Eye health is extremely important for people’s quality of life. For this reason; such erroneous information that we get from friends and family and social media, such as stye in the eye passes with garlic, cataract can be treated with drops, there is no need for routine eye control in children if there is no complaint, threatens our eye health.

Ophthalmology Specialist Assoc. Prof. Dr. Özge Begüm Comba explained 10 erroneous information about eye health that is thought to be true in the society; made important suggestions and warnings. Pointing out that erroneous beliefs in the society can prevent early diagnosis and treatment of eye diseases, she said, “Delay in the treatment of diseases can cause serious eye problems such as permanent vision loss in the future. For example, conjunctivitis, which is common in our country and popularly known as ‘red eye’ disease, can lead to visual defects and even loss of vision if not treated on time. In addition, in some diseases such as lazy eye, which can be completely eliminated with early diagnosis and treatment, children lose the chance of treatment when it is late. Myopia, which is quite common in our country, can also progress if not followed up regularly.”

Eye Number Increases as You Wear Glasses: False!

There is a widespread belief in the society that the eye number will progress as you wear glasses. Assoc. Prof. Dr. Özge Begüm Comba pointed out that glasses are only an apparatus that allows us to see well and said, “Therefore, wearing glasses will not progress or stop the numbers. It is important to wear glasses especially in childhood for the visual system to work fully and completely. Because glasses are a part of the treatment of permanent conditions such as lazy eye.”

Red eye goes away with artificial tear treatment: False!

In conjunctivitis, one of the most common eye diseases in Turkey and popularly known as ‘red eye’, using only artificial tears or drops that have benefited others can cause serious problems. Assoc. Prof. Dr. Özge Begüm Comba warned that if this disease is not treated on time, visual defects and vision loss may develop, “Conjunctivitis is inflammation of the membrane covering the inside of the eyelid and the most common source is viral and bacteria. It is of great importance that this picture is evaluated by a physician and the treatment is carried out in accordance with the causative agent. Otherwise, conjunctivitis may cause spots that may cause vision loss.”

It is Not Possible to Stop Eye Number: False!

The most important factors in the progression of eye number are genetic and environmental factors. In the light of scientific studies; limiting close work, resting the eyes by looking away for 20 seconds every 20 minutes and outdoor activities for at least 2 hours a day are recommended. In addition, until the age of 18, it is possible to stop the progression of the eye number thanks to drops that enlarge the pupil, special lenses and lenses that are used at night and shape the cornea.

Do Not Have Children Have an Eye Checkup If There Are No Symptoms: False!

Early diagnosis and treatment of serious problems such as cataracts and eye tumors are both visually and vitally important. Assoc. Prof. Dr. Özge Begüm Comba said, “In addition, conditions such as lazy eye and strabismus may not be noticed by parents because they occur in one eye. In such diseases, it is very important to perform eye examinations in children at regular intervals starting from the first 2 months after birth, especially since there is a race against time.”

Cataract can be treated with drops: False!

Ophthalmologist Assoc. Prof. Dr. Özge Begüm Comba stated that the only known treatment method of cataract is surgery and continued as follows: “The intraocular lens that has aged and lost its transparency should be surgically removed and replaced with an artificial lens. However, of course, the progression of cataracts can be slowed down by reducing oxidative stress with methods such as healthy nutrition, regular blood sugar monitoring, and the use of sunglasses with UV blockage.”

Cataract is only seen in the elderly: False!

Although cataracts mostly develop in older people, they can also occur in childhood and infancy. Congenital cataracts can accompany various syndromes and can also be caused by infections in the womb and drug use. In childhood, it can also occur due to medications such as cortisone or accompany other diseases.

Eye pressure often causes eye pain: False!

Eye pressure is an extremely insidious disease. While it can sometimes manifest itself with a pain behind the eye, it often does not cause any pain. Closed angle glaucoma, on the other hand, has a more severe course and can cause serious pain due to sudden high eye pressure. Ophthalmologist Assoc. Dr. Özge Begüm Comba warns that eye pressure should be evaluated with annual follow-ups after the age of 40.

Eye diseases can be treated with herbal methods: False!

Applying garlic and lemon to any lesion in the eye, such as a stye, cannot give results and can be extremely dangerous as it can lead to different infections. Assoc. Prof. Dr. Özge Begüm Comba says, “The most effective treatment method is to manage the process with the medications recommended by the physician, keeping warm dressing and eyelash hygiene at the forefront.”

There is no need to wear sunglasses in fall and winter: False!

The sun’s harmful ultraviolet rays reach the earth even in cloudy weather and are reflected from the shadows. In addition to harmful rays, wind can cause dry eyes. For this reason, it is of great importance to use sunglasses for your eye health not only in summer but in all seasons.

June 2024

Choroideremia (CHM) is a rare genetic eye disease that affects the retina, which is the area at the back of the eye that processes all we see into signals that are sent to the brain via the optic nerve.

Choroideremia is a rare genetic retinal disease, which causes blindness in males during middle age. We still have much to understand about how the biochemical defect causes the retinal-specific disease and if it has any hidden effects on the rest of the body. Recently, there have been suggestions that CHM patients may be at risk of higher blood cholesterol or fat levels, and this is under currently investigation as part of detailed natural history studies. CHM has been used as a prototype retinal degeneration for developing novel gene therapies and hence, has provided much hope for those affected with the disease but also patients with similar inherited retinal disorders. Choroideremia affects about 1 in 50,000 individuals and is caused by a genetic defect in one single gene called the CHM gene, which is located on the X-chromosome. Male patients manifest the severe blinding form of the disease and suffer from a progressive retinal degeneration with obliteration of the light sensing cells (photoreceptors), their support cells (the retinal pigment epithelium) and part of the blood supply to these retinal layers (the choroid). The healthy orange retina is lost and the pale white sclera (tough white coat of the eye) can be seen when you look into the eye. Females are carriers and largely unaffected, however they can develop mild symptoms of visual impairment, such as night blindness, in more in later stages of life.

