Sudden Worsening of Astigmatism: Causes and Solutions - Ophthalmology

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Understanding the sudden worsening of astigmatism can be a complex issue, as it involves various factors that can influence the shape and function of the cornea and lens in the eye. Astigmatism is a common refractive error caused by an irregular curvature of the cornea or lens, leading to blurred or distorted vision. In your case, you mentioned having a history of astigmatism with a prescription of -50.75 diopters, which is quite significant. The recent increase in astigmatism by 100 degrees, along with symptoms like double vision when looking at traffic lights, raises important questions regarding the underlying causes and necessary evaluations.


Possible Causes of Sudden Worsening of Astigmatism
1. Changes in Corneal Shape: The cornea can change shape due to various factors, including keratoconus, a condition where the cornea thins and bulges into a cone shape. This can lead to a rapid increase in astigmatism.

2. Eye Injury or Surgery: Any trauma to the eye or surgical procedures can alter the corneal curvature, resulting in changes in astigmatism.

3. Inflammation or Infection: Conditions such as keratitis (inflammation of the cornea) or other infections can affect the cornea's shape and lead to increased astigmatism.

4. Systemic Conditions: Certain systemic diseases, such as diabetes, can affect vision and may lead to changes in astigmatism.

5. Contact Lens Wear: If you wear contact lenses, improper fit or overuse can lead to corneal changes, resulting in increased astigmatism.


Diagnostic Steps
Since you have already undergone a dilated eye exam and the doctor found no immediate issues, it is essential to consider further evaluations if the problem persists. Here are some recommended steps:
1. Corneal Topography: This test maps the surface curvature of the cornea and can help identify irregularities that may not be visible during a standard eye exam.

2. Pachymetry: This test measures the thickness of the cornea, which can provide insights into conditions like keratoconus.

3. Refraction Tests: A comprehensive refraction test can help determine the exact prescription needed for your vision correction and assess any changes in astigmatism.

4. Consultation with a Specialist: If the increase in astigmatism is significant or if you experience other symptoms, it may be beneficial to consult with a corneal specialist or an ophthalmologist who can provide a more in-depth evaluation.


Solutions and Management
1. Updated Prescription: If the increase in astigmatism is confirmed, updating your glasses or contact lens prescription is crucial for optimal vision correction.

2. Specialized Contact Lenses: In cases of irregular astigmatism, specialty contact lenses, such as toric lenses or scleral lenses, may provide better vision correction.

3. Surgical Options: If the astigmatism is due to keratoconus or other corneal irregularities, surgical options such as corneal cross-linking or even corneal transplant may be considered.

4. Regular Monitoring: Regular eye exams are essential to monitor any changes in your vision and to adjust your treatment plan accordingly.

In conclusion, while the sudden increase in astigmatism can be concerning, understanding the potential causes and pursuing appropriate diagnostic tests will help in managing your condition effectively. It is essential to maintain open communication with your eye care provider and report any changes in your vision promptly.