugar and fat
Itching, red and swollen eyelids
Flakes or crusts around the roots of the eyelashes (The crusts of seborrheic blepharitis are yellowish and greasy)
Sometimes may appear misdirected eyelashes or trichiasis
Certain infectious blepharitis will be accompanied by conjunctivitis
In the early stage, you can try to apply warm compresses to improve the gland occlusion. Blocked oil glands can be unclogged through heat and allow oil discharge. You can use hard-boiled eggs as the heat source, wrap it with a clean towel and message around the area with chalazion for 5 to 10 minutes. Massage it for 3 to 4 times. Ophthalmologists will also prescribe antibiotic drops or ointments.
If the condition does not improve, you should consult your ophthalmologist for curettage. This surgery involves making a small incision at the chalazion and then cleaning out the contents. It is a high-precision surgery with small incision, so infection or swelling can be reduced.
Pain
Sensitivity to light
Tearing
Eyelid twitch
Ciliary hyperaemia
Corneal opacification, infiltrates or ulcer
After the ulcer is recovered, the scar may block the light to enter the eye, it may change the corneal curvature and distort the refraction. Therefore, objects cannot clearly focus on the retina and lead to vision loss.
The more common kind of keratitis is caused by the herpes virus, which is a common viral infection in humans. When the immune system starts to decline, herpes ulcers will appear around the lips. The virus will also invade the eyes and cause keratitis. If keratitis that is caused by the viral infection of herpes is not treated in time, it will easily lead to new growth of vessel in the cornea and scarring (Figure A). In serious cases, patients may need to improve their visual function through corneal transplant (Figure B).
Figure A: New growth of vessel in the cornea and a scar is formed. 
Figure B: After receiving corneal transplant, a clear cornea is replaced to improve visual function. Medication treatment: including antivirals, antibiotics and antifungals etc.
Surgery
Mydriatic
Eye trauma causes bacteria, viruses, foreign bodies and chemicals etc. to get into the eye
Systemic disease such as tuberculosis, leprosy, rheumatic disease and leptospirosis
The eye tissue around the iris is inflamed, eg. keratitis, scleritis etc.
Pain
Sensitive to light, tearing
Ciliary hyperaemia
Keratic precipitate
Aqueous humor/ vitreous opacity
Loss of corrugated texture of iris
Pupils shrink
Corneal opacity, posterior synechiae, pupil block, peripheral anterior synechiae or chamber angle synechiae, occlusion of the pupil, iris bombe
Complications like cataract, secondary glaucoma, retinal degradation and atrophy of eyeball
Anti-inflammatory eye drops, mydriatic and eye drops that reduce intraocular pressure
Oral steroids
Inject steroids to subconjunctival space or into your eyes
In most cases, a clear cause cannot be found, it may be related to stress
Endocrine abnormalities
Triggered by autoimmune diseases
1. Hyperemia and edema of episcleritis only appears on the surface of sclera. The color is usually in dark reddish, however, blood vessels turn into white colour quickly after epinephrine is applied.
2. The blood vessels on the surface of sclera relatively do not move, so episcleritis is usually found between the corneal margin and the connective tissue layer. This will not reach the palpebral conjunctiva. The vessels that have hyperemia spread out vertically and extend to the back from the corneal margin.
Abscesses accumulate in anterior chamber
Scleral melt
Corneal edema
Cataract
This is the most common type of episcleritis which mostly found in females. Patients will have symptoms such as eye redness and eye pain. The scleral surface will form a lump of hyperemic, bulbar conjunctiva will have diffuse congestion and edema which is in purple-reddish colour (as seen in the figure). Its symptoms are generally mild with minimal discomfort and burning sensation. Visual function is not affected. Sphincter pupillae muscle and ciliary muscle spasm will appear sometimes and lead to miosis and temporary myopia. The onset of this episcleritis is periodic and acute. It lasts from one to several days each time and some patients may have it again every one to three months.
Comparing to simple episcleritis, nodular episcleritis usually develops in young females and the recovery period is longer. Patients may have symptoms of eye redness, eye pain, sensitive to light and tearing, but visual function is generally not affected. It usually lasts for around 2 weeks and inflammation will fade gradually. Around two third of patients will have nodular episcleritis again for several times.
Since episcleritis is usually related to other systemic diseases and is easy to have recurrent, so the significant treatment principle is to remove the cause and prevent recurrency.
1. If the symptoms are mild: you can consider applying tropical steroid drugs.
2. If the condition is severe or has frequent attacks: to prevent serious complications, patients should have comprehensive examination to see if they have other autoimmune or connective tissue diseases.
