A pterygium is a benign condition produced by chronic exposure to UV radiation. It produces an abnormal conjunctiva growth that involves the cornea usually in the nasal aspect. As the lesion grows it produces chronic redness, itching, burning, light sensitivity and eventually visual disturbances and it advances into the cornea altering its normal topography.
Pterygium formation can be prevented by the judicious use of UV 400 rated protective sunglasses when outdoors at all times. Additionally using special computer screens helps to reduce conjuntival irritation in predisposed patients.
Finally the use of artificial tears may help alleviate the initial symptoms of pterygium irritation.
Older treatment techniques involved removal of the lesion with direct closure. These techniques had a very high recurrence rate of almost 40%. In many cases the pterygium grows back with a more aggressive behavior inducing significant scarring and even eye motility problems. In order to reduce this high recurrence rate radiation using beta-therapy was employed in many centers. These techniques produced significant scleral thinning and cataract formation and have been abandoned.
Dr. Salomon Esquenazi performs pterygium surgery employing the most advanced surgical techniques including the use of limbal conjunctiva auto-grafting, use of Mitomycin-C, fibrin glue and amniotic membrane grafting in some cases. These modern techniques result in an excellent cosmetic appearance and a reduced recurrence rate of less than 5%.
Dry eye syndrome is one of the most common problems treated by eye doctors. Over ten million Americans suffer from dry eyes. The problem is more frequent in post-menopausal women, patients with rheumatologic conditions and after refractive procedures such as LASIK surgery.
Tears are composed of water, oil and mucus. The water layer is produced in the lacrimal gland, located under the upper eyelid in the outer third. Several smaller glands in the lids make the oily and mucus components of the tear film. With each blink, the eyelids spread the tears over the eye. Excess tears are drained into two tiny drainage ducts in the inner corner of the eye into the nasal cavity. Blockage of these passages produces excessive tearing. Tears are also produced as a reflex response to outside stimulus such as an injury or emotion
However, reflex tears do little to soothe a dry eye, which is why someone with watery eyes may still complain of irritation.
Many diseases can cause dry eye syndrome. One of the most common reasons for dryness is simply the normal aging process. As we grow older, our bodies produce less oil that destabilizes the tear film and increases evaporation. This is more pronounced in women, who tend to have drier skin then men. Many other factors, such as dry or windy climates, air-conditioning or sealing fans, medications such as diuretics and anti-depressants, low fluid intake and cigarette smoke also cause dry eyes. Many people also find their eyes become irritated when reading or working on a computer.
Contact lens wearers may also suffer from dryness because the contacts absorb the tear film, causing proteins to form on the surface of the lens. Certain medications, thyroid conditions, vitamin A deficiency, and diseases such as Parkinson’s and Sjogren’s can also cause dryness. Parkinson’s disease reduces the blinking rate and increases evaporation producing uncomfortable dryness.
The symptoms of dry eye include itching, burning, redness, irritation, blurred vision and excessive reflex tearing. These symptoms are worse in the evenings or after reading or working in the computer.
There are several methods to diagnose dry eyes. The doctor will first determine the underlying cause by measuring the production and quality of the tear film. Examination of the lid margin and special staining of the ocular surface are particularly helpful to diagnose the presence and extent of the dryness.
The treatment of dry eye should be individualized for each patient. Many find relief simply from using artificial tears on a regular basis. Some of these products are watery and alleviate the symptoms temporarily; others are thicker and adhere to the eye longer. When more that four drops are needed daily, preservative-free tears are recommended because they have fewer additives that could potentially induce allergic reactions.
There are also simple lifestyle changes that can significantly improve irritation from dry eyes. For example, drinking eight or more glasses of water each day, avoiding sealing fans and air condition blowing directly to the patient’s face, using humidifiers at home or at work, using omega-3 fatty acids and avoiding medications that reduce the tear production such as diuretics, antidepressants or sleeping pills may contribute to control the symptoms.
Cyclosporine-A topical medication may help reduce the inflammatory T-Cell infiltration of the lacrimal gland allowing the gland to produce more of its own tears. Finally, closing the opening of the tear drain in the eyelid with special inserts called punctal plugs is frequently used in moderate cases. They reduce the drainage of the tears allowing the small amount of tears that the patient produces to remain longer wetting the ocular surface. This may be done on a temporary basis with a dissolvable collagen plug, or permanently with a silicone plug. Finally, very severe cases may require the use of autologous serum eye drops that are produced from the patient’s own blood and/or the use of tarsorraphy surgical techniques that reduce the corneal exposure.
