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The Role of the Orbital Tissue Expander in Anophthalmia and Microphthalmia Treatments

Posted on May 4, 2012 by FCI

The orbital tissue expander (OTE) is an award-winning enhancement in treating congenital conditions such as anophthalmia and microphthalmia, or acquired anophthalmia from tumors or trauma. Dr. David Tse’s design consists of a flexible balloon fixed in place by a titanium plate to help mitigate the problem of permanent facial disfigurement from improper growth of the eye orbit during development. Here we’ll discuss how the OTE design plays a critical role in the treatment of these conditions.

  • Anophthalmia results from one or both eyes not forming during early fetal life. Anophthalmia may be primary (complete absence of the eyeball), secondary (tiny eyes or a small amount of eye tissue) or degenerative (the eye began to develop but the development was not complete and blood supply is damaged).
  • Microphthalmia is defined as an eye globe that is below the average size by 1-2 standard deviations. Microphthalmia may be simple (intact eye with shortened globe length) or complex (malformation of various parts of the eye).

Causes of anophthalmia and microphthalmia can be linked to genetic mutations, abnormal chromosomes, and environmental factors. These conditions are rare, occurring in only 1 of 10,000 live births. They account for 3-11% of child blindness. There is currently no treatment for severe anophthalmia or microphthalmia to restore vision or rebuild the eye globe. Tissue expanders and prosthetics are used to allow for growth of facial bones and to maintain a uniform appearance. Early intervention of these conditions is essential to proper anatomical development.

Conformers are placed during infancy and exchanged frequently as the child grows. A prosthesis fashioned to look like a normal eye usually replaces these conformers between the ages of one and two. Orbital implants are placed to allow for normal bone growth and to support the prosthesis. Types of orbital implants used today include the orbital tissue expander, bioceramic orbital implants, mesh-wrapped bioceramic orbital implants, silicone orbital implants, and acrylic orbital implants.

Benefits of the Orbital Tissue Expander

The orbital tissue expander’s titanium fixation plate is anchored to the lateral orbital wall. The flexible balloon implant is then expanded as the child’s eye orbit grows to help ote The Role of the Orbital Tissue Expander in Anophthalmia and Microphthalmia Treatmentsmaintain normal orbital bone growth and a symmetrical facial appearance.

The orbital tissue expander has proven to be a great improvement to previous models as it is flexible in nature and includes many benefits, including:

  • Enables the ocular orbit to grow as if it were surrounding a healthy eye. This prevents facial disfigurement over time, which can occur if natural pressure on the ocular orbit is absent during development.
  • Has the ability to be implanted using standard oculoplastic techniques.
  • Easily inflates and deflates to omit the need for multiple surgeries as the child grows.
  • Extrusion by the body is prevented by a fixed bone plate.
  • Requires minimal follow-up, surgical adjustment, and intervention.

The greatest and most notable benefit of the OTE is that it can be easily increased in size as a child develops. Unlike the OTE, less popular solutions such as acrylic spheres that are not anchored to the lateral orbital rim to promote self-centering can cause complications over time. Without proper anchoring, these spheres can prolapse against the conjunctiva. Over time, issues such as this can lead to permanent facial disfigurement in the developing child.

Another great benefit of the OTE is that with patient cooperation, no general anesthesia is necessary. Patients can be locally anesthetized in order to inject the implant with fluid to maintain accurate pressure on the eye orbit. Tested at the University of Miami, the device is currently manufactured by Innovia LLC, and has been used with great success in patients with anophthalmia and microphthalmia.

The orbital tissue expander has found its place in patients with congenital anophthalmia and microphthalmia. Named in the 2010 Medical Design Excellence Awards competition, the OTE is a high-ranking medical product used both throughout the United States and also in the Middle East. Study results are overwhelmingly positive, and all patients included in these studies have had increased orbital sizes as a result of using this medical advancement.The orbital tissue expander has found its place in patients with congenital anophthalmia and microphthalmia. No infections, erosions, or implant-related issues have been documented.

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Use of Vitrectomy in Treating Diabetic Retinopathy

Posted on May 1, 2012 by FCI

Diabetic retinopathy is a complication of diabetes that is caused by damage to the blood retina1 150x150 Use of Vitrectomy in Treating Diabetic Retinopathyvessels of the retina. The retina is responsible for transmitting light and images in the eye via nerve signals sent to the brain. As a complication of diabetes such as cataracts or glaucoma, this eye disease is the most common of the bunch, and can cause severe vision loss or blindness. Those with diabetes that is poorly controlled are at a higher risk of diabetic retinopathy.

