STRABISMUS: A visual problem in which the eyes are not aligned properly and point in different directions. One eye may look straight ahead, while the other eye turns inward, outward, upward, or downward. The eye turn may be consistent, or it may come and go. Which eye is straight (and which is misaligned) may switch or alternate. CAUSES:With normal vision, both eyes aim at the same spot. The brain then combines the two pictures into a single, three-dimensional image. This three-dimensional image gives us depth perception.
When one eye is out of alignment, two different pictures are sent to the brain. In a young child, the brain learns to ignore the image of the misaligned eye and sees only the image from the straight or better-seeing eye. The child then loses depth perception. SYMPTOMS:The main sign of strabismus is an eye that is not straight. Sometimes children will squint one eye in bright sunlight or tilt their head to use their eyes together. CURE: Treatment for strabismus works to straighten the eyes and restore binocular (two-eyed) vision.
In some cases of strabismus, eyeglasses can be prescribed for your child to straighten the eyes. Other treatments may involve surgery to correct the unbalanced eye muscles or to remove a cataract. Patching or blurring the strong eye to improve amblyopia is often necessary. In some cases of strabismus in children and adults,strabismus treatment consists of glasses, prisms, patching or blurring of one eye, botulinum toxin injections, or a combination of these treatments. Other times, eye muscle surgery is necessary to straighten the eyes.
RETINAL DETACHMENT:The retina is the light-sensitive tissue lining the back of our eye. Light rays are focused onto the retina through our cornea, pupil and lens. The retina converts the light rays into impulses that travel through the optic nerve to our brain, where they are interpreted as the images we see. A healthy, intact retina is key to clear vision. CAUSES:Vitreous gel, the clear material that fills the eyeball, is attached to the retina in the back of the eye. As we get older, the vitreous may change shape, pulling away from the retina.
If the vitreous pulls a piece of the retina with it, it causes a retinal tear. Once a retinal tear occurs, vitreous fluid may seep through and lift the retina off the back wall of the eye, causing the retina to detach or pull away. Vitreous fluid normally shrinks as we age, and this usually doesn’t cause damage to the retina. However, inflammation (swelling) or nearsightedness (myopia) may cause the vitreous to pull away and result in retinal detachment. SYMPTOMS:Vitreous gel, the clear material that fills the eyeball, is attached to the retina in the back of the eye.
As we get older, the vitreous may change shape, pulling away from the retina. If the vitreous pulls a piece of the retina with it, it causes a retinal tear. Once a retinal tear occurs, vitreous fluid may seep through and lift the retina off the back wall of the eye, causing the retina to detach or pull away. Vitreous fluid normally shrinks as we age, and this usually doesn’t cause damage to the retina. However, inflammation (swelling) or nearsightedness (myopia) may cause the vitreous to pull away and result in retinal detachment.
Floaters and flashesin themselves are quite common and do not always mean you have a retinal tear or detachment. CURE:Torn retina surgery Most retinal tears need to be treated by sealing the retina to the back wall of the eye with laser surgery or cryotherapy (a freezing treatment). Both of these procedures create a scar that helps seal the retina to the back of the eye. This prevents fluid from traveling through the tear and under the retina, which usually prevents the retina from detaching.
These treatments cause little or no discomfort and may be performed in your ophthalmologist’s office. Laser surgery (photocoagulation)With laser surgery, your Eye M. D. uses a laser to make small burns around the retinal tear. The scarring that results seals the retina to the underlying tissue, helping to prevent a retinal detachment. Freezing treatment (cryopexy)Your eye surgeon uses a special freezing probe to apply intense cold and freeze the retina around the retinal tear. The result is a scar that helps secure the retina to the eye wall.
Detached retina surgeryAlmost all patients with retinal detachments must have surgery to place the retina back in its proper position. Otherwise, the retina will lose the ability to function, possibly permanently, and blindness can result. The method for fixing retinal detachment depends on the characteristics of the detachment. In each of the following methods, your Eye M. D. will locate the retinal tears and use laser surgery or cryotherapy to seal the tear. Scleral buckleThis treatment involves placing a flexible band (scleral buckle) around the eye to counteract the force pulling the retina out of place.
The ophthalmologist often drains the fluid under the detached retina, allowing the retina to settle back into its normal position against the back wall of the eye. This procedure is performed in an operating room. Pneumatic retinopexyIn this procedure, a gas bubble is injected into the vitreous space inside the eye in combination with laser surgery or cryotherapy. The gas bubble pushes the retinal tear into place against the back wall of the eye. Sometimes this procedure can be done in the ophthalmologist’s office.
Your ophthalmologist will ask you to constantly maintain a certain head position for several days. The gas bubble will gradually disappear. VitrectomyThis surgery is commonly used to fix a retinal detachment and is performed in an operating room. The vitreous gel, which is pulling on the retina, is removed from the eye and usually replaced with a gas bubble. Sometimes an oil bubble is used (instead of a gas bubble) to keep the retina in place. Your body’s own fluids will gradually replace a gas bubble.
An oil bubble will need to be removed from the eye at a later date with another surgical procedure. Sometimes vitrectomy is combined with a scleral buckle. If a gas bubble was placed in your eye, your ophthalmologist may recommend that you keep your head in special positions for a time. Do not fly in an airplane or travel at high altitudes until you are told the gas bubble is gone. A rapid increase in altitude can cause a dangerous rise in eye pressure. With an oil bubble, it is safe to fly on an airplane. GLAUCOMA:Glaucoma is a disease that damages the eye’s optic nerve.
