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The proper functioning of the eyes also depends on the position and function of the eyelids. Additionally, the eyelids have a great influence on the appearance. The most common abnormalities of the upper eyelids are excess skin and hanging eyelids. The lower eyelids can - especially at old age - turn inwards or outwards. All of these abnormalities can cause eye irritation and deterioration of vision. Surgery can help to correct this.
A hanging eyelid (ptosis)
A hanging eyelid which arises in the course of your life can have several causes. At old age, it is often caused by the muscle which gradually releases from the eyelid. At younger ages, the muscle can also release, usually this is due to wearing hard contact lenses for a prolonged time. Rare causes of a hanging eyelid in adulthood includes muscle diseases and disorders of the nerves.
In both cases, adjustment is possible by making a small incision in the upper eyelid and secure the muscle under local anesthesia.
Blood thinning agents
Eyelid Surgery cannot be performed while taking blood thinners. These are medications that contain acenocoumarol or acetylsalicylic acid. Even if blood thinners are used which are used by the thrombosis service it is possible that eyelid surgery cannot be performed. Also, other drugs may have an impact on the operation.
Therefore report all the medications you are taking to your ophthalmologist.
In some cases it is possible that due to correction of the hanging eyelid problems are caused with regard to the closure of the eye. This can lead to pain and visual impairment due to dehydration of the cornea.
Operation of a hanging eyelid doesn’t deliver the desired result in some cases immediately. Reoperations are therefore not uncommon. When the difference in height between the two lids is 1 mm or less, the result of the operation is considered as a success.
An excess of skin in the upper eyelids (dermatochalasis)
Before the procedure it is outlined how much excess skin can be removed. The eye must be able to close well after treatment. You’ll be seated in a comfortable bed, after receiving anesthetic eye drops. The skin is removed by means of the CO2 laser. Subsequently, excess fat in the various layers will be found and removed. This can only be performed safely (meaning no blood loss) by means of the CO2 Laser. The advantage of the removal of fat is that the result is much better and that the result has a long-lasting effect. The opening through which the fat is removed is closed with a self-soluble continuous suture.
The skin is closed with nylon sutures and removed after 10-14 days.
After the treatment you will feel for a few hours a poignant feeling. Sometimes the eyelids are thick and blue. Immediately after the treatment thin paper patches are placed on the sutures. These can be removed the next day, after they are made properly wet (for example after a shower) .The sutures partially shed spontaneously and the remainder will be taken out after 10 - 14 days. It is recommended that the first night you apply a towel to your pillow (since wound fluid can leak). The first week after the treatment you should take it easy, do not exercise or do any heavy lifting. During the first days you can cool the eyelids best with a special cooling pack for 10 minutes three times a day. You should put this cooling pack in the fridge and not in the freezer. After the upper eyelid correction, you will receive the following:
- Appointment for the removal of the sutures
- Cooling pack and sunglasses
An exwardly turned lower eyelid (ectropion)
With the aging process the lower eyelid weakens horizontally. This may hang lower and tilt outwards. This may also be caused by scars or skin diseases.
An outward turned eyelid causes irritation, tearing, redness and sensitivity to bright light and wind. In addition, inflammation may occur.
In general, the ectropion can be corrected under local anesthetics.
An inwardly turned lower eyelid (entropion)
Also this deviation is usually the result of aging.
The eyelashes and the skin of the eyelid rub against the eye. This causes a red irritated eye, which is sensitive to light and wind. If the entropion is not operated on, there is a risk of corneal damage by abrasion of the eyelashes. Also inflammation can occur with an entropion.
In general an entropion can be corrected under local anesthetics.
What Is Optometry?
Optometry has already been an independent profession in primary care in most English-speaking countries for decades. In the Netherlands the profession has been in development since 1988 and on November 15, 2000 it’s officially included in the “BIG” act (Act on professions in individual health care). Thus, the optometrist was legally recognized as a health care professional in eye care!
Previously only the ophthalmologist's did the eye exam and the optician took care for glasses and / or contact lenses. Now there are also optometrists. The optometrist performs an optometric examination in order to detect any eye diseases.
Optometry is because of the waiting lists and the aging population playing an increasingly important role for eye care in the Netherlands. The OVN works closely regional with opticians, contact lens specialists, general practitioners, ophthalmologists and orthopaedists. As a result, your eyes quickly get the care they need.
At OZE an optometrist is present working under the supervision of the ophthalmologist. Our optometrist also performs all functional assesments.
What is cataract?
Cataract means that the lens in the eye has become cloudy. As a result, the light rays are, with the aid of which the lens forms an image on the retina, disturbed in their gradient. The result is that you see worse and less sharp.
Cataract can have a rapid or slow development. The development is not accompanied by pain or inflammation.
The most common complaints are:
When to treat cataract?
If you start to see bad due to cataract, surgery is the only solution.
In cataract surgery, the ophthalmologist replaces your clouded lens with a clear artificial lens.
Before surgery you will be installed with mydriatic and anesthetic eye drops. This makes sure you don’t feel any pain during the surgery. Through an incision of 2.2mm. at the edge of the cornea by means of phacoemulsification (ultrasonic vibrations) your lens will be removed and replaced with an artificial lens. You’ll wear your own clothes and be sat down in a comfortable chair in the operating room.