Choroideremia is Genetic
Choroideremia is caused by mutations in the CHM gene. The condition is passed down in families by the X-linked pattern of inheritance. In this type of inheritance, the mutated gene for the disease is located on the X chromosome. Females have two X chromosomes and can carry the disease gene on one of their X chromosomes. Because they have a healthy version of the gene on their other X chromosome, carrier females are usually not affected by X-linked diseases. Males have only one X chromosome (paired with one Y chromosome) and are therefore genetically susceptible to X-linked diseases. Males with X-linked diseases pass their Y chromosome to their sons, and therefore will never pass an X-linked disease to their sons. Female carriers have a 50 percent chance (or 1 chance in 2) of passing the X-linked disease gene to their daughters, who become carriers, and a 50 percent chance of passing the gene to their sons, who are then affected by the disease.

How the CHM Gene Works
The CHM gene encodes a protein called Rab Escort Protein-1 (REP1). This protein works in all our cells by helping to shuttle other small proteins (called Rabs) to their correct destination so they can undertake their role, such as allowing nutrients to pass across cells and removal of waste products. If these small proteins cannot be transported to their correct location to fulfill their job, the cells can starve and waste products build up causing damage and cell death. Humans are fortunate to have a second copy of REP1 called Rab Escort Protein-2 (REP2), which works well to transport Rabs in all the cells of our body except for the retina. The photoreceptors and retinal pigment epithelium have a subset of Rab proteins that prefer to be escorted by REP1 over REP2. Therefore, in the presence of a defective CHM gene with lack of REP1, there is a buildup of Rabs that are not able to function appropriately, and this leads to a retinal-specific disease that causes blindness in an otherwise fit and healthy individual.

Choroideremia Symptoms and Disease Progression
As an X-linked disease, choroideremia occurs primarily in males. In childhood, night blindness is the most common first symptom. As the disease progresses, there is loss of peripheral vision or “tunnel vision” and later a loss of central vision. Progression of the disease continues throughout the individual’s life, although both the rate and the degree of visual loss can vary, even within the same family. In affected male patients, the first symptom of CHM is night blindness, which is most commonly noticed in early childhood from as early as five or six years of age. The disease continues to progress with loss of the peripheral field of vision, this occurs at a relative fast rate in late adolescence and into the early twenties, leaving the patient with only a small area of central “tunnel” vision. The rate of decline lessens but the retinal degeneration continues to progress slowly over the next few decades, patients lose depth perception, color perception and finally loss of central vision with complete blindness into their fifties and sixties. Both the rate of disease progression and the degree of visual loss are variable among those affected, even within the same family. Female carriers are usually unaffected, but some do experience symptoms of night blindness later in life with some patchy loss in vision. This occurs because despite women having two X-chromosomes, one is switched off in every cell to ensure the correct amount of gene product (protein) is being produced. This process is random, called X-inactivation or lyonization, and means if the healthy X-chromosome is inactivated, then the X-chromosome carrying the defective CHM gene will prevent normal function in that particular retinal cell leading to disease in a patchy distribution.

Disorders with Similar Symptoms
Symptoms of the following disorders can be similar to those of choroideremia. Comparisons may be useful for differential diagnosis: X linked retinitis pigmentosa (RP) is the most common inherited vision disorder that has similar symptoms to choroideremia. X linked RP is passed from a mother (who carries or has RP) to a son. In RP, the retina degenerates, vision decreases and can be lost. Symptoms include night blindness leading to progressive loss of peripheral vision, followed by tunnel vision. Night blindness is usually the first noticeable symptom, generally occurring during childhood. This is followed by tunnel vision (loss of peripheral vision). The extent and progression of symptoms is variable. An eye doctor can differentiate between RP and choroideremia with an eye exam. Gyrate atrophy of the choroid and retina is characterized by a circular degeneration in the choroid and retina of the eye. Because this eye disorder results from the accumulation of ornithine in the blood, a blood test can be used to help diagnose it. In general, patients with this eye condition as have other medical problems such as muscle weakness. Very rarely, a single genetic variant in the RPE65 gene can cause a dominantly inherited condition that affects the retinal pigment epithelium and looks like choroideremia. The key feature is the pattern of inheritance is not X-linked.

How to Diagnose Choroideremia
A diagnosis can be made by an ophthalmologist with a specialist interest in genetic eye disease. They will have the expertise to interpret the patient history, signs from the clinical examination and investigations such as electrophysiology, fundus autofluorescence and optical coherence tomography. But ultimately, a genetic test to screen the CHM gene for mutations is required to make a definitive diagnosis. There have been rare cases of patients with a retinal appearance similar to CHM, but upon genetic testing have shown mutations in different genes known to cause other retinal dystrophies, such as RPE65. Another genetic condition called gyrate atrophy, which is an inborn error of metabolism, displays similar clinical features to CHM. It is caused by mutations in the ornithine ketoacid aminotransferase (OAT) gene found on chromosome 10.Patients show an increase in plasma levels of ornithine, however, reduction of the amino acid arginine in the diet prevents disease progression. This highlights the need to see a specialist so that CHM can be diagnosed correctly.

