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how long does a cataract surgery take melbourne

How Long Does a Cataract Surgery Take? All You Need to Know

December 30, 2022/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

If you’re about to be one of the 250,000 Australians undergoing cataract surgery every year, you may have a few questions about this common eye care procedure. In addition to wondering how long does a cataract surgery take, you may also like to know whether there’s any way you can influence this duration. Here’s what to expect.

How Long Does a Cataract Surgery Take?

Not many people enjoy lying on an operating table, so you’ll be pleased to know that cataract surgery is usually quite a short procedure. Although your cataract surgeon will probably tell you to allow up to 2 hours in the clinic, the actual time spent on the cataract surgery itself is often as little as 10 to 15 minutes per eye. The rest of the time is spent preparing your eye for surgery, such as sterilising the area, dilating your pupils with eyedrops, administering sedation, and then ensuring that after your cataract surgery, you’re feeling okay before being driven home.

When it comes to the cataract operation itself, there are several factors that can affect the duration of your procedure. These can include:

Whether your pupils dilate well with the eyedrops or need further intervention. Pupil dilation is an important step in the cataract surgery procedure because the cataract sits behind the iris. Widening the aperture in the middle of the iris, the pupil, allows the surgeon to access the cataract with all his or her tools. An inadequately dilated pupil can be a cause for complications during the operation, so if pharmacological eyedrops are insufficient, your cataract surgeon will need to employ another technique. Needing to insert iris stitches, iris hooks, or ring expanders during the operation will prolong the surgery time.
Experience of your surgeon. As expected, the more experienced your cataract surgeon, the shorter the answer to how long does a cataract surgery take. Conversely, a more junior surgeon may take longer as he or she moves more cautiously or may take more time to manage complications during the cataract surgery.
The type of anaesthesia can also make a difference to your cataract surgery duration. A general anaesthetic is not typically used for this outpatient eye care operation, however, cataract surgeons may choose between a local anaesthetic or nerve block, or topical anaesthesia with numbing eye drops. Using topical anaesthetic will keep operating time shorter while administering local anaesthesia naturally takes a longer time. There are pros and cons of each type of anaesthesia, so you may wish to discuss this with your cataract surgeon ahead of time if you’re concerned.
If your surgeon encounters any complications during the cataract surgery, it will naturally extend the operating time. Some complications can be anticipated, such as if you have known risk factors, while others are unexpected. If your operation is less straightforward than average, your cataract surgeon will need to use additional interventions or simply move more slowly and cautiously.

Can You Influence How Long Your Cataract Surgery Takes?

While the unexpected can happen even in the hands of the most prepared and experienced eye care surgeons, there are some steps you can take to minimise the likelihood of a prolonged operation. Bear in mind that these do not guarantee you a perfectly smooth and uneventful cataract extraction but can help to reduce the risk of encountering a complication or adverse outcome.

Ensure that your cataract surgeon is fully aware of your general health and medications. Although you may feel an over-the-counter medication you take is irrelevant to your cataract operation, you may be surprised at how different systemic medications or other health conditions can interact with the success of your cataract surgery. Even naturopathic herbal remedies may factor in. For example, turmeric or curcumin is often taken for its antioxidant effects, but not everyone knows it also has blood-thinning properties, which can affect wound healing after surgery.

Don’t wait for too long to go for your cataract operation. Infrequently is there a need for an eye care practitioner to encourage a patient towards cataract surgery before they feel ready. In most cases, it’s safe to postpone the operation until you feel your vision is significantly impacting your daily tasks. However, people who allow their cataract to advance to a hypermature stage are at a higher risk of experiencing a complication during their operation. More energy is required to break down an overly advanced cataract, and there is often more post-operative inflammation in the eye. If you’re unsure when is the appropriate timing for your cataract surgery, your optometrist or ophthalmologist will be able to perform regular reviews and advise you accordingly.

Depending on where you live and whether you have your operation via the private or public system, you may not have many options for choice of cataract surgeon. However, if the choice is available to you, choose a reputable, experienced ophthalmologist. You may wish to ask your family optometrist or GP for recommendations or get a personal recommendation from friends or family who have had a successful cataract operation with a particular surgeon.

Ultimately, it is not possible to completely control what will happen on the operating table. However, taking sensible precautions and keeping an open line of communication with your cataract surgeon can help to contribute to a smooth and uneventful procedure. Call us now on (03) 9070 5753.

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

References

The incidence of falls after first and second eye cataract surgery: a longitudinal cohort study.
https://www.mja.com.au/journal/2022/217/2/incidence-falls-after-first-and-second-eye-cataract-surgery-longitudinal-cohort#:~:text=In%20Australia%2C%20about%20250%20000,one%E2%80%90third%20in%20public%20hospitals.

Factors affecting cataract surgery operating time among trainees and consultants.
https://pubmed.ncbi.nlm.nih.gov/30879720/

Glaucoma Symptoms — Discover Them Early to Save Your Sight

December 14, 2022/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

Even if you’re not entirely sure what glaucoma is, it’s likely you’ve at least heard of the term. Conversely, you may be well familiar with this disease through a family member who is under the care of a glaucoma specialist for ongoing management. If you do have a blood relative undergoing glaucoma treatment, this puts you at a higher risk of one day requiring glaucoma management yourself. Although glaucoma symptoms are experienced in only a minority of cases, being aware of them could potentially save your sight.

What are the Glaucoma Symptoms?

As mentioned earlier, glaucoma symptoms actually occur quite infrequently. This is because the majority of glaucoma cases are a subtype known as open-angle glaucoma, which tends to develop slowly and silently.

In another subtype of glaucoma known as closed angle or angle-closure glaucoma, you may experience some glaucoma symptoms. In situations of sudden, acute angle closure, glaucoma symptoms can include:

Sudden and severe pain around the eye
Nausea with or without vomiting
Headache
Watering eye
Red eye
Blurred vision
Haloes around lights

Angle-closure glaucoma is an ocular emergency, and you should seek urgent glaucoma management if you suspect your symptoms are due to this condition.

