What is lazy eye? Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. It is commonly called a 'lazy eye'. When one eye develops normal vision, while the other does not, the eye with poor vision is called amblyopia, but it is possible for both eyes to be 'lazy'. This condition is quite common, affecting approximately two or three out of every 100 children. The development of equal vision in both eyes is necessary for normal vision, making it essential for lazy eye to be detected and treated as early as possible in infancy or early childhood., What causes lazy eye? Lazy eye is caused by any condition that affects normal use of the eyes and visual development. In many cases, the conditions associated with lazy eye may be inherited., Lazy eye has three major causes: 1. Strabismus (squint) - Lazy eye occurs most commonly with misaligned or crossed eyes. The crossed eye 'turns off' to avoid double vision, and the child uses only the better eye. The misaligned eye then fails to develop normal vision. 2. Unequal focus and refractive errors - are eye conditions that are corrected by wearing glasses. Lazy eye occurs when one eye is out of focus because it has more near-sight, far-sight or astigmatism (irregular focus) than the other. The unfocused (blurred) eye 'turns off' and becomes amblyopic or lazy. The eyes can look normal, but one eye has poor vision. This is the most difficult type of amblyopia to detect since the child appears to have normal vision when both eyes are open. Lazy eye can also occur in both eyes if both eyes have very blurred vision. This can happen when there is a high amount of focusing abnormality in both eyes. 3. Cloudiness of normally clear inner eye structures - any factor that prevents a clear image from being focused inside the eye (like a cataract) can lead to the development of this condition in a child. This is often the most severe form of lazy eye., How is lazy eye diagnosed? It is not easy to recognise lazy eye. A child may not be aware of having one strong eye and one weak eye. Unless the child has a misaligned eye or other obvious abnormality, there is no way for parents to tell that something is wrong. Lazy eye is detected by finding a difference in vision between the two eyes or poor vision in both eyes. Special techniques are used to measure vision in young children. Our paediatric eye specialist often estimates vision by watching how well a baby follows objects with one eye when the other eye is covered, or uses picture tests in pre-schoolers. They will also carefully examine the interior of the eye to see if other eye disease may be causing decreased vision., How is lazy eye treated? A child must be made to use the weak eye. This is usually done by covering (patching) the strong eye for several hours per day until the vision is restored to normal or doesn't improve any further. Alternatively lazy eye may also be treated by blurring the vision in the good eye with special drops or glasses to force the child to use the lazy eye. Glasses will also be prescribed to correct any errors in focusing. If there is a cataract or other abnormality, surgery may first be required to correct the problem. An artificial intraocular lens may be implanted. After surgery, glasses or contact lenses can be used to restore focus while patching improves vision., Early detection and early treatment If lazy eye is detected and treated early, most children will regain vision. Lazy eye caused by a squint or unequal refractive errors may be treated successfully during the first eight years of age. If it is not detected until after early childhood, treatment may not be successful. Lazy eye caused by cloudiness of the eye tissue needs to be detected and treated extremely early, within the first few months of life, in order to be treated successfully.

What is Blepharitis? Blepharitis is a common chronic condition of the eyelids, characterised by persistent inflammation of the lid margins., It is often classified into two types: Anterior blepharitis - mainly affects the outer front edge of the eyelid margin, where the eyelashes grow. It often causes scales around the eyelashes and an overgrowth of bacteria, which produce toxins that irritate the eye. Posterior blepharitis - (meibomian gland dysfunction) mainly affects the inner back edge of the eyelid margin, which is in contact with the eye. The meibomian oil glands, located in a row behind the eyelashes, become blocked with thickened waxy oil. This leads to drying of the tears on the surface of the eye because they lack their normal healthy oil coating. It also causes an overgrowth of bacteria, which produce toxins that irritate the eye., Who gets blepharitis? Blepharitis is a common condition that can occur in anyone, at any age. It is most common in people with oily skin or rosacea., What are the main symptoms of blepharitis? Blepharitis may cause irritation, burning, itching and the sensation of something scratching the eye. The eyes often become red and watery, but may feel dry. The vision may be variable. The eyelids may appear red-rimmed and there may be crusts in the eyelashes or cysts near the eyelid margins., Is blepharitis serious? In most cases blepharitis is annoying but does not cause serious harm to the eye. However, complications of blepharitis may develop, including meibomian cysts, ingrown eyelashes, dry eye and corneal ulcers., What treatments can help with blepharitis? There is no simple cure for blepharitis and controlling it often involves a combination of several different treatments: Eyelid hygiene should be done on a regular basis. There are several methods including: 1. Hot compresses – this softens the oil in the meibomian glands and loosens any crusts around the eyelashes. Use a small wheat bag which is heated in the microwave for about 30 seconds then placed over the eyes for 5-10 minutes. A warm damp cloth is another option. 2. Eyelid massage – after the hot compress, use the tips of your fingers to massage the eyelids, along the whole length of the upper and lower lids. This is useful in posterior blepharitis to help squeeze the oil out of the clogged meibomian glands. 3. Lid scrubs – using warm water and either a facecloth or a cotton bud, scrub gently along the rims of the eyelid, close to the eyelashes. A few drops of baby shampoo may be added to the water. Alternatively a commercial product such as lid wipes, or foam may be used. Lid scrubs are particularly useful in anterior blepharitis, to remove any scales from around the eyelashes., Tear supplements often help relieve some of the symptoms of blepharitis by replacing the natural tears. There are numerous different artificial tear drops, which are available without prescription at pharmacies. Most of these drops can be used safely up to four times daily. Should these artificial tear drops be required more frequently, then preservative free ones are recommended., Antibiotic ointment may be prescribed for a period of time. It can be applied with a clean fingertip or a cotton bud to the eyelid margins or applied directly into the eye. This helps to reduce the buildup of bacteria in the oil glands and around the eyelashes. Steroid eyedrops may occasionally be prescribed for a short course. They are anti-inflammatory, which reduces the redness, swelling and discomfort caused by blepharitis. If steroid drops are used you will be monitored by your eye specialist for potential side effects, such as glaucoma, cataracts and infections. Oral antibiotics, such as doxycycline, may be prescribed for more persistent blepharitis. A low dose is normally used and sometimes for a long course. Although generally well-tolerated, potential side effects include sun-sensitivity and abdominal upsets can occasionally occur. Omega 3 supplements, such as fish or flax seed oil, are widely available over the counter. They have anti-inflammatory properties and may also improve the quality of the oil component of the tears. Other treatments may occasionally be recommended by your eye doctor depending on the type and severity of your blepharitis.

