Calligraphy in the form of a Sufi dancer

I now have dancing cobwebs in my eye. In the left one, to be precise. They are more like floating wisps of brownish smoke that dart to one side or the other as I shift my eyes, but cobweb seems a more appropriate word. Smoke rises and clears once its source of energy is extinguished; cobwebs accumulate precisely because its maker is now absent. And they don’t leave on their own. Like ghosts.

They appeared last Friday afternoon just as I was finishing work and were preceded by a 20-minute episode of flashing zigzags of bright light. These streaks of lightning–like Zorro etching his monogram in laser light–in turn had been preceded and indeed been precipitated two days earlier by a blow to the ridge of bone immediately above my eye. It had hurt but not for very long, and my only concern that afternoon was that it might leave a bruise that would complicate my going out later that evening. In the end, as my ophthalmologist told me on Friday, the blow had left a far more insidious mark in the form of a small vitreous hemorrhage and a shaking loose of debris in the gel that fills the eye.

The debris manifests itself in my field of vision as two ever-present clumps of darkish suspended threads called, I learned, floaters or mouches volantes. A perfect term, I think. They are indeed the visual equivalent of a pesky fly that buzzes in and out, managing to escape me just as I move to seize it. As I focus on one or the other mouche and try to follow her, she springs up and sails to the side of my eye. It is only if I fix my gaze on one single point that I no longer see them, but of course as soon as my eye moves just a bit, they return, swishing through my field of vision like the tufts of dandelion seeds I would blow as a child before making a wish.

I make a wish. I wish I hadn’t gone to the pool that evening or dropped my goggles on the floor or bent down so quickly to pick them up. I wish I had seen the edge of the glass table before it met the ridge of my eye. Most of all, I wish there was a way I could get rid of these floating ghostly cobwebs.

But there is no therapy for the mouches, no drug or drops that will rid me of this curtain of brown filaments. I have no regimen to follow to lift this curtain, except—and this because of the hemorrhage and not the floaters—not to exert myself for the time being, no swimming, no heavy lifting, and no aspirin. I am helpless.

I think of Sylvia Plath’s poem, “The Eye Mote”, the one that begins with the narrator’s eye being struck by a splinter as she’s riding in the countryside.

Neither tears nor the easing flush
Of eyebaths can unseat the speck:
It sticks, and it has stuck a week.

My doctor tells me that it will be months before these floaters finally settle to the rim of my eye, if they do at all. She used that word, settle. It made me think of lees suspended in a viscous liquid, making their imperceptible slow descent to the base of a fishbowl. I am also told that before they settle—again, if they settle—the brain is likely to have compensated to some extent and started to learn to see through them, as if they weren’t there.

I find this preposterous at the moment. How could my brain learn to ignore anything so conspicuous? For the moment I am the captive of these flitting sprites, these twirling arabesques. They beguile me as much as they frustrate me. I keep checking for evidence of their dissipation. Yes, that would encourage me, having some indication that they were slowly getting thinner or fainter. But they don’t change shape or width or length. And the more I follow them, the less likely I will become accustomed to them, I suppose. I must learn to stop following them around all the time. But they keep waving at me, taunting me.

It is a test of patience, and I am not a very patient man. But I know others have much more awful burdens to bear and so I don’t complain. I am restless. “What I want back is what I was/Before…” Plath writes in the last stanza of the poem. But however much I wish for the same, however much I pray to a God I no longer believe in, let me awake without this curtain of gloom, I know there is no way back.

Ironically I once wrote about another case of hemorrhage in the eye, this time of the artist Edvard Munch (his was much more serious). In the autumn of 1930 Munch executed a series of very unusual drawings and watercolors that documented the damage to his eye from an intraocular hemorrhage he had suffered earlier in the summer.

All these paintings featured a stain. In some, it is a ring of brightly colored concentric circles or a treelike fleck, but in many instances it takes the form of a large dark bird: “[I see] the bird move before me,” Munch wrote. “It gives off illuminating rays of blue, which turn into green and then into a brilliant golden ring, and as it changes position, anything it touches with its colors begins to move—thick snakes in the most extraordinary colors begin to slither about on the chaise longue and coil up together.”

In one work, the bird appears in the midst of a green globe, in another it has occupied the torso of a seated nude. It is everywhere to be seen. Yet it is, in fact, nowhere, an optical illusion created within the very substance of the eye itself.

My flies, in contrast, are drab in color and thankfully much fainter, more ghosts than snakes. They are not the stuff of fable or painting. It was only because of the pressing need to talk about my new condition that I wrote about it at all. They are not the stuff of art but horrible irksome guests who I wish would leave but won’t. They, too, are everywhere I look. I need to find a way to ignore their company until I can forget that they are there at all.

Corneal abrasion as stained with fluorescein (yellow)

A corneal abrasion is a scratch on the surface of the eye, resulting in a defect in the epithelium — the topmost of the 5 layers of the cornea. The most common cause of a corneal abrasion is trauma (fingernail, ball, etc.) and it can be very painful. Once the epithelium is unroofed, thousands of nerve endings are exposed and lead to light sensitivity, pain and tearing.

Healing is fast

The good news about an abrasion is that they usually heal very quickly. In a normal eye, a complete corneal abrasion (meaning the entire epithelial surface is missing) will heal over in about 4 days. More commonly, abrasions are smaller than the entire eye surface and will likely be better within 24 hours.

