Patient information

Conditions treated

The following is information on some common conditions treated by Mr Williams. For any questions or to request a consultation please contact his office.

Background

The cornea is the clear window of the eye which allows light to be focused on to the back of the eye. Different diseases can compromise the clarity, shape or integrity of the cornea resulting in a perforation. This can result from infection, injuries, predisposition to thinning of the cornea and inherited conditions which cause the cornea to become cloudy or unable to maintain its own clarity.

Why do I need a corneal transplant?

Many diseases affecting the cornea may be overcome by wearing glasses or using contact lenses. Sometimes these approaches do not help or patients may not be able to tolerate contact lenses. In these instances it may be necessary to replace part or all of your cornea through surgery by undertaking a corneal transplant called a graft or keratoplasty. This graft will come from a donor who has died and given consent for their cornea to be used for transplantation after their death.

There are three layers in the cornea:

  1. The epithelium (the front surface like a skin)
  2. The stroma (the middle part which makes up most of the cornea)
  3. The endothelium (the back surface which acts as a pump to stop the cornea from becoming waterlogged)

What types of corneal transplant are there?

Different diseases may affect all or part of the cornea. There are three broad approaches

  1. Penetrating Keratoplasty (PK – a full thickness corneal transplant)
  2. Endotheliial Keratoplasty e.g. Descemet Stripping Automated Endothelial Keratoplasty (DSAEK – a partial thickness corneal transplant replacing the endothelium)
  3. Deep Anterior Lamellar Keratoplasty (DALK – a partial thickness corneal transplant replacing the epithelium and front part of the stroma up to 90% depth)

All involve the replacement of some or all of your cornea. Like all organ transplants, this involves taking corneal tissue from someone who has died and donated their organs for transplantation.

 How is the decision made?

 Your doctor will usually discuss with you what type of condition you have, and may organize other scans or tests to confirm your diagnosis. Traditionally corneal transplantation involved a full thickness or penetrating keratoplasty (Figure 1). This kind of graft is helpful if you have a scar involving most of the thickness of the cornea, an infection which may have caused a hole to develop in the eye or when other surgery is not possible.

 

Figure 1: Penetrating Keratoplasty. A side profile cartoon showing a scar involving most of the cornea (Part A). Part B shows the replacement of the scar with a full thickness graft.

 

If the endothelium (the back layer of the cornea) is not working properly then liquid cannot be pumped out of the cornea properly and it becomes waterlogged (Figure 2A). This may occur in conditions such as Fuchs’ Endothelial Corneal Dystrophy (FECD) and/or following decompensation/failure of the cornea following cataract surgery. These conditions are usually approached by selective replacement of the endothelium which has stopped working properly by endothelial keratoplasty (Figure 2B).

 

Figure 2: Endothelial Keratoplasty. A side profile cartoon showing a waterlogged cornea (Part A). Part B shows the replacement of the back surface of the cornea with donor endothelium (white).

 

Finally if the front part of the cornea is affected but the endothelium appears to be working your surgeon will attempt to remove the defective part of the cornea and replace it with the donated part of a donor cornea (DALK). This may take place because of a scar that does not involve the back part of the cornea (Figure 3A) or when the cornea is misshapen e.g. in conditions such as Keratoconus. The selective replacement of the front part of the cornea may involve removing the diseased cornea by hand (manual DALK) (Figure 3B) and/or injecting an air bubble to try and remove as much tissue as possible (big bubble DALK).

 

Figure 3: Deep Anterior Lamellar Keratoplasty. A side profile cartoon showing a scar involving the front part of the stroma of the cornea only (Part A). Part B shows the replacement of the front surface of the cornea with donor tissue.

 

What is involved in the surgery? 