Blepharoplasty refers to the operation to remove skin from the upper lid. Excess skin in the upper lid can cause lash ptosis and reduce visual field. This skin can be removed and give a natural look. Surgery can be performed for function field loss or for cosmetic purposes. This treatment is usually done under local anaesthesia and you can go home the same day.

What is a cataract? Like a camera, every eye has a lens. When the lens inside your eye clouds over it reduces the amount of light reaching the retina at the back of the eye. This makes it difficult for you to see clearly and is called a cataract., Why do cataracts develop? Cataracts develop as a normal part of the aging process. By the age of 70 nearly everyone has some degree of cataract formation. Sometimes cataracts may develop at a younger age due to other diseases like diabetes, following an eye injury or due to specific medications, like steroids., What are the main symptoms of cataracts? The earliest symptoms can begin with glare and sensitivity to bright light, or haloes around lights. Vision then typically becomes progressively more blurred, foggy and sometimes doubled. Colours often become duller and darker., When is cataract surgery necessary? A mild cataract, that does not cause many symptoms, can sometimes be left alone, or vision can be improved a little with updated glasses. Cataracts will continue to progress, but usually slowly. When the blurred vision becomes troublesome in daily activities, then surgery is usually recommended., What does cataract surgery involve? Modern cataract surgery restores the eyesight lost due to a cataract, by removing the natural cloudy lens in the eye and replacing it with a clear artificial lens implant. Eye Doctors undertake this operation using the latest small incision techniques and most up to date equipment available to give the fastest recovery and best possible vision. Cataract surgery is usually carried out under topical anaesthesia, where the eye is numb, but you are awake. In most cases injections and intravenous lines are not required. How long does cataract surgery take? The procedure itself generally takes about twenty minutes. You will go home the same day, after spending two to three hours in hospital. How long does it take to recover from cataract surgery? A shield or patch may be worn following surgery and you are advised not to drive until given clearance by your surgeon, which is often the next day. Rubbing your eye, very strenuous activity and swimming should be avoided for one week. You can resume most other activities straight away. Eyedrops are usually required for 4 weeks following the surgery. Can a cataract come back? No. Once it has been removed, a cataract does not recur. The artificial lens implant that replaces the cataract stays in your eye for the rest of your life. Is cataract surgery safe? Cataract surgery is the most common eye operation and one of the most common surgical procedures performed in New Zealand. It has a very high success rate due to the modern methods used. Like any operation, there is a small risk of complications during and after the surgery that your surgeon will discuss with you. What lenses are used? A full range of intraocular lenses are available for people having a cataract operation with Eye Doctors. Just as there are different types of glasses; single vision, bi-focal, and progressive, there are different types of lenses that can be inserted into the eye during cataract surgery. The lens implants used are able to correct for focus errors (myopia, hyperopia and astigmatism) and in some cases glasses will not be required following cataract surgery. Eye Doctors surgeons will discuss your options and recommend which lens is best for your requirements.