5 layers of the cornea

Treatments

My favorite treatment for corneal abrasions are antibiotic ointments (like erythromycin). Ointments are nice in that they coat the corneal surface, protecting the exposed nerve endings and reducing pain and discomfort. If the patient is a contact lens wearer (and therefore more prone to getting corneal infections), I use a fourth generation fluroquinolone antibiotic eye drop.

What to do

If you get hit in the eye and think you may have a corneal abrasion, it is best to seek immediate medical attention and have a full eye exam (including dilation of the pupils). Your ophthalmologist will be able to make sure that all you have is a corneal abrasion and nothing worse — like a torn retina, retinal detachment, bleeding in the eye (hyphema or vitreous hemorrhage), torn iris, or some other potentially visually threatening condition.

Once everything looks good, you’ll get a prescription for an antibiotic and will hopefully be better in a day or two.

Neoretina Eye Institute (www.neoretina.com) , a dedicated retinal eye care hospital has introduced a new highly advanced minimally invasive sutureless (stitch free) surgical services which will benefit patients suffering from eye disorders like diabetes-related retina diseases, retinal detachment, vitreous hemorrhage and macular holes. Neoretina has been breaking new ground when it comes to ophthalmic care since its establishment in 2010. The latest microsurgery backed by world’s latest instruments promises safety, speed and precision.

“With high incidence of diabetes leading to severe retina-related disorders which can even lead to blindness, loss of vision, and a large number of elderly people suffering from various retinal disorders of the eye, the introduction of the new service will be a boon to patients who now can get inexpensive world class sutureless retinal surgery services right here in the city,” explained Dr. Raja Rami Reddy, Director and Chief Retinal surgeon, Neoretina Eye Care Institute.

Many types of retinopathy are progressive and may result in blindness or severe vision loss or impairment, particularly if the macula becomes affected. Availability of most-advanced retinopathy treatment will reduce the burden on patients in terms of costs, effort, travel, wait and hospital stay time, Dr. Raja Rami added.  As part of Neoretina’s effort to provide the right information that makes you more knowledgeable about your eyes and eye care we also run free eye camps for diabetics in the city and 6 (six)  districts in Andhra Pradesh.

The newly introduced 23 and 25 Gauge suture-less Vitrectomy ( a microsurgical procedure ) now being performed at Neoretina is fast becoming the gold standard in vitreo-retinal surgery as the process is quicker, less painful and allows for faster post-operative recovery.

Neoretina’s focus is to give patients a good diagnosis and treatment plan. The services at Neoretina include intra-vitreal injections of medications as well as laser therapy. In the diagnostic area Neoretina has state-of-the-art Digital Fluorescein Angiograpghy, Optical Coherence Tomograms (OCT – both posterior and anterior), which provides its physicians with highly precise results helping them make accurate decisions about the best treatment therapy.

“We have state of the art diagnostic and treatment facilities, manned by highly accomplished medical professionals with vast international experience and credentials,” emphasized Dr. Raja Rami Reddy. “Our continued investments in advanced ophthalmic special surgical instruments are aimed at bringing a lot of difference both in terms of meeting surgeons’ requirements and patient expectations, without compromising surgical results. We also want to ensure that such world class procedures are offered to patients at costs that are very affordable.”

The newly launched sutureless vitreoretinal surgery is headed by Dr. Raja Rami Reddy (MD, FRCS) a specialist in retinal surgery with close to 10 years. He is supported by Dr Srinivas Ambatipudi (MD, FMRF) – Consultant Retinal Surgeon, Dr. Syed Maaz Mohiuddin (MS, DNB, FRCS) – Consultant Cornea, Anterior Segment and Trauma and a team other specialist doctors.

Vitreo-retinal surgical services offered at Neoretina are mostly utilized for cases of persisting retinal detachment, macular holes and management of cataract surgery complications, while the Institute also provides intra-vitreal injections used in cases of age-related macular degeneration, and diabetes-related macular edema.

The newly introduced advanced surgical technique provides lot of benefit for Diabetic related retinal indications that is highly complex in nature and need special minimally invasive surgical procedure which are affordable and safe. With the addition of the new Operation Theater the hospital will comprise three operation theatres, of which one is dedicated to infection and ocular trauma.

The results showed that patients receiving bevacizumab cleared anywhere from 2-20 weeks (avg 12 weeks), whereas the patients who did not receive bevacizumab required 6-30 weeks (avg 18 weeks) to clear.  Only 10% of those receiving bevacizumab required PPV, whereas 40% of those who did not receive the drug required PPV.

So, clearly, intravitreal bevacizumab is helpful in the initial treatment of VH from proliferative diabetic retinopathy.  It improves the rate of resolution of VH, and decreases the need for surgery.  Two points were of interest to me.  Neither was specifically studied in the paper, but the authors raise the issues in their study design .  First, they remind us that bevacizumab can induce a fibrous response (“Avastin crunch”) and lead to tractional retinal detachments, and so they excluded patients whose ultrasounds showed the presence of tractional detachments or fibrous responses.  They repeated the B-scans as they followed the injected patients to watch for tractional detachments.  Second, they chose 4-6 weeks as the interval for re-injection of bevacizumab. They based this on two previous papers.  One by Jorge et al. which showed that peak regression of NV in diabetic retinopathy occured at 6 weeks, and that by 12 weeks, leakage had resumed; and the other by Arevalo et al. which showed that regression of NV could occur as quickly as 7-15 days after injection of bevacizumab.

Pearls to take away:  Inject bevacizumab for dense vitreous hemorrhages, get a baseline B-scan and follow the B-scans after injection for tractional detachments, and consider re-injections at 4-6 weeks.