April 2023 - Armadale Eye Clinic

retinal vein occlusion symptoms melbourne

Retinal Vein Occlusion Symptoms — Everything You Need To Know

April 24, 2023/0 Comments/in Armadale Eye Blogs /by armadaleeye

The retina is a complex piece of tissue. It’s responsible for receiving light coming into the eye, converting it into a neural signal, and sending it through a series of cells, down the optic nerve, where it eventually reaches the visual parts of the brain. After the cells of the retina have sent on their signals, they need to reset to do it all over again. The retina is supported by various other tissues in order to achieve this, all of which need oxygen and nutrients to perform properly.

Blood Vessels of the Retina

Due to its constant activity, the retina needs a constant supply of oxygen and blood flow through its blood circulation system. The main retinal blood vessels include the central retinal artery and the central retinal vein. The central retinal artery carries high-oxygen and nutrient-rich blood flow into the retina while the central retinal vein takes deoxygenated blood out of the retina to be replenished back at the heart and lungs.

Similar to other blood vessels of the body, it is possible to develop a blockage in a retinal blood vessel, whether an artery or a vein. In medical terms, this is known as an artery or vein occlusion. The blood vessels of the eye can be subject to various different types of occlusions, including central retinal vein occlusion, branch retinal vein occlusion, central retinal artery occlusion, or branch retinal artery occlusion. Compared to blockages of the retinal arteries, retinal vein occlusions are more common.

What Causes a Retinal Vein Occlusion?

A retinal vein occlusion can occur in either the main retinal vein- the central retinal vein, which is then termed a central retinal vein occlusion (CRVO), or in a smaller blood vessel, called a branch retinal vein occlusion (BRVO).

The main cause of a retinal vein occlusion is the formation of a blood clot, which typically occurs at the point where a retinal artery crosses over a vein. The result of this is poor blood flow through that point of the retinal circulation. As the outflow of blood is slowed, it accumulates behind the point of blockage. This leads to swelling, including around the macula. This is known as macular edema, which can result in central vision loss.

Other effects of a retinal vein occlusion include haemorrhaging and fluid leakage into the retina (bleeding). This leakage of blood into the surrounding retinal tissues can cause further cellular damage and vision loss.

Symptoms of Retinal Vein Occlusion

The symptoms of retinal vein occlusions are non-specific. That means, there is not one single symptom that would make you realise you’re experiencing a retinal vein occlusion.

In most cases retinal vein occlusion occurs just in the one eye. If the retinal vessel occlusion results in swelling of the macula (macular edema), you will notice a gradual, painless loss of vision in your central sight. In some cases, the loss of vision can be quite sudden. However, if the blood clot occurs in a retinal vessel further away from the macula, you may actually not be aware of any changes to your vision. In situations that involve a large vitreous hemorrhage, where there is a significant bleed into the space of the eyeball containing the retina, you may experience sudden complete vision loss in that eye.

Some people also report seeing dark specks, lines, or squiggles in their vision. These are known as floaters. During a retinal vein occlusion, floaters are typically droplets of blood leaking into the vitreous.

Risk Factors for Retinal Vein Occlusion

Risk factors are characteristics of a person that make them more likely to experience a disease or condition. For any condition, including central or branch retinal vein occlusions, having a risk factor does not guarantee you will develop the condition. Conversely, not having any of the risk factors does not rule you out from ever experiencing the disease.

The risk factors relevant to retinal vein occlusions are similar to those for strokes and heart attacks. They include:

Older age (particularly being over the age of 60)
Hypertension (high blood pressure)
Hypercholesterolaemia (high blood cholesterol levels)
Diabetes (a systemic disease involving elevated blood sugar levels)
Smoking
Being overweight or obese

It is possible to reduce your risk of retinal vein occlusion by managing these modifiable risk factors. Apart from getting older, all other factors can be controlled.

