GENERAL RATING FORMULA FOR DISEASES OF THE EYE:

Choroidopathy, including uveitis, iritis, cyclitis, or choroiditis 

Choroidopathy refers to a group of conditions that affect the choroid, a layer of blood vessels in the eye located between the retina and sclera. It can include various inflammatory disorders such as uveitis, iritis, cyclitis, or choroiditis. These conditions involve inflammation of different parts of the eye, leading to visual disturbances and potential complications.

Causes 

Certain risk factors have been identified that might cause Choroidopathy: 

• Autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), or sarcoidosis.
• Infections, including viral, bacterial, fungal, or parasitic infections.
• Trauma or injury to the eye.
• Certain medications or toxins.
• Inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis.
• Genetic factors or family history.

Symptoms

Here are some symptoms of Choroidopathy 

• Eye redness.
• Eye pain or discomfort.
• Blurred vision or decreased vision.
• Sensitivity to light (photophobia).
• Floaters or spots in the field of vision.
• Eye watering or tearing.
• Changes in the color of the iris.
• Headache or eye headache.

Diagnosis 

The diagnosis of choroidopathy typically involves:

• Comprehensive eye examination by an ophthalmologist, including visual acuity test, slit-lamp examination, and dilated fundus examination.
• Medical history assessment to identify any underlying conditions or triggers.
• Blood tests to evaluate for signs of inflammation, autoimmune markers, or infectious agents.
• Imaging tests, such as optical coherence tomography (OCT) or fluorescein angiography, to assess the structures and blood flow in the eye.
• Analysis of ocular fluid or tissue samples obtained through a biopsy or aspiration, if necessary, to determine the cause of inflammation.

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Keratopathy 

Keratopathy is a term that refers to a group of diseases of the cornea with a vast array of underlying causes and mechanisms

Types

Following are the types of keratopathy and their characteristics:

Exposure keratopathy: It is damage to the cornea that occurs primarily from prolonged exposure of the ocular surface to the outside environment. It can lead to ulceration, microbial keratitis, and permanent vision loss from scarring

Calcific band keratopathy: It is a corneal degeneration that is most often composed of calcium phosphate deposits in the superficial cornea

Band keratopathy: It is a disease of the cornea that causes calcium deposits in some layers of the cornea. It can be caused by an underlying condition, such as chronic kidney disease or hypercalcemia

Superficial punctate keratitis: It is a type of keratopathy that causes damage to small pockets of epithelial cells. It is commonly seen in corneal inflammation

Metabolic keratopathy: It is caused by the abnormal accumulation of proteins, carbohydrates, or fats in the cornea due to a wide array of metabolic disorders

Neurotrophic keratopathy: It is a disease of the cornea caused by decreased corneal nerve function

Causes 

Here are some causes of keratopathy:

Exposure to the outside environment for a prolonged period of time can cause exposure keratopathy.

• Metabolic disorders can cause metabolic keratopathy.
• Inflammation of the cornea can cause superficial punctate keratitis.
• Calcium deposits in the cornea can cause band-shaped keratopathy and calcific band keratopathy.
• Infectious or non-infectious causes can lead to neurotrophic keratitis.
• Keratitis, which is inflammation of the cornea, can be caused by various factors such as infections, exposure to ultraviolet light, vitamin A deficiency, and eyelid disorders.
• Endothelial compromise and associated corneal edema may also result in calcium deposition and band keratopathy.

The causes of keratopathy can be local or systemic, and each type of keratopathy is associated with different clinical scenarios.

Symptoms 

Signs and symptoms of keratopathy include:

• Eye redness.
• Eye pain.
• Excess tears or other discharge from your eye.
• Difficulty opening your eyelid because of pain or irritation.
• Blurred vision.
• Decreased vision.
• Sensitivity to light, called photophobia.
• A feeling that something is in your eye.
• Eye discomfort/irritation.
• Pruritus.
• Minor blurring of vision.
• Conjunctival injection.
• Conjunctival chemosis.
• Watery discharge and epiphora.
• Bilateral burning, irritation, foreign body sensation.

Diagnosis

The diagnosis of keratopathy depends on the underlying cause and the clinical scenario associated with it.

• Eye exam conducted by an ophthalmologist or optometrist.
• Keratometry, which involves focusing a circle of light on your cornea and measuring the reflection to determine the basic shape of your cornea.
• Computerized corneal mapping, such as corneal tomography and corneal topography, which record images to create a detailed shape map of your cornea.
• Corneal tomography, which can also measure the thickness of your cornea and detect early signs of keratoconus.
• Slit-lamp examination, which involves directing a beam of light onto the eye to examine the cornea and other structures of the eye.
• Specular microscopy, which is a non-invasive imaging technique that provides high-resolution images of the corneal endothelium.
• Confocal microscopy, which is a non-invasive imaging technique that provides high-resolution images of the cornea.
• Ultrasound biomicroscopy, which is a non-invasive imaging technique that provides high-resolution images of the anterior segment of the eye.

Scleritis

The sclera is the protective outer layer of the eye, which is also the white part of the eye. It’s connected to muscles that help the eye move. About 83 percent of the eye surface is the sclera.

