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  • Outpatient appointment

You are entitled medical leave after your cataract surgery. Usually try to take time off for at least 2 weeks. Depending upon your job, this can be increased as well. The nurse will give you a discharge letter which will also contain information about medications and eye drops.

You may read and watch TV.

Gentle exercises are fine too.

You can go out, but try to avoid crowded and dusty places. Wearing sunglasses when you are outdoors may help to keep your eyes comfortable and less sensitive to light.

You will be given eye drops for about a month to prevent infection and reduce inflammation. Follow your doctor’s instructions carefully. If you need to, ask a family member or friend to help instill the eye drops.  If you were to go out, make sure you have access to hand hygiene facilities so that you can clean your hands before you instill your eye drops.

For mild pain, you may take paracetamol. If you have pain that is not relieved by this medicine, call your doctor.

When you sleep, please put on the eye shield given to you for at least 1 week so that you don’t press on the operated eye.

For the first few days, your vision may be blurred, so be careful to avoid falling over or hurting your head or eye.

Do not do gardening for at least a month.

It is common to experience some eye irritation and discharge after surgery. However, for the first month, refrain from rubbing or touching your eye. Also avoid getting dust or soap water in your eye. Do not swim; do not use a hot tub, visit a sauna or spa. This is because there is a small wound in your eye, and you need to prevent it from getting contaminated.

No matter how small your wound is, try to avoid exerting yourself. Try not to bend over, carry heavy loads or perform strenuous exercises.

Take a break from carrying the grandchildren for 2 to 3 weeks. Let your eye heal.

You may find that your pre-existing spectacles are not right anymore after the cataract operation. This is because the power of your operated eye has changed due to the surgery. Usually the power of the operated eye would stabilize at 1 month after the operation, at which time you can be measured for a new power for your glasses.

Refrain from driving or riding a motorcycle till you are confident that your vision is clear. The law in England states you are not eligible to drive unless you can see a car number plate at 20 meters in good light.

For the first few days, please clean the operated eye gently clean your eye with cool boiled water and clean cotton gauze or cotton wool.

Please use the eye drops and medications as the doctor prescribed, even when you feel that your eyes are fine. Do not instill anything else into your eye apart from the prescribed eye drops. Always wash your hands before your instill your eye drops.

Store your eye drops and medications as instructed. Do not keep them for longer than the instructed period as they may become contaminated.

Shake the eye drop bottle before use. Tilt your head back, look up and pull the lower eyelid down. Instill just ONE drop into the eye, avoiding contact with the eye lashes. Wait 5 minutes before instilling a different eye drop.

You can keep to your usual diet. There are no new dietary restrictions following your cataract surgery.  Any pre-existing diets should be continued.

You will need to return for an eye examination after your surgery. Further appointments are usually after a few weeks to see if the eye is settling well and there is no need for adjustment of eye drops or medication. Keep all your appointments, even if you feel and see well.

Do not hesitate to contact us should you experience any of the following:

  • Pain that is not relieved by medication.
  • Deterioration of vision.
  • Pain and redness in the operated eye which worsens over time.
  • Excessive discharge from the operated eye.
  • Sudden onset of flashes or floaters.

More Questions

    Macular diseases
    • Dry macular degeneration is a slowly progressive disease of the retina which causes loss of central
      vision. This is usually age related. The retina is like a camera film at the back of the eye which
      processes pictures and sends them to the brain. In dry macular degeneration, the centre of the
      retina called the macular area has undergoes wear and tear changes. This may result in central
      visual distortion or even blank patches in the centre of your vision. Your peripheral (outer) vision is
      likely to remain OK unless there are other problems as well.
      There is no cure for dry macular degeneration but some aids like stronger glasses, magnifying
      glasses, telescopic lenses and illuminated magnifiers may help with vision and reading etc. These
      are sometimes called low visual aids.
      Usually large print books or electronic devices (like e-readers or computers) may help in reading by
      enlarging the font.
      There is some evidence that high dose vitamin supplements may help to retard or stabilise the
      progression of macular degeneration. Approximately 1 in 5 people in high risk groups of dry
      macular degeneration may benefit from high dose vitamins in a combination called the AREDS
      formula. Some people may benefit from these vitamins, some may not and a few people may
      come to harm because of high dose vitamin supplements. If you do decide to take these vitamin
      supplements, please contact your GP for advice. The NHS usually does not supply these vitamins.
      Examples of these vitamins are I-caps, presser-vision, macu-shield, Ocu-vite and others.
      Groups of people who should not take high dose vitamins are smokers, who may have a higher risk
      of lung cancer. There is a suggestion that diabetics and people with certain heart conditions may
      be at an increased risk of heart failure with high doses of vitamin E.
      We recommend a balanced diet to everyone, especially people with dry macular degeneration.
      Please contact your optician for further assessment.
      Recommended patient groups
      Macular disease society

    Wet macular degeneration is a serious condition in which abnormal new blood vessels
    grow in between the layers of the retina and choroid (retina is the sensitive film at the back
    of the eye). These blood vessels can leak, bleed and cause scarring or water logging
    (called odema) in the retina. This leads to loss of vision in the area of the damaged retina.
    Unfortunately in most cases, this area, called macula, is responsible for central vision. The
    damaged retina caused by these leaky blood vessels ultimately leads to loss of central
    vision.
    Patients suffering with wet macular degeneration may have central visual loss, blurring of
    vision, a grey or black patch in the centre of vision, distortion of straight lines etc. Most
    patients will complain of difficulty in reading.
    Previous treatments for this eye disease were either not very effective or were very
    expensive. Treatments for this kind of eye disease have been developed in the last few
    years. One of the most effective and promising treatments is an injection of a anti VEGF
    drug into the eye. This may be Eylea (Aflibercept), Lucentis (Ranibizumab) or Avastin
    (Bevazicumab). However some patients may benefit from special types of laser treatment
    called Argon laser, photodynamic treatment (verteporfin with laser treatment) or even
    extensive laser surgery called vitreo retinal surgery.
    Intravitreal injections of Eylea (Aflibercept), Lucentis (Ranibizumab) or Avastin
    (Bevazicumab) are now routinely given to try and stabilize vision and preserve as much
    vision as we can. The goal of treatment is to prevent further loss of vision. Although some
    patients will regain vision, the treatment may not restore vision that has already been lost,
    and may not ultimately prevent further loss of vision caused by the disease. The damage
    in the retina may be reduced by the injections but not totally reversed. Visual loss will be
    expected but hopefully not as much if the eye was not treated at all.
    The patient usually undergoes tests which include a colour photograph of the retina, a dye
    test and a scan of the retina. If there are signs of wet macular degeneration that are
    expected to benefit from treatment, then the patient undergoes 3 injections of anti VEGF
    treatment (one injection each month for 3 months). The patient then enters an observation

