Blog

The Aging Eye

Posted on September 21, 2011 by FCI

Age-related vision impairment champions the leaderboards as the main cause of vision impairment and blindness in the United States. Cataracts, one of the most prevalent age-related eye diseases, affect over 20 million Americans over 65 years of age. Glaucoma, macular degeneration, and diabetic retinopathy also sit high on the list of these diseases. Each age-related eye disease comes with its own cause and complications. Eye diseases that have been closely tied to the aging process include:

senioreye 300x157 The Aging Eye

  • Cataracts

Cataracts are most often age-related. A cataract is a clouding of the transparent lens structure behind the iris. Cataracts may form as early as age 40 and then become advanced enough to limit vision by age 60. Fortunately, cataract surgery can restore this vision loss.

  • Macular degeneration

This condition destroys the macula, a group of cells in the central retina that are responsible for sharp vision and fine detail. It is essential to diagnose and monitor macular degeneration to help preserve vision over time.

  • Glaucoma

Older adults are at an increased risk of glaucoma. Glaucoma is the result of excessive fluid buildup within the eyeball that places pressure on the optic nerve. Over time, the optic nerve can gradually suffer major damage.

  • Diabetic retinopathy

In patients with diabetic retinopathy, high blood glucose causes fragile blood vessels to overgrow. These fragile vessels burst, leaking fluid behind the retina that causes inflammation and scarring. Age and the length of time an individual has had diabetes are both factors in the development of diabetic retinopathy.

  • Dry or watery eyes

Dry eye is a common occurrence in older individuals. Dry eye can be caused by tear evaporation, underproduction of the tear film, abnormal pH, or ptosis.

Watery eyes can be caused by the weakening of the structures that support your eyelids, causing them to lose the ability to properly sweep tear film towards tear ducts.

  • Presbyopia

Farsightedness develops as the lens of the eye loses elasticity and the ability to focus the lens becomes increasingly limited. This age-related eye condition is so prevalent that reading glasses of varying prescriptions are often found on racks in pharmacies and grocery stores.

  •  Blepharitis

This condition can cause redness, swelling, and crusting and can be caused by bacterial overgrowth in the oil glands of the eyelashes.

As the eye ages, anatomical and physiological processes also gradually decline. This results in a natural decline in vision quality. Areas of natural degeneration in the eye that contribute to a loss of vision include:

  • Pupil changes

The most significant of these natural changes occurs in the pupil. A reduction in pupil size, the loss of focusing, and the lesser extent of pupil dilation reduces the amount of light that can reach the retina. This is often apparent in older people as they tend to use additional lighting for illumination where younger individuals do not have trouble seeing.

 

  • Color and Contrast

Color and contrast sensitivity is also affected. The lens of the eye yellows over time, causing a reduction in the ability to discriminate between certain colors such as blue and green.

 

  • Lens Elasticity

The lens of the eye begins to lose its elasticity and makes it more difficult for the lens to bend and focus on close objects. This results in the common farsightedness of older individuals known as presbyopia.

As one ages, regular eye exams are critical to maintaining vision and eye health. Although age-related eye conditions usually present gradually, individuals should be careful to seek immediate medical assistance if they experience:

  • Flashing lights, floaters, or a gray creeping curtain moving across the field of vision. This sudden onset may indicate a retinal detachment. Unless treated immediately, retinal detachment can lead to blindness.
  • Any sudden loss of vision. Sudden vision loss can be related to macular degeneration, glaucoma, or other conditions that require immediate attention.
  • Eye pain can be caused by many of the common age-related eye diseases, but should be assessed immediately.
  • Blurred vision can often be a sign of glaucoma, uveitis, a retinal tear, macular degeneration, or a blocked blood supply to the eye.

Although many age-related changes are not preventable, close monitoring and routine examinations can help minimize the complications of an aging eye and keep eyesight at its best throughout the lifetime of every individual.

 

Posted in Cataracts, Dry Eyes | Leave a comment

Using Vitrectomy Lenses and Scleral Buckling for Retinal Detachment Cases

Posted on August 31, 2011 by FCI

Common in midlife through the golden years, but possible at any age, retinal detachment occurs when the retina is separated from its position on the back wall of the eye. Affixed to this wall like a sheet of wallpaper, the retina is responsible for taking images through a physical and chemical reaction and sending this imagery to the brain through the optic nerve.

Retinal detachment can occur when the vitreous gel separates from the retina, causing tension and pulling the retina away from its location or causing tears in its surface. Vitreous gel can seep through these tears and pool behind the retina, exerting pressure and detaching the retina from the wall of the eye. When retinal detachment occurs, the result is visual loss or blindness.

Surgery is the prescribed treatment to return the retina back to its original location on the inner wall of the eye;  thus restoring its image-capturing capabilities and returning vision to the patient.

Conditions

Conditions that increase the chances of retinal detachment include nearsightedness, cataract surgery, glaucoma, trauma, family history, or retinal weakness.

Symptoms

Symptoms of retinal detachment can include floaters or flashing lights in the periphery of a patient’s vision. A gray veil moving across the field of vision or a sudden reduction in peripheral vision can also be symptoms of retinal detachment.

