Punctal Plugs

The use of punctal plugs can be an effective step in treating moderate to severe dry eye that is unresponsive to artificial tear drops and ointments. The tears drain into the nose via the tear ducts and blocking this outflow is a reasonable strategy to keep the tears in the eye for a longer time. The term 'puncta' refers to the opening of the tear ducts on the eyelid margin.

Plugs that can be inserted inside the tear ducts to block them are called 'punctal plugs'. Punctal plugs increase the comfort level and lower the frequency of artificial tear use in most dry eye patients. The decreased artificial tear use may be economically beneficial, considering the high cost of preservative-free artificial tears.

Chalazion Removal

SLT (Selective laser trabeculoplasty – Laser Treatment for Glaucoma)

Selective Laser Trabeculoplasty is clinically proven to treat glaucoma by safely and effectively reducing intraocular pressure in a single, office procedure. SLT can be an effective adjunct to medication therapy or used as a primary treatment to reduce or eliminate the need for topical glaucoma medications, along with their common systemic side effects. SLT has the potential to save patients thousands of dollars in prescription medication costs and improve compliance.
SLT protects trabecular meshwork against thermal or coagulative effects by selectively targeting only the pigmented cells and preserving surrounding tissue.

Laser Peripheral Iridotomy (LPI)

YAG Capsulotomy

The modern technique of cataract surgery involves removing the cloudy contents of the eye's natural lens, while leaving the clear outer membrane (called the capsule) to hold the new intraocular lens in place.

This capsule has cells on it which will, in some cases, continue to produce lens fibers. These fibers cannot be laid down in an organized manner and will form little beads or "pearls" on the lens capsule, forming a secondary membrane. When these pearls accumulate in the pupil, they cause a blurring of vision similar to that which one experiences with a cataract. This occurs approximately 30-40% of the time and can appear at any time after surgery, even as much as five or more years later.

Although the blurred vision produced by this membrane can be quite significant, fortunately, there is a very easy way of clearing the pupil of this cloudy capsule. During the procedure, called YAG Laser Capsulotomy, a special laser (Yttrium Aluminum Garnet) is used. There is absolutely no pain involved in this procedure and patients can resume their normal activities quickly. The patient will usually notice an improvement as soon as the pupil, which is dilated, goes back to its normal size.

Pterygium Surgery

The conjunctiva lines the inside of the lids and covers the sclera (white part of eye). The cornea lies in front of the colored part of the eye (iris). A pterygium is a slightly elevated, superficial, wing-shaped, fleshy conjunctival growth that covers and alters the shape of the cornea. It may be yellow, gray, white, pink, red, or even colorless. It may have blood vessels. Pterygium may be small or grow large enough to interfere with vision. Most patients with pterygium express concern regarding the appearance of the lesion, or because the lesion is irritating the eye or it is adversely affecting vision. Typically, the pterygium is first noticed on the conjunctiva, and then is noted to gradually grow onto the cornea of the eye. When the growth is confined to the conjunctiva, it is known as a pingueculum. When it extends onto the cornea it is called a pterygium. Left alone, some pterygia will eventually grow to obscure the optical center of the cornea, thereby obstructing vision. Facts about Pterygium

• A pingueculum may develop into a pterygium.
• Commonly found in individuals who spend a lot of time in the sun or live in dry, windy, smoky, dusty, sandy tropical climates.
• Reported to occur in males twice as frequently as in females.
• Almost always confined to the exposed surface of the conjunctiva, and usually on the side closest to the nose. Less often, it can also occur on the outer side of the cornea.
• One or both eyes may be involved.
• Some pterygia grow slowly throughout a person's life, while others stop growing after a certain point.
• Pterygium is alteration of normal tissue resulting in a deposit of protein and fat.
• Usually a pterygium does not lead to anything catastrophic such as a serious loss of vision or blindness.
• Can eventually distort vision due to growth onto the cornea, and eventually even onto the central part of the eye blocking light from entering.
• Removing a pterygium surgically typically resolves the problem.

Entropion

• Aging
• Chemical burn
• Infection with trachoma

• The conjunctiva and cornea can become sore due to the eyelashes rubbing against them.
• Watery eyes.
• Damaged cornea. A corneal ulcer may develop. The cornea is vital for vision and a damaged cornea may affect eyesight.

A physical examination of the eyes and eyelids confirms the diagnosis.

Ectropion

• A defect that occurs before birth (for example, in children with Down syndrome)
• Facial palsy
• Scar tissue from burns

• The inner lining of the eyelid that droops forward may become dry and sore.
• Watery eyes. The drooping eyelid may prevent the tears from reaching the tear duct and the eye may become constantly watery.
• Damaged cornea. The eyes may not close properly. Therefore the cornea (the front of the eye) is not fully protected and may get damaged. A corneal ulcer may develop. The cornea is vital for vision and a damaged cornea may affect eyesight.

