SYMPTOMS: The patient stated that she experienced reduced vision centrally since her car airbag deployed, hitting her directly in the face in a motor vehicle accident. She went to the ER and was treated for minor injuries, but did not get any CT scans or other imaging done. She did not have diplopia or pain with eye movement.

HISTORY: The patient stated that prior to the event, she had good vision in each eye. Her last dilated eye exam was 2 years prior and no pathology was seen or found. She did not have any medical issues aside from the recent accident and only took birth control pills.

TESTING: BCVA was 20/150 OD and 20/20 OS. Confrontation fields showed a hemianopic field restriction in the right eye, but the left eye was normal. EOMs were also normal, without restriction or pain on eye movement. Pupils were reactive to light without an APD. Biomicroscopy of the anterior segment was normal for each eye. Dilated fundus exam of the right eye showed 3+ edema of the nerve head and surrounding peripaillary region area, involving the macula. No hemorrhages were seen. The left eye was normal. Humphrey visual fields were unreliable for each eye and showed non-specific defects.

Dx and Mx: The patient was diagnosed with traumatic commotion retinae with mild nerve contusion and Berlin’s edema. Considering the look and presentation of the injury, it was recommended that she get a CT of the orbits prior to treatment with oral prednisone to rule out retro bulbar lesions. CT scan of the orbits came back negative for pathological lesions and the patient was immediately started on 60mg of prednisone with an every 3 day taper. After 2 weeks of oral treatment, the patient’s vision improved to 20/40 with an improvement in nerve edema.

SYPMTOMS: The patient reported no increased floaters, flashes of light, recent trauma or injury, or decrease central or peripheral vision. His mother stated that he just went for a routine eye exam.

HISTORY: The patient reported no ocular or medical problems. He was not taking any medications and had no known drug allergies. Upon further questioning, his mother reported that he was a pre-mature baby, born at 29 weeks gestation and weighing less than 3 lbs.

TESTING: BCVA was 20/20 OD and OS. All other preliminary tests were normal; however, we were unable to test his pupils because he was already dilated from his eye doctor’s visit. Anterior segment of each eye were normal. Dilated fundus examination revealed C/D ratios of 0.2, normal vessels coming out of the nerve, and a flat and even pigmented macula OD, OS. Peripheral retina exam showed prominate white without pressure (WWP) along the temporal edge of each eye. There was an avascular zone within the WWP and a well demarcated ridge separating the vascular and avascular zones. No neovascularization, fibrosis, or sub-retinal fluid was seen.

Dx and Mx: The patient was diagnosed with probable retinopathy of prematurity, stage 1 OU. The mother was educated on the findings and it was recommended that the patient should be seen for follow-up in 6 months or sooner if he experienced symptoms.

SYMPTOMS: The patient complained of increasing frequency of headaches recently, but without problems with her vision.

HISTORY: Her ocular and medical history was not remarkable for any current conditions. However, she mentioned that she has lost 45lbs in the last year with some mild nausea along with the headaches. She denied of any pregnancy, tingling, or recent illness.

TESTING: BCVA was 20/20 OD and OS. All other preliminary testing was normal, including EOMs, pupils, CF, and IOP. A HVF 24-2 sita standard was administered without complications. There were mild, scattered, non-specific defects in both eyes, not indicative of anything neurological. Biomicroscopy of each eye was normal. Dilated fundus exam revealed slightly elevated, crowded optic nerved of both eye. The borders had a scalloped appearance, without blurred margins hemorrhages, or obscuration of vessels. Larger magnification of the nerve head revealed “lumpy” yellowish deposits that gave the rim a pale appearance. B-scan ultrasonography was done in low gain and revealed reflective deposits at the nerve head of each eye.

Dx and Mx: The patient was diagnosed with pseudopapilledema secondary to probable buried optic nerve head drusen OU. The patient was educated on her findings and advised that this is not likely true papilledema. She was given the option of getting an MRI is desired, but declined. She was to RTC to clinic in 3 months for repeat testing or sooner if her vision or symptoms worsens.

SYMPTOMS: The patient complained that she had been experiencing blurred vision in the right eye for the past six days as well as eye pain coming from inside the eye. The patient had never experienced these symptoms before. There was no discharge or redness. The patient denied of any headaches, nausea, vomiting, and reported no increase in photophobia.

HISTORY: His ocular history was unremarkable. The patient’s last eye exam was six months ago where he received a new spectacle prescription. His medical history was unremarkable. The patient’s family medical history was positive for diabetes and systemic hypertension. The family ocular history was positive for cataracts.

TESTING: BCVAs were 20/25 in the right eye and 20/20 in the left eye. EOMs revealed no restriction or pain and confrontation fields were full in all quadrants. Pupils were equal, round and reactive to light with no afferent pupillary defect present. IOPs were 45 mmHg OD and 16 mmHg OS with Goldmann applanation. Gonioscopy revealed open angles of 3+ in both eyes with dense iris processes in all angles. Biomicroscopy revealed a few keratic precipitates (KPs) on the corneal endothelium and a 1+ AC reaction in the right eye. There was no corneal edema present and no iris heterochromia. The remainder of the anterior segment of the right eye was normal. Biomicroscopy of the left eye was unremarkable. An undilated view of the retina revealed healthy maculas and C/D ratios of 0.35 round in each eye.

Dx and Mx: The patient was diagnosed with Posner Schlossman Syndrome OD. Treatment with Lotemax qid OD for the AC reaction and Combigan bid OD to lower the IOP was administered. The patient returned the next day for a follow up visit. His IOP had decreased in the right eye to 16 mmHg. The KPs and the 1+ AC reaction were still present. He continued the Lotemax and Combigan drops as before. At his 1 week visit, the IOP was measured at 13 mmHg OD. The AC reaction had increased to 2+ cells and a few more fresh KPs were present. The Lotemax was discontinued and the patient was changed to Durezol to be used qid OD. Combigan was to be used bid as before. The patient returned two weeks later for a follow up visit. The IOP in the right eye was 16 mmHg and there was a trace AC reaction present. There were no KPs present. The patient was told to use the Durezol bid OD and the Combigan bid OD for the next two weeks. Two weeks later, the patient returned and her IOP was 17 mmHg OD with no AC reaction present and no KPs. A HVF 24-2 was performed as well as an OCT of the RNFL of both eyes. The results were within normal limits for both eyes. The HVF and OCT will serve as baseline data for the patient and she will be monitored frequently for the recurrence of glaucomatocyclitic crisis attacks to make sure the episodes of elevated IOP do not cause any glaucomatous damage in the future. The patient was advised to call immediately if any eye pain or blurred vision occurs in the future. She will be closely monitored with frequent eye exams.

SYMPTOMS: The patient complained of poor vision at distance since childhood. Her contact lenses were intolerable and she would like to get out of thick glasses.

HISTORY: Patient reported good ocular and physical health. She was only taking an OTC allergy medication for seasonal allergies.

TESTING: Her obscans showed no pathology, but revealed thin pachs of 491 microns OD and 502 microns OS. The waveprint estimated her Rx to be -11.26 -0.25 x 004 OD and -10.32 -0.75 x 001 OS. Both eyes were correctable to 20/20.