Treatment

Treatment for retinal tears includes laser surgery or cryotherapy, but detachments most often require surgery to return the retina to its original location. These treatments include pneumatic retinopexy, scleral buckling, and vitrectomy.

Pneumatic retinopexy

A pneumatic retinopexy involves injecting a gas bubble into the vitreous space via an intravitreal injection to push the retina back to its original position against the wall of the eye. The patient is often instructed to maintain a certain head position for several days after this procedure. The injected gas bubble will gradually dissipate and be replaced by the body’s own fluids.

Medications are sometimes injected into the eye with the help of an intravitreal injection assistant such as the disposable Invitria®  which ensures a predictable procedure without the need for usual instruments such as the speculum, calibrator or pressure plate. This instrument allows the physician to insert the injection into the eye with ease, making it a surgical solution that is user, budget, and patient-friendly.

Scleral buckle

Scleral buckling is the most common retinal surgery and an effective way to close large breaks and reunite layers of the retina. A scleral buckle can be placed around the equator of the eye to counter the traction pulling the retina from its position. The fluid under the detached retina is removed so that the retina can return to the wall of the eye and then the scleral buckle is positioned to keep it in place. Usually permanent, this buckle is sewn to the outer layer of the eye and pushes the sclera toward the middle of the eye, relieving traction on the retina and allowing it to heal.

Vitrectomy

A vitrectomy is used to remove vitreous gel that is applying traction to the retina and pulling it out of place, along with any other tissues that are tugging at the retina. Vitrectomies are also used to remove vitreous gel before performing a pneumatic retinopexy or combined with scleral buckling. Disposable vitrectomy lenses offer a highly effective solution that allows the physician to efficiently view the retinal surface during retinal surgery. These lenses are available in 30 degree prismatic lenses and planoconcave silicone options.

Risks

Risks of surgery are low and include infection, bleeding, raised eye pressure, or cataracts. Sometimes a second surgery is necessary, but the risks of surgery are far outweighed by the guaranteed loss of vision resulting from lack of treatment.

Outlook

Vision may take months to fully improve, and may not return entirely. An eye patch is necessary and often a change of prescription lenses is needed after surgery. The longer and more severe the initial detachment is, the lower the vision recovery, which can be expected after surgery.

Quick surgical correction is of ultimate importance in cases of retinal detachment. Although treatment for retinal tears includes laser surgery or cryotherapy; detachments most often require surgery to return the retina to its original position through the use of vitrectomies, scleral buckling and pneumatic retinopexy. These procedures are most often performed using advanced surgical instruments, which include intravitreal injection assistants, disposable vitrectomy lenses, and scleral buckling components.

 

Posted in Eye Surgery | Tagged | Leave a comment

Lacrimal Stents for Dacryostenosis

Posted on August 9, 2011 by FCI

The lacrimal system is a small and complex system that aids in sustaining an appropriate tear film in the eye. Anatomical conditions such as nasolacrimal duct obstruction, also known as dacryostenosis, can upset the delicate physiological balance between tear production and drainage. The most common symptom of dacryostenosis is epiphora, or the overflow of tears. Ranging from bothersome to chronic and affecting both children and adults, dacryostenosis may be cured easily with a simple outpatient procedure, or it may require additional assistance from lacrimal stents or tubes.

The first step in assessing the appropriate course of treatment is to assess the cause of dacryostenosis. Dacryostenosis can be congenital, or it can be acquired by a primary or secondary obstruction.

Congenital Cases – Affecting one eye or both, blocked tear ducts occur in up to 20% of newborns and may not be evident until after the first month, sometimes resolving on its own. If the condition does require intervention, a quick and highly successful outpatient probe and irrigation can be performed. This procedure is conducted under general anesthesia and employs a small metal instrument that is passed through the nasolacrimal duct to open the pathway and clear the obstruction.

Acquired Cases – Dacryostenosis can also be caused by infections, abnormal growth or injury of the facial bones or surrounding tissues, underdeveloped puncta (the openings in the corners of the eyelids), and thickening of the tear duct lining, sinus problems or tumors.

If the condition cannot be resolved by simple probing, stents can be inserted to open up these ducts. Commonly used types of stents include the Mini Monoka, the Crawford & Mono-Crawford, and the Ritleng & Self-Threading Monoka.

 

Mini Monoka

The Mini Monoka is used for patients who have suffered a canalicular injury or have a canalicular anomaly. The canaliculi are the mucosal ducts through which tears drain from the eye, and injuries and anomalies of the canaliculi are fairly common. The Mini Monoka is a silicone stent that can be securely anchored at the punctum with no need for sutures. Threaded through the punctum into the lacrimal system, the Mini Monoka recreates the passageway that is being interfered with by the compromised canalicula.

As the Mini Monoka does not feed all the way through the nasolacrimal system, it eliminates possible injury to the normal canaliculus and nasolacrimal duct.

 

Ritleng Probe and Self-Threading Monoka

The Self-Threading Monoka (Ritleng style) tube is designed for canalicular stenosis procedures, laceration, or imperforate nasolacrimal ducts and requires no sutures. This tube is attached to a thin thread-guide which is fed through a Ritleng probe and gently out the nose. The probe is then removed, and the thread-guide is pulled along with the silicone tubing into proper position in the nasolacrimal duct. The tube is securely anchored at the punctum by a small plug and requires no suturing.

