At Vista Eye Centre, we offer state-of-the-art, comprehensive ophthalmology assessments and treatment in the community of West Toronto and Etobicoke. Each patient evaluated carefully with a comprehensive eye exam, onsite diagnostic tests and a management or treatment plan are established.
Comprehensive Eye Exam & Eye Health
This is a full evaluation of the front, middle and back of the eye, focusing on the issues of concern and includes an assessment of vision, pupils, eye pressure, anterior segment, retina and optic nerve and select diagnostic tests. In certain circumstances this may be accomplished through virtual eye care.
A. Preliminary Eye Assessment
i. Vision Measurement
You will read an eye chart to determine how well you see at various distances. You cover one eye while the other is being tested. This exam will determine your best vision with and without glasses (whether you have 20/20 vision or not)
ii. Pupils
The technician will check how your pupils respond to light by shining a bright beam of light into your eye. Pupils usually respond by getting smaller.
iii. Auto-refraction
This is a measurement that estimates what strength of glasses you may require to correct your vision
iv. Eye pressure (intraocular pressure) measurement
Eye pressure testing, or tonometry, measures the pressure within your eye (intraocular pressure or IOP). Elevated IOP is a sign of glaucoma. You will receive a numbing drop on the eye to improve comfort when testing.
v. Other specialized tests may include: colour vision test, Amsler grid, tear film testing
B. Diagnostic tests at the time of your visit may include:
i. OCT test (cross sectional image of the back of the eye – retina and optic nerve)
ii. Pachymetry test (measurement of thickness of the cornea at the front of the eye)
iii. Anterior chamber angle testing (OCT picture and gonioscopy measurement of the angle between the cornea and the iris at the front of the eye)
iv. Visual field test (peripheral or side vision test)
2. After the ophthalmic technician completes the pre-assessment and diagnostic tests, you may then have dilating drops instilled into the eyes, which opens up the pupils (dilating drops) and allows for a more complete assessment of the deeper structures of the eye, including the retina and optic nerves.
3. Once the dilating drops have worked (on average 20-30 minutes after instillation) you will then be directed to one of the exam rooms, where you will see the eye doctor (ophthalmologist)
4. Examination with an Ophthalmologist
a. The ophthalmologist will meet with you and will confirm why you have come for your visit today. She or he will then review your eye history, medical history and medications, allergies. You may be asked to repeat a few questions which you have answered previously. The doctor will review any forms which you completed earlier during your visit and will also review other documentation including doctor reports, test results, diagnostic tests (OCT, pachymetry, angle measurement, visual field test, IOL master, and/or topography). Testing done outside of the office will also be reviewed and discussed if available/applicable.
b. Your eyes will then be examined by the ophthalmologist. The examination will include a slit lamp examination (a microscope mounted on a table) in order to see the “anterior segment” or front part of the eye of the eye, (the eyelids, the cornea, the iris, the angle, the lens and other structures) and the back of the eye (including the retina and the optic nerve). The ophthalmologist may also use an indirect ophthalmoscope (headset) to view the retina and optic nerve.
5. If required, you may have a test involving a mirror-lens that is placed on the surface of the eye (after freezing drops are instilled), in order to check more details at the front and back of the eye.
6. Other tests may involve eye movement testing, eye muscle balance testing, pupil testing and measurement of eyelid opening and movement.
7. Virtual care and telephone visits:
Virtual care or telephone visits are not a substitute for in-person communication or clinical examinations, where appropriate, or for attending the Emergency Department when needed (including for any urgent care that may be required). If it is determined that you require a physical exam, or if there are concerns that virtual care may not be adequate to assess your eye care needs, you may still need to be assessed in person or you may need to go to the Emergency Department if urgent care is needed.
Virtual Care and telephone visits have some inherent privacy and security risks that your health information by be intercepted or unintentionally disclosed. In order to improve privacy and confidentiality, you should take steps to participate in virtual care or telephone visits in a private setting, using an encrypted email service if available. You should not use an employer’s or someone else’s computer or device as they may be able to access your information.
NORMAL HEALTHY EYE
The eye sits in a protective bony socket called the orbit. Surrounding the eyeball is fat + 6 extraocular muscles. The orbit also contains various nerves including the optic nerve and the lacrimal gland. The eyeball is made up of a strong white layer of tissue called the sclera. The sclera is covered by episclera and conjunctiva on the eye surface. The conjunctiva also covers the inside of the upper and lower eyelids.
