Pediatric Onco Surgery:

Surgery in children with cancer has a major role in same tumors like Wilms Tumor, Neuroblastoma, Bone Tumor, Soft Tissue Sarcoma, Gonadal Malignancies, Brain Tumor etc and it has a supportive role in Leukemias and Lymphomas where mainstay of treatment is Chemotherapy. All surgical procedures are performed by surgeons who are specifically trained in the field of Pediatric Oncosurgery. Pediatric Cancers are potentially curable and in the modern era. The focus is to formulate treatment plans with minimum complication and suffering. Pediatric Oncosurgery plays a major role in decreasing the morbidities of cancer treatment.

Initially the treatment of long bone tumors was amputation of the limb but now most of the tumors can be resected without sacrificing limb especially if tumor is detected in early stage. We want to cure, but not by performing mutilating surgery. This is made possible by multimodality approach and working in close association with Pediatric Oncologist, Orthopedic Surgeons and Radiation Therapist.

While treating a pediatric cancer patient a lot of stress is laid down on maintaining the reproductive abilities of these patients. Pelvic tumor like PNET, Rhabdmyosarcomas which require Radiation Therapy to pelvis, may impair the ovarian functions and minimally invasive surgery can be undertaken, to move the ovaries out of the radiation field and thereby saving the ovaries from radiation.

Most of the pediatric patients are afraid of needle sticks. We deal with this problem by placement of central vascular access devices like PICC line, Hickman Line and Portacath. These devices make the oncology treatment acceptable and to a great extent painless. All the blood sampling can be done through these devices and all the IV medications can be given through these devices.

We work as a team throughout the treatment. Whenever the patient goes to operation theatre, an experienced Anesthesiologist provides Anesthesia to the patient. One of the parents is allowed to come with the patient to Operation Theatre, after wearing OT clothes. This process alleviated the anxiety of the patient to a great extent.

Category based treatment of tuberculosis in children:

Abstract:

Childhood tuberculosis is treated with multiple regimens for different clinical manifestations. World Health Organization has suggested a category-based treatment of tuberculosis that focuses on adult type of illness. To include children as DOTS beneficiaries, there is a need to assess the feasibility of classification and treatment of various types of childhood tuberculosis in different categories.

METHODS:

The study was conducted in the Pediatric Tuberculosis (TB) Clinic of a tertiary care hospital in North India. All children registered in the TB clinic were classified in four categories, similar to the categorization in World Health Organization’s guidelines for treatment of tuberculosis in adults. All children with freshly diagnosed serious form of tuberculosis were included in category I. Category II included patients who had treatment failure, had interrupted treatment, relapse cases and those who were suspected to have drug resistant tuberculosis. Patients with primary pulmonary complex (PPC), single lymph node tuberculosis, minimal pleural effusion and isolated skin tuberculosis were included in category III. Category IV included patients who did not improve or deteriorated despite administration of 5 drugs (as per Category II) for at least 2 months.
RESULTS:

A total of 459 patients were started on antituberculosis drugs and were available for analysis. Pulmonary tuberculosis was the commonest followed by lymph node tuberculosis. Identification of AFB was possible only in 52 (11 percent) of the patients and was more commonly seen in lymph node tuberculosis. The mean age of the children was 93 months and sex distribution was almost equal. 323 patients were in category I, 12 in category II, 120 in category III and 4 in category IV. 365 (80 percent) children completed the treatment. Of these, 302 (82.7 percent) were cured with the primary regimen assigned to them in the beginning, 54 (14.8 percent) required extension of treatment for 3 months and 9 (2.5 percent) patients required change in the treatment regimen. Side effect in form of hepatotoxicity was observed in 12 (2.6 percent) patients and was significantly more in patients who were getting category IV treatment.
CONCLUSION:

It is feasible to classify and manage various types of tuberculosis in children in different categories similar to WHO guidelines for adult tuberculosis.

Glaucoma :

Glaucoma is a group of eye diseases in which the normal fluid pressure inside the eyes slowly rises, leading to damage to the eye’s optic nerve resulting in vision loss or even blindness.

What causes Glaucoma?

At the front of the eye, there is a small space called the anterior chamber. Clear fluid flows in and out of the chamber to bathe and nourish nearby tissues. In Glaucoma, for still unknown reasons, the fluid drains too slowly out of the eye. As the fluid builds up, the pressure inside the eye rises. Unless this pressure is controlled, it may cause damage to the optic nerve and other parts of the eye and loss of vision.

How is it detected?

To detect Glaucoma the following tests are done:

Tonometry: This standard test determines the fluid pressure inside the eye. There are many types of Tonometry. One type is the “air puff,” test, which measures the resistance of the eye to a puff of air.

Visual Field: This test measures your side (peripheral) vision. It helps your doctor to find out if you have lost side vision, a sign of Glaucoma.

Pupil dilation: This examination provides your doctor with a better view of the optic nerve to check for signs of damage. To do this, drops are placed in the eye to dilate (widen) the pupil.