Scleritis is a disorder in which the sclera becomes severely inflamed and red. It can be very painful. Scleritis is believed to be the result of the body’s immune system overreacting. The type of scleritis you have depends on the location of the inflammation. Most people feel severe pain with the condition, but there are exceptions.

Causes

Scleritis is often linked with an autoimmune disease. Sometimes there is no known cause. Scleritis may be linked to:

• joint swelling and stiffness (arthritis)
• lupus, or other connective tissue disease
• eye infection
• inflammatory bowel disease (IBD)
• Sjogren’s syndrome (causes very dry eyes and other symptoms)
• granulomatosis
• scleroderma
• Scleritis may be caused by trauma (injury) to the eye. Rarely, it is caused by a fungus or a parasite.

Symptoms

Each type of scleritis has similar symptoms, and they can worsen if the condition isn’t treated. Severe eye pain that responds poorly to painkillers is the main symptom of scleritis. Eye movements are likely to make the pain worse. The pain may spread throughout the entire face, particularly on the side of the affected eye.

Other symptoms may include:

• excessive tearing, or lacrimation
• decreased vision
• blurry vision
• sensitivity to light, or photophobia
• redness of the sclera, or white portion of your eye

The symptoms of posterior scleritis are not as evident because it does not cause the severe pain as other types. Symptoms include:

• deep-seated headaches
• pain caused by eye movement
• eye irritation
• double vision

Some people experience little to no pain from scleritis. This may be because they have:

• a milder case
• scleromalacia perforans, which is a rare complication of advanced rheumatoid arthritis (RA)
• a history of using immunosuppressive medications (they prevent activity in the immune system) before symptoms began

Diagnosis

Your doctor will review a detailed medical history and perform an examination and laboratory evaluations to diagnose scleritis.

Your doctor may ask questions about your history of systemic conditions, such as whether you’ve had RA, Wegener’s granulomatosis, or IBD. They may also ask if you’ve had a history of trauma or surgery to the eye.

The following tests can help your doctor make a diagnosis:

• ultrasonography to look for changes occurring in or around the sclera
• complete blood count to check for signs of infection and immune system activity
• a biopsy of your sclera, which involves removing tissue of the sclera so that it can be examined under a microscope

Retinopathy or maculopathy not otherwise specified 

Retinopathy refers to any disorder affecting the retina, which is the light-sensitive tissue at the back of the eye responsible for capturing and transmitting visual information to the brain.  Maculopathy specifically refers to conditions affecting the macula, the central part of the retina responsible for central vision and detailed visual tasks.

Retinopathy or maculopathy not otherwise specified refers to a condition involving abnormalities or damage to the retina or macula of the eye that cannot be specifically categorized into a known subtype or cause. This designation is used when the exact underlying cause or specific classification of the retinal or macular condition is uncertain or cannot be determined.

Causes 

Following are some of the causes of retinopathy or maculopathy 

• Systemic diseases, such as diabetes or hypertension, which can cause damage to the blood vessels supplying the retina or macula.
• Age-related changes and degeneration.
• Inflammatory conditions affecting the eye.
• Genetic or hereditary factors.
• Exposure to certain medications, toxins, or radiation.
• Trauma or injury to the eye.
• Underlying vascular disorders or autoimmune diseases.

Symptoms

The signs and symptoms of retinopathy or maculopathy include:

• Blurred or distorted vision.
• Loss of central vision or difficulty with detailed visual tasks.
• Floaters or spots in the field of vision.
• Fluctuations in visual acuity.
• Color vision abnormalities.
• Dark or empty areas in the visual field.
• Visual disturbances or changes in perception.

Diagnosis

The tests and exams involved in the diagnosis of retinopathy or maculopathy are

• Comprehensive eye examination by an ophthalmologist, including visual acuity test, dilated fundus examination, and evaluation of the macula and retina.
• Imaging tests, such as optical coherence tomography (OCT) or fluorescein angiography, assess the structures, blood flow, and any abnormalities in the retina or macula.
• Electroretinogram (ERG) or other specialized tests to assess the function of the retina.
• Medical history assessment and evaluation of systemic health to identify any underlying conditions or factors that may contribute to the retinopathy or maculopathy.
• Collaboration with other specialists, such as a retina specialist or a medical specialist, to investigate potential underlying causes or associated systemic conditions.

Intraocular hemorrhage 

An intraocular haemorrhage or vitreous haemorrhage is bleeding in the internal part of the eye known as the vitreous cavity. Vitreous humour is a clear gel that makes up two-thirds of the eye's total volume, consists 99 % of water and lies between the retina at the back and the crystalline lens and the ciliary body at the front.

When there's a haemorrhage in the vitreous humour, this loses its transparency and light can't pass through it, causing the loss of vision.