 What are the Treatments Ooptions
There is currently no cure or effective treatment for CHM. Much research is underway to seek a viable and sustainable therapy and there are a number of promising gene-based approaches under development. Firstly, the use of a drug administered orally to patients, which has the ability to override a specific genetic mutation, called a nonsense mutation, has been used which introduces an abnormal stop signal into the CHM gene. Nonsense mutations account for over 30% of CHM.

May 2024

Do you know that parasites called demodex may underlie complaints such as itching, watery eyes and eyelash loss?

Our eyes, like our skin, deserve to be nourished from the inside, not the outside. Because no matter how healthy you stay, there are some important eye problems that you may encounter during the aging process, and these are not the natural consequences of aging, but diseases related to the care you show to your eyes.
Prof. Dr. Göktuğ Demirci said, “These parasites called demodex, which consist of a mouth, tail and 8 legs, are too small to be seen with the naked eye. These parasites damage our eyes and skin with the germs they carry. Demodexes are thought to be one of the causes of diseases such as recurrent stye, eye inflammation, eyelash loss, contact lens intolerance, dry eye.” Prof. Dr. Göktuğ Demirci pointed out that the incidence of demodex has increased recently. Prof. Dr. Demirci stated that demodexes, known as demodex in Latin but in Turkish as ‘oil-eating worm’, live on the skin and eyes, especially where there are sebaceous glands and hair follicles, and said, “Recently, the number of patients coming with complaints of itching, watering in the eyes and loss of eyelashes has increased. At first, these complaints were thought to be allergic or a skin disease such as eczema. Thanks to the progress in our imaging technology, when we examined in detail, interesting parasites hiding in the eyelash bases and skin of the patients were discovered. These parasites, which consist of 3 parts called demodex, have a mouth like a pincer, 8 digging legs and a tail. Too small to be seen with the naked eye, demodexes are 200-400 microns in size and can only be seen with special microscopes. These parasites lay their eggs at the base of our eyelashes and eat fat and skin particles. They damage our eyes and skin with the germs they carry. It is thought to be a factor that increases complaints especially in rosacea, and is thought to be one of the causes of diseases such as recurrent stye, eye inflammation, eyelash loss, contact lens intolerance, dry eye.”
Beware of Tea Tree Oil
First of all, the underlying cause must be identified. The disease that causes these parasites to increase, which lowers the immune system, should be treated, and measures should be taken to reduce the number of parasites, slow down their reproduction and prevent their numbers from increasing again. Systemic or local treatments should be applied. These include antibiotics prescribed by ophthalmologists and dermatologists specifically for this parasite and specially prepared creams, laser treatments, eyelash cleaners. Especially those who search for demodex treatment on the internet come across tea tree oil. According to internet information, instead of tea tree oil taken from herbalists, original products with a certain ratio of terpinen-4-ol in it work better. Otherwise allergic reactions may occur. Again, eyelash hygiene, weight control, hypertension control are very helpful in reducing the number of parasites. It is also very important for those who use make-up not to share these materials with others to prevent the spread of parasites. It is of great importance for patients with symptoms such as recurrent stye, eye inflammation, eyelash loss, dry eye to consult a physician for correct diagnosis and treatment.

April 2024

A retinoblastoma is a rare malignant tumor of the retina. It occurs as both hereditary and non-hereditary forms. It is seen typically in children who are below the age of 5 years.

The diagnosis of retinoblastoma is a clinical diagnosis. The most characteristic symptom is a whitish reflex from the pupils of the affected eye in children. This is most often picked up when a flash photo is taken, and the pupils look white instead of the normal orange-red glow. This sign is called leukocoria or cat’s eye pupil. Other symptoms include strabismus, or crossed eyes. This may be discovered by the parents, and may be confirmed by uncovering each eye in turn while the child is looking at some object.

Some children complain of redness and soreness of the eyes. This pseudoinflammation is seen in about a tenth of such patients. Other less common symptoms include bulging of the eyeball, discoloration of the iris in the eye with the tumor, differences in the size, shape and activity of the pupil of the affected eye, and symptoms due to metastasis such as bone pain. Visual acuity may be affected, or the child may complain of double vision.

Confirmation of Diagnosis

An indirect ophthalmoscopy is required to confirm the diagnosis of retinoblastoma. This is done through dilated pupils, and examination under anesthesia is required in very young children and infants. The interior of the eyeball must be thoroughly visualized, including the whole of the retina and the optic nerve head. A slit lamp examination, called biomicroscopy, is also done to examine the inside of the eye using a powerful focused light beam and a microscope.

Further eye tests may be ordered:

• Fluorescein angiography: a dye called fluorescein is injected into the blood vessels of the eye to look for blocked or dilated or leaking vessels on an X-ray film.
• Ultrasonography of the eyeball: ultrasound waves are used to create a picture of intraocular tissues.
• Magnetic resonance imaging (MRI): this gives a more detailed image of soft tissues, including the spread of the tumor into nearby tissues.
• Computerized tomography (CT) scanning: this uses a series of X-rays taken from different angles to synthesize a composite image of the area images. It is often avoided in young children, especially if they have a family history of retinoblastoma or other tumors, because of the potential danger of exposure to ionizing radiation.

A full physical examination of the child is done as usual to pick up signs of related or unrelated disease. A bone scan may be required to check for signs of bone spread.