Intubation can be a complicated process in infants and small children, as the nasal passages are compact and complicated in youths. The removal of a thin suture or thread-guide from the nose is easier and less traumatic than traditional metallic probes, facilitating canalicular procedures in young children.

 

Crawford

The Crawford Bicanaliculus Intubation is a highly effective tool for the treatment of canalicular system stenosis (narrowing of the canalicular system) or nasolacrimal duct obstruction. It attaches to a metallic glide with an olive tip that is fed through the system and retrieved below the inferior turbinate using a Crawford Hook.

 

Mono-Crawford

The Mono-Crawford can be used for both nasolacrimal duct obstruction or in a canalicular laceration repair. This stent feeds all the way down into the nasolacrimal duct, unlike the Mini Monoka, and is anchored at the punctum by a plug and then retrieved using a Crawford Hook.

Although choices for lacrimal stents and tubes are many, recent studies have demonstrated better success with silicone stents. Silicone stands as the most ideal material to date—as it is soft, pliable, inert, and stable.

Monocanalicular stents are also preferable over bicanalicular for a variety of reasons, including their ease of removal, quick office procedure, and no danger of punctum erosion (which can occur occasionally with bicanalicular stents). The most common issue with monocanalicular stents remains the chance of postoperative scarring, obstruction or stenosis from spontaneous dislodgement.

Dacryostenosis remains a common but curable condition. With the use of simple probing or further assistance by the use of stents, dacryostenosis can be effectively treated with minimal intrusion and an overwhelmingly positive outcome.

 

Posted in Dacryostenosis, Lacrimal Stents | Tagged | Leave a comment

KITARO Kits: A Superior Way to Practice Cataract Surgery

Posted on July 12, 2011 by FCI

The KITARO© WetLab and DryLab kits are created with the learning surgeon in mind. With both wet and dry lab kits, the beginner can practice techniques repeatedly without the added complication of long preparation times and costly live tissue samples. These tools simulate the stages of cataract surgery using both a wet lab and dry lab environment to allow new surgeons the ability to train repeatedly on basic surgical techniques.

Beginners can learn instrument manipulation with the KITARO DryLab and then move on to the KITARO WetLab to learn the intricacies of machine operations before performing actual surgeries.

KITARO DryLab

Without the need for a microscope or a phaco machine, procedures such as continuous curvilinear capsulorhexis (CCC), nuclear dividing, IOL insertion, and wound construction can be practiced repeatedly in a low-cost, pressure-free environment. The DryLab also monitors eye movement upon instrument contact to mimic a real surgical environment.

Mastering the essential specialized techniques of cataract surgery can be difficult for a surgeon to practice using conventional methods. Precise instrument manipulations require repetitive rehearsal, and available lab provisions such as porcine models can be tough and costly to obtain. With the KITARO DryLab, these issues are abated by allowing the novice to practice techniques repeatedly at their own desk.

Necessary surgical skills can be quickly improved through DryLab technologies designed to simulate the multiple stages of cataract surgery.

Continuous Curvilinear Capsulorhexis

The DryLab polyester film has a 2-layer structure that mimics the ocular cortex. This technology can simulate the CCC procedure necessary to release the original cornea, and help surgeons learn the skills necessary to perform successful CCC in preparation for phacoemulsification. In practice, common mistakes can be encountered and resolved, and the polyester film can be quickly shifted to yield a brand new practice site for each rehearsal.

Nucleus Dividing

The nucleus dividing technique is the process of segmenting the pieces of the cataract nucleus in preparation for removal. The DryLab allows surgeons to perform the basic techniques for this segmentation with 3 artificial nuclei that provide divide & conquer, stop & chop, and phaco-chop techniques. The DryLab comes with three plastic pre-divided nuclei and CCC-processed film to aid in the practice of the three nucleus dividing techniques.

A polymer clay nucleus is also included that can be maneuvered and pierced for stop & chop and phaco-chop techniques just like a human nucleus.

Phacoemulsification

Phacoemulsification for emulsifying the eye’s internal lens and aspirating the nucleus is simulated using an artificial nucleus made of special resin clay. This clay mimics the consistency of a human nucleus and can be reused multiple times by simply hand-kneading back to its original shape and letting it set for a short period of time.

Wound Construction and IOL Insertion

Surgeons can practice construction of self-sealing wound incisions with the DryLab resin sheet. This sheet mimics the human sclerocornea, and effective practice can be performed using a keratome or crescent knife. The DryLab also allows the surgeon to practice IOL insertion with both forceps and an injector.

KITARO WetLab

The KITARO WetLab was constructed to replace the porcine wetlab, lowering the cost and setup of conventional labs. Surgical techniques, complication management, and common mistakes can all be mastered through repeated practice with this revolutionary learning tool.

The KITARO WetLab provides advantages over the usual porcine wet lab, including: easy preparation, a hygienic environment and high-quality, predictable materials for CCC and nuclear segmentation practice.

