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General | Cataract | Glaucoma & Macular Degeneration | Ocular Surface Disease & Eyelids | Retina | Miscellaneous

 

Blepharitis & Chalazion
Botox
Corneal Diseases
Dry Eyes
Ectropion
Entropion
Eyelid Surgery
Facial Spasms
Pink or Red Eye
Pterygium & Pinguecula
Shingles (Herpes Zoster Virus)
Tumors & Cancers

 

 

Dry Eyes

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Your eyes constantly produce tears at a slow and steady rate so that they stay moist and comfortable. Some people are not able to produce enough tears or the appropriate quality of tears to keep their eyes healthy or comfortable. Tears are made of water, oil and mucous.  Any imbalance to these three components can cause irritation to the eye and/or vision distortions.  This condition is known as dry eye, and is very common in the state of Colorado.

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Symptoms of dry eye include scratchiness, stinging, stringy mucus in or around the eyes, and blurry vision. Sometimes people with dry eye will experience excess tearing. This is the eye's response to the discomfort from dry eye. When the eyes get irritated, the gland that makes tears releases a larger than usual volume of tears in an attempt to soothe the eye, which overwhelms the tear drainage system. These excess tears then overflow from your eyes, sometimes onto your cheeks even.  

Ironically, tears running down your cheek can mean your eyes are dry!

Dry eye often increases with age as tear production slows. For women, this is especially true after menopause. Dry eye can be associated with other problems like Sjögren's syndrome, which can cause dry eyes along with dry mouth and arthritis.  Dr. Haas can usually diagnose dry eye just by examining your eyes with fluoroscein (orange/yellow) eyedrops. Sometimes tests that measure tear production are necessary. The Schirmer tear test measures tear production by placing filter-paper strips between your eyeball and your lower lid.

Treatments for dry eye include eyedrops called artificial tears or preservative-free artificial tears to lubricate the eyes and help maintain moisture. Other medicated drops, such as Restasis, can work to reduce inflammatory mediators within your tear film, which overall improves the quality of the tears produced. Restasis can be an excellent medication for some people, but it can take several weeks to have maximum effect. Dr. Haas may alternatively help conserve your tears by closing the channels through which your tears drain (eyelid puncta) with a punctal plug. These plugs are permanent (though they can be removed if you do not like them), and they work by keeping your tears on the ocular surface longer (by not draining), which naturally acts like improved lubrication for the surface of your eye. You can also try to prevent tears from evaporating by avoiding wind and dry air from overheated rooms and hair dryers. Humidifiers can help as well.  Smoking irritates dry eyes and should be avoided.

Punctal Plugs in the puncta:    
 

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Diet can also play a role in the symptomatic relief for dry eyes.  A well-balanced diet is always recommended, but supplements can play an important role as well.  Omega-3 fatty acids (found in fish oil and flaxseed oil) are an important element in the formation of the oily portion of your tear film.  Your body cannot produce this essential fatty acid on its own, and a lack of omega-3 fatty acids in your diet can lead to decreased oil production in your tears.  The result can be a tear film that evaporates quickly, leaving you susceptible to dry eye symptoms.  Vitamin supplements of these omega-3 fatty acids can therefore help to improve symptoms for many people.

In less developed countries, dry eye due to a lack of vitamin A in the diet is not uncommon. Ointments with vitamin A can help dry eye caused by unusual conditions like Stevens-Johnson syndrome or pemphigoid.

Conjunctivitis (Red Eye or Pink Eye)

Many medical conditions will cause red eye or pink eye. Red Eye essentially refers to any redness of the eye, from any condition.  Causes of red eye can be infectious, inflammatory, glaucoma, dryness, trauma or other reasons.  Pink Eye is the common name for viral conjunctivitis, which is a highly contagious viral infection of the conjunctiva. The conjunctiva is the outer, normally transparent covering of the sclera (the white part of the eye). Conjunctivitis refers to inflammation of the conjunctiva for any reason.  The eye appears red or pink when you have conjunctivitis because the blood vessels of the conjunctiva are dilated.

