Amblyopia, or lazy eye, is the most common condition causing poor vision in children. It arises as a result of suppression of the vision from the poorly focused eye (eye with refractive errors), or eye with misalignment (cross eye, or outward turning of the eye) by the developing brain in children less than 7 - 8 years of age. If seen and treated early, almost all of those children suffering from amblyopia will regain normal vision. On the other hand, if left untreated, or if there is a delay in getting treatment, the child will be left with permanent visual impairment in the amblyopic eye and will lose the ability to see 3 dimensionally or lose his or her “3D” vision (stereopsis). As a result, those children will have limitations in their future career choices. We recommend you have your child checked if you have any concerns in this regard as soon as possible. Causes of Amblyopia The most common causes for amblyopia are focus errors in the eye, such as long-sightedness (Hypermetropia), focus difference between two eyes (Anisometropia) and rarely near-sightedness (Myopia). The next most common cause of amblyopia is Strabismus (squint). This can be “cross eye” (convergent strabismus), or outward turning of eye (divergent strabismus). Other causes include congenital cataract (opacity of the lens inside the eye) or drooping eyelids (ptosis). Treatment of Amblyopia The correct treatment depends on the exact cause of amblyopia; this can only be identified after a thorough examination of the eye. In many children, simply by correcting their eye focus with the aid of glasses will improve their vision. Some will need to use eye patching to force the child to use the poor sighted eye (amblyopic eye) and by doing so the vision in the amblyopic eye will be improved. There are other options for treating amblyopia and Eye Doctors will guide you and your child through the entire process of treatment based on your child’s specific ocular condition.

What is Blepharitis? Blepharitis (ble-fuh-REYE-tis) is a chronic disease of the eyelids, characterised by persistent inflammation of the lid margins. It is often classified into two types: Anterior blepharitis mainly affects the outer front edge of the eyelid margin, where the eyelashes grow. It often causes scales around the eyelashes and an overgrowth of bacteria, which produce toxins that enter the tears, irritating the eye. Posterior blepharitis (meibomian gland dysfunction, MGD) is the most common form of blepharitis. It mainly affects the inner back edge of the eyelid margin, which is in contact with the eye. The meibomian oil glands, located in a row behind the eyelashes, become blocked with thickened waxy oil. This leads to drying of the tears on the surface of the eye because they lack their normal healthy oil coating. It also causes an overgrowth of bacteria, which produce toxins that enter the tears, irritating the eye. Who gets blepharitis? Blepharitis is a common condition that can occur in anyone, at any age. It is most common in people with oily skin or Rosacea. What are the main symptoms of blepharitis? Blepharitis may cause irritation, burning, itching and the sensation of something scratching the eye. The eyes often become red and watery, but may feel dry. The vision may be variable. The eyelids may appear red-rimmed and there may be crusts in the eyelashes or cysts near the eyelid margins. Is blepharitis serious? In most cases blepharitis is annoying but does not cause serious harm to the eye. However, complications of blepharitis may develop, including meibomian cysts, ingrown eyelashes, dry eye and corneal ulcers. What treatments can help? There is no simple cure for blepharitis and controlling it often involves a combination of several different treatments: Eyelid hygiene should be done twice daily for the first few weeks, and then may be reduced to once daily once the blepharitis has improved. There are three components: 1. Hot compresses – This softens the oil in the meibomian glands and loosens any crusts around the eyelashes. It should take a full five minutes. There are two ways to perform a hot compress. Either wet a clean folded facecloth in hot (not scalding) water and wring it out. Press it gently on closed eyelids until it starts to cool. Repeat 2-3 times. Or use a small wheat bag (available from pharmacies or easily made with a cotton sock and some dry wheat) which is heated in the microwave for about 30 seconds then placed over the eyes. This retains its warmth for five minutes. 2. Eyelid massage – After the hot compress, use the tips of your fingers to massage the eyelids, pressing the skin towards the edge of the eyelid, along the whole length of the upper and lower lids. This is useful in posterior blepharitis to help squeeze the oil out of the clogged meibomian glands. 3. Lid scrubs – Using warm water and either a facecloth or a cotton bud, scrub gently along the rims of the eyelids, close to the eyelashes. A few drops of baby shampoo may be added to the water. Alternatively a commercial product such as ‘Lid Care’ wipes, or 'Sterilid' foam may be used. Lid scrubs are particularly useful in anterior blepharitis, to remove any scales from around the eyelashes. Tear supplements often help relieve some of the symptoms of blepharitis by replacing the natural tears, which may be evaporating too fast, and by diluting any toxic chemical in the tears, produced by an overgrowth of bacteria on the eyelid margins. There are numerous different artificial tear drops, which are available without prescription at pharmacies. Most of these drops can be used safely up to four times daily. Should tear supplements be required more frequently, then preservative free ones, which come in boxes of small throw-away vials, are recommended. Antibiotic ointment may be prescribed for a period of time. It can be applied with a clean fingertip or a cotton bud to the eyelid margins or applied directly into the eye. This helps to reduce the build-up of bacteria in the oil glands and around the eyelashes, which often contribute to the inflammation caused by blepharitis. Steroid eyedrops may occasionally be prescribed for a short course. They are anti-inflammatory, which reduce the redness, swelling and discomfort caused by blepharitis when it has a significant flare-up. If steroid drops are used you must be closely monitored by your eye doctor for potential side effects, such as glaucoma, cataracts and infections. Oral antibiotics, such as doxycycline, may be prescribed for more persistent blepharitis. A low dose is normally used for a long course, usually several months. Although generally well-tolerated, potential side effects include sun-sensitivity and abdominal upsets. Omega 3 supplements, which are widely available over the counter, may be beneficial with long term use. They have anti-inflammatory properties and may also improve the quality of the oil component of the tears. Other treatments may occasionally be recommended by your eye doctor depending on the type and severity of your blepharitis.