The extraocular muscles or eye muscles are attached to the eye (the scleral) and move the eye in different directions. There are 6 muscles that move the eye.
The tear film (or tears) cover the eye and are made up of three layers. The layer closest to the eye is called the mucous layer and is produced by goblet cells in the conjunctiva. The central layer is called the watery or aqueous layer and is produced by the lacrimal gland. The top part of the tear film is called the oily layer and is produced by the Meibomian glands (in the upper and lower eyelids). Tears drain from the eye through the nasolacrimal duct.
When light enters the eye, it is first bent or refracted/focused by a dome-shaped clear tissue at the front of the eye called the cornea. Light then passes through a fluid-filled space called the anterior chamber (filled with aqueous humour). (The aqueous humour is constantly being produced and maintains the eye pressure. The aqueous humour drains out of the eye through the anterior chamber or drainage angle).
Light then passes through the opening in the iris (the colored part of the eye) called the pupil. (Muscles in the iris dilate (widen) or constrict (narrow) the pupil to control the amount of light reaching the back of the eye.)
After passing through the pupil, light is then bent or refracted/focused by the lens, toward the back of the eye. The lens changes shape to help the eye focus on objects up close. Small fibers called zonules are attached to the capsule holding the lens, suspending it from the eye wall. The lens is surrounded by a lens capsule, which is left in place when the lens is removed during cataract surgery. During cataract surgery, an intraocular (plastic or acrylic) lens goes inside the capsule, to replace the natural lens.
After passing through the lens, light moves through the vitreous space (a jellylike substance called the vitreous humour) and is then focused onto the retina (the light sensitive tissue lining the back of the eye).
The macula is the central part of the retina. It is responsible for the most detailed vision in the eye.. The surrounding, peripheral retina, provides us with our peripheral (side) vision.The retina has special cells called photoreceptors (rods and cones) These cells change light into energy that is transmitted through retinal nerve fibers (axons of ganglion cells) to the brain. Rods perceive black and white, and are helpful in night vision or vision in low light conditions, while cones perceive colour and provide detailed central vision.
The retina sends light as electrical impulses through the optic to the brain. The optic nerve is made up of millions of nerve fibers that transmit these impulses to the visual cortex in the occipital lobe — the part of the brain responsible for our sight.
Source Documents: AAO website: https://www.aao.org
All images in this section © 2019 American Academy of Ophthalmology
Cataract Surgery
The natural lens becomes cloudy with age and starts to block light from reaching the back of the eye. If it is cloudy enough obstruct vision, it is called a cataract. Surgery is needed to remove the cataract, and replace it with a new acrylic “intraocular” lens. Cataract surgery is one of the most common & successful surgical procedures performed in North America.
What are cataracts?
The eye works like a camera. Light rays from objects enter the eye through the cornea and then the through the natural lens, which focuses (or bends) these light rays onto the retina (a layer of light sensitive cells like a photographic film at the back of the eye) to produce an image, which is transmitted to the brain.
Over time, the natural lens becomes cloudy and starts to block light from reaching the back of the eye. The cloudy natural lens is an early cataract, and over time, it will grow and block more light. The cloudiness in the lens may be so mild that vision is barely affected or can be so severe that shapes and movements becomes hard to see. When the natural lens becomes cloudy enough to obstruct vision to any significant degree, it is called a cataract. A cataract is not a “film over the eye” but your natural lens which has become clouded.
What causes cataracts?
Cataracts are a normal part of aging, which starts around age 40, when proteins break down in the natural lens leading to mild cloudiness of the natural lens. Clouding of the natural lens increases gradually, so that by age 60 most people have some clouding of the natural lens; however noticeable problems with vision may not happen until years later.
Other causes of cataract include: eye injury, previous eye surgery, certain diseases (such as diabetes and uveitis), radiation, spending a lot of time in the sun and some medications (such as steroids). However, in 95% of cases, cataracts are caused by the aging process. People who smoke often get cataracts earlier than non-smokers. Occasionally babies are born with a cataract.
