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Ocular Lesions

Here at Fusion Eye Care, we see patients with ocular lesions on a regular basis. If you think you might be developing ocular lesions, please schedule an appointment with Dr. Bassiri as soon as possible by calling (919) 977-7480.

What Are Ocular Lesions?

Ocular LesionsOcular lesions in the eye may grow in size as time passes, however, it could take several years before the lesions grow to a noticeable size. A majority of lesions could cause surface irritation, something that may result in constant eye discomfort and redness. People with eye lesions should have them evaluated by an ophthalmologist to determine the right course of treatment based on lesion type and cause.

Pinguecula

Pinguecula are raised, yellowish lesions that build upon the “white part” of the eye known as the conjunctiva. These lesions form after an alteration of normal tissues, resulting in a deposit of fat and proteins. Why this happens is yet to be known. However, prolonged exposure to infrared radiation and ultraviolet rays from the sun is believed to encourage the growth of pinguecula.

Signs and Symptoms:

Pinguecula generally do not exhibit any symptoms; however, if irritated, you may feel as though there’s something trapped in your eye. In some cases, these lesions get infected and swell. The condition is referred to as pingueculitis and is characterized by irritation and eye redness, symptoms that may be worsened by extremely dry weather, wind, or dust.

Treatment:

The severity of pingueculitis symptoms normally determines the course of treatment to be taken. Lubricating eye drops could be prescribed for mild cases to ease dryness of the eyes. Anti-inflammatory or steroid eye drops could also be prescribed to relieve severe inflammation and swelling. In extreme cases, the removal of the lesions surgically could be prescribed if they start interfering with blinking, vision, or wearing contacts.

Pterygium

Pterygium is fleshy growths that resemble a tissue or film growing over a patient’s eye. This happens when the conjunctiva starts invading the transparent part of the eye that covers the pupil, anterior chamber, and iris known as the cornea. An overgrowth of the conjunctiva is often what gives these lesions their unsightly appearance. Just like pingueculae, pterygium is likely to be caused by an overexposure to ultraviolet rays from the sun.

Signs and Symptoms:

A majority of people with pterygium don’t experience any symptoms; however, the growth may swell or become red when infected. The lesion may also become thick or large, leaving the patient with the feeling like there’s a foreign object in his or her eye. In advanced cases, the lesion may be visible and may look like a film covering the eye. The patient could have the lesion surgically-removed for aesthetic purposes. Nevertheless, surgical removal is often unsuccessful since the lesions have a 40%-50% chance of reoccurring after the procedure.

Treatment:

If the lesion is small but becomes swollen, it could be treated with steroids or lubricating eye drops to relieve inflammation. As mentioned above, surgical removal is one way to get rid of these lesions; however, it is generally not needed. Dr. Bassiri could help determine the best course of action to take when it comes to treating the condition.

If you have any additional questions about ocular lesions, Fusion Eye Care is here to help. Please schedule an appointment with Dr. Bassiri as soon as possible by calling (919) 977-7480.

Punctal Plugs

punctal plugs dry eyes 300×200Punctal plugs are very small, biocompatible devices that get inserted into the tear ducts for blocking drainage. They increase the surface moisture and tear film in the eyes to provide relief for dry eyes.

These devices are also called occluders, lacrimal plugs or punctal plugs, and are no bigger than a single grain of rice.

Usually, punctal plugs are considered whenever prescription or non-prescription eye drops do not provide relief for a dry eye condition. In fact, many people consider them to be the best way to treat dry eyes as you can see on our dry eye treatment page.

There are two general kinds of tear duct plugs:

  • Semi-permanent: These tend to be made out of long-lasting materials like silicone.
  • Dissolvable: These are made out of materials like collagen that are eventually absorbed by the body.

Dissolvable or temporary punctual plugs normally will last from a couple of days up to several months. Those kinds of plugs are used in situations like to prevent dry eyes following LASIK if you decide to get refractive surgery.

Temporary, dissolvable punctal plugs are sometimes used to determine whether the treatment will work on the dry eye condition that you have. If it does, then you might be able to consider semi-permanent punctal plugs.