What is Glaucoma?

Glaucoma is a type of eye disease that can result in permanent loss of sight. It’s not common to lose all your sight, but there can be a significant loss if glaucoma treatment is delayed.

Glaucoma involves damage to the optic nerve. The optic nerve brings neural signals from the eyeball to the brain. During this disease, retinal nerve fibres slowly die away. The damage usually begins in the nerves that connect to the periphery of the retina, meaning most cases of glaucoma begin with loss in the peripheral visual field. However, this damage to the nerve fibres and loss of sight is painless, which is why experiencing glaucoma symptoms is not common. It is also the reason why many people don’t seek glaucoma treatment in a timely manner. In fact, around 50% of Australians with glaucoma don’t realise they have the condition.

It’s not fully understood what causes this disease. In essence, the pressure inside the eyeball, known as intraocular pressure, is too high for the health of the optic nerve. However, it is not clear why some optic nerves are more susceptible to intraocular pressure or why some people require glaucoma management even when their intraocular pressures are within a normal range.

Your glaucoma specialist divides this condition into two broad categories mentioned above – open-angle glaucoma and closed-angle glaucoma. The angle refers to the gap created between where the coloured iris meets the transparent cornea. Aqueous humour fluid is drained through this structure as part of the normal cycle of aqueous production and outflow. As described in the name, open-angle glaucoma involves this gap being adequately open for the sufficient drainage of fluid. However, fluid is still unable to drain through these channels at a normal rate, typically resulting in an increase in intraocular pressure.

In closed-angle glaucoma, there is very little space between the iris and the cornea for fluid to enter the drainage channels at the angle. This physical hindrance to fluid drainage causes a rise in intraocular pressure. Sometimes, this angle can close very suddenly, resulting in a sudden and very high spike in intraocular pressure. This is known as acute angle closure glaucoma.

Glaucoma Management

If you’re looking for glaucoma treatment, it is not always necessary to see a glaucoma specialist. Many general ophthalmologists are capable of providing glaucoma treatment. However, you may be referred to an ophthalmologist with a specialised interest in glaucoma if you require more complex treatments, such as surgery.

Because most cases of glaucoma begin silently with no noticeable symptoms, it’s most likely that your condition will first be picked up during a routine eye exam, perhaps with your local optometrist. You may have some or all of the following tests to diagnose glaucoma:

Tonometry to measure the intraocular pressure
Fundoscopy to visualise the optic nerve
Retinal photography to record the appearance of the optic nerve
Optical coherence tomography scanning for additional measurements of the retinal nerve fibre layer
Visual field testing to assess any damage to your peripheral vision

While some cases of glaucoma are obvious, others can take some time to diagnose. The results of the tests may not always be conclusive or may need several results over a period of time to ascertain if there is true progressive glaucomatous damage.

If your optometrist is the first to suspect glaucoma, he or she may initiate treatment if suitably qualified or may refer you immediately to an ophthalmologist.

Treatment for glaucoma will vary based on a number of factors. If you have angle closure glaucoma, the primary aim is to widen the angle to allow aqueous humour to flow out. This is typically achieved through a procedure known as a peripheral laser iridotomy. During this in-room procedure, the ophthalmologist uses a laser to create a small hole near the outer edge of your iris to allow aqueous to drain out that way. Some people with angle closure may also benefit from cataract surgery. Removing the eye’s natural lens allows the iris to move backward, creating more space between the iris and the cornea.

For those with open-angle glaucoma, first-line treatment is usually in the form of eye drops to lower the intraocular pressure. If eyedrops are ineffective or if you have difficulty instilling them, you may be offered surgery or selective laser trabeculoplasty. Both these treatment options are aimed at increasing the outflow of aqueous from the eye.

Call us on (03) 9070 5753 today.

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

References

Glaucoma.
https://www.healthdirect.gov.au/glaucoma

What is Glaucoma? Symptoms, Causes, Diagnosis, Treatment.
https://www.aao.org/eye-health/diseases/what-is-glaucoma

how long to recover from cataract surgery melbourne

How Long to Recover from Cataract Surgery? Tips for Recovery

November 29, 2022/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

Although cataract surgery itself is a quick procedure, the cataract surgery recovery period takes much longer. For information on how long it takes to recover from cataract surgery, as well as tips on how to smooth it out as much as possible, keep reading.

How Long to Recover from Cataract Surgery?

Most people will have completed their cataract surgery recovery after 4 to 6 weeks. However, every individual is different – some may heal slightly faster, while others may take a little longer until they feel back to normal. By the 6-week mark post cataract surgery, you can expect that your sight has stabilised and any temporary side effects after your operation have resolved. But a 6-week cataract surgery recovery period doesn’t mean you’re sitting in bed doing nothing. Most people are able to return to their usual activities much sooner.

Immediately after cataract surgery, your eye can be expected to feel:

Sore and/or gritty
Red
Slightly puffy and swollen
Blurry
Glare sensitive
Watery

However, as soon as several hours after having your operation, you may find your vision already begins to clear. Even if it’s not as clear as you’re expecting, don’t worry. Over the 4 to 6 weeks after your cataract surgery, your sight will fluctuate as your eye heals and the lens implant settles. This also means your prescription will vary during this time, so it would be wise to avoid purchasing any new expensive glasses during this time.

If your occupation is non-strenuous and doesn’t require exposure to chemicals, dirt, dust, other contaminants, or the risk of physical trauma, you may return to work as soon as 1 or 2 days after cataract surgery. However, if your job is more physically demanding or puts you at risk of getting an eye infection, your surgeon will want you to take time off work for longer. This includes people who work in the military, physical trainers, swimming instructors, builders, or professional athletes.

In regards to driving, though you may feel you’re seeing clearly enough within a few hours, it’s important to avoid getting behind the wheel until your surgeon has checked your eye. Most clinics will organise a review appointment one day after the cataract operation.