Stages and Symptoms

Diabetic retinopathy most commonly develops over a period of months as high blood sugar damages the retina’s blood vessels and the disease begins to progress. There are four main stages of diabetic retinopathy:

  • Mild non-proliferative retinopathy – small swelling in the retina’s blood vessels
  • Moderate non-proliferative retinopathy – some nourishing blood vessels become blocked
  • Severe non-proliferative retinopathy – more vessels become blocked, signaling the body to grow new vessels
  • Proliferative retinopathy – signals sent by the retina trigger growth of new abnormal vessels that may leak blood into the vitreous gel of the eye and cause vision loss and blindness

Symptoms of this disease include blurred vision and slow vision loss over time, floaters, shadows, and decreased night vision.

Prevention

The damage of small blood vessels can be mitigated by keeping diabetic blood sugar levels and blood pressure managed. Diabetics who are also smokers are at a greater risk of retinal damage. A regular yearly dilated eye exam can also help identify and prevent diabetic retinopathy and help prevent vision loss and blindness. Timely treatment is a very important part of maintaining vision and helping to slow the progression of the disease by removing unhealthy blood vessels.

Treatment

Laser eye surgery and laser photocoagulation, scatter photocoagulation, pan-retinal and focal photocoagulation, and intravitreal Triamcinolone acetonide can all help slow down the progression of this disease. Retinal reattachment can also reaffix a retina to the back of the eye to restore vision.

If blood pools in the center of the eye, vitrectomies may restore sight by clearing blood and removing scar tissue. This treatment often prevents further hemorrhage by removing the abnormal vessels that caused the original bleeding. Performed under either local or general anesthesia in a hospital or ambulatory surgery center, a vitrectomy is performed by first creating a tiny incision in the eye. A small instrument is then used to remove the blood-clouded vitreous gel. This natural vitreous gel is then replaced with a saline solution to help maintain the eye’s shape. A gas bubble may be placed to help flatten the retina, press it against the back of the eye, and allow it to heal. Vitrectomies can also remove scar tissue that is tugging on the retina and pulling it out of place, helping to prevent possible retinal detachment. This procedure of removing blood and scar tissue restores the retina’s ability to collect and transmit light and images to the brain.

Aside from a sensitive eye, most vitrectomies are an outpatient procedure requiring nothing more than a temporary eye patch and medicated drops after treatment. If a gas bubble is placed in the eye, the patient may need to keep their head in a specific position until the eye heals.

Complications

Along with common surgical risks such as infection, vitrectomies can rarely cause retinal detachment, high intraocular pressure, bleeding in the eye, and cataracts. Despite these minimal risks, over 80 percent of patients experience significant improvements after surgery. Complications are uncommon, and eye surgeries are carefully conducted by highly trained ophthalmologists.

Outlook

Approximately 65,000 diabetics per year develop this eye disease. Vitrectomies for diabetic retinopathy are effective in removing scar tissue, blood, and abnormal vessels. But this treatment to staunch bleeding vessels is not a cure. Vitrectomies are reserved for patients whose complications have already developed, and additional surgeries may be required to remove scar tissue or repair additional retina detachments. Although results vary and depend on many factors, results of vitrectomy surgery are usually seen within a week.

Diabetic retinopathy is a progressive, dangerous, and potentially debilitating eye disease common to diabetics with uncontrolled blood sugar. Vitrectomies are a successful means by which to resolve this issue with minimal risk and maximum results. Although these patients often require multiple surgeries over their lifetimes, vitrectomies can effectively restore vision and prevent progressive blindness.

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Benefits of Bioceramic Orbital Implants in Enucleation and Evisceration Procedures

Posted on April 18, 2012 by FCI

Orbital implants are medical prosthetics used to replace the eye following enucleation or evisceration procedures. These implants aid in replacing the lost eye in the orbit and allow for realistic movement of an ocular prosthesis. After orbital implantation, an ocular prosthesis, or artificial eye, is then fit over the implant to mimic the appearance of a natural eye.

mesh orbital 150x150 Benefits of Bioceramic Orbital Implants in Enucleation and Evisceration Procedures

Orbital implants in history have most commonly been constructed with hydroxyapatite as their main material. Original eye implant models even recruited substances such as cork, glass, and various metals. Although hydroxyapatite is well-tolerated by the body and recognized as a similar substance, the later introduction of bioceramic material has accelerated this advancement to a new level. The bioceramic orbital implant of today uses a ceramic biomaterial made of aluminum oxide (Al2O3). This material is well-known in the medical industry and has found use for more than 30 years in the orthopedic and dental fields for many types of prosthetics. Bioceramic implants became FDA-approved in April of 2000.