How Do Punctal Plugs Get Inserted Into The Tear Ducts?

Your eye doctor in Raleigh, NC may first use a special instrument for measuring how large your tear duct openings are (puncta), depending on the kind of punctal plug you have chosen. It will help to determine the right size punctal plug that is needed for blocking drainage in the change and for keeping it in place securely.

There are many eye doctors that only need a close-up, light exam of your eye to determine the type and size of punctal plug that is needed. A one-size-fit-all type of punctal plug might be used in some cases.

To get you prepared for this procedure, a local anesthetic will be used by some eye doctors before the punctal plug is inserted. No anesthetic will be needed in many cases.

There is one punctum on each eyelid, that is located on the inner margin close to the nose. It is possible to insert a punctal plug into the puncta of the upper lids, lower lids, or both of them. An instrument can be used for dilating the tear duct opening to insert it more easily.

There are many punctal plugs that come prepackaged along with disposable devices for helping your eye doctor get the plug inserted.

There are inserters that are available in various designs, like forceps style that may squeeze to push a plug in place. Syringe-style, narrow inserts can also be used. Other instruments may be used by your eye doctor like forceps for help to put a punctal plug into the tear duct of your eye.

There are some punctal plugs that get inserted just inside the puncta so they are still able to be seen, and if necessary removed mechanically.

Other punctal plugs get inserted deep inside of the canaliculus, so they are not visible. Those kinds of tear duct plugs – which are technically referred to as intercanalicular plugs – don’t protrude out of the punctum. They conform automatically to the cavity’s shape and are not felt or seen.

In the rare cases where removal is necessary, intercanalicular plugs get extract through flushing them out.

Except for a bit of initial discomfort, after it has been put into place, you shouldn’t feel the punctal plug. Right after the procedure is over, you most likely will be able to drive home on our own and resume your regular activities.

Kinds of Punctal Plugs

There are many different shapes and designs of punctal plugs, including the following:

  • Umbrella. This kind doesn’t “disappear” inside of the tear duct, which makes it easy to find and removed if needed.
  • Tapered. With this type of design extra force is exerted horizontally in order to help keep a punctal plug in the right place.
  • Hollow. Having a hollowed interior may help the punctal plug with adhering to the the shape of the tear duct of the eye.
  • Reservoir. With this style, the tears are captured and held, which helps to increase comfort and reduce foreign body sensations.
  • Low profile or slanted cap. With this design it can help with maintaining comfort and also provide some extra stability.

dry eyes treatment 300×200The materials that are using for making punctal plugs include hydrogel, polydiaxonone, hydrophobic acrylic polymer, collagen and silicone. There are some punctal plugs that get coated with a type of slick surface to make it easier to insert them.

Pliable, soft punctal plugs that are made out of common materials may increase the comfort level and help to more readily conform the device to the tear drainage channel’s shape.

There are currently two kinds of soft intracanalicular plugs that are available. One kind is made out of an acrylic material. At room temperature it is solid but on contact with the body’s heat melts. SmartPlug (Medennium)is an example of this, and it exists in a semisolid state similar to gelatin within the drainage channel.

Another kind of soft intracanalicular plug is made from hydrogel material that after it has been inserted inside of the lacrimal punctum, it then hydrates util the cavity is completely filled. One example of this kind of punctal plug is Form Fit (from Oasis Medical).

Old people especially may benefit from using soft punctal plugs since – with the aging process – orifices like tear drainage channel get larger and the muscular lining also gets less elastic. Softer punctal plugs in this case are more likely to remain in place compared to harder ones.

Problems And Side Effects Of Punctal Plugs

Punctal plug insertion is usually uneventful and very rarely involves problems or serious side effects.

Watery eyes and excessive tearing (epiphora) may occur whenever the punctal plug actually does too good of a job. When that happen, you might have to go see your eye doctor to have the plug removed or replace it with a different kind to control better how many tears are in your eyes.

Loss or displacement of the plug is fairly common and may happen for many different reasons, like when an individual rubs her or his eyes and dislodges the device accidentally. Hard kinds of punctal plugs especially are much more likely to get dislodged and then fall out. If that happens you will need to go see your eye doctor to get a replacement punctal plug.