Blepharoplasty refers to the operation to remove skin from the upper lid. Excess skin develops through ageing of the skin. This fold of skin can affect vision if it comes over the visual axis and also causes cosmetic concerns. A successful blepharoplasty operation both improves vision and the appearance of the lid. Southern Cross Affiliated provider benefit to blepharoplasty patients: - no need for prior approval - Southern Cross pays Eye Doctors directly.

After refractive error (glasses), cataracts are the most common cause of visual loss. In every eye there is a lens. The eye’s natural lens sits behind the pupil and focuses light on the retina. With age, the lens enlarges and becomes yellow. If the natural lens loses its transparency, vision is decreased and this is called a cataract or a lens opacity. Cataracts can cause vision to become fuzzy in a progressive fashion and may also be the source of disabling glare. When cataracts affect the vision too much, refractive-cataract surgery is needed. Refractive-cataract surgery involves removing the eye’s natural lens and replacing it with a thin, transparent artificial lens. The operation is almost always done under local anaesthetic. It is relatively short in duration and an overnight stay in hospital is not required. Post-operative care consists of eye drops and a check at 1-2 days then after 2-4 weeks.

What is a corneal transplant? The cornea is the dome-shaped window that forms the front surface of the eye. It is made up of several layers, all of which are transparent. Diseases of the cornea may affect one or more of these layers. Corneal transplant surgery, also known as corneal graft surgery and keratoplasty, replaces an abnormal cornea with a cornea from a donor eye in order to restore vision. Who needs a corneal transplant? Many people with a cloudy cornea from scarring after infection or injury will benefit from corneal transplant surgery. Some inherited or degenerative conditions, like Fuchs' endothelial dystrophy, may lead to swelling of the cornea, which requires corneal transplant surgery when it affects the vision or causes pain. In keratoconus the cornea becomes thinned and distorted, resulting in blurring of vision. In about 15% of cases, when other treatments such as contact lenses no longer help, corneal transplantation is necessary. Unlike most other organ transplants, if a corneal transplant fails it can be repeated, although the success rate of repeat transplants may be lower than first time transplants. How is corneal transplant surgery performed? Corneal transplant surgery may be performed under general or local anaesthetic. It generally takes between one and two hours and is day surgery, not requiring an overnight hospital stay. There are several types of corneal transplants performed by Eye Doctors. In about half of corneal transplant surgery all corneal layers are affected, requiring a standard, full thickness transplant or ‘penetrating keratoplasty’ (PK). This includes surgery for some corneal scars and some keratoconus, which is the most common reason for corneal transplant surgery in New Zealand. The central 7-8mm of the damaged cornea is removed and replaced with a similar sized piece of clear donor cornea, which is stitched in place with fine nylon microsutures. In other cases, particularly the less advanced cases of keratoconus, a partial thickness ‘deep anterior lamellar keratoplasty’ (DALK) may be suitable. In this surgery the innermost corneal layer, or endothelium, is healthy, so is not replaced. This reduces the risk of corneal transplant rejection and failure in the long term. Other corneal disorders only require replacement of the innermost corneal layer, or endothelium. In Fuchs’ dystrophy and bullous keratopathy only this thin layer needs to be replaced, in a procedure known as ‘Descemets stripping automated endothelial keratoplasty’ (DSAEK). This is done through a small keyhole incision at the edge of the cornea and has the advantages of a faster healing time and no/minimal stitches on the eye. Eye Doctors are experienced in medical treatment of corneal diseases and in the latest surgical techniques for corneal transplantation, including partial thickness corneal transplantation. Our corneal surgeon can discuss the different types of corneal transplant with you and which type of surgery is most suitable. Is corneal transplant surgery safe? Corneal transplantation is quite a major surgery for the eye and should not be undertaken lightly. The healing period can be over a year for full-thickness corneal transplant and while the final vision can be as good as 20/20 (6/6), this is certainly not guaranteed. Significant complications during the surgery are rare, but there are some potentially serious risks, such as transplant rejection, which can lead to transplant failure if not treated promptly. Our corneal surgeon can advise you of the pros and cons of corneal transplant surgery.

