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Eye Q
Cataract & IOL
       Cataract formation is a natural part of the eye's aging process. Cataract is the clouding of the normally transparent lens in the eye, leading to diminished or blurred vision.

Causes:

• Aging: Cataract formation is a natural part of the aging process (just like graying of hair or wrinkling of skin).
• Severe Eye Injury: Either injury by mechanical, thermal, chemical, electrical or by radiation.
• Congenital: This may be inherited or may be present at birth, due to infections, like German measles, in the mother during pregnancy.
• Other Systematic Diseases: Like eye inflammation, tumors or general body disorders like diabetes.
• Excessive or Indiscriminate: Use of certain drugs like corticosteroids. Most people regain the vision they had earlier with microsurgery (Cataract Extraction).

Diagnosis and Treatment

• Cataract cannot be prevented, delayed or stopped with medication.
• Surgery is the only cure, wherein the opaque lens is removed and replaced by intra-ocular lens implant. We perform various surgeries for cataract such as, Phaco-emulsification with rigid or foldable or multi-focal IOL, no injection cataract surgery and small Incision Cataract surgery. We do operate complicated surgery i.e., subluxated cataract, traumatic cataract, complicated cataract.
• Recent techniques, such as Phaco-emulsification, enable the cloudy lens to be emulsified, by means of ultrasound energy within the eye and removed by suction through a small incision. A foldable substitute lens is placed through the same small incision and usually no stitch is required. Post operative recovery is faster than conventional surgery by 3 - 4 weeks.
• Lasers are used to clear the after cataract membrane which grows in about 35% of cases after cataract surgery. We are equipped with latest state of art Phaco-emulsification machines.

Symptoms:

Do not rub the operated eye. Do not use any eye cosmetics until the doctor allows it. Do not wash your hair until the doctor says you can. Shave carefully, soap or water should not enter the eye. Avoid any vigorous activity. Do not lift heavy things.

Do not bend so that your head is lower than your waist. Avoid driving till your vision improves. Avoid sleeping on the operated side. No sexual intercourse until permitted by the doctor. Avoid alcoholic beverages. Watch television for short periods only.

AMD (Age related Macular Degeneration)
       AMD is one of the leading causes of visual impairment in individuals more than 50 years of age.

       AMD begins with characteristic yellow deposits in macula (central area of the retina) called DRUSEN. Most people with these earlier changes have good vision. People with drusens can go on to develop advanced AMD. The risk is considerably higher when the drusens are large and numerous and associated with disturbance in the pigmented cell layer under the macula.

There are 2 types of AMD - ‘Dry’ and ‘Wet’

• Dry AMD: Here the visual loss tends to be very gradual, over 5-10 years or so. This is the most common form and occurs in 9 out of 10 cases.
• Wet AMD: Occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. This occurs in about 1 in 10 cases.

Causes: Symptoms (presenting complaints):

• Blurred vision
• Central scotomas (shadows or missing areas of vision)
• Distorted vision (i.e. metamorphosis) – A grid of straight lines appears wavy and parts of the grid may appear blank.

• Trouble to differentiate colours and their intensities.

Other risk factors include:

• Smoking: This may increase risk of AMD.
• Obesity: Research studies suggest a link between obesity and the progression of early and immediate stage of AMD to advanced AMD.
• Race: Whites are much more likely to loose vision from AMD than African Americans.
• 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 a greater risk than men.

AMD is detected during a comprehensive eye examination which includes:

• Visual Acuity Test: This chart test measures how well one sees at various distances.
• Dilated Eye Exam: Drops are instilled in the eyes to dilate pupils and to see the fundus, with a special magnifying lens to examine retina and optic nerve for signs of AMD and other eye problems. After the examination vision may remain blurred for several hours.
• Tonometry: An instrument measures the pressure inside the eye. Local anesthetic drops may be applied for this test.

Other Investigations:

• Fluorescein Angiography
• Indocyanine Angiography
• Optical Coherence Tomography
• Ultrasound Biomicroscopy

Diet, dietary supplements and AMD:
       A recent large research trial aimed to clarify whether diet and dietary supplements had a role to play in the treatment of AMD. It was called the ‘Age Related Eye Disease Study (AREDS). This showed that in some cases, high quantities of dietary supplements that contain the antioxidant vitamins A, C, E, beta-carotene and the minerals zinc and copper, can help to slow down the progress of AMD.

