Do you have a problem seeing zig zag lines? This can be an alarming symptom. Sometimes, they are described as jagged or resembling a heat wave coming off of a hot asphalt road. Others describe the symptom as looking like a kaleidoscope. The zig zag lines usually come on without warning and may slowly increase in size and intensity over several minutes. They often interfere with vision by blocking out part of the vision. For example, you may only be able to see part of a person’s face or part of a printed word. After 15–20 minutes or so, they disappear without any permanent vision loss.
What causes this symptom?
There are many causes of zig zag lines in the vision. However, the most common cause is a migraine phenomenon, called a visual aura. Migraines with visual aura may occur with or without a headache. Often, they often follow stress by several weeks. Migraine is a diagnosis of exclusion. That means it is necessary to exclude or rule out other more serious causes of zig zag lines before settling with the diagnosis of migraine.
What are more serous causes of zig zag lines in the vision?
Serious causes of may include problems in the eyes, the brain, the heart, and other medical problems. Eye problems include retinal breaks, retinal detachment, and inflammation in the eyes. Brain problems include bleeding, aneurysm, seizure, and tumors. Sometimes, zigzag lines are associated with a heart problem, such as patent foramen ovale. In this case, a cardiologist assesses and provides treatment as needed. Rarely, blood clot problems and connective tissue disease are implicated.
Who should I see about this problem?
The ophthalmologist (Eye MD) is equipped with the knowledge, skill, and equipment to diagnose the cause of your zig zag lines. Sometimes, you may need to see a retinal specialist (a type of ophthalmologist with specialty education in retinal disease). In some cases, the ophthalmologist will send you for a brain scan or to a neurologist for further care.
What is the treatment for zig zag lines?
The treatment of zig zag lines depends on the cause. Once the doctor excludes serious diseases, he may diagnosis migraine. In that case, no treatment is usually necessary. However, if the symptoms are recurrent and bothersome, the ophthalmologist will usually send you to a neurologist for assessment and possible medication.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
A hypermetropic eye is a far-sighted eye. Without glasses the vision may be good at distance or blurred, but the vision is usually blurred or strained at near without glasses. Hypermetropia is different from presbyopia (aging eyes). Hypermetropia affects many people and is treated with glasses, contact lenses, and, rarely, laser surgery. It is a common underlying reason for the need to wear optical correction (glasses).
What causes hypermetropia?
Hypermetropia is an inherited condition that usually develops in childhood or early adulthood. The eye develops with either a flat cornea or a short eyeball length, or both. As a result, the image entering the eye is focused behind the plane of the retina. In this case, the eye tries to focus the lens to make the image projection sharp. Sometimes, the natural lens in the eye can compensate for the focusing of images, but often eyeglasses or contact lenses are needed. The outer appearance of the eye is not usually changed. It is not obvious that an eye is hypermetropic by inspecting the outside of the eye.
Why is it important to know about hypermetropia?
Although most people with hypermetropia do not develop complications, some far-sighted people are at increased risk of losing vision from narrow-angle glaucoma, central serous choroidopathy (also known as central serous retinopathy), and choroidal effusion.
Angle-Closure Glaucoma is a condition in which the pressure inside the eye damages nerve tissue that helps you see. High pressure is the result of closure of the internal drain in the eye. The pump inside the eye does not sense the closure of the drain; it continues to pump fluid into the eye. The drain cannot keep up with the pump, so the pressure inside the eye rises. This pressure may or may not cause pain or discomfort. Over time, the pressure slowly takes away the side vision. If undetected and untreated, it may cause total, irreversible blindness. The best way to diagnose glaucoma is to have regular eye exams each year with pressure measurements and gonioscopy. Treatment is effective in preventing vision loss. Laser is often used to open the drain. Sometimes operative surgery is required with or without removal of the lens in the eye (to make more room for the drain to stay open). Often, eye drops are needed long-term to keep the pressure under control.