Surgery is usually undertaken under general anaesthetic in the case of PK and DALK (as these are longer procedures) or local anaesthetic for DSAEK and performed as a day case. A PK or DALK involves the removal of all or some of the cornea as outlined and replacement with a donor graft measuring 7.5-8.5mm in diameter. The graft must be sutured (stitched) into place and this may involve putting/inserting? several (typically 16) interrupted or continuous (usually one or two) ‘permanent’ stitches (Figure 4A or 4B). These will remain in place and will usually be completely or selectively removed several months after surgery. A DSAEK involves a smaller incision that allows replacement graft material to be placed inside the eye e.g. with an insertion device which allows coilling of the graft and unfurling inside the eye, akin to getting a ‘ship in a bottle’. The graft is floated onto the back surface of the cornea with an air bubble and only a few sutures are required (Figure 4C). This procedure may be combined with cataract surgery or completed as a separate operation. For the air bubble to attach the graft you will usually be asked to lie flat on your back for an hour or so after the operation.

 

Figure 4: Corneal suturing in different types of grafts (blue). Interrupted (Part A) or Continuous stiches (Part B) in a Penetrating/Deep Anterior Lamellar Keratoplasty. A small side incision with limited sutures is seen for an Endothelial Keratoplasty e.g. DSAEK (Part C)

 

What are the benefits of surgery?

 DALK vs. PK By maintaining the back surface of the cornea, selective replacement of corneal tissue in a DALK procedure allows the integrity of the eye to be maintained, reducing the risk of complications such as bleeding inside the eye during surgery and longer term the risk of rejection. It also facilitates removal of sutures more quickly. DSAEK vs. PK By making a smaller incision (up to 4.5mm) in DSAEK, the strength of the eyeball is maintained and makes this a much safer operation than in PK. This means less fewer? stitches and a faster recovery. The risk of rejection is overall much less and if problems are encountered with the graft it is much simpler to replace it.

What are the risks and complications of surgery?

 All Grafts All grafts carry a risk of rejection. This is because the body’s immune system may recognize the transplant as not belonging to the recipient’s** body. This can occur in less than 20% of patients in a PK at 2 years but is lower, around 10% for a DSAEK. Corneal graft rejection may or may not be reversible with treatment, usually steroid eye drops or tablets to dampen the immune response. All patients are given steroid drops after transplantation as a preventative measure but it is unusual for immune suppressing tablets to be given for most patients needing a corneal graft. Rejection may lead to failure of the graft i.e. it no longer works and the graft becomes cloudy resulting in blurring of vision. Other risks include:

  • Astigmatism (curvature of the eye becoming more steep in one plane after suturing)
  • Glaucoma (high pressure in the eye which can usually be managed with drops)
  • Cataract (clouding of the lens), which is amenable to surgery. However, the cataract is usually removed prior to or at the time of DSAEK.
  • Retinal detachment
  • Infection
  • Bleeding within the eye
  • Loss of sight which may be permanent, especially if unusual but serious complications such as infection or bleeding occur

DALK There is a risk of conversion to a full thickness graft (PK) in around 10% of cases. DSAEK There is a risk of the graft becoming detached from the cornea. This happens to around 10% of patients and will usually require a further air injection to re-attach the graft. 

Follow up and aftercare

Your surgeon will assess you following the operation and the vast majority of patients will be able to go home the same day and will be followed up in clinic within a week. You will be advised on specific aftercare e.g. intensity of anti-rejection drops and antibiotic drops. We usually advise avoiding submerging the eye, taking care to wear a shield at night or when near young children and pets and to remain off work for at least two weeks. Individual circumstances can be discussed with your surgeon. You will be monitored more closely in the first few weeks with outpatient appointments usually being spread out over the coming months. It may also be necessary to organise additional visits to an optician to help optimise your vision later on, and this may include where appropriate the use of specialist contact lenses to maximize your vision. This will usually be organized following the removal of stitches. Other advice  

  • Stop wearing your usual contact lenses prior to and after your surgery until advised to do so.
  • You may feel that wearing sunglasses can make your eye(s) feel more comfortable following surgery.
  • Contact the department as soon as you notice any problems e.g. increased blurring of vision, redness or pain which is getting worse. See an ophthalmologist as soon as possible if you start noticing these symptoms or any problems that may be of concern, so that the right treatment can be started straight away.