Treatment modalities for Progressive Lesions:
Laser Surgery:
       A procedure used to destroy the fragile, leaky blood vessels. Laser surgery is more effective if the leaky blood vessels have developed away from the fovea, the central part of the macula. The risk of new blood vessels developing after laser treatment is high. Repeated treatments may be necessary. In some cases, vision loss may progress despite repeated treatment.

Photodynamic Therapy:
       A drug called Verteporfin is injected into patient’s arm. It passes through out the body, including the new blood vessels in patient’s eye. The drug tends to “stick” to the surface of new blood vessels. Next a laser beam is made to fall into the eye for about 80 seconds which activates the drug. The activated drug destroys the new blood vessels and leads to stabilization of vision. Unlike laser surgery, this drug does not destroy surrounding healthy tissue. Because the drug is activated by light, patients must avoid exposing skin or eyes to direct sunlight or bright indoor light for 5 days after treatment.

       Photodynamic therapy is relatively painless. It takes about 20 minutes and can be performed as an out patient procedure. It slows the rate of vision loss. It does not stop the vision loss or restore vision in eyes already damaged by advanced AMD. Treatment results often are temporary, may need to be treated again.

Injections:
      Wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF therapy). Abnormal high levels of a specific growth factor occur in eyes with wet AMD and promote the growth of abnormal new blood vessels. The drug treatment blocks the effects of the growth factor.

      Patients may need multiple injections that may be given as often as monthly dosages. The eye is numbered before each injection. After the injection, the patient will remain in the hospital for a while and monitored. This drug treatment can help to slow down the vision loss from AMD and in some cases improve sight.

Practical help for patients already blind due to AMD:
       When vision becomes poor due AMD, patients will be referred to a low vision clinic. Staff at the clinic provides practical help and advice, how to cope with poor vision, detailed as under:

• Magnifying lenses, large print books and bright lamps which may help for reading.
• A patient being registered as partially sighted or blind can be entitled to certain benefits.

MYOPIA

NORMAL FUNDUS

MYOPIC FUNDUS

       Myopia causes distant objects to appear blurred, while close objects can still be seen clearly. Myopia usually appears around puberty, but may appear at any age from early childhood up to the age of 25. In most cases, myopia will stop getting worse when the growth process has been completed.

Causes:
       There is a tendency for myopia to run in families. Children have about 30% chance of developing myopia if one of their parents has myopia and 55% chance if both have it. High degree myopia (pathological myopia) also runs in families.

Symptoms:

• Seeing distant objects such as the blackboard at school may become difficult, while near objects can still be seen clearly and they may think this is ‘normal’ and not tell anyone.
• Schoolwork may suffer for a while before the condition is identified and treatment is provided.
• Other symptoms can include headache and tired eyes.

       Myopia that starts in early childhood often gets worse in adult life and may become very severe. It is known as high degree myopia (or sometimes as pathological myopia). It can create problems in later because of its association with changes at the back of the eye.

Complications:
       High degree myopes (pathological myopes) are more likely to develop eye disorders in later life, which includes –

• Degenerative changes in the peripheral retina including thinning that can easily develop into tears, holes and retinal detachments.
• Retinal detachment
• Glaucoma
• Cataracts

Signs of Retinal Detachment:
       Every patient with myopia must know the signs of retinal detachment.

• Sudden appearance of flashes of lights, like lightening flashes, floaters, little shadowy dots, cobwebs or strands could be the first sign of an impending retinal detachment or a tear of the retina.
• If a person experiences the sudden onset of both flashes and floaters at the same time, the risk of detachment is extremely high.

       In retinal detachment, the person may notice impairment in one area of his vision described like a curtain coming down. This can occur from any direction including the right or left side or from the top or bottom of the vision.

Management for short sightedness:

• Spectacles: These are the common treatment. They have a concave lens which bends the light rays slightly outwards. Therefore the light rays have a greater angle to bend back to focus when going through the cornea and lens. This means they focus further back – on the retina.
• Contact Lenses: These are an option and do the same job as glasses.
• Simple Procedure: Various types of operations have been developed to ‘cure’ short sight. The most popular at present is a technique called LASIK. In this procedure a computer guided laser ablates part of the cornea.

Regular Retinal Monitoring:
       The best way to reduce the risk of vision loss is to have regular dilated retinal examinations, rather than a casual change of glasses at an optical shop and to seek immediate eye care if one has any flashes, floaters or decrease in one’s vision.