Conjunctivitis: 


Either a bacterial or a viral infection may cause conjunctivitis.  A simple swab test may be performed in the office to help determine the diagnosis.  Viral conjunctivitis is much more common. It is highly infectious and will keep a person out of school or work for over a week during the infectious phase.  It may last several weeks and is frequently accompanied by a respiratory infection or cold. Antibiotic drops or ointments do not cure it, but symptomatic treatment such as cool compresses or over-the-counter decongestant eyedrops can be used while the infection runs its course.

Unlike viral conjunctivitis, bacterial conjunctivitis can be treated with a variety of antibiotic eyedrops or ointments, which usually cure the infection in a day or two.
Conjunctivitis can be very contagious. People who have it should not share towels or pillowcases and should wash their hands frequently. They may need to stay home from school or work (up to two weeks), and they should stay out of swimming pools.

Not all cases of conjunctivitis are caused by an infection. Allergies can cause conjunctivitis, too. Typically, people with allergic conjunctivitis have itchy eyes, especially in spring and fall. Eyedrops to control itching are used to treat allergic conjunctivitis. It is important not to use medications that contain steroids unless prescribed by Dr. Haas (names of steroids usually end in œ-one or œ-dex).

Finally, not all cases of pink eye are caused by conjunctivitis. Sometimes more serious conditions, such as infections, damage to the cornea, very severe glaucoma, or inflammation inside the eye (iritis or uveitis) will cause the conjunctiva to become inflamed and pink. Vision is usually normal when pink eye is caused by conjunctivitis. If your vision is affected or you experience eye pain, we recommend that you see us right away.

Sub-conjunctival Hemorrhage

A sub-conjunctival hemorrhage is similar to an ordinary bruise except that the bruise is to the eye. It usually appears as a single red spot or many red splotches spread out over the sclera, the white part of the eye.

Sub-Conjunctival Hemorrhage (SCH):  


Seeing a sub-conjunctival hemorrhage on the eye can be alarming, but it is quite common, it is usually harmless, and it will heal on its own. It will not affect your vision and usually will not cause pain.

The most common causes of this condition are sneezing, coughing, straining, or anything that raises the blood pressure in the veins, leading to a small rupture in a blood vessel or capillary. They frequently appear in people who take blood thinners such as aspirin, Coumadin, warfarin, ibuprofen or naproxen.  Other causes include rubbing the eye vigorously or trauma to the eye. Rare causes include blood clots or systemic blood disorders.

If the condition is recurrent or excessive, Dr. Haas may perform a medical workup, assess risk factors, and order laboratory studies.

Even though a sub-conjunctival hemorrhage can seem alarming, treatment is generally not necessary. The blood spot will slowly disappear on its own. If your eye is irritated, Dr. Haas recommends using over-the-counter artificial tears for comfort.

Corneal Diseases

Corneal Abrasion


The cornea is the clear front window of the eye. It covers the iris (the colored portion of the eye) and the round pupil. The cornea is composed of five layers. The outermost layer is called the epithelium.

Injuries to the epithelium, such as scratches, cuts, or scrapes, are known as corneal abrasions. Usually, these injuries are caused by fingernail scratches, makeup brushes, paper cuts, or rubbing of the eyes. Sometimes conditions like dry eye can cause abrasions. Symptoms associated with corneal abrasions include tearing, redness, pain, soreness, and blurred vision.

Abrasion:         



Treatment options for corneal abrasions include patching the injured eye, dilating pupils to relieve pain, wearing special contact lenses that promote healing, using topical antibiotics to prevent infection, and using lubricating ointments and eyedrops.  Minor abrasions usually heal within a day or two, while larger abrasions take about a week.

Corneal Erosion

Corneal erosions are caused by loose attachments of the epithelium to the underlying tissue. This often happens at the site of an earlier abrasion. Some patients have an underlying condition called œmap-dot-fingerprint dystrophy that predisposes them to having recurrent corneal erosions.  Symptoms of corneal erosion are similar to those of abrasions: pain, soreness, redness, and blurred vision.