Dr Esquenazi, our corneal specialist has done extensive research on dry eye after LASIK. He has identified key cytokines produced under dry eye conditions and has determined how they can be modulated to, in turn reverse the condition and alter the wound healing response.
Airala Laser & Cataract Institute's oculoplastic division is proud to offer the most advanced plastic and reconstructive medical and surgical procedures including eye lid surgery:
Eyelid Surgery is used to enhance the appearance of the eyes by removing excess skin and fat from the eyelids. Eyelid surgery can be done in conjunction with other procedures such as facelift and brow lift to achieve the desired look. Your surgeon will advise you what you will benefit from most.
1. Botox injections
2. Upper and lower functional and cosmetic blepharoplasties
Blepharoplasty is usually performed under local anesthesia along with intravenous sedation as an outpatient procedure. The incisions are made in the creases of your upper eyelids and just below the lash line of the lower eyelids. If only fat is to be removed from the lower eyelids, the incisions will be made inside the lower eyelids. This procedure is called Transconjunctival Blepharoplasty and is performed on patients whose major complaint is fat pockets beneath the eyelid.
3. Eyelid ptosis repair
4. Repair of lid mal-positions including Ectropion and Entropion
5. Removal of lid skin lesions
6. Eyelid reconstruction procedures
7. Trichiasis procedures
8. Permanent make-up
9. Skinﾠ volume Fillers (Juvederm, Restylane, Fat Grafting)
10. Facial dermo-abrasion
11. Tear drainage malfunctions including Dacriocystorhinostomies and Craford sets and Jones tubes.
12. Symblepharon repair and ocular surface reconstructions including fibrin glue and amniotic membrane grafting
Comprehensive retinal-vitreous clinics including the treatment of:
1. Macular degeneration:
Most people with AMD have the dry type of the disease.ﾠ In this type, there are deposits, called drusen, under the retina, or degeneration of the layers under the retina (atrophy) with loss of photoreceptor function.ﾠ Vision can range from minimal changes with the presence of drusen to severe loss with advanced atrophy.ﾠ Dry macular degeneration can progress to wet AMD.ﾠ There is no treatment for dry type of AMD, but prevention of progression to wet AMD is possible with a healthy diet and AREDS multivitamins.
2. Retinal detachment
The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.
In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.
3. Diabetic retinopathy
Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.
In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.
If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.
4. Retinal vascular oclussions such as BRVO:
Branch retinal vein occlusion occurs when, because of hardening of the arteries, a branch retinal artery compresses a branch retinal vein causing blockage of the vein and decreased circulation in the distribution of that branch retinal vein.
There are several possible treatments for branch retinal vein occlusion including intravitreal injections, laser, and even surgery. If you click on the above tab, showing the results of the recent BRAVO trial, you can see the effect of Lucentis on visual acuity in patients with BRVO. At this moment, Lucentis is the most effective treatment for patients with BRVO who have macular edema.
Patients with BRVO lose vision for several reasons: poor circulation, hemorrhage and macular edema (swelling). There is no treatment, at the moment, to increase circulation or to remove hemorrhage. The macular edema, however, does respond well to intravitreal injections with Lucentis, Avastin, or steroids.
Pediatric ophthalmology and pediatric and adult strabismus management
Pediatric ophthalmology is a subspecialty of ophthalmology dealing with children's eye diseases. The human visual system develops as the brain matures, a process that takes about ten years. Although a baby's eyes are optically capable of seeing, infant vision is limited to around 20/1500, in part because the brain has not learned how to process the visual messages it receives. As visual development proceeds, that same child will eventually be able to detect the finest details in an image.
The most common conditions treated in our pediatric clinics includes:
>> Amblyopia or Lazy eye
>> Pediatric Glaucoma
>> Retinopathy of Prematurity
Medical, laser and surgical treatment of Glaucoma
Glaucoma is a common condition affecting nearly three percent of the general population. There are many different types of glaucoma, but they all have two common features: (1) damage to the optic nerve in the back of the eye and (2) loss of the visual field (often described as the "peripheral vision"). Glaucoma is not just a high pressure in the eyes. Central vision is usually spared until glaucoma is quite advanced. It has generally been accepted that once the optic nerve is damaged, this damage is irreversible. Treatment has always been aimed at trying to prevent further damage.
Elevation of the intraocular pressure (pressure inside the eye) is the most common risk factor for glaucoma. While treatments, both medical and surgical, have been traditionally geared towards lowering the intraocular pressure (see below for further details), current research is more centered on how to protect the optic nerve from further damage or even how we may be able reverse this damage in the future.
View test results and recent medical records
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