It is not abnormal for some discomfort in your eye to persist for the first week or two during your cataract surgery recovery. This doesn’t necessarily mean something has gone wrong. Some people experience some ongoing dryness of the eyes and glare sensitivity, which may last for several months. Your surgeon will give you some simple tips on how to manage these side effects if they persist, such as using lubricating eyedrops or wearing sunglasses when you’re feeling uncomfortable in the light.

There are some conditions that are known to stretch out the cataract surgery recovery period. If you are at a higher risk of a cataract surgery-related complication, such as having diabetic retinopathy, a very advanced and dense cataract, or a corneal condition, the answer to how long to recover for cataract surgery can be very different for you. Although the corneal incision made during cataract surgery is very small, if you have a disorder that causes wounds to heal slowly, you may find your recovery period to be protracted.

Tips on Maximising Your Cataract Surgery Recovery Process

Prior to your cataract surgery, your surgeon will have probably already given you an idea of what to expect during your recovery period so you can make the appropriate arrangements and take time off work. Always follow your surgeon’s specific instructions, as they’re designed to give you the best chance of recovering after cataract surgery with minimal discomfort and complication. In essence, you want to keep the eye clean and protected from physical injury or infection. You will have the best chance of achieving that through:

Using your prescribed eye drops. You will have up to three bottles of different medications, with varying dosage schedules. Even if you’re feeling good within a week or two, keep using the drops until the end of the prescribed course.
Avoiding any movements that might increase the pressure in your head (and eye). This includes bending over, heavy lifting or other strenuous activity, coughing, sneezing, and vomiting.
Ensuring you keep your eye away from the risk of physical injury. This might even include not putting your face too close to your young grandchildren or active pets.
Keeping soaps, lotions, aerosols, etc, away from your eye area.
Avoiding dusty, dirty environments, including being outdoors on a windy day or in a dusty basement.
Keeping unsterile water out of your eye. This includes the swimming pool, ocean, spas, and saunas. Although these bodies of water are okay to sit in, they are often home to microorganisms that are known to cause severe infections, particularly in compromised eyes.

You shouldn’t expect any significant deterioration during the healing process. That means if your eye begins to become redder, more blurry, more painful, or starts producing discharge, it’s important to see your surgeon immediately. If you’re unable to get hold of your surgeon, consider going to your local optometrist or the emergency department at the nearest hospital.

Even if your cataract surgery went smoothly and you followed all the post-operative healing instructions to the letter, it is still possible to develop a complication such as an infection or swelling around the macula. Anything that doesn’t feel right with your eye after cataract surgery should be attended to immediately.

Call us now on (03) 9070 5753.

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

References

Recovery: Cataract Surgery.
https://www.nhs.uk/conditions/cataract-surgery/recovery/#:~:text=These%20side%20effects%20usually%20improve,healed%2C%20usually%20after%206%20weeks.

8 tips to reduce cataract surgery recovery time.
https://www.allaboutvision.com/en-au/conditions/cataract-surgery-recovery/

How to Prevent Glaucoma? Ways to Manage the Possible Risks

November 14, 2022/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

Around 300,000 Australian adults have glaucoma, but it is thought that half these people don’t even realise they have it. If you know you have an elevated glaucoma risk through a family history of glaucoma or other factors identified by your eye health professional, questions on how to prevent glaucoma may have already crossed your mind.

When it comes to discussing how to prevent glaucoma, while the straight answer may not be what you’re hoping for, there are still steps you can take to combat this blinding eye disease.

What is Glaucoma?

Glaucoma is a type of eye disease known as an optic neuropathy. This is a descriptive term referring to disease and damage to the optic nerve. As the optic nerve is responsible for transmitting signals from the eyeball to the brain, if it becomes damaged, your sight will subsequently be affected. After cataracts, glaucoma is the leading cause of blindness around the world. However, unlike cataracts, this blindness can’t be cured.

In most cases, the development of glaucoma is associated with elevated pressure inside the eye; this is known as intraocular pressure (IOP). Intraocular pressure is determined by the balance of aqueous fluid production to its drainage through a structure known as the anterior angle inside the eyeball. If this fluid is unable to be drained out at a sufficient rate, the IOP can rise. This can put the optic nerve at glaucoma risk. However, as we’ll see, elevated intraocular pressures don’t explain all cases of glaucoma.

Your eye surgeon and other eye health professionals will divide glaucoma into three broad subtypes:

Open-angle glaucoma. This is a type of glaucoma where the drainage structures of the eye appear open, but for some reason (not always understood), fluid is unable to drain out properly.
Closed-angle glaucoma. As the name suggests, the drainage angle is narrowed or closed, physically impeding the drainage of aqueous fluid and causing the IOP to rise.
Normotension or low-tension glaucoma. In this type of glaucoma, the intraocular pressure is still within a normal range, yet optic nerve damage is occurring. There are likely other underlying causes, such as compromised blood flow to the optic nerve.

How to Prevent Glaucoma – Is it Possible?

Glaucoma, in all its forms, is a complex disease. The eye health community doesn’t fully understand what causes it, why some people with all the glaucoma risk factors never develop it, and why some people with no risk factors do. So, when it comes to discussing how to prevent glaucoma, unfortunately, the blunt answer is that you can’t. However, there are ways you can reduce your glaucoma risk.

Manage Your Glaucoma Risk

There are a number of known glaucoma risk factors. Some of these can be controlled, while others can’t. It’s due to these uncontrollable risk factors (both those that are currently known and those that are yet to be discovered) that your eye surgeon will tell you that we cannot prevent this disease.