What is a corneal transplant? The cornea is the dome-shaped window that forms the front surface of the eye. It is made up of several layers, all of which are transparent. Diseases of the cornea may affect one or more of these layers. Corneal transplant surgery, also known as corneal graft surgery and keratoplasty, replaces an abnormal cornea with a cornea from a donor eye in order to restore vision., Who needs a corneal transplant? Many people with a cloudy cornea from scarring after infection or injury will benefit from corneal transplant surgery. Some inherited or degenerative conditions, like Fuchs' endothelial dystrophy, may lead to swelling of the cornea, which requires corneal transplant surgery when it affects the vision or causes pain. In keratoconus the cornea becomes thinned and distorted, resulting in blurring of vision. In about 15% of cases, when other treatments such as contact lenses no longer help, corneal transplantation is necessary. Unlike most other organ transplants, if a corneal transplant fails it can be repeated, although the success rate of repeat transplants may be lower than first time transplants., How is corneal transplant surgery performed? Corneal transplant surgery may be performed under general or local anaesthetic. It generally takes between one and two hours and is day surgery, not requiring an overnight hospital stay. There are several types of corneal transplants performed by Eye Doctors. In about half of corneal transplant surgery all corneal layers are affected, requiring a standard, full thickness transplant or ‘penetrating keratoplasty’ (PK). This includes surgery for some corneal scars and some keratoconus, which is the most common reason for corneal transplant surgery in New Zealand. The central 7-8mm of the damaged cornea is removed and replaced with a similar sized piece of clear donor cornea, which is stitched in place with fine nylon microsutures. In other cases, particularly the less advanced cases of keratoconus, a partial thickness ‘deep anterior lamellar keratoplasty’ (DALK) may be suitable. In this surgery the innermost corneal layer, or endothelium, is healthy, so is not replaced. This reduces the risk of corneal transplant rejection and failure in the long term. Other corneal disorders only require replacement of the innermost corneal layer, or endothelium. In Fuchs’ dystrophy and bullous keratopathy only this thin layer needs to be replaced, in a procedure known as ‘Descemets stripping automated endothelial keratoplasty’ (DSAEK). This is done through a small keyhole incision at the edge of the cornea and has the advantages of a faster healing time and no/minimal stitches on the eye. Eye Doctors are experienced in medical treatment of corneal diseases and in the latest surgical techniques for corneal transplantation, including partial thickness corneal transplantation. Our corneal surgeon can discuss the different types of corneal transplant with you and which type of surgery is most suitable., Is corneal transplant surgery safe? Corneal transplantation is quite a major surgery for the eye and should not be undertaken lightly. The healing period can be over a year for full-thickness corneal transplant and while the final vision can be as good as 20/20 (6/6), this is certainly not guaranteed. Significant complications during the surgery are rare, but there are some potentially serious risks, such as transplant rejection, which can lead to transplant failure if not treated promptly. Our corneal surgeon can advise you of the pros and cons of corneal transplant surgery.

What is diabetic eye disease? Diabetes can damage the small blood vessels in the retina at the back of the eyes. If this is left untreated then permanent visual loss can occur., What does the retina do? The retina is the light-sensitive nerve tissue lining the back of the eye. Like a film in a video camera, the retina continually 'takes pictures', then sends signals through the optic nerve to the brain, producing vision. The central part of the retina, which generates fine detailed vision, is known as the macula. The retina is nourished by oxygen-rich blood that is brought to it by arteries and then drained away again by veins., What does diabetes do to the eye? Diabetes can cause reduced vision due to leaking blood vessels at the macula (the central part of the retina). Also the peripheral retina can have abnormal blood vessel formation, bleeding and scarring. These problems can lead to retinal detachment and blindness if not treated., What are the symptoms of diabetic eye disease? Early on there are often no symptoms. Reduced vision usually occurs when severe disease has already been present for some time. Vision changes often occur gradually, but can be sudden if there is bleeding into the eye., How is diabetic eye disease detected? Early detection is essential as the sooner the disease is treated the better the results. Your eye specialist will check your vision then dilate the pupils with drops. They will examine the back of your eye with a microscope. Photos or scans are required for monitoring diabetic retinopathy. All those newly diagnosed with type 2 diabetes should have a retinal check soon after diagnosis and those with type 1 diabetes should have a check within 5 years of onset. The frequency of ongoing checks then depends on the degree of retinopathy found., Do all diabetics get retinopathy? Most people with diabetes do not lose vision from diabetic retinopathy. Those with poor diabetic control, or who have had diabetes for a long period of time, have higher risks of developing the retinal complications. Other important risk factors include high blood pressure, high cholesterol and smoking., How is diabetic retinopathy treated? Early diabetic retinopathy may resolve with improved diabetic, blood pressure and cholesterol control. More advanced disease treatment may be required with retinal laser and/or injections of medication into the eye, such as Avastin (Bevacizumab), Lucentis (Ranibizumab) and Eylea (Aflibercept). Very rarely, surgery may also be needed in severe disease.

These relatively common problems of abnormal eyelid position are usually due to aging. They can cause discomfort, dry or watery eyes and cosmetic problems. At Eye Doctors we can tighten and reposition lids back to their natural positions, with a day stay surgical procedure. Ectropion - outward rotating eyelid. Entropion - inward rotating eyelid.

Misdirected eyelashes can cause considerable irritation. In the first instance the eyelid position should be checked and corrected if it is a factor. Misdirected lashes can also be remedied simply by removal. Eye Doctors offer electrolysis, laser and surgical excision to provide a permanent solution to this condition.

