Strabismus (squint).

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Strabismus is poor eye alignment. It can be un-cosmetic and can lead to amblyopia in children. The cause for strabismus can be restrictive, a palsy (where the nerve does not innervate the muscle to move the eye) or more due to poor control of alignment from the brain, but the eye can move in every direction normally. In the last cause, the eye can be turned in (Esotropia) or out (Exotropia) with respect to the other eye. Often glasses can help the alignment. Some patients benefit from surgery as well. Prisms in the glasses can be used in the older population, especially for small deviations. Some deviation can result from previous strabismus surgery (often as a child). This new deviation needs to be assessed as a new baseline with again potential for glasses to help. If glasses/prisms are not helpful, surgery may be recommended.

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Strabismus Surgery

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Strabismus surgery is done under a general anaesthetic as a day surgery where the patient goes home the same day. While under anaesthetic, the muscles around the eyes are moved to assist alignment. This may be done in conjunction with glasses to achieve the best visual and cosmetic results.

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The most common strabismic surgeries in adults are to correct horizontal deviation: esotropia or exotropia. It may be an esotropia surgery as a child can result in exotropia later in life. It is helpful but not essential to know the previous deviation and what previous surgery was performed. There are rare but significant risks with this surgery, including the need for more surgeries for alignment in the future and potential complications including vision loss and slipped or lost muscle, meaning the eye cannot move well in a direction, and more surgery is required.

 

Cataracts

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The intraocular lens should be crystal clear at birth, but throughout life, lenticular material collects and causes the lens to lose its clarity. With time the lens becomes opaque and reduces vision where glasses (which are outside the eye) do not help. The only way to recuperate clarity is to remove the lens surgically and replace it with a new intraocular lens. This surgery is performed in hospital/day surgeries with often a local anaesthetic to make the eye not move and not feel pain. The eye is padded up overnight after surgery, and once the patient is reviewed the next day, postoperative drops are started for a month. One eye is done at a time. Detailed discussion regarding the benefit and risk ratio for surgery will be conducted.

 

Diabetic Eye Disease

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Diabetes is the loss of regulation of blood sugar levels by the lack of insulin. Treatment is directed at controlling the blood sugar level. Prolonged elevated blood sugar levels can result in diabetic eye disease. This includes a faster progression of cataracts. The sight-threatening consequences result from bleeding and loss of healthy blood supply to the retina (the inside eye lining that sees an image and directs it to the brain via the optic nerve). The regular review ensures early intervention can be organised, including laser, injections and surgery.

 

Glaucoma

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The back of the eye has the retina, which channels the picture to the brain via the optic nerve. Glaucoma is the damage of the optic nerve leaving the eye. The most common risk factor for this disease is increased intraocular pressure. Accurate intraocular pressure measurements and a careful review of the optic nerve with direct visualisation and OCT (a non-touch machine that can analyse the contour and substance of the nerve) is required if glaucoma is suspected. As glaucoma often affects the peripheral vision first, visual field tests also diagnose and monitor disease.

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