Optical Coherence Tomography: This is a newer diagnosis imaging technique which does high resolution cross sectional or tomographic imaging of biological tissues and hence helps in the early detection of glaucomatous optic nerve damage

SYMPTOMS:

Most types of Glaucoma cause no symptoms. Vision stays normal, and there is no pain. If Glaucoma remains untreated, people may notice that although they see things clearly in front of them, they miss objects to the side and out of the corner of their eye. Without treatment, people with Glaucoma may find that they suddenly have no side vision. It seems as though they are looking through tunnel. Over time, the remaining forward vision may decrease until there is no vision left. Some forms however cause pain, redness, vomiting, decrease in vision and colored rings around bulbs.

Treatments:

Patients benefit from our state-of-the-art Glaucoma testing capabilities and specially trained Glaucoma staff who have expertise in the diagnosis and the medical and surgical management of primary, secondary and complicated Glaucoma.

Although Glaucoma cannot be cured, it can usually be controlled. The loss of vision that already exists cannot be recovered. This makes early diagnosis and treatment important to protect vision.

Glaucoma treatments include:

Medications: These may be either in the form of eye drops or pills. For most people with Glaucoma, regular use of medications will control the increased fluid pressure. But, these drugs may stop working overtime. Or they may cause side effects. If a problem occurs, your doctor may select other drugs, change the dose, or suggest other ways to deal with the problem.

Laser Surgery: During laser surgery, a strong beam of light is focused on the part of the interior chamber where the fluid leaves the eye. This results in a series of small changes, which makes it easier for fluid to exist the eye. Overtime, the effect of laser surgery may wear off. Patients who have this form of surgery may need to keep taking Glaucoma drugs.

Surgery: Surgery can also help fluid escape from the eye and thereby reduce the pressure. However, surgery is usually reserved for patients whose pressure cannot be controlled with eye drops, pills or laser surgery.

FAQs:

Who is most likely to get it?

Glaucoma is one of the leading causes of blindness in India. Although anyone can get Glaucoma, some people are at higher risk. They include:

People over age of 45: While Glaucoma can develop in younger patients, it occurs more frequently as we get older.

People who have a family history of Glaucoma: Glaucoma appears to ‘run’ in families. The tendency for developing Glaucoma may be inherited. However, just because someone in your family has Glaucoma does not mean that you will necessarily develop the disease.

People with abnormally high intraocular pressure (IOP): High IOP is the most important risk factor for Glaucomatous damage.

People who have Diabetes, Myopia, Regular, long-term Steroid/Cortisone use and a previous eye injury.

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Sankara Eye care.

Retinal Detachment:

Retinal detachment is separation of the retina from the underlying layers that line the inner wall of the eye. Through the retinal tear, liquid from the vitreous may pass through the tear, and detach the retina. As the fluid accumulates, more and more of the retina detach. Detached retina loses its function; hence the person with retinal detachment loses vision suddenly or gradually. more…

Although anyone can develop a retinal detachment, some people are at a high risk. Myopic patients (nearsighted people), those who have ‘weak areas’ in the retina, known as lattice degeneration, those who have had significant eye injuries, and those with a family history of retinal detachment are at higher risk of retinal detachment. Retinal detachment can also occur following cataract surgery.

Retinal Detachment is an emergency; Earlier the treatment better the vision.

What is Retina?

The retina is a thin sheet of light sensitive nerve tissue lining the inner aspect of the eye. The light that enters the eye passes through the cornea and lens and is focused on the retina. It is this layer of the eye that turns into light into the visual signal transmitted to the brain, allowing one to see. If the retina is damaged, spectacles alone cannot improve one’s vision.

What is Vitreous?

The vitreous is a clear jelly-like material that fills most of the space inside the eye. As we age, the vitreous often liquefies and the gel structure may collapse.

What is a Retinal Tear?

In most people, the vitreous gel separates from the retina easily without any problems. In some people, the gel may be strongly adherent to the retina and when gel separates it may tear the retina as well. When this happens, one may perceive “flashes of light” even if there is no light in the room or even if the eye is closed.

What causes retinal detachment?

The vitreous-a gel like material is present is maximum areas of eye. Meanwhile, the presences of retinal tear allow gel from vitreous space to pass through the hole and flow between the retina and the back wall of the eye. As a result the retina detaches from its underlying layer of support tissue at the back of the eye. The detached area of the retina will not function properly and if not treated initially the whole retina will peel off and the person may lose his/her vision.

Why do Retinal detachments occur?

Retinal detachment can occur for a number of reasons, some of these reasons include:

Shrinkage of the vitreous: The gel-like material that is present inside the maximum area of eye that may generate tugging on the retina and a retinal tear, leading to a retinal detachment.
Injury
Advanced diabetes
High Myopia

SYMPTOMS :

Most people notice floaters and flashes before the retina detaches. As the detachment increases a gradually enlarging dark shadow engulfs vision. It may appear as a curtain or a shade drawn slowly across the field of vision. Central retina is the area that helps one see fine detail also allowing one to read small print. When retinal detachment progresses to involve the central retina, the reading ability is lost. In complete retinal detachment, one may just see light and no other details.

TREATMENTS:

Retinal tears with minimal or no detachment can be treated on an out-patient basis using laser therapy or cryopexy (freezing) procedures. These treatments decrease the risk of a retinal detachment. Retinal detachment may rarely occur even after these treatments; it is hence essential that the patient is on regular follow-up after the treatment.

