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Ophthalmology Surgical Excellence
Oculoplastic | Retina | Cornea | Cataract
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Problems of the Eye
A clear lens in the eye focuses light. This lets the eye see images sharply. With age, the lens slowly becomes cloudy. The cloudy lens is a cataract. A cataract scatters light and makes it hard for the eye to focus. Cataracts often form in both eyes. But one lens may cloud faster than the other.
The Aging of Your Lens
Your lens may cloud so slowly that you don`t notice any vision changes at first. But as the cataract gets worse, the eye has a harder time focusing. In early stages, glasses may help you see better. As the lens gets cloudier, your doctor may recommend surgery to restore your vision.
Do your eyes ever sting, burn, or feel scratchy? To be comfortable, your eyes need to be lubricated, or bathed, with tears. Normally, there is always a film of tears on the surface of your eyes. But if your eyes don't produce enough tears, the surface gets irritated. This is known as “dry eyes.”
Not Enough Lubricating Tears
When you cry, your eyes make reflex tears. Each time you blink, another kind of tears, called lubricating tears, spread over the surface of your eyes. These tears keep the eyes moist and comfortable. You aren't aware of these tears because they stay on the surface of the eyes. But without them, your eyes get dry. Then they burn or sting and feel scratchy. They may also water. This doesn't relieve the dryness, however, because the eyes water with reflex tears, not lubricating tears.
What Causes Dry Eyes?
- Heaters and air conditioners
- Wind, smoke, or dry weather
- Allergies such as hay fever
- Eyelid problems, injuries to the eye, or diseases like rheumatoid arthritis
How Lubricating Tears Flow
Lubricating tears flow from glands in the upper eyelid over the surface of the eye. From the eye, the tears drain into canals that lead to the nose.
Eyelid surgery (blepharoplasty) is a type of cosmetic surgery. It is most often done to improve the look of the eyelids. Both the upper and lower eyelids can be treated during the surgery. Discuss your treatment goals with your doctor. He or she can tell you more about what to expect.
Preparing for Surgery
Prepare for the surgery as you have been told. In addition:
- Tell your doctor about all medications you take. This includes herbs and other supplements. It also includes any blood thinners, such as Coumadin, Plavix, or daily aspirin. You may need to stop taking some or all of them before surgery.
- Do not eat or drink during the 8 hours before your surgery, or as directed by your surgeon. This includes coffee, water, gum, and mints. (If you have been instructed to take medications, take them with a small sip of water.)
The Day of the Surgery
The surgery takes about 1-2 hours. You will likely go home the same day.
Before the surgery begins:
- You'll remove any makeup from your eyes. You'll also remove contact lenses if you wear them.
- An IV line is put into a vein in your arm or hand. This line supplies fluids and medications.
- You'll be given medication to keep you free of pain during the surgery. You may have general anesthesia, which puts you into a state like deep sleep during the surgery. (A tube may be inserted into your throat to help you breathe.) Or you may have sedation, which makes you relaxed and sleepy. With sedation, local anesthesia will be injected to numb the areas being worked on. The anesthesiologist will discuss your options with you.
During the surgery:
- For the upper eyelids, an incision is made along the eyelid crease.
- For the lower eyelids, an incision is made inside the lower eyelid. Or it is made in the skin just under the lower lash line.
- With either the upper or lower eyelids, fat may be shaped or removed. Skin may be removed. If muscles are loose, stretched, or torn, they may be tightened or repaired.
- Incisions are closed with stitches (sutures). In some cases, surgical glue is used.
After the Surgery
You're taken to a recovery room to wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. If needed, you'll be given pain medication to relieve any discomfort. You'll sit semi-inclined or with your head propped on pillows, and may have cold packs on your eyes. These measures help reduce bruising and swelling. When you are ready to leave the hospital, an adult family member or friend must drive you.
Recovering at Home
Once at home, follow all instructions you are given. Your doctor will tell you when you can return to your normal routine. You may have some bruising and swelling around your eyes and your vision may be blurry. This is normal and should improve within a week or two. And you may notice your eyes burning or feeling strained during certain activities, such as watching TV, reading a book, or using the computer. While this persists, avoid doing such activities for too long at a time. Be sure to:
- Take all medications exactly as directed. These may include applying eye ointment or using eye drops.
- Apply an ice pack or cold compress to the eyes as directed, for the first 12-24 hours after surgery.
- Care for your incisions as instructed.
- Wear protective sunglasses as directed.
- Avoid wearing eye makeup and contact lenses as directed.
- Avoid swimming or placing your head under water as directed.
- Avoid heavy lifting and strenuous activities as directed.
- Avoid driving until your doctor says it's okay. Do not drive while taking medications that make you drowsy or sleepy.
