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Treatment of lagopthalmos can include both supportive care methods as well as surgical. If unable to receive surgery, artificial tears should be administered at least four times a day to the cornea to preserve the tear film. Leading up to a surgery, a patient can undergo a tarsorrhaphy which partially sews the eye shut temporarily to further protect the cornea as the patient waits for care. Multiple surgical treatments exist for Lagopthalmos but the most prevalent method includes weighing the upper eyelid down by surgically inserting a gold plate. Due to possible complications in conjunction with both the upper and lower eyelid, it might also be required to undergo a second surgery to tighten and elevate the lower eyelid to ensure both the upper and lower eyelids can fully close and protect the cornea.
The main treatment is symptomatic, since the underlying genetic defect cannot be corrected as of 2015. Symptomatic treatment is surgical.
There does not yet exist a specific treatment for IP. Treatment can only address the individual symptoms.
If dermatochalasis is severe enough to obstruct the peripheral or superior visual fields, then it may be treated with a surgical procedure called blepharoplasty. In blepharoplasty surgery, excess skin, muscle and fat are removed. While the improvement of vision is an indication for blepharoplasty on the superior eyelid, if the visual fields are not obstructed, it may be performed for cosmetic reasons. In general, blepharoplasty of the inferior eyelid is considered cosmetic, as dermatochalasis in the lower eyelid does not interfere with vision.
Madarosis has different possible treatments and can be reversed if treated early enough. The treatments for madarosis are completely dependent upon the pre-existing condition. When suffering from blepheritis, antibiotics are used to combat the bacterial infection. People who are suffering from trichotillomania need to seek behavioral and psychological help. Many people look to hair transplant surgeries, especially in non-scarring cases. These surgeries are mainly used as a cosmetic reason rather than a medical one. There are also other treatments that can be used for cosmetic purposes.
There are restoration surgeries for the eyebrows in severe cases. Many surgeons opt for nylon implants, but have been banned in some countries due to infections. Follicular transplantation is now the procedure of choice. In this surgery, hair samples are individually taken for a donor area and transplanted into the thinning area. Small incisions are made and grafts are placed individually according to the amount of hair in each follicle, eyebrows single. In this procedure, there are no scars or stitches and hair begins to grow after a few months post surgery.
Aponeurotic and congenital ptosis may require surgical correction if severe enough to interfere with vision or if cosmetics is a concern.
Treatment depends on the type of ptosis and is usually performed by an ophthalmic plastic and reconstructive surgeon, specializing in diseases and problems of the eyelid.
Surgical procedures include:
- Levator resection
- Müller muscle resection
- Frontalis sling operation (preferred option for oculopharyngeal muscular dystrophy)
Non-surgical modalities like the use of "crutch" glasses or Ptosis crutches or special scleral contact lenses to support the eyelid may also be used.
Ptosis that is caused by a disease may improve if the disease is treated successfully, although some related diseases, such as oculopharyngeal muscular dystrophy currently have no treatments or cures.
Treatment is usually unnecessary. In severe cases, surgery with a bilateral levator excision and frontalis brow suspension may be used.
Although treatment may be unnecessary, there may be social implications, especially in young children when venturing from a supportive home environment to a public environment (e.g., starting school). Continued support, including monitoring behavior and educating the child about his or her appearance as seen by others, is encouraged. Gradual or sudden withdrawal from interaction with others is a sign that may or may not be related to such behavior. Studies are being conducted to elucidate these implications.
A surgeon trained to do eyelid surgery, such as a plastic surgeon or ophthalmologist, is required to decide and perform the appropriate surgical procedure. The following procedures have been described for blepharochalasis:
- External levator aponeurosis tuck
- Blepharoplasty
- Lateral canthoplasty
- Dermis fat grafts
These are used to correct atrophic blepharochalasis after the syndrome has run its course.
Cherry eye, if caught early, can be resolved with a downward diagonal-toward-snout closed-eye massage of the affected eye or occasionally self-corrects alone or with antibiotics and steroids. Sometimes the prolapse will correct itself with no interference, or with slight physical manual massage manipulation as often as necessary coupled with medication.
Treatment is a relatively simple surgery in which excess skin of the outer lids is removed or tendons and muscles are shortened with one or two stitches. General anesthesia is sometimes used before local anesthetics are injected into the muscles around the eye. Prognosis is excellent if surgery is performed before the cornea is damaged.