Once the retina is detached, surgery to reposition the separated retina is required. Scleral buckling or vitrectomy operation will be necessary to reattach the retina. Surgical treatment of retinal detachment requires admission to the hospital and a day’s stay. The patient may be allowed to go home in the evening. Surgery is usually performed under local anesthesia, by making the eye and area around it numb by giving an injection.

In Scleral buckling surgery, a flexible silicone rubber piece is sewn to the sclera (white of the eye) to close the hole. This surgery is performed on the outer wall of the eye.

Vitrectomy is performed by placing three micro incisions on the white of the eye and is performed within the eye ball.

An oil or gas may be placed within the eye to close the hole. If oil is placed inside the eye for reattaching the retina a minor surgery will be required 4-6 months later for removing the oil.

A simple technique of injection a gas bubble and doing laser or cryopexy may reattach the retina in a small group of patients. This technique is called Pneumoretinopexy.

FAQs :
Will I get my vision back if I have detached retina?

Retinal detachment is serious problem that needs early, highly specialized treatment. Despite surgery, one out of 10 people on an average may develop recurrence of the disease necessitating re-operation.

Retina being nerve tissue, some loss of function always occurs after retinal detachment. After successful attachment of the retina, vision will improve but not to normal levels. Visual recovery varies and depends on factors such as how soon after the detachment operation is performed and whether the central retina is detached or not, among others.

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Sankara Eye care.

Computer Vision Syndrome:

Computer Vision Syndrome is the complex of eye and vision problems related to near work which are experienced during or related to computer use.” Computer Vision Syndrome results from focusing eyes on a computer display for protracted, uninterrupted periods of time. American Optometric Association studies indicate that 50% to 90% of computer users suffer from visual symptoms of computer vision syndrome.

Regular use of computers for more than 3 hours in a day is known to predispose to Computer Vision Syndrome in the presence of one or a combination of the following factors:

Uncorrected vision problems
Poor lighting
Improper viewing distances
Glare from the computer screen
Poor seating posture

Pixels in a computer are brightest at the centre and become dim towards the edges. Due to this, the eye muscles have to adjust constantly to maintain focus. The computer can make the eye focus nearly 25,000 times in a single day, as a result of which eye muscles work 3 times harder and blinking reduces by 70%.

All these factors add to the burden placed on the visual demands while working on the computers and thus contribute to the problem.

SYMPTOMS:

The vision problems due to computer vision syndrome result in visual inefficiencies and in eye-related symptoms. The symptoms occur whenever the visual demands of the task exceed the visual abilities of the individual over time.

The symptoms of Computer Vision Syndrome can be one or all of the following:

Eye Strain
Headaches
Blurred Vision
Dry Eyes
Temporary Blurring of Near or Distance vision
Light sensitivity
Red and Watering eyes
Neck and Back pain

The symptoms associated with Computer Vision Syndrome result in a gradual deterioration in the quality of life of an individual due to the fatigue associated with them.

Studies have shown that Computer Vision Syndrome negatively impacts productivity of Computer workers.

Treatments:

Computer Vision Clinic at Sankara Eye Hospital:

Many aspects of computers and the work environment in which they are used are likely to cause or contribute to the development of eye or vision difficulties. The symptoms associated with Computer Vision Syndrome can largely be resolved with right diagnosis, proper management of environment and by providing proper visual care for computer workers.

Sankara Eye Hospital offers holistic, specialized treatment for Computer Vision Syndrome at the Computer Vision Clinic.

Treatment of Computer Vision Syndrome is achieved by:

Glasses: Normal or specially designed for computer eye
Vision Therapy: included various exercise of the eyes that help the eyes to focus, move and to work together.
Eye Care: to prevent the recurrence of the symptoms of computer Vision Syndrome
Artificial tears: to reduce dryness of eyes
Altering ergonomics

FAQs:
Who is most likely to get it?

50% to 90% of computer users suffer from visual symptoms of computer vision syndrome.

What are the services offered by Computer Vision Clinic at Sankara Eye Hospital?

The services offered at the in-house clinic are:

Evaluation and consultation by experts in the field of Computer Vision Syndrome
Screening and diagnostic software that helps in through screening of Computer vision syndrome
Holistic treatment of Computer Vision Syndrome including Vision Therapy
Home Therapy System: With the help of this system, the client can undergo vision therapy at either his/her home/office
Option between Home therapy system or hospital sessions
Please note that the duration of the treatment will depend on the severity of the problem.

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Sankara eye care.