Dx and Mx: It was advised to her that due to her high myopia and thin pachs, LASIK and PRK would not be an option for best vision and ocular health. Risks, benefits, and procedure were discussed about the Visian ICL. Due to the invasiveness of the procedure compared to LASIK or PRK, the patient wanted to be given some extra time and more information to consider before making her final decision. 2 weeks later the patient returned to the clinic for a Visian ICL evaluation that included an IOL master, gonioscopy, white-to-white measurements, dry and wet refractions, and dilated exam.

PEARLS: For patients who are high myopes and may not be the best candidate for traditional LASIK, iLASIK, or PRK; consider Visian ICL. These patients should be aware of their refractive surgical options.

SYMPTOMS: The patient complained of prominent bulge of her OS for the past 2 weeks with mild tearing and redness. She denied of any diplopia, pain with eye movement, recent trauma, headaches, weight changes, heat or cold intolerance, or recent usage of prescription or OTC medications.

HISTORY: The patient claimed she has never had any eye problems until now. Her last eye exam was 2 years ago and was prescribed glasses for distance only, but she lost them and never got it renewed. She also stated that she doesn’t get regular physical exams and was healthy as far as she knows.

TESTING: BCVA was 20/20 OD and 20/25 OS with a mild myopic Rx. EOMS were full without restrictions or pain on movement. IOP were 14mmHg OD, OS with tonopen. The patient presented to the office already dilated so we could not check pupillary reaction. Gross examination revealed proptosis of the OS with 1mm of inferior scleral show. Marginal reflex distance was 4mm OD and 7mm OS. There was no lagopthalmos or no Bell’s phenomenon. Exophthalmometry with a base of 100 was 19 OD and 20 OS. SLE of the anterior segments of each eye was normal. Fundus examination was also unremarkable for each eye with only white without pressure in the peripheral retina.

Dx and Mx: The assessment was acute proptosis OS without diplopia and pain, likely thyroid eye disease. A CT scan of the brain and orbits were ordered to rule out extraocular and extracranial mass. The patient underwent CT imaging and was positive for left EOM thickening, suggestive of thyroid disease. The patient was notified and referred to an endocrinologist for a thyroid work-up and treatment if needed. She was to report back to our clinic 1 month after or endocrinology workup or if her symptoms worsen.

Children
To start off children should have routine eye exams, starting from when they are weeks old. It is important to watch your child for evidence of poor vision or crossed eyes. Some indications of vision problem may include: squinting, constant rubbing, or inability to see objects at a distance. If you notice any eye problems, have your child examined immediately so that the problem does not become permanent. If caught early, eye conditions often can be reversed.

20s-30s
The majority of adults in their 20s and 30s can correct their vision problems by either wearing contact lenses or eyeglasses. At this age it is important to take proactive steps to protect vision. Eating foods rich in nutrients can boost eye health. Don’t be hesitant to add spinach, green beans, or broccoli to your meal. Also remembering to wear sun glasses will protect your eyes against harmful UV radiation. Sunglasses are considered to be one of the most important anti-aging tools.
Smoking is a bad habit at any age. It exposes they eyes to high levels of harmful chemicals and increases the risk for developing age-related macular degeneration and cataracts in the future.

40s-50s
People will often begin to notice vision changes around age 40, with the most common complaint of difficulty seeing while reading or doing close work. This normal change in the eyes focusing ability due to age is called Presbyopia. Other vision changes that may occur are, sensitivity to glare, dry eye, or problems seeing at night. Also adults over 40 may be at risk for developing vision problems if they have conditions such as diabetes or high blood pressure. With many medications there may be some ocular side effects. In addition to having health habits, patients should discuss any family vision history with their doctor to help protect your eyes.

60s and Beyond
At this stage in life, it is very important to have their eye doctor to check for signs of Age-Related Macular Degeneration, Cataracts, and Glaucoma. Many of these conditions develop painlessly with no early symptoms. Depending on your family history and risk factors, your eye doctor may recommend checkups more than once a year.

Early detection and treatment is the best way to maintain good vision at any age. At The Eye Center of Texas, we guide you through any vision changes you may encounter and help you have a better quality of life.

AMD occurs when the Macula, the central portion of the retina, becomes damaged. AMD is a single disease, but it can take 2 different forms: Dry and Wet.

 Dry Macular Degeneration (Non-Neovascular)

Dry Macular Degeneration is the most common form of AMD. This is the early stage of the disease and may result from the aging and thinning of macular tissues, depositing of pigment in the macula or a combination of the two processes.

Dry macular degeneration symptoms usually develop gradually and may affect one eye or both eyes. If only one eye is affected, you may not notice any or much change in your vision because your good eye compensates for the weak one. However, some people may still be able to notice some of these vision changes:

• The need for increasingly bright light when reading or doing close work

• Increasing difficulty adapting to low light levels, such as when entering a dimly lit restaurant

• blurriness of printed words

• A decrease in the intensity or brightness of colors

• Difficulty recognizing faces

• A gradual increase in the haziness of your overall vision

• A blurred or blind spot in the center of your field of vision

• Hallucinations of geometric shapes or people, in cases of advanced macular degeneration

 These changes may be the first indication of macular degeneration, particularly if you are older than 50. So it is important to see you eye doctor, when you start to notice these changes in you eye sight.

Wet Macular Degeneration (Neovascular)

This is a chronic eye disease that causes vision loss in the center of your field of vision. Wet macular degeneration is swelling caused by leaking blood vessels that affect the macula, which is in the center of the retina and the layer of tissue on the inside back wall of your eyeball. Wet macular degeneration almost always begins as dry macular degeneration. It's not clear what causes wet macular degeneration to develop.

Wet macular degeneration falls into two categories:

• Occult. New blood vessel growth beneath the retina is not as pronounced, and leakage is less evident in the occult CNV form of wet macular degeneration, which typically produces less severe vision loss.

• Classic. When blood vessel growth and scarring have very clear, delineated outlines observed beneath the retina, this type of wet AMD is known as classic CNV, usually producing more severe vision loss.

Wet macular degeneration signs and symptoms typically appear and progress rapidly. Signs and symptoms may include:

• Visual distortions, such as straight lines appearing wavy or crooked, a doorway or street sign looking lopsided, or objects appearing smaller or farther away than they really are

• Decreased central vision

• Decreased intensity or brightness of colors

• Well-defined blurry spot or blind spot in your field of vision

• Abrupt onset

• Rapid worsening

• Hallucinations of geometric shapes, animals or people, in cases of advanced macular degeneration

Like Dry Macular Degeneration, these changes maybe the first signs of macular degeneration especially if you are over the age of 50. Be sure to see your eye doctor if any of the symptoms appear.

