Minor ophthalmic procedures

Treatments using a neuromodulator called botulinum toxin are well recognized.

Although the word ‘toxin’ sounds dangerous, and the substance is indeed a poison, the doses that have been used in medicine for about 30 years, not only in aesthetic medicine, but also in ophthalmology and neurology, are microscopic.

Botulinum injection causes muscle paralysis. The muscle that is not stimulated stops working, stretches and does not contract, and the skin in that area straightens.

The procedure is preceded by taking a detailed medical history to ensure maximum safety for the patient and rule out any contraindications.

The product is administered by a micro-needle injection, under the skin into the muscle. The treatments are painless and have almost no complications.

At Retina we administer botulinum toxin to the muscles in:

• blepharospasmus,
• strabismus ,
• nystagmus,
• ocular motility disorders following retinal detachment surgery,
• ocular motility disorders associated with hyperthyroidism,
• dry eye,
• migraines,
• hemifacial spasms, tics, facial synkinesis

Contraindications for botulinum injection:

• neuromuscular junction disorders (myasthenia gravis, Lambert-Eaton syndrome),
• neuromuscular diseases,
• blood clotting problems,
• being pregnant or breast-feeding,
• infections at sites of planned injections,
• patients taking drugs belonging to aminoglycoside and aminoquinoline group, cyclosporine, D-penicillamine or tubocurarine, should wait about two weeks after taking the last dose of these drugs before starting botulinum treatment. The listed drugs can react with botulinum toxin and cause an enhanced or reduced effect.

Adverse effects:

As with any medical procedure, adverse effects are possible. Local adverse effects include: hematomas at the injection site, swelling, soreness, excessive lowering or raising of the eyebrows, excessive muscle laxity (e.g. drooping of the eyelid, drooping of the corner of the mouth). General adverse effects: headaches.

Important after botulinum toxin administration::

• On the day of the procedure, do not consume alcohol, apply makeup, take acetylsalicylic acid preparations or massage the injection sites.
• For 2-3 days after the procedure, patients need to give up saunas, tanning beds, gyms and other intense physical activities.

Xanthelasma lumps (yellow tufts) are yellowish, papular skin lesions usually located in the area of the eyelids near the medial canthus of the eye.

The best method removal method is surgical excision. The procedure is performed under local anaesthesia and takes several minutes. Potential small scars hide in the natural wrinkles of the eyelid, becoming completely invisible over time.

The procedure is short and involves an incision in the skin around the lesion (such as a wart or a cystadenoma). The doctor then performs a drainage of the contents with a thorough cleaning of the surrounding tissues. To prevent recurrence, it is necessary to carefully remove the entire lesion along with its walls.

The procedure is performed under local anesthesia, so it is painless. At the end the doctor may decide to put in stitches.

Chalazion is a cyst of the Meibomian gland (an eyelid gland that produces lipids). A chalazion is formed because a gland orifice becomes clogged and lipid material remains inside instead of being released outside.

Once the orifice is blocked, a process of bacterial multiplication inside the gland starts and an abscess develops inside the eyelid. On the eyelid we see a protrusion that resembles a small button. Over time, when inflammation develops inside, patients begin to feel pain and swelling appears.

One way to stop the development of chalazion early, is to inject it with a steroid drug. Often the steroid injection does the job and the patient gets rid of the problem. Occasionally (when bacterial superinfection occurs), a surgical procedure is recommended, during which the doctor thoroughly cleans the eyelid.

If necessary, the doctor will prescribe antibiotic drops or ointment to be applied after the procedure.

The procedure is short and uncomplicated. It usually does not require stitches.

The patient is given local anesthesia. The doctor makes an incision in the skin where the lesion is located, and curettes it together with the surrounding sac.

At the end, a dressing is applied.

If necessary, the doctor will prescribe an antibiotic ointment.

The cause of an eyelid cyst (known also as a simple cyst) can include a clogged tear duct or the use of inappropriate cosmetics.

Eyelid and conjunctival cysts are demarcated by a membrane filled with clear fluid. Treatment involves complete excision of the lesion (cyst csac + removal of fluid).

The procedure is performed under local anesthesia, so it is painless. At the end the doctor may decide to put in stitches.

Actylise is the trade name for plasminogen activator. Actylise is a drug used for treating subretinal macular hemorrhages.

Its purpose is to liquefy the clot which will make it easier to move the blood to another less important area of the retina.

It is always used in conjunction with a surgical procedure, intraocular gas injection or as a step in vitrectomy procedure.

Cryoretinopexy involves using extreme cold to freeze areas of weak or torn retina in order to create a scar in the retina and seal breaks when laser therapy is not possible. It is most often used when blood gets into the vitreous body and the operating area is not clearly visible.

Retinal cryopexy is used to treat retinal tears and accelerate hemorrhage absorption.

The procedure is performed in the operating room, under local anesthesia and after pupil dilation. Under visual control, the doctor applies a probe freezing to – 70 degrees Celsius to the affected areas. Freezing takes up to several seconds, depending on the thickness of the wall of the eye.

After the procedure, the eye may be swollen and bloodshot. After a few days it returns to normal.

A procedure performed to treat glaucoma using low temperature.

It involves freezing the ciliary body, located in the posterior chamber of the eye, at -80 degrees C.

Removal of defectively growing eyelashes. A method of permanent hair removal using low-intensity current that damages the hair’s reproductive cells, which are responsible for its growth.

The amniotic membrane is a thin, semi-permeable tissue that creates the innermost layer of the fetal membranes; it is obtained from the placenta coming from consenting mothers who are undergoing elective caesarean sections.

In ophthalmic surgeries it is used as a natural biological dressing for damaged corneas. After suturing this natural dressing protects the cornea and releases regenerative factors, as it also contains small amounts of stem cells. The amniotic membrane has immunological properties that protect the patient against tissue rejection. Once the amniotic membrane graft has served its purpose, it disintegrates.

Amniotic membrane graft has a wide range of indications, such as in ocular cicatricial pemphigoid, Stevens-Johnson syndrome, extensive conjunctival tumors, recurrent pterygium, after burns.

Pterygium is an abnormal and progressive wing shape proliferation of the ocular conjunctiva, usually appearing on the nasal side of the eye.

Pterygium must be removed surgically under local anesthesia.

Simple excision of the lesion with leaving the sclera exposed, or with suturing the conjunctiva often leads to recurrence. Therefore now it is recommended to perform excision of the pterygium together with conjunctival or amniotic membrane grafting.