Orbit & Oculoplasty :

Oculoplasty is a special discipline in ophthalmology that deals with plastic and reconstructive surgery of the peri-orbital and facial tissues which include the eyelids, orbit and lacrimal system. Services available include management of abnormal eyelid position (entropion, ptosis ), removal of eyelid tumors, lid reconstruction, lacrimal surgery, medical management of orbital infections & inflammations, medical & surgical management of thyroid eye disease, orbitotomy, repair of orbital fractures as well as rehabilitation of anophthalmic socket with orbital implants, BOTOX treatment for various therapeutic purposes and cosmetic enhancement of age related changes in facial skin (orbital fat prolapse, brow ptosis, wrinkles) to a more youthful appearance by a wide variety of cosmetic and functional surgical intervention (Blepharoplasty, brow lift, botox injections).
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Facilities available in Orbit and Oculoplasty department
Surgical and therapeutic

Well-equipped ophthalmic plastic operating rooms.
Radio Frequency Surgical unit
Endoscopy for transnasal procedures
LASER dacryocystorhinostomy
Custom made ocular and facial prosthesis

Eyelid and Eyebrow

Ptosis correction
Entropion and Ectropion correction
Eyelid tumor removal and reconstruction
Blepharoplasty and Brow lift
Botox injections

Lacrimal system

Dacryocystorhinostomy, external, laser and endoscopic endonasal
Management of congenital dacryocystitis

Socket

Enucleation with orbital mplant
Cosmetic evisceration with orbital implant
Socket reconstruction
Custom made artificial eye and facial prosthesis

Orbit

Orbitotomy
Decompression

Trauma

Eyelid trauma repair
Repair of Lacrimal Canalicular Laceration
Orbital fracture repair

BOTOX injections & Cosmetic lid surgeries

What is Orbit?

Orbit is the bony socket in the skull which houses the eyeball and other structures. It is akin to the jewel box which keeps the jewels safe and protected. Apart from housing the eyeball there are a lot of structures in the orbit. The extra ocular muscles, blood vessels, nerves and fat pads and connective tissues make the major contributors to the orbital contents apart from the eyeball.

What is Oculoplasty?

Oculoplasty refers to a subspecialty of ophthalmology which deals with the plastic reconstruction around the orbital region of the face. Conditions which warrant an oculoplastic surgeon intervention is an abnormal rotation or position of the lids, a swelling of the lids, a tumour of the lids, tearing of the eyes and orbital conditions such as fractures and orbital tumours.

What is Ptosis?

Ptosis is the medical term for droopy eyelids. Droopy upper lids may be present in children since birth or present in the early years of life. This condition can obstruct the visual axis in children and cause amblyopia (“lazy eye”). Early intervention usually surgery is imperative in such a condition. Adults can develop ptosis as a consequence of trauma, prior surgery, chronic lid inflammation, long term contact lens use or aging. There are various methods of correcting ptosis depending on the type, degree and severity of ptosis. Recovery from ptosis surgery is usually quite rapid, and patients find themselves returning back to work within a few days.

Tearing from the eye

Tearing eyes is a very common symptom. The causes may vary from emotional tearing to a problem in the ocular surface or swellings causing blockage of the drainage system to a frank block of the lacrimal drainage system of the eye. It is important to consult an oculoplastic surgeon to assess the cause of the block and the tearing. Treatment is generally medical but in some cases surgical procedures may need to be done to correct the drainage system abnormalities and diseases.

What are the abnormal rotational problems of the lids? (Entropion and Ectropion)

The eyelids maintain a close apposition to the globe. The close apposition of the lid margin with the globe maintains a delicate film of the tears known as the tear film. Any malposition of the lids can cause irritation resulting in tearing, pain, discharge and reduction in vision due to corneal surface irregularity. Entropion is a condition in which the eyelid is “turned in” toward the eye. Ectropion is a condition where the lower eyelid is “turned out” away from the eye. Both these conditions need to be surgically corrected to bring the lid back to its normal natural position.
TREATMENT
FAQs

Orbital Surgery

Orbital tumors: The orbit can have all different varieties of tumors. Tumors may arise from the bone, periosteum, blood vessels, nerves, fat and the connective tissues of the orbit. Most tumors mandate surgical removal and histopathological examination to know the nature and characteristics of the tumor and also to know whether it is a benign or a malignant tumor. Aggressive tumors may require coordination with other surgical specialists and oncologists.
Thyroid Decompression: Thyroid Eye Disease or Thyroid Related Orbitopathy (also known as Graves’ disease) is an autoimmune inflammatory disorder that affects the tissues of the orbit (i.e. eyelids, eye muscles and other soft tissues around the eyes.) Thyroid Eye Disease can develop and affect patients with varying degrees of severity. Surgical and non-surgical treatments exist to manage the complications of this condition including eyelid malposition or retraction, ocular proptosis (bulging eyes), and double vision.
Evisceration & Enucleation (removing blind painful eyes): In spite of all ophthalmic endeavors to save the eye and vision there may be situations when the eye may have to be removed. Removal of the eye results in an unacceptable cosmetic deformity which is corrected by the placement of an orbital implant followed later by prosthesis. “Enucleation “is the surgery where the eyeball is removed in entirety and “Evisceration” refers to removal of the contents of the eyeball but leaving the outer coat of the eyeball intact.
Orbital Trauma & Fractures: Trauma to the orbit can result fractures of bones of the orbit. When these fractures cause symptoms such as double vision or when the fracture is large, surgical repair is normally recommended. The surgical repair is typically performed within a few weeks of the injury.

What is DCR Surgery?

DCR (Dacryocystorhinostomy) refers to a surgical procedure to correct tearing of the eyes due to a block in the drainage system of the eyes. There are various ways to do a DCR procedure. It may be done from the nose (Nasal endoscopic DCR)or from the skin or external approach. There are lasers to assist in the procedure as well. The oculoplastic surgeon will discuss and decide on the best option for the patient.