Low Vision
One of the most common side effects of AMD is Low Vision. Low Vision is a term commonly used to mean partial sight, or sight that is not corrected with contact lenses or standard glasses. Vision is still functional but the amount of loss interferes with the ability to do everyday activities. The severity of Low Vision varies; some people experience moderate vision loss while others may lose their vision completely.
Although low vision can occur at any stage in life, it primarily affects the elderly. However, low vision is not a natural part of aging. Although most people experience some physiological changes with age, these changes usually do not lead to low vision.
Most people develop low vision because of eye diseases. Common causes of low vision, particularly with older adults, include Age- Related Macular Degeneration, Glaucoma, and Diabetic Retinopathy. When vision impairment is recognized early, treatment can be more effective, enabling people to maintain as much independence as possible.

Low Vision Exams
To determine the amount of your useful vision, you will need to have your eyes examined. The examination for low vision is a little different that a regular eye exam. During a low vision examination, your doctor may administer the following tests:

• Refraction (to assess your vision and determine the prescription for your glasses, if glasses may be of any use)

• Visual field (to assess your peripheral vision)

• Ocular motility (to assess how well your eyes move) Because low vision examinations may involve a variety of tests, they are often more time consuming than the standard examination.

Symptoms

These symptoms may not necessarily mean that you have low vision. However, if you experience one or more of these symptoms, contact your eye doctor for a complete exam. Your eye doctor can tell the difference between normal changes which are common with age and changes caused by eye disease. The symptoms may include:

• Difficulty recognizing objects at a distance (street signs or bus signs)
• Difficulty differentiating colors (particularly in the green-blue-violet range)
• Difficulty seeing well up close (reading or cooking)

With those who have lost some of their vision, there are vision aids that may be used to fill in the spots where sight has been lost. Some popular vision aids include: telescopic glasses, lenses that filter light, magnifying glasses, hand magnifiers, closed-circuit televisions, and reading prisms. There are also some non-optical aids that some may people find helpful such as, text reading software, check guides, high clocks and watches, talking watches and clocks, large print publications, and clocks, phones and watches with enlarged numbers. Visual aids may improve sight and quality of life for many people.
Occupational therapy programs may also help improve the quality of life. These sessions include and evaluation of your environment and suggestions for modifying your home to enable you to become more independent and to improve safety. These sessions may last as long as several months or be as brief as one session.

Testing and Diagnosing of AMD
During a complete eye exam, your eye doctor may use a test called the Amsler grid to test for defects in the center of your vision. If you have macular degeneration, when you look at the grid some of the straight lines may seem faded, broken or distorted.
Your eye doctor will examine the back of your eye to look for a mottled appearance that's caused by Drusen — yellow deposits that form in people with macular degeneration. To examine the back of your eye, your eye doctor will dilate your eyes using eye drops and then use a special magnifying lens.
During an angiogram of your eye, a colored dye is injected into a vein in your arm. The dye travels to the blood vessels in your eye. A special camera is used to take pictures of your eye. The pictures show the dye highlighting the blood vessels in your eye. Your eye doctor uses the information from the angiogram images to determine whether the back of your eye shows blood vessel or retinal abnormalities, such as those that might be associated with wet macular degeneration.
This noninvasive imaging test helps identify and display areas of retinal thickening or thinning. These changes are associated with AMD. It's often used to help monitor the response of the retina to macular degeneration treatments.

Who’s At Risk for AMD?
The greatest risk factor for AMD is age. Studies have shown that people over the age of 60 are at greater risk than any other age group. Other risk factors may include:

• Smoking

• Obesity: studies suggest a link between obesity and the progression of early and intermediate stage AMD to advanced AMD

• Race: Caucasians are more likely to lose vision from AMD

• Family History: Those with immediate family members who have AMD are at a higher risk of developing the disease.

• Gender: Women appear to be at greater risk than men.

Maintaining a healthy lifestyle can help reduce the risk of developing AMD. By eating a healthy diet high in green leafy vegetables and fish, not smoking, maintain normal blood pressure, watching your weight, and exercising can help reduce your risk of any disease for that matter.

Treatment for AMD
With Dry macular degeneration, since the tissue of the macula gradually becomes thin and stops functioning there is no cure and any loss in central vision cannot be restored. If detected early, Wet macular degeneration can be treated with laser treatment, which is often called photocoagulation. A highly focused beam of light seals the leaking blood vessels that damage the macula. Photodynamic Therapy (PDT) uses a medication injected into the bloodstream, which is then activated with a laser shone into the eye. A new therapy available, where a medication is injected into the back of the eye, is showing favorable results. These are not permanent cures but are used to slow the rate of central vision loss.

At The Eye Center of Texas, our goal is to guide you and provide you with all the information needed to have a better quality of life. 

SYMPTOMS: The patient complained that she’s been having constant double vision for the past 2 months at all distances that goes away when she closes one eye or the other, but it gets worse when she looks to her right. She stated that the onset was intermittent and then became constant a few weeks ago. She compensated by turning her head slightly to the right in order to minimize the diplopia. The patient’s mother reported that the patient first complained of a pressure sensation behind her eyes, but they thought it was due to a sinus infection so her PCP prescribed an oral antibiotic that she just recently finished. She denied of any recent injury, new onset of headaches, tingling or numbness, weight changes, recent fever or current malaise.

HISTORY: Her ocular history was unremarkable, but her last eye exam was 3 years ago with no spectacle correction. Her mother admitted that no one in the family has had a dilated eye exam, including the patient. Her medical history aside from the recent “sinus infection” was unremarkable. The patient is 5’5” and weighs approximately 220lbs.

TESTING: BCVA was 20/25- OD and 20/20 OS. EOMs showed a significant restriction of the OD in abduction. The patient reported no pain with eye movement. All other preliminary tests were normal, including pupils.  Biomicroscopy of the anterior segment was unremarkable. Fundus examination revealed 4+ ONH edema of both nerves with vessel obscurations, blurry margins, and splinter hemorrhages. Retinal veins were highly tortuous and dilated OD>OS.
Color vision was normal and Humphrey visual field revealed nonspecific scattered defects in each eye and enlarged blind spots OD>OS. Blood pressure was taken in the office at the time and was 119/89 with a pulse of 72bpm.

Dx and Mx: The patient was diagnosed right VI nerve palsy and severe bilateral optic nerve head edema – likely pseudotumor cerebri. The plan was to order an MRI with/without contrast of the brain and orbits and a MRV of the brain to rule out a mass. The patient was also immediately referred to Texas Children’s Hospital Blue Bird Neurology clinic for neurology work up following the MRI and MRV. The patient was to report back to our clinic once initial consultation at TCH was done to check on her progress.

SYMPTOMS: The patient stated his OS has been slightly red and swollen for the past 2 months. It gets better with topical treatment, but gets worse again. In the past 2 months, he had used various topical medications that included prednisolone acetate 1%, Tobradex, Zylet, Azasite, and Pataday. He denied of pain, having been recently sick, contact with individuals with “pink eye,” or used any new products in and around his eyes.

HISTORY: Prior to this event that patient reported that he had no ocular problems. Medical history was also unremarkable. The patient worked in retail sales and was not married.