Background

The cornea is the clear window of the eye, which allows light to be focused ontotheback of the eye. Keratoconus is a diseases that can compromise the integrity of the corneaby becoming misshapen, a process called ectasia. This predisposes to thinning and bulging of the cornea. Instead of having a curved ‘football’ shape it become pointed like a ‘rugby’ ball (Figure 1). This in turn increases astigmatism (when light is focused in different direction on to the back of the eye, the retina) and myopia (when an image is focused in front of the retina).

Who gets Keratoconus?

 Both men and women may develop the condition, and usually this starts when we are teenagers or in our early twenties. The condition is problematic as it may continue to progressuntil vision becomes increasingly blurry, which may not be managed with spectacles or conventional soft contact lenses. Although inflammation of the surface of the eye or certain genetic conditions can result in keratoconus, usually a direct cause cannot be identified.

How do we diagnose Keratoconus?

Usually an optician will become suspicious that you have Keratoconus when they test your spectacle prescription. They may notice that you have become more myopic (short –sighted) or that your astigmatism has got worse. They may also notice that you have changes in your cornea that suggest you have Keratoconus. Normally they will refer you to see the ophthalmologist (eye doctor) who will also examine you and undertake special tests such as

  • Topography (a painless test that measures how steep and thick your cornea is)
  • OCT (a painless tests which measures the profile of the cornea)
  • Specular microscope (a painless test that measures the health of the cells lining the back of your cornea, called the endothelium)

Sometimes the diagnosis is not clear and you may need to be monitored for a period to see whether the changes in your cornea become more apparent. We usually need to monitor you condition to decide if the disease is progressing (getting worse) and would benefit from treatment.

How can this be treated?

 Keratoconus cannot be treated with eye drops or tablets. Often, and as long as we/your optician thin it is safe, we will try and improve your vision with contact lenses if glasses are of limited help to you. Contact lenses usually need to be hard (rigid), or occasionally scleral lenses to fit the shape of the cornea caused by keratoconus. Patients usually find contact lenses better than glasses as they allow light to enter the eye more normally, improving the quality of the image.If there is evidence that your disease is getting worse and it is safe we will consider arranging a treatment called corneal collagen cross-linking (CXL) to prevent the eye from warping further. Sometimes the cornea can become so thin that a break within causes fluid to build up which can be painful and suddenly causes clouding of vision. This is called hydrops and will need attention from the doctor quickly, involve specialist eye drops and can lead to scarring of the cornea.

What does corneal collagen cross-linking involve?

This is a treatment that aims to stiffen or harden the cornea and prevent it from becoming more misshapen. Although very long-term data is not available, this treatment has a good safety profile and low risk of complications such as infection. Further details can be discussed should you need this treatment but briefly it involves a day case procedure that requires the application of a specialist drops followed by ultra-violet light shone on the eye for several minutes.

 Why might I need a corneal transplant?

Keratoconus can result in the cornea becoming so thin that CXL is not safe or likely to be effective, too pointed or scarred that KC cannot be managed by specialist contact lenses, you develop a perforation or when one cannot wear a contact lens. In these instances it may be necessary to replace part or all of your cornea through surgery by undertaking a corneal transplant called a graft or keratoplasty. This graft will come from a donor who has died and given consent for their cornea to be used for transplantation after their death.

There are three layers in the cornea:

  1. The epithelium (the front surface like a skin)
  2. The stroma (the middle part which makes up most of the cornea)
  3. The endothelium (the back surface which acts as a pump to stop the cornea from becoming waterlogged)

What types of corneal transplant are there?

Different diseases may affect all or part of the cornea. There are two broad approaches in keratoconus:

  1. Penetrating Keratoplasty (PK – a full thickness corneal transplant)
  2. Deep Anterior Lamellar Keratoplasty (DALK – a partial thickness corneal transplant replacing the epithelium and front part of the stroma up to 90% depth)

All involve the replacement of some or all of your cornea. Like all organ transplants, this involves taking corneal tissue from someone who has died and donated their organs for transplantation. Further information can be found in our leaflet concerning corneal transplantation.

Follow up and aftercare

 Your surgeon will determine whether you have Keratoconus, whether it needs treatment with contact lenses, cross-linking or surgery. If you do not need treatment other than lenses we will usually monitorthe condition every few months to see if the disease is progressing and you would benefit from further treatment.