What is BOTOX?

Botox or Botulinum Toxin A is a toxin derived from the bacteria Clostridium botulinum manufactured by Allergan, USA. BOTOX is injected into muscles and used to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (Blepharospasm) and face ( hemifacial spasm)in people 12 years and older. Blepharospasm (BLEH-far-o-spaz-em) is a muscle disorder that causes involuntary spasms of the muscles around your eye. Botox is a US FDA approved drug for the treatment of Blepharospasm and millions of patients have benefitted from the drug worldwide. Botox injection is an outpatient procedure and the results will be discussed by the oculoplastic surgeon.

What is Artificial eye (Prosthesis)?

Following removal of an eye the orbital socket is “empty”, or devoid of the eye. The deficiency of volume is corrected by the placement of an orbital implant. This though corrects volume it does not provide adequate cosmesis. An artificial eye or prosthesis is the cosmetic answer to the problem.

Ocular prosthesis is made of a very fine medical grade plastic that is molded, colored and polished to create a realistic and comfortable artificial eye. The plastic is lightweight, yet tough enough to resist breakage if dropped. Each artificial eye is custom made and designed to specifically fit the individual eye socket. The ocular prosthetic is hand painted using the patient’s companion eye as a model and guide for matching. Our methods and technique allow us to create a custom prosthetic eye with the best possible cosmetic results.

What are the cosmetic lid surgeries?

Cosmetic surgeries can be performed around the lids, both upper and lower lids, for facial enhancement. Surgeries involved are upper and lower lid blepharoplasty and brow lifts. Surgery is done to correct “puffy” upper lids and lower lid “bags”. The “puffy lids” and lid “bags” occur due prolapse of orbital fat following a defect or thinning of the orbital septum. The incisions given for the procedures are either given subconjunctivally or masked along the existing lid folds to give an excellent cosmetic result. The excess or prolapsed fat is either removed or readjusted over the face to correct cosmetic blemishes. Recovery from the surgery generally takes about 7 to 14 days.

Brow ptosis is a droop of the brow giving rise to a “tired aged” look. Conversely brow ptosis may exist along with ptosis of the lids. There are many different ways to correct brow ptosis, your surgeon will discuss the options and pros and cons of each procedure before planning the surgery. When there is an additional ptosis of the lids along with brow ptosis, both the problems can be addressed together.

Some patients may have “crow’s feet” appearance at the outer aspect of the eye lids. Crows feet give rise to an aged appearance and are usually prominent when patients smile or laugh and are also known as dynamic wrinkles. These are corrected using a combination of BOTOX injections and filler injections. The cosmetic acceptance following these procedures is very high.

FAQs:

Why are eyelid swellings important to consult an oculoplastic surgeon?

There are many types of eyelid swellings, some can be observed safely while others should be biopsied or completely excised. Depending on the location and other general characteristics of the swelling a decision will be taken whether to biopsy the swelling or to completely remove the lesion. Some of the most common benign eyelid lesions are chalazion (stye), cysts, skin tags, and nevi (moles).

Facial weakness and the oculoplastic surgeon

Weakness of the facial nerve will lead to weakness on one side of the face. Depending on the severity of the weakness, the eyelids and eye itself can be affected. There can be weakness in blinking and closing the eyelids that can result in irritation, pain, and a potential risk for infection. Surgical and non-surgical techniques are available to protect the eye and provide symptomatic relief and functional improvement.

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Sankara eye care

Squint:

A Squint (Strabismus) is a condition of the eye that causes one of the eyes to turn inwards (converge), outwards (diverge) or sometimes upwards, while the other eye looks forward. The cause, severity, and direction of a squint vary from person to person. It is usually spotted in childhood, sometimes within weeks of a baby being born, and affects 5-8% of children (1-2 in every 30).
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A squint can occur for a number of reasons, these include:

Poor vision in one or both eyes
A need for glasses
Poor development of the eye muscle control centres in the brain
Damage to the nerves controlling eye muscles

What causes a Squint?

There are six muscles attached to the outside of each eye that are responsible for eye movements. When there is an imbalance of these muscles, a Squint occurs. The cause of the squint may not be obvious but can include a family history, long or short sightedness, injury or viral illness.

SYMPTOMS:

The most common symptom of a Squint is one of the eyes not looking straight ahead. In newborn babies it is quite normal for their eyes to ‘cross’ occasionally, particularly if they are tired. However, if you notice that this happens to your child beyond three months of age, it is advisable to talk to your ophthalmologist.

Your child may also look at you with one eye closed, or with the head turned to one side. These may be clues that they are experiencing double vision, and could be a sign that they have a Squint.

TREATMENTS:

A Squint is a condition that should be treated as soon as possible after it’s detected. Treatment is most effective in very young children.

A Squint will not disappear as the child gets older, and in fact the sight in the affected eye will gradually get worse.

There are several types of treatment available:

If your child is long sighted, glasses may be prescribed which can often correct the long sight and squint.
Alternatively, a patch may be needed to be worn over the good eye, to encourage the eye with the squint to work harder and become trained to work properly.
In some cases, the Squint can be treated with special eye drops, or with eye exercises.