TESTING: BCVA was 20/20 OD and 20/20 OS. Preliminary tests were unremarkable. Biomicroscopy of the OD was normal. The OS revealed chemotic superior and inferior lids with 3-4+ follicular reaction of the palpebral conjunctiva. There was trace diffuse bulbar conjunctival chemosis and trace mucous-like discharge along the lash line. The cornea, AC, and iris were normal for the OS.

Dx and Tx: The patient was diagnosed with probably adult inclusion conjunctivitis (given the history) vs. recurrent ADV conjunctivitis OU. He was prescribed azithromycin 500mg BID for 1 day and Lotemax TID for the local inflammation. The patient returned in 3 days and reported marked improvement of his subjective and objective ocular findings. It was discussed with the patient the likely etiology of his recurrent red eye and that he needed to take precautions to prevent this from happening again. It was offered to the patient for another oral prescription for the azithromycin for his partner, but the patient declined.

SYMPTOMS: The patient noticed a dull aching pain in and around his OD 1 week prior. Then 3 days ago he noticed a slight decrease in his vision.

HISTORY: The patient stated that up until this event, he had good vision at distance and only used readers. He had never had an eye exam until now. The patient stated that he had a fever a few months prior and went to see a doctor, who discovered he had high blood pressure and started him on medication. He is scheduled to see her again in 2 months for a follow-up.

TESTING: BCVA was 20/50 OD and 20/25 OS. EOMs and confrontation fields were normal. The OD pupil was extremely sluggish to react and there was a slight APD. IOP measured with applanation was 45mmHg OD and 13mmHg OS. Biomicroscopy of the right anterior segment revealed diffuse corneal edema, 2+ conjunctival injection and inflamed nasal pterygium, trace flare, deep AC, and severe rubeosis of the iris 360° without signs of a hyphema. Gonioscopy of the right eye revealed severe neovascularization of open angles 360°. The left eye was normal with open angles. Dilated fundus exam showed scattered dot blot hemorrhages and CWS throughout the fundus of both eyes. Arterioles of the right eye were attenuated and sclerosed in some areas. Blood pressure in the office was 141/77 and pulse was 97bpm. Blood sugar testing in-office was 145mg/dL.

Dx and Mx: The patient was diagnosed with neovascular glaucoma secondary to ocular ischemic syndrome. He was prescribed Combigan BID, Lumigan QHS, and Azopt BID for the eye pressure. Bloodwork was ordered that included CBC with differentials, lipid profile, serum and plasma glucose, and hemoglobin A1C. A carotid Doppler was ordered for both sides and immediate cardiac evaluation was recommended secondary to increase risk of cerebral stroke. The patient was to return in 5-7 days for a pressure check and possible PRP/anti-VEGF therapy with the retinal specialist for the right eye.

   After your treatment you will be warned about discomfort that may occur in the days after your procedure. You doctor may recommend some pain medication such as Tylenol to help relieve any discomfort you may feel. However, if your pain is not getting soothed by OTC medication you will need to let your doctor as this could be a sign of a bigger issue. It is very important to not rub or press on your eye no matter how much discomfort you feel. Also you will be given somewhat of a list of this you can and can’t do after your procedure.

After your treatment, it is important to not get any foreign substances in your eye.

•  You may take a bath, but do not put your head under water for about a week. Also avoid splashing water directly   into the eye; instead you may use clean, soft, wet towels to wipe your face.

•  To help keep your eye clean, it is important to not wear any eye make up for up to 6 weeks after your procedure.

•  The cotton patches placed over your eye after the eye surgery are optional, the main reason they are placed is to catch tears and some discharge and to keep bright light from entering your eye immediately after the procedure.

•  As advised by your doctor, you may wear a protective eye shield at night for the first week to avoid any pressure that might be applied to your eye while you sleep. Dark eyeglasses may be worn during the daytime, especially outdoors, to avoid any discomfort that you may have from bright light.

   Following surgery, your eye will be very soft. During this time, the new blood vessels inside the eye will be swollen as they get used to the new, low pressure. While this is happening, there is risk that these blood vessels might break or bleed if the blood pressure inside the vessels goes up. You may return to work as soon as you feel better if you have a desk-type job. However, if you do manual labor you should remain off work for a couple of weeks. This is to help from straining your eye and protect it from foreign matter that may cause complications. Light activities such as, driving to work as long as you can see clearly, watching TV, reading books, and walking are acceptable as long as you feel well.

    Your Selective Laser Trabeculoplasty will take about 6weeks to kick in. You will be instructed to continue your Glaucoma drops unless told otherwise by your doctor. Your surgeon will usually want to evaluate your eye on the day of surgery or on the first post-operative day. At your appointments following the SLT therapy your doctor will continue to make sure everything is healing the properly. It’s important to see your doctor every 3-6 months for pressure checks.                                                                                                                                                    The average duration of an SLT procedure is 3-5 years and can be repeated if necessary. However, if SLT does not seem to work or make any changes, Trabeculectomy (Filtration Surgery) would be the surgery option.

Antibiotic and anti-inflammatory eye drop medications are continued after surgery for up to 6 weeks examples of these may include,Zymar or Ofloxacin for antibiotics, Prednisolone to reduce inflammation, and Atropine dilating drops to keep your eye relaxed and comfortable. In some cases, the surgeon will apply additional medicines (e.g., 5-FU) to further prevent scarring and failure of the filter. The exact regimen will vary from one surgeon to another as well as surgical outcome variables. In order to keep the eye drops clean do not allow the nozzle to touch anything including your eye.
     If you are using more than one kind of eye drop, wait 5 minutes between drops. If you are using eye drops and ointment in the same eye, always use the drops first and wait 5 minutes before applying the ointment. To apply eye ointment wash hands, tilt head back, and gently pull the lower eyelid down until it forms a small pocket or pouch. Once there is a pouch, squeeze and line (1/2in) of ointment into the pouch, release the lower lid and blink; wipe away the excess ointment with a tissue.
    After the treatment site of your eye has entirely healed, whether you will need glaucoma medications will depend largely on the pressure in your eye as well as your peripheral vision (based on a visual field test). In most cases, dependence on glaucoma medication is reduced, and in some cases, glaucoma medications are no longer required. One of the most important post-op instructions is making sure you go to all of your post-operative appointments.

    At these appointments Dr. Wade or Dr. Mayo will make sure everything is healing the correct way, as well as catch any complications or infections that may surface before they become a serious problem. Infection of your glaucoma operation can occur any time after surgery including years later, but rarely occur. Severe eye damage or loss of vision can occur if infection is not immediately treated. If you start to feel any of the following symptoms report those to your doctor immediately, symptoms such as eye redness, pain, loss of vision, or excessive eye discharge.

   Following your doctor’s orders after your procedure will help your recovery be a successful one and help your vision improve greatly.

SYMPTOMS: The patient stated that she had a sudden, painless loss of vision one morning, 3 days ago in her right eye. She denied of recent trauma, headaches, tingling of the scalp, jaw claudication, pain with eye movement, recent fever or current malaise.

HISTORY: The patient claimed she had good and equal vision in both eyes prior to the event and only occasionally used readers when needed. She stated that her medical history is unremarkable at her last physical exam a 3 months prior. She reported that her blood work was normal for cholesterol, but she has always been slightly anemic.