Central Serous Chorioretinopathy is an uncommon cause of vision loss from hyperopia. The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. In hypermetropic eyes, the layer under the retina called the choroid becomes crowded and thickened. The outer coat of the eye known as the sclera may be thickened as well. As a result of thickened choroid and sclera, the flow of fluid inside the eye that normally drains out through these structures, is restricted. This fluid may then collect under the retina and cause the central vision to become blurred or distorted even with proper glasses. Distortion is when straight lines look wavy or crooked. Blood vessels under the macula may bleed causing sudden blurring, blind spot, or distortion. Any of these symptoms should be reported to the eye doctor without delay, as early treatment with laser may prevent further loss of vision.
Choroidal Effusion is a separation of the choroid from the sclera, the wall of the eye. This is different from retinal detachment. When the choroid detaches, it is no longer in proper position inside the eye. As a result, symptoms of a dark curtain or shadow slowly starts off to the side and takes away the vision as the choroid detaches. Pain is not common. The diagnosis is made by a retinal specialist; it is critical to identify and differentiate choroidal detachment from retinal detachment and tumors. Treatment of choroidal effusion is typically started with medications. Sometimes, however, surgery is needed.
Will refractive surgery help prevent these complications of hypermetropia?
Although refractive surgery (laser correction) is effective at changing the shape of the cornea to help eliminate the need for corrective lenses (glasses and contacts lenses), it does not restore the natural shape of the eye. Therefore, it is still necessary to be aware of the warning signs of possible complications from hypermetropia.
What should a hypermetropic patient do?
Using your eyes to read or work at a computer will not weaken them. Remember to have your eyes examined once a year with special attention to the opening of the drainage apparatus (the corneoscleral angle). Not all eye doctors are proficient with determining the risk of angle-closure glaucoma; therefore, consider seeing a fellowship-trained glaucoma specialist if needed. In Tampa there are several choices including doctors Levitt, Gamell, Richards, King, and Fridman. Apart from an annual exam, report the following symptoms to your eye doctor without delay:
Sudden-onset pain in the eye (sometimes, associated with nausea)
Sudden-onset redness (especially, if associated with pain and blurred vision)
Loss of side-vision (possibly, a very late sign of glaucoma)
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
The retina is a “tissue-paper” thin layer of nerve tissue, which lines the inside of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain.
What is retinal detachment?
When the retina detaches, it is no longer in proper position inside the eye. Instead, it is like film that has unrolled inside a camera. When this occurs, a camera cannot take a picture. Similarly, when the retina detaches the eye loses vision.
How is silicone oil used to repair retinal detachment?
Silicone oil is injected into the eye during vitrectomy surgery to hold the retina in place against the eye wall. It works by pushing and holding the retina in position from the inside. This is different from scleral buckle surgery in which the eye wall in indented to push it against the retina from the outside. Depending on the characteristics of a retinal detachment, during vitrectomy surgery silicone oil or gas may be used to hold the retina in place.
What are the advantages and disadvantages of silicone vs. gas to repair retinal detachment?
Various gas bubbles (air, SF6, or C3F8) are most frequently used hold the retina in position for healing after vitrectomy for retinal detachment repair. However, the effect of gas bubbles is temporary. Silicone oil may be used instead of a gas bubble (pneumatic retinopexy) for longer duration of action. Although gas has a higher surface tension with better ability to close retinal breaks, gas bubbles dissolve in the fluids of the eye and disappear over a period of days (air) to weeks (SF6 and C3F8). Silicone oil remains in the eye until it is removed with surgery in the operating room; it does not dissolve in the fluids of the eye. The long duration of effect with silicone oil makes it helpful when treating retinal detachments with inferior retinal breaks and with proliferative vitreoretinopathy. Silicone oil may also be used when a patient cannot stay in proper position, as is often required after retinal detachment surgery for proper healing with pneumatic retinopexy (gas injection). Head positioning is much less critical for success with silicone oil as compared to gas tamponade. Air travel is another reason silicone oil may be used over gas tamponade; there are no restrictions on air travel with silicone oil as there are with gas. As long as gas or silicone is in the eye, the vision is poor. The only way to remove silicone oil is with surgery in the operating room.
How long is silicone oil left in the eye?
