Patient guide

What happens at the first visit?

The doctor decides the exact plan for the examination. According to the source, a usual eye examination includes these parts:

• Reading letters up close and far away
• Checking the visual field, which means seeing things at the side without moving your eyes
• Following a moving object with your eyes
• Looking at a small light so the doctor can see how the pupil reacts
• Measuring eye pressure, with a puff of air or a gentle touch, which does not hurt
• Sometimes dilating drops so the doctor can see the back of the eye

If you need glasses or a change of glasses, a prescription is given. For dilating drops, see the next page.

What documents to bring

• Your current glasses or lenses, and your previous glasses prescription
• Reports of earlier eye examinations, operations or tests, if you have them
• A list of all your medicines, including drops, tablets, ointments and supplements. If you cannot write it, bring the packages themselves.
• If you have diabetes: your latest blood sugar tests and the results of earlier examinations
• Identity documents and insurance papers, if you have insurance
• Sunglasses for after the examination
• A companion, if your pupils are going to be dilated

What to write down for the doctor

Write a few lines before the visit so you do not forget:

• What is the problem and when did it start?
• Is it one eye or both?
• Is it constant, does it come and go, or is it getting worse?
• Do you have pain, redness, flashes of light or floaters?
• Does anyone in your family have glaucoma, cataract or a retinal disease?
• Do you have diabetes, high blood pressure or another illness?
• Do you have any drug allergies?
• Have you had eye surgery or an eye injury before?

What questions to ask

• What is the problem with my eye?
• Do I need another test or imaging?
• Is treatment needed, or only follow-up?
• If treatment is needed, what are the other options?
• How long until my next visit?
• What sign means I should come back sooner?

A few tips

• If you do not understand something, ask again.
• If your problem is an emergency, do not wait for the visit. See the guide “When should I get urgent help?”.
• Ask the centre about costs and insurance cover.

What are dilating drops?

In a dilated examination, drops open up the pupil so the doctor can see inside the eye and the back of the eye. Many eye diseases, such as retinal disease in diabetes or glaucoma, have no symptoms in the early stages and are found by this examination.

How does it feel?

• For a few hours afterwards, near vision is blurred and the eyes are sensitive to light. The source says “a few hours”, and the exact time differs between people.
• Bright light may bother you.

What to bring

• Sunglasses
• A companion to take you home. Your vision may be blurred, so it is better not to drive yourself.

Who should have a dilated examination?

According to the source:

• People over 60, and people with a family history of glaucoma, every one to two years
• Patients with diabetes and people with high blood pressure, at least once a year
• Everyone else, according to their risk. Ask your doctor about the interval between examinations.

After the examination

• Until your vision is completely normal, take care with fine work, driving and stairs.
• If after the examination you get severe eye pain, nausea or coloured rings around lights, go straight to the guide “When should I get urgent help?” and act on it. This is an emergency.
• If you take a particular medicine or are sensitive to drops, tell the doctor before the examination.

First of all

This guide is written for cataract surgery, because we know it better than the others. For any other eye operation, the instructions of the doctor and the treatment centre come first. If their instructions differ from this page, follow theirs.

A few weeks or days before the operation

• Measuring the eye. Before the operation the eye is measured to decide the power of the lens.
• Medicines. Give the doctor a list of all your medicines. Some may need to be stopped or changed before the operation. Only the doctor decides this. Do not stop any medicine without their advice.
• Drops. You may be given drops before the operation to lower the risk of infection and swelling. Use them as instructed.
• Contact lenses. If you wear lenses, according to the source you may need to leave them out for a few days before the operation. The centre will tell you when.
• Other conditions. If you have diabetes, high blood pressure or another condition, tell the doctor and keep taking your medicines as the doctor advises.