A physical examination of the eyes and eyelids confirms the diagnosis.

Ptosis Surgery

Ptosis may be caused by damage/trauma to the muscle which raises the eyelid, or damage to the nerve (3rd cranial nerve (oculomotor nerve)) which controls this muscle. Such damage could be a sign or symptom of an underlying disease such as diabetes mellitus, a brain tumor, and diseases which may cause weakness in muscles or nerve damage, such as myasthenia gravis. Ptosis is also called "drooping eyelid."

• Drooping of one or both eyelids
• Increased tearing
• If ptosis is severe, interference with vision.

Ptosis may require surgical correction if severe enough to interfere with vision or if cosmesis is a concern. Treatment depends on the type of ptosis and is usually performed by an ophthamolic plastic and reconstructive surgeon, specializing in diseases and problems of the eyelid.

Cataract Surgery

A cataract is a clouding of the natural lens inside the eye. Cataracts are the leading cause of treatable blindness in all areas of the world, especially in adults 55 and older. Contrary to popular belief, a cataract is not a "film" over the eye. Rather it is a gradual thickening of the lens that causes the lens to become so clouded that light is either distorted or cannot reach the back of the eye (the retina) for transmission to the brain. When left untreated, cataracts will eventually cause blindness in most cases.

As the eye ages, cataracts can often develop. Age–related cataracts develop very slowly and painlessly. In fact, we may not even realize that our vision is changing until we find ourselves going to the eye doctor seeking a change in our eyeglass or contact lens prescription. It is often during one of these routine trips that the doctor will perform an eye examination and ask if we are experiencing any of the symptoms, blurry or dim vision, colors appearing faded, poor night vision, halos appearing around lights, and sensitivity to bright lights can all be symptoms of a cataract.

Traditional IOLs are monofocal, meaning they offer vision at one distance only (far, intermediate or near). They definitely are an improvement over the cataractous lens that is replaced during surgery, which provides only cloudy, blurred vision at any distance. But traditional IOLs mean that you must wear eyeglasses or contact lenses in order to read, use a computer or view objects in the middle distance, especially if you already are experiencing presbyopia before cataract surgery.

The new multifocal and accommodating IOLs such as Crystalens offer the possibility of seeing well at more than one distance, with much less need for glasses or contacts. Most health care plans will not cover these extra costs, because the additional benefits of these IOLs are considered a luxury and not a medical necessity.

Systemic diseases can also cause cataracts, including diabetes and hypothyroidism.
Certain medications, such as chronic use of corticosteroids, can contribute to cataract formation. Several studies have linked the development of cataracts to alcohol consumption and exposure to cigarette smoke as well.

Secondary causes, such as eye surgeries, chronic inflammation, and some types of glaucoma and extreme nearsightedness (high myopia) can also cause cataracts to develop.

If you are like most people, you were probably first diagnosed with a cataract during a routine eye exam. The next step involves visiting our ophthalmologist, who will work with you to determine if and when you will need surgery.

Our ophthalmologist will perform a few simple tests to determine the severity of your cataract and the type and power of implant you'll need. If the doctor determines you have cataracts in both eyes, he may recommend having surgery on the eye with the most advanced symptoms first.

Today, our ophthalmologists can fit you with an intraocular lens that best matches your visual needs. The doctor will probably perform three other exams that will help determine the type and power of intraocular lens that you'll need. Keratometry measures the curvature of your cornea. Biometry measures the length of your eye using a laser. Corneal Topography analyzes the surface of the eye.

Unlike standard cataract replacement lenses, the Crystalens corrects your cataracts and gives you the maximum range of clear vision. The Crystalens flexes like your eye's natural lens, allowing you to see better at all distances. Crystalens is an accommodating intraocular lens that, unlike a standard IOL, can treat both a person's cataracts and presbyopia—loss of near and intermediate vision. You may have noticed a gradual loss of your up-close vision and had to start wearing reading glasses. Crystalens not only treats your cataracts (a clouding or hardening of your lens), but can also reduce or eliminate your dependence on glasses.

It does so by recreating accommodation similar to your eye's natural lens. The unique Crystalens can reduce or eliminate glasses for most activities, including: reading a book, working on the computer, and driving a car.

Crystalens was modeled after the human eye. Like the natural lens, it uses the eye muscle to flex and accommodate in order to focus on objects in the environment at all distances. Crystalens dynamically adjusts to your visual needs.