    Age-related macular degeneration (AMD) is the leading cause of blindness in people over
    50 years of age. It is caused by the breakdown of the central portion of the retina (the nerve
    layer part of your eye that works like the film in a camera to pick up the picture) called the
    macula. The macula is responsible for the fine central vision that’ is needed for driving a
    car, reading fine print, recognizing faces, etc.
    There are two types of macular degeneration: dry and wet.
    In the ‘wet’ form of AMD, abnormal blood vessels grow in the back of the eye.
    Sometimes these vessels leak blood or fluid that causes blurred or distorted vision. This
    process is also known as choroidal neovascularization (CNV). Without treatment, vision
    loss may be quick and severe.
    Anti VEGF agents work by blocking vascular endothelial growth factor (VEGF). Blocking or
    inhibiting VEGF helps prevent further growth of the abnormal blood vessels that cause
    leakage and damage in the eye.
    The standard treatment for most forms of wet AMD is intravitreal injections (injections into
    the eye). A few forms of wet AMD will require special types of laser as well as intravitreal
    injections.
    Lucentis and Eyelea treatments are approved by the National Institute of Health & Clinical
    Excellence (NICE). As per the NICE guidelines, all patients will not be eligible for treatment
    with Lucentis or Eyelea with NHS funding. For patients not meeting the NHS funding
    eligibility criteria, patients are often offered treatment with intravitreal Bevacizumab
    (Avastin).
    Your choices are:
     Avastin (Bevazicumab)
     Lucentis (Ranibizumab)
     Eyelea (Aflibercept)

    Risk when anti VEGF agents are given to treat patients with eye conditions:
    Most ophthalmologists believe that the risk of these complications for patients with eye
    conditions is low.
    All 3 medicines are anti VEGF
    agents, which are delivered by an
    injection into the jelly of the eye.

    Known risks are stroke, heart problems and high blood pressure amongst others.
    Known risks of intravitreal eye injections:
     Infection inside the eye called endophthalmitis.
     Inflammation of the eye
     Retinal detachment
     Cataract formation (clouding of the lens of the eye)
     RPE rip ( inward curling of a layer of the retina)
     Glaucoma (increased pressure in the eye)
     Bleeding
    Additional procedures may be needed to treat these complications.
    Any of these rare complications may lead to severe, permanent loss of vision.
    Patients receiving an injection may experience less severe side effects related to the
    procedure. These usually settle down in a day or two with the ointment or drops.
    These side effects may include
     eye pain caused by scratched cornea ( corneal abrasion)
     subconjunctival haemorrhage (bloodshot eye)
     vitreous floaters or grey bubbles ( intravitreal air)
     irregularity / dryness the cornea (dry eye)
    Lucentis treatment
    Lucentis is licensed for the treatment of wet macular degeneration and is recommended by
    NICE. Currently it is the most commonly used drug for the treatment of wet macular
    degeneration.
    Eyelea treatment
    Eyelea is also licensed for the treatment of wet macular degeneration and is recommended
    by NICE. Eyelea is the latest drug to be approved for the treatment of wet macular
    degeneration. Studies suggest that less injections of Eyelea may be required for visual
    stabilisation compared to Lucentis over a year.

    Avastin treatment and “Off Label” Status
    Avastin was not initially developed to treat your eye condition. Avastin is approved for the
    treatment of metastatic colorectal cancer. It does not have a licence for eye use.
    Once a device or medication is approved by the regulatory authorities, physicians may use
    it ‘off-label’ for other purposes if they are well informed about the product, base its use on
    firm Scientific method and sound medical evidence, and maintain records of its use and
    effects. Ophthalmologists all over the world are also using Avastin ‘off-label’ to treat AMD
    and similar conditions.
    Two large trials (CATT trial in the USA and IVAN trial in the UK) comparing Lucentis and
    Avastin shows fairly similar results in treatment of wet AMD.
    Avastin is a significantly cheaper drug than Lucentis. There appears to be a slightly higher
    risk of infection, stroke or heart trouble with Avastin when compared with Lucentis. The risk
    appears to be low when both drugs are compared. However any number of coincidental
    life-threatening problems may occur that have no relationship to treatment drugs.
    Prospects with Anti VEGF treatment
    Approximately 80% of patients are likely to respond to Anti VEGF treatment and their vision
    may stabilize. Of these approximately 20% patients may find an improvement in their sight.
    Around 20% of patients will not respond and their vision will deteriorate.
    Some patients may just need 3 injections while others may need significantly more before
    the vision stabilises.
    Patient Responsibilities
    You should contact your Ophthalmologist if any of the following signs of infection or other
    complications develop such as pain, blurry or decreased vision, sensitivity to light, redness
    of the eye (compared to immediately after the injection), or discharge from the eye.
    You are instructed not to
     rub your eyes
     swim
     use makeup around the eye
     gardening for five days after each injection

    You should attend-all your post-injection appointment schedules.
    Although the likelihood of serious complications affecting other organs of your body is low,
    you should immediately contact your GP or visit A&E if you experience abdominal pain,
    chest pain, severe headache, slurred speech or weakness on one side of the body and you
    should notify these problems to your ophthalmologist.

    If you have had an injection and are concerned about a serious complication with redness,
    eye pain and decreased vision, please visit your closest eye casualty department. If you are
    in central London, please visit Moorfields eye hospital eye casualty.

    Wet macular degeneration is a serious condition in which abnormal
    new blood vessels grow in between the layers of the retina and
    choroid (retina is the sensitive film at the back of the eye). These
    blood vessels can leak, bleed and cause scarring or water logging
    (called odema) in the retina. This leads to loss of vision in the area
    of the damaged retina. Unfortunately in most cases, this area,
    called macula, is responsible for central of vision. The damaged
    retina caused by these leaky blood vessels ultimately leads to loss
    of central vision.
    Patients suffering with wet macular degeneration may have central
    visual loss, blurring of vision, a grey or black patch in the centre of
    vision, distortion of straight lines etc. Most patients will complain of
    difficulty in reading.
    Treatments for this kind of eye disease have been developed in the
    last few years. One of the most effective and promising treatments
    is an injection of a drug into the eye. This may be Lucentis
    (Ranibizumab), Avastin (Bevazicumab) or Eylea (Aflibercept).
    Previous treatments for this eye disease were either not very
    effective or were very expensive. However some patients may benefit from special types of laser treatment called Argon laser,
    photodynamic treatment (verteporfin with laser treatment) or even
    extensive laser surgery called vitreo retinal surgery.
    Intravitreal injections (Lucentis, Avastin or Eylea) are now routinely
    used to try and stabilize vision and preserve as much vision as we
    can. The goal of treatment is to prevent further loss of
    vision. Although some patients may regain some lost vision, the
    treatment may not restore vision that has already been lost, and
    may not ultimately prevent further loss of vision caused by the
    disease. The damage in the retina may be reduced by the injections
    but not totally reversed. Visual loss will be expected but hopefully
    not as much if the eye was not treated at all.
    The patient usually undergoes tests which include a colour
    photograph of the retina, a dye test and a scan of the retina. If there
    are signs of wet macular degeneration that are expected to benefit
    from treatment, then the patient undergoes 3 injections of antiVEGF
    treatment (one injection each month for 3 months). The patient
    then enters an observation period and will then be offered treatment
    only if it is required. This injection is given directly into the eye (in the jelly of the eye), by
    an eye surgeon.
    The eye will be sore for a while and the vision will be blurred for a
    period of time after which it will clear to previous levels.
    The chances of stabilization of the vision are upto 80% in patients
    with certain types of wet macular degeneration. In approximately
    20% the treatment will not work and the vision will drop. The
    damage caused by leakage and fluid may be minimised but the
    ageing changes cannot be stopped.
    In most cases, patients do not have any problems after the
    injection. Sometimes the front surface of the eye can get scratched
    (corneal abrasion), which can cause eye pain/soreness but settles
    down in a day. Rarely, patients can get an infection in the eye,
    called endophthalmitis (1% chance), which can cause permanent &
    total loss of vision.
    Possible complications and side effects of the procedure and
    administration of injection treatments include retinal detachment,
    cataract formation (clouding of the lens of the eye), glaucoma
    (increased pressure in the eye), inflammation (soreness), hypotony
    (reduced pressure in the eye), damage to the retina, cornea or lens
    (structures of the eye), and bleeding. Another complication called

    retinal pigment epithelial rip (inward curling of lining of the retina)
    can cause decreased vision in patients with certain types of wet
    macular degeneration. Any of these rare complications may lead
    to severe, permanent loss of vision.
    There is also some evidence emerging suggesting slightly higher
    chance of strokes (2%) in patients receiving Lucentis or Avastin.
    Summary
    Benefits: Possible stabilization of vision
    Risks: Frequent injections into the eye which may be painful.
    Complications may cause permanent loss of sight. Failure of
    treatment may lead to loss of sight