What is Glaucoma? Glaucoma is a wasting disease of the optic nerve. This causes progressive vision loss, starting unnoticed in the surround (peripheral) vision and causing noticeable patches of vision loss and sometimes blindness later in the disease., Who gets glaucoma? About 1-2% of New Zealanders have glaucoma. But the proportion of people affected increases with age. One in ten New Zealanders over the age of 80 has glaucoma. Glaucoma is caused by the combination of genes you carry. The inheritance is unpredictable but if you have a first-degree relative with glaucoma your chances of having the disease yourself are increased 25%. A first-degree relative is a mother, father, brother or sister. It is very important to pass on information on the condition to others in your family as it may help with early detection. So, in summary, a cocktail of genes and aging causes glaucoma., How is glaucoma detected? There are several tests necessary to diagnose and monitor glaucoma. These include measuring the pressure in the eyes, examining the optic nerves and mapping the sensitivity of the surround vision with special automated visual field testing. These tests will be repeated on a regular basis to monitor and manage the glaucoma. Optometrists are often the first to diagnose glaucoma. This is because the need for spectacles increases with aging and optometrists are alert to the disease and screen for it., Spectral domain OCT scanning With the advent of spectral domain OCT scanning (SDOCT), Eye Doctors have a powerful modern tool for measuring the amount of optic nerve tissue in each eye directly. The SDOCT retinal nerve fibre analysis is recommended as an annual test, especially for those at risk of glaucoma or those with early stage disease. It can accurately detect loss of nerve tissue from glaucoma before this is manifest in the visual field test., Corneal thickness measurements Ultrasound measurement of the thickness of the cornea should be undertaken on all glaucoma patients and those at risk of glaucoma. The observed intraocular pressure is adjusted on the basis of the corneal thickness and furthermore the corneal thickness is an independent predictor of glaucoma and glaucoma severity. For example those with thick corneas have higher intraocular pressure even though they may not have glaucoma and those with thin cornea may have a seemingly normal intraocular pressure which when adjusted upwards gives the true picture and explains the presence of the disease., Risk assessment Due to statistics compiled from large US studies it is possible to assign a probability of getting glaucoma to a patient in some instances. On the basis of this probability treatment may be instituted prior to the development of glaucoma. The benefit is a delay in the onset of glaucoma. The downside is possibly using drops unnecessarily., Visual Field Test Patients with glaucoma require long term follow up. During the period of follow up it is most important to know whether the glaucoma is getting worse. Regular visual field tests tell if the vision is getting worse. A visual field test is a map of the surround vision of each eye. Usually visual field tests are made every year but if the glaucoma is severe more frequent field tests may be required., Glaucoma treatment There is no doubt that lowering the eye pressure slows the progression of glaucoma. The usual way of lowering the eye pressure is by instilling pressure lowering eye drops on a daily basis., Long-term basis Depending on the type and severity of the glaucoma there are other options for treatment., Angle closure glaucoma This is a common type of glaucoma that affects long-sighted people. Long-sighted people have smaller eyes than others. Long-sighted people never needed glasses when they were young but had to get glasses for reading in their forties. The lens in the eye grows as a person matures. The increase in size of the lens may cause pressure on the eye's plumbing in particularly in people with small eyes. Such people are helped by a safe laser procedure called a peripheral iridotomy, which provides a way of bypassing this type of plumbing congestion., Laser trabeculoplasty This is a laser method of reducing the intraocular pressure by exposing the trabecular meshwork to laser. The trabecular meshwork is the name given to the eye's internal gutter that drains eye fluid away from the eye., Surgery may be necessary for treating glaucoma. The surgical procedures that are employed for treating glaucoma are as follows:, Cataract surgery - this can reduce the pressure by freeing up the plumbing of the eye. It is especially useful in those long-sighted patients with small eyeballs and large lenses. The mature tissue lens is removed and replaced with a much smaller plastic lens. Immediately following successful cataract surgery there is much more room inside the eye to provide for the uninterrupted drainage of eye-fluid. Trabeculectomy surgery - a small, gated hole is made in the sidewall of the eye to permit the drainage of eye fluid directly from the eye into a space between the skin of the eye (conjunctiva) and the wall of the eye. Tube surgery - a silicone tube is placed within the eye to allow for the drainage of fluid away from the eye to be absorbed back into the body from the space between that wall of the eye and the skin of the eye. iStent surgery - currently the smallest implant used in medicine, the Glaukos iStent is a 2mm titanium snorkel that creates an exit passage for blocked eye fluid, relieving the pressure that causes glaucoma. The iStent is not only effective but it has also dramatically reduced recovery time following surgery. Cyclodiode laser - in very serious cases the tissue within the eye that makes the eye-fluid can be destroyed by infrared laser light directly straight through the wall of the eye., Glaucoma New Zealand is a charity that provides support for New Zealanders with glaucoma and is committed to eliminating glaucoma blindness by raising community awareness and running professional education programmes. If you have glaucoma you may join Glaucoma NZ and as a member you will receive regular newsletters with information about glaucoma and new treatments that are becoming available. Click here for info: , glaucoma.co.nz

What is keratoconus? The cornea is the transparent dome-shaped window on the surface of the eye, overlying the coloured iris. Its smooth round surface is important for maintaining clear vision. In keratoconus the cornea becomes thin and distorted, eventually protruding forwards in a cone-like shape. It typically affects both eyes, but can often be quite asymmetric., Why does keratoconus develop? The causes of keratoconus are not very well understood. However there is a genetic tendency, so it can sometimes run in families. There is also an association with allergies and most people with keratoconus have itchy eyes and rub their eyes to some degree. Over several years the pressure on the eye from rubbing may contribute to distortion of the cornea., Who gets keratoconus? Keratoconus occurs in young people, often starting in the teens, or even younger. It usually progresses slowly, and then stabilises in the twenties or thirties. It affects males and females in all racial groups, although in New Zealand it is most common in the Maori and Pacific and Indian populations., What are the main symptoms of keratoconus? Keratoconus causes blurring and distortion of vision in one or both eyes. It often gets slowly worse over time, but occasionally causes quite a sudden deterioration in vision. People with keratoconus often have associated allergic conjunctivitis, which causes itchy eyes and eye rubbing., What treatments can help with keratoconus? There are two main aims in treating keratoconus; improving vision and preventing progression of the disease. In the early stages of keratoconus, glasses or soft contact lenses may help correct blurred vision. As the cornea becomes more distorted only hard contact lenses are able to improve vision. About 15% of people with keratoconus progress to the stage where corneal transplant surgery is required. Traditionally full thickness corneal transplant surgery has been necessary, but in some cases of keratoconus it is now possible to perform a partial transplant, which may have advantages in long term transplant survival. In recent years preventing progression of keratoconus has become a priority for people with mild or moderate keratoconus. Treating allergic eye disease and avoiding eye rubbing may be of some benefit., Corneal collagen crosslinking Corneal collagen crosslinking is a treatment designed to stabilise keratoconus. It uses a combination of ultraviolet light and vitamin B2 to stiffen the cornea, slowing or halting keratoconus progression. It is effective in at least 90% of cases and about 50% of people also have some improvement, with better vision and improved contact lens tolerance. Crosslinking may reduce the need for corneal transplant surgery by preventing keratoconus from progressing to more advanced disease., Both crosslinking and corneal transplant operations are undertaken by Eye Doctors and we can advise which type of treatment is most suitable for you.