This is a complication of diabetes and is caused by small blood vessel damage within the retina of the eye. It commonly affects both eyes and may cause permanent loss of vision. Macular oedema is often present with diabetic retinopathy. Macular oedema is when fluid leaks into the retina and causes swelling and blurred vision. This may occur at any stage of diabetic retinopathy, but is more common as the disease progresses. There are often no symptoms in the early stages but as the condition progresses vision may begin to become impaired. Often visual loss may be sudden and without warning. This is why it is imperative that diabetic patients have frequent eye checks. Poorly controlled diabetes and pregnancy in diabetes are special risk factors for developing diabetic eye disease. Often, first-stage diabetic retinopathy requires no active treatment on the eye but requires stabilisation of high blood sugar and control of high blood pressure and regular eye examinations. With progressive retinopathy, a laser treatment called the PRP laser can be used. This works by shrinking enlarged blood vessels to prevent bleeding into the retina. Treatment of macular oedema, if present, is also by laser treatment. Vision is stabilised by reducing the degree of fluid leakage into the retina. Often more than one treatment is required.

These relatively common problems of abnormal eyelid position are usually due to aging. They can cause discomfort, dry or watery eyes and cosmetic problems. At Eye Doctors we can tighten and reposition lids back to their natural positions, with a day stay surgical procedure. Ectropion - outward rotating eyelid. Entropion - inward rotating eyelid.

Misdirected eyelashes can cause considerable irritation. In the first instance the eyelid position should be checked and corrected if it is a factor. Misdirected lashes can also be remedied simply by removal. Eye Doctors offer electrolysis, laser and surgical excision to provide a permanent solution to this condition.

Glaucoma is a group of diseases that can damage the eye’s optic nerve and may result in vision loss and blindness. The type of vision loss is the main characteristic of the disease: vision is lost from the surround or periphery before affecting "straight ahead" vision. Multiple factors are often important in causing glaucoma, but it is most commonly related to hereditary and increasing age. Symptoms are most often entirely absent until the condition has progressed to an advanced stage. Hence the need to be checked. You may be more likely to develop glaucoma if you: have someone else in your family with glaucoma are over 40 years are either short- or long-sighted are known to have high pressure in your eye have experienced injury to your eye in the past have migraine or circulation problems. The following tests are used to diagnose and monitor glaucoma: Visual field testing (mapping of the surround vision). Tonometry – measures eye pressure. It is often the first screening test for glaucoma. The eyes are numbed with eye drops and then examined. Dilated eye exam - this is done with an ophthalmoscope (a medical instrument that allows the doctor to look through the pupil to the back of the eye). The retina and optic nerve are then examined for any sign of the typical glaucoma damage. The only method at present for slowing the progression of glaucoma is to reduce the pressure in the eye. Although glaucoma cannot be cured, early treatment can prevent further worsening of the condition and vision loss. Regular eye examinations are required life-long. The eye is like a soccer ball in that it has no shape unless it is pumped up. It is not pumped up with air but with a special clear fluid called aqueous which is continuously made within the eye and continuously drains out. The pressure of the eye can be manipulated by reducing the production of aqueous or by increasing the drainage of aqueous. Eye drops are the most common early treatment. Surgery may be required, especially if medications are not taking adequate effect or the drops are causing troubling ocular irritation. Laser iridotomy is a very useful procedure for reducing the risk of angle closure glaucoma - the glaucoma that most often affects long-sighted people. Glaucoma - intraocular lens surgery. Long-sighted people tend to have shorter eyeballs. The lens inside the eye enlarges with life and can get to be as fat as 5 mm. This increase in lens size which occurs over a lifetime eventually puts the natural drainage pathways at the front of the eye under pressure because the eyeball remains the same size. In serious cases glaucoma - intraocular lens surgery is recommended. This procedure, which is done under local anaesthetic, sees the enlarged natural lens replaced with a thin silicone or acrylic lens, greatly increasing the drainage space at the front of the eye. Trabeculectomy surgery is a method of reducing the pressure in the eye by making a small hole in the side of the eye and allowing the eye fluid to drain out beneath the skin of the eye where it is resorbed into the blood stream. This method achieves the lowest intraocular pressure of any of the methods for patients at highest risk of ongoing vision loss. It is also a very good method of reducing reliance on eye drop medication. Laser trabeculoplasty is a useful laser technique that can reduce the pressure well in some people, avoiding the need for drops or surgery.