Treatment is the same as for corneal abrasion and may also include saline solution eyedrops or ointments. However, if the erosion keeps occurring, further treatment may be necessary. These treatments may include procedures to remove the damaged epithelium, removal of corneal cells using a laser, or performing an anterior stromal micro-puncture, which involves making tiny holes on the surface of the cornea to promote stronger attachments between the top layer of corneal cells and the layer of the cornea underneath.

Corneal Ulcers

Corneal ulcers can form due to trauma, contact lens use, eyelid disease, severe dry eye, fungal infections, herpes simplex viral infections, and other causes.
There are two very common types of corneal ulcers. Bacterial ulcers tend to be the most painful type of corneal ulcer, and in some cases, if left untreated, can cause severe damage or even corneal perforation. Sterile ulcers, on the other hand, usually cause little or no pain.  Improper care and handling of contact lenses, which can lead to infection, are often causes of corneal ulcers.
The symptoms of corneal ulcers may include:

  • pain;
  • redness;
  • blurred vision;
  • tearing;
  • discharge; and
  • sensitivity to light.

Treatment for corneal ulcers depends on the cause. It usually includes steroid or anti-inflammatory eyedrops, and strong antibiotic eyedrops.  In rare cases when the cornea is severely damaged, a corneal transplant may be necessary to improve vision.

Small Corneal Ulcer:                  


Herpetic Keratitis (HSV Keratitis)

Herpetic keratitis is a viral infection of the eye caused by the herpes simplex virus, which is best known for causing cold sores. Herpes keratitis usually affects only one eye and most often occurs on the cornea, the normally clear dome that covers the front part of the eye.
The symptoms of herpes keratitis may include:

  • pain;
  • redness;
  • blurred vision;
  • tearing;
  • discharge; and
  • sensitivity to light.

If the infection is superficial, with ulcers involving only the cornea's top layer, called the epithelium, it will usually heal without scarring. However, if it involves the deeper layers of the cornea, it may lead to scarring of the cornea, loss of vision, and sometimes even blindness. Left untreated, herpes keratitis can severely damage your eye.

Herpetic Keratitis:     
 

Herpes keratitis is usually treated with antiviral medications, both in eyedrop and/or pill form. Depending on the progression of the infection, Dr. Haas may treat your condition with steroid eyedrops as well to reduce inflammation. Rarely, when the cornea is severely damaged, a corneal transplant may be necessary to improve vision.

Shingles (Herpes Zoster)

One's first encounter with the herpes zoster virus is usually childhood chicken pox. Later in life, the virus may reactivate, causing a characteristic rash of small blisters, frequently on the chest or forehead, which form crusts and may leave scars. This second encounter with the virus is commonly known as shingles.

Shingles (Herpes Zoster):
        

Unlike chicken pox, shingles is usually quite painful. Although this disease often occurs in normal, healthy people, it occurs more frequently in elderly or immune-compromised individuals.  It is important to see Dr. Haas when herpes zoster occurs on the face, because the virus can invade the eye. He looks for elevated pressure in the eye, inflammation inside the eye, and herpes zoster lesions on the surface of the eye. All of these problems can be treated, but they are sometimes difficult to manage. Careful treatment and follow up are required. Today, new oral antiviral medications are providing shingles patients with a quicker, more complete recovery.

Pterygium and Pinguecula

A pterygium is a mass of fleshy tissue that grows over the cornea. It may remain small or may grow large enough to interfere with vision. A pterygium most commonly occurs on the inner corner of the eye, but it can appear on the outer corner as well.

The exact cause of pterygia is not well understood. They occur more often in people who spend a lot of time outdoors, especially in sunny and dry climates like Colorado. Long-term exposure to sunlight, especially to ultraviolet (UV) rays, and chronic eye irritation from dry, dusty conditions seem to play an important role. Dry eye also may contribute to pterygium.