Age-related Macular Degeneration (ARMD)is the leading cause of vision loss in the western world, and typically affects people over 60 years of age. Eye Doctors specialists are experts in the diagnosis and treatment of ARMD. What does the retina do? The retina is the light-sensitive nerve tissue lining the back of the eye. Like film in a video camera, the retina continually 'takes pictures', then sends signals through the optic nerve to the brain, producing vision. The central part of the retina, which generates fine detailed vision, is known as the macula. The retina is nourished by oxygen-rich blood that is brought to it by arteries and then drained away again by veins. What is the macula? The macula is part of the retina at the back of the eye, in the direct line of central vision. Its function is to give us colour vision and fine detailed vision for tasks such as reading. What are the symptoms of macular degeneration? Finding it difficult to read and see small detail are warning signs to be aware of. The development of distorted vision, where straight lines appear bent, is an important symptom that needs expert evaluation within days. What are wet and dry ARMD? There are two types of ARMD: 'Dry' ARMD causes a very slow loss of central vision clarity due to the wearing out of the macula. This condition uncommonly leads to blindness. 'Wet' ARMD however, often causes rapid loss of central vision due to abnormal blood vessels developing underneath the retina, which can leak and bleed. This may result in retinal scarring, with permanent vision loss. Both types of ARMD often occur in both eyes and sometimes the dry type can change into the wet type. How is ARMD detected? An eye specialist can detect active disease and those at higher risk of progressing to loss of vision. After checking the vision your eye specialist will dilate the pupil with eyedrops and examine the retina. Further tests may be required to identify the extent of the disease. What is an OCT? Optical Coherence Tomography (OCT) is a light scanner that can image the retina in great detail, providing useful information for detecting and monitoring ARMD. At Eye Doctors we have the latest technology high definition OCT scanner. OCT scanning just takes a few minutes and is simple and painless to do. What treatments are available? We now have successful treatments for active 'wet' ARMD. Medications that are injected into the eye can reduce retinal swelling, leading to visual recovery and minimise the development of scarring in many patients in the earlier stages of the disease. These medications, called Vascular Endothelial Growth Factor (VEGF) inhibitors include Avastin (Bevacizumab), Lucentis (Ranibizumab) and Eylea (Aflibercept). In addition, your eye specialist may give you nutritional advice, or recommend specific vitamin supplements that have been shown to reduce the risk of ARMD progression.

What is a Meibomian cyst? A meibomian cyst, or chalazion, is a blocked meibomian gland in the eyelid. Behind the eyelashes is a row of oil glands, which open onto the back edge of the lid margin. If the oil becomes thickened it can block the opening of the gland, leading to a build up of oil in a cyst. This often causes a lot of inflammation in the surrounding tissues, resulting in swelling, tenderness and sometimes infection. Meibomian cysts may come and go over a few days or may persist for weeks or months., Who gets a meibomian cyst? A meibomian cyst can occur in anyone, at any age. Some people can be prone to recurrent or multiple cysts, particularly if they have chronic blepharitis, causing thickening of the oil in the glands and inflammation of the eyelid margins. When a child has a tendency to recurrent cysts, they usually become less frequent as they get older., What are the main symptoms of a meibomian cyst? As well as a tender, inflamed lump in the eyelid, a meibomian cyst can cause irritation of the eye and sometimes blurring of vision, due to pressure on the eyeball., What treatments can help with a meibomian cyst? Warm compresses – Wet a clean folded facecloth in hot (not scalding) water and wring it out. Press it gently on closed eyelids for at least one minute, until it starts to cool. Repeat two - three times. This softens the oil in the blocked meibomian gland, making it more likely to discharge from the cyst. Eyelid massage – After the hot compress, use the tips of your fingers to gently massage the eyelid over and around the cyst, pressing the skin towards the edge of the eyelid. This may help the cyst to discharge, reducing the need for surgery. Antibiotics – In some cases an antibiotic ointment may be prescribed to apply to the cyst for a few days. When a more severe infection of the cyst occurs an oral antibiotic may occasionally be prescribed. Surgery – If a cyst persists for weeks or months a minor operation, known as incision and curettage, may be required. In adults this is performed in the clinic. Children require surgery under general anaesthetic. After an injection of anaesthetic into the eyelid, a small clamp is placed on the eyelid. A cut, a few millimetres long, is made on the inside of the eyelid and the contents of the cyst are scooped out with a special ‘spoon’. The whole procedure takes only a few minutes. A short course of antibiotic ointment or drops is prescribed. There is usually some degree of swelling or bruising of the eyelid for a few days as it heals.

