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When there is a blockage of the lacrimal passage, tears run down the cheeks. Sometimes this happens outside due to the wind. These are reflex tears and are normal. It can also lead to inflammation and a bonding eye, because the lacrimal sac is closed, and dirt cannot be drained.
The lacrymal system
In the inner corner of the nose side in the upper and lower eyelid is a tube located. The beginning of this tube is called the "edge tear". The two tear ducts come together in the lacrimal sac. From the lacrimal sac, there runs a channel through the nasal wall to the nasal cavity. All of these compounds are very small and narrow, so they can easily become clogged.
The ophthalmologist first examines what is the cause of excessive tearing for you. This may be the result of an increased formation of tears or of impaired discharge of the tear fluid. In the latter case, it is important to determine where the obstruction is. This can be done by purging the tear duct and to probing, whereby the blockage can be undone. In some cases, the ENT doctor is asked to see if there are abnormalities in the nose which explain the blockage.
In some cases surgical approach may be necessary.
More information about glaucoma
The spherical shape of the eye is also maintained due to that within the eye fluid is produced, which is called chamber water. This eye fluid has nothing to do with the external tear fluid. The amount of the eye pressure is dependent on the balance between production and drainage of the chamber water. Too high eye pressure may arise when the outflow of chamber water is obstructed.
The mechanism, which is caused due to glaucoma leads to damage of the optic nerve, is still not known in detail. However there are many factors known to significantly increase the probability of the occurrence of glaucoma .
Types of glaucoma
Glaucoma is common; 1.5% of the Dutch population over age 40 has glaucoma. Glaucoma is classified into primary and secondary glaucoma. Primary glaucoma means that it is a self-contained glaucoma disease. Secondary glaucoma arises as a phenomenon due to a different (eye) disease or as a result of certain medication or eye drops. Primary glaucoma is divided into open-angle glaucoma, closed angle glaucoma and congenital (inborn) glaucoma. The most common considering primary glaucoma is open angle glaucoma. We hereby know the high-tension glaucoma and normal tension glaucoma
When suffering from high-pressure glaucoma, the drainage system of the eye gets clogged. This increases eye pressure and ultimately affects the optic nerve damaging it and causing visual field defects. In normal tension glaucoma other risk factors play a role such as blood flow in the vessels probably being more important than the eye pressure that isn’t increased. Also, this kind of glaucoma leads to damage of the optic nerve and visual field loss. When closed-angle glaucoma is the construction of the eye is in such a way that due to the iris, the drainage system of the eye can become blocked, causing the fluid in the anterior chamber not being able to escape and causing the eye pressure to increase. This form of glaucoma may be acute or chronic. The acute form is usually associated with blurred vision, red eye, headache, nausea and vomiting. The eye pressure being very high causes these symptoms and a prompt treatment is required to prevent damage to the optic nerve. The chronic form is more common and is in early stage treatable. People, who are farsighted, with strong plus glasses, have a greater risk of this type of glaucoma.
Diagnostics to glaucoma
It would be ideal if everyone older than 40 years could be screened for glaucoma. However, only the eye pressure is measured, not all glaucoma patients discovered in this investigation. As the list of risk factors makes clear, in glaucoma many more factors play a part than just the eye pressure. So, in addition to the measurement of the eye pressure it should include checking the optic nerve, and, if necessary, a visual field examination is carried out. Oogziekenhuis Eindhoven also has more sophisticated measurement equipment, such as the Optical Coherence Tomography. This instrument scans in a few seconds, the optic nerve, and provides information on the existence or non-existence of 'glaucomatous' damage to the optic nerve. If after this diagnostics is suspected glaucoma, our ophthalmologist determines together with the patient whether and how it is treated. A glaucoma patient should be monitored for life.
Treatment of glaucoma
At this time, the only proven therapy for glaucoma is to reduce eye pressure. If the eye pressure is reduced sufficiently, a further increase in visual field defects can be prevented. However, existing visual field defects cannot be undone. Therefore it is important that glaucoma is detected in its earliest stage. However, not all people are treated with an elevated eye pressure. There are people with a (moderately) increased eye pressure only. These people do not have glaucoma but ocular hypertension. A treatment is then unnecessary, good control is, however, necessary. Depending on the presence of other risk factors for glaucoma, the ophthalmologist will discuss with you how often check up for the eye pressure is needed. On the other hand there are also people with normal eye pressure (<22 mmHg), which do have optic nerve damage. These people have glaucoma and should be treated (normal pressure glaucoma). As with the therapy usually there is a first choice for treatment with eye drops. There are many different types of eye pressure reducing drops. The ophthalmologist will chose the eye drops which cause a maximum eye pressure lowering effect with minimal side effects.