What is keratoconus? The cornea is the transparent dome-shaped window on the surface of the eye, overlying the coloured iris. Its smooth round surface is important for maintaining clear vision. In keratoconus the cornea becomes thin and distorted, eventually protruding forwards in a cone-like shape. It typically affects both eyes, but can often be quite asymmetric. Why does keratoconus develop? The causes of keratoconus are not very well understood. However there is a genetic tendency, so it can sometimes run in families. There is also an association with allergies and most people with keratoconus have itchy eyes and rub their eyes to some degree. Over several years the pressure on the eye from rubbing may contribute to distortion of the cornea. Who gets keratoconus? Keratoconus occurs in young people, often starting in the teens, or even younger. It usually progresses slowly, and then stabilises in the twenties or thirties. It affects males and females in all racial groups, although in New Zealand it is most common in the Maori and Pacific and Indian populations. What are the main symptoms of keratoconus? Keratoconus causes blurring and distortion of vision in one or both eyes. It often gets slowly worse over time, but occasionally causes quite a sudden deterioration in vision. People with keratoconus often have associated allergic conjunctivitis, which causes itchy eyes and eye rubbing. What treatments can help with keratoconus? There are two main aims in treating keratoconus; improving vision and preventing progression of the disease. In the early stages of keratoconus, glasses or soft contact lenses may help correct blurred vision. As the cornea becomes more distorted only hard contact lenses are able to improve vision. About 15% of people with keratoconus progress to the stage where corneal transplant surgery is required. Traditionally full thickness corneal transplant surgery has been necessary, but in some cases of keratoconus it is now possible to perform a partial transplant, which has advantages in long term transplant survival. In recent years preventing progression of keratoconus has become a priority for people with mild or moderate keratoconus. Treating allergic eye disease and avoiding eye rubbing may be of some benefit. Corneal collagen cross linking (CXL) is a fairly new treatment designed to stabilise the disease. It uses a combination of ultraviolet light and vitamin B2 to stiffen the cornea, slowing or halting keratoconus progression. It is effective in at least 90% of cases and about 50% of people also have some improvement, with better vision and improved contact lens tolerance. CXL may reduce the need for corneal transplant surgery by preventing keratoconus from progressing to more advanced disease. Our corneal surgeon Dr Penny McAllum can advise which treatment is most suitable for you.

Age-related Macular Degeneration is a common condition of maturity which interferes with the ability to read and see directly ahead. Although it does not make the sufferer blind it is a devastating condition. It is possible after retinal examination to assign a risk of developing macular degeneration. There are treatments that are able to reduce the risk of vision loss in those who are found on retinal examination to be at high risk. The preventative treatment in common use at present is a tablet called Ocuvite®, which is a high dose multivitamin and mineral supplement. If the devastating form of macular degeneration is detected early enough, it is now possible to offer an intraocular injection of Avastin® which in many cases is able to restore sight. The warning of the serious form of macular degeneration is the development of a black spot in the centre of the vision which is often experienced in the morning, twisting or distortion of straight lines, delayed recovery of sight on coming in from the bright outside and difficulty reading.