Call the Doctor If You Have Any of the Following:
- Chest pain or trouble breathing (call 911 or other emergency service)
- Fever of 100.4F or higher (or as directed by your doctor)
- Increased redness, tearing, or itching of the eyes
- Changes in vision, such as double vision, blurry vision, or loss of light perception
- Symptoms of infection at an incision site, such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
- Discomfort or swelling that's worse in one eye than the other
- Pain that cannot be managed with medications
- Other signs or symptoms as indicated by your doctor
You'll have follow-up visits with your doctor. During these visits, your doctor will check the results of your surgery and how well you're healing. If stitches need to be removed, this is done in about 5-7 days.
Risks and Possible Complications Include:
- Problems with vision, such as blurry or double vision and trouble closing the eyes
- Dry or teary eyes
- Changes in sensation, such as numbness or pain
- Skin discoloration
- Damage or injury to the eyes
- Vision problems (including blindness)
- Displacement of the lower eyelid margin (ectropia), which can be temporary or permanent
- Not happy with cosmetic results
- Risks of anesthesia (the anesthesiologist will discuss these with you)
Glaucoma is an eye disease that can cause blindness. If caught early, it can usually be controlled. But it often has no symptoms, so you need regular eye exams. Glaucoma usually begins when pressure builds up in the eye. This pressure can damage the optic nerve. The optic nerve sends messages to the brain so you can see. There are two main kinds of glaucoma: "open-angle" and “closed-angle.”
The eye is always producing fluid. The eye's drainage areas may become clogged or blocked. Too much fluid stays in the eye. This increases eye pressure.
Too much pressure in the eye can damage the optic nerve. If damaged, this nerve cannot send the messages to the brain that let you see.
Open-angle is the most common kind of glaucoma. It occurs slowly as people age. The drainage area in the eye becomes clogged. Not enough fluid drains from the eye, so pressure slowly builds up. This causes gradual loss of side (peripheral) vision. You may not even notice changes until much of your vision is lost.
Closed-angle glaucoma is less common than open-angle. It usually comes on quickly. The drainage area in the eye suddenly becomes completely blocked. Eye pressure builds rapidly. You may notice blurred vision and rainbow halos around lights. You may also have headaches, nausea, vomiting, and severe pain. If not treated right away, blindness can occur quickly.
LASEK (pronounced "Lay-SEEK") stands for laser epithelial keratomileusis. It is a technique for reshaping corneal tissue. It can help you see better without glasses or corrective lenses. The epithelium (top layer of cornea) is softened with an alcohol solution. This makes a flap in the cornea. An excimer laser is then used to reshape the corneal tissue below the flap. The excimer laser produces a concentrated beam of cool ultraviolet (UV) light. LASEK can treat myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (vision distortions caused by cornea irregularities).
What to Expect During the Procedure
- Before treatment, you may be given medication to help you relax.
- Eyedrops numb your eyes. A device is used to keep your eyes open.
- An instrument with alcohol solution in it is briefly placed on the cornea. The surgeon then rolls back the softened epithelium to expose the inner corneal tissue.
- Your surgeon uses a computer-guided excimer laser to reshape the cornea. Laser treatment lasts for 10-90 seconds.
- The epithelium is folded back over the cornea. You will wear a contact lens as a bandage for a few days. This protects the cornea as it heals.
- For a few days after the procedure, your vision may seem worse. It should begin to improve in about 5 days, and become stable in about 6 months.
Pros of LASEK
- Better for patients with thin corneas, previous glaucoma surgery, mild corneal scars, or other cornea problems
- Possibly less postoperative discomfort, haze, regression, or corneal scarring than with PRK
- Possibly faster vision recovery than with PRK
Cons of LASEK
- Mild to moderate pain after surgery
- Longer vision recovery than LASIK
- May need to use eyedrops for 3 months or longer
- Risk of corneal scarring or haze
- Possible temporary or permanent dry eye
- Risk of night vision problems, such as halos or glare
- Possible undercorrection or overcorrection
- Possible loss of best corrected vision
Retinal Tears and Detachments
The retina is the inside lining of the eye. It turns light into nerve signals. These signals are then sent to the brain where they become the images you see. The retina may be torn or detached due to aging, an eye injury, or other problems. Tears and detachments are painless. But they often cause troubling vision changes. If you have symptoms of a tear or detachment, see your ophthalmologist right away, within 24 hours of noticing symptoms. He or she will assess your vision changes and help you decide on treatment.
Symptoms of a Detachment
If you have a detachment, you may notice:
- A shadow or “curtain” across your vision.
- Signs of a tear (floaters, flashes, and blurry vision)
Symptoms of a Tear
If you have a tear, you may notice:
- Floaters (spots or threads in your vision)
- Flashes (bursts of light in your vision)
- Sudden blurry vision