Diabetic Retinopathy
What is Diabetes?
       Diabetes is a common condition in which the amount of glucose (sugar) in the blood is too high because the body is unable to use it properly. Normally person’s pancreas (an organ in the body) produces a natural hormone called insulin, which controls the levels of glucose in the blood. Diabetes occurs when the body does not produce enough insulin, or produces insulin but cannot use it properly.

Types of Diabetes:
       Diabetes may affect both the young (type 1) and the old (type 2). The latter type is far more common. One of the effects of type 1 and type 2 diabetes is that small blood vessels in the body may get damaged.

Diabetic Retinopathy:
       Diabetes cause weakening of the blood vessels in the body, accomplished by structural changes in the retina. This is termed as Diabetic Retinopathy.

Development and Progression of Diabetic Retinopathy:
Diabetic retinopathy is related to –

• Duration of diabetes
• High blood glucose levels
• High blood pressures
• Generic factors

NORMAL FUNDUS

DIABETIC FUNDUS

Types of Diabetic Retinopathy:
       Diabetic retinopathy may lead to bleeding or swelling in the centre of the retina, making the light unable to reach parts of it. This can affect the eye sight. There are 2 main stages of Diabetic retinopathy:

• Non-Proliferative: When the blood vessels leak, macular edema may occur, thereby reducing vision.
• Proliferative: When new, weak blood vessels grow or proliferate it may cause bleeding into the vitreous causing severe visual loss.

How does Diabetes cause visual loss?

• Fluid can leak into the centre of the macula, (part of the centre of the eye necessary for sharp vision). The fluid makes the macula swell; causing blurring of vision and this condition is called Macular Edema. This can occur in any stage of Diabetic Retinopathy.
• Early onset of cataract
• Vitreous Hemorrage
• Retinal Detachment

MACULAR EDEMA

MACULAR EDEMA

What are the symptoms of proliferative retinopathy if bleeding occurs?
       Diabetic Retinopathy often has no early warning symptoms. Instead of waiting for symptoms it is better to have a comprehensive dilated eye examination once in a year.

Symptoms of Proliferative Retinopathy if bleeding occurs:

• Asymptomatic
• At first, a few specks of blood, or spots, causes floaters (black spots).
• Can be blurred vision, before more bleeding occurs.

Detection of Macular Edema and Diabetic Retinopathy:
Macular Edema and Diabetic Retinopathy during comprehensive eye examination that includes:

• Visual Acuity Test
• Dilated Eye Examination
• Slit Lamp Examination
• Indirect/ Direct Ophthalmoscopy

Features of Diabetic Retinopathy:

• Leaking of blood vessels
• Retinal swelling (macular edema).
• Pale, fatty deposits on the retina-signs of leaking blood vessels.
• Damage to nerves
• Changes in the blood vessels

Role of Fluorescein Angiography in Diabetic Retinopathy:
      In this test, a special dye is injected into the arm. Pictures are taken as the dye passes through the blood vessels in the retina. This is done to –

• Identify any leaking blood vessels
• Recommend appropriate treatment
• Assess the visual prognosis. The first angiogram is usually done during the first evaluation.

Treatment of Diabetic Retinopathy:
       During the early stages of diabetic retinopathy, no treatment is needed, unless there is macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. Laser treatment is used mainly if there are new vessels growing (proliferative retinopathy).

LASERS
       A Laser is a very bright light that is focused, so that it makes tiny burns on whatever it is focused on. A ‘burn’ can seal leaks from blood vessels, and stop new vessels from growing further. The burns are so tiny and accurate that they can treat a tiny abnormal blood vessel. This procedure is called scatter laser treatment. Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.

       Treatment of Macular Edema: Macular edema is treated with lasers. This procedure is called focal laser treatment. Here small laser burns in the areas of retinal surrounding the macula are given.

Mechanism of action:

• Slow the leakage of fluid
• Reduce the amount of fluid in the retina

AFTER LASER TREATMENT
Problems that may occur after operation: LASIK
       Many types of employment require excellent vision without correction devices. Men & Women in active sports very much wish freedom from glasses & contact lens. Boys and Girls in the matrimonial market find wearing glasses to be uncomfortable and inconvenient. Wearing spectacles can be expensive with periodic replacements.