The WetLab comes with a high-quality artificial cornea and cataract lens. This artificial lens comes in three consistencies (medium-soft, medium-hard, and very hard) to represent natural consistency variations. The artificial cornea is 500 µm thick at the central part and 700 µm thick at the periphery to mimic the resistance experienced during an actual surgery.

With this equipment, a complete cataract surgery can be practiced that includes:

  • Creating appropriate incisions
  • Filling the anterior chamber with viscoelastic gel
  • Performing CCC
  • Executing hydrodissection and hydrodelineation
  • Grooving and splitting the nucleus
  • Emulsification and aspiration
  • Removing the cortex
  • IOL implantation

This training system is the future of cataract surgery practice for beginning surgeons. It can limit mistakes made in real surgical settings, and allows surgeons to master techniques and manage complications through a simulation that uses a realistic surgical environment without the lengthy preparation. The KITARO Wetlab and Drylab provide realistic eye movements and materials of comparable consistency to human eyes to assist the beginner surgeon in practicing the techniques necessary for successful cataract surgeries.

Posted in Cataracts, Eye Surgery, Industry News, KITARO Kits | 4 Comments

Various Types of Orbital Implants

Posted on July 7, 2011 by FCI

Orbital implants are used in the ophthalmic arena in the treatment of anopthalmia (the absence of an eye) enucleation, or evisceration (the removal of an eye). Anopthalmia is often a congenital condition that can be caused by genetic mutations or abnormal chromosomes. Anopthalmia can also be due to trauma incurred through accidents and tumors. Anopthalmia by enucleation may be necessary when trauma, tumors, or disease warrants the removal of the entire eye.

Children should be fitted for a prosthetic (artificial) eye to promote socket growth and facial symmetry. By using conformers and tissue expanders to help support the facial structure and encourage the eye socket to grow, children can experience a normal development. Once a child is fully developed, a prosthetic can be placed for cosmetic purposes.

There are a variety of orbital implants to choose from, and different options are selected based on the individual needs of the patient and the preference of the surgeon.

Implants may either be free-floating, attached to the surrounding muscles, or pegged within the socket.

  • Free-floating implants such as acrylic and silicone are used when severe trauma has compromised the surrounding muscles. In these cases the implant is placed in the orbit and the conjunctiva is sewn over the top.
  • Many implants have the option of a mesh wrap or outer shell that can be affixed to the surrounding tissues to improve the motility of the implant within the socket.
  • Pegging essentially ‘snaps’ the implant into place. Used with porous implants, it is employed to improve the motility of the implant by allowing the surface to fit into a corresponding groove.

Orbital Tissue Expander

The revolutionary orbital tissue expander is a flexible balloon, held in place by a plate that is anchored to the lateral orbital wall. This implant can be easily expanded in the socket as it grows by inflating it with sterile saline inserted through an injection port.

This simple method of implant expansion removes the need for multiple surgeries and offers the ability to incrementally increase the size of the implant.

Bioceramic Orbital Implants

Bioceramic orbital implants allow for vascularization and integration into the eye socket. Used primarily in enucleation and evisceration procedures, these implants are lightweight, easy to insert, strong, nontoxic, bioinert, biocompatible, and nonallergenic. Commonly well-received by the patient, these implants are more stable than many other implant options.

Mesh-Wrapped Bioceramic Orbital Implants

A common problem with implants is the “stickiness” that occurs when the implant clings to the surrounding tissue. Models that include a vinyl mesh wrapping allow the muscles to be sutured to the implant and enhance the movement of the implant within the socket.

Mesh-wrapped bioceramic orbital implants include a vicryl mesh wrapping and a silicone band. The pore system included in this implant enhances fibrovascular ingrowth which helps prevent implant migration and improves implant motility. This implant can be coupled with the peg system to allow the surgeon to choose a solution that best mimics natural eye movement.

Silicone Orbital  Implants

Silicone orbital implants are another option for physicians performing enucleation and evisceration procedures. Silicone implants are more pliable than acrylic, and are also non-porous. This type of implant is best used when severe trauma has made the surrounding muscles unidentifiable and therefore unusable for attaching to the implant.

Acrylic Orbital Implants

The acrylic sphere is the simplest type of implant. Much like the silicone orbital implant, the acrylic implant is also non-porous, but less pliable than its silicone counterpart.

Posted in Eye Surgery, Orbital Implants | Leave a comment

Unknown Eye Conditions and Solutions

Posted on June 30, 2011 by FCI

Eye conditions can occur in patients both young and old, for a variety of reasons. Many of these lesser-known conditions can result from disease, genetics, tumors, or trauma. Lagophtalmos, ptosis, anopthalmia and other conditions can often result from an uncommon eye condition. Sometimes even common symptoms such as dry or light-sensitive eyes can be the result of an uncommon underlying cause.