What is a pterygium? A pterygium is a thickened growth on the surface of the eye. It starts on the white of the eye, usually on the inner corner, and extends onto the cornea, the clear front window of the eye., Why does a pterygium develop? Pterygia are caused primarily by ultraviolet light damage, although there may also be associations with dust and wind exposure. It usually develops in people with a history of significant sun exposure and tend to occur on the sun-exposed parts of the eye., What are the main symptoms of pterygium? As well as being noticeable growths, pterygia often cause redness and irritation of the eyes. Sun, wind and dry environments, like air-conditioning, may exacerbate this. Pterygium may affect vision by distorting the shape of the eye, causing astigmatism, or by growing large enough to cover the pupil. Pterygium may also cause contact lens intolerance., What treatments can help with pterygium? Artificial teardrops, which are available without prescription from pharmacies, lubricate the surface of the eye to improve comfort and redness. They can be used safely on a regular basis. If a pterygium becomes particularly inflamed non-steroid or steroid anti-inflammatory drops may be prescribed for a short period, under supervision of an eye specialist. Over the counter decongestant drops are not recommended as they can cause rebound redness, making the eyes worse. Protecting the eyes from ongoing ultraviolet light exposure may reduce the chance of a pterygium enlarging, so sunglasses should be worn when outside. When symptoms persist despite medical treatment, surgical removal of the pterygium may be required., What does pterygium surgery involve? Surgery may be recommended if a pterygium is growing progressively larger or if it is interfering with vision or contact lens wear. Surgery may also be required if the pterygium is causing persistent discomfort, redness or cosmetic concerns. Surgery is typically performed on one eye at a time, although both eyes can be treated at once. Pterygium surgery is generally done under local anaesthetic as a day-stay procedure. It takes less than half an hour and is not particularly uncomfortable. The pterygium is excised from the surface of the eye, and then a small piece of healthy conjunctival tissue from under the upper lid is transplanted onto the exposed white of the eye so stitches are not required. Eye Doctors use fibrin glue in the majority of cases. The transplant helps the eye to heal with an improved cosmetic appearance and reduces the risk of pterygium recurrence, to about 1/50., What happens after surgery? Following surgery a patch is placed on the eye overnight and drops/ointment are prescribed, usually about four times daily for 4-8 weeks after surgery. Painkillers are also recommended in the first few days, because the eye may be quite uncomfortable. The eye may look red for up to a month after surgery and there may be mild swelling or discomfort during this time, as the eye heals.

This is when the retina detaches, meaning it is lifted or separated from its normal position within the eye. An acute retinal detachment requires urgent assessment and appropriate treatment. Unless prompt and effective treatment is given, some forms of retinal detachment may lead to irreversible blindness. Signs and symptoms include: a sudden or gradual increase in floaters, deterioration in vision, cobwebs or specks with the visual field, light flashes in the eye or the appearance of curtains over the visual field. You are more likely to have a retinal detachment if you are very short-sighted or have had an injury or previous surgery to the eye. For minor detachments, a laser or freeze treatment (cryopexy) are used. Both therapies re-attach the retina. For major detachment, surgery will be necessary. A band is often put around the back of the eye to prevent further detachment. Surgical treatment is usually a vitrectomy, where the jelly (vitreous) is removed from the eye. This often involves a hospital stay. It can take several months post-surgery to see the final visual result.

Ptosis - drooping of the upper eye lid. As we age it is fairly common for the upper lid to droop, sometimes one eye droops more than the other. This can cause distress due to vision impairment and altered appearance. At Eye Doctors we offer a day stay procedure to adjust the height of the upper eyelid by reattaching the muscle that lifts the lid at the correct position. In most cases asymmetry between the eyes can also be improved and the signs of aging reduced.

The most common children's eye conditions are strabismus (squint) and amblyopia (lazy eye), and both can be successfully treated. The earlier they are detected the better. What is a squint? A squint is a visual defect in which the eyes are misaligned, so they point in different directions. One eye may look straight ahead, while the other eye turns inward, outward, upward or downward. The eye turn may be constant, or it may come and go. In some cases, which eye is straight (and which is misaligned) may switch or alternate. What causes squints? The exact cause is not fully understood. Any factors influencing the brain's control of binocular vision, or the eye muscle functions can cause it. Occasionally squints can be associated with other conditions. What are the signs of squints? The main indication is that an eye is not straight. Sometime the child may turn or tilt their head to see better. Favouring one eye over the other can lead to amblyopia (lazy eye) and long term poor sight in that eye. What are the most common types of squints in children? Infantile (or congenital) esotropia - where the eye turns inward, is the most common type of squint in infants and it usually occurs between 3-6 months of age. Accommodative esotropia - is a common form of squint and often occurs in children two years of age, or older. The eye turns inward due to excessive focusing effort to give better vision. It can present when the child is looking at distant or near objects. Exotropia - refers to the outward turning of the eye. It can be constant or intermittent. Intermittent exotropia most often occurs when the child is looking at distant objects. It tends to become more noticeable when the child is tired or sick. How are squints treated in children? After a complete medical eye examination the child may be prescribed glasses. If glasses cannot control the squint, or are not needed then eye muscle surgery will be recommended to restore normal alignment and binocular vision (so the two eyes can work together). How is squint surgery performed on children? It is performed as a day stay procedure, under general anaesthetic. Our anaesthetists are experienced in children's anaesthesia and surgery is performed in a fully equipped private hospital. The eye muscle causing the eye to turn inward, or outward, are 'loosened', or 'tightened', as required. The eyes are not normally patched and recovery is fast so the child can resume normal activities within a few days. When should treatment start? Children suspected of a squint should be seen without delay by a specialist. No child to too young to be assessed and for treatment options to be discussed. What is pseudosotropia? The eyes of an infant may appear to be crossed, though they actually are not. This is often due to a wide, flat nose, or a fold of skin in the inner lids. Children may grow out the of pseudosotropia but they never grow out of a true squint. Strabismus Surgery Adjustable Suture Eye Muscle Surgery Nystagmus, or jiggling of the eyes, can occur from poor vision in childhood, or as a result of albinism (lack of pigmentation in the skin) and other neurological conditions. In these patients, turning their head to certain directions minimises the intensity of the jiggling of the eyes and their vision often improves. Eye Doctors offers special eye muscle surgery that can lead to straightened head posture, reduced jiggling of the eyes and improved vision.

