Vision presentation Dr. Arosemena at Boquete Panama TCM 13-Sept 2011

1. 1
Augusto Arosemena M.D
Ophthalmologist
Clínica de Ojos
Consultorios Médicos Paitilla
Tel: 206-2424
Cell-phone: 66162020

2. Introduction
 My name is Augusto Arosemena,
Ophthalmolgist and I did my eye surgery
training in the USA.
 Finally I’m here in Boquete And would like to
thank Mr. Stole Barger for making possible
this visit to this beatifull part of Panama where
you have chosen to retire.
 Also like thanks mrs Magda Crespo who made
the initial aproaches for my visit.
 The words of Keith Woolford are very much
appreciated and I thanks you all for coming .

3. 2
Index
3) Today we are going to review some of the diseases that affect your
vision and your quality of live. :
I will start at the front of the eye with the lids and move further back.
 Blepharitis (Chronic Eyelid Inflammation)
 DRY EYE
 GLAUCOMA
 CATARACT
 MACULAR
DEGENERATION
 Diabetic Retinopathy

4. 3
Blepharitis
(Chronic Eyelid Inflammation)

5. 4 BLEPHARITIS
 A chronic or long term inflammation of the eyelids
at the base of the eyelashes. It affects people of all
ages.
 Among the most common causes of blepharitis
are:
o A bacterial infection with Rosacea.
o An allergic reaction
o A poor eyelid hygiene

6. 5 BLEPHARITIS
Symptoms
 Burning
 Itching
 Irritation an redness at the edge of the lids
In severe cases, it may also causes granulated
eyelids with styes, irritation and inflammation of the
cornea (keratitis) and conjuntiva (conjuntivitis).
Some patients have no symptoms at all.

7. 6 BLEPHARITIS
Treatment (Topical - Systemic)
 Topical treatment includes eyelid hygiene with
medicated pads. Ocusoft Plus
 Warm compreses
 Antibiotics eyedrops and ointments .
 Systemic treatment includes low doses of
Tetracycline for a very long time.
It is important to note that Blepharitis is a chronic
condition, and patients diagnosed with it must take
extra care to keep their eyelids as clean as possible.

8. 7
DRY EYE

9. 8 DRY EYE
 It is a disturbance of the Lacrimal Functional unit, which
comprises the lacrimal glands, ocular surface, and eyelids,
together with the sensory and motor nerves that link them. It
reduces the amount of tears produced. Normally tears are
produce on a continuous flow during the day that decrease
when sleeping.
 The dry eye syndrome is a multifactorial disease of the tears
and ocular surface that produces tear film instability with
discomfort, visual disturbance, inflammation and potential
damage to the ocular surface.
 The key features of the dry eye syndrome are:
 Decreased tear production
 Increased tear evaporation
 Incorrect composition of tears
 These result in inadequate lubrication of the eyes with
Sleepiness, irritation, red eyes, foreign body sensation and
vision not as clear as it us to be.

10. 9 DRY EYE
TREAMENT ATTEMPTS
To maintain moist the superficial layers of the eyeball.
 Artificial tears that correct the missing portion of the tears film. When
you apply artificial tears to the eye they are drained at the inner
corner of the eye toward the nose and throat. When you drop the
eyes you made feel the taste.
 Treating the inflammation of the eye and the immunologic attack to
the lacrimal gland is achieve with systemic medications like chronic
oral Tetracycline Omega 3, vit E and time release vit C. Topical eye
drops of cortisone and immunologic agents like Ciclosporine are
use.
 Punctum Plugs when the production of tears is reduce Plugs are
inserted in the upper and lower lagrimal puntums, to maintain in the
eye the tears for a longer time.
The treatment is chronic and depends of the portion of the tear film
missing and that is another reason to live in a humid place like
Boquete.

11. 10
GLAUCOMA OPEN
ANGLE
Production of a liquid call
acquosus brings the
nutrients to the cristaline
and cornea, and mantein
the pressure in the eye.
When the outflow is reduce
the pressure builds up.

12. 11
What is glaucoma?
 Glaucoma is a disease of the optic nerve. The optic nerve receives
light-generated nerve impulses from the retina and transmits these
to the brain. Glaucoma is characterized by progressive damage to
the optic nerve that generally begins with a subtle loss of side vision
(peripheral vision). If glaucoma is not diagnosed and treated, it can
progress to loss of central vision and blindness.
 Glaucoma is usually, but not always, associated with elevated
pressure in the eye. Generally, it is this elevated eye pressure that
leads to damage of the eye (optic) nerve. In some cases,
glaucoma may occur in the presence of normal eye pressure. This
form of glaucoma is believed to be caused by poor regulation of
blood flow to the optic nerve

13. 12
What are glaucoma risk factors?
 Age over 45 years
 Family history of glaucoma
 Diabetes
 History of elevated intraocular pressure
 Nearsightedness (high degree of myopia).
 History of injury to the eye
 Use of cortisone (steroids), either in the eye or
systemically.
 Farsightedness (hyperopia). Farsighted people may
have narrow drainage angles, which predispose them
to acute [sudden] attacks of angle-closure glaucoma.

14. 13
What are glaucoma symptoms and
Patients with glaucoma in general have no symptoms
early in the course of the disease. Visual field loss
(side vision loss) is not an early symptom.
Glaucoma will not produce a red eye, inflammation,
burning, eye secretions, nor pain.
There is no way for the patient to realice that he is
affected until very late in the disease, the only way to
know is by having and eye exam by a qualified
ophthalmologist.

15. 14
Treatment
Decrease the pressure inside the eye. This is achieve
with:
 Eye drops (some of them decrease the amount of
acqueous production and others increase the
outflow)
 Laser trabeculoplasty (to facilitate the outflow)
 Eye surgery. The surgery includes trabeculectomy
and valves; both implies continuos follow up
during the first month

16. 15
MACULAR
DEGENERATION

17. 16 MACULAR DEGENERATION
 During the early stages of
macular degeneration, there
may be no symptoms. However,
an ophthalmologist may be able
to detect early signs of the
disease.
 Often, the dry form of macular
degeneration initially causes
slightly blurred central vision,
both close up and far. The
center of vision may become
fuzzy or shadowed.
 In the wet form, straight lines
may appear wavy. Also, in this
more severe form, central vision
loss can occur rapidly,
sometimes within days or weeks.

18. 17
Between 10 and 15 year patients with poor control will
Form new and defective blood vessels.
Diabetic Retinopathy

19. 18
CATARACT

20. 19 CATARACT

21. 20 CATARACT
NORMAL VISION CATARACT VISION

22. 21
CATARACT SURGERY

27. Gracias