medical units
Eye Pressure (Glaucoma)
HOW IS GLAUCOMA DIAGNOSED? Especially in the most common type of glaucoma called chronic open-angle glaucoma, if the intraocular pressure is not very high, the disease progresses insidiously without any obvious symptoms. Therefore, the diagnosis of the disease is made in its advanced stages. 1. Glaucoma is diagnosed by chance, mostly during an ordinary eyeglass examination or an examination performed in patients who consult a doctor for simple reasons. For this reason, measurement of eye pressure during eye examination should not be neglected. 2. In addition, it presents with a noisy picture such as severe eye pain, headache, red eye, nausea and vomiting, which is called acute glaucoma crisis in some patients and occurs when the intraocular pressure suddenly rises to very high levels. In this case, the diagnosis is very easy and urgent treatment is required. 3. Three findings that ophthalmologists classically look for together are necessary in the diagnosis of glaucoma. The first is high intraocular pressure. Normally, the intraocular pressure is 10-20 mm. mercury pressure level. The presence of intraocular pressure above 20 mm of mercury pressure is mostly in favor of glaucoma, but high intraocular pressure alone is not sufficient for the diagnosis of glaucoma. Because there are eyes with normal intraocular pressure when the intraocular pressure is above 20 mm of mercury, and there are also eyes with glaucoma although the intraocular pressure is below 20 mm of mercury. The second sought finding for the diagnosis of glaucoma is optic nerve damage seen in the fundus examination. The third finding is visual field distortions in visual field examination, which indicates damage to the optic nerve. Patients with glaucoma are monitored by evaluating the level of intraocular pressure, the condition of the optic nerve and visual field together, and drug treatment or surgery is decided based on these findings. IS GLAUCOMA A TREATABLE DISEASE? Glaucoma is a disease that can be treated once diagnosed. However, if it is not diagnosed in time and the disease is damaged in the optic nerve and is diagnosed after reducing the degree of vision, the treatment will only help to preserve the current vision. It cannot bring back the lost. For this reason, patients can be easily treated by preventing vision loss if they are caught in the early period before vision loss occurs and the optic nerve is not destroyed.
Strabismus
What is strabismus? Strabismus is a visual defect in which the parallelism of the eyes is impaired and they look in different directions. While one eye is looking straight, the other may look inward, outward, up or down. Slippage may be permanent or occur intermittently. Sometimes the deviated eye may look straight and the other may glide. Strabismus is a common condition among children. It can also occur later in life. The distribution between men and women is equal. It can be inherited in the same family. However, in many people with strabismus, the relative with strabismus may not be detected. » How do the eyes work together? In normal vision, both eyes look at the same point. The brain then combines these two images to form a three-dimensional image. This three-dimensional image gives us depth perception. If one eye slips, two different images are sent to the brain. In a young child, the brain ignores the image from the deviating eye and only perceives the image from the normal, well-seeing eye. Thus, the child loses depth perception. When strabismus occurs in adult patients, double vision usually occurs. Because the brain is accustomed to seeing images from both eyes and cannot ignore the image from the shifting eye. » lazy eye If both eyes are parallel during childhood, there is good vision development. The brain perceives the image of the well-seeing eye and ignores the image of the lazy eye. This is seen in almost half of children with strabismus. Treatment of lazy eye: Treatment of lazy eye should be done until the age of 8-10. It cannot be treated afterwards. There are several treatment methods. The first of these is the treatment performed by closing the good eye and strengthening the vision in the lazy eye. Another treatment method is the treatment performed in sessions with instruments called CAM in private clinics. In this form of treatment, the child is asked to paint over the rotating lines, draw shapes or solve puzzles by sitting at the head of a tool. It consists of at least 20 sessions. A third method of treatment is drugs. It is based on the principle of operating the other eye by dripping atropine group medication into the healthy eye. If the treatment is delayed, lazy eye becomes permanent. As a rule, the sooner lazy eye is treated, the better the outcome. For this, children should have an eye examination in their infancy and at least once a year thereafter. » Causes of strabismus The exact