What is a Meibomian cyst? A meibomian (my-BO-me-an) cyst, or chalazion, is a blocked meibomian gland in the eyelid. Behind the eyelashes is a row of oil glands, which open onto the back edge of the lid margin. If the oil becomes thickened it can block the opening of the gland, leading to a build up of oil in a cyst. This often causes a lot of inflammation in the surrounding tissues, resulting in swelling, tenderness and sometimes infection. Meibomian cysts may come and go over a few days or may persist for weeks or months. Who gets a meibomian cyst? A meibomian cyst can occur in anyone, at any age. Some people can be prone to recurrent or multiple cysts, particularly if they have chronic blepharitis, causing thickening of the oil in the glands and inflammation of the eyelid margins. When a child has a tendency to recurrent cysts, they usually become less frequent as they get older. What are the main symptoms of a meibomian cyst? As well as a tender, inflamed lump in the eyelid, a meibomian cyst can cause irritation of the eye and sometimes blurring of vision, due to pressure on the eyeball. What treatments can help with a meibomian cyst? Warm compresses – Wet a clean folded facecloth in hot (not scalding) water and wring it out. Press it gently on closed eyelids for at least one minute, until it starts to cool. Repeat two - three times. This softens the oil in the blocked meibomian gland, making it more likely to discharge from the cyst. Eyelid massage – After the hot compress, use the tips of your fingers to gently massage the eyelid over and around the cyst, pressing the skin towards the edge of the eyelid. This may help the cyst to discharge, reducing the need for surgery. Antibiotics – In some cases an antibiotic ointment may be prescribed to apply to the cyst for a few days. When a more severe infection of the cyst occurs an oral antibiotic may occasionally be prescribed. Surgery – If a cyst persists for weeks or months a minor operation, known as incision and curettage, may be required. In adults this is performed in the clinic. Children require surgery under general anaesthetic. After an injection of anaesthetic into the eyelid, a small clamp is placed on the eyelid. A cut, a few millimetres long, is made on the inside of the eyelid and the contents of the cyst are scooped out with a special ‘spoon’. The whole procedure takes only a few minutes. A short course of antibiotic ointment or drops is prescribed. There is usually some degree of swelling or bruising of the eyelid for a few days as it heals.

What is a pterygium? A pterygium (ter-IDG-ee-um) is a thickened growth of the conjunctiva, on the surface of the eye. It starts on the white of the eye, usually on the inner corner, and extends onto the cornea, the clear front window of the eye. Why do pterygia develop? Pterygia are caused primarily by ultraviolet light damage, although there may also be associations with dust and wind exposure. They usually develop in people with a history of significant sun exposure and tend to occur on the sun-exposed parts of the eye. What are the main symptoms of pterygia? As well as being noticeable growths, pterygia often cause redness and irritation of the eyes. Sun, wind and dry environments, like air-conditioning, may exacerbate this. Pterygia may affect vision by distorting the shape of the eye, causing astigmatism, or by growing large enough to cover the pupil. Pterygia may also cause contact lens intolerance. What treatments can help with pterygia? Artificial teardrops, which are available without prescription from pharmacies, lubricate the surface of the eye to improve comfort and redness. They can be used safely on a regular basis. Decongestant drops, such as ‘Clear Eyes’ temporarily take away redness, but should only be used occasionally as they can cause rebound redness if over-used. If a pterygium becomes particularly inflamed non-steroidal or steroid anti-inflammatory drops may be prescribed for a short period, under supervision of an eye specialist. Protecting the eyes from ongoing ultraviolet light exposure may reduce the chance of a pterygium enlarging, so sunglasses should be worn when outside. When symptoms persist despite medical treatment, surgical removal of the pterygium may be required. What does pterygium surgery involve? Surgery may be indicated if a pterygium is causing persistent discomfort, redness or cosmetic concerns and if it is growing progressively larger or interfering with vision or contact lens wear. Surgery is typically performed on one eye at a time, although both eyes can be treated at once. Pterygium surgery is generally done under local anaesthetic as a day-stay procedure. It takes less than half an hour and is not particularly uncomfortable. The pterygium is excised from the surface of the eye, and then a small piece of healthy conjunctival tissue from under the upper lid is transplanted onto the exposed white of the eye. Although traditionally held in place with stitches, Eye Doctors use fibrin glue in the majority of cases, to make the surgery quicker and reduce the irritation on the eye afterwards. The transplant helps the eye to heal with an improved cosmetic appearance and reduces the risk of pterygium recurrence, to about 1/50. Following surgery a patch is placed on the eye overnight and drops are prescribed, usually about four times daily for 4-6 weeks. Painkillers are also recommended in the first 1-2 days, because the eye may be quite uncomfortable. The eye may look red for up to a month after surgery and there may be mild swelling or discomfort during this time, as the eye heals.