     

    You may have received an intravitreal injection of Lucentis / Eylea/ Avastin today. For
    some patients an injection can be painful, in some instances it will be felt as a prick.
    In almost all instances, after the injection, you will be asked to count fingers. If after the
    injection , you feel you cannot see anything please inform the doctor, who may need to
    do more tests or perform an additional procedure related to the injection, before he or
    she decides you are ok to leave.
    Almost all patients will be given an antibiotic drop bottle or antibiotic ointment. This is to
    try and reduce the chances of an infection. Please put in the drops 3 to 4 times a day on
    the day of injection and then 4 times a day for 3 days after the injection. Some patients
    may also be given an eye gel called Viscotears. This is to try and improve the corneal
    healing after small scratches or corneal dryness.
    You may expect the vision to be blurry for a while after the intravitreal injection. This is in
    part due to the injection and also due to the dilation of the pupil. This is expected to get
    better in 3 to 4 hours as the drops wear off.
    Sometimes a small bubble of air can get into the eye with the injection. It can look like a
    small round grey blob in the bottom part of your vision. This is usually harmless and
    goes away in 24 to 48 hours.
    Sometimes the cornea can get small scratches due to the speculum (the clip that keeps
    the eye open during the injection). In such instances, the eye may feel gritty and sore.
    You may feel this as soon as the anaesthetic wears off in 20-30 minutes. You may need
    to use lubricant gels like Viscotears or Lacrilube to keep the eye comfortable. These are
    available in a pharmacy, “over the counter”, without a prescription.
    If your eye gets red and painful with decreased vision, this may be a sign of infection. If
    you have these symptoms, please attend the eye casualty as soon as possible. Do not
    delay to come to any eye casualty, if you suspect an infection.
    In the first instance, try to contact Mr Saeed’s secretary 01372-275161 option 2
    Local Eye casualty departments are as follows
    Moorfields eye hospital, City road, London has a 24 hours casualty
    St Helier Eye Unit has an eye casualty, Monday to Friday 9 to 4:30. (walk in ; no
    appointment is necessary)
    Outside these hours and on Saturday and Sunday, please attend the Eye department at
    St Georges Hospital in Tooting.

    Diabetic Eye Conditions

    Diabetes is a condition that can damage many parts of the body including the eyes.
    The nerves, blood vessels, kidneys and other organs of the body can get damaged due to
    complications of diabetes.
    Over time, damage can develop in the blood vessels that supply the central retina (at the back of
    the eye). This can lead to vision loss, which can affect distance vision and near vision or fine detail,
    such as the small print in a document.
    As diabetic retinopathy reaches advanced stages, some of the blood vessels that supply the retina
    will become blocked. To compensate for this, the body will start to produce new blood vessels to
    restore the supply of blood. These blood vessels may bleed or leak.
    As the new blood vessels are unstable and prone to bleeding, they can cause blurred and patchy
    vision as the blood obscures your sight. Over time, the bleeding can lead to the formation of scar
    tissue. There is a risk that this will pull your retina out of position. This is known as retinal
    detachment. Retinal detachment can lead to a darkening of vision, floaters and, if left untreated, a
    total loss of vision.
    The central part of the retina called macula can also become affected by water-logging and leakage
    due to diabetes. This is called diabetic maculopathy and can lead to central visual loss, patchy
    vision and inability to see small print etc.
    Risk factors
    There are a number of risk factors that increase your chances of developing diabetic retinopathy.
    Duration of diabetes; the biggest risk factor for diabetic retinopathy is the length of time that you
    have lived with diabetes.
    Blood glucose level; People with high blood glucose levels are more likely to progress to advanced
    diabetic retinopathy.
    High blood pressure; People with high blood pressure (hypertension) are likely to progress to
    advanced diabetic retinopathy.

    • Other risk factors are:
       age
       family history
       African-Caribbean or south Asian origin
       obesity
       stress
       lack of exercise
       smoking
       excessive alcohol consumption
       a high amount of salt in your diet
       a high-fat diet
      Treatment
      For early or moderate diabetic retinopathy the best treatment is good control of diabetes and
      control of risk factors including keeping your blood pressure at optimum levels ( around 120/80
      mmHg)
      Advanced diabetic retinopathy like diabetic maculopathy (with sight threatening features) and
      proliferative retinopathy usually require laser treatment.
      In advanced proliferative retinopathy, laser treatment may not be possible and a type of eye
      surgery called vitreous surgery may be required.

    Aim of treatment
    Aim of the laser treatment is to keep your vision stable. It is unlikely to improve your vision.
    Statistics show 70% stabilization of vision, 15% improved vision and 15% worse vision after focal
    laser for diabetic maculopathy.
    Laser or injection treatment cannot replace good diabetic control. If your diabetes, blood
    pressure and cholesterol remain out of control, laser or injection treatments will fail and you
    may lose vision.
    Laser treatment
    The type of laser treatment used to treat diabetic retinopathy is known as photocoagulation.
    Photocoagulation involves using a laser to burn away any abnormal blood vessels or abnormal
    retina which may affect the normal retina.
    Laser for diabetic maculopathy stabilizes or improves vision in 85% of patients. Approximately 15%
    of patients will experience visual loss even after laser treatment for diabetic maculopathy. This is
    usually because of progressive damage by diabetes affecting the blood vessels of the retina.
    Photocoagulation reduces the risk of severe visual loss over 5 years by 50% in patients with
    proliferative diabetic retinopathy.
    More than 50% of people who have laser treatment for diabetic retinopathy notice some difficulty
    with their night vision, and 3% notice some loss of peripheral vision.
    Injection treatment:
    Injections can help in certain types of diabetic retinopathy by reducing leakage in the retina.This
    type of retinopathy is called diabetic maculopathy. Initial stages of diabetic maculopathy may be
    treated with laser. However in some instances or later stages, injections may be more helpful. The
    injections of drugs called Ranibizumab (Lucentis®), Bevazicumab (Avastin®), Afiblicept (Eyelea®),
    Triamcinolone or Flucinolone acetate (Illuvien®) are usually used depending on circumstances. You
    should talk to your doctor about these as each of these will have risks and benefits, which will
    need to be considered on a case to case basis.
    Seek medical advice if you experience any new eye problems following treatment.

    Disclaimer: This information leaflet is produced to help increase awareness regarding diabetic retinopathy. It is not
    intended to replace professional medical advice or to provide advice in any special individual circumstance. Please
    seek expert medical advice regarding your specific medical condition.