If none of these treatments helps, then surgery may be required. Surgery for Squint involves moving the muscles attached to the outside of the eye to a new position. It may sometimes be necessary to operate on both eyes in order to ‘balance’ them effectively, even if the Squint is only in one eye.

If your child is long sighted, glasses may be prescribed which can often correct the long sight and the Squint.

Non-Surgical treatment modalities

Prisms, refractive lenses and pharmacologic measures have been used to help patient achieve fusion (alignment of the eyes) and alleviate diplopia, in addition to surgery. Some patients will adapt by suppressing the vision of one eye to eliminate their diplopia. An additional technique is the use of Botulinum toxin.

FAQS:

If my child needs an operation what happens next?

Your child will be sent an appointment for pre-assessment where we will measure the size of the Squint. The surgeon will see you and your child to discuss the details of the surgery. Our anesthetist would examine the child and advise any laboratory investigations for fitness for the surgery.

Are there any risks?

Although most Squint operations successfully straighten the eyes all surgery carries risks and Squint surgery is no different. The following are recognize

There may be some bruising on the eye, which can make it look red for a few weeks.
There may be under or over correction of the Squint.
There may get some double vision although this often settles.

The result of Squint surgery is not completely predictable as the healing and the brain-eye coordination are variable. If the eye is not quite straight after the operation it may settle by the three month post-op appointment. If it does not then we may need to prescribe prisms or do a further operation to improve the position of the eyes.

Adjustable Stitches

In some adults who undergo Squint surgery a better surgical outcome may be achieved by using adjustable stitches. The doctor will tell you if this is an option. The operation is performed under general anaesthesia and the stitches are tied in a bow at the end of the operation. You are then woken up and the eyes position measured.

If the eye position has not been altered enough we can tighten up the bow to adjust the position, using some drops to numb the eye. This makes the operation more precise , especially, when there has already been previous surgery.

Post Operation

The eye will be mildly sore after the operation for a few week days. Redness will last for two to four weeks, but will get better each day.
Covering the eye is not necessary
Your child’s tears will appear a little blood stained for few days. This is normal.
The stitches used in Squint surgery are dissolving, so will not require removal.
You will need to use eye drops or ointment as per doctor advice.
If your child wears glasses, he can continue to wear them after the operation unless told otherwise by your consultant.
Your child’s eye may be little sticky after the operation, and the lids may be stuck together with mucus after sleep. This can be cleaned by using cooled boiled water and cotton.
If the stickiness and redness do not improve each day or gets worse contact your ophthalmologist.

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Sankara eye care

Amblyopia

Amblyopia is reduced vision in an eye that has not received adequate use during early childhood. Amblyopia, or “lazy eye,” has many causes. Most often it results from either a misalignment of a child’s eyes, such as crossed eyes, or a difference in image quality between the two eyes (one eye focusing better than the other). Amblyopia is the most common cause of visual impairment in childhood. The condition affects approximately 2 to 3 out of every 100 children.
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What causes an Amblyopia?

Amblyopia mainly occurs during childhood when the nerve pathway from one eye to the brain does not develop.Generally, when the eyes are not working together send a wrong or blurred image to the brain. As a result, brain confuses and may start to ignore the image from the weaker eye resulting in amblyopia.

Strabismus is one of the most common causes of amblyopia. However, amblyopia can occur with or without strabismus and vice versa.

Other causes include Farsightedness, nearsightedness, astigmatism or childhood cataracts, especially if it is more in one eye.
SYMPTOMS:

Amblyopia mainly develops in the child of age group below 6. The signs mention below may not necessarily indicatethat the child has amblyopia. In most of the cases, good eye and the brain make up for the problem so well that the child does not notice he/she has Amblyopia. Due to this reason, it is advised that children should get full eye check-up at 6 months, and again at 3 years.

The symptoms of Amblyopia include:

Eyes do not appear to work together
Dual vision
Significant favoring of one eye
Blurred vision
Poor depth perception
Poor vision in one eye
A squint (either upwards, downwards, outwards, or inwards).

Tratments:
The goal of amblyopia treatment is to improve the visual acuity of the poorer eye, so that it equated to the acuity values of the preferred eye, or to get the patient within one or two lines of the target acuity.With early diagnosis and treatment, the sight in the “lazy eye” can be restored. A recent NEI report suggests that older children can also benefit from amblyopia treatment.

Before treating amblyopia, it may be necessary to first treat the underlying cause.

Glasses are usually prescribe to improve focusing or misalignment of the eyes.Surgery may be performed on the eye muscles to straighten the eyes and for allowing them to work together better. Eye exercises may be recommended either before or after surgery to correct faulty visual habits associated with strabismus and also to teach comfortable use of the eyes.
Patching or covering one eye may be required for a period of time ranging from a few weeks to as long as a year. The better-seeing eye is patched, forcing the “lazy” one to work, thereby strengthening its vision. Any prescription glasses would need to be worn over the patch.

Help your child understand why the patch is needed. Rewards, support, and reassure your child. This will help your child comply with the patching treatment so that he or she can develop the best vision possible.

Here are some of the things you can do to help your child wear the patch and make the treatment more effective.

