Congenital obstruction of the lacrimal duct

Congenital obstruction of the lacrimal duct is common in children. 6-10% of children are born before the tear ducts are fully opened. In some sources, it is stated that the prevalence of this disorder in babies is 50%. The cause of this blockage is the remaining membrane (curtain) at the end of the nasolacrimal duct on the side of the nose.

Usually, babies who have this problem show symptoms in the first 2 to 6 weeks after birth, the most common of which are tears. In the first month after birth, we don't have reflex secretion of tears (tears) when crying, and if tears come, it is most likely pathological (caused by a disease). Another symptom of this disease is secretion, frequent inflammation of the conjunctiva and inflammation and infection of the lacrimal sac, in which case the area under the eyes, myopia becomes red and inflamed and is sensitive to touch. This area may be swollen and mucous discharge can be seen on the inner side of the eye. In 1.3 cases, this conflict is two-sided. Usually, the baby's symptoms are aggravated by dust and wind, but there is no photophobia.

Note: In children with lacrimation and photophobia, congenital glaucoma should be considered.

Congenital obstruction of the lacrimal duct in children improves by itself in most cases, so that the lacrimal duct opens in 95% of children before the age of 1 year. Interventional treatments of this disease include non-surgical and surgical methods.

1. Conservative (non-surgical) treatment includes observation, lacrimal sac massage, and topical antibiotic use. For massage, it is necessary to wash your hands and place your index finger on the inner side (nose side) of the eye and press down. You may also be asked to apply a warm compress. If there is an infection, it is useful to use a topical antibiotic ointment or drops. Note that antibiotics will not clear the blockage.
2. If the blockage of the tear duct is not resolved after a few months with the above treatments, or if a severe infection occurs, or if your child has recurring infections, probing is necessary, which is successful in 95-85% of cases in children under one year of age. but as the child gets older, the probability of success decreases. Probing is a surgical procedure that takes about 10 minutes and a thin metal probe is passed through the closed tear duct to remove the blockage. Some doctors believe that the appropriate age for probing is 6 months, which can be done without general anesthesia in the clinic, but some others believe that probing should be delayed until one year of age to give the child the maximum chance of spontaneous opening of the duct. This year, probing is done in the operating room under general anesthesia.
3. If probing is unsuccessful or if it is shown that there is stenosis (narrowing of the duct), more extensive surgical procedures such as silicone tube intubation may be needed, in which a silicone tube is placed inside the lacrimal duct for a period of time. 6 months pass, which causes the canal to expand, and after this period, it is removed from the eye through a small surgery.
4. Balloon dacryoplasty: is a newer balloon catheter dilation surgery in which a balloon is placed in the corner of the eye and inside the tear duct. At first, this balloon is expanded by a sterile liquid for 90 seconds, and then the liquid is removed, and again the balloon is expanded for 60 seconds and finally the liquid is removed. The success rate of this method is reported between 80-100%.
5. In rare cases where children still have tears despite the above treatment measures, DCR or dacryocystorhinostomy may be performed in children like adults. This method, which is the main treatment in most patients with acquired obstruction, should also be used in people who have recurrent dacryocystitis, return of mucoid fluid, painful dilatation of the lacrimal sac, or annoying tears. Although there are various methods to treat this condition, the main technique in all of them is to open a passageway from inside the lacrimal sac to the nasal space.

Posterior blepharitis

Posterior blepharitis or MGD stands for Meibomian Gland Dysfunction. This complication is mostly called Meibomitis and its other names are meibomianitis and lid margin disease. Sometimes it is also called posterior blepharitis in some texts. This phrase refers to the dysfunction and inflammation of the meibomian glands. The basis of treating blepharitis (both anterior and posterior) is commitment to a long-term eyelid health program.

dermatochalasis

Drooping eyelid or ptosis is a complication characterized by loosening and drooping of the upper eyelid. This condition, which is also called "blepharoptosis" in the medical term, has different types. For example, drooping of one eyelid is called "unilateral ptosis" and drooping of two eyelids is called "bilateral ptosis". If there is excess and puffy skin in the upper part of the upper eyelid, it is called dermatochalasis.

Drooping eyelids are sometimes congenital and sometimes develop during life and are acquired. Ptosis may be temporary or permanent. The most common treatment for drooping eyelids is surgery. This operation is performed on the eyelid lifting muscle (Müller's muscle or levator/aponeurosis muscle).