The body has shown to respond better to this aluminum oxide material and is therefore more biocompatible than its hydroxyapatite counterpart. Tissue grows more readily on this recent advancement, and has thus helped it to become the new standard in orbital implant material.

Noted Benefits of the Bioceramic Implant

There are three basic types of bioceramic implants: mesh wrapped, spherical, and egg-shaped. These three forms of bioceramic orbital implants have an improved vascularization structure, allowing for quick fibrovasculariation. This bioceramic material is a biocompatible, bioinert, nontoxic, and nonallergenic substance. These implants are well-known by surgeons as a stable and easily handled implant for use in enucleation and evisceration procedures. Beneficial features of these implants include:

  • Porous, strong and non-brittle composition
  • Rapid fibrovascularization
  • No risk of disease-transmission
  • Lightweight and easy to insert during surgery
  • Easy to suture to extra ocular muscles
  • Effortlessly hand-drilled without crumbling
  • Non-dissolving
  • Does not release soluble components
  • Does not cause excessive tissue inflammation
  • Improved motility of the artificial eye

Another great benefit of this material comes in that after implanted, a protein coating is formed over the implant that camouflages the implant and prevents rejection. On the mesh-wrapped form of these implants, the vinyl mesh wrapping allows the intraocular muscles to be sutured directly to the implant, which creates a more natural movement. The porous composition of the implant allows for the previously mentioned fibrovascular ingrowth, which also helps to prevent migration of the implant over time.

Study Results

One study performed to assess the effectiveness and benefits of bioceramic orbital implants showed marked benefits in the reviewed patient surgeries. One such study mapped 107 patients who received bioceramic orbital implants over a 3-year period (Jordan, D., Gillberg, S, Mawn, L. 3,2003. The Bioceramic Orbital Implant: Experience with 107 Implants Ophthalmic Plastic & Reconstructive Surgery: 19 (2):128-135). This study analyzed many of the aspects of these patients and their procedures, including, but not limited to: patient age, surgery type, implant type, complications, and treatment.

Results showed implant-related problems in only 11% of these patients, with no patients suffering from infection. Additionally, in a paper published after this study, researcher Dr. Jordan stated that these implants were also quieter than other implants. The conclusions of this study revealed that the bioceramic implant is a preferred alternative to hydroxyapatite implant. It is structurally strong, easily manufactured, and cheaper than other manufactured implants on the market. The noted complications are similar to conventional implants, but have been found to be less common.

Bioceramic orbital implants have provided ophthalmologists with easy and effective means by which to perform successful enucleation and evisceration procedures. Proven to be more biocompatible than hydroxyapatite, bioceramic orbital implants are easily inserted, non-sticky, and promote quick fibrovascularization after implantation. The improved connectivity and easy suturing to surrounding muscles helps aid in the motility of the implant while also helping to prevent implant migration.  This latest generation of orbital implant is easy to manufacture, strong, and easily drillable. Its immediate protein coating after implantation relieves the concern of rejection, and the implant overall is very well tolerated by the body. It has become today’s implant of choice by ophthalmologists for use in enucleation and evisceration surgical procedures.

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Symptoms and Treatment of Lagophthalmos

Posted on April 13, 2012 by FCI

Lagophthalmos is a condition in which the eyelids do not close to cover the eye completely. The term lagophthalmos actually comes from the Greek word for hare (lagoos) and derives from a myth that hares sleep with their eyes open. A normal, healthy eye is covered by a film of tears that protects the surface and washes away dust and particles. Dry eyes that result from lagophthalmos are not only uncomfortable, but are also subject to injury or infection from foreign objects landing in and abrading the eye surface. Left untreated, lagophthalmos can lead to permanent loss of vision.

Doctors consider lagophthalmos to be a symptom more than a disease, as it usually has an attributable cause. A few of the most common causes of lagophthalmos are:

  • facial paralysis (such as Bell’s palsy)
  • stroke
  • infection
  • trauma
  • skin conditions such as ichthyosis
  • surgical procedures

Surgical procedures that can cause lagophthalmos include a common plastic surgery procedure called a blepharoplasty, in which the upper eyelid is cut and tightened to reduce signs of aging. This surgery can result in a misalignment with the lower eyelid. Comatose patients can also suffer from lagophthalmos due to a decrease in use and tone of the orbicularis (a facial muscle). Lagophthalmos may also be a sign of thyroid disease or a tumor such as an acoustic neuroma, which is why doctors recommend early diagnosis to identify the source of the problem and eliminate any serious causes.