Lagophthalmos

Lagopthalmos is a diminished blink reflex and improper eyelid closure. These symptoms affect the eye’s ability to maintain a stable tear film and can cause dry eye and long-term vision damage if not corrected. Among other causes, lagopthalmos can be due to:

  • Bell’s Palsy– Bell’s Palsy causes sudden paralysis of one side of the face. Commonly treated with steroids and often ultimately resolvable, Bell’s Palsy affects only an average of .02% of the population. Because Bell’s Palsy causes lagopthalmos on the affected side, sufferers often develop severe dry eye, which can lead to permanent vision loss if not corrected.
  • Eye Trauma and Tumors – Eye trauma may cause damage to the facial nerve responsible for proper eyelid closure and the blink reflex. Skull fractures and surgical procedures can both cause damage to this nerve. Rare tumors such as acoustic neuromas can be credited for some lagopthalmos cases. Damage to the eyelids from burns, trauma, and eyelid surgery can also cause this condition, as well as aging.
  • Infectious Diseases – Lyme disease, chickenpox, mumps, polio, Guillain-Barré syndrome, leprosy, diphtheria and botulism can all contribute to lagopthalmos in patients.

This condition can be successfully managed with the use of internal eyelid weights to aid the lid in proper closure. Internal eyelid weights effectively provide corneal protection and a decreased reliance on eye ointments or occlusion therapy.

Ptosis

Ptosis presents itself in a contrasting nature to lagopthalmos. Ptosis occurs as a drooping of the upper or lower eyelid. This condition can cause eye fatigue, double vision and trouble blinking.

Although often developed as a result of aging, a variety of less common causes can be credited to the development or presence of ptosis, including:

  • Congenital Defects – Ptosis can present itself at birth and may be a lifelong issue for some, caused by abnormalities in a person’s inherent anatomy.
  • Trauma and Disease– Trauma, tumors, and neurological diseases can affect the levator muscles responsible for lifting the eyelid.
  • Eye Surgery – Rarely, eye surgery that involves the nerves and muscles of the eye may be the cause of ptosis.

To treat this condition, severe cases may be remedied by lifting the eyelid and affixing it to the brow using ptosis strips and slings.

Anopthalmia and Micropthalmia

Anopthalmia and Micropthalmia are very uncommon conditions, often congenital in nature or as a result of enucleation or evisceration after a severe traumatic event. Micropthalmia is the underdevelopment of an eye, whereas anopthalmia is the complete lack of the eye. Both of these conditions present an issue when the cause is congenital, as the developing features of the face and skull are dependent on a fully developed eye and orbit.

These conditions can be treated with orbital eye surgery and the use of implants such as an orbital tissue expander to maintain the symmetry of the face during development.

Additional Rare Eye Diseases

  • Bietti’s Crystalline Dystrophy – Bietti’s is an inherited disease that causes crystals to develop in the cornea, as well as yellow deposits on the retina and progressive retinal atrophy. Symptoms include visual field constriction and night blindness. At this time there is no solution for this rare disease.
  • Retinoblastoma – Retinoblastomas are a type of cancer that forms in the retina. Usually occurring in children younger than 5 years, it is sometimes hereditary in nature. This life-threatening condition can be treated with early diagnosis, surgery, and repair of the retina.
  • Retinitis Pigmentosa – Retinitis pigmentosa causes progressive degeneration of the retina, resulting in night-blindness and a loss of peripheral vision. Though no sure treatment exists, the use of Vitamin A palmitate may slow the progression of this condition.
  • Coloboma – This condition is due to a lack of development of one or more structures of the eye. The missing structure can be part of the eyelid, lens, macula, optic nerve, or uvea. Unfortunately no treatment exists for this condition, but using corrective lenses and treating resultant complications can reduce the negative effects of this condition.

Though rare, these diseases have been documented and assessed, and many already have valuable treatment options available through cutting-edge advancements and tailored surgical enhancements.

Posted in Internal Eyelid Weights, Lagopthalmos, Orbital Implants, Ptosis | 1 Comment

External Eyelid Weights: Options other than Surgery

Posted on June 1, 2011 by FCI

Lagophthalmos, or the inability to fully close the upper eyelid, can be caused by a variety of temporary and permanent conditions. Most often connected with the paralysis of the 7th cranial nerve, lagopthalmos can be caused by:

  • Bell’s palsy
  • stroke
  • trauma
  • infections
  • tumors such as acoustic neuromas
  • cosmetic surgery

The different causes of lagopthalmos necessitate different types of treatment based on the temporary or permanent status of the condition. It’s important to recognize and address lagopthalmos early to maintain optimum eye health. Treatment is necessary to preserve corneal lubrication of the eye and maintain a stable tear film. When the blink function is compromised, the eye becomes dry, irritated, and less capable of flushing out foreign objects. Long-term effects of this condition can cause permanent vision loss as a result of prolonged dehydration.
BlinkEze™External Eyelid Weights

To treat these conditions, external lid weights such as BlinkEze™weights can be used to weigh down the eyelid. These strips are secured to the outside of the lid and weigh it down by the simple use of gravity on the upper eyelid. These weighted strips assist the blinking mechanism so that the patient can achieve a full and effective voluntary blink. Held on by double-sided, hypo-allergenic adhesive, they are non-invasive and offer an immediate remedy for eyelid paralysis. This treatment is ideal for patients with temporary conditions, or those who are otherwise not well-suited for surgical implantation. External eyelid weights can also reduce dependency on ophthalmic ointments and lubricants. As a comfortable and convenient treatment, these weights can eliminate the need for occlusion therapy, humidifiers in the home, and moisture chamber goggles.
BlinkEze™external eyelid weights are made of painted 99.99% pure tantalum, a durable metal with high biocompatibility. Strips are available in a variety of different colors to match the patient’s skin tone and decrease strip visibility to make their presence less socially invasive.