What is adult strabismus (squints)? Strabismus (commonly known as squints) is a condition in which the eyes are not aligned properly and point in different directions., What causes squints in adults? Most adults with squints have had the condition since childhood. However, strabismus can also begin in adulthood due to medical problems, such as: - Diabetes - Thyroid disease (Graves’ disease) - Myasthenia gravis - Brain tumours - Head trauma - Strokes. Occasionally, misalignment of the eyes can also occur after other operations on or around the eye, such as retinal surgery if the eye muscles are moved during the procedure., What are the symptoms of squints? Adults with squints may experience: - Eye fatigue - Double vision - Overlapped or blurred images - A pulling sensation around the eyes - Reading difficulty - Loss of depth perception. To correct the inability to focus properly, many adults with squints have to tilt or turn their heads when focusing. They may also be unable to make direct eye contact with both eyes when looking at people., How are squints in adults treated? Squints in adults can be treated using several methods, including: - Eye muscle exercises - can be helpful in treating a condition called convergence insufficiency, a form of squint in which the eyes cannot align themselves for close work or reading. - Glasses containing prisms - these can correct mild double vision associated with squints in adults. A prism is a clear, wedge-shaped lens that bends, or refracts, light rays. Prism eyeglasses realign images together so that the eyes see only one image. Temporary adhesive prisms can be worn on the inside of the eyeglasses frames or can be manufactured directly into the lens itself. Prism eyeglasses usually cannot correct more severe cases of double vision where images are far apart and the eye misalignment is too large. - Eye muscle surgery - is the most common treatment for squints. Typically, squints occur when the muscles surrounding the eyes are either too stiff or too weak. Surgery can loosen, tighten or reposition selected eye muscles so that the eyes can be rebalanced to work together., What are the benefits of surgery? Surgery can: - Improve eye alignment - Reduce or eliminate double vision - Improve or restore the use of both eyes together (binocular visual function) - Reduce eye fatigue - Expand peripheral (side) vision - Improve social and professional opportunities., How is squint surgery performed? It is performed as a day stay procedure, under general anaesthetic. The position of one or more eye muscles is altered depending on the type of squint. Patients may experience some discomfort after surgery, but it is usually not severe and can be treated with over-the-counter pain medication such as Panadol or paracetamol. You can often return to your normal activities within a few days. More than one surgery may be needed to treat this condition depending on the severity of the case., Adjustable stitches surgery To obtain more precise alignment of the eye, the surgeon may use adjustable slip-knot stitches. This allows the eye alignment to be fine-tuned immediately after waking from surgery., What are the risks of squint surgery? Vision loss from squint surgery is extremely rare. However, as with all surgeries, there are risks to consider. Complications can include: - Allergic reaction to the anaesthesia - Infection - Reduced vision, often temporary - Double vision within the first week or two after surgery, long lasting double vision is very rare - Inadequate eye alignment., It is never too late to treat squints Adults do not need to live with the discomfort or embarrassment caused by misaligned eyes. Surgery, and/or a combination of other treatment methods, can improve the symptoms associated with squints.

Various skin lesions occur commonly on the eyelids. New Zealand’s harsh sun is responsible for our high rate of skin cancers and the lids are one of the most frequent places these occur. Eye Doctors surgeons are specialised in completely removing the lesions and repairing the lids to look as natural as possible, with reconstructive surgery if required.

Tears are produced by the lacrimal glands, under the upper eyelids, then any excess is drained away by the tear ducts in the inner corner of the eye. Minor surgery to enlarge the tear duct opening may be required or surgery to bypass the tear ducts. Blocked tear ducts can also cause watery eyes recurrent infections.

Misdirected eyelashes can cause considerable irritation. In the first instance the eyelid position should be checked and corrected if it is a factor. Misdirected lashes can also be remedied simply by removal. Eye Doctors offer electrolysis, laser and surgical excision to provide a permanent solution to the condition.