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• involve one or both eyes.
• be hereditary
• Occur at birth.
• It happens at an older age.

Optometrist She can carry out a comprehensive review of your problem and provide you with the necessary information about various treatment methods and their possible complications and risks.(feminine)
To diagnose the cause of ptosis and choose the best treatment method, it may be necessary to perform blood tests, special photographs or other tests. If an underlying cause is found, this should be corrected first, but in most cases, the final treatment is surgery, and the type of surgery is determined based on the severity of ptosis and other clinical findings.

Blepharitis (eyelid inflammation)

Blepharitis is inflammation of the eyelids, especially at their edges. This disease is common and may be caused by a mild microbial infection or widespread skin disease. In blepharitis, particles of fat and bacteria cover the edges of both the upper and lower eyelids. This causes discomfort, itching, redness, burning, or the feeling of a foreign object in the eye.

Regardless of the type of blepharitis, the symptoms that are usually seen in blepharitis are: itching, burning, tearing, foreign body sensation, scaling (on the eyelashes and in the corner of the eye or on the eyelid), dry eyes , and redness of the edges of the eyelids.

In case of such symptoms, it is necessary to see an ophthalmologist. If blepharitis is not treated, in the long term it causes thickening of the edges of the eyelids, dilation of capillaries, trichiasis (reverse growth of eyelashes towards the inside of the eye), eyelash loss, ectropion (turning of the eyelid outwards) and entropion (turning back of the eyelids). eyelids inward). It may also lead to reactions and complications in the conjunctiva and cornea.

Blepharitis can be difficult to treat because it tends to recur. Treatment depends on the type of blepharitis. Treatment may include applying warm compresses to the eyelids, cleaning them, using antibiotics, and/or massaging the eyelids. If blepharitis causes dry eyes, it may be necessary to use artificial tear drops or lubricant ointments (which reduce the friction of the eyelid with the surface of the eye). Cortone is sometimes used to control inflammation, but the side effects of these drugs prevent their long-term use.

The warm compress loosens the scales on the eyes, and in this way, these scales are easier to remove when cleaning the eyelid. The warm compress also warms and loosens the plaques that block the oil glands of the eyelid. Obstruction of these glands causes inflammation. First, wash your hands and place a towel moistened with warm water on your closed eyes. At the beginning of the treatment period, the ophthalmologist may prescribe this 4 times a day for 5 minutes each time. After that, a warm compress may be enough once a day for a few minutes.

Cleaning the eyelids is necessary to treat blepharitis. This is done by massaging the eyelids with diluted baby shampoo. To massage the eyelids, first wash your hands and massage the edges of the eyelids and around the eyelashes with baby shampoo with the help of your fingers or an ear cleaner or gauze or a clean towel, and then rinse thoroughly with lukewarm water.

In some cases, it is necessary to prescribe antibiotics in the form of topical ointment or oral treatment.

If the sebaceous glands of the eyelids are also dysfunctional, warm compresses and eyelid massage are necessary to remove excess fat. How to perform massage in these cases is taught to the patient by the ophthalmologist.

Because blepharitis tends to become chronic, treatment may continue for a long time. If the patient uses contact lenses, depending on the type of blepharitis, it may be necessary not to use contact lenses during the treatment of blepharitis and even after. For some of these patients, lenses with high permeability are prescribed, and others are advised to change the lenses more often. Some patients will find it difficult to use the lens and must use other methods to correct their refractive error.

It is better not to use cosmetics because it may interfere with eyelid washing and massage therapy. In some cases of blepharitis, the patient is advised to use anti-dandruff shampoos for the head and eyebrows.

Blepharospasm

It means involuntary blinking or involuntary closing of the eyelids. Blepharospasm is a progressive neurological complication that occurs mostly in middle-aged and elderly women. The most common form of blepharospasm is "benign essential blepharospasm" (Benign Essential Blepharospasm), which manifests as frequent involuntary closing of the eyelids.

Blepharospasm is actually a type of dystonia. Dystonia means frequent and prolonged involuntary contraction of a muscle or a group of muscles.