Most age-related cataracts develop slowly and progressively, causing a gradual, painless decrease in vision. At early stages of cataract, eye glasses or contact lenses can correct refractive error caused by a cataract. Some cataracts can develop more quickly, such as those in younger people or those in people with diabetes. Doctors cannot predict how quickly a person’s cataract will develop
How cataracts can affect vision:
Hazy or blurred vision
Loss of brightness or contrast
Fading or yellowing of bright colours (or decrease in colour intensity)
Seeing double
Sensitivity to light
The need to use bright light to see clearly
Glare or halos/rings around lights, especially at night time
Frequent changes in your eyeglass prescription
A tendency to become nearsighted (better near vision and worsening of their distance vision)
A temporary stage, where it is easier to see up close without glasses, called “second sight” (people who were previously farsighted can experience improved near vision and become less dependent on reading glasses)
Loss of brightness or contrast
Fading or yellowing of bright colours (or decrease in colour intensity)
Seeing double
Sensitivity to light
The need to use bright light to see clearly
Glare or halos/rings around lights, especially at night time
Frequent changes in your eyeglass prescription
A tendency to become nearsighted (better near vision and worsening of their distance vision)
A temporary stage, where it is easier to see up close without glasses, called “second sight” (people who were previously farsighted can experience improved near vision and become less dependent on reading glasses)
How to slow down development of cataracts in your eyes.
Protecting your eyes from the sunlight is the best way to do this. Wear sunglasses that screen out the sun’s ultraviolet (UV) light rays and wear a wide-brimmed hat. Regular eyeglasses with a clear, anti-UV coating can also help. However, once a cataract has developed, there is no cure except to have the cataract surgically removed.
CATARACT SURGERY
Cataract Surgery
Surgery is needed to remove the clouded natural lens or cataract, and replace it with a new acrylic lens called an intraocular lens (IOL). Cataract surgery is a common procedure. In North America, 1.5 million people have cataract surgery every year.
Cataracts are treated with an outpatient surgical procedure. Typically, this procedure lasts about 15-20 minutes. Although you are awake for the surgery, topical freezing drops are applied and sedative is given to ensure you are pain-free and relaxed throughout the procedure.
During the procedure, your ophthalmologist can remove the cataract is removed by making a small incision at the edge of the cornea, at the front of the eye and then using ultrasound energy to break up the cataract into small pieces and removing each small piece from the eye.
After removal of the cataract, a synthetic intraocular lens is inserted into the eye. The IOL replaces the focusing power of the natural lens. IOLs can focus at a pre-set distance (monofocal IOL) or can focus at multiple distances (multifocal IOL). Your ophthalmologist will discuss the different IOL options with you and will recommend the most appropriate option for your eyes. (Not all IOLs options are possible in each individual situation).
Cataract surgery is a very successful surgery and risks are small; however, like any surgery, cataract carries a risk of bleeding 1/1000, infection 1/1000 and retinal detachment 1/100. Other less common risks include swelling of the retina (cystoid macular edema), and IOL dislocation or persistent swelling or inflammation at the front of the eye. In rare situations, the entire cataract cannot be removed at the time of cataract surgery and a second eye surgery is required to remove the rest of the cataract.
All patients will have temporary and mild inflammation at the front of the eye which is treated with topical steroid drops after surgery.
Cataract surgery will not restore decreased vision because of other eye conditions such as corneal conditions, macular degeneration, macular scarring or epiretinal membrane, glaucoma, or diabetic retinopathy.
Your ophthalmologist will talk with you about the risks and benefits of cataract surgery.
Source Documents:
AAO website: https://www.aao.org
COS website: https://www.cos-sco.ca
All images in this section © 2019 American Academy of Ophthalmology
TREATMENT OF RETINAL CONDITIONS
Retina conditions may affect central or peripheral vision and require specialized assessment and treatment. These conditions include:
Diabetic eye disease
DIABETES AND DIABETIC RETINOPATHY
People with diabetes can have an eye disease called diabetic retinopathy. This is when high blood sugar levels cause damage to blood vessels in the retina, causing these blood vessels to leak and sometimes to close, which shuts down blood flow to parts of the retina. When blood flow stops (ischemia), abnormal new blood vessels (neovascularization) can proliferate. Leakage of damaged blood vessels can also cause swelling of the retinal tissues (diabetic macular edema or DME).
Diabetes is the leading cause of legal blindness in working age Canadians. In 2006, 500.000 Canadians had diabetic eye disease. This number is expected to increase by 60% in 2031.
MORE INFO:
Stages of Diabetic Eye Disease
Diabetic eye disease is also called: “diabetic retinopathy”.
There are two main stages of diabetic eye disease, or “diabetic retinopathy”: Non-proliferative diabetic retinopathy and Proliferative diabetic retinopathy.