Pterygium:


When a pterygium becomes red and irritated, eyedrops and/or ointments can be used to help reduce the inflammation. If the pterygium grows rapidly or is large enough to threaten sight, it can be removed surgically.  Despite surgical removal, a pterygium may return, particularly in young people. Protecting the eyes from excessive ultraviolet light with proper sunglasses, avoiding dry, dusty conditions, and using artificial tears can help.

A pinguecula is a yellowish patch or bump on the white of the eye (seen to the right in the picture below), most often on the side closest to the nose. It is not a tumor but is an alteration of normal tissue resulting in a deposit of protein and fat. It is also a response to chronic eye irritation and sunlight, just like a pterygium.  Unlike a pterygium, a pinguecula does not actually grow onto the cornea by definition. A pinguecula becomes a pterygium if any corneal growth occurs. 

Pinguecula:      
 

No treatment is necessary unless the pinguecula becomes inflamed. A pinguecula does not threaten sight. On rare occasions, a pinguecula can be surgically removed if it is particularly annoying.

Blepharitis (Lid Margin Disease)

Lid margin disease is a common and frequently chronic inflammation of the eyelids (blepharitis). Symptoms include irritation, itching, and, occasionally, a red eye. This condition frequently occurs in people who tend to have oily skin, dandruff, or dry eyes.  Bacteria normally reside on the skin, but in some people, they thrive in the skin at the base of the eyelashes. Nearby oil glands may be overactive, causing dandruff-like scales and particles to form along the lashes and eyelid margins, which can cause redness, stinging, or burning.

Meibomian Gland Dysfunction:    

Meibomian gland dysfunction, as seen above, can also contribute to lid margin disease.  The Meibomian glands are sebaceous glands that produce the oil layer of your tear film.  The openings to the glands are just behind the eyelashes, and abnormal oil goblets can be seen in the photo above in a person with lid margin disease. 
Lid margin disease cannot be cured, but it can be controlled with a few simple, daily hygienic measures, such as the following:

  • At least twice a day, place a warm, wet washcloth over your closed eyelids for a minute. Rewet it as it cools, two or three times. This will soften and loosen scales and debris. More important, it helps liquefy the oily secretions from the eyelids' oil glands, which helps prevent the development of a chalazion, an inflamed lump in an eyelid oil gland.
  • With your finger covered with a thin, wet washcloth, cotton swab, or commercial lint-free pad, gently scrub the base of the lashes for about 30 seconds per eyelid.  It may help to use dilute baby shampoo (1 part shampoo to 3-4 parts water, just a few drops in the bottle cap) for scrubbing.

When medications are necessary, they may include:

  • artificial tears (over-the-counter eyedrops) to relieve symptoms of dry eye;
  • antibiotics (oral or topical or both) to decrease bacteria on the eyelids; and
  • steroids (short-term), to decrease inflammation.

Medications alone are not sufficient to control lid margin disease; the application of warmth and detailed cleansing of the lashes daily is the key.

Chalazion

A chalazion is a large bump (swelling) in the eyelid caused by inflammation of one of the small oil-producing glands located in the upper and lower eyelids. A chalazion is sometimes confused with a stye, which also appears as a lump in the eyelid. However, a stye is an infection of a lash follicle and forms a red, sore lump. Chalazia tend to occur farther from the edge of the eyelid than a stye, and tend to œpoint toward the inside of the eyelid. Sometimes a chalazion can cause the entire eyelid to swell suddenly, but usually there is a particular tender point.

Chalazion:
      

When a chalazion is small and without symptoms, it may disappear on its own. If the chalazion is large, it may cause blurred vision. Chalazia are treated with any or a combination of the following methods:

  • Warm compresses help to clear the clogged gland (2 hours daily or 8-10 x daily for 10-15 minutes);
  • Antibiotic ointments may be prescribed if bacteria infect the chalazion;
  • Steroid injections may be used to reduce inflammation;
  • Surgery may be used to drain a large chalazion if it does not respond to other treatments. The procedure is usually performed under local anesthesia in Dr. Haas's office.