@Congenital entropion:: may resolve with time ,or Hotz procedure
@Cicatricial entropion::
1 Anterior lamellar resection
2 Tarsal wedge resection
3 Transposition of tarso conjunctival wedge
4 Posterior lamellar graft
@Senile entropion::
1 Wies operation
2 Transverse everting suture
3 Quicker procedure
Surgery is the most common means of repairing a cherry eye. Surgery involves gland replacement, not excision, by anchoring the membrane to the orbital rim. In severely infected cases, preoperative antibiotics may be necessary by means of antibiotic eye ointment. Removal of the gland was once an acceptable treatment, and made the eye appear completely normal. Despite cosmetic appeal, removal of the gland reduces tear production by 30 per cent. Tear production is essential in maintaining and protecting the eye from the external environment. Reduced tear production is especially problematic in breeds of animals predisposed to Keratoconjunctivitis sicca (KCS). With surgeries performed in this manner, KCS often results later in life.
KCS is common in dogs, affecting one per cent of the dog population. KCS is a chronic degenerative conjunctivitis that can lead to impaired vision and blindness. KCS has a wide array of causes including drug toxicity, cherry eye, previous surgery, trauma, and irradiation. KCS can be treated, but treatment often spans the entirety of the animal’s life.
In contrast to this, several replacement surgical procedures exist to remedy cherry eye. Replacement of the gland results in lower instances of dry eye later in life. Surgery types are broken into two groups: anchoring procedures and pocket/envelope procedures. At least 8 surgical techniques currently exist. In anchoring procedures, the prolapsed gland must be sutured to the periorbital fascia, the sclera, or the base of the third eyelid. In contrast, pocket procedures involve suturing healthy tissue around the prolapsed to enclose and secure it. Each of these techniques may be performed with an anterior or superior approach, depending on which direction of suturing will cause the least complications to the eye.
There is no known curative treatment presently. Hearing aids and cataract surgery may be of use. Control of seizures, heart failure and treatment of infection is important. Tube feeding may be needed.
Oral Antibiotics: Ophthalmologists or optometrists may prescribe a low-dose, oral antibiotic such as Doxycycline.
Topical Antibiotics: If prescribed, topical creams or ointments can be applied after the cleansing of the lid margin. A small amount of antibiotic ophthalmic ointment is spread along the lid fissure with a swab or fingertip, while the eyes are closed. It is prescribed for use prior to bedtime to avoid blurred vision. Another method to reduce side effects of blepharitis are antibiotics such as erythromycin or sulfacetamide, which are used via eye drops, creams, or ointments on the eyelid margin. blepharitis caused by Demodex mites can be treated using a diluted solution of tea tree oil, via application by a cotton swab, for 5–10 minutes per day.
Steroid eyedrops/ointments: Eye drops or ointments containing corticosteroids are frequently used in conjunction with antibiotics and can reduce eyelid inflammation.
Evidence to support the use of antibiotic eye ointment is poor. Occasionally erythromycin ophthalmic ointment is recommended. Other antibiotics, such as chloramphenicol or amoxicillin may also be used. Chloramphenicol is used successfully in many parts of the world, but contains a black box warning in the United States due to concerns about aplastic anemia, which on rare occasions can be fatal.
Antibiotics are normally given to people with multiple styes or with styes that do not seem to heal, and to people who have blepharitis or rosacea.
Most cases of styes resolve on their own, without professional care. The primary treatment is application of warm compresses. As a part of self-care at home, people may cleanse the affected eyelid with tap water or with a mild, nonirritating soap or shampoo (such as baby shampoo) to help clean crusted discharge. Cleansing must be done gently and while the eyes are closed to prevent eye injuries.
People with styes should avoid eye makeup (e.g., eyeliner), lotions, and wearing contact lenses, since these can aggravate and spread the infection (sometimes to the cornea). People are advised not to lance the stye themselves, as serious infection can occur. Pain relievers such as acetaminophen may be used.
Blepharitis is a chronic condition causing frequent exacerbation, thus requires routine eyelid hygiene. Hygienic practices include warm compresses, eyelid massages generating consistent heat at body temperature (98.6 degrees F), and eyelid scrubs. A Cochrane Systematic Review of topical antibiotics was shown to be effective in providing symptomatic relief and clearing bacteria for individuals with anterior blepharitis. Topical steroids provided some symptomatic relief, but they were ineffective in clearing bacteria from the eyelids. Lid hygiene measures such as warm compresses and lid scrubs were found to be effective in providing symptomatic relief for participants with anterior and posterior blepharitis.
Topical antibiotic eye drops or ointment (e.g., chloramphenicol or fusidic acid) are sometimes used for the initial acute infection, but are otherwise of little value in treating a chalazion. Chalazia will often disappear without further treatment within a few months, and virtually all will reabsorb within two years. Healing can be facilitated by applying a warm compress to the affected eye for approximately 15 minutes 4 times per day. This promotes drainage and healing by softening the hardened oil that is occluding the duct.
