1 Augusto Arosemena M.D Ophthalmologist Clínica de Ojos Consultorios Médicos Paitilla Tel: 206-2424 Cell-phone: 66162020
Introduction My name is Augusto Arosemena, Ophthalmolgist and I did my eye surgery training in the USA. Finally I’m here in Boquete And would like to thank Mr. Stole Barger for making possible this visit to this beatifull part of Panama where you have chosen to retire. Also like thanks mrs Magda Crespo who made the initial aproaches for my visit. The words of Keith Woolford are very much appreciated and I thanks you all for coming .
2 Index 3) Today we are going to review some of the diseases that affect your vision and your quality of live. : I will start at the front of the eye with the lids and move further back. Blepharitis (Chronic Eyelid Inflammation) DRY EYE GLAUCOMA CATARACT MACULAR DEGENERATION Diabetic Retinopathy
4 BLEPHARITIS A chronic or long term inflammation of the eyelids at the base of the eyelashes. It affects people of all ages. Among the most common causes of blepharitis are: o A bacterial infection with Rosacea. o An allergic reaction o A poor eyelid hygiene
5 BLEPHARITIS Symptoms Burning Itching Irritation an redness at the edge of the lids In severe cases, it may also causes granulated eyelids with styes, irritation and inflammation of the cornea (keratitis) and conjuntiva (conjuntivitis). Some patients have no symptoms at all.
6 BLEPHARITIS Treatment (Topical - Systemic) Topical treatment includes eyelid hygiene with medicated pads. Ocusoft Plus Warm compreses Antibiotics eyedrops and ointments . Systemic treatment includes low doses of Tetracycline for a very long time. It is important to note that Blepharitis is a chronic condition, and patients diagnosed with it must take extra care to keep their eyelids as clean as possible.
8 DRY EYE It is a disturbance of the Lacrimal Functional unit, which comprises the lacrimal glands, ocular surface, and eyelids, together with the sensory and motor nerves that link them. It reduces the amount of tears produced. Normally tears are produce on a continuous flow during the day that decrease when sleeping. The dry eye syndrome is a multifactorial disease of the tears and ocular surface that produces tear film instability with discomfort, visual disturbance, inflammation and potential damage to the ocular surface. The key features of the dry eye syndrome are: Decreased tear production Increased tear evaporation Incorrect composition of tears These result in inadequate lubrication of the eyes with Sleepiness, irritation, red eyes, foreign body sensation and vision not as clear as it us to be.
9 DRY EYE TREAMENT ATTEMPTS To maintain moist the superficial layers of the eyeball. Artificial tears that correct the missing portion of the tears film. When you apply artificial tears to the eye they are drained at the inner corner of the eye toward the nose and throat. When you drop the eyes you made feel the taste. Treating the inflammation of the eye and the immunologic attack to the lacrimal gland is achieve with systemic medications like chronic oral Tetracycline Omega 3, vit E and time release vit C. Topical eye drops of cortisone and immunologic agents like Ciclosporine are use. Punctum Plugs when the production of tears is reduce Plugs are inserted in the upper and lower lagrimal puntums, to maintain in the eye the tears for a longer time. The treatment is chronic and depends of the portion of the tear film missing and that is another reason to live in a humid place like Boquete.
10 GLAUCOMA OPEN ANGLE Production of a liquid call acquosus brings the nutrients to the cristaline and cornea, and mantein the pressure in the eye. When the outflow is reduce the pressure builds up.
11 What is glaucoma? Glaucoma is a disease of the optic nerve. The optic nerve receives light-generated nerve impulses from the retina and transmits these to the brain. Glaucoma is characterized by progressive damage to the optic nerve that generally begins with a subtle loss of side vision (peripheral vision). If glaucoma is not diagnosed and treated, it can progress to loss of central vision and blindness. Glaucoma is usually, but not always, associated with elevated pressure in the eye. Generally, it is this elevated eye pressure that leads to damage of the eye (optic) nerve. In some cases, glaucoma may occur in the presence of normal eye pressure. This form of glaucoma is believed to be caused by poor regulation of blood flow to the optic nerve
12 What are glaucoma risk factors? Age over 45 years Family history of glaucoma Diabetes History of elevated intraocular pressure Nearsightedness (high degree of myopia). History of injury to the eye Use of cortisone (steroids), either in the eye or systemically. Farsightedness (hyperopia). Farsighted people may have narrow drainage angles, which predispose them to acute [sudden] attacks of angle-closure glaucoma.
13 What are glaucoma symptoms and Patients with glaucoma in general have no symptoms early in the course of the disease. Visual field loss (side vision loss) is not an early symptom. Glaucoma will not produce a red eye, inflammation, burning, eye secretions, nor pain. There is no way for the patient to realice that he is affected until very late in the disease, the only way to know is by having and eye exam by a qualified ophthalmologist.
14 Treatment Decrease the pressure inside the eye. This is achieve with: Eye drops (some of them decrease the amount of acqueous production and others increase the outflow) Laser trabeculoplasty (to facilitate the outflow) Eye surgery. The surgery includes trabeculectomy and valves; both implies continuos follow up during the first month
16 MACULAR DEGENERATION During the early stages of macular degeneration, there may be no symptoms. However, an ophthalmologist may be able to detect early signs of the disease. Often, the dry form of macular degeneration initially causes slightly blurred central vision, both close up and far. The center of vision may become fuzzy or shadowed. In the wet form, straight lines may appear wavy. Also, in this more severe form, central vision loss can occur rapidly, sometimes within days or weeks.
17 Between 10 and 15 year patients with poor control will Form new and defective blood vessels. Diabetic Retinopathy