Reviewed by Dr Olivia Huang, Senior Consultant Ophthalmologist and Director of Glaucoma, IECRC

Most people take their eyesight for granted until something goes wrong. The challenge with many serious eye conditions is that they develop silently, without pain or obvious symptoms, until significant and sometimes irreversible damage has occurred. These five mistakes are common, understandable, and entirely avoidable.

Key Takeaways

• Glaucoma affects 1 in 20 Singaporeans over 60 (Gupta et al, 2025) and is undiagnosed in more than 70% of cases at the time of detection (Chua et al, 2015)

• One-third of older Singaporeans have at least one undiagnosed age-related eye disease (Yee et al, 2026)

• Steroid medications have a risk of causing steroid-induced glaucoma and cataracts, and require medical supervision when using it

• Chronic eye rubbing can increase the risk of keratoconus (a progressive corneal condition that can require transplantation), acute corneal damage (e.g. corneal abrasions), increased eye pressure (which can worsen glaucoma or trigger retinal tears), and infections

• In eye care, a "wait and see" approach to serious symptoms can turn a treatable condition into a permanent one

Why These Mistakes Are So Common and So Consequential

The eye is uniquely vulnerable because many of its most serious conditions are painless and gradual. Glaucoma destroys peripheral vision over years without any discomfort. Diabetic retinopathy can progress to the point of haemorrhage before a patient notices symptoms. Age-related macular degeneration can quietly erode central vision while everyday activities still feel manageable.

By the time symptoms become noticeable, irreversible damage may have already occurred. Data from the Singapore (https://pubmed.ncbi.nlm.nih.gov/41264299/) shows that one-third of older Singaporeans have at least one undiagnosed age-related eye disease. Singapore has excellent healthcare accessibility, yet many patients still present late because they assumed their eyes were fine.

The five mistakes below are drawn from decades of clinical experience at IECRC. Avoiding them does not require medical expertise. It requires awareness.

Mistake 1: Ignoring Gradual Vision Changes Because "It Is Just Ageing"

Many patients dismiss blurry vision, difficulty reading, or trouble driving at night as a normal part of getting older. While presbyopia, the age-related loss of near focusing ability, is indeed a universal change after 40, it is not the only explanation for gradual vision decline.

Cataracts, glaucoma, diabetic retinopathy, and age-related macular degeneration all present with gradual vision changes. Glaucoma is often called the "silent thief of sight" because it destroys peripheral vision painlessly and irreversibly. The SEED study in Singapore (https://pubmed.ncbi.nlm.nih.gov/26043441/) found that more than 70% of patients with glaucoma were undiagnosed at the point of detection. Among these patients with undiagnosed glaucoma, about half already had clinically significant visual field loss, and 4% were already blind in one eye.

Glaucoma surgeries have nearly tripled in the 40 to 49 age group between 2015 and 2025, largely linked to untreated high myopia in younger Singaporeans (https://www.straitstimes.com/singapore/health/more-younger-adults-develop-glaucoma-because-of-untreated-myopia).

The key message is straightforward: gradual vision loss may not be harmless. Any noticeable change in vision warrants professional evaluation as soon as possible.

Mistake 2: Using Over-the-Counter Eye Drops for Chronic Symptoms

Reaching for eye drops when your eyes feel irritated seems reasonable. The problem arises when over-the-counter drops become a long-term substitute for proper diagnosis.

Redness-relief drops containing tetrahydrozoline constrict blood vessels temporarily, making the eye look whiter. But with prolonged use, they cause rebound redness, a cycle where the eyes become redder than before each time the drops wear off. The underlying cause remains untreated.

Over-the-counter "allergy drops" may mask symptoms of conditions far more serious than allergies. Uveitis (inflammation inside the eye), scleritis (inflammation of the white of the eye), and acute angle-closure glaucoma can all present with redness that mimics a simple allergic reaction.

Perhaps most dangerous is the misuse of steroid eye drops. Patients sometimes share leftover prescription steroid drops with family members, or continue using them long after the original condition has resolved. Steroid eye drops can elevate intraocular pressure, leading to steroid-induced glaucoma, and accelerate cataract formation, and must be used under close medical supervision. Prolonged use can also cause corneal thinning and increase susceptibility to infection.

The rule is simple: if you need eye drops for more than a few days, see a specialist for a proper diagnosis.

Mistake 3: Skipping Eye Exams When You Have No Symptoms

Glaucoma, diabetic retinopathy, and early AMD are commonly asymptomatic during the stages when treatment is most effective. By the time you notice vision loss from glaucoma, up to 40% of the optic nerve fibres may already be permanently damaged (Joshi et al, 2022).