    Sources: http://www.cks.nhs.uk/patient_information_leaflet/diabetic_retinopathy

                 Patient information Diabetic Retinopathy

    Diabetes mellitus is a condition which affects the regulation of blood glucose in your body. Diabetes can damage many organs in the body including skin, nerves, kidneys, blood vessels, heart and eyes. Sustained and uncontrolled blood glucose levels eventually cause damage to the structures of the eye called diabetic retinopathy or diabetic maculopathy. These changes can be by an eye doctor either by special scans and photographs or by examining the eye with special pieces of equipment. Over time, damage can develop in the blood vessels that supply the retina . This can lead to some vision loss, which can affect both seeing things clearly at a distance and seeing things in fine detail, such as the small print in a document. As diabetic retinopathy reaches its most advanced stage, some of the blood vessels that supply your retina will become blocked. To compensate for this, your body will start to produce new blood vessels to restore the supply of blood. These blood vessels may bleed or leak. As the new blood vessels are unstable and prone to bleeding, they can cause blurred and patchy vision as the blood obscures your sight. Over time, the bleeding can lead to the formation of scar tissue. There is a risk that this will pull your retina out of position. This is known as retinal detachment. Retinal detachment can lead to a darkening of vision, floaters and, if left untreated, a total loss of vision. Risk factors There are a number of risk factors that increase your chances of developing diabetic retinopathy. Duration of diabetes; The biggest risk factor for diabetic retinopathy is the length of time that you have lived with diabetes. Blood glucose level; The higher the levels of glucose in your blood, the greater your risk of developing diabetic retinopathy. People with high blood glucose levels are more likely to progress to advanced diabetic retinopathy. High blood pressure; People with high blood pressure (hypertension) are likely to progress to advanced diabetic retinopathy. Other risk factors are:  age  family history  African-Caribbean or south Asian origin  obesity  stress  lack of exercise  smoking  excessive alcohol consumption  a high amount of salt in your diet  a high-fat diet Treatment For early or moderate diabetic retinopathy the best treatment is good control of diabetes and control of risk factors. Advanced diabetic retinopathy like diabetic maculopathy (with sight threatening features) and proliferative retinopathy usually require laser treatment. In advanced proliferative retinopathy, laser treatment may not be possible and a type of eye surgery called vitreous surgery may be required. Laser or injection treatment cannot replace good diabetic control. If your diabetes, blood pressure and cholesterol remain out of control, laser or injection treatments will fail and you may lose vision. Laser treatment The type of laser treatment used to treat diabetic retinopathy is known as photocoagulation. Photocoagulation involves using a laser to burn away any abnormal blood vessels or abnormal retina which may affect the normal retina. Photocoagulation reduces the risk of severe visual loss over 5 years by 50%. More than 50% of people who have laser treatment for diabetic retinopathy notice some difficulty with their night vision, and 3% notice some loss of peripheral vision. Injection treatment: Injections can help in certain types of diabetic retinopathy by reducing leakage in the retina.This type of retinopathy is called diabetic maculopathy. Initial stages of diabetic maculopathy may be treated with laser. However in some instances or later stages, injections may be more helpful. The injections of drugs called Ranibizumab (Lucentis®), Bevazicumab (Avastin®), Afiblicept (Eyelea®), Triamcinolone or Flucinolone acetate (Illuvien®) are usually used depending on circumstances. You should talk to your doctor about these as each of these will have risks and benefits, which will need to be considered on a case to case basis. Seek medical advice if you experience any new eye problems following treatment. Disclaimer: This information leaflet is produced to help increase awareness regarding diabetic retinopathy. It is not intended to replace professional medical advice or to provide advice in any special individual circumstance. Please seek expert medical advice regarding your specific medical condition. Draft version 1.2 /MUS Sources: http://www.cks.nhs.uk/patient_information_leaflet/diabetic_retinopathy
    Laser treatments and what to expect

    YAG laser may be used to create a small opening in a thickened capsule
    (membrane), just behind the artificial lens of the eye (after cataract surgery).
    There are no special preparations before eye laser treatment. You should eat
    normally and take your regularly prescribed medications before surgery.
    Nd-YAG laser capsulotomy (laser surgery) is performed in the consulting room or a
    special laser room.
    Eye drops will be given to dilate the pupil and numb the eye. The treatment is
    performed while you are seated in a chair, similar to the one used for regular eye
    examinations. You will remain awake and comfortable.
    Treatment is usually painless.
    The treatment generally takes 5 to 10 minutes after starting the procedure.
    Most people will notice improved vision approximately 3-4 hours after the procedure
    ( if there is no other eye condition affecting the eye or vision)
    Almost all patients can expect floaters. These floaters usually settle down after a few
    weeks and become less troublesome. Some floaters may take a few months and in
    very rare patients remain permanent.
    You may expect improvement in vision. In particular the brightness, colour and
    contrast should improve.
    Post operative medications are usually not required in a significant proportion of
    patients. In some patients drops and tablets may be required for a few days after the
    laser treatment. This may depend on your individual circumstances and the doctor’s
    preference. The surgeon will write you a prescription only if it is required.
    There are virtually no restrictions following retinal laser surgery, and you should be
    able to resume your normal activities and work schedule the following day.


    Disclaimer: This information leaflet is produced to help increase awareness in patient s undergoing laser
    treatments. It is not intended to replace professional medical advice or to provide advice in any special
    individual circumstance. Please seek expert medical advice regarding your specific medical condition.

    YAG laser may be used to create a small opening in a the iris (which is the coloured
    part of the eye). In simple terms, this creates improved flow of fluids inside the eye
    and reduces chances of sudden rise in eye pressure called acute glaucoma. Acute
    glaucoma is a serious condition which can cause permanent loss of sight within 48
    hours if left untreated.
    There are no special preparations before eye laser treatment. You should eat
    normally and take your regularly prescribed medications before surgery.
    Nd-YAG laser iridotomy (laser surgery to make a hole in the iris) is performed in the
    consulting room or a special laser room.
    Eye drops will be given to dilate the pupil and numb the eye. The treatment is
    performed while you are seated in a chair, similar to the one used for regular eye
    examinations. You will remain awake and comfortable.
    Treatment is usually painless but some patients can have mild discomfort.
    The treatment generally takes 5 to 10 minutes after starting the procedure.
    Most patients notice no vision changes following their laser surgery, although there
    may be some temporary blurring for a few days or weeks. Some patients may have a
    gritty sensation in the eyes for a few days which usually settles down with drops.
    It will take several weeks to months before we can tell whether the laser surgery has
    been successful.
    Post operative medications are usually required. These include drops and
    occasionally tablets for a few days after the laser treatment.
    There are virtually no restrictions following laser surgery, and you should be able to
    resume your normal activities and work schedule the following day.
    If the pressure becomes high you may experience, eye pain and redness with
    decreased vision. The YAG iridotomy is to try and reduce the chances of such a
    pressure rise. If the treatment is successful the chances of a pressure rise are
    reduced but not to zero. You can still have an episode of raised pressure in the eye
    called acute glaucoma. If this happens please contact the closest ophthalmic eye
    casualty to start immediate treatment.


    Disclaimer: This information leaflet is produced to help increase awareness in patient s undergoing laser
    treatments. It is not intended to replace professional medical advice or to provide advice in any special
    individual circumstance. Please seek expert medical advice regarding your specific medical condition.