3. If patients also have iritis or iridocyclitis, they should apply dilating eye drops in time to reduce inflammation.
Cornea is comprised of five layers. Epithelium is the outer surface. If there is a scratch or a scrape on the surface of your cornea, it is called corneal abrasion.
Corneal scratches caused by improper wearing of contact lenses
Long-term corneal hypoxia leads to detachment and edema
Foreign bodies directly damages the cornea, exposure to ultraviolet radiation or welder's arc (corneal abrasion generally appears after 6 to 12 hours)
Dry eyes
Eyelids do not close completely (cornea has a scratch due to dryness)
Corneal degradation etc.
There are many nerves under the epithelium. It causes a lot of pain when those nerves underneath are exposed once cornea is damaged
Sensitive to light, tearing
Can hardly to open eyes
Conjunctiva around the cornea will have redness
Foreign body sensation when opening or closing eyes
Apply antibiotic eye drops to prevent infection. Using eye ointment everyday before sleeping, so it can form a protection between the eyelids and the cornea to avoid new growth epithelium to be torn down again. Also, wearing bandage contact lens until the wound heal.
Use a needle to puncture some deeper wounds over the affected area, so the outer surface can form a scar that can tightly attach with the tissue below. However, this method is easily to cause corneal scarring and has the risk of ocular penetrating injuries. Therefore, this method is rarely to be used now.
Photo-Therapeutic Keratectomy can treat recurrent corneal abrasion. It has good efficacy and the recurrent rate is lower than 10%.
Keratoconus is an eye disease where there is localized corneal thinning and subsequent bulge leading to cone shaped cornea. Patients who have keratoconus may have induced myopia or astigmatism. In serious cases, it may cause corneal edema and affect visual function.
At present, a clear cause is not yet found. It is possible to be recessive modes of inheritance from chromosome
Allergic diseases
Common seen in people with Down syndrome and serious allergies
Excessive eye rubbing
Greater and faster changes in myopia or astigmatism
In advanced stage, the tip of the cornea may develop edema, so visual function is worsened suddenly and has eye pain
Hard contact lenses exert greater pressure on the top, so they can press the cornea to deform. However, they are less comfortable and may move on the surface of our eyes. Hybrid contact lens (Figure 1) can withstand greater pressure and is more comfortable.
Apply riboflavin (vitamin B2 that boosts energy absorption and generates more reactive oxygen species) on the cornea. Then, UV light will be shone, and the corneal tissue will generate some particles, so the new corneal collagen will cross-link together. Therefore, cornea becomes stiffer and stronger.
It is a method to treat keratoconus. However, if the condition of corneal scarring is severe, patients may eventually need to improve their visual function through corneal transplant.
Corneal transplant is to replace damaged cornea with a normal one, so vision can be restored or corneal diseases can be controlled. This surgery can improve visual function or treat certain corneal diseases. Through this treatment, patients with corneal diseases that can lead to severe visual impairment or even blindness may be able to be treated. As the cornea does not contain blood vessels, so it has immune privilege. The success rate of corneal transplant is the highest among all kinds of organ transplant.
Eye injuries: eg. stab incision, burns or chemical injuries etc.
Severe corneal infection such as bacterial and filtrable virus infection
Corneal degeneration diseases
Congenital corneal diseases eg. keratoconus
Corneal degeneration or damage after surgery
Rejection of the donor cornea
Eye infection
Glaucoma
Loose stitches
Refractive error after surgery
Traditional corneal transplant surgery mostly adopts full thickness corneal transplant, in which all 5 layers of corneal tissues are replaced and transplanted. However, not every kind of degeneration may damage the full thickness of cornea.
Lamellar keratoplasty is a new technique that only removes part of the cornea and keeps the other part of the cornea that is still able to function, so rejection rates can be lowered. It is a safer and more effective surgery. The recovery of incision and visual function are also faster.
A: As cornea does not have blood vessels, so the success rate of corneal transplant is the highest among all kinds of organ transplants. The success rate is lower, if the patients have new growth vessels in the cornea or have other eye diseases. However, the overall success rate is still quite high if appropriate medications are used.
A: Maintain a good mood, have sufficient sleep and rest, quit smoking and drinking, prevent colds and maintain bowel regularity.
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1) Avoid rubbing eyes, eye trauma, labour work and strenuous exercise.
2) Attend follow-up appointments (include: eyesight, intraocular pressure, slit lamp examination etc.)
3) Apply medications according to ophthalmologists’ advice. If there are any adverse reactions during medication, please consult your ophthalmologist for dosage adjustment.
4) Conditions that require emergency treatment: sudden blurring of vision, eye redness, eye pain, sensitive to light, eye trauma etc.