      Hence, it is true but distressing to observe that millions of men & women all over the world suffer from visual abnormalities and each one of them desperately wish that he/she should have been born and wishing a solution or relief that could get rid them of glasses or contact lenses. As if an answer to their prayers, Lasik Laser arrived in their world and offered them revolutionary relief.

FAQs on Lasik Laser System:
What is Lasik?
      LASIK - Laser Assisted In-Situ Keratomileusis. Lasik is the safest and accurate method to correct short sight (myopia), long sight (Hyperopia), astigmatism (cylindrical powers) and other corneal scarring disorders.

How old is this treatment?
      There is a general misconception that Lasik is a new modality of treatment. This is not correct. Lasik is in existence since 1988, and has already gained wide acceptance world over. More than 5 million people in USA have undergone Lasik.

How is Lasik better than Contact Lenses?
      Contact lenses require special care and careful maintenance whereas LASIK is once-in-lifetime procedure. Moreover, wearing of contact lenses is a recurring expenditure. A full 5 years use of contact lenses would cost you almost the same as that of Lasik treatment.

Is Lasik a surgery?
      Lasik is a very simple procedure done with application of just anesthetic drops. It is just the reshaping of the Cornea with the help of a cold laser (Excimer Laser) with sub micron accuracy. Lasik is not at all a complicated procedure.

How safe is the Lasik treatment?
      Lasik is a very safe procedure with accurate and predictable results.

How long is the treatment?
      The entire procedure takes around 15 minutes and is done as a day surgery procedure without the need for admission to hospital.

Do I have to undergo any tests prior to Excimer laser treatment?
      Yes. Preoperative corneal and retinal evaluation would have to be carried out. They can be fixed by taking a prior appointment at the Doctor Eye Institute.

Is it painful?
      During the Laser treatment, there is no pain at all. However you may experience some mild ocular discomfort and watering during the first 24 hours after surgery. It will gradually resolve by second or third day. Painkillers and sedatives may be prescribed to ease the pain and discomfort.

Will my number become zero?
      The aim of the Laser treatment is to remove dependence on spectacles or contact lenses or in many cases eliminate them altogether. How long does it take to recover? The surface of the cornea takes 2-3 days to heal and vision will improve thereafter. Stability in vision is achieved in 1-3 months.

When can I resume my normal activities?
      Normal activities can be resumed after 1 week. However swimming and watersports can be resumed after 3 months.

When can I have my other eye done?
      The second eye can be done immediately after the first eye. Same sitting/after 3 days.

What are the other advantages of Lasik?

• No injections.
• Bowman's layer is spared.
• No removal of the corneal surface tissue is necessary and therefore post-operative pain is substantially reduced.
• Post-operative visual acuity is restored within a few days rather than weeks.
• Eyedrops are usually discontinued after one week.
• Stability usually occurs within one to three months
• Less corneal scarring in the long term, less change due to healing (regression) and thus greater stability of the correction.
• LASIK allows correction of myopia, astigmatism, and hyperopia in the corneal bed, underneath the flap.
• No prolonged medications after the treatment.

What is special about Lasik at your Centre?
      Zyoptix is the latest technology tagged to the Lasik machine, which promises “Super Vision’. Here customised laser ablation is performed, specific to each individual eye. The vision at the end of the treatment with Zyoptix is better than norma, natural vision and hence called “Super Vision”.

What can Lasik treat?
      Lasik Laser System can treat a huge range of refractive errors with minimal risk detailed as under.

• Myopia or short sight
• Hyperopia or long sight
• Astigmatism

       With the advent of the excimer Laser, refractive surgery is opening up new life choices to people who were previously dependent on spectacles or contact lenses for clear vision.

Who are the suitable candidates for Lasik Procedure?
      You are a good candidate for Lasik Surgery if you

• Enjoy general good health
• Have no major eye disease
• Have a relatively stable refraction for the last 12 months
• Over 18 years of age

Who are the not suitable candidates for Lasik Procedure?
      You are not a candidate for Lasik Surgery if you

• Suffer from eye diseases like ocular herpes, cataracts, keratoconus and glaucoma
• Are under 18 years of age
• Are pregnant and nursing
• Suffer from autoimmune disorders like rheumatoid arthritis, lupus, Sjogren’s syndrome etc.

Phakic IOL
       Surgically implanted lenses are called Phakic IOLs (intraocular lenses), are a new option for people seeking more permanent correction of common vision errors such as myopia (nearsightedness). These implants, which resemble contact lenses, are placed between the clear front covering of the eye (cornea) and the iris (colored portion of the eye) or just behind the iris.