Another potential problem that may occur with the devices is an eye infection, although they are rare. Canaliculitis is the result of a reaction to a punctal plug that is quite rare. Symptoms include swelling along with yellowish secretions coming from the tear ducts. These infections might result from an upper respiratory infection when blow one’s nose under pressure might force germs back from the nasal cavity into the canaliculus.

In those situations, you might need to be treated with oral antibiotics, topical antibiotics and/or have the punctum plug removed.

Another rare complication that might occur is when a plug migrates unexpectedly outside of the target area and deep inside of the drainage channels of the eye. That can create blockages that lead to conditions like dacryocystitis, that come with discomfort, pain and swelling.

Soft kinds of punctum plugs usually may be removed through flushing them out (referred to as irrigation). However, surgery may be necessary whenever a hard kind of punctum plug ends up migrating into the drainage canal of the eye. However, due to the current hard plug’s nail-shaped head, it is rare to have entrapment inside of the tear drainage canal.

With rigid kinds of punctum plugs, there is extra tissue formation that might happen as a reaction which causes the channel to narrow (referred to as stenosis). If needed, your eye doctor may take the punctal plug out. However, the purpose of the punctal plug is slowing down the exit of tears, therefore extra tissue may be beneficial since it helps with achieving this goal.

When Should You Have Punctal Plugs Removed

Although semi-permanent punctal plugs may last indefinitely, it is also easy to remove them.

If you feel any discomfort or think you might have an eye infection or another type of complication, then make sure that your eye doctor is notified.

If it is considered necessary to remove the punctal plug, then forceps might be used by your eye doctor to grasp the plug and extract it. Another removal method involves flushing it out using a saline solution. The punctal plug is forced to exit into the throat or nose where the tear ducts drain.

Astigmatism

astigmatismOf the many vision problems that exist, astigmatism may be the most misunderstood. Even the name, astigmatism is confusing since a person doesn’t suffer from a stigmatism, but instead has astigmatism. The condition results from a refractive error just like farsightedness or nearsightedness. It is not an eye disease nor is some type of eye health issue. Instead, it is simply an issue involving how the eye focuses light.

When a person has astigmatism, light doesn’t focus correctly on the retina. It does not narrow to properly focus on the retina which is required to see clearly. Instead, light focuses on multiple points, either behind or in front of the retina or both.

Symptoms Of Astigmatism

Individuals with astigmatism will usually experience distorted or blurred vision at all distances. They may have headaches or eye strain, especially after completing prolonged visual tasks such as reading. Another common symptom is squinting.

The Causes Of Astigmatism

Astigmatism typically results because of an irregularly shaped cornea. In a healthy eye, the cornea is symmetrically round. In an eye with astigmatism, the cornea is shaped like a football, and one meridian is much more curved than the other. The meridians are the vertical and horizontal lines across the cornea. With astigmatism, the vision problems are caused by issues with the meridians. The meridians which are the flattest and steepest are called the principal meridians. Astigmatism may also be caused when the lens of the eye is not shaped correctly. When this occurs, a patient has lenticular astigmatism.

Different Categories Of Astigmatism

Astigmatism is categorized into three different types:

  • Myopic astigmatism happens when both of the eye’s principal meridians are nearsighted.
  • Hyperopic astigmatism happens when one or both of the eye’s principal meridians are farsighted.
  • Mixed astigmatism happens when one of the principal meridians is nearsighted and the other principal meridian is nearsighted.

Astigmatism is also categorized as regular astigmatism or irregular astigmatism. When the eye’s principal meridians are perpendicular to each other, a person has regular astigmatism. When the meridians are not perpendicular to each other, a person has irregular astigmatism. Irregular astigmatism may be caused by several things including keratoconus which is a condition that causes the cornea to gradually get thinner, an eye injury or eye surgery.

Astigmatism Is A Common Condition

Most people get astigmatism early in life. This is why it is important to schedule regular eye exams for children. If left untreated, astigmatism can cause problems with learning. According to a recent study which looked at more than 2,000 children who were between 5 and 17 years old, childhood astigmatism is a significant issue. This study found that more than 28 percent of those examined had astigmatism of 1.0 diopter or greater.