Silicone oil may be left inside the eye for weeks, months, or years after surgical repair of retinal detachment. How long before surgical removal of silicone largely depends on the nature of the retinal detachment. The average duration of silicone oil retention in the eye is 3-4 months; however, some surgeons prefer to leave silicone in place for one year after repair of retinal detachment associated with scar tissue (proliferative vitreoretinopathy). In severe cases of retinal detachment, the only way to keep the retina attached is by leaving silicone oil in the eye permanently. Although this situation is not desirable, it may be necessary to retain silicone oil in the eye to preserve limited vision and keep the eye from shrinking and becoming deformed and/or painful from advanced scar tissue formation. When silicone oil is retained long-term inside the eye, periodic evaluation is needed to identify and treat late complications.
What complications are associated with silicone oil?
Although silicone oil may be the only way to successfully repair difficult retinal detachments, complications may occur. The most common side-effect with silicone oil is cataract formation. If a silicone lens implant is in the eye, the silicone oil may adhere to the lens implant and impair vision. Rarely, silicone oil may cause glaucoma (high pressure in the eye that can result in loss of vision if left untreated). This may be treated with eye drops, laser, or glaucoma surgery. Sometimes, it is necessary to remove and/or replace the silicone oil. In exceedingly rare cases, glaucoma may drive silicone oil from the eye through the optic nerve into the brain.
After many months to years, silicone oil may emulsify (break into tiny bubbles). These bubbles may then travel into the front of the eye and cause the cornea (the clear front window of the eye) to fog over. This may require removal/replacement of silicone and, rarely, corneal transplantation.
Severe complications from silicone oil are rare. The use of silicone oil may be the only hope of retaining vision and the eye in some cases. With routine exams and follow-up care, complications may be prevented or detected early, and managed appropriately.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Over-the-counter (OTC) pain medications are pills that can be purchased without a prescription. There are a number of brands available. Examples include ibuprofen (Motrin) and acetaminophen (Tylenol). As ibuprofen and acetaminophen work via different pathways, they can be used together for improved pain control.
What side effects might be expected?
Most drugs have many possible side-effects. The major concern with acetaminophen is liver damage especially seen in patients with known liver disease. The major concern with ibuprofen is kidney damage in patients with known kidney disorders. Also, ibuprofen may irritate the stomach and increase the risk of stomach ulcers. This is especially seen in patients over the age of 65, history of stomach ulcers, or taking medications such as aspirin, steroids, or warfarin (Coumadin). Ibuprofen thins the blood and, therefore, may increase the tendency to bleed by slowing the ability of the blood to clot. The risk of stomach problems with ibuprofen may be reduced by using Zantac or Pepcid, which are available over-the-counter.
How can OTC pain medications be optimally used to control post-operative pain?
Because pain from surgery is short-lived, drug dependence is not a significant issue. The best strategy is to stay ahead of severe pain rather than trying to catch up due a lapse in medication. The optimal use of OTC medication may reduce the need for prescription narcotic pain medication. Prescription narcotic pain medications have side-effects such as sedation, constipation, nausea, and vomiting. With the proper use of OTC pain medications, the need for narcotics can be minimized.
As most narcotic pain medication is combined with acetaminophen, the dosage of OTC acetaminophen (Tylenol) must be decreased so as to avoid exceeding the maximal daily dosage (3,000mg per day).
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
The retina is a “tissue-paper” thin layer of nerve tissue that lines the inside of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. Proliferative vitreoretinopathy is a condition in which sheets of scar tissue grow on the surface of the retina. It usually occurs after retinal detachment as a part of the healing process. Unfortunately, the PVR scar tissue pulls on the retinal and is the most common cause of failure of attempted repair of retinal detachment. There is evidence of PVR in about 10% of eyes that present with retinal detachment.
What is retinal detachment?
When the retina detaches, it is no longer in proper position inside the eye. Instead, it is like film that has unrolled inside a camera. When this occurs, a camera cannot take a picture. Similarly, when the retina detaches the eye loses vision.
What causes PVR?
Proliferative vitreoretinopathy is caused by the excessive formation of scar tissue. Scar tissue is a common healing mechanism in the body. For example, if the skin is cut, scar tissue closes the laceration. In the eye scar tissue develops in response to retinal detachment and surgical repair. If it becomes excessive, the scar tissue causes the retina to detach again. The abnormal production of scar tissue in the eye is called PVR. Tobacco use may increase the risk of PVR.