Tantalum Sizing Sets

Tantalum sizing sets are used by the ophthalmologist to ensure the proper weight is provided for each individual. Standard weights from 0.6 to 1.8 grams or specialty weights up to 2.8 grams can be used to determine the appropriate weight for correct eyelid closure. When assessing weight size, the patient is asked to look around in various directions to assess whether the weight is providing the desired result.
How to Apply External Eyelid Weights

As an external remedy, BlinkEze strips are maintained in a non-sterile environment, which lends them well to at-home use and maintenance. It’s important to start with a clean, dry surface. When applying an external eyelid weight, first remove any makeup and use a mild soap and water to clean the eyelid before applying the adhesive strip.

  1. Affix the double-sided adhesive strip to the concave (inside) side of the BlinkEze eyelid weight and press down for 30 seconds to ensure adhesion.
  2. Remove the protective coat on the other side of the adhesive strip.
  3. Press the strip onto the eyelid by looking into a mirror and placing it near the center of the eyelid, just above the lashes. Press firmly for 30 seconds to securely adhere the eyelid weight to the skin.

These weights can be worn up to three days without removal. To remove the weight, gently pull it off of the eyelid one side at a time. These weights can be cleaned with mild soap and water. Be sure to scrape away any old adhesive before placing another adhesive strip on the external weight. Side effects are rare, but contact your ophthalmologist if irritation of the adhesion site occurs.
External lid weights are a great alternative to surgery for temporary or long-term treatment of lagopthalmos. They can help patients reduce their dependency on lubricating ointments and occlusion therapy. They can also be used to test the effectiveness of an eyelid weight before surgical implantation.

Safe, hypo-allergenic, relatively concealed and effective for long-term use, strips made of this long-lasting, biocompatible metal help maintain essential hydration of the eye. External lid weights for the treatment of lagopthalmos provide a non-invasive and immediate fix to an often imminent issue.

Posted in Eye Surgery, Lagopthalmos, Orbital Implants | Leave a comment

Types of Eye Surgery

Posted on May 25, 2011 by FCI

There are a variety of conditions that may call for eye surgery; from cosmetic changes to vision-saving procedures. Each treatment comes with its own benefits, risks, and indications for use. From corrective treatments to orbital implants, today’s advancements can tackle almost any condition and provide a successful solution.

Corrective Surgery
Corrective laser eye surgery is by far the most popular eye surgery in today’s times. It has taken the world by storm, with approximately 2,000 people having it performed every day. The two most common methods of corrective surgery are LASIK (Laser-Assisted In Situ Keratomileusis) and PRK (photorefractive keratectomy). Laser eye surgery can correct myopia, hyperopia, and astigmatism, thereby eliminating an individual’s dependency on corrective lenses.

  • Most popular, LASIK uses a precision laser to remove corneal tissue and reshape the cornea to change its level of focus.
  • PRK is preferred for individuals with thin corneas where creating a flap may be more difficult.

Both types of corrective surgery take approximately 15 minutes per eye. New “bladeless” wavefront technology has been introduced to mitigate some of the issues caused by aberrations in flap edges.

Cataract Surgery
Cataracts, commonly affecting both eyes, occur in over half of adults over 60. The surgery to remove cataracts is a very safe and successful procedure, with over 1.5 million cataract surgeries performed in the United States to date. It is generally recommended for those individuals who have vision loss that is impeding their daily life, but may be avoided for those who have additional eye diseases. Cataract surgery is performed with minimal sedation and generally takes less than 30 minutes. During surgery, an artificial lens is put in place of the original to restore vision.

There are three different approaches to cataract surgery:

  • Phacoemulsification

Most common, this approach requires only local anesthesia. Ultrasonic vibrations dissolve the cloudy lens via an inserted probe.

  • Extracapsular cataract surgery

This type of surgery is often performed when the lens is too dense forphacoemulsification. This surgery requires sutures, and recovery is longer.

  • Intracapsular cataract surgery

This technique requires a larger incision, and the entire lens and surrounding capsule are removed. This method is rare, and is only used when existing eye trauma makes it the most practical option.

Over time, the lens replacement may begin to cloud. This is easily corrected with an additional laser treatment.

Glaucoma Surgery
Glaucoma results in raised intraocular pressure and vision loss over time. Unfortunately, surgery for glaucoma cannot reverse this vision loss. However, surgery can reduce the intraocular pressure when medication is not a sufficient solution. If necessary, glaucoma surgery can be performed multiple times with low risk.

There are two types of common glaucoma surgery: laser and conventional.

Laser Surgery – During laser surgery, a laser is used to make a small opening in the eye’s drainage system to help increase fluid drainage out of the eye. When laser surgery fails to solve the condition or the condition re-emerges, the ophthalmologist may opt for conventional surgery.