It is important that the patient applying the drops (one or more times per day) makes a habit of it so that no droplets are forgotten. The technique of the drops can cause problems in the beginning. The patient should continue dripping until he feels a drop in the eye. If applying the drops remains difficult than the patient could possibly use a tool, which is available at the pharmacy. If eye drops do not achieve a sufficient reduction in eye pressure, laser treatment may be carried out with some patients. Here, the drainage of the eye fluid by means of laser light is made wider. Lastly, also an eye tension lowering operation can be carried out. One speaks of a filtering surgery or trabeculectomy. In this operation, a hole in the wall of the eye is made. The inner eye fluid then receives an additional outflow.. Finally, when eye drops, tablets, optionally, a laser treatment and a trabeculectomy there is not enough in order to succeed in lowering the pressure in such a way that the visual field defects remains stable, there also can be chosen for a glaucoma implant. An extra drainage system is also surgically created where also to some extent the size of the drainage can be determined in advance.
Keratoconus is a disorder of the cornea (the outer transparent layer of the eye), in which the cornea is gradually thinner, and instead of a round shape, will have a conical shape.
Keratoconus affects about 1 in 2000 people in the Netherlands, usually in both eyes, and develops generally in the teens or puberty. Because of the change (abnormal) form of the cornea, it isn’t good to correct the vision with glasses. Contacts compensate these altered shape of the cornea and correct optically better, thereby improving vision.
It is important to detect keratoconus in an early stage. This may be done by using corneal topography in order to diagnose. The surface of the cornea is then mapped. The progression of keratoconus may be limited by wearing hard contact lenses.
Treatment of keratoconus
Initially, in advanced keratoconus customized medical contact lenses are a solution. These special lenses are made to measure for optimal correction of the vision.
Additionally, there are surgical solutions, such as so-called ring segments which are placed in the cornea to flatten the center of the cornea, or a cornea transplant (which is a last resort).
Also corneal cross-linking may stabilize the progression of keratoconus.
Macular degeneration is an umbrella term for many conditions. It is therefore not surprising that macular degeneration is not the same for everyone. Some people see a blurred or dark spot, which is everywhere you look. For others, macular degeneration reveals itself by distortions of the image. Also, the progress of macular degeneration can be different. In the majority of cases (the dry form), the process is slow.
That makes it difficult for many to people to figure out when starting to see worse. In other cases (the wet form), the process can go very quick. You will see from one day to another distortions in the image, and the vision decreases sharply. The various forms of macular degeneration all have one thing in common. Due to failure of the light-sensitive cells in the macula (yellow spot) vision declines sharply.
In most cases there is medically little or nothing to do with the degeneration process. A reassurance is that it rarely leads to complete blindness. For those with macular degeneration, and his / her environment, it is, therefore, important to learn how to deal with the limitation of vision.
Is it possible to treat macular degeneration?
A possible treatment depends strongly on the type of macular degeneration. In recent years, opportunities have arisen to treat certain types of macular degeneration. Most of these modern treatment techniques are designed for wet macular degeneration and they primarily combat the effects of the disease, but do not eliminate the cause of macular degeneration. Damage that is done once to the retina caused by wet or other forms of macular degeneration cannot be restored.
For dry macular degeneration certain nutritional supplements can be used. Studies have shown that nutritional supplements can slow the progression of dry macular degeneration. The ophthalmologist can tell you more about it.
Below a short description of the treatment for slowing down vessel growth, which with wet macular degeneration, will follow as applied in our clinic.
Treatment with so called vessel growth inhibitors
In early stages of the disease process wet macular degeneration with the aid of so-called vessel growth inhibitors, which are injected into the eye, may be brought to a standstill. Since 2007 age-related wet macular degeneration is in most cases, treated with a new class of drugs, the vessel growth inhibitor: Bevacizumab (Avastin). This drug inhibits the vascular growth factor VEGF, a substance that allows the vessels to grow beneath the retina and they cause the leakage of fluid and blood. Treatment with vascular growth inhibitors, by means of an injection in the eye must be administered regularly, is burdensome, but occurs in the majority of those with age-related wet macular degeneration or any further deterioration, while approximately one-third of the patients treated will see better.
The availability of vessel growth inhibitors means a huge improvement in the outlook for patients with age-related wet macular degeneration. People who visit the ophthalmologist at a late stage, can still be visually impaired by the disorder. Early detection is very important.
If you think you qualify for the treatment of macular degeneration it is wise to go to your GP as soon as possible in order to make an appointment at our clinic. So you are assured of good advice and (possible) a short-term treatment.
Macular Degeneration-patients often not suffice with glasses in reading for example. Today, ranges of loupe- and magnification systems are available. Your eye doctor may refer you to a lowvision counselor in order to find the appropriate tool for you.