How is PVR treated?
The treatment of PVR requires one or more surgeries. Your doctor is skilled in a number of techniques to prevent blindness. Which type of surgery is recommended depends on the precise findings on examination.
Scleral buckle surgery: Some retinal detachments require the placement of a permanent plastic supporting belt around the eye to create a “ledge of support” for the retina. This belt is placed in the hospital operating room in a major surgery. The eye is often rendered more near sighted by this procedure. Rarely, side effects include double vision.
Vitrectomy surgery: Performed in the hospital operating room as a major eye surgery, vitrectomy surgery involves making small incisions into the eye to remove floaters, dissect scar tissue, remove fluid from under the retina, apply laser, and place a gas bubble or silicone oil into the eye to hold the retina in place. Specific head positioning is sometimes needed. Sometimes a cataract or lens implant must be removed to adequately repair the retina. After surgery, it may be necessary to lie in a specified position for several days for success. This surgery may be repeated if necessary to prevent blindness.
With one or more surgeries most retinal detachments with PVR can be repaired keeping useful vision. The vision usually does not return to normal. It is frequently blurred or distorted. There are always risks to surgery including hemorrhage, infection, scarring, glaucoma, cataract, and double vision. Sometimes despite all efforts with surgery, all vision may be lost. Surgery is recommended for retinal detachments with PVR because blindness usually results if treatment is withheld. If you have questions, please do not hesitate to ask your doctor.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Vitreous is the gel that fills the eye (click on image to enlarge)
What is vitreous hemorrhage?
Vitreous hemorrhage means blood has leaked into the vitreous gel of the eye. The vitreous is a clear gel that fills the center of the eye and helps to hold the retina in place against the eye-wall like wallpaper in a room. The retina is a thin layer of delicate nerve tissue, which acts like film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. The retina has many fine blood vessels, which sometimes leak blood into the vitreous and cause a loss of vision.
What symptoms does vitreous hemorrhage cause?
Vitreous hemorrhage usually causes many new floaters in the vision. Floaters may appear as round specks, hair-like or bug-like debris, or clouds moving in your vision as though they were in front of your eye. They are more noticeable when looking at a blank surface and may interfere with the good vision in the fellow eye.
Flashes are brief streaks of light that are usually seen off to the side, especially at night when you turn your head or eyes. Flashes are caused by vitreous gel pulling on the retina with eye movement.
Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous. In some people with these symptoms, the retina may tear and detach resulting in loss of vision.
What causes vitreous hemorrhage?
There are many causes of vitreous hemorrhage. Diabetes can cause vitreous hemorrhage by weakening the blood vessels in the retina and by causing the vitreous gel to shrink and pull on the retinal vessels. Hardening of the arteries in the eye can cause vitreous hemorrhage by blocking a retinal vein where the arteries cross over the veins in the retina. Ageing changes of the vitreous gel can cause it to pull on the retina and tear it. The tearing of the retina may result in bleeding into the vitreous. Less common causes of vitreous hemorrhage include birthmarks inside the eye, inflammation, trauma, tumor, surgery, blood disorders, and macular degeneration.
How is vitreous hemorrhage treated?
The most important step is to have a thorough eye examination with ultrasonography. The ultrasound machine uses sound waves to safely and effectively “look through” the blood in the vitreous to see if the retina is attached. If a retinal detachment is found, surgery (scleral buckle, pneumatic retinopexy, and/or vitrectomy) is required in an attempt to repair it. If no retinal detachment is found on ultrasound exam, your doctor may allow the vitreous hemorrhage to clear on its own with time. The ultrasound exam may be repeated periodically to assure the retina remains attached. In many cases the cause of the vitreous hemorrhage cannot be determined until the hemorrhage has cleared. If the hemorrhage does not clear on its own, vitrectomy surgery as a one-day surgery in the hospital operating room may be considered. The amount of visual return depends on several factors including the health of the underlying retina.
What should I be on the lookout for?