NPDR (non-proliferative diabetic retinopathy)
This is the early stage of diabetic eye disease characterized by leakage of damaged retinal blood vessels causing proteins to leak out from the blood vessels (exudates), bleeding (hemorrhages) and swelling of the centre of the eye (macular edema). Macular edema is the most common reason that people with diabetes lose their vision). In NPDR, blood vessels in the centre of the retina can also close causing macular ischemia and loss of vision.
If you have NPDR, your vision can be blurry.
PDR (proliferative diabetic retinopathy)
PDR is the more advanced stage of diabetic eye disease. It happens when bloodflow is lost to a large part of the retina and new blood vessels grow (neovascularization). These fragile new vessels can bleed into the vitreous, which can look like dark coloured floaters and or can cause a sudden loss of vision (if there is a lot of bleeding).
If these new blood vessels shrink and form scar tissue or fibrosis, this can lead to scarring in the macula (loss of vision) or sometimes a retinal detachment.
PDR is very serious, and can impair both central and peripheral (side) vision.
Diabetic Retinopathy Symptoms
In the early stages, diabetic retinopathy can be present, but the patient may not know they have it.
Once diabetic retinopathy gets worse, patients may notice: more floaters, blurred vision, fluctuating vision, blank or dark areas in the peripheral or central vision, poor night vision and faded or washed out colours.
Usually diabetic retinopathy affects both eyes.
Treatment for diabetic retinopathy
The initial treatment for anyone with diabetes affecting the eyes is to treat the diabetes and general health. That means controlling the blood sugars , blood pressure, cholesterol and any other medical conditions. Your ophthalmologist will ask you to see your family doctor or diabetes doctor (endocrinologist) to “optimize” your blood sugar levels and to manage Blood pressure and cholesterol.
Other local eye treatments for diabetes include: laser to the retina, injections into the vitreous gel of the eye (anti-VEGF agents, steroids). These treatments are guided by OCT and other photos of the retina.
Source Documents:
PHOTOS FROM AAO WEBSITE
Macular degeneration
AGE-RELATED MACULAR DEGENERATION
Age-related macular degeneration (AMD) is a disease that causes people to lose central vision as they age. Over 100,000 Canadians are affected by macular degeneration, and the prevalence is expected to double over the next 15 years. Most patients with AMD are over 65 years old.
AMD damages the macula, a central part of the retina which provides the most detailed vision. Therefore people with AMD lose their central detailed vision, for both distance and near. But peripheral side vision is not affected by macular degeneration (it will still be normal). Central vision is blurred, or distorted or black spots can appear in the center.
There are two types of macular degeneration: dry AMD and wet AMD
MORE INFO
Dry AMD
This is the most common type of ARMD, affecting 80% of people with AMD. In this form of AMD, small clumps of drusen appear (when the photoreceptors stop pumping debris out of the retina) and the macula tissue gets thinner. Because this happens gradually in the center of the retina, people lose central vision. There is no way to treat dry AMD yet, but some studies have shown that patients with moderate to advanced dry AMD may benefit from special vitamins (AREDS 2) for the eyes (to delay progression of AMD).
Wet AMD
This form is less common and affects 10% of patients with AMD but causes the majority of severe vision loss in AMD. Wet AMD happens when there are breaks (openings) in Bruch’s membrane allowing abnormal blood vessels to grow under the retina and bleed or leak fluid, causing the macula to swell and possibly scar. Vision loss with wet AMD can be sudden. Patients with wet AMD sometimes see distorted images or black spots in their vision.
Many people don’t realize they have AMD until their vision is very blurry. This is why it is important to have regular visits to an ophthalmologist. He or she can look for early signs of AMD before you have any vision problems.
Treatment of wet AMD includes injections into the vitreous gel of the eye (anti-VEGF medications), guided by OCT testing.
