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Eye disease on the rise in Bengaluru. Is pollution to blame?

Eye disease case study: The patient was a four-year-old female who was first seen three months before with a two day history of swelling of the upper lid of the left eye and lower lid of the right eye. This was apparently due to some skin eruption. The patient was also thought to have congenital glaucoma and the sclerae were noted to be blue. The corneas also protruded anteriorly and it was thought the patient might possibly have keratoconus. The patient was thought to have the syndrome of blue sclerotics with a high myopic astigmatism. Incidentally, the parents were first cousins. Generally, the patient had a brachycephaly, there was no nystagmus and the heart was normal. The patient was thought to possibly have osteogenesis imperfecta. She was also thought to have the typical physique of Marfan's, but the lenses were not dislocated. She had blue sclerae ([1], [2]) and keratoconus and she was -6.00 to -8.00 diopters myopic. It appeared that the patient had type VI Ehler's Danlos syndrome on the basis of the blue sclera, high myopia and keratoconus.
The cornea of a four-year-old girl with keratoconus. Image credit: National Eye Institute.
In a hospital in Bengaluru, cases of a serious eye disease have increased by twenty percent in the last year.

Keratoconus is an illness which causes the cornea to thin over time, usually affecting both eyes and causing a range of complications such as blurred vision and sensitivity to light. In the 2017-18 period, Dr Agarwal’s Eye Hospital in Bengaluru registered 400 cases of the condition. In the 2018-19 period, cases have jumped to 480 – forcing the hospital’s senior consultant for cornea and refractive surgery Dr Raghu Nagaraju to encourage parents to look out for signs.

Dryness and inflammation are a vicious combination which leads to allergies. When children continuously rub their eyes due to allergies, it could lead to keratoconus,” Dr Nagaraju said. He noted that children aged ten to fifteen are at highest risk of developing the condition, which he asserts to affect one in every 1,500 Indian children.

Keratoconus’s symptoms include eye itching and blurring. This can lead to eye strain due to having to squint to see. Consultant ophthalmologist Dr Preeti DK notes that keratoconus can be detected if vision continues to be blurred even after eyewear starts to be worn.

Pollution may be escalating the condition, with some studies linking exposure to pollutants with exacerbating allergies. This can lead to the rubbing of the eyes which Dr Nagaraju links to the development of keratoconus. The news comes at a time when other ophthalmological conditions such as dry eye disease are on the rise.

Rising pollution is on the rise in India, home to seven of the world’s ten most polluted cities. The effects of pollution on child health is evident not only in the effects on eye health, but also due to respiratory diseases such as asthma. Every year, 700,000 children under the age of five die due to conditions linked with exposure to pollution.

Ensuring vigilance and minimising exposure to risks such as indoor pollution and other environmental factors which could worsen eye health is vital. Meanwhile, the issue highlights once again  the vitality of tackling pollution as more and more evidence comes to light about the range of health complications arising from it.

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