After examination or treatment for a vitreous hemorrhage, you should notify your doctor if you have a burst of new floaters, a loss of side vision, or pain. Sometimes, retinal tears or a retinal detachment occur at a later date after the examination.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
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Scleral buckle surgery is an advanced form of eye surgery for the repair of retinal detachment that is performed in the operating room under a microscope. Scleral buckle surgery may take thirty minutes to several hours to perform depending upon what task is being accomplished. Despite common tales, the eye is not taken out and placed on the cheek. It remains in its normal position throughout the surgery. During scleral buckle surgery a silicone band or sponge is sutured to the external eye wall (the sclera) behind the eye muscles and hidden by the covering of the eye (the conjunctiva). The surgery creates an indentation (buckle) in the sclera that offers a ledge of support for the retina inside the eye and offsets traction on the retina from the vitreous gel (a major cause of retinal break and retinal detachment).
Artistic rendition of scleral indentation (click on image to enlarge)
Below is an example of scleral buckle surgery. If you are uncomfortable watching surgery, please do not click on this video.
What type of anesthesia is available?
Although some surgeons and patients choose local anesthesia, general anesthesia is also available. With local anesthesia the patient is sedated with IV medication so there is no memory of the anesthetic injection around the eye. Surgical drapes are placed over the face leaving plenty of breathing room. During surgery the patient is awake, but generally does not feel pain. It is important to lie still on the operating room table as movement during surgery may result in damage to the eye and affect the final visual result.
General anesthesia offers some advantages over local anesthesia. With general anesthesia the patient is motionless and remembers nothing of the surgery. The anesthesiologist places a tube to hold the airway open. Which type of anesthesia is best for a patient may be determined by the health of the patient, so you may wish to ask your internist for advice. If a person cannot lie still for the surgery or if claustrophobia is a problem, general anesthesia is preferred. Although there are risks with any type of anesthesia, modern techniques offer a high degree of safety for the patient.
How can I prepare for scleral buckle surgery?
Your EyeMD will schedule an appointment with your primary care doctor if evaluation is needed prior to surgery. Please inform your doctor of any chest pain/pressure, fever, productive cough, or shortness of breath. Unless otherwise notified by your doctor, do not take aspirin-containing products or any herbal supplements for two weeks prior to surgery. Coumadin should be stopped four days prior to surgery. On the morning of surgery, take no medications for diabetes unless instructed differently by your doctor, but please do take all of your other medications with a sip of water. Otherwise, do not eat or drink anything after midnight the day before surgery. If you usually use eye drops in the morning, they may be taken on the morning of surgery. Please click on this link for further information on how to prepare for surgery.
What are the risks of scleral buckle surgery?
Although uncommon, problems such as bleeding and infection may arise from any surgery. Retinal detachment or abnormal scar tissue formation may require additional surgery. Rarely, there may be loss of vision/loss of the eye from surgery. Although serious problems are not encountered often, the risks and benefits must be weighed for each individual prior to surgery. In retinal detachment, surgery is the only way to improve vision and prevent blindness.
What can I expect after scleral buckle surgery?
A soft eye patch and a hard eye shield are placed on the eye at the end of surgery. Leave these in place until your exam on the day after surgery. You may use Tylenol or Advil for aching pain, but call the doctor for a prescription if your pain is not relieved.
Over-The-Counter Pain Medication Schedule for Maximum Effect
Dosing Schedule:
8AM
2PM
8PM
2AM
Maximum
Ipubrofen
800mg
800mg
800mg
800mg
3200mg
(200mg tablets)
4 tablets
4 tablets
4 tablets
4 tablets
Dosing Schedule:
11AM
5PM
11PM
Maximum
Tylenol Extra-Strength
1000mg
1000mg
1000mg
3,000mg
(500mg acetaminophen)
2 caplets
2 caplets
2 caplets
Note: This schedule may need to be altered if you have kidney or liver disease.
This schedule is designed not to exceed maximum dosages of these medications.
Do not take addiitonal medications that also contain ibuprofen or acetaminophen.