This is when the retina detaches, meaning it is lifted or separated from its normal position within the eye. An acute retinal detachment requires urgent assessment and appropriate treatment. Unless prompt and effective treatment is given, some forms of retinal detachment may lead to irreversible blindness. Signs and symptoms include: a sudden or gradual increase in floaters, deterioration in vision, cobwebs or specks with the visual field, light flashes in the eye or the appearance of curtains over the visual field. You are more likely to have a retinal detachment if you are very short-sighted or have had an injury or previous surgery to the eye. For minor detachments, a laser or freeze treatment (cryopexy) are used. Both therapies re-attach the retina. For major detachment, surgery will be necessary. A band is often put around the back of the eye to prevent further detachment. Surgical treatment is usually a vitrectomy, where the jelly (vitreous) is removed from the eye. This often involves a hospital stay. It can take several months post-surgery to see the final visual result.

Ptosis - drooping of the upper eye lid. As we age it is fairly common for the upper lid to droop, sometimes one eye droops more than the other. This can cause distress due to vision impairment and altered appearance. At Eye Doctors we offer a day stay procedure to adjust the height of the upper eyelid by reattaching the muscle that lifts the lid at the correct position. In most cases asymmetry between the eyes can also be improved and the signs of aging reduced.

Strabismus (Squint) in Children Strabismus, or squint, is the misalignment of the eyes. It can be convergent (crossed eye), or divergent (outward turning of eye). One eye can be higher than the other eye (Hypertropia), or lower than the other eye (Hypotropia). About half of those children with cross-eyes are due to uncorrected long-sightedness. Wearing appropriate glasses will not only improve their vision but also correct their cross-eye condition. The other half of children with cross eyes and almost all children with constant out-turning of the eye will need eye muscle surgery to correct their squint. Sometimes, a child with life threatening tumors in the eye or in the brain can first present with squint. So a sudden onset of a squint requires urgent investigation. Research and clinical trials involved in straightening the eyes of children have shown there is not only the advantage of improved appearance, but more importantly improved ability for the child to see “3 D” vision and in their overall motor skills. Strabismus in Adults Common causes of strabismus (squint) in adults can be due to trauma to the eye muscle or bony structure around the eyeball, paralysis of the nerves innervating the muscle(s) and sometimes due to thyroid diseases. A small number of adults have residual strabismus left uncorrected, or unsuccessfully corrected from their childhood. Like childhood strabismus, adult strabismus can also cause significant functional impairments and is therefore not merely a cosmetic concern. For example, an adult with cross-eyes can only see half of the visual field usually seen by a person without cross eyes. An adult with strabismus is often severely disabled because the person will have “double vision”. Because of the double vision, the person will not be able to drive or do his/her normal duties at work. Treatment for adult strabismus often needs surgery to align the eyes properly. This will get rid of the double vision, enlarge the visual field and return the appearance back to normal. Special surgical techniques performed by Eye Doctors such as ‘adjustable suture’ strabismus surgery increase the success rate of adult strabismus surgery well above 95%. Strabismus Surgery Adjustable Suture Eye Muscle Surgery Nystagmus (jiggling of the eyes) & abnormal head posture. Nystagmus, or jiggling of the eyes, can occur from poor vision in childhood, or as a result of albinism (lack of pigmentation in the skin) and other neurological conditions. In these patients, turning their head to certain directions minimises the intensity of the jiggling of the eyes and their vision often improves. Eye Doctors offers special eye muscle surgery that can lead to straightened head posture, reduced jiggling of the eyes and improved vision.

