CATARACT

A cataract is one of the most common eye conditions, causing blurring of vision as a result of clouding of the natural lens inside the eye. The lens is located behind the coloured part of the eye (iris) and is mostly made up of water and proteins. These proteins change over time causing clouding. This process can be accelerated by injuries to the eye, certain medications, certain health problems and exposure to sunlight.

Surgery is the only treatment for cataracts, and is recommended based on the severity of the cataracts and the impact it will have on daily life. Cataracts are removed using an ultrasound aspiration probe, inserted through very small incisions made in the eye. Once the lens has been removed, an artificial lens implant is inserted to focus light. Stitches are not usually necessary. There are many different lens options, and you will have the opportunity to discuss these options and choose the lens best suited to your lifestyle and visual needs.

CATARACT SURGERY AT A GLANCE

SURGERY TIME

15–30mins

HOSPITAL STAY

Day Case

TIME OFF WORK

3–5 days

REASONABLY MOBILE

1 day

Exercise inc gym

4 weeks

Washing

Pat dry, keep out of
direct shower 1 week

Driving

1 week

Full recovery

4 weeks

PTERYGIUM

A pterygium is a wedge-shaped area of thickened tissue that grows from the white of the eye towards the coloured part. A pterygium typically starts growing near the inside corner of the eye, and extends onto the cornea, toward the pupil. Both eyes can be affected.

A pterygium may grow large enough to interfere with sight and can cause other annoying symptoms such as redness, irritation or pain. In these cases, it may need to be surgically removed. Alternatively, it can be monitored. A pterygium is not a type of cancer and they typically grow very slowly.

During surgery, the pterygium is removed, as well as its hidden roots which extend under the surface. To reduce the risk of regrowth a small portion of conjunctiva from the under the top eyelid, is relocated to the site of the excised pterygium. There are usually multiple tiny stitches used in this surgery, which will dissolve as the eye heals.

Most patients have local anaesthesia during pterygium surgery. An injection may be given near the eye to numb the area. Some patients require sedation which is administered via a small vein in the arm or hand.

PTERYGIUM SURGERY AT A GLANCE

SURGERY TIME

45 mins

HOSPITAL STAY

Day Case

TIME OFF WORK

1 week

REASONABLY MOBILE

1 day

Exercise inc gym

2 weeks

Washing

Pat dry, keep out of
direct shower 1 week

Driving

1 week

Full recovery

6 weeks

UPPER EYELID REDUCTION [BLEPHAROPLASTY]

As we age, the skin around our eyes starts to lose its natural elasticity causing gradual emergence of fine lines. Over time, the upper eyelids can start to droop, and under eye bags can develop as the muscles relax. This can cause discomfort, but also give the eyes an older, more tired look and a hooded appearance that understandably makes people feel self conscious. Symptoms such as heaviness or tiredness can vary with stress.

During a short operation (1-2 hours), loose skin and excess fatty tissue around the eye area is removed, giving the skin a smoother, more youthful appearance. Blepharoplasty can restore your field of vision, as well as the natural beauty of the eye.

The effects of ageing around the eyes

  • Loses elasticity, fine lines and wrinkles
  • Eyebrow becomes lower
  • Crow’s feet appear and the rim of the orbit becomes visible
  • Deeper collagen and muscles relax, allowing pockets of fat to bulge forward at the inner angle of the upper eye and in parts of the lower lid

Management options:

Non surgical treatments can reduce wrinkles, but not folds. Surgical skin reduction of the upper eyelid leaves a faint scar, which is usually disguised in the natural crease of the eye. The small surgical scars for lower lid surgery are hidden by the lashes. Bulging fat can be reduced or repositioned during surgery. Fat or filler can be used to restore lost fat or volume.

A simple upper eyelid reduction takes less than an hour, but surgery to multiple lids or manipulation of fat may take longer. Procedures are usually carried out under local anaesthesia, with or without sedation. Initial bruising and swelling resolves in as little as 1-2 weeks, but the final result of surgery may not be seen for several weeks.