Talk to your child before treatment begins. Explain that the patch is needed to help make vision in the affected eye stronger.
Explain to family and friends why your child is wearing patch and how important it is that the patch stays on. Ask them to be supportive.
If your child is in day care school, talk with the caregivers and teachers. Often they will be glad to explain to your child’s classmates why he or she is wearing the patch and how they can help your child’s treatment be successful. This can help your child feel more comfortable in school.
Some parents have had success with a reward calendar, marking each time the child wears the patch as prescribed. Consider providing rewards when your child wears the patch without complaints and difficulties.
Schedule the times when your child wear the patch. It may be possible to wear the patch only at home. Then your child can avoid any teasing comments that may hurt because of the patch.
Try to minimize skin irritation when using hypo-allergic adhesive patches. This kind of patch occludes sight better than those with elastic bands or patches glasses. If your child is wearing adhesive-type patches, let him or her decorate them.
Spend time with your child just after the patch is put on. It takes a short time-about 10 or 15 minutes – for the brain to adjust to having the dominant eye covered. Doing something funny during this time can make the transition smoother.
Give your child as much attention while he or she is wearing the patch. Your child will enjoy the time spend you spend together, and this will help take his or her mind off the patch. Find the game & activities that capture your child’s attention and make the affected eye work harder.
Patching treatment for amblyopia will be more effective if your child’s weak eye has to work harder while the normal eye is patched. Games and activities that require visual acuity and eye-hand coordination work well.
Ensure your child wears the prescription glasses over the patch.
Include one hour of near work while the child is being patched.
Article by
sankara Eye care

Retinoblastoma:

Your child’s eye surgeon must have informed you that your child had ‘Retinoblastoma’ for which immediate treatment is necessary. Retinoblastoma is a cancerous growth that occurs in the eye.

The tumors are of two types. The cancerous tumor can spread to other parts of the body, ultimately causing death. The other ‘benign’ form of tumor does not spread like a cancerous one and is thus relatively safer. Retinoblastoma is a cancerous tumor needing immediate attention.

Retinoblastoma can present as a white reflex at the pupil of the eye (Cat’s eye like appearance) or as a squint. Rarely if ignored in the early stage, it can cause protrusion of the eyeball.
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What causes a Retinoblastoma?

As in most cancers, we still do not know why some children develop Retinoblastoma. Retinoblastoma can however occur in families due to a genetic defect and children born in such families are definitely at risk. However, most children who develop this tumor do not have other affected family members.

Usually Retinoblastoma affects only one eye of the child. Rarely both eyes of the child may be affected, particularly if other family members (either parents or brother and sister) are affected.

If either parent is affected, there is approximately 40% chance of future offspring developing Retinoblastoma. Hence future children of the family where a parent and a child are affected should be checked by an ophthalmologist immediately after birth. For this reason, your ophthalmologist may advice examination of the parents’ eyes.

The risk of the future children developing Retinoblastoma can be assessed in some cases by doing a ‘genetic analysis’ of the blood. If necessary, a test can also be done on the pregnant mother to find out if the fetus has the risk for tumor.

SYMPTOMS:

The most common symptom of Retinoblastoma is white pupillary reflex. In an eye affected with Retinoblastoma, pupil will appear white or pinks instead of red when light shines into it. This can be seen by child’s parents after taking a flash photograph, especially if the pupils are of distinct colors. This can also be noticed by the child’s doctors during a routine eye check-up.

Lazy eye- The eyes of the child do not seem to look in the same direction. Lazy eye in child mainly occurs due to the mild weakness of the muscles which control the eyes, but Retinoblastoma is also one of the exceptional causes.

The other symptoms include:

Pain in the eyes
Redness in the white part of the eye.
Eyeball is larger than normal.
Colored part of the eye and pupil look cloudy.
Each iris is of different colors
TREATMENT:
Most cancers are treated by:

Removing the affected part so that it does not spread to other part of the body and cause death
Using radiation treatment
Giving intravenous medicines (chemotherapy)
Using laser or cryo treatment
Retinoblastoma is also treated based on these broad principles

As an initial step, your ophthalmologist may advice ‘examination under general anaesthesia”, where the child is examined in detail after giving a short anaesthesia. This is essential to examine the child’s eyes completely and plan treatment. This examination under general anaesthesia may have to be repeated at every visit of the child to assess the treatment response.

Your doctor might have already briefed you about the tentative plan of treatment for your child. He may have advised ‘Enucleation’, that is removal of the eye if the tumor is very advanced. Enucleation is usually advised when the tumor is very large and the eye does not have any vision. Removing this sightless eye will decrease the chances of the tumor spreading to other parts of the body and causing death. Most children adapt to this procedure quite well and grow up normally with one eye. They can attend regular school and be as normal as any other child. To make the child appear normal, your doctor will fit a ‘cosmetic shell’ in place of the removal eye, 6 weeks later. Some movement of this cosmetic eye can be expected though it cannot match the normal eye.

Subjecting to child enucleation is a traumatic experience. However it is in the child’s own interest. Your child’s life may be in danger if the eye is not removed.

Eye saving treatment may be tried if the eye with the tumor has vision. If the tumor is small, your doctor may advice ‘Laser treatment, Cryo treatment or Transpupillary Thermotherapy’, which are treatments that can be performed during examination of the child under anaesthesia.