It is common to have moderate discomfort after scleral buckle surgery. A scratchy feeling may result from sutures on the white of the eye. These sutures dissolve in about a month. At your exam after surgery, you will be given eye drops and/or an ointment to keep the eye comfortable, to prevent infection, and to promote healing. Wearing the eye patch is optional after you are seen in the office. Be sure you understand any positioning requirements given by your surgeon and feel free to ask about special pillows and equipment available to help maintain head position. If a gas bubble is placed in your eye at the time of surgery, you may not fly on a plane or undergo nitrous oxide anesthesia until the gas has dissolved, or you could risk severe pain and blindness. You may see the gas bubble as a horizontal, dark, curved line or as a dark ball in the vision. If a gas bubble is used during surgery, please keep a MedicAlert bracelet on your wrist until the gas has disappeared. The swelling and redness slowly disappear over weeks to months. The vision usually returns slowly after surgery and may take months to years for final recovery. Sometimes, the vision does not recover completely to normal. If the center of the retina was detached, there is usually some degree of permanent blurring of vision or distortion.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Retinal cryopexy is a procedure performed in the office or operating room designed to treat retinal problems. The name, cryo, comes from a Greek word meaning icy cold. This procedure utilizes the freezing effect to treat damaged retina.
Cryopexy Probe
How is retinal cryopexy performed?
After the eye has been anesthetized, a pencil-like probe is gently pressed against the eye. The cryo machine, activated by a foot pedal, cools the tip of the cryo probe. The freezing effect is conducted through the eye wall to the retina. The procedure takes several minutes to perform.
What conditions may require retinal cryopexy?
Retinal cryopexy is used to treat abnormal or damaged retinal tissue. The most common condition requiring retinal cryopexy is a retinal tear. Retinal tears threaten loss of vision from retinal detachment. Retinal cryopexy is used to make the retinal tear adhere to the inner eye wall. Retinal cryopexy is preferred over laser to treat retinal tears in attached retina when cataract or vitreous hemorrhage obscures the view of the retina and blocks the path of laser light.
Other conditions that are occasionally treated with cryopexy include diabetic retinopathy, retinal vein occlusion, Coats disease, neovascular glaucoma, pars planitis, retinopathy of prematurity, tumors, and familial exudative vitreoretinopathy (FEVR).
What are the risks of retinal cryopexy?
While cryopexy is generally safe, there are risks to consider. The most common adverse effects include redness, swelling, bruising, tearing, and pain after the procedure. Sometimes, cryopexy does not prevent retinal detachment, and more surgery is needed at a future date. Severe complications are rare and include infection, bleeding, scarring, deformity, blindness, deformity, and loss of the eye. When cryopexy is recommended, the benefits of treatment outweigh the risks.
What is expected after retinal cryopexy?
An eye patch may be placed over the eye after the procedure and prescription eye drops may soothe the eye after the patch has been removed. For several days after retinal cryopexy, the eyelids may appear swollen. Tearing and achiness is common for several days. The white of the eye may be red for a week or two. Over-the-counter pain medications often help improve comfort. Cryopexy will not prevent distortion of vision due to macular pucker that sometimes develops after retinal tears.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
A break is a tear or hole in the retina. The retina is a thin layer of nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. Because the retina is very thin, breaks may develop and cause retinal detachment with loss of vision. There are two kinds of retinal breaks: holes and tears. Retinal tears cause retinal detachments more often than retinal holes.
Horseshoe-shaped retinal tear as seen in an eye with retinal detachment (Click on image to enlarge)
What are the causes and symptoms?
Retinal breaks are fairly common in near-sighted eyes because near-sightedness is usually due to an elongation of the eye. As the eye enlarges deep in the eye socket, the retina has to stretch over a larger area. This stretching causes the retina to become thinner and may result in tiny round holes. These holes may cause no symptoms and may not cause retinal detachment.
In any eye, near-sighted or not, tears can occur from abnormal pulling on the retina by the vitreous (a clear gel that fills the eye and normally helps to hold the retina in place). Usually due to degeneration from aging, the vitreous gel condenses inside the eye and pulls on the retina. When this happens, patients usually notice the sudden onset of floating spots or “cobwebs”. Sometimes, brief lightning-like flashes of light occur in the side vision. About 10-15% of the time, new floaters and flashes mean a retinal tear has developed. This event places the eye at high risk of blindness from retinal detachment.