       Implantable lenses do not require tissue to be removed from the eye as with LASIK; these lenses are effectively added to the eye.

       Eye surgeons may consider implantable lenses for their patients when other vision correction procedures aren't a good option, such as in cases of thin corneas or myopia between -3.00 diopters and -20.00. With some patients receiving Phakic IOLs, LASIK may be used as a follow-up to refine vision correction.

Verisyse
Intra-ocular Contact Lens (ICL)
Procedure:
      Prior to surgery, drops are placed in the eye to reduce pupil size. An instrument is attached to hold open the eyelids during the procedure, and a local anesthetic is given to numb the eye's surface. An incision then is made into the eye. The Verisyse Phakic IOL is inserted and attached to the iris. An eye shield will need to be worn for a short time following the procedure.

      The folded Visian ICL is inserted just behind the eye's iris and in front of the natural lens. After being placed through the microincision, the artificial lens then unfolds to its full width following implantation, which requires no sutures. Once inserted during about a six-minute procedure, the Visian ICL is invisible to the naked eye because of its location behind the iris.

Expect Immediately After Lens Implantation:
      After the procedure, vision often is instantly improved, though there may be a feeling of mild scratchiness. Most patients are able to resume driving and return to work within a day. A series of routine, follow-up visits with the eye doctor also are required.

      After the lenses are inserted, patients cannot feel them (unlike traditional contact lenses). Because these lenses are designed to be permanently added to the eye, they have the added advantage of never requiring removal for cleaning, as occurs with traditional contact lenses.


Glaucoma
      Glaucoma is a result of build of fluid within the eye and the resultant increase in pressure. This pressure falls on the sensitive optic nerve resulting in irreversible damage.

      Glaucoma has been rightly called the “The silent stealer of eyesight”. The loss of vision is so gradual from along the periphery of the eye that the patient is largely unaware. The most tragic is that vision loss due to Glaucoma is irreversible. Medication and surgery can at best preserve the residual eyesight of the patient.

The different types of Glaucoma commonly found are:

• Chronic Open Angle Glaucoma:As there are hardly any symptoms, the patient is largely unaware while there is a progressive loss of vision. The only way through periodic eye examinations.
• Acute Angle Closure Glaucoma: The angle is narrower than normal. This is of sudden onset. Blurred vision, severe pain, rainbow haloes around light, nausea and vomiting are the immediate symptoms. Unless medical attention is provided; blindness can result in a day or two.
• Congenital Glaucoma: This is visible literally from birth. Since the eye of an infant is more elastic than that of an adult, the increase of pressure leads to the eye bulging out.

Are you at risk?
If you are/ have

Over 40 years of age Family history of glaucoma Myopia Diabetes/ Hypertension Eye injury

Use of steroid drops, tablets or ointments Those who wear 'minus' glasses for short-sightedness; Anyone with complaints of pain, redness, and watering in the eyes; and People who see colored rings around lights.

Constant Care:
      Life long monitoring is essential, the frequency of follow up visits depends on the individual case. At each visit most of the tests may be repeated to determine the progression of the disease and to decide whether change in treatment is needed.


Paediatric Ophthalmology
      Paediatric Ophthalmology is a specialized branch of Ophthalmology which focuses on children’s eyes. Till this age, the eye of a child is developing and requires specialized training and equipment to correctly assess the visual needs of a child.

      Some of the most common problems in children are Refractive errors, Eye allergies, Trauma Squints, Amblyopia (lazy eye). In case of children, it is necessary for early detection and intervention. If this is not done: the entire development process may be hampered, and in extreme cases, may result in irreversible blindness.

      It is normally advised that children up till age of 16 years should visit a Paediatric Ophthalmologist every 6 months. Quite often, during these routine examinations, the doctors pick up conditions which otherwise left unattended may adversely affect the child’s eye.

Tips for Parents:
      If your child displays any of the following symptoms, get in touch with a Paediatric Ophthalmologist

Regular complains of headache or watery eyes Blinks or squints excessively Rubs eyes vigorously during or after short periods of reading

Makes frequent written mistakes even while copying Repeatedly bumps into or drop things Suffers from nausea, dizziness, motion sickness or double vision.