The optic nerve is connected to the retina — a layer of light-sensitive tissue lining the back of the eye — and is made up of many nerve fibers, like an electric cable is made up of many wires. It is the optic nerve that sends signals from your retina to your brain, where these signals are interpreted as the images you see. CAUSES:Glaucoma can often be caused by another eye condition or disease. This is known as secondary glaucoma. For example, someone who has a tumor or people undergoing long-term steroid therapy may develop secondary glaucoma.
Other causes of secondary glaucoma include: Eye injury; Inflammation of the eye; Abnormal blood vessel formation from diabetes or retinal blood vessel blockage; Use of steroid-containing medications (pills, eyedrops, sprays); or Pigment dispersion, where tiny fragments or granules from the iris (the colored part of the eye) can circulate in the aqueous humor (the fluid within the front portion of the eye) and block the trabecular meshwork, the tiny drain for the eye’s aqueous humor SYMPTOMS: In its early stages, open-angle glaucoma has no obvious signs.
As the disease progresses and more damage occurs, blind spots develop in your peripheral (side) vision. These spots may not be noticeable until the optic nerve has become severely damaged — or until detected by an ophthalmologist during a complete exam. People at risk for closed-angle glaucoma (also called narrow-angle or angle-closure glaucoma), where the eye’s drainage angle becomes blocked, usually have no symptoms before the attack, though some early symptoms can include blurred vision, halos, headache or mild eye pain or redness.
At the time of a closed-angle glaucoma attack, symptoms include: Severe eye or brow pain Redness of the eye Decreased or blurred vision Seeing colored rainbows or halos Headache Nausea Vomiting People with “normal-tension glaucoma” may have eye pressures within normal ranges, but have glaucoma signs and symptoms, such as blind spots in their field of vision and optic nerve damage. CURES:Glaucoma medication Medicated eyedrops are the most common way to treat glaucoma.
These medications lower your eye pressure in one of two ways — either by slowing the production of aqueous humor or by improving the flow through the drainage angle. These eyedrops must be taken every day. Just like any other medication, it is important to take your eyedrops regularly as prescribed by your ophthalmologist. Never change or stop taking your medications without talking with your doctor.
If you are about to run out of your medication, ask your doctor if you should have it refilledGlaucoma surgery In some patients with glaucoma, surgery is recommended. Glaucoma surgery improves the flow of fluid out of the eye, resulting in lower eye pressure.
Laser trabeculoplastyA surgery called laser trabeculoplasty is often used to treat open-angle glaucoma . There are two types of trabeculoplasty surgery: argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). During ALT surgery, a laser makes tiny, evenly spaced burns in the trabecular meshwork. The laser does not create new drainage holes, but rather stimulates the drain to function more efficiently. With SLT, a low level energy laser targets specific cells in the mesh-like drainage channels using very short applications of light.
The treatment has been shown to lower eye pressure at rates comparable to ALT. Even if laser trabeculoplasty is successful, most patients continue taking glaucoma medications after surgery. For many, this surgery is not a permanent solution. Nearly half who receive this surgery develop increased eye pressure again within five years. Many people who have had a successful laser trabeculoplasty have a repeat treatment. Laser trabeculoplasty can also be used as a first line of treatment for patients who are unwilling or unable to use glaucoma eyedrops.
Laser iridotomyLaser iridotomy is recommended for treating people with closed-angle glaucoma and those with very narrow drainage angles. A laser creates a small hole about the size of a pinhead through the top part of the iris to improve the flow of aqueous fluid to the drainage angle. Peripheral iridectomyWhen laser iridotomy is unable to stop an acute closed-angle glaucoma attack, or is not possible for other reasons, a peripheral iridectomy may be performed. Performed in an operating room, a small piece of the iris is removed, giving the aqueous fluid access to the drainage angle again.
Because most cases of closed-angle glaucoma can be treated with Glaucoma medications and laser iridotomy, peripheral iridectomy is rarely necessary. In trabeculectomy, a flap is first created in the sclera (the white part of the eye). Then a small opening is made into the eye to release fluid from the eye. | TrabeculectomyIn trabeculectomy, a small flap is made in the sclera (the outer white coating of your eye). A filtration bleb, or reservoir, is created under the conjunctiva — the thin, filmy membrane that covers the white part of your eye.
Once created, the bleb looks like a bump or blister on the white part of the eye above the iris, but the upper eyelid usually covers it. The aqueous humor can now drain through the flap made in the sclera and collect in the bleb, where the fluid will be absorbed into blood vessels around the eye. Eye pressure is effectively controlled in three out of four people who have trabeculectomy. Although regular follow-up visits with your doctor are still necessary, many patients no longer need to use eyedrops. If the new drainage channel closes or too much fluid begins to drain from the eye, additional surgery may be needed.
Aqueous shunt surgeryIf trabeculectomy cannot be performed, aqueous shunt surgery is usually successful in lowering eye pressure. An aqueous shunt is a small plastic tube or valve connected on one end to a reservoir (a roundish or oval plate). The shunt is an artificial drainage device and is implanted in the eye through a tiny incision. The shunt redirects aqueous humor to an area beneath the conjunctiva (the thin membrane that covers the inside of your eyelids and the white part of your eye). The fluid is then absorbed into the blood vessels. When healed, the reservoir is not easily seen unless you look downward and lift your eyelid.