Repeat the method twice daily. When the procedure is completed, drops/ointment may be applied to the lid margins as instructed if prescribed.  If tablets have been prescribed, then you should take them as directed. This treatment will help in the reduction of the inflammation of the eyelids. 

Blepharoplasty

There are many causes of unusually shaped eyelids including congenital or traumatic, but usually sagging skin over the eyelid is the problem, which happens to all of us in time to some degree!  Blepharoplasty is the name given to an operation in which the shape of the eyelids is addressed . 

In some cases, the whole brow may droop (brow ptosis) and this may also need to be addressed. Sometimes, there is also fat which needs to be removed, along with skin. Unless the eyelids are drooping enough to obstruct the vision, this is usually considered a cosmetic procedure.

Blocked Tear Ducts

A lacrimal duct obstruction is blockage of the tear duct, the thin channel that normally drains tears from the surface of the eye.  

A tiny hole at the inner edge of each eyelid marks the opening of the ducts, which lead to the lacrimal sacs located on the side of the nose. The tears pass from the sacs into the nasolacrimal ducts and then into the nose.

When a tear duct becomes obstructed, tears may spill over the eyelids and run down the face. Stagnant tears within the system can become infected, leading to recurrent red eyes and infections. Excessive tearing can also produce secondary skin changes on the lower eyelids.

Children frequently have a congenital lacrimal duct obstruction. Six to ten percent of all children are born before their tear ducts are open. In adults, a common cause of lacrimal duct obstruction is involution, which is progressive degeneration occurring naturally with advancing age, resulting in shrivelling of organs or tissues. 

Other causes include eyelid disorders, infections by bacteria, viruses, fungi, and parasites, inflammations, the use of eye drops or excessive nasal spray, systemic chemotherapy, trauma from previous surgeries, injury to the bone at the side of the nose, foreign bodies, sinus disease, nasal polyps, and malignant or benign tumors.

Diagnosis

If the primary symptom is excessive tearing, the first step is for the health care professional to determine if the overflow of tears is due to an increase in tear production or a decrease in tear drainage. Causes of increased tear production may include trichiasis, a disease in which the eyelashes produce constant irritation, and eyelid malpositions and diseases. 

If abnormal tear production is ruled out, then obstructions in tear drainage is the most likely cause of the excessive tearing. Additional observations of swollen lacrimal sac area and purulent eye discharge indicate that there may be a lacrimal duct infection present. To further define the diagnosis, the lacrimal discharge may be cultured to determine possible infective agents, while various imaging techniques may be used to detect the type of obstruction. Dye tracer tests are also used to test for blockages.

Treatment

Lacrimal duct obstructions in children often resolve spontaneously, with 95% showing resolution before the child is one year old. Daily massaging of the lacrimal sac may help open the blockage. A topical antibiotic ointment may be applied if infection is present. If the blockage is not resolved after several weeks to months of this therapy, a physician may attempt forceful irrigation. Surgical probing to open up the duct under anesthesia is a last resort, after a year or so of less invasive treatments.  

Cataract Surgery

What is a cataract?  

When we talk about cataract in the eye, we mean that there is a cloudiness developing in the crystalline lens of the eye. Early symptoms may include dazzle or glare, reduced focus, or a change in the strength of spectatcle correction. 

Cataract commonly happens as a result of ageing, but there are many other causes. Usually cataracts progress slowly, but certain varieties progress much faster.  Whatever the cause, the surgical treatment is the same. 

Can cataract be treated medically?

Medical treatments have been tried for many years, but none has been successful. The chairman of the scientific committee of the Royal College of Ophthalmologists in UK made the following statement on N-acetyl-carnosine eye drops.

‘The evidence for the effectiveness of N-acetyl-carnosine eye drops is based on experience on a small number of cases carried out by a Russian research team. To date, the research has not been corroborated and the results replicated by other. The long-term effect is unknown. We do not feel the evidence base for the safety and efficacy is in any way sufficient to recommend its use. More research is needed.’

What is the best treatment available?

The established modern treatment is through surgical removal of the cloudy lens, which is achieved using ultrasound (phacoemulsification).  This allows the lens to be removed through a hole much smaller than the lens itself (as in keyhole surgery). In fact the incision is so small, around 2.8-3.5mm in most cases, that the eye usually require no sutures to seal itself at the end of the operation.  This small incision means that there is very little distortion of the eye during healing and the risk of infection is low. 

Measurements will be made at the clinic so that a new lens (known as an IOL, or intraocular lens) of the right strength can be inserted at the time of surgery.  This frequently means that no glasses are needed when looking into the distance after the surgery, although readers may be needed. However, a lens of any power can be chosen, so that a patient may choose a strength to allow reading without glasses. 