As far as we know so far, unmodifiable risk factors include:

Genetics. Mutations in certain genes are known to be associated with glaucoma. Family history can dramatically increase your risk of developing this eye disease yourself. If you have a parent or sibling with glaucoma, your likelihood increases up to 10-times.
Ethnicity. Although all ethnic backgrounds have the potential to develop glaucoma, Asians and Africans are known to be at the highest risk.
Age. Being older than 50 years is considered to be a factor for glaucoma. The older you get, the higher your risk. Older adults are at a higher likelihood of developing other eye health problems and general health issues, which can indirectly increase your glaucoma risk too.
Eye anatomy. If your anterior angle is naturally narrow, this will automatically elevate your risk of glaucoma. However, unlike the other unmodifiable risk factors, your eye surgeon can proactively treat this through a laser procedure if necessary.
Very high myopia (short-sightedness) or hyperopia (long-sightedness). Structural changes to the eyeball from these high prescriptions can be a risk factor for glaucoma.

Although you cannot eliminate your risk of glaucoma entirely, there are some risk factors that you do have some control over. Above all, maintaining regular visits with your optometrist or eye surgeon to check your eye health is crucial. The vision loss from glaucoma cannot be reversed, so the best course of action is to try and prevent it from progressing in the first place. There are a number of effective treatments that can help to slow or stop the progression of glaucomatous damage, but the first step is to be diagnosed.

Here are some risk factors you can control:

Stop smoking.
Treat any obstructive sleep apnoea.
Wear protective gear if you’re doing an activity with a risk of eye injury.
Manage any diabetes well.
Avoid taking corticosteroid medications, or keep a close watch on your intraocular pressures if it’s unavoidable.
Keep your blood pressure within a healthy range.

It is also important to manage your intraocular pressures if they’re elevated, as high pressures increase your likelihood of glaucomatous vision loss. It is possible to have pressures above the normal range without developing glaucoma – this is often termed ocular hypertension. Your eye surgeon will make a decision through experience and your glaucoma test results about whether it’s recommended to proactively treat your IOP, even if there’s not yet any evidence of glaucoma. Treatment is always aimed at lowering the intraocular pressures, although there is some evidence that vitamin B3 supplementation may also be useful for protecting the optic nerve in glaucoma. Pressure-lowering treatments include laser procedures, eyedrop medications, or surgery.

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.

References

Glaucoma
https://www.cera.org.au/conditions/glaucoma/

Epidemiology of Glaucoma: The Past, Present, and Predictions for the Future.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769798/

Risk Factors for Glaucoma.
https://glaucoma.org.au/what-is-glaucoma/risk-factors-for-glaucoma

recurrent corneal erosion syndrome melbourne vic

Recurrent Corneal Erosion Syndrome – Causes, Symptoms & Treatment

February 28, 2021/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

The cornea is a delicate structure and the most sensitive part of the eye. That transparent dome of tissue at the front surface of your eye, the cornea is responsible for bending, or refracting, light to provide clear vision. There is a myriad of conditions that can affect the cornea, with effects ranging from no noticeable symptoms to significantly debilitating pain and permanent loss of vision. Recurrent corneal erosion syndrome is a disease that can cause real distress for some patients, leading to corneal surgery, while for others is only a mild irritation that can be easily managed with over-the-counter lubricant eye drops.

The Cornea

As mentioned earlier, the cornea is a very sensitive part of the eye. The lightest touch from a speck of dust can cause irritation and reflexive tearing, an important reflex response designed to protect the eye. It’s no wonder that a more significant injury, such as the severely-named “recurrent corneal erosion”, can have a real impact on quality of life.

The cornea is made up of five layers:

The epithelium at the front surface of the eye; the epithelial cells are adhered to a basement membrane
Bowman’s membrane underneath the epithelial basement membrane
The corneal stroma, which makes up the bulk of the cornea
Descemet’s membrane, immediately behind the stroma
And the corneal endothelium, which is comprised of cells responsible for controlling the water content of the cornea

Recurrent Corneal Erosion Syndrome

Recurrent corneal erosion syndrome is a corneal condition that involves the epithelium and its basement membrane. In this disease, the epithelial cells are poorly adhered to the basement membrane in certain patches across the cornea, resulting in these cells separating from each other in what is known as a recurrent corneal erosion. A recurrent corneal erosion is basically a defect at the level of the corneal epithelium. They are most common in people in their 30s and 40s, with a slight bias towards females.

A recurrent corneal erosion is typically characterised by a sudden sharp pain in the eye upon waking in the morning. The theory behind this presentation is that overnight, the corneal epithelial cells stick to the inside of the upper eyelid as the eye’s surface dries. Combined with mild superficial swelling of the epithelium due to the lids being closed during sleep which leads to weakened anchoring of the epithelium to its basement membrane, as the eyelids open in the morning this can mechanically erode, or pull, the epithelium from the basement membrane. Other symptoms associated with this condition include tearing, redness, and light sensitivity in the affected eye. There may also be some disturbance to the vision, whether from the corneal defect itself or from the excessive tearing. As the name suggests, recurrent corneal erosion tends to happen again and again, often in the same area of the cornea.

It is not always understood why a patient may have a weakened epithelial adhesion to the corneal basement membrane. However, in up to about 65% of cases, a history of previous corneal trauma can be identified, such as a scratch from a tree branch, fingernail, or piece of paper. Another predisposing factor for recurrent corneal erosion syndrome is the presence of an epithelial basement membrane dystrophy, which is a genetic corneal condition. Epithelial basement membrane dystrophies account for up to 29% of cases of recurrent corneal erosions. Patients who have dry eye syndrome, diabetes, ocular rosacea, or blepharitis also tend to be at a higher risk of experiencing a recurrent corneal erosion.

Recurrent Corneal Erosion Treatment

Recurrent corneal erosion syndrome can be difficult to treat, leading some patients to get quite frustrated at the lack of relief. Many eyecare practitioners will begin with conservative therapy before escalating to corneal surgery in very severe, stubborn cases.