A variant of this condition is nocturnal lagophthalmos, in which sufferers do not completely close their eyes while sleeping. This is difficult to discover, as many people don’t know they have it unless someone tells them they are sleeping with their eyes open. Patients sometimes report poor sleep patterns or waking with dry or painful eyes. Doctors can identify nocturnal lagophthalmos by asking a patient to close his or her eyes as though sleeping or just to blink normally. Even an opening of a few millimeters can cause dryness.

Treatment

blinkeze 150x135 Symptoms and Treatment of LagophthalmosThere are two basic types of treatment for lagophthalmos: supportive care and surgery. As a first effort to relieve the condition and in cases where surgery is not feasible, artificial tears can be applied several times a day to keep the cornea moist. Sufferers of nocturnal lagophthalmos can use an ointment at night or tape their eyelids closed with surgical tape, but problems reported with these methods include blurry vision upon waking with the ointment and skin irritation from the tape. Flexible goggles, similar to a sleep mask, can prevent the tear film from evaporating during sleep. A newer method recommended for short- or long-term therapy is external weights taped to the eyelid to help restore normal blink function. These reduce a patient’s dependence on ointments and drops and can be a good way to test the effectiveness of internal weights before going forward with implantation surgery.

If surgery is possible but will not occur immediately, a procedure called a tarsorrhaphy is thin profile Symptoms and Treatment of Lagophthalmosoften recommended. The lids are sewed partially shut to protect the cornea. This is reversible and usually causes no complications. A more permanent method is to insert gold or platinum weights into the upper eyelid to pull the eyelid down into position. Often a follow-up surgery is required to tighten and raise the lower lid to make sure the lids meet properly, and sometimes one lid will drop lower than the other one. Occasionally, the weight causes a corneal astigmatism, which leads to vision problems.

Doctors advise people who suffer from mild lagophthalmos to discuss their condition carefully with a corneal and external disease specialist before undergoing blepharoplasty, BOTOX injection, or LASIK corrective surgery. These procedures can, but will not always, exacerbate the problem. The specialist can evaluate the dysfunctional tear film and make recommendations on how to proceed safely.

Lagophthalmos is itself not a serious condition, but it can lead to acute and permanent damage if not effectively treated. Furthermore, it is often a symptom of a more pernicious disease that may not manifest in other ways until it’s too late for treatment. Symptoms include dry, irritated eyes and the physical inability to close the eyelids and often follow facial paralysis, trauma, or plastic surgery. Therapy for lagophthalmos, whether external or surgical, is fairly simple and with no lasting side effects.

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What to Expect After Your Retinal Detachment Surgery

Posted on February 10, 2012 by FCI

The retina is the light-sensing membrane that captures and transmits images to the brain. Most retinal detachments experienced by individuals are originally caused by a small tear or hole in this sensitive retina wall. Often due to thinning of the retina or shrinking of the vitreous gel within the eye over time, retinal detachments cause vision loss that may become permanent if not treated quickly and effectively.  Often affecting those individuals who are middle-aged or older, retinal tears and detachments are most common in nearsighted individuals and those with a genetic predisposition.

Prompt treatment of a retinal detachment is vital to the prevention of permanent vision loss. Scleral buckling, pneumatic retinopexy and vitrectomies are the most common treatments of retinal detachment. These treatments help press the retina against the wall of the eye and hold the tissues in place so that they can heal. Surgical retinal reattachment surgery is conducted through a quick one-and-a-half to two-hour surgery.

Complications

Although every surgery comes with its risk of complications, most retinal detachments come with infrequent and treatable complications, which include: bleeding under the retina, cataracts, recurrence, or infection.

Going Home after Surgery

Retinal detachment surgery is normally followed by a short recovery at the hospital before returning home. Patients can often return to normal activity one to two weeks after surgery. Traveling should be avoided for some time, and increases in altitude should be avoided until cleared by the surgeon.

Pain and Eye Protection

After a retinal detachment surgery is performed the eye may be inflamed, sore, and swollen for some time. Although very little pain is expected after surgery, pain medications are often sent home with the patient to aid in post-surgical pain control. Eye drops and an eye patch may be necessary aftercare to keep the eye moist, sanitized, and protected. A shield may also be used to avoid accidental pressure on the eye during sleep. Follow-up visits will be scheduled for the day after surgery and again for regular checkups over the next two to three months depending on patient progress. Some discharge is expected during the healing process, but the eye should be monitored for unusual drainage.