Chalazia usually respond well to treatment, although some people are prone to recurrences. If a chalazion recurs in the same place, Dr. Haas may suggest a biopsy to rule out problems that are more serious.

Eyelid Surgery

Eyelid surgery is a common method of treatment for entropion (inward turning of the eyelid), ectropion (outward turning of the eyelid), ptosis (drooping of the eyelid), and some eyelid tumors.
Eyelid surgery is usually an outpatient procedure performed under local anesthesia. Risks of surgery are rare but can include bleeding, infection, and eyelid asymmetry due to uneven wound healing. Differences in healing between the eyes may cause some unevenness after surgery.
After eyelid surgery, bruising or a black eye is common but resolves quickly. It may be difficult to close your eyelids completely, making the eyes feel dry. This irritation generally disappears as you heal. Serious complications are rare but can include vision loss, scarring, and infection. To most people, the improvement in vision, comfort, and appearance after eyelid surgery is very gratifying.

Blepharoplasty (Dermatochalasis or excessive eyelid skin)

As we mature, the delicate skin around the eyes can appear puffy, saggy, or droopy. Eyelid skin stretches, muscles weaken, and the normal deposits of protective fat around the eye settle and become more prominent. The surgical procedure to remove excess eyelid tissues (skin, muscle, or fat) is called a blepharoplasty (eyelid lift).
Blepharoplasty can be performed on the upper eyelid, lower eyelid, or both. The surgery is performed for either cosmetic or functional reasons. Sometimes excess upper eyelid tissue obstructs the upper visual field or can weigh down the eyelid and cause the eyes to feel tired. Most often, people choose blepharoplasty to improve their appearance by making the area around their eyes firmer. When blepharoplasty is performed to improve vision rather than for cosmetic reasons only, the costs may be covered by your health insurance plan.

Blepharoplasty for the lower eyelid removes the large bags under the eyes. It is unusual for third-party payers to cover lower-lid blepharoplasty. 
Swelling, bruising, and blurry vision are common after blepharoplasty. Stitches are removed a few days after surgery.

Possible complications associated with blepharoplasty include bleeding and swelling, delayed healing, infection, drooping of the upper or lower eyelid, asymmetry, double vision, and dry eye, to name a few. It is important to note that the puffiness of the fat pockets may not return, but normal wrinkling and aging of the eye area will continue.

Dermatochalasis of the left upper eyelid:



(excessive, redundant tissue)

Brow lift

Sun, wind, and gravity affect the skin and muscles of the face over time. One of the most noticeable aspects of aging is a progressive drooping of the eyebrows. This can cause wrinkling of the forehead from raising one's eyebrows as well as vertical wrinkles or furrows between the eyebrows. Sometimes the eyebrows or excess eyelid tissue can obstruct vision.

A brow lift (also called a forehead lift) elevates the brow, smoothes forehead skin, and can remove vertical lines between the eyebrows. Incisions are made in inconspicuous places, either behind the hairline, in one of the forehead wrinkles, or immediately above the eyebrows. If an endoscope (a small tube with a fiber-optic light) is used, the incisions can be very small. After the muscles are tightened and excess skin is removed, the incision is closed with sutures. The operation is usually performed on an outpatient basis under either monitored anesthesia care (MAC) or general anesthesia.

Swelling and bruising, common after a brow- or forehead lift, begins to subside in seven to 14 days. Numbness and itching are common during the healing process. Sutures, staples, or clips are removed within seven to 14 days after the surgery. Incisions in the hairline may damage hair follicles and result in some hair loss.

Lacrimal Drainage Surgery

Keeping the eyes moist and healthy requires tears. Tears are produced in the lacrimal glands, some of which are located under the upper eyelid. Tears drain from the eye into the nose through the nasolacrimal duct, or tear duct. A blockage of this drainage duct can cause wet eyes or excessive tearing. A blocked tear duct can also cause mucus buildup in the eye or ongoing infections in the lacrimal sac where tears collect. Infections are noticeable as a swelling of the inner corner of the lower eyelid.