Other advice:

  • Stop wearing your usual contact lenses prior to and after your clinic visits as advised so that we can get an accurate scan.
  • Contact the department as soon as you notice any problems e.g. increased blurring of vision, redness or pain that is getting worse. See an ophthalmologist as soon as possible if you start noticing these symptoms or any problems that may be of concern, so that the right treatment can be started straight away.

Pterygium

A pterygium is a growth of the conjunctiva (the membrane covering the white of the eye) on to the surface of the cornea (the window of the eye).

This often noticed when a patch may appear in he corner of one or both eyes. A pterygium is more commonly seen in hot climates, where exposure to sunlight is thought to play a role in its development. This is not always the case however and while occupations and recreations such as sailing and surfing may increase the risk, genetic factors play a role.

 

It is difficult to predict exactly who will develop a pterygium/pterygia (more than one pterygium). It usually develops slowly, over months or years. It may also cause episodes of redness or irritation. With time it can alter the profile of the cornea, leading to astigmatism (as the curvature of the eye becoming more flat) or cross the pupil. These can lead to a reduction in vision.

 

The treatment for pterygium is surgery. The aim is to remove the growth and create a barrier to prevent the pterygium from growing back. We do this by taking a healthy area of conjunctiva (usually from the top of the eyeball) in order to create a graft and move it to fill in the gap created. This is usually held in place by a harmless glue which dissolves after a few days or occasionally through stiches. This is enough time to allow the graft to heal. The eye will be red for a period of some weeks and will require drops to help reduce this inflammation and prevent infection.

 

All surgery carries risk including bleeding and infection. The risks of pterygium surgery include damage to one of the muscles surrounding the eye which is rare but can lead to double vision. The graft may also move following surgery and require further surgery. Very rarely an area of thinning may occur after surgery requiring additional treatment including surgery. There is a risk of high pressure during the period following surgery called glaucoma (high pressure in the eye which can usually be managed with drops).

Less than 10% of pterygia will return and this may require further surgery.

 

What is Microbial Keratitis – a ‘corneal ulcer’?

Microbial Keratitis (MK) is an infection of the window of the eye called the cornea. It can be caused by a number of micro-organismssuch asbacteria, viruses, fungi or even parasites. By far the commonest cause in colder climates such as Europe are bacteria. Viral infections are commonly caused by the Herpes virus family e.g. Herpes Simplex Virus (which causes cold sores) or Varicella Zoster Virus (which causes chickenpox or shingles). Fungal infections are more commonly seen in tropical climates but can occur in certain at risk individuals. Acanthamoeba is a parasite which contact lens wearers are more vulnerable to.

Risk Factors

  • Contact lens wear
  • Injuries including foreign and vegetable matter
  • Use of steroid drops
  • Use of drugs to suppress the immune system e.g. for rheumatoid arthritis
  • Abnormalities of eyelids e.g. lashes turning inwards
  • Previous corneal transplant
  • Co-existing infection of the cornea e.g. herpes virus

How will it affect me?

An infection can come about quickly, in a matter of hours, or more slowly over days.  This can result in pain, redness, sensitivity to light, watering and blurred vision. An infection may result in destruction of the cornea leading to perforation of the eye or scarring leading to long term reduction in sight. It is a serious, potentially blinding condition.

It is imperative that the diagnosis is made quickly and that you are seen as early as possible by an ophthalmologist (eye doctor). You will usually be referred by your GP, optician or the accident and emergency department. It is critical that you are treated as early as possible.

Our natural immune response for fighting off infection can sometimes have an unfavourable effect. The inflammation can cause the cornea to become swollen and cloudy, or cause new blood vessels to grow into the cornea, making vision worse. If left untreated the cornea is vulnerable to becoming thin and perforating.

How is it diagnosed?

Youreye doctorwill usually take samples from the cornea (a scrape) or swab from the surface of the eye to send to a laboratory. This can help in confirming the diagnosis, identifying whichmicroorganism has caused your infection and guiding the best treatment to use. Unfortunately the tests may not prove positive even if the picture is convincing for MK.