Risk Factors for AMD:
You are more likely to develop AMD if you:
• Unhealthy diet, high in saturated fat (found in foods like meat, butter, and cheese)
• Obesity
• High blood pressure or cholesterol or heart disease
• Smoking cigarettes
• Age over 50
• Family history of AMD
• Caucasian race or light-skinned
What you can do at home if you have been diagnosed with macular degeneration:
1. Take vitamins prescribed by your doctor
2. Eat healthy foods
• A diet low in fat and rich in fruits, vegetables, and whole grains, oils & nuts
• dark green leafy vegetables and cold water fish
• Low intake of high-fat or processed foods
3. Stop smoking
4. Wear sunglasses with 100% UVA and UVB protection
5. Use an Amsler grid at home every 2-3 weeks to check the central part of your vision (one eye at a time – so cover one eye and with your reading glasses look at the grid with your other eye)
• If you notice a change in the Amsler grid (missing squares or sections of the grid, wavy or distorted lines), please notify your ophthalmologist
Source Documents:
AAO website: https://www.aao.org
COS website: https://www.cos-sco.ca
https://www.aao.org/eye-health/diseases/amd-macular-degeneration
https://www.aao.org/eye-health/tips-prevention/fabulous-foods-your-eyes
COS website: https://www.cos-sco.ca
https://www.aao.org/eye-health/diseases/amd-macular-degeneration
https://www.aao.org/eye-health/tips-prevention/fabulous-foods-your-eyes
Floaters and Flashes
What Are Floaters and Flashes ?
Floaters look like small specks, dots, circles, lines or cobwebs that seem to move in your field of vision. They move around when you look in different directions. They are most obvious when you are looking at a light-coloured background or blank wall or blue sky.
Flashes can look like flashing lights or lightning streaks in your vision, often to one side. They usually happen in one eye at a time and continue even with the eye closed.
Flashes that look like jagged lights or shimmering lights that last 10-20 minutes in both eyes can be caused by a migraine.
MORE INFO
What causes floaters?
Floaters are actually tiny clumps in the gel or vitreous that fills your eye. Although they seem to be in front of you, they are floating in the vitreous and the black shadow that they cast on the retina are the floaters that you see. Sometimes floaters can be caused by inflammatory cells in the vitreous or crystal-like deposits in the vitreous.
Many people have floaters, which can be annoying at first but the brain slowly learns to ignore them. In a few months, most people will hardly notice them.
As we get older, our vitreous starts to thicken or shrink and becomes less homogeneous or smooth. The irregularities or clumps or strands in the vitreous cause the floaters. You are also more likely to get floaters if you are nearsighted (or myopic), have had cataract surgery, or have inflammation (or uveitis) inside the eye.
As we get older, our vitreous starts to thicken or shrink and becomes less homogeneous or smooth. The irregularities or clumps or strands in the vitreous cause the floaters. You are also more likely to get floaters if you are nearsighted (or myopic), have had cataract surgery, or have inflammation (or uveitis) inside the eye.
The vitreous can separate from the back of the eye and cause a “posterior vitreous detachment (PVD)“. Floaters and flashes can appear with a posterior vitreous detachment. (Half of all people have a PVD by the age of 50, but most people are not aware of this.)
In most cases, the vitreous separates from the retina without an problem, but sometimes part of the vitreous can remain attached while the other parts separate, and this can cause the retina to tear. Retinal tears are more likely to be associated with a shower of floaters.
If a retinal hole or tear occurs, it is important to treat it right away (usually with laser treatment). A retinal tear can develop into a retinal detachment, which is a serious threat to vision. Retinal tears can be treated in an office, clinic or hospital with a laser treatment. Retinal detachment usually requires an operation in a hospital. If you are nearsighted or have had cataract surgery or other eye surgery, there is a higher risk of retinal tears and detachment.
What causes flashes?
Flashes are caused when the vitreous gel pulls on the retina, causing flashing lights or lightning streaks in the vision. (This is similar to when you get hit in the head and see “stars” or when you rub the eye and see flashes). When the vitreous separates from the retina, flashes can continue on and off for weeks, or even months.
As people age, it is common to see flashes occasionally.
As people age, it is common to see flashes occasionally.
Flashes and Migraines
Light flashes that look like jagged lights or shimmering lights that last 10-20 minutes in both eyes can be caused by a migraine. Migraines happen when there is a spasm of blood vessels in the brain. These types of flashes can be followed by a headache, called a “migraine headache” or sometimes, the flashes are not followed by a headache, in which case we call the flashes an “ocular or ophthalmic migraine”.
How do I know if the flashes or floaters are signs of a problem?
You will need a dilated eye exam in order to check your vitreous and retina (especially the periphery of the retina), to look for signs of a posterior vitreous detachment and to look for a retinal tear. If the ophthalmologist notices a retinal tear, it will need to be repaired, typically with laser. If you notice the sudden appearance of floaters, you should see your ophthalmologist.