Care will need to be taken when showering not to get soap in the eye. Some procedures require a gas bubble to be placed in the eye during surgery to help keep the retina pressed up against the inner wall of the eye. Patients may be asked to position their head facing down to aid in the effect of this pressure bubble. This positioning may be necessary for one to two weeks after surgery.

Activity

The first week after surgery should be reserved for rest and slow movement. Excessive close concentration or TV watching should be avoided to prevent eye strain and further discomfort. Some patients may experience sensitivity to light after surgery. Activity can often be resumed after a month, but heavy lifting over 20 pounds and strenuous activities should be avoided while the eye heals.

Driving should also be avoided until vision improves and stabilizes. Initial depth perception and field of view is compromised after surgery and care should be taken before patients get back behind the wheel. Sedentary jobs may be returned to between ten and fourteen days after surgery, but more active jobs should be cleared by the surgeon before resumed.

Outlook

Surgical treatment for retinal detachment is successful in over 90 percent of cases. If the retinal reattachment is a success, the patient will have some degree of vision restored. Depending on the condition of the retina, a varying degree of reading and traveling vision may be restored, and oftentimes patients can expect a full recovery of their vision.

A period of healing is necessary after surgery before patients will begin to see an improvement in their vision. This improvement should be expected to begin two weeks after surgery, and within six weeks postoperative vision improvement should be complete. The retina may continue to heal for a year or more, and it may take months for vision to stabilize after surgery.

Retinal detachment procedures are highly successful, come with few complications, and are imminent when a detachment occurs to help restore vision before blindness becomes permanent. Recovery is quick and requires a short period of rest and care while the retina heals and vision improves.

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FCI Ophthalmics Welcomes Jim Perez as National Sales Manager

Posted on February 8, 2012 by FCI

Jim FCI Ophthalmics Welcomes Jim Perez as National Sales Manager

FCI Ophthalmics is pleased to announce the appointment of Jim Perez as our new National Sales Manager, as of February 7, 2012.

Jim has over 20 years experience in medical sales, business development and sales management.  Most recently, Jim was Director of Sales at Porex Surgical for 7 years before it was acquired by the Stryker Corporation in 2010.  At Stryker, Jim was responsible for helping to integrate the sales team into the new business unit as Director of Strategic Accounts.

Jim brings experience, knowledge and skills that will enhance our capabilities and help propel us to the next level of growth.  He came up the old fashioned way, starting as a sales rep for seven years then District Manager, Region Sales Manager, Distribution Manager, Business Development Leader, US Segment and Market Manager and eventually US Sales Director.  While at Porex Surgical Jim learned to wear many hats and developed key relationships within the Oculoplastic community across the Nation.

Jim will take on the overall leadership of the sales team and business development activities at FCI Ophthalmics.

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Causes of Watery Eyes and Their Solutions

Posted on February 1, 2012 by FCI

The human tear is made in a gland under the skin of the eyelid that flows over the surface of the eyeball and drains into the naso-lacrimal ducts into the nose. Necessary for normal lubrication of the eye and to wash away foreign substances and allergens, normal tear production is rarely something one thinks much about. But when natural function goes awry, it can cause something called epiphora, or more simply put, excessive tearing.

Epiphora occurs when your body makes more tears than it can remove by way of drainage or evaporation. Although temporary excessive watering can occur as a result of emotions, allergies, or the elements, other issues can cause a more longstanding and concerning issue. In adults, this can be commonly caused by diseases, disorders, or aging. In children, epiphora is most often caused by a blocked or incompletely opened tear duct.

Causes of Epiphora

Epiphora can be caused by many passing and chronic conditions. If the condition persists, an ophthalmologist can best identify the cause of epiphora and decide the best route of treatment.

Epiphora can be attributed to any of the following causes:

  • Ingrown eye lashes
  • Dry eye
  • Foreign substances
  • Blepharitis or eyelid laxity
  • Naso-lacrimal duct blockages
  • The common cold, hay fever, or eye/tear duct infections
  • Pink eye
  • A blow to the face
  • Allergies or chronic sinusitis
  • Congenital or early-onset glaucoma infants
  • Granulamatosis, rheumatoid arthritis, or sarcoidosis
  • Radiation therapy
  • Seventh nerve palsy or Sjögren’s syndrome
  • Eye or nose surgery
  • Thyroid disorders
  • Tear drainage tumors
  • Antihistamines, beta blockers, diuretics, pain relievers, or sleeping pills
  • Blockage of the tear duct
  • Eyestrain

Often epiphora resolves and intervention is not necessary. Although not usually cause for emergency, this issue should be addressed if it becomes more than a transient discomfort. If prolonged and unexplained tearing or excess discharge, redness, and pain occur, it’s important to locate the cause of the discomfort and assess proper treatment by a professional.

