When eye allergies affect your vision

Dear doctor,

I am writing on behalf of my son, who is 17 years old and in high school. He has had a problem with his eyes since birth, and I have always wondered whether it was an infection contracted during delivery (I’ve read that a mother’s infections like chlamydia can affect a child’s eyes during childbirth).

Since birth, the boy has experienced continued irritation of his eyes; itching which makes him scratch or vigorously rub his eyes to ease the itch, reddening of the eyes and tearing. This condition was more pronounced when the child looked at shiny surfaces, especially black shiny surfaces, which I first noted when he wore a shiny black suit as a pageboy in a wedding. Doctors in various eye clinics and hospitals attributed it to allergies and prescribed eye drops, promising that the child would outgrow the allergies before or at the age of seven. However, he is now 17 years and instead of the condition improving as promised by doctors, it has worsened. It began with formation of whitish hard deposit (like hard white fat) around the Irises. The whitish deposits continued to grow and increase, obstructing large areas of the Irises. He can’t read from the blackboard for two reasons: one, it’s black and shiny and two, he cannot see. His right eye has now lost almost all ability to see while the left eye is blurry and can only see objects (and numbers and letters) that are only close by, one to three metres away. He depends on classmates to read what is written on blackboards then copies from their books! He’s a bright boy but this condition has massively affected his academic performance. Could it be more than allergy, say trachoma or something else?  What could be the correct diagnosis and treatment?

Samuel

Dear Samuel,

It is highly likely that your son does have an allergic condition. For most people, allergies affecting the eyes are usually mild and improve with time. However, there are some types of eye allergies that can cause severe symptoms and, in a few people, can lead to severe complications, like for your son.

The reaction is most likely triggered by one or more specific irritants such as dust, pollen, smoke, animal fur and dust mites. Symptoms of the allergic reaction may include itching, redness, tearing and swelling. These symptoms may improve when the irritant is removed or when anti-allergy medication is used.

When there is repeated irritation, however, there may be progression of symptoms and the individual develops eye pain, dry eyes, photophobia (discomfort when exposed to light), excessive redness of the eyes and blurring of vision.

Also, persistent rubbing of the eyes can lead to problems with the cornea like corneal ulceration, scarring, corneal opacification and keratoconus (thinning and bulging of the cornea), which can cause problems with vision. Other complications of the longstanding irritation and eye-rubbing include swelling of the conjunctival membrane, loosening and sagging of the conjunctiva, and having growths on the eyelids (papillae) or on the conjunctiva (pinguecula and pterygium), like what you have described.

In addition to all these possible complications, if there is long-standing use of steroid eye drops without proper management by an eye specialist, there is a risk of developing cataracts, which would affect the vision.

It is advisable for your son to be urgently reviewed by an eye specialist/ophthalmologist for thorough review. This includes eye examination using different equipment in addition to other tests. If an infection is present, including trachoma, it will be treated with antibiotics. There are also different types of medications given to manage the allergic reaction, both eye drops and oral medications. Due to the presence of multiple complications, your son may also benefit from surgical interventions and eye glasses depending on the guidance of the eye specialist.

Dear doc, when is it necessary to have renal dialysis?

Dear reader,

Dialysis is a treatment process where waste products and excess fluid are removed from the blood stream. It is also known as renal replacement therapy. Dialysis is done when the kidneys fail and are only able to perform 15 per cent or less of their normal function, and this results in a build-up of waste, toxins and excess fluid in the body. If the kidney failure happened fast (acute kidney failure) and the cause can be reversed, then dialysis is done for a short period until the kidneys recover their ability to function.

However, if the kidney failure has been present for a long time (chronic kidney failure), or if the cause or damage is irreversible, then dialysis is needed three to four times a week for the rest of the individual’s life or until they get a successful kidney transplant.

The kidneys are two bean shaped organs found below the rib cage and towards the back. Most people have two normally functioning kidneys though you can have a normal and healthy life with just one kidney, if it is functioning well. The kidneys have several tasks including filtering blood to remove waste, regulating blood pressure and production of vital proteins that are necessary for the function of the body. The kidneys filter about 100 to 140 litres of blood per day in adults, producing between 900ml and two litres of urine per day. When the kidneys fail, waste products build up in the body, which is toxic and causes illness, and eventually, death.

Kidney failure can be a result of genetic disorders, uncontrolled diabetes, uncontrolled high blood pressure, heart disease, autoimmune disease, long term use of some medications, polycystic kidneys and other kidney diseases. Kidney failure that develops quickly (acute kidney failure) may occur as a result of severe dehydration, excessive blood loss, kidney injury infection, urinary tract obstruction, some medications, auto-immune disease or following other illnesses such as liver disease and heart disease. Symptoms of kidney failure include fatigue, dizziness, nausea and vomiting, swelling of the feet, hands and face, loss of appetite, itchy or dry skin, confusion, muscle cramps and changes in urinating habits.

Diseases affecting the kidney should be managed by a kidney specialist (nephrologist). Kidney check-up should be a part of regular annual check-ups, especially if the individual is on treatment for another illness.

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