Source Documents:
AAO website: https://www.aao.org
COS website: https://www.cos-sco.ca
https://www.aao.org/eye-health/diseases/what-are-floaters-flashes
COS website: https://www.cos-sco.ca
https://www.aao.org/eye-health/diseases/what-are-floaters-flashes
All images in this section © 2019 American Academy of Ophthalmology
TREATMENT OF GLAUCOMA AND NARROW ANGLES
Glaucoma is a disease that damages the optic nerve in the eye. It usually happens when fluid builds up in the eye and raises the eye pressure or intraocular pressure (IOP) leading to damage of the optic nerve. Narrow angles are a risk factor for glaucoma.
Glaucoma and Narrow Angles
Glaucoma and Narrow Angles
Glaucoma is the most common cause of irreversible blindness in the world and the leading cause of blindness for people over 60 years of age. . It is undiagnosed in 50% of cases. Over 400,00 Canadians have glaucoma. In a recent survey in Toronto of people over the age of 50, 3.9% of individuals were diagnosed with glaucoma. Although the risk of blindness with glaucoma is high, blindness can be prevented with early diagnosis and treatment.
Types of glaucoma
There are two major types of glaucoma: open angle glaucoma and closed angle glaucoma. 85-90% of glaucoma patients have primary open angle glaucoma and 15-20% of glaucoma patients have closed angle glaucoma.
Primary open-angle glaucoma
This type of glaucoma happens gradually, because the eye does not drain fluid as well as it should (like a clogged drain). As a result, eye pressure builds and starts to damage the optic nerve. This type of glaucoma is painless and causes no vision changes at first.
Some people can have optic nerves that are sensitive to normal eye pressure. This means their risk of getting glaucoma is higher than normal and optic nerve damage can happen even at normal eye pressures. Regular eye exams are important to detect early signs of damage to their optic nerve.
Angle-closure glaucoma (also called “closed-angle glaucoma” or “narrow-angle glaucoma”)
This type of glaucoma happens when someone’s iris is very close to the drainage angle in the eye (the angle between the iris and the cornea is narrow). In this situation, the iris can end up blocking the drainage angle, causing the pressure inside the eye to rise. When the drainage angle gets completely blocked, the eye pressure can rise quickly. This is called an acute angle-closure glaucoma attack and is an eye emergency with a risk of blindness.
The following are signs of an acute angle-closure glaucoma attack (some or all of these symptoms can be present during an acute glaucoma attack).
• Vision becomes suddenly blurry
• Severe eye pain
• Headache
• Feeling sick to your stomach (nausea) or vomit
• Seeing halos or rainbow-colored rings around lights
Acute angle closure glaucoma can lead to blindness and should be treated right away.
Chronic angle-closure glaucoma:
Some people with narrow angles can have gradual closing of the angle, which can lead to a gradual buildup of pressure inside the eye over a longer period and damage to the optic nerve. This is called chronic angle-closure glaucoma. There are no symptoms at first, so you may not know there is any damage or even severe damage. Chronic angle closure glaucoma can also lead to vision loss and should be treated promptly.
Narrow angles is a risk for both types of angle-closure glaucoma (acute and chronic angle-closure glaucoma).
Some people have narrow angles but no glaucoma In this situation, the iris is very close to the drainage angle in their eye, or the angle between the iris and the cornea is narrow. Fluid produced in the eye exits the ey through the drainaige angle. If the drainage is working (even if the angle is narrow), there may not be any damage to the nerve, and therefore no glaucoma; however, having a narrow angle is a precursor to angle closure glaucoma. The risk of developing glaucoma if you have a narrow angle is 10%.
Treatment of glaucoma:
Treatment for glaucoma generally involves reducing the eye pressure or intraocular pressure. This can be done with drops, laser treatments and surgery. Selective Laser Trabeculoplasty (SLT) is a medical office procedure that helps to lower intraocular pressure (IOP) for the treatment of (open angle) glaucoma. Laser iridotomy is a preventative procedure in someone who has narrow angles (to prevent glaucoma) and is also performed in acute angle-closure glaucoma.
Your ophthalmologist will decide which treatment is appropriate, depending on what kind of glaucoma you have and how severe it is.
Source Documents:
PHOTOS FROM AAO WEBSITE
Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of glaucoma in the adult eye, CJO—VOL. 44, SUPPL. 1, 2009
Chris J. Hong and Graham E. Trope. CMAJ September 08, 2015 187 (12) E398-E399; DOI: https://doi.org/10.1503/cmaj.140401. (2) Can J Ophthalmol. 2011 Aug;46(4):352-7. doi: 10.1016/j.jcjo.2011.06.013. Epub 2011 Jul 7.