Drug treatments:

Because the underlying cause of blepharospasm is unknown, there is no specific medication to treat it. Anticonvulsants, sedatives, and antidepressants are medications commonly used to control blepharospasm. The response of different people to different drugs is different and it is not possible to predict in advance which drug is more suitable for a particular person. It is often necessary for a person to try different drugs under the supervision of a doctor to determine which drug is most suitable for him. However, drug treatment is not very effective in blepharospasm. At best, the use of medication only causes partial and transient improvement. In addition, many patients do not respond well to drug therapy.

botax injection:

Currently, the best treatment method for blepharospasm is Botox injection, which is sold in our country under the brand name Dysport. Botox is the brand name of a complex protein extracted from a bacterium called Clostridium botulinum. After botox is injected locally, it is absorbed by the nerve endings that control the muscles. In these terminals, Botox prevents the release of a chemical mediator called acetylcholine, which is responsible for muscle contraction. As a result, a kind of temporary paralysis is created in the muscles, which lasts between 3 and 6 months.

When Botox is injected locally into the muscles that are responsible for closing the eyelid, these muscles are paralyzed and are no longer able to contract, thus relieving the symptoms of blepharospasm. Usually, the effect of injection appears after one or two weeks and lasts for 3 to 6 months. After this period, it is necessary to repeat the Botox injection. Of course, in a few patients, the symptoms disappear after one or two injections, but this is not common and it is usually necessary to repeat Botox injections every 3 to 6 months. Botox injection is a very effective method in controlling the symptoms of blepharospasm, so that in more than 90 to 95% of cases, it causes a significant improvement of the person. Of course, botox injection can cause side effects such as drooping eyelids, blurred vision or double vision, but all these side effects are temporary and will be resolved within a maximum of 6 months.

surgery 

Surgery is usually used for cases where either Botox injection has not had any beneficial effect or the person is not interested in repeated injections. The most common surgical method used to treat blepharospasm is muscle removal or myectomy. In this method, part of the muscles that are responsible for closing the eyelids are surgically removed. This method improves the symptoms of blepharospasm in 70 to 80% of cases. But the side effects of surgery are more than Botox injection, in addition, the side effects of Botox injection are reversible, but the side effects of surgery are often irreversible.

گل مژه (Stye | Hordeolum)

A bleb is an inflammation and infection of a gland called "meibomian" in the eyelid wall; This gland is responsible for the secretion of fat; The fat that makes the tears of the eyes evaporate with a delay and the eyes do not suffer from dryness. In fact, fat is one of the components and necessary for the health of the tear film.
Some factors increase the concentration of lacrimal gland secretions; this causes blockage of the ducts of the lacrimal glands and the appearance of eyelash flower.

Cystitis is one of the common eyelid diseases that can affect people of different ages. A stye appears as a swollen, sensitive, painful, red mass on or near the edge of the eyelid. This lump is actually a small abscess that is caused by infection or inflammation of the roots of the eyelashes or the sebum-secreting glands of the eyelid. The contact of contaminated hands with the eyes (especially if it is contaminated with nasal secretions) and inflammation of the edge of the eyelid (blepharitis) are important factors that cause blepharitis.

Symptoms and signs of eyelash

•  Heaviness and eyelid pain
• A painful red raised lump on or near the edge of the eyelid
• Burning and itching and tears
• Sometimes purulent discharge from the lesion
• Blurred vision: Blurred vision is not a common symptom of cilium, but if the cilium is relatively large, it causes blurred vision by blocking the path of vision or by putting pressure on the cornea and causing astigmatism.

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Most cilia will gradually improve within a few days and do not cause any special problems. For the first few days, applying a warm compress will relieve pain and may help to loosen the cilia and drain the purulent discharge. For this purpose, moisten a clean towel with warm boiled water (not hot!) and place it on the affected eye for 10 to 15 minutes. Gentle massage also helps relieve pain and discharge secretions. Warm compress massage can be applied 3-4 times a day to drain secretions and improve eyelash growth. Never try to pop the eyelash or forcefully drain it, this can cause the infection to spread to nearby tissues or even enter the brain. If the eyelash flower does not improve after a few days, be sure to see an ophthalmologist who can solve the problem by prescribing medicine or a small surgery if necessary. The surgery is performed under local anesthesia using an anesthetic drop and the eyelash is drained from the back of the eyelid.
In normal eyelashes, the use of antibiotic drops or oral antibiotics does not have much effect. But in young children or people who have severely inflamed eyelashes, it may be necessary to use topical or oral antibiotics with the opinion of an ophthalmologist to prevent the spread of infection to the rest of the eyelid and adjacent parts.

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