    There are no special preparations before eye laser treatment. You should eat
    normally and take your regularly prescribed medications before surgery.
    Retinal laser surgery is performed in the consulting room or a special laser room.
    Eye drops will be given to dilate the pupil and numb the eye. The treatment is
    performed while you are seated in a chair, similar to the one used for regular eye
    examinations. You will remain awake and comfortable.
    Treatment is usually painless, although some patients may require a numbing
    injection for discomfort or sensitivity to the laser light. Patients who have laser
    treatment for diabetic retinopathy may experience more discomfort towards the end
    of a laser treatment session.
    The laser treatment usually takes less than 30 minutes to complete, and you can go
    home immediately following surgery.
    Arrangements for transportation should be made in advance since you may not be
    able to drive right away.
    You may expect blurred vision for the rest of the day after laser treatment.
    There are virtually no restrictions following retinal laser surgery, and you should be
    able to resume your normal activities and work schedule the following day.
    Most patients notice no vision changes following their laser surgery, although there
    may be some temporary blurring for several weeks to months. In addition, depending
    on the condition being treated, some may notice a permanent blind spot or decrease
    in peripheral and night vision.
    It will take several weeks to months before we can tell whether the laser surgery has
    been successful.
    Many patients, however, will need more than one treatment to control their eye
    problem and prevent further loss of vision.


    Disclaimer: This information leaflet is produced to help increase awareness in patient s undergoing retinal
    laser. It is not intended to replace professional medical advice or to provide advice in any special individual
    circumstance. Please seek expert medical advice regarding your specific medical condition.

    Miscellaneous
    Questions About
    Miscellaneous

    Questions About

    • Floaters are extremely common over the age of the age of 65, with 50% of over 65 experiencing
      floaters.
      Early stage of floaters can be extremely worrying.
    Symptoms

    In some cases, the only noticeable symptom is a sudden appearance of a floater.
    In most cases, the floater can be preceded by or accompanied by flashing lights.

    Symptoms of may include:

     discoloured spots (known as floaters that ‘float’ in your field of vision)
     Floaters which moves around in your field of vision and may be like a cobweb, a fly, a
    tadpole or any other random shape
     Flashing lights

    Why do floaters form?

    Over time, the jelly of the eye undergoes changes. Some parts of the jelly of the eye become
    thinner and some other parts become thicker. The jelly which previously was well formed breaks
    up and separates from the retina. The separation phase can cause the symptoms of flashes. You
    may expect the flashes phase to last up to a few months after which they will subside.
    The floaters will persist but will become less noticeable as your brain gets used to them.

    Can they be treated?

    In most instances, floaters are not treated. Your brain simply adapts to their presence and ignores
    them.
    Occasionally, if floaters become troublesome, an operation called Vitrectomy may be offered. This
    is major surgery and has its own risks. You should talk to your doctor and carefully consider this
    option.
    Can floaters cause further problems?
    In 1 % to 10% of patients (depending on the risk factors), floaters can be a sign of a problem called
    a retinal tear or a retinal detachment. The likelihood of this particular problem depends on some

    risk factors which may or may not be present in your eye.
    A retinal tear or a retinal detachment is a serious problem that can cause blindness.
    A retinal tear or detachment may require urgent laser treatment or surgical treatment or both. The
    urgency depends upon the size of the tear and the amount of retinal detachment.
    What should I do if I notice floaters?
    You should go to your local eye doctor and have a full eye check up called dilated fundal
    examination. Your pupils will be dilated (and vision becomes blurred for a few hours), and then the
    doctor will examine your retina and vitreous.
    What are the danger signs?
    If you notice:
     New floaters
     Flashing lights
     Visual loss
     Visual field loss
     A curtain falling on your eye through which you cannot see
    If you notice any of the above, see your eye doctor immediately.
    Seek medical advice if you experience any new eye problems following treatment.


    Disclaimer: This information leaflet is produced to help increase awareness regarding floaters. It is not intended to
    replace professional medical advice or to provide advice in any special individual circumstance. Please seek expert
    medical advice regarding your specific medical condition

    Fluorescein angiography is a specialised dye test to discover specific abnormalities
    in the retina. A dye, called Fluorescein, is injected into the vein of your arm and
    photographs of the back of the eye are taken. The FFA test gives your doctor more
    information about the condition of your retina in the back of your eye. ICG test
    provides information about the choroid which lies underneath the retina.
    The tests help the doctor to consider the best treatment options for you.
    Please tell us if you have any chest or breathing problems. It is also very important to
    inform us of any allergies particularly to shellfish, medications, fluorescein,
    sulpha drugs or latex.
    Your vision will be tested. Your pupils will then be dilated with eye drops; these drops
    might blur your vision for 3 to 6 hours. It is therefore advisable not to drive home
    after your appointment. Once your pupils are dilated, you will be taken into the
    fluorescein photography room. You will be seated at a camera with your arm
    supported, and some photos will be taken. A cannula (small plastic tube) will be
    inserted into a vein. The fluorescein dye will be injected into your arm while a series
    of photos are taken as the dye enters the vessels at the back of your eye.
    The whole test only takes about 10 – 30 minutes, but please expect to be in the
    department for one to two hours so that we can do the necessary pre and post test
    checks.
    The fluorescein dye will give your skin a yellow tinge and your urine will be bright
    yellow for a few days. You might experience a hot flush sensation as the dye is
    injected, One in 10 patients might feel nauseous or short of breath, or develop a
    transient rash, but this rarely lasts for more than a few seconds. There is a very
    remote risk of a severe allergic reaction to these intravenous drugs. For this reason,
    an emergency resuscitation team is always available.
    The cannula will be left in your hand for half an hour. Once we are certain that you
    have not suffered any adverse reactions, the cannula will be removed.

    Associated risks with Fluorescein angiography

    Fluorescein angiography may be associated with any of the following risks:
     Yellow colour change of skin and urine – this affects everyone and lasts 24
    hours.
     Nausea – may develop 30 seconds or so after injection, but often passes
    quite quickly.
     Vomiting – rarely follows nausea and again resolves quickly.
     Fainting or dizziness
     Temporary dazzling
     Temporary rose coloured vision
     Allergy reactions: These are very rare. The most common allergy reaction is
    an itchy skin rash known as hives. In very exceptional circumstances severe
    and life threatening allergy reactions can occur resulting in hospitalisation or
    even rarely in death. (Risk less than 1 in 50,000).
    Associated risks with ICG angiography
     Same as above but the dye does not make the skin or urine yellow
     ICG angiogram is thought to have less adverse effects than fluorescein
    angiogram.
     ICG angiogram does not give the same information as the Fluorescein
    angiogram therefore sometimes both tests may be necessary
    You must not have fluorescein angiography if you are pregnant – please tell your
    Doctor.
    Please inform your Doctor if you have had any reaction to fluorescein angiography
    on a previous occasion.
    The doctor will discuss the results with you at your next consultation or will write to
    you and your GP and make recommendations for any treatment you might need.