How is a retinal break treated?
Not all retinal breaks require treatment. The doctor may recommend observation alone. If a retinal break threatens to cause retinal detachment, the break is usually treated by laser or a freezing probe (cryopexy) to seal the retina to the eye wall at the site of the break. Treatment is NOT aimed at eliminating the flashes and floaters. Flashes usually disappear over a few weeks or months. The floaters gradually fade over many months, but they rarely disappear completely.
Treatment does not always prevent retinal detachment, so the patient should always report the new onset of more floaters or, more importantly, any progressive loss of side-vision or “curtain across the vision.”
Rarely, the central vision may become blurred and distorted due to scar tissue formation from the retinal break. This problem cannot be prevented with laser or cryopexy, though the scar tissue can be removed by surgery if it interferes with vision.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Vitreous gel fills the eye (click on image to enlarge)
What is vitrectomy surgery?
Vitrectomy surgery is an advanced form of eye surgery that is performed in the operating room under a microscope. It is often used to treat conditions such as retinal detachment, macular pucker, macular hole, vitreomacular traction, diabetic retinopathy, vitreous hemorrhage, dislocated cataract/lens implant, endophthalmitis, and uveitis. Vitrectomy may take thirty minutes to several hours to perform depending upon what task is being accomplished. Despite common tales, the eye is not taken out and placed on the cheek. It remains in its normal position throughout the surgery. Vitrectomy may be performed under general anesthesia to avoid pain and to avoid eye movement during surgery. During vitrectomy, tiny needle-like incisions are made to enter the white of the eye to gain access to the central core of the eye, which contains a gel called vitreous. Various instruments no larger around than needles are placed into the small incisions to perform tasks such as peeling or cutting membranes from the retinal surface, cauterizing blood vessels, removing blood or inflammatory debris from the eye, and applying laser. The surgeon views the tips of the instruments through the dilated pupil with an operating microscope. Sometimes, a gas bubble or silicone oil is placed in the eye to hold the retina in position to heal properly.
What type of anesthesia is available?
Although some surgeons and patients choose local anesthesia, general anesthesia is also available. With local anesthesia the patient is sedated with IV medication so there is no memory of the anesthetic injection around the eye. Surgical drapes are placed over the face leaving plenty of breathing room. During surgery the patient is awake, but generally does not feel pain. It is important to lie still on the operating room table as movement during surgery may result in damage to the eye and affect the final visual result.
General anesthesia offers some advantages over local anesthesia. With general anesthesia the patient is motionless and remembers nothing of the surgery. The anesthesiologist places a tube to hold the airway open. Which type of anesthesia is best for a patient may be determined by the health of the patient, so you may wish to ask your internist for advice. If a person cannot lie still for the surgery or if claustrophobia is a problem, general anesthesia is preferred. Although there are risks with any type of anesthesia, modern techniques offer a high degree of safety for the patient.
How can I prepare for vitrectomy surgery?
Your retinal specialist may schedule an appointment with your primary care doctor if evaluation is needed prior to surgery. Please inform your doctor of any chest pain or pressure, fever, productive cough, or shortness of breath. Unless otherwise notified by your doctor, do not take aspirin-containing products or any herbal supplements for two weeks prior to surgery. Coumadin may be stopped four days prior to surgery. On the morning of surgery, take no medications for diabetes unless instructed differently by your doctor, but please do take all of your other medications with a sip of water. Otherwise, do not eat or drink anything after midnight the day before surgery. If you usually use eye drops in the morning, they may be taken on the morning of surgery. Please click on this link for further information on how to prepare for surgery.
What are the risks of vitrectomy surgery?
Although uncommon, problems such as bleeding and infection may arise from any surgery. Retinal detachment or abnormal scar tissue formation may require additional surgery. Rarely, there may be loss of vision/loss of the eye. The most common problem following vitrectomy surgery is progression of cataract. Although serious problems are not encountered often, the risks and benefits must be weighed for each individual prior to surgery. For many eye problems, vitrectomy surgery is the only way to improve vision or prevent blindness.
What can I expect after vitrectomy surgery?