Treatment of a Retinoblastoma

How a retinoblastoma is treated depends upon:

• Tumor size
• Tumor number
• Tumor location
• Extent of involvement of intraocular and extraocular structures
• Any other tumor
• Family history of retinoblastoma
• Extent to which vision can be conserved

In any case, the treatment of a retinoblastoma requires the services of a team of health care providers who have experience with childhood cancer treatment. The aims of treatment are to prevent death from cancer, as well as to save the child’s eye, and vision if possible, as well as achieving the minimum possible side effects.

Treatment Approaches

• Cryotherapy: a cryoprobe is used to freeze and destroy tumors with a diameter of up to 5mm and thickness of 3mm. This technique may need to be repeated, with intervals of 3-4 weeks.
• Laser photocoagulation: laser light energy is used to heat tumors and destroy their blood supply, making them non-viable, or in other cases to render them more sensitive to other tumor-ablating techniques.
• Thermotherapy: microwaves are used to heat the tumor cells and destroy them.
• Radiotherapy: both external beam irradiation and brachytherapy are used. External beam radiation therapy has the advantage of greater precision, sparing surrounding tissues and therefore conserving more vision. Three modalities are in use: intensity modulated radiation therapy (IMRT), stereotactic external beam radiation therapy (gamma knife), and proton beam radiation therapy.

Brachytherapy consists of plaque radiotherapy, where radioactive metals like I-125, are placed in the form of seeds on a plaque, which is sutured to the sclera outside the tumor. The plaque remains in position from 3 to 7 days depending on tumor size and extent. Radiation therapy is associated with a greater risk of side effects to the brain and the eye, in the very young children who are the typical targets of this cancer.

• Chemotherapy: systemic chemotherapy is used when distant metastases have occurred. Drugs used include cisplatin, etoposide and vincristine. A specialized form of chemotherapy involves the use of high dosages of very potent drugs, with the use of stem cells to replenish the stock of non-tumorous cells such as bone marrow cells which are also severely affected by the chemotherapy regimen – called stem cell rescue. Chemotherapy may be administered intravenously, orally, or intra-arterially (into the artery that supplies the eyeball – only for tumors limited to the eye), or intrathecally (into the space around the central nervous system containing cerebrospinal fluid).
• Enucleation: this surgical procedure involves the removal of the entire eye, with part of the optic nerve. It is often used with larger or more extensive tumors. It may also be the second-line therapy if radiation or other eye-sparing techniques fail, and if there is no hope that vision can be conserved. It is usually combined with the insertion of an adult-size artificial eye implant to which the ocular muscles are reattached. This helps eye movements to look more natural. In addition, a skillfully colored shell is fitted over the implant to simulate the appearance of the normal eye. The child must be followed up for recurrence or a new tumor for at least 2 years.
• Orbital exenteration: this procedure involves the removal of all intraorbital tissue, and is a disfiguring surgery.

Late effects of treatment include:

• Effects of radiation on the growth of the face may produce midfacial hypoplasia, as well as problems with hearing and vision
• Effects on cognition and mood
• Second cancers especially of the lung or bladder, osteosarcomas or sarcomas, or melanomas, are quite common in individuals with a heritable form of retinoblastoma

About nine of every ten children with retinoblastoma are cured, or show no recurrence of the tumor in five years after treatment. Life-long follow up is mandatory because of the high risk of second tumors, and tumor development in the other eye. This is usually seen to happen within the first 3 years after the first tumor develops, so the eyes should be examined every 2-4 months for at least 28 months. The risk of trilateral retinoblastoma is high with the heritable form. For this reason, MRI scanning is required every six months, until the child is at least five years old.

Source: News Medical

February 2024

We are used to eye twitches caused by fatigue, stress or too much screen use. But what if the contractions around the eyes indicate a more serious problem? Ophthalmology Specialist Assoc. Prof. Dr Ayşe Burcu Dirim warned about the dangers behind this problem that we do not dwell on.

Eye twitching is one of the body reactions that occur suddenly during the day and can sometimes reach annoying dimensions. Although this discomfort is not considered a serious problem for many of us, experts warn that it may be an indicator of a serious health problem. So much so that many of us do not think that this is a problem with the eye muscles or that it may be caused by intense stress. There are several reasons why eyelid twitching can occur. If only one eyelid is twitching, this is usually what we call a muscle twitch, which is quite normal, temporary and typically resolves on its own. However, in some cases it can be a little more difficult to find the underlying problem. Ophthalmology Specialist Assoc. Prof. Dr Ayşe Burcu Dirim explained the causes and possible risks of eye twitching.

EYE MUSCLES MAY BE AFFECTED İN ELECTROLYTE İMBALANCE

These contractions in the orbicularis muscle surrounding our eyes, called ‘myokymia’ in medicine, are popularly called twitching. The severity of these twitches, which occur as a result of temporary cramps in the muscles around the eyes, varies depending on the amount of muscle fibres involved. One of the most common causes of eye twitching may increase as a result of fatigue, insomnia and stress tiring the muscle fibres. Eye muscles that work very actively are quickly affected by fluid and electrolyte imbalance and such temporary contractions occur. Sometimes dryness, infection, allergy conditions can also cause eye twitching.

WE SHOULD AVOİD COFFEE AND STRESS

Reminding that eyelid twitching is usually a benign and spontaneous condition, Assoc. Prof. Dr. Ayşe Burcu Dirim said, “Increasing fluid intake, mineral water consumption to balance electrolyte loss, caffeine restriction, regular sleep, and reducing stress will quickly improve eye twitching. The use of sunglasses in people who are sensitive to light, intermittent resting of the eyes in people who use computers intensively will also contribute to the process. An underlying neurological or eye-related condition should be investigated in twitching that persists continuously and exceeds one week.”

