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Eye diseases

Diabetes is a disease that especially affects all vessels in the body and causes
significant damage. It is the picture that occurs when the capillaries in
the retina, which is the nerve layer of the eye, are affected in patients with
diabetes. As a result of changes in these small capillaries, red blood
cells and coagulation cells, the retina cannot be fed and remains without
oxygen. Damage occurs in the vascular walls, there is an increase in
vascular permeability. This causes bleeding outside the vein, ie inside
the retina, and serum leakage. Low oxygen levels can lead to the formation
of abnormal new vessels. These vessels cannot be as solid as the retina’s
own vessels, and the blood they carry easily begins to leak from its walls.

Symptoms of Diabetic Retinopathy

Diabetic retinopathy is one of the most important treatable
causes of blindness in our country and in the world. Long-lasting and
regularly untreated diabetic disease, insulin dependent diabetes in young
patients, pregnancy, diabetes-related kidney damage and hypertension are the
most important risk factors for diabetic retinopathy. However, the
important information that should be kept in mind in diabetic patients is that
early diagnosis and treatment with modern devices under the guidance of
ophthalmologists experienced in retinal diseases is an effective method of
protection against severe vision loss. For this reason, it is vital that
patients diagnosed with diabetes consult a doctor for an early retinal
examination.

Diagnosing Diabetic Retinopathy

Patients diagnosed with diabetes should have an eye
examination every year, even if they have no complaints. The pupil is
dilated with the drop and the fundus of the eye is examined in detail in terms
of retinopathy. When diabetic retinopathy is detected, follow-up
examinations are performed more frequently. When necessary, the structure
of the vessels at the bottom of the eye is examined by administering drugs
through the forearm vein and the retinal areas that cannot be fed are detected. This
procedure is called retinal angiography (fundusfluorescein angiography-FFA). Changes
in the visual center due to diabetes are easily tested and evaluated by ocular
tomography (OCT).

Treatment of Diabetic Retinopathy

In order to avoid the progression of diabetic retinopathy,
blood sugar, blood pressure and cholesterol levels of diabetic patients should
be kept under control. Diabetic retinopathy is treated with argon laser as
needed. This method is called scatter laser treatment. The aim of
laser therapy is to help cover abnormal blood vessels. Treatment is
usually completed in a few sessions. Although there may be a decrease in
environmental vision after treatment, the current level of vision can be
preserved with laser treatment. Laser therapy can cause pale colors and a
slight decrease in night vision. Laser therapy is more effective when
applied before abnormal blood vessels begin to bleed. Therefore, from
diabetic patients regularly dilated pupils, detailed eye fundus
examination should be done. Even if bleeding begins, laser treatment may
still be possible, depending on the level of bleeding. Surgery may also be
required in advanced damage, and vitrectomy is planned in this surgery.

Strabismus Treatment

Strabismus is when both eyes lose their parallelism with each other. There are six
extraocular muscles in each eye. Lack of strength or excess in one or more
of them is the reason for crossing eyes. Since two different images will
appear in the brain when there is a misaligned eye, the brain will suppress the
image from the sliding eye, which will cause a decrease in the sense of depth
and vision with both eyes. Since the suppression of the image coming from
the sliding eye in adults can no longer be done, double vision complaint
occurs. In the treatment of strabismus, early diagnosis is very important
for effective treatment. Strabismus examination can be applied to children
of all ages. However, it will be beneficial for children before the age of
4 to have an eye examination. When the diagnosis is delayed, permanent
vision defects occur as well as aesthetic problems that will last a lifetime.

Types of Strabismus: Strabismus is named according to the directions in which the
eyes cross:

Upward

Strabismus (hyperopia)

Downward
Strabismus (Hyperopia)

Inward
Strabismus (Isotropies)

Strabismus
Outward (Exotropia)

Causes of Strabismus

It is not known exactly how strabismus occurs. The movement of the eyes is
produced by 6 muscles. These muscles move the eyes right, left, up and
down. These muscles must work in harmony. In order for us to be able
to track any moving object with our eyes, all these muscles must contract to
maintain the angle the object makes to our eyes. The contraction of these
muscles is controlled by our brain.