On the day of the operation

• Fasting. The sources differ. One says you can usually eat and drink, and the other says that if the surgeon asks, you should not eat solid food for at least six hours. Follow only the instructions of the centre that is doing the operation.
• Companion. Make sure someone takes you there and brings you home. Do not drive yourself after the operation.
• Clothes. Wear comfortable clothes. Avoid make-up around the eyes.
• Anaesthetic. You are awake. The eye is numbed with drops or an injection. You may feel some movement and changes in light. If you are worried, tell the doctor beforehand. Sometimes a sedative is also given.
• Duration. The operation itself usually takes about twenty to forty-five minutes. Then you rest for a while, and most patients go home the same day.

What to ask the doctor

• Why do you suggest the operation, and what happens if I wait?
• What type of lens suits me, and what should I expect from my vision afterwards?
• What are the risks for my eye?
• Which medicines should I stop before the operation, and which should I keep taking?
• What are the fasting instructions?
• After the operation, how long and how often should I use the drops?
• When should I come for my next visit?
• Which number do I call if there is a problem?

At home

Before the day of the operation, read the page “Care after eye surgery” and get your drops and eye shield ready. Write the centre’s phone number somewhere handy.

First of all

This page is written for the time after cataract surgery. The instructions on your discharge sheet and what your own doctor says come first. If they differ, follow them.

What is normal?

• Blurred vision in the first few hours, from the dilating drops
• Mild discomfort in the eye that may last a few days
• Tiredness in the first few days
• Vision improving gradually over a few days

According to the source, full healing can take four to six weeks. It differs from patient to patient.

What to do

• Drops. Use the drops exactly as instructed. According to the source they may be needed for about four weeks, but your doctor writes your schedule. For how to put them in, see the next page.
• Shield. If you were given a plastic shield, use it at night.
• Sunglasses. Wear sunglasses in bright light or wind.
• Pain. For discomfort, take the painkiller your doctor has named.
• Visits. Go to your follow-up visits, even if you see well.

What not to do

• Do not rub or press the eye.
• Do not let water or soap get into the eye.
• Do not swim. The source says not even with goggles.
• Do not wear make-up around the eyes.
• Do not exercise, do heavy work or lift heavy objects until the doctor allows it.
• Do not drive until your vision is back to normal and the doctor has allowed it.

When to call

Contact the doctor or the treatment centre the same day if:

• Pain gets worse or is not eased by simple painkillers
• Redness gets worse
• Vision gets worse

If glare or halos bother you and are getting worse, tell the doctor as soon as you can.

Go to the emergency department at once if:

• You suddenly see new floaters, or many more than before
• You see flashes of light
• A curtain or dark shadow comes over your vision
• Your vision suddenly becomes blurred

These can be signs of retinal detachment and are urgent. The full list is in the guide “When should I get urgent help?”.

If, months or years later, your vision slowly becomes blurred again, the membrane behind the lens may have become cloudy. This is treated with a short laser procedure. Book a visit.

Before you start

• Use the drops exactly as prescribed, in the same number and at the same times.
• Wash your hands.
• If you wear contact lenses, take them out before the drops, unless the doctor has said to leave them in.
• Shake the bottle well.
• Take off the cap and do not touch the tip of the dropper.

The steps

1. Tilt your head back a little and look at a spot on the ceiling.
2. With one hand, pull down the lower eyelid to make a small pocket.
3. Hold the dropper just above that pocket. The bottle must not touch the eye or eyelid.
4. Squeeze the bottle gently so that one drop falls into the pocket.
5. Close your eye and do not blink. With a finger, gently press the inner corner of the eye next to the nose for one to two minutes, or as long as the doctor said. This stops the drop from draining into the nose.
6. Wipe any extra drop from the closed eyelids with a tissue.
7. If the other eye also needs drops, repeat.
8. Wash your hands with soap and water.

If putting them in is hard for you

• Lie down or tilt your head back and close your eyes.
• Hold the bottle with your thumb and two fingers, and rest the other two fingers on your nose so your hand stays steady.
• Put one drop in the inner corner of the eye next to the nose, without the bottle touching the eyelid. Then open your eye and blink a few times to spread the drop.
• Ask someone to help, or ask the doctor whether there is an aid for aiming and squeezing.