If they continue to enlarge or fail to settle within a few months, smaller lesions may be injected with a corticosteroid, or larger ones may be surgically removed using local anesthesia. This is usually done from underneath the eyelid to avoid a scar on the skin. If the chalazion is located directly under the eyelid's outer tissue, however, an excision from above may be more advisable so as not to inflict any unnecessary damage on the lid itself. Eyelid epidermis usually mends well, without leaving any visible scar. Depending on the chalazion's texture, the excision procedure varies: while fluid matter can easily be removed under minimal invasion, by merely puncturing the chalazion and exerting pressure upon the surrounding tissue, hardened matter usually necessitates a larger incision, through which it can be scraped out. Any residual matter should be metabolized in the course of the subsequent healing process, generally aided by regular appliance of dry heat. The excision of larger chalazia may result in visible hematoma around the lid, which will wear off within three or four days, whereas the swelling may persist for longer. Chalazion excision is an ambulant treatment and normally does not take longer than fifteen minutes. Nevertheless, owing to the risks of infection and severe damage to the eyelid, such procedures should only be performed by a medical professional.
Chalazia may recur, and they will usually be biopsied to rule out the possibility of a tumour.
Chalazion surgery is a simple procedure that is generally performed as a day operation, and the person does not need to remain in the hospital for further medical care.
Chalazion removal surgery is performed under local or general anesthesia. Commonly, general anesthesia is administered in children to make sure they stay still and no injury to the eye occurs. Local anesthesia is used in adults and it is applied with a small injection into the eyelid. The discomfort of the injection is minimized with the help of an anesthetic cream, which is applied locally.
The chalazion may be removed in two ways, depending on the size of cyst. Relatively small chalazia are removed through a small cut at the back of the eyelid. The surgeon lifts the eyelid so he or she can access the back of its surface and makes an incision of approximately 3 mm just on top of the chalazion. The lump is then removed, and pressure is applied for a few minutes to stop any oozing of blood that may occur because of the operation. Surgery of small chalazia does not require stitches, as the cut is at the back of the eyelid and therefore the cut cannot be seen, and the cosmetic result is excellent.
Larger chalazia are removed through an incision in front of the eyelid. Larger chalazia usually push on the skin of the eyelid, and this is the main reason why doctors prefer removing them this way. The incision is not usually larger than 3 mm and it is made on top of the chalazion. The lump is removed and then pressure is applied on the incision to prevent oozing. This type of surgery is closed with very fine stitches. They are hardly visible and are usually removed within a week after the surgery has been performed. Although chalazia are rarely dangerous, it is common to send the chalazion or part of it to a laboratory to screen for cancer.
When surgery for a chalazion is considered, patients who take aspirin or any other blood-thinning medications are advised to stop taking them one week prior to the procedure as they may lead to uncontrollable bleeding. There are several tests taken prior to surgery to make sure the patient is in good condition for the operation.
In rare cases, patients are kept overnight in the hospital after chalazion surgery. This includes cases in which complications occurred and the patient needs to be closely monitored. In most cases however, patients are able to go home after the operation has ended.
The recovery process is easy and quite fast. Most patients experience some very minor discomfort in the eye, which can be easily controlled by taking painkilling medication. Patients are, however, recommended to avoid getting water in the eye for up to 10 days after surgery. They may wash, bathe, or shower, but they must be careful to keep the area dry and clean. Makeup may be worn after at least one month post-operatively. Patients are recommended to not wear contact lenses in the affected eye for at least eight weeks to prevent infections and potential complications.
Commonly, patients receive eye drops to prevent infection and swelling in the eye and pain medication to help them cope with the pain and discomfort in the eyelid and eye. One can use paracetamol (acetominophen) rather than aspirin to control the pain. Also, after surgery, a pad and protective plastic shield are used to apply pressure on the eye in order to prevent leakage of blood after the operation; this may be removed 6 to 8 hours after the procedure.
People who undergo chalazion surgery are normally asked to visit their eye surgeon for post-op follow-up three to four weeks after surgery has been performed. They may start driving the day after surgery and they may return to work in one or two days.
Chalazion surgery is a safe procedure and complications occur very seldomly. Serious complications that require another operation are also very rare. Among potential complications, there is infection, bleeding, or the recurrence of the chalazion.
The prognosis tends to be good for patients with MG. It is often best not to treat mild cases of MG. Management necessitates avoidance of medications that can worsen neuromuscular transmission, such as aminoglycoside antibiotics, quinolone antibiotics, beta-blockers, chloroquine, anti-arrhythmics, calcium channel blockers, some anticonvulsants and intravenous iodinated contrast should be avoided.
MG is characteristically variable in course, with the frequency of diplopia and ptosis affected by environmental, emotional and physical factors such as bright sunlight, stress, viral illness, menstruation, pregnancy, etc. Spontaneous remission can occur in any patient and remain for years. In a study of the natural history of generalized MG among 168 patients (with an average follow-up of 12 years), 14% experienced complete remission.