    What is OCT?
    OCT is short for Ocular Coherence Tomography. It is a technology used to scan the
    retina, optic nerve, macula, cornea and the irido-corneal angle of the eye. The scan is
    non invasive and shows the area of interest in great detail and usually in layers.
    Why do I need a scan?
    A retinal scan is a great way of finding about retinal diseases that may otherwise
    remain undetected if no scan is done. Subtle changes in the retinal structure can be
    detected much sooner than the human eye is able to detect. Objective
    measurements can also be performed and scans done can show changes from
    previously done scans.
    When is it used
    Retinal OCT scans are usually requested when patients have retinal diseases like
    macular degeneration, retinal vein occlusions or diabetic retinopathy.
    OCT can also be useful in other retinal conditions which may detect macular odema
    or macular pathology.
    OCT scans for the optic nerve are used in glaucoma detection or optic nerve
    swelling detection.
    What does a scan look like

    Scan of optic nerve Scan of the retina and macula (Normal)

    Disclaimer: This information leaflet is produced to help increase awareness regarding uveitis It is not
    intended to replace professional medical advice or to provide advice in any special individual
    circumstance. Please seek expert medical advice regarding your specific medical condition

    What is iritis or uveitis?
    The iris is the coloured part of your eye, and iritis simply means that this has become
    inflamed. This usually causes misty vision, redness of the eye and a dull ache which is
    worse in bright light.
    Why have I got iritis?
    In many people the cause of iritis is unknown. Sometimes people get iritis in association
    with other conditions like arthritis and autoimmune conditions. If you have repeated
    attacks, you may have some tests done to see if there is any associated general health
    condition.
    Can Iritis cause blindness?
    Iritis or uveitis can cause loss of sight by several mechanisms. It can cause
    cataracts, raised pressure in the eye, damage to the optic nerve, damage to the
    retina, extremely low pressure in the eye, and corneal problems. Sight can be lost
    permanently by any of these mechanisms. It is therefore essential that you seek
    professional help consulting by an eye doctor with a special interest in uveitis.
    How is iritis treated?
    Most people with iritis respond to eye drops within a few weeks. The drops used are:
    (1) Steroids; These drops are given throughout the day as eye drops (such as Maxidex
    or Predforte) and at night as a longer action cream (eg, Betnesol). The frequency and
    the amount of eye drops is usually determined by your eye doctor keeping in mind the
    severity of iritis. As your symptoms improve your doctor will suggest that you gradually
    reduce the number of drops you use each day.
    (2) Drops to dilate the pupil (such as atropine or cyclopentolate). These make the vision
    blurred but usually take the pain away. They are usually necessary in the early stages of
    a uveitis / iritis episode and make the eye feel more comfortable. They also reduce the
    chances of damaging complications.

    Severe Iritis
    In severe uveitis, patients may need injections around the eye. These are usually
    steroid injections. These can be given in or around the eyeball.
    Occasionally patients need steroids in a tablet form. These are usually reserved for
    very severe cases of uveitis with retinal complications. The side effects of high dose
    oral steroids can be severe, so please ask your doctor if you think that you are
    having problems with high dose oral steroids.
    Very severe iritis / uveitis
    Some patients with very severe uveitis will need oral steroids followed by steroid
    sparing agents. These may be drugs like Methotrexate, Infliximab, adalilumab,
    cyclosporine and Azathioprine. Sometimes these drugs are also used in cancer
    treatments.
    Will the iritis come back again?
    Iritis tends to recur and it is important that you go to eye unit if your symptoms return,
    so that you can be treated promptly.

    What are Mr Ijaz Sheikh credentials in treating uveitis?
    Mr Ijaz Sheikh has a lot of experience in treating uveitis patients. He runs a weekly uveitis clinic in St
    Helier hospital London to treat uveitis patients. He set up the Liverpool Uveitis database and
    Liverpool paediatric Uveitis database. He has several publications in the field of uveitis.


    Disclaimer: This information leaflet is produced to help increase awareness regarding uveitis
    It is not intended to replace professional medical advice or to provide advice in any special
    individual circumstance. Please seek expert medical advice regarding your specific medical
    condition.

    Blepharitis is a condition where the edges of the eyelids become inflamed (red and
    swollen).
    It is a common condition, accounting for an estimated 1 in 20 eye problems. Blepharitis
    can develop at any age, but is more common in people over 40.
    Signs of blepharitis can include:
     itchy and sore eyelids
     eyelids that stick together and are difficult to open
     eyelashes that become crusty or greasy
    Blepharitis can be caused
     by an infection with bacteria
     seborrhoeic dermatitis – (oily or flaky skin)
     rosacea – (red and blotchy skin)
    Blepharitis is not contagious.
    Blepharitis is usually a long-term condition.
    Most people experience repeated episodes, separated by periods without symptoms.
    Blepharitis cannot usually be cured, but a daily eyelid-cleaning routine that involves
    applying a warm compress – gently massaging your eyelids and wiping away any crusts –
    can help control the symptoms.
    Sometimes antibiotics and mild steroids are needed to treat these. They should be taken
    only with consultation with an ophthalmologist. More severe cases may require oral
    antibiotics.
    Shampooing the eyelids
    Taking a mild baby shampoo and shampooing the eyelid margins once or twice a week
    may be helpful. Take care not to let any shampoo get in the eye itself and just shampoo
    the eyelashes. Remove any crusts if you can.
    Warm compresses
    Take a warm flannel and apply it to the lids affected for a few minutes. The flannel should
    be warm and comfortable. Do not apply a hot flannel to the eyelids. Massage the eyelids
    as you keep the warm flannel on the eye. This will help the oily secretions and oily tears to
    flow much better.


    Disclaimer: This information leaflet is produced to help increase awareness regarding blepharitis. It is not intended to replace
    professional medical advice or to provide advice in any special individual circumstance. Please seek expert medical advice regarding
    your specific medical condition.

    A chalazion is a firm round lump in the upper or lower eyelid caused by a chronic
    inflammation/blockage of the meibomian gland. It can sometimes be mistaken for a stye.
    Eyelid glands are called the meibomian glands. There are 30-40 of these glands in each of
    the upper and lower lids. These glands produce an oily secretion which is mixed into the
    tear film of the eye and provides eye surface lubrication. The tiny openings of each of these
    oil or sebaceous glands are just behind the eyelashes at the lid margins of both the upper
    and lower eyelids.
    The narrow opening through which a meibomian gland secretes its material can become
    clogged from narrowing of the opening or hardening of the sebaceous liquid near the
    opening. This can happen because of dead cells, eyelashes, inflammation or low grade
    infections on the eyelid surface. If this occurs, the gland will have a backup of the material it
    secretes and the obstructed gland will swell. This leads to thickening of the walls of the
    gland and leakage of oil into the lid itself, causing inflammation both within the gland and
    the eyelid. This inflamed enlargement is a chalazion.
    A chalazion may present as an eyelid swelling or lump, eyelid tenderness or heaviness of the
    eyelid. Sometimes, as it presses on the surface of the eye, it can cause blurred vision.
    If a chalazion is inflamed, it can cause a red, watering and sore eye

    Treatment
    Treatment involves cleaning and warm compresses to the eyelid. Apply a warm compress
    which can be used to increase drainage of the affected gland. Gently massage after warm
    compress to help to express the contents of the cyst.
    If acutely inflamed, the patient may need antibiotic ointments and mild steroid drops for a
    few weeks. Please contact your doctor who will prescribe this for you if needed.
    Upto 50% Chalazia will disappear with the above treatment over the course of a few
    months.
    If conservative therapy fails, chalazia can be treated by a surgical procedure under local
    anaesthetic. This is called incision and curettage. The procedure can take upto 10 minutes
    once started. This procedure involves a surgical incision into the tarsal gland followed by
    curettage of the retained secretions and inflammatory material under local anaesthetic.