It is helpful if you keep your contact lens solution and contact lenses and bring them with you. These can be sent to the laboratory and may help guide treatment. Suffice it to say the contact lenses will not be returned.

How is it treated?

The treatment of MK depends on its severity. Infections of the eye surface are treated with intensiveantisepticdrops or eye ointment. You will need these up to every half an hour day and night as directed by your doctor. This is because conventional tablets or injections of antibiotics will usually not reach the eye infection sufficiently, although you may be prescribed tablets as well.

The first few hours and days are crucial to prevent the infection getting worse. If you are unable to instil drops/ointment yourself or with the help of a friend or family member you may need to be admitted to hospital for treatment. You will be monitored closely,a review organised within a few days. Usually the antibiotics will be tapered if you respond to treatment but it is sometimes necessary to increase or change them depending on information from the laboratory or your response.

If the deeper layer of the cornea is affected, called the stroma, then antiseptictreatment may not be enough. Steroid eye drops may be needed to reduce inflammation. Note: steroid eye drops must be used under the supervision of an eye doctor, because although they improve inflammation, they can makeinfection worse.

Complications of disease

Ulceration of the eye can be slow to heal and in rare circumstances cause a severe inflammation of the cornea, called melting. This is a serious complication and is more common with certain types of infection. It may require surgery to try and seal the ulceration,for example with the help of a special glue. Longer term, scarring and blood vessel growth may limit vision sufficiently for surgery to be considered to replace the front layer or occasionally all layers of the cornea, a corneal transplant.

Complications of treatment

Some antiseptics can cause the surface of the eye to become sore and with prolonged treatment they may prevent healing. Steroid drops can make the eye vulnerable to the infectionbeing treated or other infections. Steroid drops can also cause the pressure in the eye to rise, which in turn can cause damage to the optic nerve at the back of the eye, a process called glaucoma orclouding of the lens in the eye, called cataract.

Monitoring the condition

You will usually be monitored closely as an outpatient.It is essential to attend the ophthalmology clinic to monitor the eye. Subtle changes may not be obvious to see or feel, and can only be detected by slit lamp examination or by specialist scans of the surface of the eye such as corneal topography and optical coherence tomography (OCT). Regular follow up appointments are offered so that deterioration does not go unnoticed and can be treated early on. It may also be necessary to organise additional visits to an optician to help optimise your vision, and this may include the use of specialist contact lensesasinfection resolves.

General advice

  • Stop wearing contact lenses during your acute infection or if you keep getting infections as they increase your risk of recurrence.
  • Wearing sunglasses can make your eyes feel more comfortable during an attack.
  • Steroid eye drops should only be used under close supervision of an eye doctor, as they can cause viral infections to get worse by decreasing your eye’s ability to fight infection.
  • See an eye doctor as soon possible if you notice symptoms, so that the correct treatment can be started straight away to limit irreversible damage to the cornea.

What is HSK?

Herpes Simplex Keratitis (HSK) is an infection of the window of the eye called the cornea,caused by the Herpes Simplex Virus (HSV).

There are 2 types of this virus:

  1. Type I is the main type affecting the cornea, the virus which causes cold sores.
  2. Type II is sexually transmitted and causes genital herpes. Although unusual this virus can also cause cold sores.

Most people in the world are infected with Type I HSV; it is easily spread bycoughing, sneezing and touch. The infection is often picked up in childhood, and can be so mild that it is not noticed. In many people the virus stays inactive, not causing a problem. In some the virus re-activates. Re-activation in the sensory nerves of the cornea is called keratitis.

How will it affect me?

Like a cold sore, the virus can re-activate from time to time, and during these episodescauses pain, redness, sensitivity to light, watering and blurred vision. Each infection may result in scarring of the cornea leading to a reduction in eyesight. Corneal ulcers can feel very painful, but with repeated infections the nerves can become damaged and less sensitive to touch. Inflammation in the cornea may also cause you to feel light sensitive.