TESTING: BCVA was CF @ 1’ OD and 20/30 OS. Pupils revealed a positive RAPD, no color vision, and negative confrontation fields OD. The patient declined visual field testing, stating that her OD already did a visual field and that she could not afford to have another one done. Biomicroscopy was normal with mild cataracts and arcus OU. Dilated fundus exam revealed diffuse retinal edema centrally with attenuated arterioles OD. No elevation, pallor, or edema of the optic nerve was seen. The OS fundus exam was normal with trace changes in the macula. Blood pressure in office was 112/89 with a pulse of 111bpm.

Dx and Mx: The patient was diagnosed with probable central retinal arterial occlusion with the need to rule out AION. The patient was advised of her irreversible vision loss and the importance of follow-up. Blood work-up was ordered and included CBC with differentials, lipid panel, sed rate, and CRP. Right internal carotid Doppler was also ordered to check for plaque obstruction. She was told to immediately see her PCP or go to the ER to get a full cardiovascular work-up. The patient got the blood work done, but refused the carotid Doppler secondary to finances (she was private pay). Her blood work came back 2 days later with elevated cholesterol levels and anemia. She was notified of the blood results and encouraged to get a Doppler and see her internist STAT secondary to her increase risk of cerebral stroke.

SYMPTOMS: She reported seeing a darken spot just inferior to her central vision for 2 weeks She denied any pain, flashes, floaters, or ocular trauma.

HISTORY: The patient’s ocular history was unremarkable. She reported that she has Marfan’s Syndrome and that her 2 daughters were also positive for the disorder. Her medical history included surgeries for several arterial aneurysms, including a small cardiac aortic aneurysm.

TESTING: Visual acuities were 20/20 OD and 20/25 PH 20/20 OS. IOP, EOMS, pupils, and confrontation fields were normal. Biomicroscopy of the anterior segment was normal in each eye with no subluxation of the optical lens. Fundus examination of the right eye revealed 0.3/0.3 C/D ratio and normal macula. The superior arcade exhibited a large bullous retinal hemorrhage-like lesion with no associated exudates or subretinal fluid. The left fundus was unremarkable for pathology. Fluorescein angiography was ordered with special attention to the lesion. The fluorescein showed a localized weakness of the arterial wall, consistent with arterial aneurysm. It did not demonstrate ischemia, leakage, or an occult CNV.

Dx and Mx: This patient was diagnosed with a retinal arterial macroaneurysm OD. It was discussed with the patient that the aneurysm could cause localized leakage and edema. At that point, sectorial photocoagulation may be needed.

SYPMTOMS: The patient complained of excessive tearing, mucous discharge, matting, crusting, redness, and foreign body sensation for the past 3 years.

HISTORY: Patient’s ocular history for positive for cataract surgery OU 8 years prior and metallic foreign body removal OD 10 years ago. His medical history consisted of CVD, HTN, and COPD.

TESTING: BCVA was 20/30 OD and 20/25 OS. Preliminary testing were unremarkable. Biomicroscopy of the anterior segment of the right eye revealed a moderate nasal pterygium and 3mm mid-peripheral corneal scar. The left eye showed severe lower lid entropion and secondary trichiasis with lashes rubbing on the inferior cornea. The lashes of the superior and inferior lids had mucous discharge and crusting at the tips. Involutional laxity of the lower eyelids were evident OS>OD, making it easier to “roll” inward.

Dx and Mx: The patient was diagnosed with primary entropion LLL and secondary trichiasis. The plan was to surgically repair the lower lid with a lateral tarsal strip procedure in order to improve the apposition of the lower eyelid to the globe. The procedure is performed in office and lateral sutures are treated with abx ointment for 2-3 weeks post-op. Typically sutures will fall and/or dissolve after 2 weeks.

SYMPTOMS: The patient first noticed a change in his vision about 1 month ago. He stated that the onset seemed sudden and that the vision started to get a little better in the past week, but still not comparable to his OS. He denied using any new medications (prescribed, OTC, or otherwise), recent trauma, tingling of his hands or feet, new headaches, nausea, dizziness, or associated factors that altered visual changes.

HISTORY: His last eye exam was the day prior and the optometrist reported that his OD optic nerve was swollen with some inferior rim thinning. His medical history was unremarkable, but admitted that he hasn’t had a full physical in over 5 years.

TESTING: BCVA were 20/100 OD and 20/20 OS. Confrontation fields were full in each eye, but color vision was significantly reduced in the OD. EOMs showed no restriction in all fields of gaze. There was a positive APD of the right eye. Humphrey visual field 24-2 revealed a general depression of the OD and the non-specific scattered defects OS. Biomicroscopy of the anterior segment of each eye were normal. Fundus examination of the right eye demonstrated 2+ ONH edema with blurred disc margins, but no hemorrhages or obscuration of tertiary vessels. Maculae, vessels, and peripheral retina were normal OD, OS. ONH of the OS was also normal.

Dx and Mx: The patient was diagnosed with optic neuritis OD and sent out for a MRI of the brain and orbits with and without contrast STAT. The results came back later that night positive for a focal enhancement of the left frontal lobe without indication of a mass or acute ischemic event. The patient was set up for IV methylprednisone for 3 days, followed by oral prednisone for 11 days. The patient was also referred for neurology consult for the possibility of multiple sclerosis evaluation the following week. 

Prior to embarking into Glaucoma treatment you would have to be formally diagnosed with it. There are four different way to test for glaucoma known as Tonometry, Opthalmoscopy, Perimetry, and Gonioscopy.

            Tonometry is simply when your doctor numbs your eye and takes a small tool that will measure the pressure in your eye. If the pressure is high enough then you have glaucoma.

            Opthalmoscopy is when your doctor puts dilating eye drop in your eye so he can then look at the optic nerve. If your nerve is damaged then it is very likely that you have glaucoma.

            Perimetry is a visual field of tests, which indicate if you have lost vision or if the glaucoma has hurt your eye.

            Gonioscopy is when your doctor numbs your eye and uses a special contact lens that magnifies inside your eye. In order to diagnose you with glaucoma, the area where your iris and cornea meet is open either wide or narrow.

Once you are diagnosed, you will fall into the one of the four small categories of the type of glaucoma you have.  

First, there is Angle Closure Glaucoma where the angle of the canal is blocked by a part of the iris. This kind can only be treated with laser surgery to almost completely remove it.

Secondly there is, the type you are born is called, Congenital Glaucoma. Having this type comes with symptoms such as, cloudy eyes, excessive tearing, and sensitivity to light.

The third type is Pigmentary, which occurs when pigment from the iris flakes off and blocks the drainage canal.

Also there is Secondary Glaucoma, which can develop from things such as a tumor, diabetes, and a medical condition having something to do with your eye.

The last type is Open Angle Glaucoma, this is the most common and doesn’t have any symptoms and can cause you to go blind, which means you should get your eyes tested once every two years. If you have this kind, you vision will slowly start becoming like you are looking through a tunnel.         