Conventional Surgery – During conventional surgery, a new drainage canal is created that allows intraocular fluid to flow out of the eye.

Lid Repair Surgery
Lid repair may be indicated for both cosmetic and functional reasons. Lid repair is most commonly used to treat ptosis, also known as droopy eyelids. This has become a very popular surgery as the condition can cosmetically age the patient, obstruct vision, or create a visual incongruence between the eyelids.

Surgeries for ptosis can include blepharoplasty (ptosis resulting from aging), Fasanella-Servat and Müller’s muscle-conjunctival resection (for mild to moderate ptosis), and frontalis suspension (for more severe congenital cases).

Orbital Surgery
Orbital eye surgery is indicated for conditions such as anopthalmia, enucleation, and evisceration. These types of surgeries are indicated for individuals with: congenital defects resulting in absent eyes, large eye tumors, or when the eye cannot be preserved due to trauma.

Surgical approaches include introducing an orbital implant such as the Orbital Tissue Expander, and bioceramic or silicone orbital implants. The Orbital Tissue Expander helps the preserve the congruency of facial structure in congenital cases where maintaining pressure on the surrounding structures is imperative to proper growth.

Orbital implants are used to preserve the natural structure of the eye orbit and provide support for the placement of an artificial eye. Recent advancements in orbital implants have aided in improving implant motility and allowing for the natural movement of artificial eyes. Stable materials that are biocompatible, bioinert, nontoxic, and nonallergenic provide a lower rate of migration and rejection in patients.

Eye surgery has become a prevalent part of modern society, and advancements have come a long way from methods of the past. Upgrades in lasers and biocompatible materials have created a new level of safety and success.

Posted in Cataracts, Eye Surgery, Orbital Implants | Leave a comment

Comparing Droopy Eye (Ptosis) Solutions

Posted on May 16, 2011 by FCI

The condition of drooping eyelids (ptosis) affects both children and adults, although it is most commonly associated with the aging process. Depending on the degree of the condition, drooping eyelids may become a vision impediment in addition to a cosmetic issue. Ptosis can also cause symptoms such as tearing, eye fatigue, double vision, and trouble blinking.

This condition can be congenital or can occur as a result of injury, cataract or other eye surgery, problems with the levator muscles that lift the eyelid or even neurological and systemic diseases.

Ptosis is not an uncommon condition, and therefore a variety of surgical remedies exist for patients suffering from ptosis, including:

  • Blepharoplasty
  • Fasanella-Servat
  • Müller’s Muscle-Conjunctival Resection
  • Frontalis Suspension

Blepharoplasty

When the cause of ptosis is an excess of upper eyelid skin, muscle, and fat, a blepharoplasty can be performed to increase peripheral vision as well as the patient’s cosmetic appearance. This treatment is the most popular, as it addresses ptosis that is caused by the aging process.

External incisions are made along the natural creases of the eyelids, and excess skin is removed. This outpatient operation typically takes one to three hours to complete, and recovery can be achieved in one to two weeks. The final outcome of this popular procedure can be seen after a few months.

Fasanella-Servat procedure and Müller’s muscle-conjunctival resection

Both the Fasanella-Servat procedure and the Müller’s muscle-conjunctival resection are effective for patients suffering from mild to moderate ptosis caused by more than simply an excess of eyelid tissue. Patients eligible for these treatments should first have a phenylephrine test performed to determine the appropriate course of action.  A positive test indicates that Müller’s muscle is viable, and the Müller’s muscle conjunctival resection procedure is chosen over the Fasanella-Servat procedure. The Fasanella-Servat resects less of the Müller’s muscle and has slightly less predictable results.

In these procedures, hemostats are used to clamp the tarsus and lower part of Muller’s muscle and conjunctiva, and the tissue defined between the clamps is excised.

Complications of these procedures can include corneal abrasion, under-correction, or overcorrection. The most common complication is caused by faulty placement of the clamps, which can result in a peaked lid arch.

Frontalis Suspension Procedure

As an inexpensive alternative to the Fasanella-Servat procedure, a frontalis suspension procedure can be performed. Best results have been observed with the Ptose-Up procedure, which employs the use of Ptosis Strips. These strips consist of a biocompatible material known as expanded polytet-rafluoroethylene (ePTFE). This material is thicker and has better longevity than the conventional supramid suture.

The frontalis sling method is most commonly performed in patients with congenital ptosis and is especially useful when the levator function of the eyelid is compromised.  This procedure transfers the elevating function to the frontalis muscle by using a sling to suspend the eyelid to the brow.

In this procedure, two small incisions are created in the upper lid and three placed above the eyebrow.  A Ptosis Strip is threaded through the upper eyelid and then through the incisions above the brow. After threading, a knot is made and the ptose-up material is tightened to lift the eyelid. The incisions are then sutured closed and the procedure is complete.

Sling materials have little elasticity by nature, and therefore lagopthalmos is an expected side-effect of this surgical procedure.