BLEPHAROPLASTY AT A GLANCE

SURGERY TIME

1–2 hours

HOSPITAL STAY

Day Case

TIME OFF WORK

1 week

REASONABLY MOBILE

1 day

Exercise inc gym

2 weeks

Washing

Pat dry, keep out of
direct shower 1 week

Driving

1 week

Full recovery

2 weeks

EYELID LIFT (PTOSIS REPAIR)

The effect of drooping upper eyelids may be both cosmetic and functional, with the common complaint that the eyelid is obstructing the vision. The term ‘ptosis’ comes from the Greek ‘to fall’ – and represents an eyelid that has fallen down and can’t be lifted. Ptosis can cause visual obstruction, which can limit activities such as driving and reading. The most common cause of this is when the muscle that lifts the upper eyelid becomes stretched or weak. Often patients will try to lift the lids using the forehead muscles, which can lead to frontal headaches and strain. In some cases ptosis may be present at birth, or it can arise after other eye surgery, injury or a nerve palsy / stroke.

There are many techniques for repairing ptosis. Most commonly, surgical repair of ptosis involves shortening the weak muscle in the eyelid which results in raising the position of the upper lid. A small incision is made along the natural skin crease of the upper eyelid, which hides the postoperative scar. In most cases, you will be awake for the surgery so that the eyelid shape and height can be checked during the operation, for the best aesthetic and functional outcome.

PTOSIS AT A GLANCE

SURGERY TIME

1–2 hours

HOSPITAL STAY

Day Case

TIME OFF WORK

1 week

REASONABLY MOBILE

1 day

Exercise inc gym

3 weeks

Washing

Pat dry, keep out of
direct shower 1 week

Driving

1 week

Full recovery

3 weeks

ECTROPION

Ectropion is the turning out or sagging of the lower lid. This can occur naturally as a result of the ageing process, or as a result of previous facial trauma, scarring, paralysis or previous surgery. When the lower lid becomes excessively loose, it sags away from the eye causing increased exposure to wind, dust and the sun – all of which can irritate the eye and the lining of the lower eyelid. The eye can become very watery and irritated, with sticky discharge on waking.

Ectropion repair restores eyelid function by tightening the tendons in the lower eyelids to return it to its normal position. This will cause the underlying muscle to reattach to the lower eyelid tissues. In some cases, tissue can be borrowed from the upper eyelid or elsewhere to reconstruct the eyelid.

ENTROPION

Entropion is the turning inwards of the lower (or upper) eyelid causing lashes to rub against the eye. This condition can not only cause irritation, but also carries a risk of corneal ulceration, infection and loss of vision. Entropion typically affects the lower eyelid due to age-related stretching or detachment of the retractor muscles. It can also be caused by scarring of the inside of the eyelid from previous surgery or trauma.

Surgical correction of entropion involves tightening the lower eyelid and reattaching the muscles. This is usually done under a local anaesthetic with or without sedation.

ENTROPION & ECTROPION AT A GLANCE

SURGERY TIME

45–60 minutes

HOSPITAL STAY

Day Case

TIME OFF WORK

1 week

REASONABLY MOBILE

1 day

Exercise inc gym

2 weeks

Washing

Pat dry, keep out of
direct shower 1 week

Driving

1 week

Full recovery

3 weeks

SKIN CANCER

The upper and lower eyelids protect your eye. They do this by distributing tears to moisturise the surface of the eye, cleaning the front ‘window’ of the eye – the cornea, keeping out dust and dirt and by protecting your eye while you sleep. A tumour growing on your eyelids may change the shape of your eyelid or affect the surrounding tissue. This can cause irritation to the eye. If left untreated, tumours can grow and affect other structures such as your eyeball, or your eye socket.

Tumours of the skin can be removed by relatively minor surgery while you are awake. When a surgeon removes a skin tumour, they also need to remove a clear margin of healthy skin around the growth to make sure there are no cancer cells left behind. The piece of skin which is removed is sent to a laboratory for examination by a specialist pathologist using a microscope.

In some cases this is done while you are still at the hospital, so that the eyelid can be reconstructed knowing that no cancer cells are left behind. If some cancer was missed, more skin will be removed, but if the margins are clear of cancer cells, there is no need to remove any more skin.

Reconstruction may involve just a few stitches if the tumour was small. For larger tumour excisions more complex surgery is required which can involve the use of a skin graft. There is usually moderate bruising and swelling after eyelid reconstruction. Sometimes further surgery may be required to fix the eyelid position due to asymmetry, distortion or loss of eyelashes. Even with adequate margins, some tumours may reoccur months or years later requiring further surgery or radiation.