Singapore's screening recommendations are clear: adults should have a dilated eye examination every 1 to 2 years after age 40, or earlier if they have diabetes, high myopia, or a family history of glaucoma.

Despite easy access to eye specialists in Singapore, many Singaporeans only see an eye doctor when they fail a driving licence renewal vision test or when symptoms become impossible to ignore. By then, the window for early intervention may have closed.

The absence of symptoms is not evidence of health. Regular screening detects conditions when treatment can preserve vision. This is especially important given that many causes of vision impairment can be prevented or treated when caught early (GBD, 2019).

Mistake 4: Rubbing Your Eyes Habitually

Chronic eye rubbing is far more harmful than most people realise. It is linked to keratoconus, a progressive condition in which the cornea thins and distorts into a cone shape, causing increasingly irregular astigmatism that cannot be corrected with standard spectacles. Keratoconus most commonly affects younger patients and, in severe cases, requires corneal transplantation.

Rubbing also transfers bacteria and viruses from your hands to the delicate tissues of the eye, increasing the risk of conjunctivitis and other infections. In patients who have had eye surgery, including cataract surgery, LASIK, or corneal transplants, rubbing can displace surgical flaps or grafts. Forceful rubbing can also increase the risk of corneal damage such as corneal abrasions.

During allergy season, rubbing may feel like the only way to relieve itching. But rubbing triggers mast cell degranulation, releasing more histamine and making the itching worse. It provides momentary relief followed by escalating discomfort.

If your eyes itch, use preservative-free lubricating drops or prescribed anti-allergy drops. A cold compress can also reduce itching without the mechanical damage that rubbing causes.

Chronic eye rubbing can also accelerate the progression of glaucoma, and in severe cases, directly contribute to glaucomatous nerve damage. Glaucoma is driven by raised eye pressure, and research has shown that forcefully rubbing your eyes can cause the eye pressure to rise, presumably due to the direct application of force (Turner et al, 2019). Sudden changes in eye pressure can also temporarily cut off or restrict oxygen and blood flow to the back of the eye, accelerating the death of retinal nerve fibres.

Mistake 5: Delaying Treatment Because You Are "Waiting to See"

In many areas of medicine, watchful waiting is a reasonable strategy. In certain eye emergencies, it is the most expensive decision you can make.

Retinal detachment is time-critical. A partial detachment that could be repaired with a relatively straightforward procedure can progress to a total detachment within hours, dramatically worsening the visual outcome. The warning signs are sudden onset of floaters, flashes of light, or a shadow across the vision.

Acute angle-closure glaucoma is a true emergency. Untreated, it causes permanent optic nerve damage which can cause irreversible vision loss or blindness in severe cases within hours. It presents with severe eye pain, headache, nausea, and blurred vision with halos around lights.

Wet Age-related Macular Degeneration (AMD), a painless condition that results in irreversible loss of central vision because of the damage to the macula, or the central part of the retina, responds to anti-VEGF injections, but outcomes are significantly better when treatment starts early. Each week of delay allows the abnormal blood vessels to leak further, creating larger scars and worser final vision.

Corneal infections can progress from treatable to sight-threatening within 24 to 48 hours. What starts as mild redness and discomfort can become a deep corneal ulcer requiring months of intensive treatment or, in the worst cases, emergency transplantation.

The message is clear: when eye symptoms are sudden, severe, or rapidly worsening, seek care immediately. Do not wait for your next scheduled appointment.

When Minor Becomes Major: Signs You Need Urgent Eye Care

Certain symptoms require same-day evaluation. These include sudden vision loss or a significant drop in vision in one or both eyes, sudden onset of flashes of light or a shower of new floaters, a shadow or curtain appearing across part of your vision, severe eye pain especially if accompanied by nausea or headache, and any eye injury involving pain, bleeding, or a foreign body.

At IECRC, we provide emergency eye consultations for urgent presentations. If you are experiencing any of the symptoms above, contact IECRC for an urgent assessment.

Frequently Asked Questions

How often should I have an eye exam if I have no eye problems?

Adults without known eye conditions should have a comprehensive dilated eye examination every 1 to 2 years after age 40. If you have diabetes, high myopia, a family history of glaucoma, or are taking medications that affect the eyes (such as steroids or hydroxychloroquine), annual examinations (or more frequent depending on the eye condition) are recommended. Early detection of asymptomatic conditions like glaucoma and diabetic retinopathy is one of the most effective ways to preserve vision.