First line therapy is generally lubricant eye drops or eye ointment. Typically, this involves frequent use of preservative-free artificial tears during the day plus a thicker, more viscous eye ointment at night before bed to discourage the corneal epithelium from sticking to the underside of the eyelid. This should be considered as a preventative measure to avoid an attack from occurring. During an active episode of a corneal erosion, the optometrist or ophthalmologist may prescribe a preventative antibiotic to avoid a bacterial infection from taking advantage of the epithelial defect, as well as pain relief tablets as needed. Large corneal defects may benefit from having a contact lens inserted on the eye to provide some protection from the environment. If these treatments are ineffective, you may be referred for corneal surgery with an anterior eye specialist.

Corneal surgery options for recurrent corneal erosion syndrome include:

Anterior stromal micropuncture – this involves using a fine needle to prick through the superficial layers of the cornea. The basis of this treatment is that the micro punctures stimulate the cornea to fortify the basement membrane
Debridement and superficial keratectomy – using a burr or scalpel, loose epithelium is removed from the eye, allowing new, healthy epithelium to regrow
Phototherapeutic keratectomy – this may be considered the last option for corneal surgery where other treatments have failed. After removing loose epithelium with debridement, a laser is used to vaporise several micrometres of Bowman’s membrane, allowing re-epithelisation with healthy cells.

If you think you may be experiencing recurrent corneal erosions, it is important to be examined by an experienced optometrist or ophthalmologist. Call us today at (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.

Chalazion vs Stye – Understanding the Differences of 2 Eyelid Bumps

February 15, 2021/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

Our eyelids are delicate structures but are also a lot more intricate and functional than we give them credit for. Most of us will experience a little lump or bump on an eyelid at some point in our lives – some of these eyelid bumps are harmless while others need the attention of a specialist in oculoplastic surgery. Out of all the garden variety eyelid bumps, the most commonly confused are a chalazion vs stye.

The Eyelid

Understanding a little of the anatomy of the human eyelid will help us to have a better grasp of the difference between a chalazion vs stye.

Our eyelids serve several purposes, including physically protecting the sensitive surface of the eye as well as providing lubrication via several different glands. The eyelid is made up of layers of smooth muscle, connective tissue, fibrous tissue, a mucous membrane known as conjunctiva, and various secretory glands. Lining the upper and lower eyelid margins are a particularly important set of glands known as the meibomian glands, which open their orifices just behind the eyelash line. The oily secretion produced by these glands is called meibum, which has the purpose of lubricating the surface of the eye, keeping these tissues healthy and contributing to clear vision.

Each eyelash follicle is paired with two additional types of glands known as the glands of Zeis and Moll. The glands of Zeis are sebaceous glands while the glands of Moll are modified sweat glands. Both of these glands support the health of our eyelashes, with their secretions keeping the lashes from becoming brittle.

While the glands of our eyelids are certainly useful, they can also be subject to infection and blockages, much like other glands throughout our bodies. It’s then that you may experience one of those inconvenient little eyelid bumps.

Chalazion vs Stye

Chalazia and styes are among the most common lumps and bumps found on the eyelid. Although both are considered benign, both types of eyelid bumps can be a cause of concern for many people, particularly if the lump is large, sore, or red, leading them to enquire about oculoplastic surgery. The underlying cause is what differentiates a chalazion vs stye, although many people will use the term “stye” to cover both types of bumps.

A chalazion (plural, chalazia), is a blockage of a meibomian gland in the eyelid without an active infection. Initially a chalazion may begin as a stye but then eventually the infection resolves, leaving behind a painless bump that we then call a chalazion. A chalazion is made up of blocked meibum accumulating in the surrounding soft tissues of the eyelid as its usual drainage route through the duct is obstructed. The main concern for someone with a chalazion is not pain or redness, even when the chalazion is touched, but more of a cosmetic issue. A chalazion can vary in size, with some being large enough to put some pressure on the cornea and causing temporarily blurred vision. Unfortunately, chalazia are known to take some time to clear, from weeks to months.

On the other hand, a stye, also known as a hordeolum, involves an active infection. An external stye is due to an infection of one the glands of Zeis or Moll, and typically appears as a yellowish-whitish pimple around the base of the affected eyelash follicle. Conversely, an internal stye or hordeolum involves an infection of a meibomian gland inside the eyelid. It’s an internal stye that is most likely to be confused with a chalazion as they both appear as bumps under the skin of the eyelid. Because there is an active infection, styes are typically sore and associated with redness and inflammation.

Treatment

Most styes and chalazia will self-resolve without needing intervention from an oculoplastic surgery doctor. To hasten the healing process, you may consider using a gentle warm compress over the affected eyelid in order to encourage blood flow to the area, or your optometrist and GP may pluck the eyelash associated with an external stye to help drainage of the blocked glands. As tempting as it may be, however, you should never try to pop a chalazion or stye as this will potentially exacerbate the lesion. Some eyecare practitioners may prescribe a topical antibiotic ointment for an external stye but these should be avoided in the case of chalazia as there is no infection.

Large chalazia and styes that are taking a long time to self-resolve with home remedies such as a warm compress can be referred to an ophthalmologist experienced in oculoplastic surgery. For very stubborn chalazia, the eye specialist can perform a surgical procedure to remove the contents of the chalazion, known as an incision and curettage. There is also the option of steroid injections into the eyelid to help the chalazion to resolve more quickly.

Styes and chalazia are known to recur, whether in the same area of the eyelid or elsewhere. Several risk factors have been identified in the likelihood of developing recurrent styes and chalazia, such as having acne rosacea or meibomian gland dysfunction. A chalazion that frequently pops up in the same area may require examination by an ophthalmologist to rule out any other conditions that may mimic a chalazion, such as an eyelid carcinoma.

Call us today at (03) 9070 5753 for more info.

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

Corneal Infection – Underlying Causes That Will Affect Your Eye Health

January 31, 2021/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

While some corneal infections result in only a mildly irritated eye, depending on the underlying cause and its location on the cornea, a corneal infection has the potential to severely impact eye health, causing permanent damage to your sight. A corneal infection can be caused by bacterial or viral infections, or be due to a fungus or microscopic parasite. In some unfortunate cases, an eye may be infected by more than one pathogen simultaneously.