Testing For Astigmatism

During a regular eye exam, the doctor will test for astigmatism just like they do for farsightedness or nearsightedness. Be sure to tell him or her if you feel you have eyes that are dry and need treatment. There are two primary ways to test for astigmatism. In the manual test called a retinoscopy, the doctor will shine a light into the eye and using a series of lenses, will test how the light focuses in the eye.

Many eye doctors are either replacing or supplementing the retinoscopy with a test that uses automated instruments. These tests are faster and provide quicker preliminary results for astigmatism and other types of refractive errors. Following these tests, the eye doctor will also perform a manual refraction. This test further refines the tests for astigmatism.

During the manual refraction which is also known as a subjective or manifest refraction, the doctor uses a phoropter to test for the level of astigmatism. The phoropter consists of several lenses which the doctor will introduce in front of the patient’s eyes. The patient then compares how well they see with each lens.

The patient will look at an eye chart while the eye doctor demonstrates different lenses. The doctor will ask the patient different questions designed to determine the patient’s eyeglasses prescription.

When a patient is diagnosed with astigmatism, the eye doctor can correct their vision using several methods including refractive surgery, contact lenses or eyeglasses. Correcting astigmatism requires an eye doctor to use “cylinder” lens power in addition to the spherical lens power which corrects farsightedness or nearsightedness. Cylinder lens power corrects the differences between the powers of the eye’s principal meridians. For example, a eyeglasses prescription correcting myopic astigmatism would read -2.75 -1.00 x 90. Similarly, a contacts prescription correcting astigmatism would contain the same information.

Another option for those with astigmatism is gas permeable contact lenses. These are rigid lenses and may be used to optically replace the eye’s refracting surface. This means an axis and cylinder power may not be necessary, however, this will depend on the severity and the type of astigmatism that is being corrected. This is also true for hybrid contact lenses.

LASIK surgery is another possibility for correcting astigmatism. This is a quick and painless surgery that takes seconds, but which produces great results. LASIK has been used for years, but recent advancements have made this one of the safest surgeries available. Improvements in equipment and technology have also resulted in price reductions making LASIK an option for more people.

It is important to discuss all options with a patient’s eye doctor. What will work for one person may not be a good choice for another. Every individual is unique, and the choice of glasses, contacts or LASIK should be carefully considered.

6 Main Causes of Dry Eyes

Irritated dry eyes can be a real source of concern with people as it can cause them to feel like they need to rub their eyes on a regular basis. The main culprit behind dry eyes is often that the moisture in one’s eye is not at a reasonable level, which causes dryness or irritation. This can be painful and isn’t something people can overlook or ignore throughout their busy day. For some, it eventually leads to redness, soreness, or a horrible combination of both that refuses to go away. Individuals who wear contacts tend to have this issue all the time, and the right approach is to speak to Dr. Bassiri at Fusion Eye Care and get your eyes examined as soon as possible.

Please remember, each and every patient is unique, and the factors causing their dry eyes often involve different variables including lifestyle, age, vision, and more. A thorough eye exam is the best way to determine what is going on with your eyes.

The eye exam is going to take into consideration not only the physical state of your eyes, but also the lifestyle you are living at the moment. This can often shed light on the real issues that are creating trouble in your life. Let’s take a look at six noteworthy actions that may be causing your eyes to dry up.

Weather

It can be the humidity of summer or the bone-chilling dryness of cold months that place stress on your eyes causing them to dry up. The eyes don’t lubricate during these harsher months leading to unfortunate symptoms. For example, those who tend to go out in the winter without glasses are putting themselves at real risk especially in adverse conditions such as seen in mountainous regions. The same applies to the summer where dehydration becomes a problem. It is essential to drink enough water to stay hydrated for this reason.

Heating or Cooling

Your eyes can take a beating when it comes to heating or cooling systems. Blowing air isn’t good for the eyes because it’s concentrated and moves rapidly. This can irritate the eyes and cause them to dry out inside the home or office. You want to think about buying a humidifier as soon as possible to eliminate this concern and make sure you can sleep well at night. This is how you are going to get rid of symptoms.