Diagnosis and Treatment

Either an optometrist or ophthalmologist will be able to diagnose a retinal vein occlusion. They achieve this by viewing the whole retina and the retinal blood vessels, assessing for any haemorrhaging or retinal swelling that may be due to a blocked vein.

If you’ve attended to an optometrist who diagnoses a retinal vein occlusion, you’ll be then referred to an ophthalmologist for treatment.

For a better view of the whole retina, you will most likely have dilating eyedrops instilled, which widen the pupil and temporarily stop it from constricting, which its natural response to light.

Macular edema is most easily visualised using a test called optical coherence tomography. Optical coherence tomography will also be used to continue monitoring the improvement of the macular edema over time. Another test called fluorescein angiography involves the injection of a dye through you veins, which helps to highlight the location of blood clots, any abnormal blood vessels, and the overall state of your retinal veins and arteries.

Treatment options will depend on the specifics of your condition. If macular edema is present, you may be recommended an eye injection of a drug called anti vascular endothelial growth factor. These injections are typically repeated until the swelling has resolved. Anti vascular endothelial growth factor injections can also be used if the retina begins to develop abnormal new blood vessels. These new blood vessels are a risk for a secondary disease called neovascular glaucoma.

Laser treatment is also an option, both for managing any retinal swelling as well as the growth of new blood vessels. Any unusual changes to your vision should never be ignored, particularly areas of vision loss.

Call us now on (03) 9070 5753 for a consultation.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Sources

Retinal vein occlusion.
https://www.mdfoundation.com.au/about-macular-disease/other-macular-conditions/retinal-vein-occlusion/

What is Branch Retinal Vein occlusion (BRVo)?
https://www.aao.org/eye-health/diseases/what-is-branch-retinal-vein-occlusion

eyelid ptosis surgery melbourne

Eyelid Ptosis Surgery — Causes, Diagnosis, and Treatment

April 24, 2023/0 Comments/in Oculoplastic Surgery, Armadale Eye Blogs /by armadaleeye

A ptosis of the upper eyelid refers to a droopy eyelid. In essence, the upper eyelid is unable to open fully. In addition to being a cosmetic concern, a ptosis may also cause problems with the vision, especially if the upper eyelids are covering a significant part of your upper visual field. Keep reading to find out more about this problem of the upper eyelid and ptosis surgery.

What Causes a Ptosis?

There can be a number of causes of a droopy eyelid. Not all may require ptosis surgery.

Congenital Ptosis

This refers to droopy eyelids that have been present from birth. The ptosis may be apparent on both sides or just one eye. A ptosis that is present at birth is typically due to underdevelopment of the levator muscle, which is the muscle that lifts the upper eyelid.

Diagnosis

Diagnosing a congenital ptosis can sometimes be challenging in infants and young children. In addition to noticing a drooping eyelid, other signs can include one fold of the eyelid being lower than the other, or the child is constantly lifting their chin to be able to see beneath the lowered upper eyelid.

Treatment

If not treated with prompt eyelid surgery, ptosis in children can cause significant vision problems, such as ambylopia. Amblyopia is also known as lazy eye, and occurs due to a lack of neural input from the eye with the ptosis to the brain during the critical developmental period. If not treated, amblyopia can result in permanently reduced vision.

Children who are compensating for their ptosis by tilting their head may also be at risk of head and neck problems.

Age-Related Ptosis

Another common cause of upper eyelid ptosis is older age. This is commonly called an involutional or acquired ptosis. Due to age, the eyelid muscles, specifically the levator muscle, can become stretched and loosened, making it difficult to lift the upper eyelids.

Diagnosis and Treatment

Your eye surgeon will assess the ptosis and amount that the upper eyelid droops by measuring the eyelid height. If the droopy eyelids are so low that they interfere with your vision, you can elect to have your upper eyelids lifted through ptosis repair surgery. If there is excess skin or skin laxity around your eyelids, this can also be treated and removed through a procedure called a blepharoplasty at the same time as your ptosis surgery.