The cornea is the front surface of the eye and must remain clear and transparent in order for light to pass through to reach the retina at the back of the eye and provide vision. Any disruption to this tissue, such as damage and scarring from corneal infections, can physically impede the passage of light into the eye, resulting in blurred vision. The cornea is also the most sensitive part of the eye, with a speck of dust being able to cause a great deal of discomfort.

Causes of Corneal Infection

A corneal infection is often referred to as keratitis, which translates to inflammation of the cornea. Although not all keratitis cases are necessarily active infections, all corneal infections involve inflammation at some point in their development.

Bacterial Infections

Most corneal infections are caused by bacteria, usually staphylococcus aureus or pseudomonas aeruginosa. Bacterial keratitis, in particular pseudomonas infections, can be aggressive and a significant threat to eye health, and so should be addressed promptly by an eyecare practitioner endorsed to prescribe antibiotic medications.

Risk factors for the development of a bacterial keratitis include contact lens wear, in particular when poor contact lens hygiene is practised, such as overnight wear or wearing a lens for longer than the recommended disposal schedule. Other underlying causes of compromised eye health can also predispose a person to bacterial keratitis, such as being immunocompromised or an eye injury.

Symptoms of bacterial corneal infections include mild pain, redness, and a mucous or pus discharge from the eye. You may also be able to see a round whitish opacity on the cornea, which is an ulcer caused by the infection. If this ulcer is large and central, or if there is significant discharge, you will also experience some effect to your vision.

Viral Infections

You may have heard of the herpes virus and adenoviruses in a context outside of eye health. However, these two viruses are in fact most commonly responsible for viral infections of the eye. Herpes simplex keratitis is caused by the type 1 herpes simplex strain of virus, the same strain responsible for causing cold sores around the mouth. It is also possible to get shingles in the eye in a condition known as herpes zoster ophthalmicus, caused by the varicella zoster virus of the herpes family. Once infected by a herpes virus, the virus remains in the body for life, typically lying dormant unless reactivated. Reactivation of the virus causes recurrent infection and inflammation, which can cause significant damage to the corneal tissues if not adequately managed.

Adenoviruses are a group of viruses often behind the common cold, causing characteristic symptoms such as fever, cough, and sore throat. Adenoviral infections of the eye are highly contagious and can be spread through droplets of bodily fluids left on surfaces, including tears.

Viral infections of the cornea typically present as a red, sore, watery eye with blurry vision. Patients also often report light sensitivity and in the case of adenoviral infections, may feel a burning or itching sensation in the affected eye. Viral keratitis is usually only on one side, though due to the contagious nature of the adenovirus, may transfer to the other eye in a matter of days if proper hygiene isn’t observed. Cases of herpes keratitis often have a history of cold sores or may have an active shingles infection along the scalp and face. Patients with an adenoviral infection may report having had a recent cold or flu or having been in contact with someone else with a cold or eye infection. Both a herpes and adenoviral infection of the cornea have the potential to cause scarring of the cornea, especially if recurrent.

Fungal Infections

Fungal keratitis is often more difficult to diagnose due to the slow nature of its development and the fact that symptoms typically present only days after the original infection. Many fungal eye infections also cause very little pain or irritation, which can further delay diagnosis and treatment, resulting in severe consequences for eye health and vision.

Contact lens wear is again a risk factor for fungal keratitis, as is an immunocompromised state. It is not uncommon for a fungal corneal infection to be caused by some sort of vegetative trauma to the eye, such as a scratch to the cornea by a branch or a leaf or dirt flicking into the eye.

Parasitic Infections

Parasitic keratitis is usually caused by a ubiquitous protozoan found in air, soil, and water, known as acanthamoeba. Acanthamoeba keratitis is uncommon, which is fortunate as the characteristic symptom of this infection is pain disproportionate to the appearance of the eye. Other symptoms include redness, watery discharge, and light sensitivity; however, these are typically mild in comparison to the pain reported. Acanthamoeba eye infections are an ocular emergency and must be treated promptly with potent antimicrobial eye drops to prevent permanent blindness.

Any suspect corneal infection should be seen immediately by an eyecare practitioner for proper diagnosis and management. Call us at (03) 9070 5753 today.

Eye Cataract Treatment – What To Expect?

January 16, 2021/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

“Cataract” can be a scary word for some. For many people the first thought that comes to mind is wondering whether they’re about to go blind. The next thought is typically wondering what happens next, and what they can expect during eye cataract treatment.

What is a Cataract?

A cataract refers to an opacity in the crystalline lens of the eye. This lens is located just behind the coloured iris and is usually clear and transparent to allow light to pass through. However, with time and age this lens gradually loses its transparency, becoming hazy or developing a discrete opacity – this is then considered a cataract. While advancing age is the most common cause of cataracts, other conditions or factors can cause a cataract or increase your risk of developing one, including:

Trauma to the eye
Metabolic diseases such as diabetes
Smoking
Certain systemic medications, such as steroids
As a complication of eye surgery, such as a retinal detachment repair

There are three types of age-related cataracts. Nuclear sclerosis appears as a yellowish-brownish haze in the centre of the lens, a section known as the nucleus. Cortical cataracts grow as spoke-like opacities in the cortex of the lens, which surrounds the nucleus. A posterior capsular cataract is an opacity at the back surface of the lens, further into the eye. Cataract symptoms will vary depending on the type and location of the opacity, though often there can be more than one type present in the eye simultaneously. Symptoms include glare sensitivity, blurred vision, altered colour perception, and increased difficulty with night vision. Nuclear sclerotic cataracts also have the potential to cause what’s known as a “myopic shift”, meaning that your contact lens or spectacle prescription becomes more short-sighted, or a higher minus script. Interestingly, this means that some patients find their reading vision improves without corrective lenses.