    Disclaimer: This information leaflet is produced to help increase awareness regarding chalazion. It is not
    intended to replace professional medical advice or to provide advice in any special individual circumstance.
    Please seek expert medical advice regarding your specific medical condition.

    Dry eye is a common condition that occurs when the eyes do not make enough tears or
    the tears evaporate too quickly.
    This leads to the eyes drying out and becoming inflamed (red and swollen) and irritated.
    The symptoms of dry eye syndrome usually affect both eyes and often include:
     feelings of dryness, grittiness or soreness that get worse throughout the day
     red eyes
     eyelids that stick together when you wake up
     temporarily blurred vision, which usually improves when you blink
    Dry eye syndrome can occur when the complex tear production process is disrupted in
    some way. There are many different reasons why this can happen, although a single
    identifiable cause is not often found.
    Common causes include:
     being in a hot or windy climate
     wearing contact lenses
     certain underlying medical conditions, such as blepharitis (inflammation of the
    eyelids)
     side effects of certain medications
     hormonal changes, such as during the menopause (when a woman’s periods stop)
    Although the condition can affect people of any age, your chances of developing dry eye
    syndrome increase as you get older. It’s estimated that up to one in every three people
    over the age of 65 experiences problems with dry eyes.
    Dry eye syndrome is also more common in women than men.
    Dry eye syndrome is not usually a serious condition.
    Treatments are available to help relieve the symptoms, which include eye drops to
    lubricate the eyes, medications to reduce any inflammation, and (if necessary) surgery to
    prevent tears from draining away easily.
    If dry eye syndrome is caused by an underlying condition, treating this condition will
    usually help relieve the symptoms.
    As well as medical treatments, there are some things you can do yourself to help prevent
    dry eye syndrome or reduce the symptoms.
    These include:
     keeping your eyes and eyelids clean and protecting them from dusty, smoky, windy
    and dry environments
     using your computer or laptop correctly to avoid eye strain
     using a humidifier to moisten the air
     eating a healthy diet that includes omega-3 fats

    Dry eye syndrome may be uncomfortable, but does not usually cause any serious
    problems. In rare cases, severe untreated dry eye syndrome can cause scarring of the
    eye’s surface, leading to visual impairment.
    Contact your GP or visit your nearest accident and emergency (A&E) department
    immediately if you have any of the following symptoms, as they could be a sign of a more
    serious condition:
     extreme sensitivity to light (photophobia)
     very red or painful eyes
     a deterioration in your vision


    Disclaimer: This information leaflet is produced to help increase awareness regarding blepharitis. It is not intended to replace
    professional medical advice or to provide advice in any special individual circumstance. Please seek expert medical advice regarding
    your specific medical condition.

    Glaucoma is a lifelong disease where a high pressure inside the eye results in damage to the
    optic nerve and loss of vision. It cannot be cured but can, in most people, be controlled. The
    pressure inside the eyeball depends on production of a clear fluid (called aqueous humour)
    which circulates through the eye and drains out of the natural drainage system called the
    trabecular meshwork.
    In some patients, this drainage system will be affected if the front part of the eye is narrow.
    Sometimes in some patients this drainage site may be totally closed leading to a sharp rise of
    the intraocular pressure causing severe eye pain, vomiting and sometimes abdominal pain. This
    leads to permanent and irreversible loss of sight if untreated. Laser peripheral iridotomy reduces
    the risk of this by creating a hole in the iris to bypass the closure and reduce the pressure in the
    eye.
    The Procedure
    Peripheral Iridotomy is performed in the laser clinic. The laser treatment itself takes
    approximately 10 minutes per eye. You will need a one-off dose of eye drops, including
    Pilocarpine 2% eye drops, approximately 15 minutes beforehand, so be prepared for an
    appointment lasting an hour. The drops can blur your vision slightly and some patients report a
    slight headache after use.
    The procedure involves a machine much like the one used in the main clinic. A local
    anaesthetic eye drop is used to allow a contact lens to be positioned on the eye. This will be
    held in place by the doctor performing the procedure and is removed at the end of procedure.
    The treatment does not hurt and afterwards the eye may be somewhat dazzled by the bright
    light but this will fully resolve within 30 minutes.
    Usually one eye is done at a time and sometimes one eye may need more laser power that the
    other eye, this is normal.
    After the procedure
    After the treatment, a single eye drop will be administered by your doctor to prevent a transient
    rise in your intraocular pressure. You will be given a prescription for a week long course of antiinflammatory eye drops to be used 3 -4 times per day. Depending upon circumstances, you will
    be seen in the Clinic usually 1 week after the procedure.

    A letter will be sent to your GP explaining the treatment you have had and details of your followup appointment.
    Dos and Don’ts after laser peripheral iridotomy
    Watch television, read and write as normal.
    Go back to work should you need to, although be aware that the Pilocarpine eye drop used
    might blur your vision slightly.
    Don’t restrict your physical exertion, there is no need
    Don’t be concerned if your vision is markedly affected immediately after the treatment – this is
    normal and is due to the bright light used. It will settle spontaneously within 30 minutes to 24
    hours.
    Risks of peripheral iridotomy
    No medical procedure is entirely risk-free but YAG Peripheral Iridotomy has very few side
    effects or complications.
     Transient pressure rise post-procedure – as mentioned above, an eye drop will be
    administered by the doctor performing your procedure immediately before and afterwards
    to prevent this
     Inflammation – a certain amount of inflammation is required for the treatment to work but
    you will be given a prescription for some anti-inflammatory eye drops to settle things down
    after the treatment.
     Sometimes treatment can cause a transient small amount of bleeding – usually controlled
    by slight increase of pressure of the contact lens to stop bleeding.
     The treatment is usually only done once – rarely laser treatment may need to be repeated
    on another day to achieve full thickness hole in the iris.
     Laser iridotomy reduces the risk of acute angle closure glaucoma and therefore sight loss.
    The risk is not reduced to zero. It is therefore possible to get acute glaucoma even in an
    eye that has been adequately treated.
    ____________________________________________________________________________
    Disclaimer: Medical information is merely information – not advice. If users need medical
    advice, they should consult a doctor or other appropriate medical professional. No warranties
    are given in relation to the medical information supplied on the website, and that no liability
    will accrue to the website owner in the event that a user suffers loss as a result of reliance
    upon the information.

    Punctal plugs are tiny devices inserted into tear ducts to block drainage of tears. This increases
    the eye’s tear film and surface moisture to relieve dry eyes.
    Also known as punctum plugs, lacrimal plugs or occluders, these devices often are no larger than
    a grain of rice.
    Punctal plugs usually are considered when lubricating eye drops fail to relieve your dry eye
    condition.
    How are punctal plugs inserted in tear ducts?
    Many eye doctors need only a lighted, close-up examination of your eye to determine the size
    and type of punctal plug you need. In some cases, a one-size-fits-all style of punctal plug may be
    used. In others, a sized punctal plug will be needed.
    To prepare you for the procedure, some eye doctors use a local anesthetic drop before inserting
    the punctal plug. In many cases, no anesthetic is needed.
    Each eyelid has one punctum, located at its inner margin near the nose. Punctal plugs can be
    inserted in the puncta of the lower lids, the upper lids or both. An instrument may be used to
    dilate the tear duct opening for easier insertion.
    Many punctal plugs are pre-packaged with disposable devices that help your eye doctor insert
    the plug. Some punctal plugs are inserted just into the puncta so they still can be seen and
    mechanically removed if necessary.
    Other than slight initial discomfort, you should not feel the punctal plug once it is in place.
    Immediately after the procedure, you should be able to drive yourself home and resume normal
    activities.