What is adult strabismus (squints)? Strabismus (commonly known as squints) is a condition in which the eyeballs are not aligned properly and point in different directions. When it occurs in adults, it is called adult strabismus. Nearly four in every 100 adults have this condition. What causes squints in adults? Most adults with squints have had the condition since childhood. However, strabismus can also begin in adulthood due to medical problems, such as: Diabetes Thyroid disease (Graves’ disease) Myasthenia gravis Brain tumours Head trauma Strokes. Occasionally, misalignment of the eyes can also occur after surgery on or around the eye, such as cataract surgery or retinal surgery. This is due to damage to the eye muscles during surgery. What are the symptoms of squints? Adults with squints may experience: Eye fatigue Double vision Overlapped or blurred images A pulling sensation around the eyes Reading difficulty Loss of depth perception. To correct the inability to focus properly, many adults with squints have to tilt or turn their heads when focusing. They are also unable to make direct eye contact with both eyes when looking at people, which can make social situations awkward. These symptoms may have a negative impact on employment and social opportunities. How are squints in adults treated? Squints in adults can be treated using several methods, including: Eye muscle exercises Glasses containing prisms Eye muscle surgery Eye muscle exercises: Muscle exercises can be helpful in treating a form of squints in adults in which the eyes cannot align themselves for close work or reading. This condition is called convergence insufficiency. Close work requires you to focus both eyes inward on close objects such as books, a needle and thread, computer screens. The coordinated movement and inward focusing of the eyes is called convergence. Dr Shuan Dai can provide advice about home eye muscle exercises to help retrain the eyes to focus inward together. However, eye muscle exercises are rarely useful in other cases of squints in adults. Prism eye glasses: Eye glasses with prisms can correct mild double vision associated with squints in adults. A prism is a clear, wedge-shaped lens that bends, or refracts, light rays. When worn by an adult with squints who has mild double vision, the prism eye glasses realign images together so that the eyes see only one image. The prisms can be worn on the outside of the eye glass frames or can be manufactured directly into the lens itself. Prism eye glasses usually cannot correct more severe cases of double vision where images are far apart or double vision caused by weak or tight muscles. Eye muscle surgery: Eye muscle surgery is the most common treatment for squints. Typically, squints occur when the muscles surrounding the eyes are either too stiff or too weak. Eye Doctors squint specialist Dr Shuan Dai can surgically loosen, tighten or reposition selected eye muscles so that the eyes can be rebalanced to work together. Surgery can: Improve eye alignment Reduce or eliminate double vision Improve or restore the use of both eyes together (binocular visual function) Reduce eye fatigue Expand peripheral (side) vision Improve social and professional opportunities. Squint surgery is usually performed on an outpatient basis using general or local anaesthesia. Patients may experience some pain or discomfort after surgery, but it is usually not severe and can be treated with over-the-counter pain medication such as Panadol or paracetamol. Stronger medications for pain, such as codeine or hydroquinone, are sometimes needed and will be prescribed by your ophthalmologist or anaesthetist. You can often return to your normal activities within a few days. More than one surgery may be needed to treat this condition depending on the severity of the case. Patient pre-op, notice the left eye is not straight. Patient post-op, notice that both eyes are now straight. Adjustable sutures (stitches) surgery To obtain more precise alignment of your eyes, Dr Shuan Dai may use adjustable sutures (stitches). This allows your eye alignment to be adjusted after surgery. If adjustable sutures are used, surgery is performed in two stages. Stage one involves repositioning one or more of the eye muscles with “slipknot” or “bow-tie” sutures. In stage two (usually performed immediately after you wake up from general anaesthesia), using anaesthetic eye-drops, the sutures are untied and retied to fine-tune the alignment. In many cases, no adjustment is needed and the slip knot or bow-tie sutures are converted to standard knots. What are the risks of squint surgery? Vision loss from squint surgery is extremely rare. However, as with all surgeries, there are risks to consider. Complications can include: Allergic reaction to the anaesthesia Infection Reduced vision, often temporary Double vision within the first week or two after surgery, long lasting double vision is very rare Inadequate eye alignment. It is never too late to treat squints. Adults do not need to live with the discomfort and problems caused by misaligned eyes. Surgery with Dr Shuan Dai, and/or a combination of other treatment methods, can improve the symptoms associated with squints.

Various skin lesions occur commonly on the eyelids. New Zealand’s harsh sun is responsible for our high rate of skin cancers and the lids are one of the most frequent places these occur. Eye Doctors surgeons are specialised in completely removing the lesions and repairing the lids to look as natural as possible, with reconstructive surgery if required.

Tears produced by the lacrimal glands, under the upper eyelids, are essential for the health of our eyes. However the build up of excess tears, from blockage of the tear drainage pathway, can result in overflow onto the cheek. Blocked tear ducts can also cause recurrent infections. Full investigation and treatment for this condition can be carried out at Eye Doctors. Surgical intervention can sometimes be necessary to widen or bypass the tear ducts.