A METHOD TO REDUCE THE DİSEASE HAS NOT YET BEEN DEVELOPED

Stating that blepharospasm is divided into two as ‘benign’ and ‘malignant’, Assoc. Prof. Dr. Ayşe Burcu Dirim states that the difference between them can be detected by Magnetic Resonance (MR) imaging method. Asked how benign and malignant blepharospasm is detected, Assoc. Prof. Dr. Dirim stated the following: In order to distinguish benign (essential, benign) or malignant blepharospasm, it should be checked whether there is a pathology originating from the brain with MR imaging method. Blepharospasm may be the first symptom of underlying Parkinson’s disease. Blepharospasm may also be a symptom of lesions in some parts of the brain. Blepharospasm usually occurs over the age of 50 and without an underlying disease and causes severe contractions in both lids. Although their severity varies according to stress and anxiety, they disappear completely during night sleep. In recent years, we have been trying to reduce the severity of contractions by using filtered lenses that block the light to which the person is sensitive in order to regulate visual stimuli. Although promising results have been obtained in some patients, a method that effectively reduces the disease has not yet been developed.

MAY BE A SYMPTOM OF PARKİNSON’S DİSEASE

A persistent twitching that lasts for more than two weeks, a visible change or pain around the eyes indicates that there is a serious problem underlying this problem. This can be seen as problems that can lead to muscle stiffness and tension, affecting movements and facial expressions. It may be an indicator of a problem in the brain or an early sign of Parkinson’s disease. In the event of such a situation, early diagnosis is very critical. Blepharospasm may be the first symptom of underlying Parkinson’s disease or blepharospasm may be a symptom of lesions in some parts of the brain. Benign and malignant blepharospasm can be differentiated by neurological examination and eye examination. For this reason, it is very important to consult a specialist doctor on time for early diagnosis.

20+20+20 RULE

First of all, those who use the computer screen too much should follow the rule of working for 20 minutes, taking a 20-second break and resting by walking 20 metres. Those working in front of the screen should not forget to blink frequently. The simplest method to get into the habit of blinking when you are at the computer is to close one page and open the other. Fatigue is a more serious factor than it is thought to be. In such cases, ensuring sleep patterns and resting your eyes while you are at home can be effective in solving the problem. In advanced cases, experts recommend using botox (botulinum toxin) injections to weaken the spasming muscles or surgical intervention to the orbicularis muscle that causes the eyelid to twitch. Since blepharospasm is a chronic condition and it is not possible to spontaneously improve or eliminate it with a single treatment, it is very important to stick to the treatment recommended by your doctor for quality vision.

March 2024

If you experience problems such as burning, redness or yellowing of your eyes, you might think that the problem occurs because of your eyes.

White or yellow swelling
If you have white or yellow bumps on your eyelids or around your nose, you may have high cholesterol. If you have these symptoms, you may want to check your cholesterol.
Yellow eyes
If the whites of your eyes turn yellow, you may have high levels of bilirubin in your blood. Yellow eyes can be a sign of jaundice, but can also indicate a liver infection, gallstones or cancer.
Light colored eye veins
When you pull down your lower eyelid, you should see a red or pink vein. If your blood values are low, you may be suffering from anemia. Anemia, which is more common in women than in men, is caused by iron deficiency.
Impaired vision
If you find that some parts of your vision are missing, you may be at risk of a stroke. The part of your brain involved in vision will be affected during a stroke.
Blurred eye
Eyes that look like they are popping out may be a sign of an overactive thyroid. One in 3 people with overactive thyroid glands experience eye problems.

November 2023

Blepharitis is a very common condition. It causes symptoms such as red eyelash bottoms and burning and stinging that disrupt patient comfort.

Inflammation of the base of the eyelashes is very difficult to treat. It is a chronic condition. Although it is not possible to cure it completely, it calms down with regular treatment and symptoms decrease. The area we call the base of the eyelash is the edge of the eyelid. In this area, the skin in front and the conjunctiva mucosa from behind meet. Eyelashes come out from here. There are also meibomian glands with pores in this area. The oil secreted by these glands lubricates the surface of the eye and slows the evaporation of tears. Inflammation of the base of the eyelashes is a common name for problems in this area. In addition, microscopic parasites called demodex that live in this area are the creatures that increase this inflammation.

There are several types of eyelash base inflammation. There are seborrheic form, which is characterized by dandruff and eyelash loss, and there are also types in which the meibomian glands located inside the eyelids do not work well, that is, the secretion of the oil layer of the tear is impaired. These conditions, which are referred to as inflammation of the root of the eyelashes, may give different symptoms. What they usually have in common is the prevention of adequate wetting of the surface of the eye and the occurrence of dry eye due to inflammation of the eyelashes.

What are the symptoms of eyelash base inflammation?
Symptoms of inflammation of the base of the eyelashes include burning due to dry eyes,

• Sting
• The feeling of sand escaping,
• Watering of eyes
• Eye redness,
• Eye tearing may include

In addition, pain in the eyes, swelling of the lids, fullness of the lids, redness, dandruff at the base of the eyelashes, itching at the base of the eyelashes, eyelash loss, whitening of the eyelashes can be counted due to inflammation of the eyelash base. Especially meibomian gland dysfunction, in which the meibomian glands do not work well, is the main cause of burning, stinging, watering and eye fatigue experienced by young people and computer workers.

The secretion of these glands is very important in terms of dry eye, because in the case of inflammation of the base of the eyelashes, the ends of these glands are blocked and when the secretions and secretions are not sufficient, the tear evaporates rapidly and the eye surface dries and also loses lubrication. Also, the lids that do not slide on the dry surface irritate the eye surface and increase the complaints of burning, stinging and watering. The comfort of our eyes depends on the adequate and proper secretion of the secretions of these glands on the eye surface. While the blockages at the ends of these glands simply increase the complaints of dry eye and cause burning, stinging and watering, fully blocked sebaceous glands cause stye, that is, chalazion.

If the ends of these glands, of which there are 20 in the lower lid and 40 in the upper lid, are blocked and destroyed over the years, very serious complaints of dry eye occur at an advanced age.

Eyelash base inflammation treatment?
In order for our eyes to be healthy and comfortable, it is necessary that the area around the base of the eyelashes is clean and healthy. Although the causes may be different, basically similar treatments are applied for all inflammations of the base of the eyelashes and meibomian gland problems. Although cortisone eye drops provide temporary relief, they have little place in the actual treatment, do not provide permanent treatment and have very serious side effects. The treatment of the inflammation of the base of the eyelashes is based on opening the meibomian gland mouths and cleaning the base of the eyelashes, in addition to controlling the demodex parasite, if any. To rid the base of the eyelashes of inflammation, they need to be cared for in the same way as we brush our teeth, because it is not possible to clean their tips very well when we wash our face. Here is what needs to be done to keep the meibomian glands working properly and to prevent inflammation of the base of the eyelashes.

They will be used for inflammation of the base of the eyelashes and meibomian gland dysfunction;

• Heat application – warming the lids and softening the oil secretion,
• Mechanical pressure – removing softened oils from the rag orifices by pressure,
• Mechanical cleaning – to remove dry oil plugs and dandruff,
• Chemical cleaning – to kill the demodex parasite,
• Lubricating the surface of the eye – tear drops.

First of all, in order for the secretions of the meibomian glands to reach the base of the eyelashes, their ends must be open, the oil secretion coming to this area dries up due to various metabolic and external influences and plugs are formed.

 

Prof. Dr. Ahmet Akman

Eye Health and Diseases Specialist

October 2023

Beware if you wake up with swollen eyes! Many diseases, especially cardiovascular diseases, can be diagnosed by the symptoms experienced in our eyes.

Stating that morning puffiness in the eyes can be a symptom of heart disease, Prof. Dr. Nur Acar Göçgil said, “During sleep, edema accumulation can occur in the eyelids at most in the body. When we wake up, we may feel swelling in our eyes. Complaints such as this swelling, which decreases later in the day, may be warnings of hidden heart disease.” Most symptoms in our eyes give us signs about other diseases in our body. Reminding that most people do not prefer to go to the doctor before experiencing a certain progression of health problems, Ophthalmologist Prof. Dr. Nur Acar Göçgil emphasized the importance of early diagnosis to prevent many diseases from diabetes to hypertension, vascular changes to clotting.

EARLY DIAGNOSIS CAN SAVE LIVES
Regular examinations increase the chances of treatment in diseases detected early and this saves lives against fatal diseases. Delay in the diagnosis of diseases such as diabetes, hypertension and heart diseases causes the disease to progress and results in the destruction of our eyes. This can result in reduced vision and even permanent vision loss.

SWELLING IN THE EYES MAY BE A SIGN OF HIDDEN HEART DISEASE
If you wake up in the morning with constantly swollen eyes, the cause of this swelling may be heart disease. During sleep, our head is at the level of the heart. During sleep, the most edema accumulation in the body can occur in the eyelids. When we wake up, we may feel swelling in our eyes. Complaints such as this swelling, which decreases later in the day, may be warnings of hidden heart disease.

DIABETES CAN BE DIAGNOSED DURING EYE EXAMINATION
Changes in vision in both eyes or one eye can also indicate diabetes and hypertension. Diabetes, which can cause significant and permanent damage to the eyes, can be diagnosed early with an ophthalmologic examination. Small vessel blockages due to diabetes and hypertension can also cause complaints such as double vision. The main cause of heart diseases is the development of arteriosclerosis. This arteriosclerosis can occur in all vessels in our body. Stiffness in the eye vessels or clot formation in the eye vessels can cause temporary visual disturbances. Disorders in the heart rhythm can also lead to consequences such as clots in the eye vessels. It is important for people with temporary vision loss to be checked for the risk of cardiovascular diseases and heart rhythm disorders. Stating that one should be aware of the symptoms experienced in the eyes, Ophthalmologist Prof. Dr. Nur Acar Göçgil listed the symptoms that may occur in the eye due to cardiovascular diseases as follows: Uncontrolled high blood pressure can cause blockages in the eye veins, causing visual impairment in the central vision or in an area. Hemorrhages in the retina and edema in the yellow spot may develop in the occluded vein area. With close follow-up and timely treatment, permanent visual damage is minimized. Treatment of the underlying systemic disease is also very important. With treatment and close follow-up, the development of new abnormal blood vessels in the retina is prevented. The severity of the disease can be determined by eye examination.

PEOPLE IN THIS GROUP ARE AT RISK OF HEART ATTACK
Especially in congenital cholesterol elevations, whitish ring formation around the iris can be seen in the eye. It is important for people in this group to have their cholesterol levels monitored in terms of the risk of heart attack and to be followed up by a specialist doctor in terms of heart health.

September 2023

Eyelid drooping, double vision, difficulty chewing and swallowing may be a sign of myasthenia gravis.

The prevalence of myasthenia gravis, which means dangerous and serious muscle weakness and prevents the transmission of messages from nerves to muscles and is rare, varies from country to country, but is approximately 20 per 100,000 people. Although there is no prevalence study in our country, it is thought that the prevalence is similar in Turkey. Prof. Dr. İhsan Şükrü Şengün, Faculty Member of Dokuz Eylül University Faculty of Medicine and Chairman of the Turkish Neurology Association Neuromuscular Diseases Working Group, shared important information about myasthenia gravis.

Prof. Dr. İhsan Şükrü Şengün said, “All voluntary striated muscles are carried by electrical impulses coming from the brain and carried to the muscles by peripheral nerves. The impulse coming from the brain to the nerve ending in the muscle causes the release of an excitatory substance called acetylcholine from the nerve ending to the gap called the nerve-muscle junction. This secreted acetylcholine then binds to acetylcholine receptors on the muscle membrane at the nerve-muscle junction, causing these channels to open and sodium ions to enter the muscle cell. The entry of sodium ions into the muscle cell leads to the generation of the electrical potential required for contraction of the muscle cell. In people with an abnormal immune system, the immune system releases antibodies that shut down, alter or destroy these acetylcholine receptors. Then there is a problem in generating the electrical potential required for muscle contraction.”

Eyelid drooping and double vision are common
Prof. Dr. Şengün stated that in the majority of patients, the disease starts with these two complaints and over time, complaints related to other muscles appear. “In some patients, other muscles are not affected and only eye-related complaints remain. In this case, the disease is called ocular myasthenia. In some patients, the functions of bulbar muscles such as chewing, swallowing, speaking and breathing are affected. These patients may have difficulty chewing, especially at dinner, difficulty swallowing, and food may escape into the windpipe while swallowing. In addition to symptoms such as slurred speech and slurring of words during prolonged speech, there are complaints of difficulty in breathing with fatigue. These complaints may occur individually in one patient or as a combination of all of them. Then we talk about bulbar myasthenia. If myasthenia gravis affects the muscles of the arms and legs, generalized muscle weakness occurs with physical work. This type of myasthenia gravis is called generalized myasthenia. Although myasthenia gravis can be in the form of ocular only, bulbar only or generalized myasthenia, it usually appears as a combination of these clinical manifestations,” said Prof. Dr. Şengün.

Patients should consult a neurologist
Prof. Dr. Şengün mentioned “Since myasthenia gravis is a nerve-muscle junction disease, patients with complaints such as droopy eyelids, double vision, swallowing and speech disorders, and weakness during physical activities should consult a neurology judge. The most basic factor in diagnosing myasthenia is the clinical complaints of the patient. The crucial point here is that these complaints occur with fatigue and decrease or disappear with rest. People who use computers intensively in their work are prone to eyelid drooping and double vision because they are constantly looking at the screen. On the other hand, people who have to talk all the time to teach a lesson, such as teachers, are more likely to experience slurred speech in the afternoon. When myasthenia gravis is suspected in a patient who applies to a neurologist with these complaints, fatigue tests as well as ice tests are methods that can be easily applied for definitive diagnosis.”

There are effective treatments
Prof. Dr. İhsan Şükrü Şengün said about the treatment of myasthenia gravis: “First of all, treatment that prevents the breakdown of the chemical called aceticoline secreted into the nerve-muscle junction is started. The main treatment is immunosuppressive treatments to suppress the overactive immune system. However, not all patients may respond fully to these treatments and sometimes intervening infections may disrupt the patient’s prognosis. For patients who do not respond to immunosuppressive treatments, we now have highly effective new treatments that we can easily apply.”

Underlining that some treatments, supplements and substances can worsen myasthenia gravis, Prof. Dr. Şengün stated that botulinum toxin (botox) application, which has been widely used in the fields of aesthetics and weight loss in recent years, can have fatal consequences in myasthenia gravis patients, as well as muscle relaxants and magnesium taken as supplements and some antibiotics can cause myasthenic worsening, so patients should not take a treatment without consulting their doctor. Explaining that myasthenia gravis is now a disease that is easily managed thanks to new diagnostic methods and treatments, Prof. Dr. İhsan Şükrü Şengün said: “Today, the increase in awareness about diseases through social media enables many patients to be diagnosed earlier and start treatment. Especially myasthenia gravis, which used to be a very feared disease because it can impair respiratory function, has now become a more easily managed disease thanks to today’s diagnostic methods and new treatments.”

Pay attention to these warnings
Stating that myasthenia gravis is different from other diseases with some features, Prof. Dr. İhsan Şükrü Şengün explained that especially heat causes worsening of myasthenic complaints. For this reason, it is unfavorable for patients with myasthenia gravis to enter very hot environments such as baths or saunas, Prof. Dr. Şengün said, “In addition, another issue that affects especially female patients is menstrual periods. Myasthenic complaints may worsen during menstrual periods. It is important for patients to be aware of this situation in order to understand that the deterioration in complaints is not a real clinical deterioration or myasthenic crisis. Another issue is that all types of infections worsen myasthenic complaints. For this reason, it is important to avoid infections as much as possible and to be vaccinated for infections that are common in seasonal returns.”

August 2023

Summer, aside from the heat, makes many of us happy. But it also threatens our eyes. Sea, pool, sun and allergic conditions that increase with summer negatively affect our eye health.

Sea, sand, sun… This trio means summer and of course it also means vacation. If you want to have a trouble-free summer, you should pay special attention to your eye health because many dangers await your eyes during the summer months. In summer, external factors cause some eye diseases to occur and some to increase in severity. Faculty Member of Acıbadem University Faculty of Medicine, Department of Ophthalmology and Acıbadem Hospital Ophthalmology Specialist Prof. Dr. Özgül Altıntaş said, “Some summer risks are also watching children from sun rays to the sea, pool and beach, from the garden to green areas. Allergic reactions, sun exposure, flies, sand and dust in the eyes, exposure to insufficiently cleaned or chemical-rich pool water, and many other summer hazards can cause significant problems in children’s eyes. For this reason, some rules should be observed in terms of eye health in children in summer. Otherwise, some simple mistakes can cause permanent eye damage in the future.” Prof. Dr. Özgül Altıntaş explained the factors that threaten children’s eyes in summer and ways of protection, and gave important warnings and suggestions.

Summer allergens
Dust and pollen, which are more abundant in the air in summer, trigger allergies, often causing bloodshot, itchy and watery eyes in children. Eye allergy is an overreaction to a substance / food / pollen / house mite etc. due to the body’s immune system being sensitive to it. Itching, bloodshot and watery eyes. Sensitivity to light develops. Eyelids may swell. The best way to prevent allergies is to identify the cause of allergy and avoid it as much as possible. It is not possible to avoid every allergen. A wide-brimmed hat and sunglasses should be worn outdoors to protect against flying pollen and dust. Cold compresses can be applied to relieve the child and reduce the need for edema and itching. The type and duration of treatment is determined by the ophthalmologist according to the severity of the allergy. Otherwise, the child’s comfort of life will decrease. Rubbing and scratching the eyes causes the need for itching in the eyes to increase. Increased hand-eye contact is an important reason for the formation and proliferation of eye infections. Therefore, we should avoid rubbing our eyes and wash our hands frequently.

Getting ‘something’ in the eye!
During the summer months when children spend more time outdoors, foreign objects such as sand, dust, flies or grass can get into their eyes. Sometimes their own eyelashes can also get into their eyes. In these cases, children’s eyes bleed, watery, sensitive to light and need increased rubbing. This risk increases at beaches and rural areas. When a foreign body gets into the eyes, if we can see the foreign body, we can wash the eyes with a tear drop and float the foreign body with liquid to get it out. In this case, old drops left at home should not be used. However, if we cannot see it and the child’s complaints persist, the foreign body may be lodged in the inner part of the lids or lodged in the surface of the eye. We should definitely see an ophthalmologist. Because as the eyelid moves, the foreign body can scratch the transparent layer (cornea), causing infection and permanent damage. The ophthalmologist should remove the foreign body under a microscope if necessary and organize the necessary treatment. If it is not a foreign body but a chemical substance, the best thing to do is to wash the eye with clean water if there are no tears and to consult an ophthalmologist as soon as possible.

Solar radiation
Prolonged exposure to ultraviolet light can result in cataracts and retinal diseases in children. For this reason, children should stay away from the sun’s rays as much as possible during the hours when the sun reaches the earth vertically, especially between 10:00 and 16:00. In early infancy, the use of wide-brimmed hats in the shade of trees and the protection provided by the canopy of strollers will be sufficient. It is also a great risk for eye health for your child to look directly at the sun, either with the naked eye or with sunglasses. Therefore, when your child does this, explain why and make sure he/she understands that this is not the right thing to do.

Attractive but poor quality sunglasses
Sunglasses that children are attracted to because of their colors or because they are decorated with cartoon heroes can cause serious, permanent eye damage if they do not have UV protection. From the age of 2, children can start wearing sunglasses with 100 percent UV protection and Solar class 2 and 3. Be sure to see the certificate. The frame of the sunglasses should be made of flexible material, the lenses should be made of polycarbonate material that does not break easily and lenses that do not crack. Even if they are made of a material that does not break easily, it does not mean that they will never break. It would be appropriate to remove them in active environments, when playing in crowds with other children. It should also be suitable for the face shape of the growing child, it should be light, it should not put pressure on the nose, the temple should be long and should not disturb the ear.

Entering the sea and pool without glasses
Eye Diseases Specialist Prof. Dr. Özgül Altıntaş said, “Pool chlorine and sea salt can cause redness or irritation in the eyes. For this reason, it is important for eye health that children wear swimming goggles when entering the sea and pool. However, if water gets into the eyes or if it is not possible to have your child wear swimming goggles, it is necessary to wash the face and eyes with clean water after getting out of the water.”

Impact to the eye during sports/games
In the summer months, there are many outdoor sports for older children. During these sports, they can be hit in the eyes by balls, elbows, hands and nails, so they should always be careful. Such direct trauma can cause serious eye injury, corneal scratches, retinal tears, intraocular bleeding and edema. An insignificant blow, even if not noticed at the time, can lead to blindness in the future. Precautions should be taken according to the sport practiced. Swimmers should use swimming goggles to protect themselves from conjunctivitis and wash their eyes after leaving the pool. In tennis, both UV-protective and impact-resistant glasses should be used. Wearing protective impact-resistant sports goggles in close contact sports is useful to reduce these risks. However, these glasses are not absolutely unbreakable. It would be more appropriate not to use them in very close sports.

Klima
The simplest precaution is to moisturize our eyes more often by blinking more often, as tears can evaporate more than normal in sunny or air-conditioned environments in summer, causing drying, stinging, burning and even damage to the eye surface. You can also use an air humidifier in an air-conditioned environment. If the problem persists despite these, you can use artificial tear drops in consultation with an ophthalmologist, but if they are not enough, more intensive treatment may be required.

July 2023