If you have several drops

• Wait three to five minutes between two different drops.
• After each drop, press the inner corner of the eye for one to two minutes, or as your doctor advises.
• Ask your doctor or pharmacist for the order of the drops, and write it down.

Keep the drops clean

• Do not touch the tip of the dropper. A finger can carry bacteria into the bottle.
• Do not let the bottle touch the eye or the eyelid.
• Wash your hands before and after the drops.
• Do not use your bottle for anyone else.

A few tips

• If the drop is for glaucoma, do not stop it without talking to your doctor, even when your vision is good.
• Ask the pharmacist, or check the package, how long a drop can be kept after opening and whether it must go in the fridge.
• If a drop causes severe stinging, more redness or worse vision, hold the drop and tell the doctor.

Before anything else

Do not wait on a sudden eye problem. If you are not sure, act where you are. Afterwards you can find out that your fear was unnecessary.

In all the cases below:

• Do not drive yourself. Have someone take you, or call 115 (the emergency number in Iran).
• Take your medicines and drops with you.
• Do not rub the eye.

Go to the emergency department at once, or call 115

Sudden loss of vision

Vision in one or both eyes suddenly becomes poor or blurred, even if there is no pain.

If it comes with any of these, call 115, because it may be a stroke:

• One side of the face drooping
• Weakness or numbness in one arm or leg
• Slurred speech or confusion
• A sudden severe headache

A curtain, flashes or new floaters

• A curtain or dark shadow comes across your vision
• You see new flashes of light
• Suddenly new floaters or strands appear, or many more than before

These may be signs of retinal detachment. The sooner treatment starts, the better for saving vision.

Severe eye pain with nausea or halos

• Severe pain in the eye or forehead
• A red eye
• Blurred vision
• Seeing coloured rings around lights
• Headache, nausea or vomiting

These may be a sudden attack of glaucoma.

A chemical splash in the eye

Start right now and do not wait for anyone:

1. Rinse the eye with clean water, not hot. Hold the eyelid open and pour the water over the eye, without strong pressure.
2. Keep going for at least 20 minutes.
3. In the meantime, have someone take you to the emergency department. Take the container or packaging of the substance with you.

An injury to the eye

• A hard or fast blow, such as flying debris from a power tool or lawn mower
• An object stuck in the eye. Do not pull it out.
• Any change in vision
• Severe pain, headache, sensitivity to light, nausea or vomiting
• Being unable to open or move the eye
• Blood or pus coming from the eye

In a child, take even a seemingly small blow seriously.

Pain when looking at light, or a very red eye

If looking at light is painful or the eye has turned dark red, go to the emergency department straight away.

Contact your doctor or treatment centre the same day

After eye surgery

• Pain is getting worse or is not eased by painkillers
• Redness is getting worse
• Vision is getting worse

These may be signs of infection or inflammation. If you cannot reach the doctor or the treatment centre, go to the emergency department. Any of the signs in the section above (a curtain, flashes, new floaters, sudden loss of vision) is also an emergency after surgery.

Diabetes

If you have diabetes and your vision suddenly gets worse or blurred, do not wait for your yearly visit.

A red, painful eye

A red, painful eye needs an early examination. If you wear contact lenses, it may be a sign of infection.

What not to do

• Do not rub the eye.
• Do not pull out an object stuck in the eye.
• After an injury, do not wear contact lenses or make-up around the eyes.
• Do not drive yourself.
• Do not use hot water for chemicals.
• Do not wait in the hope that “it might get better by itself”.

If you are not sure

If you do not know whether a sign is serious, contact the treatment centre or go to the emergency department and say exactly what you see. Gradual signs, such as blurring that has slowly got worse over months, are not urgent but need to be examined. Book a visit.