Epiphora Solutions

Artificial tears can help manage watery eyes due to irritation, dry eye, or foreign objects, and antihistamines can help solve this issue if watery eyes are the symptom of allergies. If symptoms persist, visiting an ophthalmologist can help you determine the underlying cause of your symptoms. Ophthalmologists can perform tests to determine whether your issue is due to problems with your naso-lacrimal ducts or improper eyelid or eye lash positioning, and whether your issue can be solved permanently through a surgical procedure. Many causes of chronic epiphora can be quickly remedied through a minor surgical procedure with little or no necessary recovery time.

Dacryostenosis

Children and infants often experience epiphora due to a poorly developed or narrow tear duct. This condition, called dacryostenosis, can be resolved by a painless procedure in which these ducts are probed to help open up the tear drainage system. If a simple probing procedure does not completely resolve the issue, stents and tubes can be placed to help open up this drainage system.

Improper Eyelid or Eyelash Positioning

Watery eyes can also be due to improper eyelid or eyelash positioning. Minor surgery can fix improper eyelid positioning. Often times this improper positioning can cause dry eye, and this condition results in the body reacting by overproducing tears. In-growing eyelashes, called trichiasis, can also irritate the eye and cause watering. This may be remedied by removing the lashes, although the issue may reoccur.

Poor Eyelid Function

Another cause of watery eyes can be poor eyelid function. The eye must close correctly in order to properly spread the tear film over the eye, and poor eyelid function may prevent proper closing of the eyelids. A condition called ectropion can cause a drooping and pulling away of the lower eyelid, which is often seen in older individuals. This issue can be easily remedied with a minor eyelid surgery to tighten the drooping eyelid.

Persistent eye watering should be examined by an ophthalmologist and a proper treatment plan executed in order to aid in better vision and a healthier eye. Epiphora can be caused by a multitude of issues, many of which are transient or easily resolved by a simple surgical procedure. Ectropion, trichiasis, and dacryostenosis can all be resolved with simple procedures that involve painless probing, eyelash removal, or eyelid tightening.

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Non-Cosmetic Reasons to get Lid Ptosis Surgery

Posted on January 16, 2012 by FCI

Ptosis is the technical term for the drooping of an eyelid. Ptosis can occur in one or both lids, and can often cause vision obstruction. The causes of this condition can be credited to the aging process, prior surgery, or may be congenital in nature.

Although commonly fixed for cosmetic purposes, ptosis surgery is also indicated to resolve many non-cosmetic issues. This condition can often obstruct vision and affect a person’s ability to drive, read, or otherwise perform daily activities. Children with severe ptosis are at risk of altered development, and adults may experience a lesser quality of life due to a limited field of vision.

The need for ptosis surgery is examined by reviewing the symmetry of the middle part of the patient’s face. Eyelids are measured and photographs are taken of the position of the eyelids. Lids are carefully examined and often the patient’s field of vision is reviewed to determine the best treatment option.

Levator Tightening

In most individuals who have acquired ptosis from aging, the condition is caused by the gradual stretching of the upper eyelid tissue that slowly causes the eyelid to droop. This type of ptosis can be corrected by tightening the levator muscle that is responsible for raising the eyelid. An incision is placed in the normal crease of the upper eyelid and the levator muscle is then resectioned. This tightens the muscle and restores normal function to the eyelid, allowing it to lift to a proper level.

Frontalis Suspension

If a stretching of the tissue is not the cause, then a weak levator muscle may be to blame. This is often the case in congenital cases, but can occur both in early childhood and later in life. Early childhood cases of ptosis are often caused by improper development or muscular dystrophy. Other causes include eyelid tumors, muscular diseases or neurological disorders. If the levator muscle is weak, then tightening the muscle will not sufficiently remedy the issue, and a frontalis suspension is necessary to lift the eyelid to an appropriate position and restore normal function.

A frontalis suspension uses small strands of fibrous tissue that are surgically affixed to the eyelid and the eyebrow. This biological fibrous tissue can be taken from the individual’s own body (common in children), or from a donor. After the strands are placed, they are tightened to lift the eyelid into the correct position. When the patient lifts their eyebrow, the suspension will result in a lifting of the eyelid, restoring a normal field of vision.

