Newer frontiers in oculoplasty and ptosis

Ptosis remains a problem for many. It robs one of his or her self esteem and results in the person worrying about their appearance all the time. The good news is that ptosis correction has become easier and simpler and obviously more successful.

The day care approach to ptosis surgery has made the results very predictable and comfortable for the patient. The patient is made to sit up at the end of surgery and the position of the upper lid is noted. Finalization of the lid height to look good and to match the other eye is performed and the patient is shown the correction achieved by clicking a photograph.

Oculoplasty surgery is advancing in leaps and bounds and more progress is expected in the years to come...

Children and glasses

Let us suppose one goes to an optician or ophthalmologist. The child is noted to have a refractive error.

Does it mean all children need glasses ?

No. There is a process of normalization of the refractive error of the eye called as  EMMETROPZATION.
Any refractive error in any child should not be treated. There are limits in the refraction only beyond which one needs to prescribe glasses.

The very young child like the toddler has very little need to see distant objects. For an infant the most interesting part of the world in the mother's face at a distance of 25 cm. Hence one does not  need to prescribe glasses to this age group unless the numbers are very large.

Squint and Glasses

It is interesting to note that in many instances, squint in children can be succesfuly treated with simple glass prescription. Glasses especially plus numbers are useful in accommodative convergent squints and the minus numbers in intermittent divergent squints.

Most of the times, the glasses also help the child to see better and prevent complications like amblyopia or lazy eye. Hence it is important that children are properly refracted and given glasses if needed.

One may wonder what the natural progression of refractive error in children. Children are born with a small plus number which gradually progresses towards normal. This process is called emmetropization.

It is important to note that most plus number reduce over time, minus numbers may increase and cylindrical numbers are unlikely to change much.

Protective eye glasses

I have seen many patients come with severe injuries due to damage to the eyes at the work place or in road accidents. It is quite sad that there is a careless attitude from the point of view of the workers who do not want to wear protective glasses. 

The unfortunate thing is the patients usually lose the eye and I am forced to contemplate an artificial eye for them. I agree the artificial eye is a good cosmetic solution, but there should be strict rules at the work place and more discipline on the part of industrial workers who should wear protective glasses.

These are made of CR 39 or Polycarbonate. Polycarbonate is of course superior. 
They should cover the eyes completely leaving no gaps at the edges. 

Again while driving on the road, eyewear made of CR or polycarbonate should be worn. Even small foreign bodies can get into the eyes and create problems. Indeed I have removed many of them .

Thyroid eye disease

Thyroid eye disease is an under diagnosed condition. Many patients are not diagnosed till late in the disease, when there are serious problems due to the disease. The eyes are usually red and congested. There is persistent watering from the eyes. The lids start to behave abnormally with widely open eyes which gives an angry look to the patient. The movements of the eyes can also get limited when the patient starts getting double vision. Protrusion of the eyes occurs due to the increase in fat in the orbit and enlargement of the eye muscles. The vision may drop when there is compression of the optic nerve by the eye muscles.

The serious manifestations are loss of vision and double vision. The treatment in the initial stages when the eyes are red is giving oral steroids or intravenous steroids so that the patient can tide over the inflammation or redness in the eyes.

Control of the thyroid status is also essential for the eye disease to become stable. For the double vision one can give prisms or even injection of botulinum toxin in the acute stages. Orbital decompression is needed if there is sight threatening optic nerve compression or for cosmetic reduction of the proptosis. Squint surgery may be needed for the double vision especially as there may be vertical displacement of images and adjustable sutures are used while performing the squint surgery.

I routinely perform surgery and manage many patients with thyroid eye disease, with a good outcome.

Tips to reduce eye strain

Sit about 25 inches from the computer screen and position the screen so your eye gaze is slightly downward.

Reduce glare from the screen by lighting the area properly

Post a note that says “Blink!” on the computer as a reminder. This really helps !

Every 20 minutes, shift your eyes to look at an object at least 20 feet away, for at least 20 seconds: the “20-20-20” rule.

Use artificial tears to refresh your eyes when they feel dry.

Take regular breaks from computer work, and try to get enough sleep at night.

Computers and Eye Strain

What causes computer-use eyestrain?

Normally, humans blink about 18 times a minute, but studies show we blink half that often while using computers and other digital screen devices, whether for work or play.
Extended reading, writing or other intensive “near work” can also cause eyestrain.

If not taken care of in time this can lead to computer vision syndrome.