Before seriously considering glaucoma surgery, At the Eye Center of Texas, Dr. Wade, M.D. and Dr. Mayo, M.D. may recommend medication for. There is no cure for this disease but with medication (usually in the form of eye drops), they will be sure to keep it under control.  There are several types of medication that can be taken to control glaucoma.      

Alpha-adrenergic agonist

These eye drops reduce aqueous humor production and increases its outflow. Examples include, Apraclonidine (Iopidine) and Brimonidine (Alphagan).

Prostaglandin analogs

These eye drops reduce pressure in the eye by increasing the outward flow of fluid from the eye. Latanoprost (Xalatan®) and Bimatoprost (Lumigan®)

Carbonic Anhydrase Inhibitors

Eye drops or pills used to reduce fluid production in the eye. Dorzolamide (Trusopt®) and Brinzolamide (Azopt®)

Miotics (cholinergic agents)

These medications will help control your glaucoma but might come with side effects which may include blurred vision, red eyes, headache, nausea or upset stomach; depending on your medication you doctor will go over thorough list of side effects.  

Once you have explored all of your options and nothing seems to make you feel better about your eyes, Dr. Wade and Dr. Mayo (at The Eye Center of Texas) will thoroughly explain a procedure called Selective Laser Trabeculoplasty (SLT) before going into the possibility of an incision surgery know as

Trabeculectomy (Filtration Surgery)

SLT is a non-destructive laser procedure to treat glaucoma by reducing pressure in your eye and controlling glaucoma without the need of eye drops. The SLT doesn't do any damage to the eye, unlike the older ALT lasers.

Before performing the procedure your doctor would measure pressure within your eye and examine the flow of fluid through the chamber of the eye and trabecular meshwork. Also, your doctor will record what the back of the retina looks like in order to document damage that may have been caused by the increased intraocular pressure and to demonstrate the improvement after your surgery.

SLT is one of the most significant and safest advanced in the treatment for glaucoma. Using a microscopic laser light, it will open the clogged drains of the eye and lower the pressure back to a safe level to prevent vision loss. SLT has an effective rate of about 80% and it is painless. Also it is very convenient as it only takes our doctors at the Eye Center of Texas, only about 5 minutes to perform this outpatient procedure. One application is usual for many people, but in some cases (depending on you individual circumstances and goals) another application may be needed at some point in the future.

During Trabeculectomy-sometimes also called Filtration Surgery-a piece of tissue in the drainage angle of the eye is removed, creating an opening. The opening is partially covered with a flap of tissue from the sclera, the white part of the eye, and the conjunctiva, the clear thin covering over the sclera. This new opening allows fluid (aqueous humor) to drain out of the eye, bypassing the clogged drainage channels of the trabecular meshwork.

As the fluid flows through the new drainage opening, the tissue over the opening rises to form a little blister or bubble, called a bleb. The bleb is located where the sclera, or white of the eye, joins the iris. During office visits after surgery, the doctor looks at the bleb to make sure that fluid is still draining out of the new opening. Not all blebs have to be easily seen to work. Before the procedure your doctor will check intraocular pressure, any areas of conjuctival scarring or sclera thinning, amount of visual field loss, and the presence of a cataract.

After going through all the information listed above with Dr. Wade or Dr. Mayo, you will be on your way to better vision.

PATIENT:  A 70yo White female was referred to the clinic for a posterior capsular opacity OS.

SYMPTOMS:  The patient complained of gradual decrease in vision OS over the last 6 months.  She was having difficulty reading fine print and glare for night vision. 

HISTORY:  The patient’s ocular history was positive for cataract surgery more than 10 years prior OD, OS and blepharitis, which she was taking Azasite QD OU.  Her medical history was positive for DM, heart disease, and a history of lung cancer. 

TESTING:  BCVA was 20/20- OD and 20/25- OS.  Because of her glare complaint, she BATs to 20/150 OS.  All other preliminary tests were normal.  Biomicroscopy was normal for the anterior segment with centered PCIOLs in each eye.  The left eye demonstrated a haze of the posterior capsule centrally when compared to the OD, which was clear.  Internal ocular findings were normal with only peripheral familial drusen seen. 

Dx and Tx:  The patient was diagnosed with PCO OS and a YAG capsulotomy was performed in-office without complications.  The patient was told to follow-up with her primary eyecare doctor in one week later. 

PEARLS:  When a patient's BCVA is better than 20/40, they must have a glare complaint and BATs out 2 lines worse than their BCVA> 

SYMPTOMS: He stated his symptoms all started a year ago, but has been progressively getting worse the past 3 months. He also mentioned that his OD appeared to be turning downward and that he experienced double vision 9 months ago.

HISTORY: Ocular history was positive for cataract surgery OS 1 year ago in Pakistan without complication. Medical history was only positive for diabetes and the patient was controlled with Metformin.

TESTING: BCVA were 20/30 OD and 20/50 OS, but the patient could only see the right half of the acuity line with the OS. Pupils were reactive to light with a mild APD OS. Confrontation fields showed was positive for defects in the right visual field of the OS, but OD was full to finger count. EOMs had marked restriction of movement OD > OS especially toward the superior gazes. Proptosis was noted OS > OD on gross examination. Anterior segment was normal in each eye. Fundus examination revealed 2+ ONH edema and pallor OS. The OD fundus exam was normal.

Dx and Mx: The patient was diagnosed with proptosis and EOM restriction OS > OD. ONH edema and pallor OS, likely secondary to orbital mass. A CT scan of the brain and orbits was ordered. The CT scan came back positive for orbital masses of BOTH eyes OS > OD, consistent with lymphoma. The orbital walls have deteriorated and infiltrative extension into the sinus cavities. The patient was immediately referred to MD Anderson for treatment and care.

Contact lenses and glasses can be cumbersome. Along with the time to maintain and clean your glasses or contacts, you also have to consider the annual cost. Contact lenses or prescription glasses are less expensive upfront, but consider over a lifetime. The estimated lifetime cost of wearing contacts is 3 to 5 times the cost of the iLASIK procedure. After the procedure, most patients are independent of glasses or contact lenses completely.

The iLASIK procedure is for patients with myopia, hyperopia, and/or astigmatism. With LASIK and iLASIK, a laser is used to reshape the surface of your cornea, permanently improving your vision. Want to reduce or eliminate your dependence on glasses or contact lenses? With the revolutionary technology offered by the Eye Center of Texas, you can do so with the iLASIK procedure. Find out if you are a candidate with a FREE LASIK consultation. There are also financing options available.

The iLASIK Procedure

Before the surgery, the Eye Center of Texas uses the VISX WaveScan to create a 3D map of your eye. This unique vision assessment allows for your eye surgeon to perform custom treatment for your eyes. This 3D image of your eye measures the aberrations in the eye, no matter how minuscule. The WaveScan technology then interprets the data to produce a set of instruction treatment with the Advanced CustomVue Laser. Your fingerprint is unique to you as your visual system is and the laser creates a custom fingerprint of your visual system. The treatment is personalized to fit you.