All images in this section © 2019 American Academy of Ophthalmology
Treatment of Eyelid conditions
Eyelid issues include common conditions such as blepharitis blepharitis, styes and chalazia as well as other affects lumps and bumps on the eyelids including those related to skin conditions, allergies, infections, and small growths.
Eyelid Conditions
Blepharitis, Styes and Chalazia
Blepharitis is an inflammation of the eyelids and small oil glands at the base of the eyelashes called meibomian glands. If you have blepharitis, your eyelids can appear red and swollen and may burn or feel sore. You may notice flakes or crusting on the lashes or on the lids in the morning or throughout the day. Inflammation of the eyelids or blepharitis leads to blockage of the oil glands and therefore loss of tear layer in the tear film leading to dry eyes. Blockages of the oil glands can also cause small bumps on the eyelids to develop, called styes or chalazia.
Blepharitis is very common, especially among people who have oily skin, dandruff or facial acne rosacea, atopic dermatitis or seborrheic dermatitis.
Blepharitis is often associated with dry eyes.
What causes blepharitis?
Blepharitis is a skin condition of the eyelids in which the oil glands or meibomian glands become plugged and then inflamed. Some people have bacteria at the base of their eyelashes which causes dandruff-like flakes to form.
Styes and chalazia
Both styes and chalazions look like small red bumps along the eyelid margins.
Styes look like small painful, red lumps at the base of the lashes, external stye (infection of the hair follicle or Zeis gland) or inside the eyelid – internal stye (infection of the meibomian gland). These are more sudden or “acute” bacterial infections and occasionally can become an infection of the eyelid called preseptal cellulitis.
Chalazions are clogged oil glands (Meibomian glands) that look like swollen bumps on the eyelid and are not very painful at first, but when they grow, the eyelid can get swollen and tender to touch. If the chalazion pushes on the eyelid, vision can get blurry. Sometimes the entire eyelid can become swollen.
What is the difference between a stye and a chalazion?
It can be difficult to differentiate between a stye and a chalazion. A stye is usually quite painful beginning at the edge of the eyelid and sometimes swells and affects the entire eyelid.
A chalazion is not usually painful and the bump is located further back from the eyelid edge. Although the bump can be larger, it usually does not cause the entire eyelid to swell.
A stye is a red, sore lump near the edge of the eyelid.
A chalazion is an enlargement of an oil-producing gland in the eyelid.
Treatment – Link
Treatment of both styes and chalazions involves warm-hot compresses with light massage to the bump for 10 minutes at a time, 4 times per day and cleaning of the eyelid margin 2 times per day.
Your ophthalmologist may prescribe a 1-2 week course of antibiotic drops or ointment to the bump and sometimes an oral antibiotic will be prescribed.
If a chalazion does not improve with compresses + topical or oral antibiotics, your ophthalmologist may discuss surgical treatment (drainage) or injection of a medication into the chalazion.
If a chalazion does not improve with compresses + topical or oral antibiotics, your ophthalmologist may discuss surgical treatment (drainage) or injection of a medication into the chalazion.
Other Eyelid lumps and bumps
Other lumps or bumps or discolorations can occur on the eyelids. These can include lesions related to skin conditions (seborrheic dermatitis), small infections (Molluscum contagiosum, verrucae), lipid deposits (xanthelasma), freckles (nevus), allergies (contact dermatitis)or small growths (squamous cell papillomas, actinic keratosis).
Sometimes, cancerous growths appear on the eyelids (basal cell carcinoma, squamous cell carcinoma or sebaceous cell carcinoma, melanoma).
Your ophthalmologist will assess the lump, bump or discoloration of the eyelid and will determine whether it can be treated medically or if surgical removal of the lesion is necessary (if there is a potential concern about a cancerous or malignant lesion). You may be referred to an oculoplastics or eyelid specialist if surgical treatment is required.
Source Documents:
Photos from AAO website
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TREATMENT OF UVEITIS
Uveitis is an inflammation of the middle layer of the eye, comprising the iris, the ciliary body and the choroid, but can also affecting neighbouring tissues. Ongoing inflammation can lead to permanent vision loss, therefore diagnosis and treatment are important to preserve vision.