Strabismus Treatment Methods

Glasses

Some types of strabismus occur due to visual defects. Strabismus resolves after
the patient starts wearing glasses.

Closure Treatment This treatment method is applied if the patient has lazy eye.

Orthotic treatment This treatment consists of exercises applied to the eyes in
order to gain the ability to see with both eyes and a sense of depth.

Botox treatment: When botulinum toxin is injected into the muscle causing
the slippage, the eye is paralleled, the effect is about 6 months and it is a
preferred treatment method in special cases such as strabismus due to nerve
palsy.

Surgical intervention

Strabismus surgeries are mostly performed on the muscles located outside the eyeball. Various
techniques are used to correct the strabismus and to provide parallelism
between the eyes, increasing and decreasing the strength of these muscles or
changing the points of action of the muscles.

Eyelid Diseases

Eyelids Too Open (Eyelid Retraction) It has a wider than normal eyelid ranges and
can cause dry eyes. The cause is mostly thyroid (goiter) disease. It
may also occur as a result of excessive correction after the surgery. It
can be corrected by surgery. 

Style A style is one of the tear gland infections. The disease occurs
suddenly, within 1-2 days, and it manifests itself with stinging in the eye,
tension in the eyelid, regional swelling, warmth, redness and pain. While style
formation can be prevented with antibiotic drops, ointment and hot compress in
early diagnosis, the disease resolves later, as the diagnosis usually exceeds
1-2 days. A cyst (chelation) has recently been formed in untreated sties. The
treatment of chelation is surgical, the cyst formed is drained by
surgery. 

Eyelash Ingrown The inversion of the eyelashes is called “trachealis”. Inverted
eyelashes cause a feeling of stinging and discomfort in the eye as well as a
non-aesthetic appearance. These eyelashes rub against the cornea and
damage it. They can reduce vision by causing permanent scars on the cornea. Inverted
eyelash roots are burned with cautery. It is a permanent treatment; more
than one session may be required or the inverted eyelash roots are frozen with
a device called “cryo”. If there are too many inverted
eyelashes, the skin with that row of eyelashes is surgically removed. 

Facial Paralysis Facial paralysis occurs when the nerve (facial nerve) that
provides the movements of the eyebrows, eyelids and face (facial nerve) does
not work for any reason. This condition may be congenital or may occur as
a result of tumor, infection, injury and vascular diseases. In case of
temporary paralysis, medical treatment is applied to protect the eye. In
permanent paralysis, in addition to medical treatment, different surgical
treatments are applied to place a golden weight on the upper eyelid, inability
to close and to correct deformities.

Dry Eye

The tear film consists of a mucus layer that spreads right over the eye, a watery
layer in the middle and a fatty layer on the outermost. The deficiency or
impairment of any of these three layers causes the complaints and symptoms of
dry eye. Dry eyes is a lesser known ailment. Most people attribute
dry eyes to allergies or seasonal changes. In fact, your eyes need a tear
film to protect the eye surface. Because of this, the eye surface can be
damaged. The condition that occurs is a chronic tear syndrome. If the
patient wears contact lenses, he may face much more serious problems. In
cases where dry eye is not treated, the risk of infection is very high. Whether
or not eye dryness is experienced in patients who wear contact lenses, it
causes permanent damage if not treated over time.

Dry Eye Symptoms

Dry eye symptoms vary. Patients describe their symptoms of dry eye in
different ways: they may report itching, irritation, sensitivity to light,
blurred vision, or even excess tear production. Coping with any or some of
these symptoms is a problem for millions of people. Although many of those
who suffer from it believe that this is a condition that has no choice but to
“learn to live together”, in fact untreated chronic dry eye can lead
to more serious vision problems. If the dry eye disease is mild,
intermittent or in the early stage, the patient has complaints such as mild
burning, stinging, redness, feeling of heaviness in the eye, tingling, foreign
body sensation in the eye. Although these complaints vary from person to
person, they generally affect the daily life of the patient negatively. If
the disease is in the moderate and severe stages, these complaints may be more
severe and continuous. Only a doctor can determine if your dry eye
condition is indeed chronic dry eye. To make this diagnosis, the dry eye
specialist will ask you to describe the symptoms of dry eyes you experience and
their effects on your daily life.