What does the retina do? The retina is the light-sensitive nerve tissue lining the back of the eye. Like film in a video camera, the retina continually 'takes pictures', then sends signals through the optic nerve to the brain, producing vision. The central part of the retina, which generates fine detailed vision, is known as the macula. The retina is nourished by oxygen-rich blood that is brought to it by arteries and then drained away again by veins., What is a retinal vein occlusion? When a retinal vein becomes blocked, part of the retinal blood flow slows or stops. Blood backs up, leading to bleeding or swelling of the retina, hampering its nourishment. Suddenly, and usually without warning, a patch of retina loses some of its 'picture-taking' function., What are the main symptoms of a retinal vein occlusion? The retinal swelling caused by a blocked vein can lead to a sudden loss of vision, or distortion of the central vision, which are often the first signs that many people notice. The symptoms vary from none to all to almost total loss of vision, depending on the type and severity of the vein occlusion. When the central retinal vein becomes blocked, the whole retina is affected, which can cause severe symptoms. When a branch vein becomes blocked, symptoms can be minor if the periphery of the retina is affected, but more severe if the central area of the macular is involved., What causes a vein occlusion? Vein occlusions become more common with age and as blood vessels harden. Risk factors that 'age' the veins faster can include smoking, diabetes, high blood pressure and high cholesterol. Glaucoma and inflammation inside the eye can also increase the risk of a blockage. Rarely, blood disorders are involved., What examinations are required? Your eye specialist will check your vision and examine the back of the eye. The pupil will be dilated with drops, so you will not be able to drive for a few hours. Photos may be taken with a camera and a special OCT (Optical Coherence Tomography) scan will be used to map the back of the eye and demonstrate any swelling in the retina. Sometimes further tests, such as Fluorescein Angiography may be required, where dye is injected into an arm vein and is then photographed as it travels through to the back of the eye., What treatment can help with retinal vein occlusion? Depending on the severity and position of the occlusion, often no treatment is required. However, sometimes we can speed the recovery by using medications that target the leaking vessels. These medications can include injections into the eye, which may need to be repeated. Laser treatment may also be required to close down leaking vessels in affected parts of the retina. With time, your own healing process may open up the blocked vessel. The resulting vision will depend on the amount of damage to the retina. The treatment is tailored to the individual's needs to give the best chance of regaining long term vision.

What is myopia? Also known as near-sightedness or short-sightedness, myopia is where nearby objects are clear, while objects in the distance are blurred. This usually occurs because the eye grows too long, and light focuses in front of the retina instead of directly on it., What are the symptoms of myopia? If your child is myopic, they can have difficulty seeing things in the distance clearly, such as the whiteboard in school or people when playing sports. The severity of myopia can worsen over time as the eye continues to lengthen., Who is affected by myopia? The number of people in New Zealand with myopia is growing. The condition usually develops in childhood (6-13 years), when the eye is growing. It can also occur in younger children and adults., What causes myopia? Myopia is caused by a mix of genetic and lifestyle factors. Children are more likely to develop myopia if their parents are myopic and if they're of East-Asian ethnicity. Lifestyle factors include: - Insufficient time outdoors - Prolonged periods of looking at digital devices or doing close work - Long durations spent in poor lighting conditions, How is myopia treated? Myopia can easily be corrected with glasses or contact lenses. Laser surgery is an option in adults (once the myopia has stabilised)., Why is myopia control important? Uncorrected and uncontrolled myopia can affect your child's ability to participate in school and enjoy the activities they like. It can also lead them to having a higher glasses prescription later in life than if they were treated earlier. Higher prescriptions lead to increased dependency on glasses, and thicker and heavier lenses that can be uncomfortable long term. With high myopia there is also an increased risk of permanent sight-threatening conditions later in life such as: - retinal detachment - glaucoma - myopic retinal degeneration - cataract, What options are available to prevent myopia getting worse in my child? 1. Regular glasses - correcting your child's vision with normal glasses can slow the progression of myopia. 2. Lifestyle measures - making environmental changes can prevent or limit the progression of your child's myopia. - Increase time spent outdoors in natural light. Studies have shown that spending at least 2 hours outside every day can slow myopia. - Limit the amount of time looking at screens and doing other close work. Ensure the screen is positioned at a suitable distance with appropriate lighting to avoid eye strain. - Try to have regular breaks from looking at the screen. A general principle is to look every 20 minutes outside or across the room for 20 seconds. 3. Eye Drops - low doses of a drug called atropine are put into the eyes daily, in addition to wearing glasses/contact lenses. These have been shown to slow progression of myopia. These can be prescribed by your child's ophthalmologist and some optometrists. 4. Contact lenses - these are Orthokeratology (Ortho-K) or hard contact lenses which are worn overnight and supplied by optometrists. These alter the shape of the cornea while the child sleeps and provides temporary correction of myopia, so no glasses are required during the day. These also slow progression of myopia. 5. Miyosmart glasses - these are specially designed glasses that change the focus in the peripheral vision. Each option has different advantages and disadvantages, and multiple factors can affect which option is most suitable for your child. As a result, discussion with your ophthalmologist can help you decide what will best meet your child's individual needs., Is myopia management safe? The risks of wearing contact lenses to manage myopia are similar to those of wearing traditional contact lenses. With all contact lenses there is a low risk of serious complications such as corneal infections that can cause scar and vision loss. If your child wears contact lenses, it is important to follow strict hygiene instructions from your optometrist and have regular eye examinations., How do I know if the treatment is working? Myopia management is unlikely to halt myopia progression entirely. Its aim is to reduce the rate of progression, compared to if there was no intervention. Regular appointments with your ophthalmologist help to keep track of the progression of myopia. Your ophthalmologist will monitor the length of your child's eyes, monitor their glasses prescription, and adjust treatment as necessary.