EYELID TUMOUR EXCISION AND RECONSTRUCTION AT A GLANCE

SURGERY TIME

30–180 minutes

HOSPITAL STAY

Day Case

TIME OFF WORK

1–2 weeks

REASONABLY MOBILE

1 day

Exercise inc gym

2–4 weeks

Washing

Pat dry, keep out of
direct shower 1 week

Driving

1 week

Full recovery

4 weeks

LACRIMAL

The nasolacrimal duct is part of the drainage passage that carries tears from the eye down through the bone and into the nose. Occasionally this plumbing can become blocked. In some cases this can be due to previous injury or infection. The patency of the system can be assessed by injecting fluid into the tear ducts. If there is a true blockage, surgery may be required in order to unblock the passageways to improve eye watering.

This surgery involves removing a small piece of bone between the tear sac and the nose, and opening the sac directly into the nose. This is usually done with a small incision on the skin on the side of the nose. A loop of silicone tubing is placed in the tear ducts, into the nose to keep the passages open as they heal. This is removed in the clinic after healing is complete. The name of this operation is dacryocystorhinostomy (or ‘DCR’).

DCR AT A GLANCE

SURGERY TIME

30–60 minutes

HOSPITAL STAY

Day Case

TIME OFF WORK

1 week

REASONABLY MOBILE

1–2 days

Exercise inc gym

4 weeks

Washing

Pat dry, keep out of
direct shower 1 week

Driving

1 week

Full recovery

4–6 weeks

NON-SURGICAL PROCEDURES

Facial injections such as Botox are local muscle relaxants adapted from botulinum toxin type-A. As we age, collagen in our skin reduces, which can cause creases in the skin resulting in crows feet, frown lines and forehead creases. They work by relaxing the facial muscles responsible for wrinkles and are the most performed non-surgical procedures in the world.

These treatments are an easy, relatively pain-free process and a great solution for reducing the appearance of wrinkles around the face – primarily in the brow and eye area.

The procedure is done during a 30-minute consultation and involves a few tiny injections into the areas of concern. You are able to return to normal daily routine immediately without the need for a lengthy recovery period.

The treated lines on your face will begin to soften over a 3 to 5 day period following the procedure, and will continue to improve over two weeks. Your fresh appearance will stay with you for 3 to 6 months at which point the treatment is easily repeated. Over time the treatment ‘retrains’ the muscles so the time between treatments may increase.

Dermal fillers are popular, quick injectable treatments that can soften facial wrinkles, lines and fill out hollows to recreate the smooth contours of younger skin. Dermal fillers achieve lasting results, mimicking the lifting effect of your skin’s underlying tone to keep the skin hydrated and elastic. The active ingredient is hyaluronic acid, a natural part of the skin, tendons and muscles in humans, and can combat an array of natural ageing symptoms such as wrinkles and ageing lines. They can also improve the appearance of folds and sunken areas masking fat loss.

Ocular Oncology

Ocular Oncology refers to the diagnosis and treatment of a range of eye cancers that occur in the eye, behind the eye and around the eye. Ocular oncology involves not just the ophthalmologist but a team of highly specialised physicians including radiologists, surgeons, medical, and radiation oncologists. Often times, ocular tumours require treatment in the form of radical surgeries which later require cosmetic rehabilitation; thus, requiring the expertise of ocularists as well.

Treatment of ocular tumours has evolved to become not only more effective but also have minimal collateral damage and side-effects. This evolution in the surgical and medical management of ocular tumours and their metastases is ongoing and Dr McGrath and her colleagues Drs Glasson and Warrier at the Qld Ocular Oncology Service work in collaboration with the melanoma research team at the Queensland Institute of Medical Research (QIMR) and interstate groups, to offer a modern treatment approach, with access to national and international clinical trials.

Treatment can include serial reviews to assess for change signaling risk to vision or intraocular health, as well as laser treatment, surgical excision, radiation treatment or more complex orbital procedures. Treatment is tailored to the individual in a caring and supportive atmosphere, and in most cases, a number of options are offered with risks and benefits presented. In most cases, multiple follow up visits will be required to assess for response to treatment, but these can be shared with local eye care practitioners over time.