When your doctor has decided you are a candidate for iLASIK, the next step is surgery. Traditional LASIK uses a special instrument known as a microkeratome blade to create a flap on the outside layer of your eye. However with iLASIK, the corneal flap is created with the Intralase (bladeless) Laser. This method is 25 more times precise than traditional LASIK, and very safe and effective.  The laser takes about 30 seconds to create the corneal flap, with no pain involved. By using the Intralase Laser, complications are drastically lowered than with the microkeratome blade.

The next step to improving your vision with iLASIK is reshaping your cornea. To do this, the VISX CustomVue laser uses the instructions from the WaveScan to precisely correct your vision. The laser sends pulses of laser light in order to reshape the underlying cornea. Using iris registration, the CustomVue laser is able to track the eye’s movement and adjust accordingly. This process only takes about 60 seconds per each eye.

The last step is to place the corneal flap to its original position. The flap adheres to your cornea and heals naturally.  The entire procedure takes about 4 to 5 minutes per eye. Most patients achieve 20/40 or better. With iLASIK, 74% of patients see 20/20 or better.

iLASIK is virtually painless and highly effective and most people are eligible for the procedure. According to Dr. Wade, “The Advanced CustomVue laser vision correction procedure stands in a class of its own with the broadest range of FDA-approved indications.  When combined with the power and precision of the Intralase Method, the Advanced CustomVue procedure represents the most advanced LASIK procedure available to patients today”.

So what are you waiting for? If you want immediate improvement in your vision and to eliminate the need for glasses or contact lenses, consider the latest technology in laser eye surgery. With the two most advanced LASIK technologies – the Intralase laser and VISX CustomVue laser, you can be rest assured that your vision will improve radically, achieving near-perfect vision. This is why both NASA and the US Armed Forces have approved iLasik for astronauts and fighter pilots.

PATIENT:  A 45yo Hispanic male was referred for a traumatic injury to the right eye with decreased vision. 

SYMPTOMS:  The patient was fixing the garage door earlier that day when the large gauge spring popped and hit him directly in the region of his right eye.  The patient complained of pain, decrease vision, bruising and swelling around the eye, tearing and photosensitivity immediately after the injury. 

HISTORY: His ocular history was unremarkable, but he had not had an eye exam in over 3 years.  He only wore reading glasses and stated he always had good distance vision.  His medical history was positive for hypertension and asthma, which he was taking medications for. 

TESTING:  BCVA was 20/400 OD and 20/20- OS.   EOMs were full without restrictions and confrontation fields were full.  Pupils appeared to be normal and reactive to light without an APD, but it was difficult to assess secondary to the patient’s photophobia and cooperation. IOP with tonopen were 16mmHg OD and 12mmHg OS.  There was marked peri-orbital chemosis and contusion.  Biomicroscopy revealed 4+ cells with a 5% hyphema.  No lacerations or corneal defects were seen.  Funduscopic examination of the OD also demonstrated commotio retinae involving the macula (Berlin’s edema) that extended to the superior and inferior arcades.  No choroidal rupture, retinal breaks, or hemorrhages seen. 

Dx and Mx:  The patient was diagnosed with blunt force trauma with traumatic iritis, hyphema, and commotio retinae OD.  He was prescribed Pred Forte Q2hrs while awake, Cyclogyl QID, and a Medrol dose pack for the inflammation and swelling.  We explained all possible secondary complication that can be expected (glaucoma, cataract, retinal breaks) following traumatic event to the patient.  The patient was told not to participate in strenuous activity; sleep with head inclined, not to use extra ASA/ibuprofen products, and was given retinal detachment precautions.  It was stress the importance of follow-up exams especially during the first 2 weeks.  He was to return to the clinic in 1-2 days to check on his status. 

You only have one pair of eyes, so routine eye exams are the best way to ensure that they are healthy! Here are some common tests and techniques optometrists and ophthalmologists use during eye exams.

The Importance of Eye Exams

Routine eye exams are essential in preserving your vision and in determining the signs of other medical conditions, such as diabetes and hypertension. Effects of diseases such like these can be seen in the eyes first and are one of the easiest ways to detect these diseases because eye exams are painless and simple – your eye doctor does most of the work!

However, most people do not get their eyes examined until they notice vision impairment, and by that time, it may be too late. Early detection is the best way to prevent vision loss, and the earlier eye diseases/problems are detected, the more likely the condition can be reversed or at least the progression of eye diseases can be thwarted.

Many eye diseases do not have visible symptoms and by then your vision may be adversely affected. A comprehensive eye exam can detect problems that you may not be aware of. An early diagnosis of an eye disease can save your vision, and also save you money.

A comprehensive eye exam is not just for prescription changes. Your eyes signify your overall health as well. Many times your eye doctor is the first to diagnose systemic conditions.

Systemic conditions that can be detected through a comprehensive eye exam include: hypertension, diabetes, high cholesterol, thyroid disease, rheumatoid arthritis, sarcoidosis, multiple sclerosis, and even a stroke.

Along with systemic conditions, a comprehensive eye exam can detect eye conditions such as refractive errors, amblyopia, strabismus, glaucoma, macular degeneration, diabetic retinopathy, cataracts, and presbyopia. Your eye doctor will also check how your eyes work together, your depth perception, and the ability of your eyes to focus.

During a comprehensive exam, your eye doctor will ask about your health and history such as current health problems, family history, current medications, lifestyle, and current eyeglass prescription. This will give him/her a better understanding of what risks are involved for potential eye diseases and/or systemic conditions.

How Often To Have Comprehensive Eye Exams

Your age and medical condition determines how frequently you should get your eyes examined by your optometrist or ophthalmologist.

It is recommended for most people to have an eye exam every one to two years. Shortly after birth, we should have our first eye exam at about six months. Children should then have an eye exam at the age of three and then before starting school, which will detect possible learning related visual problems. An exam every two years is advised up to the age of 60; at this age, a yearly eye exam is needed. If vision correction is needed, a yearly eye exam at any age is also advised in order to keep the prescription up-to-date.

Certain risk factors may mean an eye exam is needed more frequently- at least once a year. For children, certain factors for visual problems include prematurity, family history of genetic diseases, strabismus (crossed eyes), developmental delays, and complications at birth.

Adults should have annual eye exams if there is a family history of eye disease, if you have diabetes or hypertension, if you wear prescription glasses or contacts, if you have had an eye surgery or serious injury, if you are taking medications with visual side-effects, or if your job is visually demanding or hazardous, such as construction, metal working, sports, office clerical work, or any type of work where you spend many hours in front of a computer.

You only have one pair of eyes, so routine eye exams are the best way to ensure that they are healthy! No matter at what age, routine eye exams should be important to you. Don’t wait until you notice vision loss to get an eye exam. You may never regain what vision has been lost.

HISTORY: A foreign body sensation which began in the left eye then moved to both eyes. Medical and ocular histories are otherwise unremarkable.

TESTING: Best-corrected acuity through a mild myopic prescription was 20/20 OD, OS, OU. Pupils, motility, and confrontation fields were all within normal limits. Intraocular pressures with Goldmann tonometry were 16 mmHg OD and 14mmHg OS.