Causes 

Here are some causes of intraocular hemorrhage:

• Trauma
• Proliferative diabetic retinopathy
• Retinal venous occlusion
• Vasculitis, such as Eales disease
• Hypertensive retinopathy
• Ocular ischemic syndrome
• Blood dyscrasias
• Bleeding and coagulation disorders
• Shaken baby syndrome
• Purtscher retinopathy
• Terson syndrome
• Anemia
• Leukemia
• Sea-fan neovascularization
• Normal-tension glaucoma
• Primary open-angle glaucoma
• Posterior vitreous detachment
• Optic neuropathy

Symptoms 

Some signs and  symptoms of intraocular hemorrhage include:

• Sudden, painless complete vision loss
• Mild haze
• New floaters
• Shadows
• "Cobwebs"
• Red tint to vision
• Flashes of light in peripheral vision (photopsias)
• Blurred vision
• Small translucent spots or shadows
• Loss of vision of spots that are suspended in vision (floaters)
• Visual acuity can be quite variable among patients
• Photopsias from traction applied to the retina
• Density and location of the hemorrhage governs the severity of symptoms
• Depending on the underlying mechanism, patients may also describe flashes of light in their peripheral vision (i.e., photopsias) from traction applied to the retina

Diagnosis 

Here are some ways to diagnose intraocular hemorrhage:

• Comprehensive eye examination
• Visual acuity test
• Eye fundus examination
• Eye ultrasound
• Scleral depression
• Ultrasound (B-scan)
• Rule out retinal tear or detachment
• Monitor intraocular pressure
• Uncovering the underlying etiology

Detachment of retina

Retinal detachment describes an emergency situation in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position.

Retinal detachment separates the retinal cells from the layer of blood vessels that provides oxygen and nourishment to the eye. The longer retinal detachment goes untreated, the greater your risk of permanent vision loss in the affected eye.

Causes

The three causes of retinal detachment are:

Rhegmatogenous: The most common cause of retinal detachment happens when there’s a small tear in your retina. Eye fluid called vitreous can travel through the tear and collect behind the retina. It then pushes the retina away, detaching it from the back of your eye. This type of detachment usually happens as you get older. As the vitreous shrinks and thins with age, it pulls on the retina, tearing it.

Tractional: Scar tissue on the retina can pull it away from the back of the eye. Diabetes is a common cause of these retinal detachments. The prolonged high blood sugar can damage blood vessels in your eye and that can result in scar tissue formation. The scars and areas of traction can get bigger, pulling and detaching the retina from the back of the eye.

Exudative: Fluid builds up behind the retina even though there’s no retinal tear. As the fluid collects, it pushes your retina away. The main causes of fluid buildup are leaking blood vessels or swelling behind the eye, which can happen from such causes as uveitis (eye inflammation).

Symptoms

A detached retina doesn't hurt. It can happen with no warning. You might notice:

• Flashes of light
• Lots of new "floaters" (small flecks or threads in your vision)
• Darkness or a “curtain” over your vision, including the middle or the sides
• Your retina could tear before it detaches. A torn retina usually has the same symptoms as a detached one.
• If your retina gets torn, the fluid inside your eye can leak underneath and separate the retina from its underlying tissue. That's a retinal detachment.

Diagnosis

Your doctor may use the following tests, instruments, and procedures to diagnose retinal detachment:

Retinal examination

The doctor may use an instrument with a bright light and special lenses to examine the back of your eye, including the retina. This type of device provides a highly detailed view of your whole eye, allowing the doctor to see any retinal holes, tears, or detachments.

Ultrasound imaging

Your doctor may use this test if bleeding has occurred in the eye, making it difficult to see your retina.

Your doctor will likely examine both eyes even if you have symptoms in just one.

Unhealed eye injury

Unhealed eye injury refers to an eye injury that has not fully healed or resolved, resulting in ongoing symptoms or complications. It can occur due to various factors, such as inadequate initial treatment, delayed medical intervention, or the nature of the injury itself. The healing process in the eye can be complex and may require prompt and appropriate management to ensure proper recovery.

Causes of unhealed eye injury

• Severe trauma to the eye, such as from accidents, falls, or sports-related injuries.
• Penetrating injuries, where a foreign object enters the eye.
• Chemical or thermal burns to the eye.
• Inadequate or delayed medical treatment following an initial eye injury.
• Underlying medical conditions that impede the healing process, such as autoimmune diseases or certain medications.

Symptoms of unhealed eye injury

• Persistent pain or discomfort in the affected eye.
• Blurred or decreased vision.
• Sensitivity to light (photophobia).
• Redness or swelling of the eye.
• Discharge from the eye.
• Foreign body sensation or the feeling that something is in the eye.
• Abnormal tearing or dryness of the eye.
• Changes in eye movement or alignment.

Diagnosis of unhealed eye injury

• Comprehensive eye examination by an ophthalmologist, including visual acuity test, slit-lamp examination, and evaluation of the structures of the eye.
• Detailed assessment of the patient's medical history, including the nature and timeline of the initial injury.
• Imaging tests, such as ocular ultrasound or computed tomography (CT) scan, to assess the extent of the injury and identify any associated complications.
• Assessment of the healing process, including the presence of any scarring, inflammation, or infection.
• Evaluation of visual function and potential visual deficits caused by the unhealed eye injury.
• Collaboration with other specialists, such as an ocular plastic surgeon or cornea specialist, if specialized interventions or surgical procedures are required for optimal healing.