    Punctal plugs side effects and problems
    Usually, punctal plug insertion is uneventful and rarely involves serious side effects or problems.
    Excessive tearing (epiphora) and watery eyes can occur when the punctal plug does its job too
    well. In this case, you may need to visit your eye doctor for removal of the plug or replacement
    with a different type to better control the amount of tears on your eye.
    Displacement or loss of the plug is common and can occur for many reasons, such as when
    people rub their eyes and accidentally dislodge the device. Some types of punctal plugs in
    particular are more likely to become dislodged and fall out. You will need to visit your eye doctor
    to receive a replacement punctal plug.
    Eye infections may occur, though rarely, in association with the devices. In these cases, you may
    need treatment with topical antibiotics, oral antibiotics and/or removal of the punctum plug.
    Other uncommon complications can occur when the plug unexpectedly migrates outside the
    target area and deeper into the eye’s drainage channels. This can create blockages leading to
    conditions such as dacryocystitis, with swelling, pain and discomfort.
    When should punctal plugs be removed?
    While semi-permanent punctal plugs can last indefinitely, they also are easily removed.If you get
    excessive tearing and you feel that you no longer need them , they can be removed.

    When seeing an eye doctor, it is sometimes necessary to examine the retina. In occasional
    cases, the doctor may be able to look through the pupil and examine the retina and the optic
    nerve if your pupil is naturally large. However in most cases and especially if the doctor needs to
    see your peripheral retina (at the back of your eye), eye drops may need to be put in to dilate the
    pupil.
    Looking through the pupil is like looking through a keyhole. If the keyhole is small it will be
    difficult to see whats on the other side. If the keyhole is large, it will be easier to see and it will be
    possible to see more on the other side. If the pupil is large, it becomes easier to see the retina
    and also more of the retina can be seen by the doctor.
    Doctors will usually prescribe and then put in drops called 2.5% phenyl epinephrine and 1%
    tropicamide eye drops. Occasionally trained optometrists and nurses may also have
    qualifications to put in these eye drops. The drops can sting for 1-2 minutes but afterwards the
    eye becomes comfortable.
    After 10 to 15 minutes, the pupil usually dilates. The duration it takes to dilate can be very
    variable with some people having a dilated pupil in 5 minutes and in some other people it can
    take as long as 30-40 minutes.
    People usually feel that the near vision becomes blurred after the pupil dilates. The effect can be
    variable and some people feel distance vision is blurred as well.
    After the doctor has examined the eye you can go home. Do not drive until you feel that your
    vision is good enough. It’s usually a good idea for someone else to drive and take you home.
    The pupil will usually take 3-6 hours to come back to its proper size and reactive state. Again the
    duration can be variable depending upon the individual. Some people will have minimal problems
    and the vision will return to normal within an hour or two. In others, visual blurring may persist for
    5-6 hours. It is unusual for visual blurring to persist for more than 6 hours.

    Very few people (less than 1%) may develop significantly raised pressure in the eye after pupil
    dilation. If this happens, patients may experience pain, redness and blurred vision. In this case,
    the doctor should be contacted immediately.


    Disclaimer: Medical information is merely information – not advice. If users need medical advice,
    they should consult a doctor or other appropriate medical professional. No warranties are given in
    relation to the medical information supplied on the website, and that no liability will accrue to the
    website owner in the event that a user suffers loss as a result of reliance upon the information.

    Conjunctivitis means inflammation of the conjunctiva.
    This usually means a red eye.
    There are a lot of causes of a red eye and conjunctivitis is one of them.
    There may be many types of conjunctivitis –
    Allergic conjunctivitis – caused by allergies and can cause a red eye off and on for months to
    years
    Bacterial conjunctivitis – caused by bacteria and can cause a sore red eye with discharge and
    swelling. This may require antibiotic drops.
    Viral Conjunctivitis – caused by viruses and results in a sore red eye with watery discharge and
    swelling. This is not helped by antibiotic drops. It can spread very quickly to other members of
    the family or anyone who is in contact with the patient.
    You must go to your eye doctor and a slit-lamp examination.
    This will help diagnosing the subtype of conjunctivitis and treat it appropriately as treatment of
    each of these subtypes is radically different.
    General precautions in helping the spread of infectious conjunctivitis (bacteria or viral)
    1. Wash hands frequently specially before putting in eye drops
    2. Keep hand towel separate and do not let other members of the family use it
    3. Do not touch the unaffected eye
    4. Use tissues and then throw them away in the bin ( disposable tissues)
    5. Change pillowcases frequently and don’t let other members of the family use your pillow


    Disclaimer: Medical information is merely information – not advice. If users need medical advice,
    they should consult a doctor or other appropriate medical professional. No warranties are given in
    relation to the medical information supplied on the website, and that no liability will accrue to the
    website owner in the event that a user suffers loss as a result of reliance upon the information.

    Routine advice after Blepharoplasty

    for Mr Ijaz Sheikh patients

    • A varying amount of temporary swelling and discoloration follows this procedure. This can vary from
      minor swelling to quite significant bruising.
      AFTER YOUR OPERATION: You can help normal healing to occur several ways:
      1. Continue to take the antibiotic ointment given to you until you run out. Usually after a week no
      more is needed.
      2. Sleep with your head elevated 30 to 40 degrees for one week; use an additional pillow or two
      under your mattress, if necessary.
      3. Apply cool compresses made of face towels (usually face towels over a bag of frozen peas is a
      good idea) to your eyes for twenty-minute periods every 4 hours while awake during the first three
      days after surgery.
      4. Try to stay upright with the head above the rest of your body (sitting, standing, walking around) as
      much as possible after you return home.
      5. Avoid bending over or lifting heavy things for one week.
      6. Avoid straining at stool, which also raises the blood pressure.
      7. Avoid hitting or bumping your face and eyes.
      8. Avoid excessive exposure to sun for prolonged periods during the first 30 days following
      operation. Wear a hat if necessary. In the UK, this usually isn’t a problem.
      9. You may have your hair washed twenty-four hours after sutures are removed.
      10. You may have a shower day after surgery, but avoid getting the eyes wet. The face may be gently
      cleansed with cotton pads.
      12. Do not resume exercising, running, or swimming for 3-4 weeks after surgery.

    bleeding occurs, go to bed, elevate the head, apply cold compresses over the eyes, and
    have someone report it to us by telephone.

    If you get a fever, please report to the hospital immediately.

    MR IJAZ SHEIKH will arrange suture removal for you usually a week to 2 weeks after your
    surgery. This will depend upon the type of suture used and your personality.
    During the first several days following surgery, there will be significant swelling and perhaps bruising
    as well. Scars will start to form but these will be in the lines of skin creases and hence will usually be
    hidden within the natural lines of the face and lids. As the wound edges start healing, they go
    through a period of slight swelling and reddening; later, this subsides and the scar becomes less prominent. This is the way normal scars mature. Lumpiness of the scars is usually temporary and will
    subside with the passage of time. Cosmetics or cortisone creams may be used to minimize the
    problem while the progressive evolution is occurring.


    Disclaimer: This information leaflet is produced to help patients recover after a blepharoplasty procedure. It is
    not intended to replace professional medical advice or to provide advice in any special individual circumstance.
    Please seek expert medical advice regarding your specific medical condition.