General Ophthalmology

Blepharitis is an inflammation of the eyelids. This common problem typically affects the edges (margins) of the eyelids and is usually present in both eyes.

The inflammation is usually caused by bacterial infection and then inflammation of the meibomien oil glands in the eyelid. This changes the composition of the tears so they are less refreshing to the eye. In turn, the eye dries out. Despite the eye often compensating by secreting more tears, the eye remains uncomfortable. 

Blepharitis is often difficult to treat. The reasons for the development and persistence of this condition are usually not well known.

Blepharitis is an irritating problem that can cause discomfort, pain and great inconvenience. It is not a threat to general health, or to vision. With on-going conscientious management, blepharitis usually responds well to treatment. 

The main signs and symptoms of blepharitis include:

• Painful eye and around the eye
• Redness and swelling of the eye and eyelids
• A feeling of “something in my eye”
• Excessive tears
• Photophobia (sensitivity to light)
• Crusty or sticky eyelashes, particularly in the morning
• Sensitive to wind/air conditioners

The goal of treatment is to lower the eye pressure to minimise the risk of further damage to the optic nerve, and therefore, your vision. Lowering eye pressure can be accomplished using eye drops, laser, or surgery. Treatment needs to be carried out for life. Glaucoma can be controlled, but there is currently no cure. Glaucoma treatment will not improve your vision.

When eye drops are chosen, it is important that you instill them appropriately and regularly. Some of the drops need only be used once daily while some require twice or three times a day dosing. Like any medication, eye drops can potentially have side effects, and these may not be limited to the eye. For example, timolol eye drops can cause breathing problems in asthmatic patients. 

The laser to lower eye pressure is called Selective Laser Trabeculoplasty. This has been shown to be as effective a first treatment option as eye drops. This is a simple, mostly painless, quick procedure that can control eye pressure for a period of up to 5 years in some patients. 

Many surgeries are available and newer ones are being constantly developed and evaluated. Most of these are reserved for patients with advanced glaucoma, not adequately controlled with drops and laser.

The choice of treatment depends on many factors which are unique to each patient and should be discussed with your ophthalmologist. If you start with eye drops, but are having difficulty putting them in, forget frequently, or are having side effects, tell your ophthalmologist, and other options can be discussed.

Monitoring

Once a diagnosis and treatment plan is established, the eye pressure and optic nerve need to be monitored. If all is stable, you generally need eye pressure checks every 6 months. OCT scans and visual field tests should be repeated at least yearly. If there is evidence of progressive damage, or in advanced disease, these checks may need to be more frequent. 

Your optometrist can also help in monitoring glaucoma. Your local doctor (GP) can prescribe your glaucoma drops, but will not have the equipment to assess your eye pressure. 

When faced with a new diagnosis of glaucoma there is one question that is foremost in every patient’s mind: “Will I go blind?”

Fortunately for most patients the answer is no. Blindness does occur from glaucoma but it is a relatively rare occurrence. Blindness occurs in about 5% of glaucoma patients, and usually occurs when the diagnosis is made late, when the disease is already advanced. Sight impairment is more common and occurs in around 10% of patients. 

Loss of vision can occur even with the best treatment. Despite that sobering fact, correct treatment and follow-up will stabilise the vast majority of patients with glaucoma. A major factor in the treatment of your glaucoma is you. By correctly using your eye drops and being consistent in their use, a favorable outcome will be more likely.

We have brochures available in our clinic on glaucoma and selective laser trabeculoplasty.

Glaucoma Australia website: www.glaucoma.org.au

If you are having trouble putting drops in your eyes, there is an instructional video on the Glaucoma Australia website. Alternatively, there are special devices to help with eye drop installation. Please discuss with our staff, or your pharmacist.