A soft eye patch and a hard eye shield are placed on the eye at the end of surgery. Leave these in place until your exam on the day after surgery. You may use Tylenol or Advil for aching pain, but call the doctor for a prescription if your pain is not relieved. It is not common to have severe pain after vitrectomy surgery. A scratchy feeling may result from sutures on the white of the eye. These sutures dissolve in about three weeks. At your exam after surgery, you will be given eye drops and/or an ointment to keep the eye comfortable, to prevent infection, and to promote healing. Wearing the eye patch is optional after you are seen in the office, but you may wear the hard protective shield as needed to prevent trauma to the eye. Depending upon the reason for your surgery, it may be very important to lie face down or on either side after your surgery. Be sure you understand any positioning requirements given by your surgeon and feel free to ask about special pillows and equipment available to help maintain head position. If a gas bubble is placed in your eye at the time of surgery, you may not fly on a plane or undergo nitrous-oxide anesthesia until the gas has dissolved, or you could risk severe pain and blindness. You may see the gas bubble as a horizontal, dark, curved line or as a dark ball in the vision. If a gas bubble is used during surgery, please keep a MedicAlert bracelet on your wrist until the gas has disappeared. The vision usually returns slowly over days to weeks after surgery, but may take many months for final recovery. The swelling and redness slowly disappear over weeks to months.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Vitreous gel fills the eye (Click on image to enlarge)
What are floaters and flashes?
Floaters are small specks, fibers, or bug-like objects that may appear to move in front of your eye. They appear black or gray and may be few or numerous. At times they may appear like a veil or cloud moving in the vision even after the eye is still. They are frequently seen when looking at a brightly lit background, like a blank wall or blue sky. Floaters are actually tiny clumps of fiber or cellular debris within the jelly-like fluid (vitreous) that fills the inside of the eye. Many dot-like floaters may be due to bleeding inside the eye, especially when they come on suddenly. Long-standing, numerous, dot-like floaters may represent inflammation in the eye.
Floaters as simulated in photograph (click on image to enlarge)
Flashes are brief streaks of light that are usually seen off to the side, especially at night when you turn your head or eyes. They may appear curved or like a brief lightning flash and last for only a second. Flashes are caused by fibers in the vitreous gel tugging on the retina with eye movement. This type of flashing light is different from migraine.
What do these symptoms mean?
Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous. In some instances, the retina may tear and cause blindness from detachment of the retina.
What causes floaters and flashes?
Floaters and flashes are usually due to degeneration of the vitreous gel in the eye from ageing. Over time, the vitreous shrinks, condenses, and pulls away from the retina. The condensation causes floaters and the pulling irritates the retina and is perceived as flashes of light. Myopia (near-sightedness) is a common cause of long-standing floaters.
What should be done about these symptoms?
The most important step is to have a thorough dilated eye examination, preferably by a retinal specialist. The need for examination is urgent if the onset of symptoms is sudden. The eye doctor will check for the presence of a tear in the retina. If a tear is found, laser or cryopexy is usually recommended to decrease the chances of blindness from retinal detachment. If a retinal detachment is found, more extensive surgery is required in attempt to repair it.
Once an exam has demonstrated no retinal damage, he symptoms of flashes and floaters do not require specific treatment. The flashes usually occur less frequently over time. It may take days or weeks for the flashes to subside. Rarely, flashes will continue over many years. Likewise, floaters subside with time, but take weeks to months to become less noticeable. It is best not to concentrate on following floaters by moving your eyes as it may make them more bothersome. Depression and stress may worsen the degree in which floaters interfere with daily visual activities.
Many people have long-standing floaters that are not bothersome. In these cases, no treatment is needed after an examination to insure good eye health. Very rarely floaters will persist and interfere with vision. In these unusual cases, vitrectomy surgery may be considered. There are options to consider.
What should you be on the lookout for?
After examination or treatment, any significant new floaters (especially, many new dot-like floaters) or any loss of side vision should be reported to the doctor without delay. An occasional flash of light in itself is not usually indicative of damage to the retina. Sometimes, new tears or a retinal detachment can occur at a later date after the initial examination.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