Nasolacrimal duct obstructions can happen with no obvious cause. Sometimes previous sinus or nose surgery, or facial trauma with broken facial bones, can obstruct the tear duct.

Lacrimal drainage surgery is called dacryocystorhinostomy (DCR) and can be performed in different ways. One type of operation is an external DCR where an incision is made on the side of the nose, where eyeglasses might rest. A small amount of bone is removed to permit a new connection between the lacrimal sac and the inside of the nose. Small plastic tubes are sometimes inserted at the time of surgery to help keep the newly created opening from scarring shut during the healing process.

The tubing is removed a few months after surgery.

Another type of operation uses a special instrument called an endoscope. The endoscope is a small tube with a fiberoptic light that facilitates the creation of a new opening into the nose. Various types of laser have also been used to perform the DCR operation.

In extreme cases where the tear duct cannot be reopened or repaired, an artificial tear duct can be implanted. The artificial tear duct is called a Jones tube and is implanted behind the inner corner of the eyelid to drain tears into the nose.

Ptosis

Ptosis is drooping of the upper eyelid. The eyelid may droop only slightly or it may cover the pupil entirely. In some cases, ptosis can restrict and even block normal vision.

Congenital ptosis
, or ptosis that is present at birth, requires treatment in order for normal visual development to occur. Uncorrected congenital ptosis can cause amblyopia or lazy eye, which is an impaired visual development. If left untreated, amblyopia can lead to permanently poor vision.

Except in mild cases, the treatment for childhood ptosis is usually surgery to tighten the levator muscle, the muscle that lifts the eyelid. In severe ptosis when the levator muscle is extremely weak, the lid can be attached or suspended from under the eyebrow so the forehead muscles do the lifting. Whether they have had surgery or not, children with ptosis should be examined annually by an ophthalmologist (Eye M.D.) for amblyopia, refractive disorders, and associated conditions.

Ptosis in adults is commonly caused by separation of the levator muscle from the eyelid as a result of aging, cataract or other eye surgery, an injury, or an eye tumor. Adult ptosis may also occur as a complication of other diseases such as diabetes that involve the levator muscle or its nerve supply.

If treatment is necessary, it is usually surgical. Sometimes a small tuck in the levator muscle and eyelid can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle.

The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications occur very infrequently. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return.

Ptosis of the right upper eyelid:
        


(drooping of the lid blocking vision)

Ectropion

Ectropion is an outward turning of the lower eyelid, most commonly caused by aging, although eyelid burns or skin disease may also be responsible.

Ectropion:                      

Normally, the eyelids help lubricate and cleanse the eye during blinking. An eyelid that is drooping and has lost contact with the eye can cause dry eyes, excessive tearing, redness, and sensitivity to light and wind.

Surgery can be performed to tighten the eyelid and return it to its normal position. The eyelid can then protect and lubricate the eye properly, so that irritation and other symptoms subside.

Eyelid surgery to repair ectropion is usually performed on an outpatient basis and under monitored anesthesia care (MAC). Following surgery, you may receive antibiotic ointment to use for a few days.

Entropion

Entropion is an inward turning of the eyelid and lashes toward the eye, usually caused by relaxation of the eye muscles and tissue due to aging.

Entropion:  


(note lower eyelid eyelashes rubbing against the corneal surface)

Entropion usually affects the lower lid. The skin and eyelashes rub against the eye and cause discomfort and tearing. The irritated eye can produce mucus and become red and sensitive to light and wind. If entropion is not treated, rubbing of the skin and eyelashes can lead to infection or scarring of the eye, which can cause vision loss.

Surgery can be performed to tighten the eyelid and return it to its normal position. The eyelid then protects the eye properly, and irritation and other symptoms subside.
Eyelid surgery to repair entropion is usually performed on an outpatient basis under monitored anesthesia care (MAC). Following surgery, you may receive antibiotic ointment to use for a few days.