If the tumor is large in an eye with vision or if it is the only remaining eye of the child, then doctor may advice “Radiation or Chemotherapy”. You will be referred to a cancer hospital for these treatments. Though the treatment is done at the cancer hospital, it is your ophthalmologist who will assess the response to treatment and hence you should come back to your ophthalmologist for follow-up. If chemotherapy is done, is had to be followed-up by Laser or Cryo treatment which will be done by your ophthalmologist.
FAQs:
What are the possible side effects of treatment?

Laser or Cryo treatments are usually safe but problems like bleeding in to the eye or retinal detachment may rarely occur.

Radiation may lead to late cataract formation, improper growth of face bones and teeth. Rarely other tumors can occur in later life especially in a child with familial form of disease.

Chemotherapy has so far been found to be safe except for short term complication like loss of hair, weight, vomiting, susceptibility and infection. Hair that is lost grows back and the child gains weight after stopping the chemotherapy.

Will my child be cured?

It is every parent’s and ophthalmologist’s wish that both the eyes and life of the child with Retinoblastoma is cured. However, all Retinoblastomas do not respond well to treatment. If the tumor does not respond adequately to eye saving treatment, your doctor may advice removal of the eye in the interest of saving the child’s life.

However, with the latest advances like chemotherapy, many children who would have lost their eyes earlier retain them now.

It is very essential that the advised treatments are carried out and the child brought back for periodic follow-up as advised by your ophthalmologist. You must bring the child back for review 4-6 weeks later (or as advised by your ophthalmologist) to assess the response of the tumor to treatment and also to repeat the treatment if necessary. Even if your child’s eye has been enucleated, you may still have to come once in 3 months in the first year, 6 monthly in the second and yearly once for the first 5 years at least. Children with tumor in both the eyes may have to be followed for longer periods of time.
Article by
Sankara eye care Hospitals

Diabetic Retinopathy

Diabetes is a disease that inhibits with the body’s ability to use and store sugar, which may lead to several health problems. Excess sugar present in the blood may cause damage in the entire body including eyes. Meanwhile, the circulatory system of the retina also gets attacked by diabetes more…

Diabetic Retinopathy is an eye complication that occurs in person due to Diabetes and which causes continuous harm to the retina. Moreover, it is the outcome of damage to the tiny blood vessels that feed the retina. These tiny blood vessels drip blood as well as other fluids that results in swelling of retinal tissue and clouding of vision. Both eyes get affected by this disease. The longer an individual has Diabetes; he/she has more chance of developing Diabetic Retinopathy. Diabetic Retinopathy may also lead to blindness, if it is left untreated.

What causes a Diabetic Retinopathy?
Diabetic Retinopathy occurs mainly due to the changes in the blood vessels of the retina. Diabetes produces weakening of the blood vessels in the body. The tiny retinal blood vessels are particularly susceptible. This deterioration of retinal blood vessels accompanied by structural changes in the retina will lead to loss of vision. When the loss of vision is caused due to diabetes, a Diabetic Retinopathy occurs.

FAQs:

What are eye diseases caused due to Diabetes?

Cataract, Glaucoma and Diabetic Retinopathy are the diseases caused due to Diabetes. The most common eye complication in diabetes is Diabetic Retinopathy.

How is Diabetic Retinopathy diagnosed?

Slit lamp, Bio-microscopy, Indirect Ophthalmoscopy and Fundus Fluorescein Angiogram (FFA) are used to diagnose Diabetic Retinopathy.

What is FFA?

Magnified Photographs of the retina are taken after injection of fluorescein dye, to detect any leaks in the retina vessels. The test will help in early detection of bleeding into the eye before sudden loss of vision occurs and also helps in planning proper treatment.

What are the facilities available in Sankara for Diabetic patients?

Periodical Screening by vitreo-retinal specialist for early detection of Diabetic Retinopathy
Fundus Fluorescein Angiogram (FFA) (Topcon, Japan)
Laser Photocoagulation Facilities :
Argon Laser Unit
Diode Laser Unit
Fd-Yag Laser Unit
Fully equipped state-of-art operation theatre to perform vitro-retinal surgeries for advanced stages of Diabetic Retinopathy

Symptoms:
Diabetic Retinopathy produces ocular symptoms only in the last stage of the disease. Only an ophthalmologist can detect in early signs of Diabetic Retinopathy. So, all Diabetic patients should undergo yearly eye (Retinal) examination. Symptoms like floaters, difficulty in reading and sudden loss of vision are seen in advance stages of Diabetic Retinopathy. Early detection and timely treatment significantly reduce the risk of vision loss.

Treatments:

Laser Treatment: Lasers are widely used in treating diabetic retinopathy and is performed as an out-patient procedure. In this treatment an intense and highly energetic beam of light is focused on the area to be treated with the aid of the slit lamp and a special contact lens. This will reduce the retinal thickening and stops bleeding. Additional treatment may be required depending on the patient’s condition.

Surgical Treatment: In some patients the vitreous may pull on the retina reducing vision severely. In such cases a surgical procedure called vitrectomy is performed. This surgery is done for advanced stage of Diabetic Retinopathy.
Article By
Sankara Eye care Hospitals