Patients with mild-to-moderate ocular myasthenia are usually treated initially with oral anticholinesterase agents, Mestinon (pyridostigmine) being the most commonly employed. There have not been any randomized clinical trials conducted with these agents, and this treatment is often unsuccessful, particularly in resolving diplopia. Immunosuppressive therapy is then started and the agent of choice is usually prednisone. In a small controlled study this drug demonstrated greater efficacy than pyridostigmine. Steroid therapy is controversial, but in another study the results suggested that prednisone does decrease progression to generalized MG. There is no single recommended dosing regimen in light of the side effects commonly associated with chronic corticosteroid therapy, and the difficulty in weaning patients from steroids without exacerbation of symptoms. Response to prednisone therapy is variable.
Additionally, MG patients should be examined for thymomas, and if found, should undergo surgery to address this condition. A prophylactic thymectomy is controversial, but has been shown to be helpful in young MG patients with acute disease within 3 years of disease onset, in patients with enlarged thymus glands and for whom surgery is low-risk, and patients with generalized MG who are unresponsive to medical treatment.
The symptoms of ocular MG can also be addressed by non-medicinal means. Ptosis can be corrected with placement of crutches on eyeglasses and with ptosis tape to elevate eyelid droop. Diplopia can be addressed by occlusion with eye patching, frosted lens, occluding contact lens, or by simply placing opaque tape over a portion of eyeglasses. Also, plastic prisms (Fresnel prisms) can be attached to eyeglasses of a diplopic patient, allowing for alignment of vision from both eyes in the affected direction, but are often problematic if the degree of muscle weakness, and therefore ocular misalignment, fluctuates frequently.
People with dermatochalasis often also have blepharitis, a condition caused by the plugging of glands in the eye that produce lubricating fluid (meibomian glands). Dermatochalasis can be severe enough that it pushes the eyelashes into the eye, causing entropion.
Weakness in the orbital septum may cause the herniation of the orbital fat pads. This is observed as the presence of bulges (fat pads) in the soft tissue of the baggy eyes.
Nocturnal lagophthalmos is the inability to close the eyelids during sleep. It may reduce the quality of sleep, cause exposure-related symptoms or, if severe, cause corneal damage (exposure keratopathy). The degree of lagophthalmos can be minor (obscure lagophthalmos), or quite obvious.
It is often caused by an anomaly of the eyelid that prevents full closure. Treatment may involve surgery to correct the malposition of the eyelid(s). Punctal plugs may be used to increase the amount of lubrication on the surface of the eyeball by blocking some of the tear drainage ducts. Eye drops may also be used to provide additional lubrication or encourage the eyes to increase tear production.
The condition is not widely understood; in at least one instance a passenger was removed from a US Airways flight because of it.
A symblepharon is a partial or complete adhesion of the palpebral conjunctiva of the eyelid to the bulbar conjunctiva of the eyeball. It results either from disease (conjunctival sequelae of trachoma) or trauma. Cicatricial pemphigoid and, in severe cases, rosacea may cause symblepharon. It is rarely congenital. and its treament
1 ocular movements restricted
2 diplopia
3 lagophthalmos
4 cosmetic cause
types.
Anterior, adhesion in Anterior part
Posterior, adhesion in only fornices
total, adhesion involves whole lens
Complications.
prophylaxis, 1 sweeping a glass rod around fornices several times a day
2 therapeutic soft contact lens
curative treatment t, 1 mobilising surrounding cornea, 2 conjunctival or buccal mucosa graft, 3 amniotic membrane transplant
Treatments for tinea versicolor include:
- Topical antifungal medications containing selenium sulfide are often recommended. Ketoconazole (Nizoral ointment and shampoo) is another treatment. It is normally applied to dry skin and washed off after 10 minutes, repeated daily for two weeks. Ciclopirox (Ciclopirox olamine) is an alternative treatment to ketoconazole, as it suppresses growth of the yeast "Malassezia furfur". Initial results show similar efficacy to ketoconazole with a relative increase in subjective symptom relief due to its inherent anti-inflammatory properties. Other topical antifungal agents such as clotrimazole, miconazole, terbinafine, or zinc pyrithione can lessen symptoms in some patients. Additionally, hydrogen peroxide has been known to lessen symptoms and, on certain occasions, remove the problem, although permanent scarring has occurred with this treatment in some sufferers. Clotrimazole is also used combined with selenium sulfide.
- Oral antifungals including ketoconazole or fluconazole in a single dose, or ketoconazole for seven days, or itraconazole can be used. The single-dose regimens, or pulse therapy regimens, can be made more effective by having the patient exercise 1–2 hours after the dose, to induce sweating. The sweat is allowed to evaporate, and showering is delayed for a day, leaving a film of the medication on the skin.