As a cataract tends to form very slowly in the eye, cataract symptoms may not become noticeable for years. This also depends on a person’s visual demands and daily activities as to how bothersome their eye cataract symptoms become. For example, a painter who requires very fine colour vision discrimination will likely be more affected by a milder cataract compared to an accountant who works on a computer and can easily enlarge their screen. A person’s visual demands and health of their eye guides cataract treatment timing. This leads us to the next question – what is the best treatment for cataract?

Eye Cataract Treatment

The only definitive treatment of a cataract in current medicine is surgical removal of the cataract. Your local optometrist will usually be the first to detect a cataract in the eye; cataract treatment is generally only recommended if the symptoms bother you enough to warrant intervention. Many early cataracts, and even moderate opacities, can simply be monitored. In most cases it’s not harmful to defer cataract surgery. There will be some instances where you may be advised to undergo treatment even if you’re still content with your vision – this includes situations where your vision no longer meets the legal visual requirements for holding a driver’s licence or if the presence of the cataract is affecting the pressure in your eye by blocking the drainage of fluid from the eyeball.

Once it’s decided that your cataracts are ready for surgery, your optometrist will refer you to an ophthalmologist for the operation. Cataract surgery is typically a quick and uncomplicated procedure with very high success rates in Australia.

The procedure is conducted under local anaesthesia; very rarely is a general anaesthetic used though many surgeons will offer a sedative if you’re feeling anxious or restless. A small incision is made at the edge of your cornea, which is the clear bubble of tissue at the front of the eye, to allow the necessary instruments to access the cataract inside. The cataract is then broken into fragments small enough to be suctioned out, leaving behind the capsular bag that used to hold this cataract. Different ophthalmologists will have a preference on the method of fragmenting the cataract, either with a technique known as phacoemulsification or a combination of phacoemulsification and the use of a femtosecond laser.

Once the cataract has been removed from the capsular bag, an artificial lens implant known as an intraocular lens (IOL) is then inserted in its place, which is designed to refract, or bend, the passage of light rays such that they focus clearly on the retina at the back of the eye. The power of this IOL is calculated before you undergo surgery and can reduce your dependency on glasses and contact lenses after the operation by accounting for your existing prescription, basically like having corrective lens implanted in the eye. Your surgeon will discuss your options of IOLs, which include:

Monofocal: correcting for one viewing distance, either near or far sight. Some patients may choose to have one monofocal IOL designed for long distance in one eye and a monofocal IOL for reading vision in the other, an arrangement known as monovision
Multifocal: these provide clear vision for multiple distances
Accommodative: designed to provide some degree of flexible focus to mimic your own eye’s ability to change focus
Toric: correct astigmatic prescriptions

If you’re concerned about cataracts, speak to Armadale Eye Clinic by calling us at (03) 9070 5753 for advice tailored to your situation.

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

what is epiphora melbourne armadale eye clinic

What Is Epiphora and What Causes It?

December 29, 2020/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

Tears play an important role in the health of our eyes as well as aiding clear vision. A deficit of tears leads to dry eye, which can significantly impact quality of life by causing discomfort and variable, blurry vision. But what about the opposite end of the spectrum when someone suffers excessively watery eyes?

What is Epiphora?

Epiphora is the medical term for watery eyes and the excessive production of tears. Epiphora can occur in one eye (unilateral) or both (bilateral), and often is asymmetrical, being worse in one eye than the other.

Watery eyes can be a reflexive reaction to some sort of temporary irritation to the eye, such as exposure to chemical fumes or a speck of dust. The rapid production of tears aims to flush away the irritant and protect the delicate surface of the eye.

However, some people suffer from persistently watery eyes, which makes it more likely they may require the attention of an oculoplastic surgery specialist.

What is Epiphora Caused By?

Watery eyes can be caused by a number of factors, though not all will require referral for oculoplastic surgery.

Causes of epiphora can include:

Conjunctivitis: Conjunctivitis refers to an inflammatory condition of the conjunctiva, the translucent membrane that covers the whites of the eye. You may be familiar with infective conjunctivitis causes, such as a bacterial or viral conjunctivitis. Viral conjunctivitis often presents with watering and epiphora of the eye, accompanied by redness and itching or soreness. Allergic conjunctivitis is also commonly associated with epiphora, along with the hallmark itching and puffiness. You may also experience other symptoms of allergy, such as nasal symptoms.
Trauma: If you’ve ever accidentally been poked in the eye, you’ll know that in addition to some significant pain and discomfort, your eye is likely to water profusely. As the surface of the eye is highly sensitive, it doesn’t take much to cause this reflexive reaction – even just brushing a finger against the cornea can trigger a watery eye.
Dry eye: When discussing what is epiphora, it may be unexpected to encounter dry eye disease as a possible underlying cause. However, because the eye’s surface requires constant moisture and lubrication for good health, it makes sense for the body to have a reflexive mechanism to produce more tears when the cornea becomes dry. This results in a release of more fluid from the lacrimal gland, which can then end up overflowing. Treating the watery eye is then – counterintuitively – a matter of actually treating dry eyes, such as with artificial tear lubricants or warm compresses.
Poor structure and/or function of the nasolacrimal system and eyelids: Epiphora due to changes to the tear duct (nasolacrimal) system and eyelids can be one of the more difficult causes to identify. If your optometrist or GP suspects issues along the nasolacrimal system as a contributing factor then you may be referred to a specialist in oculoplastic surgery.

Oculoplastic Surgery for Epiphora

The nasolacrimal system is involved in the production of tears as well as its drainage from the surface of the eye. There are multiple components of a healthy tear film, produced by various glands in different locations around the eyes. As all these components are secreted onto the surface of the eye, together they form the tear film, which aims to protect and lubricate the eye. Eventually, this tear film gathers along the lower eyelid due to gravity. From there, the blinking motion of our eyelids pushes what’s known as the tear prism, or tear lake, towards the inner corners of the eyes, where two tiny openings sit on the eyelid margins, known as puncta. Tears then drain through the puncta and, via a system of ducts and channels, through the nose and down the throat.