Blepharoplasty

Blepharoplasties are best known as a cosmetic repair and are a very common procedure performed by plastic surgeons. This procedure removes the loose or baggy skin and fatty tissue around the eye that results from aging. When these folds of skin hang down or fatty tissue impedes lid lifting, it not only creates an aged appearance, but can also obstruct one’s field of vision. The issue of aging eyes and loss of vision due to baggy eyelids has become better recognized in recent years, and this procedure is much more commonly covered by insurance carriers.

These baggy eyelids are considered pseudoptosis, or false ptosis. The name comes from the fact that the patient has no issues with the strength or tightness of their levator muscle, but simply has too much skin or fat above the eyelid and therefore suffers from tissue overhang or impaired lifting abilities that restricts their field of vision. Some cases also result in eyelashes folding inward or outward, which irritates the eye itself.

Surgically removing this overhanging skin can improve a patient’s field of vision and also the function of their upper eyelid. Although this removal also causes a cosmetic improvement and an “awakening” of the eyes, the procedure to remove excess tissue around the eyes helps many individuals regain better vision.

Ptosis surgery is performed in different ways depending on the cause and severity of the condition. The specific surgery performed depends on the strength of the levator (lifting) muscle, the severity of the condition, the patient’s age, and if there is interference with the individual’s field of vision. Incidences of acquired ptosis are often treated with a different surgical procedure than congenital ptosis. Levator tightening, frontalis suspension, and blepharoplasties are all non-cosmetic cures for conditions that cause visual impairment.

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Things You Didn’t Know about the Eye

Posted on October 14, 2011 by FCI

Your eyes are a valuable, physiologically complex component of your senses. Of all of those senses, the eyes are one of the most important for everyday living. Vision is credited for the way we understand our surroundings, and is an integral part of almost every moment of every waking minute. Vision is a sense that many people take for granted. Unless you wear glasses or contacts, you most likely go through your day thinking very little about your eyes and how they are helping you navigate your surroundings. Here we’ll explore some interesting facts about the eyes and how they function, age, communicate with our body, and alert us of disease.

The Decline of Every Eye

Even if you have perfect vision, you are not exempt from the natural aging process. The vision abilities of every eye are bound to decline over time, and nearly every individual will eventually need reading glasses as their bodies age. The need for reading glasses usually arises between 40 and 50 years of age as the lenses in your eyes slowly lose their focusing abilities. The flexibility of this lens becomes limited, and the ability of your eye to focus and change shape will begin to deteriorate—therefore, so will your vision.

The development of cataracts is also a normal part of eye aging. At some point in time, an individual will begin to develop this clouding in the lens of the eye. The average age that most individuals begin to develop cataracts is between 70 and 80 years old. Luckily cataracts are a treatable condition and cataract surgery is a common treatment for individuals of every age suffering from this condition.

Fast Focus

Your eye’s natural lens focuses at a speed that is nearly instant. If you think about how fast you can move from viewing an object near you to one further away, imagine how quickly the lens of your eye must be adjusting in order to make that happen. Faster than a camera lens, your eye is quick to make these changes with seemingly effortless adjustments.

Swiftly Aging Eyes

By the age of seven, your eyes have already hit their own level of adulthood. The physiological shape of the eye and its capabilities are fully developed after these first years of life. For this reason, improvements in vision at a young age are vitally important to correct. A lazy eye or poor vision diagnosed later in life has a much lower chance of being remedied due to this swift aging.

15,000 Blinks per Day

Considered partially involuntary, blinking is an automatic and on-demand function of the body. Blinking helps clear debris, keep eyes moist, and spread this moisture across the surface of the eye. As the eye’s camera shutter, blinking is an important part of maintaining the eye’s health and moisture and ridding it of dirt and bacteria.

Eye Tests Can Reveal Medical Conditions

Diabetic retinopathy is often one of the first signs that lead to a diagnosis of diabetes. Type II diabetes often does not show blatant symptoms, and many individuals do not even realize they have the condition. This type of diabetes is often revealed during an eye exam and presents as small hemorrhages in the eye.

Your Eyes Gather, but Your Brain Interprets

Your eyes collect information, but your brain receives this information through the optic nerve and then uses it to create the visual picture and interpretation of the world around you. Your eyes can even adapt to gaps in vision and essentially ‘fill in’ the missing spaces in your eyesight.

Perfect Vision Is Far from Perfect

20/20 vision is often known as perfect vision. But many animals have much better eyesight than this. Birds such as eagles, hawks and buzzards have vision that is 3-4 times sharper than ours. Eagles can spot prey from miles away while hawks and buzzards can spot prey anywhere from a few feet to hundreds of feet away.