Causes of Dry Eye

Use of contact lenses

The use of contact lenses causes dry eyes because the tears
evaporate faster.

Air-conditioned environments

The use of air conditioning causes the environment to dry, causing dry eyes by
accelerating the evaporation of tears.

Laser operations 

Depending on theoperations, the eye surface and tear secretion organs are affected.

Intensive computer use

Dryness of the eyes is observed due to the decrease in the frequency of blinking movements that
cause tears to spread to the eye surface during intensive computer use, and
because evaporation will increase as a result of less blinking of the eye than
it should be.

Smoking

 Substances in cigarette smokeaffect the eye surface negatively.

Rheumatism

In rheumatic diseases relatedto the immune system, glands that secrete tears are also involved in the
disease.

Heart diseases and diabetes

Tear glands are also affected in various chronic diseases, especially tissue nutrition
disorders.

Eye pressure

Some eye drops used in the treatment of this ailment can cause dry eyes.

Old age

Tear secretion decreases withadvancing age in men and women.

Medications

Depression medications, hormone medications can cause dry eyes.

Environmental factors

Low humidity, hot or windy environments, radiation, chemicals, unsuitable rays, staying in high
places (due to low oxygen pressure) can cause dry eyes.

Treatment of Dry Eye

Dry eyes, which can negatively affect our quality of life, is a condition whose
symptoms can be relieved and treated. First of all, the patient should
avoid factors that cause dry eyes. For example, low humidity, hot or windy
environments, radiation, exposure to chemicals, staying in high places (due to
low oxygen pressure) are external factors that cause dry eyes. If the
person is not frequently present in these environments, there is a decrease in
dry eye symptoms. In addition, it will be beneficial not to be exposed to
the air conditioner continuously. Intermittent computer use and reducing
smoking can also reduce the complaints that the person will encounter with dry
eyes. Patients are advised to increase the humidity in their home and work
environment. In addition, it can be stated that they should not be in an
environment of heavy cigarette smoke. In severe cases, although not
appreciated cosmetically, anti-evaporation goggles, etc. tools can be
given.

Artificial Tears Supplement

Artificial tears are the main treatment method for dry eyes. There are many artificial
tears used around the world. The differences between them are based on the
active ingredient they contain, their packaging (reusable bottle, disposable
ampoule, etc.). Drugs That Increase Tear Production These drugs show their
effects on the necessary tissues by tear production and increase the natural
tear production of the person. Surgical Intervention Thanks to a plug
placed in the tear ducts, it is possible to keep the existing tears on the
surface.

Visual Impairment Operations

The vision functions of our eyes can be roughly compared to the image acquisition
function of a camera. The rays coming from the external environment pass
through the refractive surfaces such as the cornea and lens (lens), which are
the outermost transparent layer of the eye, and focus on the yellow spot in the
retina of the eye that is responsible for vision. Visual disturbances that
occur due to the focusing of the rays coming from the external environment in a
different place than the yellow spot are called “refractive errors”.

Refractive errors can be examined in 3 groups: 

Myopia 

Myopia, defined as nearsightedness, occurs when the rays
coming to the eye focus in front of the retina rather than on the retina. It
most often develops due to the anterior-posterior axis of the eye being longer
than normal. It is a structural disorder and genetic transmission is
frequent. It usually starts at school age and increases with age.

Hyperopia 

In general, it is a poor vision. It occurs as a result
of focusing of the rays coming to the eye, not on the retina, but behind it. In
contrast to myopia, in hyperopia the anteroposterior axis of the eye is shorter
than normal. The most common causes of hypermetropia are structural and
hereditary causes. Untreated hyperopia increases the risk of amblyopia in
children. For this reason, it is recommended that children have an eye examination
before school age. In addition to hypermetropia, the near vision disorder
caused by the decrease in the close focus of the eye lens over the age of 40 is
called “presbyopia”. Presbyopia is not an eye disease, but a natural part
of the aging process.

Astigmatism

It is caused by the difference in the refractive power of the
cornea in different meridians. Astigmatism is an eye disease that causes
blurred vision at any distance. It can be structural or it can occur as a
result of diseases, infections and traumas that can cause changes in the
corneal layer.