Issues with the nasolacrimal system and eyelids can contribute to epiphora, including:

Weak or incomplete blinking: If the eyelids do not blink well, whether due to a disease such as Bell’s palsy that causes weakness of the facial nerves, or simply from lazy blinking, the tear lake is less efficiently drained through the puncta, leading to overflow of tears from the eye.
Loose lower eyelids: With age, our skin loosens and can sag; the eyelids are no exception. If the lower eyelid does not sit well-positioned against the surface of the eye, it will have difficulty holding up the tear lake, resulting in these tears running down the cheek due to gravity. Additionally, a sagging lower eyelid, known as an ectropion, may result in the puncta also sitting away from the eye’s surface, making it difficult for tears to efficiently drain through it.
Narrowing of the puncta: This can often occur due to age-related changes to our skin, where the opening of the puncta becomes smaller with time, impeding the drainage of tears.
Narrowing or obstruction of the ducts: There are various locations where the nasolacrimal drainage channels may become narrowed or blocked, hindering the proper flow of tears through to the throat and resulting in a backlog and overflow of tears from the eye. These obstructions, whether full or partial, can be due to age, trauma, or even a growth or tumour.

An ophthalmologist experienced in oculoplastics is able to perform a thorough examination to determine what is your epiphora caused by and advise whether your condition is suitable for surgery.

Contact us today at (03) 9070 5753 to schedule your next appointment!

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

Symptoms of Retinal Tear & Treatment

December 16, 2020/0 Comments/in Armadale Eye Blogs /by The Armadale Eye Clinic Team

The retina is the paper-thin tissue lining the inside of the back of the eye. It’s made up of several layers of cells that work together to sense light and images entering the eye before sending along neural impulses to the brain for the perception of vision. Disease or damage to the retina, such as a significant retinal tear or retinal detachment, can result in permanent vision loss.

A retinal tear occurs when the tissue of the retina forms a break or rip. This is different from a detachment when part of the retina lifts away completely from the rest of the eye, though a retinal tear may risk deteriorating into a detachment, which must be then referred for urgent retinal surgery.

Symptoms of a retinal tear include:

Floaters – appearing as tiny black specks, dots, or sometimes described as cobwebs, that float around the vision in the affected eye. These floaters can come in and out of view and persist for some time.
Flashing lights – also called photopsia, sudden flashes in the vision from a retinal tear occurring may appear like a lightning strike or glint out of the corner of your eye.

Occasionally, a retinal tear may also result in an area of blurred vision if the tear caused some damage and bleeding from the tiny capillaries of the retina. There is never any pain or discomfort from a tear, or even a detachment, as the retina contains no pain receptors.

Most retinal tears occur spontaneously with no cause, though there are several risk factors that are associated with the likelihood of developing a tear. These include a family history of retinal tears or detachments, certain eye operations such as cataract surgery, or conditions which cause a thinned retina, such as high myopia (short-sightedness) or the presence of a peripheral retinal abnormality known as lattice degeneration. Advancing age and trauma to the eye area can also put a person at higher risk of forming a retinal tear.

Retinal Tear Treatment

Not all retinal tears need treatment. Some are safe to simply monitor with regular eye exams, and in fact, some will self-heal by naturally scarring and sealing themselves back against the eye.

When deciding if a retinal tear needs treatment, such as retinal surgery, the eye doctor will consider several factors based mainly around the risk of the tear deteriorating into a detachment. Any predisposing risk factors you have, such as the presence of high myopia or whether you’ve previously had a retinal tear or detachment in either eye, will be taken into account, as well as the location, size, and shape of the tear. Retinal tears that are small, peripheral (that is, far out to the edges of the retina, away from the central vision), and asymptomatic (not presenting with any flashes or floaters or disturbances to the vision), may be monitored by an experienced eyecare provider without needing referral for retinal surgery. The type of tear may also be taken into consideration as research has found that certain types of retinal tears and holes are more likely to deteriorate into a detachment.

If your eye doctor finds that your retinal tear is at a significant risk of becoming a sight-threatening retinal detachment, he or she will recommend retinal tear treatment as a preventative measure.

Depending on the facilities available to your local eye doctor, retinal surgery for tears is typically provided as an in-office treatment under local anaesthesia, meaning the ophthalmologist can perform it in the consulting room without needing to send you to an operating theatre or hospital. There are two types of retinal surgery procedures to treat a tear – laser photocoagulation or cryopexy.

Both photocoagulation and cryopexy aim to create controlled scarring around the edges of the retinal tear, thereby sealing the break and re-adhering the torn tissue back to the underlying structures of the eye. Photocoagulation utilises a laser device carefully aimed through the pupil of the eye to create this scarring while cryopexy is performed by placing a probe against the outside of the eye to essentially freeze the edges of the torn retina and induce scarring and reattachment. Depending on the experience and expertise of the ophthalmologist, both procedures take roughly 10 to 15 minutes to complete.

While there is minimal discomfort experienced during either procedure, the recovery time for photocoagulation tends to be much shorter than for cryopexy. Many patients are able to return to their normal routine immediately after a laser photocoagulation procedure with little to no disturbance to their vision post-treatment, though many surgeons will recommend avoiding any activities that risk traumatising the eye while the scarring forms for a couple of weeks. Conversely, an eye having undergone a cryopexy procedure may take up to 2 weeks to fully heal and settle, with the vision being temporarily blurred and the eye slightly red and swollen.

As with many medical procedures, there is a small chance of an adverse effect from either photocoagulation or cryopexy, such as permanent vision loss from the small areas of necessary scarring during treatment. However, because retinal tears tend to occur in the periphery away from the central vision and the treatment areas are quite small, it is very rare that the area of vision loss is significant enough to be noticeable or impact on normal activities.

It is important to remember to maintain regular eye examinations with your eyecare practitioner even after having successful retinal tear treatment as the tear may reoccur or a new tear may form in the same or opposite eye.

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