Dr Adam Watson Eye Institute 16:30 - 17:25 WS #188: Identifying and Managing Problems With the Surface of the Eye 17:35 - 18:30 WS #200: Identifying and Managing Problems With the Surface of the Eye (Repeated) Dr Shanu Subbiah Ophthalmologist Eye Surgeon Eye Institute
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Dr Adam WatsonEye Institute
16:30 - 17:25 WS #188: Identifying and Managing Problems With the Surface of the Eye
17:35 - 18:30 WS #200: Identifying and Managing Problems With the Surface of the Eye
(Repeated)
Dr Shanu SubbiahOphthalmologist
Eye Surgeon
Eye Institute
Copyright 2017 Eye Institute. Confidential.
Surface of the Eye-Identifying and Handling Problems
Dr Adam WatsonCataract, Cornea, Refractive,
Oculoplastic Surgery
Dr Shanu SubbiahCataract, Refractive Surgery,
Medical Retina, Cornea
Central - Remuera
South - Manukau
North - Northcote
West – New Lynn
Dr Adam Watson [email protected]
Copyright 2017 Eye Institute. Confidential.
Pterygium
Pterygium
Pterygium. What’s with the name?
from Greek “little wing”
Dr Adam Watson [email protected]
Pterygium - cause
•p53 protein overexpressed without
apoptosis
•indicates probable p53 gene mutations
•damaged p53-dependent programmed
cell death mechanism allows
progressive accumulation of other
mutations
•allow the multi-step development of
pterygia and limbal tumours
Dr Adam Watson [email protected]
Pterygium – who needs surgery?
small but prominent
• Vision
• Symptoms
• Appearance
Dr Adam Watson [email protected]
Pterygium - recurrence
Technique
bare sclera 50%
conjunctival flap 10%
conjunctival autograft <5%
beta radiation
Dr Adam Watson [email protected]
Pterygium – other possible pathologies
• pseudopterygium
• squamous neoplasia
(OSSN/CIN)
• peripheral degenerative
conditions
• trauma, scars etc.
localised chemical burnOSSNperipheral degeneration
Dr Adam Watson [email protected]
Pterygium - Summary
• prevalence 3%1
• sun exposure aetiology
• surgery remarkably safe
and effective
• be aware of atypical
pterygium mimickers
Dr Adam Watson [email protected]. Taylor Br J Ophthalmol 2000;84:289 Victoria, Australia
Copyright 2017 Eye Institute. Confidential.
Meibomian glands and the
ocular surface
Meibomian Glands
What are Meibomian glands?
Dr Adam Watson [email protected]
Heinrich Meibom (1638-1700)German physician and poet
Meibomian Glands
• oil secreting glands
• upper and lower eyelids
infra red meibography
Dr Adam Watson [email protected]
Dr Adam Watson [email protected]
“classic” tear film modeltear film model updated
tear film instability
Meibomian Gland Dysfunction - associations
• age
• rosacea
• genetic
• diet?
Dr Adam Watson [email protected]
Meibomian Gland Dysfunction
Is this the same as blepharitis?
Dr Adam Watson [email protected]
It’s a subset of blepharitis
Meibomian Gland Dysfunction
Dr Adam Watson [email protected]
anterior blepharitisposterior blepharitis
Identifying MGD
Symptoms:
• dry, irritated eyes
• stinging, burning
• intermittent watering
• variable vision
• morning predominance
Dr Adam Watson [email protected]
approx 70% of dry eye patients have MGD
Rabensteiner. Acta Ophthalmol 2018;96:e707
30 to 60% of people have signs of MGD
Identifying MGD
Signs:
• redness
• thickened lid margins, blunted architecture
• congested glands
• thickened or frothy secretions
• eyelash misdirection
• chalazia
• rosacea
• MG “dropout”
Dr Adam Watson [email protected]
Meibomian Gland Dysfunction
So what should I tell people to do?
Dr Adam Watson [email protected]
Ongoing control
MGD treatment
• heat treatments
• Omega 3 supplement
• lubricant drops
Dr Adam Watson [email protected]
restore lipid layer
MGD treatment
• heat treatments
• Omega 3 supplement
• lubricant drops
• disease modifying
antibiotic
Dr Adam Watson [email protected]
Doxycycline 50mg daily 6 to 12 weeks
Azithromycin 500mg daily 3 days
Meibomian Gland Dysfunction
Who needs referral?
Dr Adam Watson [email protected]
Unsatisfactory outcome with basic treatments
Meibomian Gland Dysfunction
• detailed tear film, MG and dry
eye assessment
• intense pulsed light therapy
• gland expression
• topical anti-inflammatories
Dr Adam Watson [email protected]
Meibomian Gland Dysfunction - Summary
• it’s common
• think of it as a cause for
your patients’ low grade
dryness, watering and
redness symptoms
And now, Dr Shanu Subbiah
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