Allergies

Allergies are known to cause stress as well because they will clog up the eyes. You need to understand what floating pollen can do as it gets caught in your eyes and that is often a point made by optometrists. You need to pay attention to the season and set up an air filter as soon as you can to avoid dealing with pollen all the time.

Skin Conditions

Do you have a skin condition that tends to relate back to your dry eyes? Some people tend to deal with blepharitis, which is known for causing issues near the eyelids. This is inflammation and will clog up the pores in the area. As soon as this happens, the eyes are impacted making it hard for the tear ducts to work efficiently. This is when most people notice their dry eyes flare up and refuse to go away. If those glands clog up, the dry eyes will often be right around the corner.

Environmental Issues

It is always nice to head outdoors for a bit of fresh air but is it always good for your eyes? No, it depends on the exposure because too much isn’t good just like anything else in life. You have to be smart about how often you head out because dehydration is a real concern. It will lead you down a path that is harsh on the body and will not feel good at all. You need to understand the environment will continue to change, and that can be stressful in the eyes.

Minimized Tear Production

Are you not producing enough tears on a regular basis? Dry eyes can often come about because the tear production is not good enough. This can happen due to a number of reasons including lupus, diabetes, rheumatoid arthritis, thyroid, and more. This is why it is always best to have your blood tested and see a physician for further examination. Treating the condition can be an excellent way to get rid of the dry eyes too.

If your eyes are not producing enough tears, it is best to look into these details including the drugs you may be using for treatment. Things such as acne medications, hormone replacement therapy, antidepressants, and birth control may ruin your eyes too.

8 Tips to Beat Winter Dry Eyes

One of the most common patient complaints during the winter months is dry eyes. In the cooler climates, cold winds and dry air, coupled with dry indoor heating can be a recipe for an eye disaster. Dryness and irritation can be particularly debilitating for those who wear contact lenses or suffer from chronic dry eyes – a condition in which the eyes do not properly produce tear film.

The harsh weather conditions can reduce the natural moisture in your eyes and the irritation usually results in a burning or itching sensation that often leads to rubbing or scratching your eyes which can worsen the symptoms. Sometimes it feels like there is a foreign object in your eye and for some, dry eyes can even cause excessive tearing. Prolonged, untreated dry eyes can lead to blurred vision as well, which is why here at Fusion Eye Care, we highly recommend treating dry eyes with the guidance of Dr. Bassiri.

Whatever the symptoms, dry eyes can cause significant discomfort during the long winters and relief can seriously improve your quality of life.

Here are eight tips to keep your eyes comfortable during the harsh winter months:

  1. To keep eyes moist, apply artificial tears/eye drops a few times a day. If you have chronic dry eyes, speak to your eye doctor about the best product for your condition.
  2. Drink a lot of fluids – keeping your body hydrated will also help maintain the moisture in your eyes.
  3. If you spend a lot of time indoors in heated environments, use a humidifier to add some moisture back into the air.
  4. Try to situate yourself away from sources of heat, especially if they are blowing. While a nice cozy fire can add to the perfect winter evening, make sure your keep your distance so dry eyes don’t ruin it.
  5. Staring at a computer or digital device for extended amounts of time can further dry out your eyes. If you spend a lot of time staring at the screen, make sure you blink often and practice the 20/20/20 rule – every 20 minutes, look 20 feet away for 20 seconds.
  6. Don’t rub your eyes! This will only increase irritation and can also lead to infections if your hands are not clean.
  7. Give your eyes a break and break out your glasses. If your contact lenses are causing further irritation, take a break and wear your glasses for a few days.
  8. Protect your eyes. If you know you are going to be venturing into harsh weather conditions, such as extreme cold or wind, make sure you wear protection. Try large, 100% UV protective eyeglasses and a hat with a visor to keep the wind and particles from getting near your eyes. If you are a winter sports enthusiast, make sure you wear well-fitted ski goggles.

If you find that after following these tips you continue to suffer, contact your eye doctor. It could be that your condition requires medical intervention.