EXAMINATION: Corneal exam revealed SPK and moderate bulbar injection superiorly.
All other findings were unremarkable.

Dx and Mx: With the findings given above, this patient was diagnosed with Superior Limbic Keratoconjunctivitis (SLK). SLK is usually bilateral and most often occurs in middle-aged females. 50% of these patients will have thyroid disease. Symptoms are often worse than the clinical signs. Her symptoms began in the left eye for which we placed a bandage lens and treated with Pred Forte q2h. A few weeks later she returned with similar but reduced findings in the right eye, which was also treated with Pred Forte this time QID. SLK has a tendency to have exacerbations and remissions which in the past has necessitated chronic steroid use. We are going to try and treat this patient with Restasis long term once the steroid has calmed the eye down.

PEARL: If suspicious of SLK rose bengal can aid in the diagnosis by showing superior bulbar staining.

SYMPTOMS: The patient stated that it started 1 week ago and that she’s had previous episodes in the past for the same thing in the same area and eye. She was not in any pain, just a mild irritation and slight blurry vision.

HISTORY: She was using Zymaxid and Tobramycin gtts alternating every 2 hours and Ciloxin ung QHS for the past week. She had another ulcer in the same eye earlier in the week that resolved at 7 o’clock, but another ulcer manifested at 5 o’clock in the OS a few days ago. She denied any trauma, soft CL usage in the past year, or handling of foreign material and inoculating her eye. She denied any allergies and was only taking birth control pills.

TESTING: Visual acuity was 20/20 OD and 20/25 PH 20/20 OS with a moderate myopic prescription. Tonopen for each eye was 18 mmHg. Anterior segment of the OS revealed 1+ bulbar conjunctival injection. There was mild pannus 1.5mm into the inferior cornea. A 2mm staining marginal ulcer with raised, infiltrative edges was located at 5 o’clock. She had inspissated glands along the inferior lid margin.

Dx and Mx: The assessment was marginal corneal OS, likely secondary to chronic staph exotoxin. She was advised to continue prophylatic Zymaxid QID and discontinue Tobramycin and Ciloxin. We added Maxitrol ung QHS to be used along the inferior lid margin and inferior cornea. She was told to call if her vision or pain worsened. Follow-up was scheduled in 2-3 days to check on the effectiveness of therapy. Once healed, she would most likely have to stay on a long-term therapy to decrease episodes of these marginal ulcers.

SYMPTOMS: She was asymptomatic with no reports of visual changes, pain, trauma, or pressure. The patient stated that she just experience mild redness and burning of both eyes, but that it was not bothersome.

HISTORY: Her medical history is positive for a premature birth, born 6 weeks early and had been on growth hormones for the past 11 years of her life. The patient stated that no one had ever told her that anything is wrong with her eyes. She’s currently taking Keppra, YAZ, Robinul, and Azasite for her posterior lid disease. She is a nonsmoker and does not drink alcohol.

TESTING: All preliminary testing, including pupils, EOMs, and confrontation fields were normal. BCVA was 20/25+ OD and 20/20 OS. IOP with tonopen were 12mmHg OD and 15mmHg OS. Biomicroscopy revealed prominent iris process projecting up and onto the inferior corneal endothelium in more than 5 clock hours OD and sparsely inferiorly in the OS. There were marked posterior embryotoxin inferior and temporally in both eyes. Dilated fundus exam was unremarkable with 0.3 cup to disc ratios OU.

Dx and Mx: Assessment was Axenfeld’s anomaly OD >> OS. The patient was educated that this is typically a congenital/genetic etiology and would not likely worsen. However, her risk for glaucoma is increased by 50% over time. Baseline RNFL OCT was taken to monitor for changes in the future. Advised the importance of regular eye exams to check IOP, monitor ONH cupping, and VF defects in the future. Baseline anterior segment photos were taken to monitor as well.

PEARLS: Axenfeld’s anomaly is a mesodermal dysgenesis of the anterior segment, where there are prominent iris processes that extend toward the corneal endothelium, often mimicking anterior peripheral synechiae. Often a congenital, bilateral disease, patients have to be monitored closely because they have a 50% chance of developing secondary glaucoma.

There are two types of AMD, dry and wet. The dry form occurs in approximately 90 percent of those with AMD. The wet form only occurs in 10 percent of those with AMD, but it accounts for 90 percent of all severe vision loss from the disease. “Wet” is a chronic condition with no cure, but it can be treated with photodynamic therapy (PDT), conventional laser, and anti – VEGF medication treatments, or combination therapies.

Like other chronic diseases, wet AMD requires that people with the condition take an active role in monitoring their symptoms. The Amsler grid is a safe and simple, self-administered screening test used to evaluate possible problem areas in the macular.

· Test each eye separately. Cover the eye that you are not using
· Keep the grid about 14 inches away
· Look directly at the dot in the center of the grid
· If you normally wear glasses, do so while looking at the grid

Repeat this test on your other eye. If you notice blurry or wavy lines, and dark or blank spots you may have a vision problem in the eye and you should call the Eye Center of Texas and schedule an appointment with Dr. Suarez (Retina Specialist) for an eye exam.

Early detection and treatment are the best defense of losing your vision. If you are at risk for macular degeneration call the Eye Center of Texas for an eye exam with Dr. Suarez.

Dr. Suarez is a board certified Retina Specialist at the Eye Center of Texas. She specializes in macular degeneration, diabetic retina care, and retinal detachments. She is fluent in 5 languages.

SYMPTOMS: He reported no diffuse or focal pain along the lid, no discharge, no recent trauma, and no visual changes.

HISTORY: His ocular and medical history was unremarkable, except for a recent cough 3 weeks prior that resolved without intervention. He is a nonsmoker and drinks socially.

TESTING: Visual acuities were 20/20 OD, OS with his habitual spectacles. IOP, EOMs, and confrontation fields were normal. Pupils revealed a marked anisocoria, greater in the dark than light. His left pupil was miotic compared to the right and had a poor response to light. Slit lamp examination did not reveal any significant swelling, papillae, or redness between to right and left upper eyelids. MRD (marginal reflex distance) for the right eye was 2mm and 0.5mm for the left eye. Internal ocular health was normal for both eyes.
Upon further questioning, the patient denied of any neck stiffness or back pain. He could not recall if he notice a decrease in perspiration in the recent weeks.

Dx and Mx: The assessment was acute Horner’s Syndrome with ptosis and anisocoria OS. MRI with and without contrast was ordered of the head and neck to look for pre-ganglionic lesions. Chest X-ray was also ordered to rule out lung mass. The patient was educated on his condition and the importance of follow-up care.
1 week later, all labs came back negative for mass or lesions. The patient is being followed closely to make sure the ptosis is stable. If ptosis is stable after 3 months, then a ptosis repair would be considered.

PEARLS: Even though the patient came into the clinic with a complaint of a swollen eyelid, do not let their complaint dictate your exam if the signs do not make sense. His eyelid appeared to be swollen only because it was ptotic and the palpebral fissure was much smaller in the eye.

Infographic by Ultralase