Eyes are amazing gadgets of the human body. With many separate components that work together to feed information to the brain, eyes are one of the body’s most valuable assets and are an integral part of our everyday living. Try your best to not take vision for granted.

Posted in About Eyes, Diseases of the Eye | Leave a comment

Cataract CTRs: A Look at the Eyejet CTR

Posted on September 30, 2011 by FCI

Cataract surgery is recommended for patients who have developed cataracts that severely impair their ability to see. These cloudy areas in the lens of the eye can cause impaired, fuzzy vision as well as sensitivity to glare. Although most cataracts develop in the elderly, some do also occur in infants and younger adults. Fortunately, cataracts are treatable through surgery and lens correction.

Cataract surgery involves removal of the natural, occluded lens of the eye, which is replaced with an artificial lens. Capsular tension rings are used most often in cases where the eye’s capsular bag encasing the lens demonstrates weaknesses in the zonules. These are fibrous strands that help hold the lens in place and assist the eye in focusing on objects.

Two to five percent of all cataract surgeries are performed on patients with compromised or partially absent zonules. These capsular tension rings increase the success of cataract surgery by mitigating the risks for patients with compromised zonules. The ring works by placing centrifugal forces on existing zonules to support areas of zonular weakness, and allows redistribution of the existing zonules. Compromised zonules can often be attributed to:

  • Congenital, metabolic, and endocrine disorders such as Marfan’s syndrome, Marchesani’s, scleroderma, homocystinuria, spherophakia, porphyria, hyperlysinemia, and sulfite oxidase deficiency
  • Pseudoexfoliation
  • Extreme myopia
  • Cataracts that have suffered significant trauma
  • Postvitrectomy patients
  • Patients with previous glaucoma filtration surgery
  • Patients who have had radial keratotomy surgery with more than eight incisions.

The success of capsular tensions rings is credited to the fact that their diameter is larger than the capsular bag, there are three sizes to choose from, and when inserted into the capsular bag, they provide pressure against the equatorial region. Focal forces are then transmitted circumferentially to the entire zonule apparatus, thereby removing the pressure from the compromised zonular areas.

Dating back to 1991, the Morcher company has created rings designed to stabilize the lens capsule in patients with weak or partially absent zonules. Beginning in 1996, these Morcher rings went under study, with the Morcher study investigator Roger F. Steinert, M.D., associate clinical professor at Harvard Medical School and Ophthalmic Consultants of Boston stating, “It does exactly what it is supposed to do, and there are no complications.”

The Eyejet is a unique disposable injector that is preloaded with one of the three available sizes of cataract tension rings. The standard diameter of the Eyejet is 12 mm. Available in left or right versions to accommodate insertion preference (The left model used for implantation in a counter-clockwise direction, the right model for clockwise), the Eyejet is pre-loaded and packaged in a sterile, peel-open container and is ready for immediate use by the surgeon with no preparation necessary.

The Eyejet poses many benefits for surgeons looking to improve the surgical outcome of their special cataract cases. Benefits of the Eyejet capsular tension ring include:

4 Eyejet5 300x225 Cataract CTRs: A Look at the Eyejet CTR

  • Easy insertion into the capsular bag
  • Circular expansion of the capsular bag
  • Stabilization of the capsular bag on small zonular damages with no sclera fixation necessary
  • Reduced risk of damaging the capsule or zonules during surgery
  • Better centration of the intraocular lens, including cases of future capsular bag shrinkage
  • Capsular bag distortion
  • Simplification of the implantation of foldable intraocular lenses

The easily operated Eyejet unit comes with a capsular tension ring affixed to the hook of the injector with a clamp. After the sterile package is opened for use, the clamp is pulled backwards to load the ring into the injector. The clamp is then removed, leaving the ring prepared for insertion into the capsular bag.

Although a capsular tension ring is best to have on-hand in every case of suspected zonular weakness, the least aggressive surgical procedure is always advised. Although capsular tension rings are very safe, they should only be used when necessary to avoid the small chance of a problem occuring.

Capsular tension rings have many advantages, with documentation of these benefits dating back since the Morcher company first introduced them over 15 years ago. With availability in three sizes, easy implantation and other proven benefits, the Eyejet system offers notable advantage for surgeons performing cataract operations on patients with zonular damages, pseudoexfoliation, and other capsular bag irregularities.

 

Posted in Cataracts, Orbital Implants | Leave a comment