Our natural immune response for fighting off infection can sometimes have an unfavourable effect. The inflammation can cause the cornea to become swollen and cloudy, or cause new blood vesselsto grow into the cornea, making vision worse. In these cases, your ophthalmologist may prescribe steroid eye drops at a low dose, to dampen the immune response. However, this must be done carefully under close supervision, as steroid can allow the virus to replicate more easily.

How is it diagnosed?

Youreyedoctor may take a swab from the surface of the eye to send to a laboratory. This can help in confirming the diagnosis. Unfortunately the tests may not prove positive even if the picture is convincing for HSK. It is unusual for a blood test to prove helpful in adults, as it can only confirm that you have been exposed to the virus at some point in your life.

How is it treated?

The treatment of HSK depends on its severity. Infections of the surface of the eye are treated with an anti-viral ointment called Acyclovir. You will need to apply this ointment five times a day for several days. The ointment helps stop the virus replicating and allows the eye to heal. It is the same ointment used to treat cold sores, although at a weaker strength.

If the deeper layer of the cornea is affected, called the stroma, thenAcyclovir ointment may not be effective alone.Steroid eye drops may be needed to reduce inflammation. Note: steroid eye drops must be used under supervision of an eye doctor, because although they improve inflammation, they can allow the virus to replicate more and make things worse.

If the infection affects only the outer layer of the cornea, the epithelium, then the infection usually settleswith little or no scarring. If the infection involves the deeper layer, the stroma, then there may be scarring and loss of vision. Recurrent episodes make scarring worse. Prompt treatment minimises damage during each episode.

Patients with HSK are also vulnerable to dry eye problems because of damage to the corneal nerves. This may require use of lubricating eye drops or ointments. Corneal scarring may be difficult to overcome and require specialist contact lenses to try to reduce the irregularity of the cornea caused by scarring.

Preventing recurring infections

Illness or stressthat lowers your immune system can allow the virus to re-activate. Around half of patients will have a recurrence within 10years. For around 1 in 10 people, recurrence is within 1 year. If recurrences are happening very often, you may need to take long-term low dose steroid eye drops or anti-viral tablets such as Acyclovir. Regular eye examination will be required as steroid eye drops can increase pressurein the eye, leading to glaucoma. Regular blood tests are required with antiviral tablets as they may damage liver and kidneys.

Complications of disease

Ulceration of the eye may be slow to heal and in rare circumstances cause severe inflammation of the cornea, called melting. This is a serious reaction to the virus and may require surgery seal the ulceration and save the eye. Longer term, scarring and blood vessel growth may limit vision sufficiently to consider surgery to replace the front layer or occasionally all of the cornea,calledcorneal transplantation.

Complications of treatment

Acyclovir ointment can cause surface of the eye to become sore and with prolonged treatment may itself prevent healing. Steroid drops can make the eye vulnerable to the virus itself or other infections. Steroid drops can cause the pressure in the eye to riseor cause clouding of the lens in the eye, called cataract.

There is evidence that resistance to some treatments such as Acyclovir is developing. This is something that your doctor will monitor during your check ups.

Monitoring the condition

In between infections, it is essential to attend theophthalmology clinic to monitor the eye. Subtle changes may not be obvious to see or feel, and can only be detected by slit lamp examination or through specialist scans of the surface of the eye such as corneal topography and optical coherence tomography (OCT). Regular follow up appointments are offered so that deterioration in the eyedoes not go unnoticed and can be treated early on. It may also be necessary to organise additional visits with an optician to help optimise your vision, and this may include the use of specialist contact lenses.

General advice

  • Stop wearing contact lenses if you keep getting episodes as these increase your risk of eye infections.
  • You may feel that wearing sunglasses makes your eyes feel more comfortable during an attack.
  • Steroid eye drops should only be used under close supervision of an eye doctor, as theycan cause the viral replication to get worse by decreasing your eye’s ability to fight the infection.
  • See an ophthalmologist as soon possible if you start noticing symptoms, so that the right treatment can be started straight away to limit irreversible damage to the cornea.

Blepharitis and Meibomian Gland Dysfunction (MGD)

Background

Normal tears of the eye are made up of three layers – an oily (lipid) layer, a watery (aqueous) layer and a sticky (mucous) layer.