Botox Injections

Botox is the trade name for botulinum toxin. In its pure form, botulinum toxin is a poisonous neurotoxic protein that is found in certain spoiled foods and causes muscle weakness. It acts as a nerve impulse blocker, preventing muscles from contracting. In an extremely dilute form, botulinum toxin has many medical applications.

Botulinum toxin is used to treat ocular conditions such as blepharospasm, an excessive contraction of the eyelid muscles that forces the eyelids closed, and hemifacial spasm, an excessive contraction of the facial muscles on one side of the face. When the toxin is injected directly into the muscles of the face or the eye, it causes the overactive muscles to relax. It usually takes a few days for the therapeutic effects to be noticeable, and the injections may need to be repeated every four to six months.

Botulinum toxin also is used to treat certain kinds of double vision. The toxin is injected directly into the eye muscle opposite the paralyzed muscle.

Botulinum toxin can also be used for cosmetic purposes to soften wrinkles around the eye. It can also weaken the brow muscles in order to diminish the deep furrows or frown lines that may appear in the middle of the forehead.

Side effects of the injections are temporary. They can include a droopy upper eyelid, double vision, and being unable to close the eyelids.

Facial Spasms

Blepharospasm

Blepharospasm is an involuntary contraction and spasm of the eyelid muscles that causes your eyes to squeeze shut. Blepharospasm is more common in women and usually appears after the age of 50. Generally, one will notice that one's eyes are blinking and twitching more often. On occasion, it can progress to repeated, forceful, involuntary closing of the eyes.

Bright lights, fatigue, watching television, driving, and stress can all exacerbate your condition. Sleeping, walking, concentrating on a task and relaxation exercises may provide temporary relief.

The most common treatment for severe blepharospasm is the injection of small amounts of botulinum toxin (Botox) into the eye muscles to partially paralyze them and return them to normal function. Results are temporary, so treatment must be repeated every few months.

Hemifacial Spasm

Hemifacial spasm (HFS) is a condition that causes involuntary contractions of the muscles on one side of the face. The disorder occurs in both men and women, usually beginning in middle age. Symptoms often begin as a twitching of the eyelid and may gradually spread to involve the muscles of the lower face. The condition may be caused by a blood vessel pressing on a facial nerve, a facial nerve injury, a tumor or it may have no apparent cause.

After Dr. Haas has ruled out other more serious underlying conditions, the most common treatment for HFS is the injection of botulinum toxin (Botox), a neurotoxin, into the affected muscles. In some cases, surgery by an oculoplastics (facial plastic) surgeon may be necessary.

If botulinum toxin (Botox) is the best treatment for your condition, Dr. Haas will inject the drug into the involved facial muscles in a simple, outpatient procedure.

Botulinum toxin has proven to be a safe treatment for HFS with few side effects. The injections will probably work for about four to six months, so repeated treatments are necessary. You should see the full effect of the injection about a week after the procedure.

Bell's Palsy

Bell's palsy is a disorder of the facial nerve, the seventh cranial nerve. This condition causes partial paralysis on one side of the face, affecting the muscles of facial expression. Bell's palsy usually occurs in adults and develops suddenly.

Symptoms of Bell's palsy include the inability to smile on one side or close one eyelid completely, decreased tear production and sense of taste, blurry vision, and distorted hearing.

The causes of Bell's palsy are varied. In most cases, the cause is never identified, but it is believed that Bell's palsy often develops secondary to a viral inflammation. Other causes include activation of the body's immune system and changes in blood flow. Bell's palsy is more common in patients with diabetes and in pregnant women.

Most of the time, Bell's palsy disappears on its own after a few months. Eye lubricants may be used to prevent complications. In some cases, corticosteroid or antiviral drugs may be used to help in the treatment of this condition.