After the treatment
After the treatment you will get an eye bandage with eyecup in order to prevent infection and irritation. The eyecup stays on for one night. The next morning, you can remove the eyecup and start with your eye drops. At your appointment at the eye hospital you’ll be provided with a prescription for the eye drops. These drops have to be started two days before surgery and over the course of 4 weeks you have to drip 3 times a day. As soon as you feel good you can leave back home. You may not yet drive yourself or independently participate in traffic.
The day after the treatment you will come for the check-up on the agreed time.
A Second check-up will be about four weeks after surgery.
After this appointment, you can, if necessary, get adjusted glasses at the optician.
Recovery from the visual acuity after the operation
The day after the operation, the picture will be significantly brighter. The sharpness of the sight the day after the surgery does not necessarily has to be optimal. This can become better in the course of a few days or weeks. The artificial lens will last a lifetime and not wear out.
The risk of complications during or after the procedure is small. However as with any surgery there is a chance to develop an infection or bleeding after cataract surgery. We only use disposable instruments in order to minimize the risk of infection.
What is Posterior Capsular Opacification?
The own lens is housed in a thin package (capsule). In a cataract surgery, the anterior part of the capsule is removed and the cataract removed. Thereafter, an artificial lens is placed back in the capsule. After a cataract operation the rear part of the capsule which can become cloudy, whereby the sight decreases gradually. In such a situation you speak of Posterior Capsular Opacification.
Laser treatment of Posterior Capsular Opacification
What is a laser? (Yag-laser)
A laser emits a very thin, bright and pure light beam. Through a microscope, this light beam can be directed in order to make a fire spot in the eye or to cut tissue. Because of the extremely thin light beam, it is possible to work with great accuracy. Laser beams do not have anything to do with X-rays or radioactivity. The laser treatment is always done on an outpatient basis. The only thing you notice is that the laser makes ticking sounds. The treatment is painless. After the treatment, the Posterior Capsular Opacification won’t come back.
What causes diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes in which there are changes in the blood vessels of the retina. The retina deteriorates flowing with oxygen resulting in growth factors being released: a stimulus for the formation of new vessels.
These changes can occur in two forms.
The wall of the small blood vessels changes, thereby the leakage of fluid and blood may occur; this occurs near the yellow spot (macula) and may reduce vision. Which is called diabetic maculopathy.
Similar changes can also arise outside of the area of the yellow spot and do not have any immediate influence on vision; this is called background diabetic retinopathy, however, which can cause a transition under the influence of growth factors in the so-called proliferative retinopathy, in which new blood vessels grow. These new blood vessels are very fragile and can easily cause bleeding in the vitreous inside the eye or seriously damage the retina, resulting in deterioration of the eyesight.
Both forms can occur simultaneously.
The risk of getting retinopathy increases the longer the patient suffers from diabetes.
Because it is possible to suffer from diabetes without noticing anything of it, it is wise to have your eyes checked as soon as diabetes is established. There may be deviations in the eyes, which give complaints or will in the future and must be treated to stop further damage.
During the examination by the ophthalmologist, the pupils are dilated with drops, so that the retina can be viewed properly. These drops make the eyesight temporarily less; therefore you are advised not to drive a car. If any abnormalities are found, it may be necessary to make a scan (OCT) of the retina. With the help of this research, the ophthalmologist can better assess the extent and severity of the defects.
The goal of treatment is to inhibit the retinopathy and so prevent or minimize visual impairment.
With laser treatment, it is possible to aim special light rays on the retina. This will turn off a part of the retina in the treatment so that the demand goes down for oxygen and there are no longer growth factors produced: the (beginning) neovascularization then comes to a stop and / or leakage is decreased. Depending on the nature of the deviations one or more laser treatments are necessary. Because the damage to the retina by diabetes can go on for a long time, additional treatment may be needed later. The preparation for the laser treatment consists of eye drops to dilate the pupil and drops to numb the eye. Depending on the extent of your laser treatment your vision may be limited. Also, the treatment can affect your vision slightly; you should consider this as an investment to prevent later, more serious problems. However with the new green laser this occurs significantly less often, we use only the green laser in these cases.
If there is a lot of leakage particularly centrally, and so a lot of fluid under the retina, it might be necessary to inject anti-inflammatory drugs in the vitreous. (Avastin injection) This causes the fluid to decrease. This is done by a number of monthly injections.
If there is a hemorrhage in the vitreous cavity that does not brighten a vitrectomy may be performed. This is an operation, wherein the vitreous is removed. During the operation, the retina can additionally with laser beams or with cold (cryotherapy) treated.
Unfortunately diabetes gives issues with the sight. Through ever improving research and treatment methods its more and more possible to prevent a retinopathy. In many cases it is possible to prevent blindness. Therefore when you have diabetes you should get your eyes checked regularly in our clinic.
On this website it is summarized what is the result of having diabetic retinopathy and what is possible in order to treat it. Further questions you can ask to our ophthalmologists.