The suitable treatment for ptosis depends on the severity and nature of each patient’s condition. The popular blepharoplasty is used most for ptosis resulting from the aging process. Treatments such as Fasanella-Servat procedure and Müller’s muscle-conjunctival resection can be used for patients with mild to moderate ptosis, and frontalis suspension procedures are most commonly used in congenital cases and when the levator function is compromised. Each has its own risk factors and anticipated outcomes, but all are minimally invasive with optimistic outcomes.

Posted in Droopy Eyelids, Ptosis | Leave a comment

Common Eye Conditions: Pink Eye (conjunctivitis), Dry Eye, Astigmatism, Styes

Posted on April 26, 2011 by FCI

At one time or another, most of us have experienced a common eye condition; be it conjunctivitis (pink eye), dry eye, astigmatism, or a stye. Each one of these conditions comes with its own list of causes, symptoms, treatments, and preventative measures. To gain a better understanding of these frequent ailments, let’s take a closer look at each of their associated factors, their treatments and―where possible―how to avoid them altogether.

Conjunctivitis (Pink Eye)

Conjunctivitis, better known as Pink Eye, is caused by an inflammation of the conjunctiva; the transparent lining that spans the eyelid and a part of the eyeball.  When the conjunctiva becomes irritated, blood vessels swell and cause the pink hue which lends this condition its name.

This condition can result from a myriad of causes, including:

  • Viruses
  • Bacteria (including some STDs)
  • Allergies (such as dust and pollen)
  • Irritants (such as smoke, chlorine and shampoos)
  • Foreign objects in the eye
  • Blocked tear ducts in infants

Although very irritating, conjunctivitis is very rarely a threat to your vision and is not considered a serious health risk, unless caused by an STD-related infection.

Symptoms of conjunctivitis include:

  • Redness
  • Itching
  • Grittiness
  • Tearing
  • Discharge
  • Green, yellow or white discharge from the eye and crusting
  • Burning
  • Blurred vision
  • Increased light sensitivity

Although most cases will resolve on their own if left untreated, conjunctivitis can be highly contagious and it is imperative that you seek timely evaluation in order to prevent the spread of the condition. Many causes of conjunctivitis can be treated quickly and successfully with a round of antibiotics, but each type must be treated differently.

Causes of conjunctivitis include:

Bacteria –Bacterial infections can be treated with antibiotics.

Viruses – A viral infection cannot be treated with antibiotics, and will resolve on its own. But because this type of conjunctivitis is highly contagious, care must be taken to avoid close contact with other individuals.

Irritants – Rinsing the eyes can help wash out irritants and resolve the condition.

Allergies – Allergic conjunctivitis must be treated by locating and removing the allergen. Seeing an allergist can help you identify the cause of the reaction.

The best defense against contagious conjunctivitis is to prevent the spread of the condition. Take measures to avoid it by washing your hands often, using clean towels, washcloths and bed linens, and not sharing cosmetics, contact lenses or other eye care items.

Dry Eye

Whether due to chronic low tear production, an imbalance in tear composition, anatomical abnormalities, post-surgical symptoms or environmental factors, dry eyes can be an irritating and persistent condition.

Dry eyes can cause a variety of uncomfortable symptoms, including:

  • Stinging
  • Stringy mucus in the eye
  • Light sensitivity
  • Blurry or fluctuating vision
  • Excessive intermittent tearing
  • Grittiness
  • Increased irritation
  • Eye fatigue
  • Trouble wearing contact lenses
  • Increased reaction to allergens and environmental irritants

Treatment for dry eye depends on the cause. For those with low tear production, post-surgical dry eye or anatomical abnormalities, punctum plugs can be used to block the tear ducts and help keep moisture in the eye. Eye drops can also be used to effectively manage dry eye, as well as a diet high in omega-3 fatty acids.

Astigmatism

Astigmatism can cause blurred vision, eye fatigue and headaches. This condition is due to an irregularly shaped cornea or lens and affects most individuals to some degree, though it is not often noticeable. Astigmatism can be caused by eye injury, surgery, or working in a position which requires consistent close focus. But most often it is simply a natural occurrence varying in degree by individual.

Astigmatism can be treated by wearing corrected lenses or through orthokeratology (the use of rigid contact lenses to reshape the eye). Astigmatism can also be cured through LASIK and other related procedures.

Styes

A stye is a painful bump that usually occurs at the base of an eyelash, on the ridge of or under the eyelid. A stye may result from an infected oil gland or hair follicle. This infection is commonly associated with the common bacterium Staphylococcus aureus.

Styes affect people of all ages, although individuals suffering from chronic conditions such as diabetes mellitus and seborrhea are more prone to developing a stye.

Treatment of styes include:

  • Application of a warm washcloth at home
  • Lancing by a doctor
  • Antibiotic or steroidal ointments

Those suffering from a stye should avoid wearing contact lenses and eye makeup, as both of these items may exacerbate the issue. The occurrence of styes can be limited by washing hands, keeping all eye-related items clean, not touching the eyes, and discarding old eye makeup.

Although each of these common eye conditions is unique in its presentation and cause, they rarely pose serious health risks and most can be easily treated if caught early. Exercising preventative measures can help you avoid common eye conditions altogether and keep your eyes in the clear.

Posted in Conjunctivitis, Dry Eyes, Styes | Leave a comment