Furthermore, at extra cost, newer designs of lens are available which can allow good vision at all distances without the use of glasses. These lenses are state of the art technology and interested patients should ask their surgeon about them. 

Congenital Rubella Eye Effects  

(PDF file available for download)

Electrolysis

This can be performed to permanently remove eyelashes which are growing in the wrong direction (trichiasis) which can otherwise be a very uncomfortable and even damaging situation. It is performed in the clinic under local anesthesia. 

Eyelid Disorder  

(PDF file available for download)

Floaters

Most people, as they age, see small dark shapes that appear to float in their field of vision, similar to a fly, flying around.  These are called floaters.  They are usually more obvious against a clear background, moving quickly with eye movement and drift away when eye movement stops.

They are particles in the vitreous body – the jelly-like substance that fills the eye. The vitreous body is attached to the retina – the layer of light sensitive tissue at the back of the eye. Floaters appear in the field of vision because they cast shadows on the retina.

Some floaters are barely noticeable, while others can severely interfere with vision.  Though they are annoying, floaters are usually harmless and can come and go over the years. 

How The Eye Works

(PDF file available for download)

Iritis

This is an inflammatory problem of the iris (the coloured part of the eye), also called anterior uveitis.  It often occurs for many unknown reasons but it may be linked to systemic diseases (or so-called connective-tissue diseases) affecting the body, infections, injury or previous eye surgery.

Symptoms/Signs:

• Red eye
• Light sensitivity (photophobia)
• Pain; ranging from aching or soreness to intense discomfort
• Small pupil
• Tearing/watering 

Keratoconus

Is a progressive disorder that thins the normally round dome-shaped cornea (the clear convex structure that forms the front of the eye) and causes a cone-like bulge to develop. This results in significant visual impairment. The cornea is the clear window of the eye and is responsible for refracting most of the light coming into the eye. Therefore, abnormalities of the cornea severely affect the way we see the world making simple tasks, like driving, watching TV or reading a book difficult. 

Onset of keratoconus is usually in the teenage years, very rarely after 30 years of age.  There has been no evidence of gender predisposition and in around 90% of cases affects both eyes.  Keratoconus also runs in families.  In its earliest stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to glare and light.  The disease process is active for about 5-10 years, then it may be stable.  During the active stage, change can be rapid.  Diagnosis of the second eye usually lags about five years after the first.

Initially eyeglasses or soft contact lenses may be used to correct the mild nearsightedness and astigmatism that is caused in the early stages of keratoconus. As the disorder progresses and the cornea continues to thin and change shape, rigid gas permeable contact lenses can be prescribed to correct vision more adequately. The contact lenses must be carefully fitted, and frequent checkups and lens changes may be needed to achieve and maintain good vision. 

In severe cases, a corneal transplant may be needed due to scarring, extreme thinning or contact lens intolerance. This is a surgical procedure that replaces the keratoconus cornea with healthy donor tissue.  In New Zealand the New Zealand National Eye Bank collects and stores corneal tissue to distribute to corneal surgeons for grafting.

Websites that may be of interest are:

www.contactlens.org.nz/kerato.htm  

www.roseklens.com  

www.kcenter.org  

www.nkcf.org  

Ptosis Surgery

Ptosis is the generally used short name for blepharoptosis, which means a drooping eyelid. This may have a number of causes, but is usually due to a breakdown in the connections between the muscles which are meant to lift the eyelid, and the lid itself. In these cases, reattachment of the connections is possible.  This can usually be done under local anaesthetic as a day case procedure. 

Refractive Surgery

Refractive surgery refers to a well-established branch of ophthalmology which aims to correct focussing errors of the eye. In that sense, since spectacles or contact lenses can often correct for these errors, the surgery is purely elective.  Some people, who may be unhappy with their appearance in spectacles, are interested in refractive surgery for cosmetic reasons alone, but the real benefits lie in better function.  Freedom from contact lenses or glasses can transform lifestyles for those who enjoy sport or who have active outdoor lifestyles. 

Focussing errors of all kinds can be addressed, including short-sight (myopia), astigmatism, long-sight (hyperopia) and even the need for reading glasses in the older person, which is known as presbyopia. 

Different methods of treatment may be appropriate for different patients and can include laser treatments (LASIK, LASEK, PRK, Epi-LASIK), clear lens extraction and intraocular lens implantation, or incisional corneal treatments (astigmatic keratotomy, limbal relaxing incisions) or  treatment sdesigned to reshape the cornea (conductive keratoplasty).  Sometimes a combination of treatments can be helpful.  Some of these treatments will be available in Timaru, some through our relationships with specialized clinics in Christchurch. 

Thyroid Dysfunction

The thyroid is a small gland situated in the neck. Its function is associated with the body’s use and turnover of energy. The thyroid can be underactive (hypothyroidism) or overactive (hyperthyroidism).

Signs and symptoms to look out for include: