Baltimore Washington Eye Center, Maryland

Tuesday, November 29, 2011

Malignant Eyelid Lumps and Bumps-What are They?

Here are definitions/descriptions of some of the most common eyelid cancers
·         Basal Cell Carcinoma-This is the most common skin cancer found on the eyelid. It is seen most often in people with fair skin who have a history of significant sun exposure.  It can occur on the upper or lower eyelid. Basal cell lesions usually appear relatively well defined, often with pearly edges and small blood vessels overlying it. Sometimes, depending on the location of the lesion, people will notice a loss in lashes in the same area. Most of the time, this is a very slow growing malignancy that is present for months before it is recognized. It rarely spreads to other parts of the body, but it does require removal and biopsy.  The extent of the tumor may be larger than it appears on the surface and a biopsy allows the pathologist to look for abnormal cells at a microscopic level so ensure that the tumor has been completely resected.

·         Squamous Cell Carcinoma-This is the second most common type of eyelid skin cancer. It is also found more often in patients with fair skin and a history of sun exposure and is usually found on the lower lid, but can occur on the upper.  Fortunately, it is a relatively slow growing cancer. It does, however, have the potential to invade the surrounding tissue, as well as metastasize and spread.  Squamous cell lesions appear flat or slightly elevated and are red and scaly; sometimes early lesions can present like a papilloma. The treatment is surgical, but this cancer often has microscopic spread, so the excision can be wider than with basal cell and often is done in collaboration with a dermatologist specializing in this type of surgery.

·         Melanoma-This is a rare form of eyelid skin cancer. The lesions are often tan, black or gray with irregular edges and can be rapidly growing. It is the most lethal of the skin cancers, but fortunately, it is rare, accounting for <1% of all eyelid cancers. The prognosis depends on the size of the lesion, the depth of growth, and the microscopic cell type.  Treatment is excision and biopsy and dermatologic evaluation for lesions elsewhere on the body.

Guest Blogger: D. Chimene Richa, M.D. Oculofacial Surgeon with the Baltimore Washington Eye Center

Friday, November 25, 2011

Bladder Cancer and Eye Disease?

A fascinating bit of research news out of New Orleans. Research conducted by Dr. Jayne S. Weiss, Chair of the Department of Ophthalmology at LSU Health Sciences, and colleagues has found that a defect in a gene involved in Schnyder's dystrophy, a rare disease of the cornea, also contributes to the progression of invasive bladder cancer. The findings are published in the November 2011 issue of the journal, DNA and Cell Biology.
http://www.liebertonline.com/toc/dna/30/11

Dr. Weiss remarks, "Research like this helps us target new treatment or prevention approaches for many seemingly unrelated diseases. She goes on to say, "Discovering a new component of the dynamic cellular cholesterol regulatory network gives us information that can be applied to every disease arising from a defect in it. Besides Schnyder's corneal dystrophy, this includes many types of cancer."

FLEX for LASIK

The end of the year is fast approaching. As you know, those Flex Spending Accounts, or FSAs, need to be used or the benefits are lost. Were you aware that LASIK costs 30% less if you use your Flexible Spending Account this year? That's right, because beginning in January 2013 FSA benefits change. Currently, there is no federally imposed limit on FSA amounts. After December 31, 2012, FSA accounts will be capped at $2,500 by the federal government.

If you are planning a big elective medical or dental procedure — like LASIK, braces or long-needed tooth implants or caps — you may want to schedule these treatments while you can still pay for a big chunk of the out-of-pocket expenses with pretax dollars.

Tuesday, November 22, 2011

Stye Alert! Help to Get Rid of a Stye!

A stye (also referred to as a chalazion) is a sometimes painful nodule that can develop in the upper or lower eyelids. It is caused by a blockage in the oil glands of the lids. This can occur when people have thick oil and inflammation in their glands, a condition known as meibomian gland dysfunction. When the oil glands get blocked, the resulting stagnant oil is a nidus for infection and once infected, the area becomes red, swollen and often tender. Sometimes these resolve on their own with hot compresses. Other times, there can be a fluctuating in the size of the chalazion where it can grow in size and will then start to get smaller until all you are left with is a small bump that is not painful, but that is not changing or resolving. The chalazion may get smaller if it "pops" and some of the infected/inflammatory tissue has a chance to get out. However, when the chalazion reaches a chronic stage where it is not changing, it has likely walled itself off from the body and the only way to treat it is to incise it to release the inflammatory tissue. At this stage, there is no active infection, but rather chronic inflammation.

At the onset of a stye or chalazion, the best treatment is hot compresses for 5 min at a time at least twice a day. In addition, you may be prescribed and antibiotic/anti-inflammatory ointment to help treat the infection and this oftentimes alleviates the need for a procedure. However, if after 2 weeks of this conservative treatment, there has not been a resolution of the chalazion, the best option is to incise and drain the lesion. This is done by anesthetizing the eyelid, making an incision from the inside of the lid, and excising the inflammatory tissue. This gives the body's immune system a chance to get to the source of the inflammation and help it heal.
If you think you have a stye the best course of action is to see an Ophthalmologist who can accurately diagnose you and start you on the appropriate treatment. Feel free to phone Baltimore Washington Eye Center at 800-495-3937.

Thursday, November 17, 2011

Lucentis for Diabetic Eye Disease

The anti-vascular endothelial growth factor (VEGF) drug Lucentis has been reported to provide positive results when used to treat Diabetic Macular Edema (DME) a cause of significant vision loss in patients with diabetes. Patients with Diabetic Retinopathy in the form of DME who received the drug experienced rapid and sustained improvement in vision compared to those who received a placebo injection.

Diabetic Macular Edema or DME is the swelling of retina in people with diabetic eye disease called diabetic retinopathy, which causes damage to the blood vessels of retina. The DME patients suffers fluid leak from the damaged blood vessel to the central portion of retina, causing it to swell leading to blurred vision, severe vision loss and blindness.

Of the 26 million U.S. people with diabetes, a portion of up to 10 percent tends to develop DME during their lifetime, and up to 75,000 new cases of DME are estimated to develop each year. Currently, DME patients are treated with laser surgery that helps seal the leaky blood vessels to slow the leakage of fluid and reduce the amount of fluid in the retina.

Lucentis is approved for use by the U.S. Food & Drug Administration (FDA) for the treatment of “Wet” Age-Related Macular Degeneration (AMD) and for Macular Edema following Retinal Vein Occlusion. In 2011, Lucentis was approved for treatment of visual impairment due to DME in Europe.

The key to successful treatment of Diabetic Retinopathy is early detection and intervention. If you or someone you know has diabetes or is even prediabetic please feel free to schedule a Diabetic Eye Examination at Baltimore Washington Eye Center by phoning us at 800-495-3937.

Tuesday, November 15, 2011

Droopy Eyelids-Help, I Can Barely Open My Eyes!

Some people have eyelids that droop so much that they can barely see and they need to use their brow to help raise their lids or even pick their chin up so that they can see better. I often hear the complaint "People always ask me if I'm tired" or "My husband thinks I am asleep." Sometimes people work so hard to keep their lids lifted that they get headaches as a result. This drop in the height of the upper eyelid, also known as ptosis (pronounced TO-sis), is very different from the excess eyelid skin, medically referred to as dermatochalasis.

There are different causes of ptosis, but the most common is involutional ptosis caused by aging.  As we age, the muscle tendon that attaches to the firm part of the upper eyelid (known as the tarsal plate) starts to lose its strength. It pulls away from its normal anatomic attachment, which weakens its ability to raise the upper eyelid.  As a result, patients see a higher eyelid crease and an upper eyelid that comes down and covers some or their entire pupil, blocking part of their vision. In order to raise the upper lid, surgery is performed to reattach the muscle that elevated the lid (the levator muscle) to the tarsal plate. This is done by making a skin incision in the upper lid along the eyelid crease and then dissecting down into the substance of the lid to find the levator and sew it back to its proper position on the tarsal plate. Then the skin incision is closed using dissolvable sutures. 

Another not uncommon cause of ptosis is congenital ptosis; this is generally present in childhood and results from a poor development of the levator muscle and it is too weak to lift the lid properly so it stays droopy.  Surgery in these cases is different than that for involutional ptosis and is typically performed by a pediatric ophthalmologist. Lid lesions, eyelid swelling, trauma, among other things are common causes of mechanical ptosis; this means that there is something in or on the upper lid that is weighing it down. In these situations, the treatment actually consists of treating the cause of whatever is pushing the lid down, rather than treating the muscle of the upper lid.

Often during a lid evaluation for ptosis, additional testing such as taped and untaped visual fields may be performed to determine if the droopy eyelid is blocking part of your vision. 

Monday, November 14, 2011

FLEX for LASIK

The end of the year is fast approaching. As you know, those Flex Spending Accounts, or FSAs, need to be used or the benefits are lost. Were you aware that LASIK costs 30% less if you use your Flexible Spending Account this year? That's right, because beginning in January 2013 FSA benefits change. Currently, there is no federally imposed limit on FSA amounts. After December 31, 2012, FSA accounts will be capped at $2,500 by the federal government. 

If you are planning a big elective medical or dental procedure — like LASIK, braces or long-needed tooth implants or caps — you may want to schedule these treatments while you can still pay for a big chunk of the out-of-pocket expenses with pretax dollars. 

Friday, November 11, 2011

Take a Moment for Our Veterans

We want to take a moment to thank all the men and women and their families in our Armed Forces around the world for keeping us safe. Your sacrifices in service to our country are very much appreciated.