There are Meibomian glands inside the eyelids with openings onto the edges of the eyelids (lid margins) which naturally produce oil.  This oil stops the watery element of the tear film from drying out.  Sometimes the glands become blocked (MGD) leading to tear film breakdown and ‘evaporative’ dry eyes. The glands may also produce excess oil which clogs the lashes causing crusting.  You may experience discomfort, visual problems and other complications listed below.

Blepharitis is an inflammation of the eyelids causing irritation and discomfort.  It can be persistent and usually affects both eyes.

It is common to have a combination of MGD, dry eye and blepharitis.

Symptoms of MGD and Blepharitis

  • Sore eyelids – both eyes usually affected
  • The eyes may feel gritty, itchy or as though they are burning
  • The eyes may look inflamed or greasy
  • The eyes may be sticky with discharge and stuck together in the mornings
  • The eyes may be watery
  • Flakes or scales may appear on the eyelids and eyelashes
  • Glands may block and fill with oily fluid (chalazion)

Symptoms may come and go. It is common to have flare ups or long periods with no symptoms.

Possible Complications of Blepharitis

  • Chalazion – swelling under the eyelid due to a meibomian cyst
  • Stye – painful swelling outside the eyelid due to an infected eyelash
  • Contact lens irritation
  • Changes to eyelashes – loss of lashes, in growing lashes (trichiasis) or loss of colour to the eyelashes
  • Eyelid ulceration and scarring
  • Entropion (lid turning in) or ectropion (lid turning out)
  • Conjunctivitis – sore red eye with discharge and/or watering
  • Corneal ulceration and scarring

Treatment for MGD and Blepharitis

The aim of treatment is to control and manage the symptoms. There is no one off cure as inflammation tends to recur without treatment.  Regular treatment will keep symptoms to a minimum. This treatment is mainly done by you.

Lid Hygiene

This is the most important part of your treatment.

The aim is to sooth the eyelids, unblock themeibomian glands and remove any stagnant oily secretions.  This is achieved by cleaning the eyelids.

Warmth is used to break down the oil.  The most successful method is a reusable bag device which can be heated in the microwave.  It is preferable to a hot flannel as it retains heat longer (A hot flannel usually cools quickly and has to be constantly re-warmed in hot water to be effective). It should be applied for 5 -10 minutes.

Massage should be done immediately after applying the warmth. It helps to push the oil out of the glands.  Massage along the length of the eyelids towards the eye (massage the upper lid down and the lower lid up) with the eyes closed using comfortable pressure. Massage for 30 seconds and repeat 5 – 10 times after warming.

Clean the eyelids following the warming and massage using a foamscrub as recommended by the doctor/nurse.

Repeat lid hygiene twice daily during a flare up.  When symptoms subside continue as part of your daily routine.

If your symptoms are severe you may also be prescribed

  • Antibiotics
  • Artificial tears/lubricating drops/gel

Other advice

  • Consider Omega 3 supplements – Research shows that these may help relieve symptoms
  • Avoid wearing eye make-up (especially eyeliner) when you have a flare up
  • Avoid rubbing the eyes as it will make inflammation worse
  • Continue your treatments for any other related conditions such as seborrheic dermatitis, rosacea or dry eye syndrome
  • It is likely that unless you have severe dry eye complications or need for specialist drops your ongoing management will be with your optician or GP

Surgical Videos - courtesy of Worcestershire Acute Hospitals NHS Trust

  • Keratoconus

    Version 1

     

    Heading

    some hyperlink

  • Herpes Simplex Keratitis

    Part 1

  • Herpes Simplex Keratitis

    Part 2

  • Herpes Simplex Keratitis

    Part 3

  • Pterygium

  • Keratitis

    Part 1

  • Keratitis

    Part 2

  • Cataract Surgery

    Part 1

  • Cataract Surgery

    Part 2

  • Corneal Transplantation

    Part 1

  • Corneal Transplantation

    Part 2

  • Corneal Transplantation

    Part 3

  • Corneal Transplantation

    Part 4

  • Surgery to remove a Pterygium

  • DSAEK

  • Cataract Surgery

  • Phaco DSAEK

Patient Feedback

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