Some patients with ptosis may not be concerned by their droopy eyelid. If this is the case, it’s not necessary to undergo ptosis surgery if it doesn’t bother you.

Other Causes of Ptosis

Other reasons for a droopy eyelid requiring ptosis surgery can include:

Injury to the upper eyelid muscle, including the levator muscle
Disease of the levator muscle and any other muscle that lifts the upper eyelid, such as myasthenia gravis
Damage to the nerve supplying the muscle that lifts the eyelid

Ptosis Surgery

Most patients suffering from a bothersome eyelid ptosis will benefit from eyelid surgery. However, if your droopy eyelid is due to a systemic disease, such as myasthenia gravis, medications may be more effective. Occasionally, your surgeon may not recommend surgery due to some other reason. Your eye doctor will advise you accordingly based on your circumstances.

The aim of ptosis surgery is to treat the drooping eyelid so that it no longer interferes with your vision. Ideally, the eyelid surgery achieves an equal eyelid margin height between the eyes, but this is not always possible.

What Happens During Ptosis Surgery

Ptosis surgery is usually performed under local anaesthetic, which is injected into the upper lid by the surgeon. Most patients will also be offered a sedative and painkillers. Children are more likely to require full general anaesthetic.

In most cases, the surgeon only needs to make small corrections to the levator muscle. However, in extreme cases, the entire levator muscle may need to shortened and reattached to successfully keep the eyelid lifted when in a normal open position.

An incision is made in the upper lid, usually around its natural crease so that any sutures and the resultant scar will be hidden when the eyelid is open.

After Ptosis Surgery

After your ptosis surgery your surgeon will give you some guidelines to help your recovery. You’ll be asked to use an antibiotic ointment around the incision to prevent infection and maybe also some eye drops in the eye itself. You can expect some swelling and bruising of the eyelids for up to a couple of weeks.

Other Effects After Ptosis Surgery

Though most cases of ptosis surgery recover uneventfully, some patients can experience temporary:

Dry eye; this can typically be managed with lubricating eye drops
Difficulty closing the eyelid completely
Alterations to vision; your prescription may need to be updated
Numbness of the skin around your eyelid and eyelashes; typically this resolves in 6 to 8 weeks

In cases where eyelid surgery is performed on only one eyelid, you may find the other eyelid begins to droop. If this becomes a problem, you may ask your surgeon about droopy eyelid surgery to keep that eyelid lifted.

Complications of Ptosis Eyelid Surgery

The vast majority of ptosis surgery cases are able to successfully treat ptosis with one round of surgery. However, in some cases it may be necessary to undergo a second ptosis operation.

Reasons for a Second Ptosis Eyelid Operation

If the eyelid and muscle are lifted too high
If the eyelid is not lifted high enough and either continues to interfere with vision or continues to appear significantly asymmetrical
If the shape of the eyelid is not quite right

Potential Complications of a Ptosis Repair

As with any operation, there are risks associated with eyelid surgery.

General Risks

Risks of any operation include:

Bleeding
Infection
Allergic reaction to the local anaesthetic or medical materials used

Risks Specific to Ptosis Eyelid Surgery

Over or undercorrection of the levator muscle
Bleeding into the eye socket
An unsightly scar
Irritation from the sutures

In order to avoid complications as much as possible, it’s important to disclose your full medical history to your eye doctor so that your risk factors can be identified and managed ahead of your ptosis operation. Or you can simply contact Armadale Eye Clinic on (03) 9070 5753, and we’ll be glad to answer all of your questions.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Sources

Ptosis.
https://eyeandear.org.au/patients-visitors/fact-sheets/ptosis/

Ptosis (drooping eyelid).
https://www.rch.org.au/kidsinfo/fact_sheets/Ptosis_drooping_eyelid/

Ptosis surgery (adult).
https://www.healthdirect.gov.au/surgery/ptosis-surgery#what-is