Eye examination benchmarks for children:
      Internationally, a child comprehensive vision examination has to include the testing of a number of visual skills, namely:

Distance Acuity Near Acuity Binocular Fusion Colour Vision Convergence and Eye Teaming Skills

Eye Tracking and Fixation Skills Focusing Skills Stereopsis Visual Form Discrimination Visual Motor Integration

Retinopathy of Prematurity (ROP):
      Retinopathy of Prematurity (ROP) is the abnormal growth of blood vessels in premature infant’s eyes. During the development, blood vessels grow from the central part of the eye towards the edges. This process will complete just a few weeks before the normal time of delivery. In premature babies this process is not complete. The vessels grow and branch abnormally and the baby develops ROP.

Premature babies at risk:
      If baby is born before 36 weeks of gestation and its birth weight is less than 1500gm, it is at risk of developing ROP.

If baby has ROP:
      If baby is at risk for ROP, an eye doctor should check your baby’s eyes. The exams must start at about 2-3 weeks of age and occur regularly until the eye vessels have grown till the edges.

       If the eye specialist sees any abnormal growth off blood vessels, he/she will record the extent of ROP. This is called staging. Infants who have mild ROP are followed with frequent eye examinations to watch for any progress. Infants with severe ROP have to be treated by lasers.

Treatment of ROP:
      Stage 1 and Stage 2 does not usually need any treatment. These stages may resolve on their own without further progression. Infants with Stage 3 may require laser treatment to stop the progression of the abnormal vessels. Using a laser, the inner lining of the eye (retina) at the ends of these vessels is made non functional to prevent abnormal of the blood vessels. This helps to prevent the inner retinal from being detached. If the retinal detaches then it becomes either Stage 4 or Stage 5. Surgery for this stage has very poor visual outcomes.

Follow-up after treatment:
      Even after treatment the baby could develop complications. So, yearly follow-ups are necessary life long.

Long term affects of ROP:
      Premature infants more frequently need glasses in early childhood than children who are not premature.


Uveitis Clinic
       Uveitis is an inflammatory disease of one or both eyes that occurs in the middle layer of the eye. It can also lead to inflammation in the adjacent areas, like the retina and fluid in the back of the eye (called vitreous). Uveitis will in severe cases lead to permanent loss of vision/blindness on the affected eye.

Causes:
       Uveitis can be caused by autoimmune disease, infections and rarely trauma, but 50 % of the cases remain of unknown origin. Intraocular infections are from previous studies, known to be responsible for approximately 40 % of the cases of severe forms of uveitis. Most infectious causes of uveitis have the potential to be treated with antibiotic. Most infectious causes of uveitis are under normal condition only possible to detect by using very specific detection methods. Further more it is often necessary to study a sample from with-in the eye (vitrectomy to get a proper diagnosis.

       It can result from allergy, bacteria, viruses, fungi, chemicals, trauma, or surgery; or it may be associated with systemic diseases, such as rheumatoid arthritis, ankylosing spondylitis, and toxoplasmosis. Uveitis occurs in 15 of every 100,000 people.

Diagnosis
       Confirming diagnosis, a slit-lamp examination shows a “flare and cell” pattern, which looks like particles dancing in a sunbeam. With a special lens, slit-lamp and ophthalmoscopic examination can also identify active inflammatory fundus lesions involving the retina and choroid, although a hazy vitreous may obscure the view.


Occuloplasty
      Occuloplastic surgery is a subspecialty of ophthalmology that focuses on problems surrounding the eyeball (the lids, the orbit and the lacrimal system) as well as artificial eyes. This may be present by birth or acquired later by aging, accident or tumour etc. The service also includes a cosmetic surgery.

Most common oculoplasty disorders are:

• Ptosis i.e. low or drooping upper lids
• Entropion or Inward turning of lids
• Ectropion or Outward turning of lids
• Eye Bags i.e. puffy upper or lower lids

Contact Lens
Contact lenses are prescribed for different eye conditions:

• For routine use in patients with myopia, hyperopia, astigmatism, and presbyopia.
• For patients with ectatic disorders or eye conditions such as keratoconus, keratoglobus, pellucid marginal degeneration, and Terrien's marginal degeneration.
• For post-surgical use in patients with aphakia, post corneal transplant or penetrating keratoplasty (PK), post corneal tear repair, corneal scars, and paediatric aphakia.
• As bandage contact lens in patients with ruptured corneal bullae, bullous keratopathy, very small corneal perforation etc.