Eyelid and Orbital Tumors

A tumor is an abnormal growth of any tissue or structure; it can be either benign or malignant. Benign tumors often remain localized, while malignant tumors often spread into surrounding structures. A tumor can affect any part of the eye, such as the eye socket, eyeball, eye muscles, optic nerve, fat, and tissues. Sometimes tumors grow into the eye area, or tumors from other parts of the body travel to the eye. Most tumors of the eye are benign.

Eyelid Tumors

Basal cell carcinomas
are the most frequently encountered kind of malignant tumor affecting the eyelid, making up 85% to 95% of all malignant eyelid tumors. The most common location is the inner portion of the lower eyelid, particularly in elderly, fair-skinned people. Prolonged exposure to sunlight seems to be a risk factor for developing this kind of tumor.

Basal Cell Carcinoma:  


(note the pearly white outer ridge with central crater and loss of eyelashes)

There are many different types of basal cell carcinomas, but the nodular variety is one of the most common. It appears as a raised, firm, pearly nodule with tiny dilated blood vessels. If the nodule is in the eyelash area, some lashes may be missing. The nodule may have some superficial ulceration and crusting and look like a chalazion or stye. Although these tumors are malignant, they rarely spread elsewhere in the body. For most of these tumors, surgery is curative. In severe cases when the tumor has been neglected for a long time, it can spread into the eye socket, which may ultimately require removal of the eye and adjacent tissue.

Squamous cell carcinoma
is the second most common kind of malignant eyelid tumor (occurring in approximately 5% of malignant eyelid tumors). As with basal cell carcinoma, the most common location is the lower eyelid, particularly in elderly, fair-skinned people. This tumor also appears as a raised nodule that can lead to loss of eyelashes in the involved area. When detected and treated early, the outcome for these tumors is excellent. However, if the tumor is neglected, it can spread to the lymph nodes in the neck. Surgery is the most effective treatment.

Sebaceous cell carcinoma
originates in glands of the eyelid in elderly individuals. It is relatively rare but still accounts for 1% to 5% of malignant eyelid tumors. These are highly malignant tumors that may recur, invade the eye socket, or spread to lymph nodes. The tumor may look like a chalazion or stye, making it difficult to diagnose. Surgery is usually necessary for this kind of tumor and the risk of metastasis or spreading and recurrence is high.

Malignant melanoma
makes up almost 1% of all malignant eyelid tumors but accounts for many of the deaths from malignant eyelid tumors. As with any other type of malignant melanoma, these tumors on the eyelid can arise from a pre-existing nevus or mole or may arise with no other pre-existing cause. Again, these tumors tend to occur in sun-exposed areas of elderly, fair-skinned people. Any areas of unusual or altered pigmented should be examined, especially if it is growing or changing color. Surgical removal is usually the recommended treatment.  An exam by an oncologist with a full body workup is often performed as well to check for spread of the tumor.

Orbital Tumors
The orbit is the bony socket that contains the eye, the muscles that move the eye, the optic nerve, and all the related nerves and blood vessels. The different kinds of orbital tumors include:

  • optic nerve glioma, a benign tumor often associated with neurofibromatosis;
  • orbital meningioma, a tumor growing from the tissue covering the brain;
  • hemangioma, a benign tumor made up of blood vessels or vessel elements;
  • lymphangioma, a tumor made up of enlarged lymphatic vessels;
  • neurofibroma, a tumor made up nerve cells;
  • sarcoma, a malignant tumor growing from connective tissue; and
  • metastasis, a malignant tumor that spreads to the orbit from other parts of the body.

Signs of an orbital tumor include bulging of the eyeball, visual loss, double vision, or pain.
Once the tumor is discovered and imaged with magnetic resonance imaging (MRI) or computerized tomography (CT scan), it is usually necessary to perform a biopsy or remove the tumor in order to diagnose the tumor. If necessary, surgery is usually sufficient for most orbital tumors, including optic nerve glioma and meningioma. Some orbital tumors may require different or additional treatments as well. For malignant tumors including sarcomas and metastases, radiation therapy and sometimes chemotherapy are necessary.

 

 





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