cause of strabismus is unknown. There are six muscles attached to the outer part of each eye that control their movements. Two muscles in each eye pull the eye to the right or left. The other four muscles move the eye up or down at certain angles. In order for the eyes to stay parallel and focus on a certain target, all muscles must work together and in a certain balance. In order for the eyes to move together, the muscles in both eyes must work in harmony. The brain controls the eye muscles. • Cerebral palsy (children who faint at birth without oxygen); • Down syndrome; • Hydrocephalus; • Strabismus is more common in children with problems such as brain tumors. Cataracts or eye injuries can also impair vision and cause strabismus. » Symptoms of strabismus The main symptom of strabismus is an eye that does not look straight. Sometimes children close one eye in the sun or tilt their head to use both eyes. » How is strabismus diagnosed? The diagnosis of strabismus is made as a result of an eye examination. It is recommended that all children undergo a visual examination before they turn four years old. If there is a family history of strabismus or lazy eye, vision can be tested before. Babies' eyes are usually crossed. The nasal root of young children is wide and flat, and there is a skin fold in the nose of the eyes. These make it look as if the eyes are crossed. As the child grows, this false strabismus disappears. There is no improvement in the condition of a child with true strabismus. The ophthalmologist distinguishes between true and false strabismus. » How is strabismus treated? Purpose of strabismus treatment: • protect vision; • Parallelizing the eyes; • It is to provide two-eyed vision, that is, depth. After a complete eye examination, the ophthalmologist determines the appropriate treatment. In some cases, glasses may be recommended for your child. With the supplied glasses, the slip can be completely or partially corrected. Apart from this, surgery may be required to parallelize the eyes or to remove cataracts, if any. It is often necessary to close the healthy eye to strengthen the lazy eye. » Common types of strabismus * Introversion (esotropia): It is the most common type of strabismus in infants. Children with inward drift cannot use both eyes together. In most cases, the eyes can be parallelized with surgery in the early period. During surgery for inward displacement, the tension of the muscles in one or both eyes is adjusted. The tight inner muscles are separated from their places and taken further back. Thus, the outward gaze of the eyes is provided. Sometimes, the outward-facing muscles can be shortened to increase their tension and correct the strabismus. Surgery does not necessarily have to be performed on the deviated eye. Surgery to the other eye can also correct the deviation. * Adaptive introversion: It is mostly seen in hyperopia (farsighted) children aged two years or older. The child may adjust their eyes to see up close, but this effort to focus (harmony) causes the eyes to cross. Glasses reduce shifting by reducing focusing effort. Sometimes bifocal lenses may be required for close work. Eye drops, ointments, or special lenses called prisms can be used to parallelize the eyes. * Outward slip: Another common slip type. Occurs when the child is looking at distant objects. Extraversion can occur especially when the child is daydreaming, sick or tired. In bright sunlight, the child may squint one eye. » How is strabismus surgery done? In any eye surgery, the eyeball is never removed. A small incision is made in the white membrane that covers the eye to reach the eye muscles. Depending on the way the eye slides, interventions are made on certain muscles. Surgery can be planned on one or both eyes. General anesthesia is required when strabismus surgery is planned for children. Local anesthesia can only be used in adults. Healing is fast. Patients return to their normal activities within a few days. Glasses or prisms may be required after surgery. In some cases, a second surgery may be needed at a later period. Early surgery gives better results in children with fixed strabismus. Therefore, if surgery is required, it should be considered before the school period. As with any surgery, eye muscle surgery carries some risks. These are other rare problems that can cause infection, bleeding, excessive scarring and vision loss. Strabismus surgery is generally an effective and safe treatment for paralleling the eyes, but cannot replace glasses or amblyopia treatment. » Injections Botulismus toxin, a special drug, can be injected to reduce the effect of a muscle. Thus, the opposite muscle is provided to work more tensely. Although the effect of the drug disappears within five to ten weeks, permanent treatment is provided in some cases. In some cases, the injection may need to be repeated and it is not as effective a treatment as surgery.