Surgical treatment of refractive errors can be divided into 2 groups:

Excimer Laser Operation

Laser, which is actually a light source, is obtained by
strengthening one of the wavelengths that make up the light with the help of
special systems, directing it to a certain direction and increasing its
intensity. Excimer laser is a light source that is obtained in this way
and is in ultraviolet wavelength, which is invisible to the eye. Since
this laser system is used in the treatment of refractive errors that require
wearing glasses or lenses, the operation is also called “excimer
laser”. Excimer laser operation

has enabled more than 50 million people around the world to  get
rid of glasses and lenses. 

In the excimer laser operation, modern laser technology is
used, all stages of which are personalized. Excimer laser operation; It
treats refractive errors by reshaping the cornea layer of the eye. Since
the structure and disorders of each eye are different from each other, a
different method is used for each person, even each eye. Special
differences in the eye structure of everybody have brought personalized
treatment to the agenda. 

The stages of excimer laser operation are as follows:

a. Determination of personal opinion profile

With the special tests applied, the structural and functional
features of our guest’s eye are determined. The special system used
creates a three-dimensional map of the visual defect, and then personal
treatment is planned through digital information from this map. In laser
therapy, a digital locking system is used between the device and the eye, as it
is very important that the device fires at the planned point of the eye.

b. Creating a layer (flap) in the cornea

A layer is created in the cornea layer of the eye without
using a surgical knife and this layer is removed. It serves to form the
diameter, thickness, attachment to the cornea and regularity of this layer as
planned.

c. Personal laser operation 

With a personalized excimer laser operation, the cornea layer
of the eye is reshaped and refractive errors are treated. 

D. Closing the layer formed in the cornea

After the personal excimer laser operation is applied, the
layer formed in the cornea is closed and the operation ends.

Intraocular (Intraocular) Lens Operation

For people with high numbered myopia, hyperopia, astigmatism
or who cannot be applied excimer laser operation due to the characteristics of
the cornea; With intraocular (intraocular) lens operation, a sharp vision
can be achieved without using glasses or lenses. It eliminates the
refractive error of the person by providing a clear reflection of the image
such as intraocular lenses, glasses or contact lenses on the yellow spot in the
eye. 

In intraocular (intraocular) lens operation, all stages are
personal. In this operation; Intraocular lenses are placed in the
spaces called the anterior or posterior chamber on the lens (lens) of the
person’s own eye, or the lens (lens) in the person’s own eye is removed and the
appropriate numbered intraocular lens is placed in the same place. Since
the structure and disorders of each eye are different from each other, a
different method is used for each person, even each eye, in intraocular lens
operation, that is, a personalized operation is planned. 

The lens to be placed in the eye is selected in accordance
with the refractive error (myopia, hyperopia, astigmatism) of the person. In
this sense, people with more than one refractive error are multifocal
(multifocal) lenses that aim to eliminate all of these refractive errors. 

Lenses used in intraocular (intraocular) lens operation can
be classified into three groups:

Monofocal (single focus) intraocular lens

 It treats only one of the refractive errors. 

Bifocal (bifocal) intraocular lens: These are bifocal lenses, namely

near and far. Although it enables both the near and the distance to be seen
without glasses, the middle distance (40 cm – 2 meters) cannot be seen clearly.

Multifocal (multifocal) intraocular lens

The most preferred of this type of
lenses called “smart lens” is trifocal (trifocal)
lenses. Trifocal lenses allow the person to see the distance, near and
intermediate distance (40 cm – 2 meters) well without glasses.

The stages of intraocular (intraocular) lens operation are as follows:

a. Removing the person’s own lens

Through a surgical incision smaller than 3 mm, the lens
belonging to the person’s own eye is reached and this lens is removed while
preserving its integrity. The eyepiece is then liquefied and absorbed by a
device that emits ultrasound waves.

b. Placement of the intraocular (intraocular) lens

A new artificial lens with foldable feature is placed instead
of the lens belonging to the person’s own eye. The lens takes its normal
shape with body temperature after being placed in the eye through the
previously used 3mm surgical incision. 

Additional information

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