Is it safe to use eye drops every day?

Preservative-free lubricating drops are generally safe for daily use and are commonly recommended for people with dry eye or those who work in air-conditioned environments. However, medicated drops, particularly steroid drops and redness-relief drops, should not be used daily without medical supervision. If you find yourself relying on eye drops every day, see an eye specialist to determine and treat the underlying cause.

Can rubbing my eyes cause permanent damage?

Yes. Chronic, vigorous eye rubbing can increase the risk of infections, corneal abrasions, glaucoma (damage to the optic nerve related to increased eye pressure), or keratoconus (a progressive corneal condition that can cause severe visual impairment). Rubbing can also displace surgical wounds, stitches or implants in patients who have had eye surgery. If you have a persistent urge to rub your eyes, this may indicate an underlying condition such as allergic conjunctivitis or dry eye that should be treated directly.

What are the early warning signs of glaucoma?

Open-angle glaucoma, the most common form, typically has no early symptoms. Vision loss begins in the peripheral field and progresses so gradually that most patients do not notice until significant damage has occurred. This is precisely why regular screening is essential. Acute angle-closure glaucoma, a less common but more urgent form, presents with severe eye pain, headache, nausea, blurred vision, and halos around lights. This requires immediate medical attention.

Should I go to A&E or an eye specialist for a sudden eye problem?

For sudden vision loss, severe eye pain, eye injuries, or symptoms suggestive of retinal detachment (flashes, floaters, curtain over vision), seek the fastest available care. If an eye specialist can see you the same day, that is ideal because they have specialised diagnostic equipment. If same-day specialist access is not available, go to the accident and emergency (A&E) or urgent care clinic (UCC). Early access to treatment is critical for conditions like retinal detachment and acute glaucoma.

References:

1.      Chua J, Baskaran M, Ong PG, Zheng Y, Wong TY, Aung T, Cheng CY. Prevalence, Risk Factors, and Visual Features of Undiagnosed Glaucoma: The Singapore Epidemiology of Eye Diseases Study. JAMA Ophthalmol. 2015 Aug;133(8):938-46. doi: 10.1001/jamaophthalmol.2015.1478. PMID: 26043441.

2.      GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021 Feb;9(2):e144-e160. doi: 10.1016/S2214-109X(20)30489-7. Epub 2020 Dec 1. Erratum in: Lancet Glob Health. 2021 Apr;9(4):e408. doi: 10.1016/S2214-109X(21)00050-4. PMID: 33275949; PMCID: PMC7820391.

3.      Gupta P, Thakur S, Wong CMJ, Man REK, Fenwick EK, Sabanayagam C, Huang O, Low JR, Perera SA, Wong TT, Lamoureux EL. Glaucoma in Older Asians Aged 60 to 100 Years: Prevalence, Factors, Trends, and Projections (2024-2040). Invest Ophthalmol Vis Sci. 2025 Jul 1;66(9):62. doi: 10.1167/iovs.66.9.62. PMID: 40704860; PMCID: PMC12309617.

4.      Joshi P, Dangwal A, Guleria I, Kothari S, Singh P, Kalra JM, Jakhmola V. Glaucoma in Adults-diagnosis, Management, and Prediagnosis to End-stage, Categorizing Glaucoma's Stages: A Review. J Curr Glaucoma Pract. 2022 Sep-Dec;16(3):170-178. doi: 10.5005/jp-journals-10078-1388. PMID: 36793264; PMCID: PMC9905872.

5.      Turner D, Girkin C, Downs J. The Magnitude of Intraocular Pressure Elevation Associated with Eye Rubbing. Ophthalmology, 2018; 126, 171-172

6.      Yee H, Wong CMJ, Gupta P, Thakur S, Fenwick E, Lamoureux EL, Man REK. Prevalence, Risk Determinants, and Burden of Undiagnosed Age-Related Eye Diseases Among Older Asian Adults. JAMA Ophthalmol. 2026 Jan 1;144(1):23-32. doi: 10.1001/jamaophthalmol.2025.4623. PMID: 41264299; PMCID: PMC12635921.

This article was reviewed by Dr Olivia Huang, Senior Consultant Ophthalmologist and Director of Glaucoma at the International Eye Cataract Retina Centre (IECRC). Last reviewed: Oct 2026.

Disclaimer: This article provides general information and is not a substitute for personalised medical advice. Please consult an eye care professional for guidance specific to your situation.