Surgical treatment of cataracts
Phacoemulsification technique (PHACO)

• Size of the incision from 1 to 2.75 mm.
• A probe is used to break the lens in microscopic pieces, which are then gently vacuumed up.
• It does not require sutures (“stitch-free” cataract surgery).

For patients over 40 to 45 years old with high degrees of refractive errors or with some degree of cataracts, the most recommendable surgical technique is extraction of the lens using the phacoemulsification technique and then implanting an intraocular lens.

The extraordinary evolution in the design of modern intraocular lenses, which incorporate biocompatible material, provides surgeons with an array of options that enable excellent clinical results to be obtained and make it possible for many patients to recover reduced dependence on glasses for seeing different distances.

An eye problem that is not diagnosed early can stop vision development and leave defects that continue throughout life.

When to take children to the ophthalmologist

There are two different situations in which children should be taken to the ophthalmologist: when a child complains or has eye pain and routine visits that should be carried out even if a child does not have eye problems.

The most common reasons that make it necessary for a child to visit the ophthalmologist are:

• Getting too close to the television or paper when they read or write.
• Squinting eyes when looking at far objects.
• Headache after straining sight.
• Common occurrence of red eyes.
• Deviation of the eyes.
• Differences in vision when covering one eye or another.
• White or greyish pupil (leucocoria).

Regarding routine visits by the ophthalmologist, the following checks are recommended:

• During the first month of life: rule out serious eye diseases or malformations (glaucoma or congenital cataracts).
• At seven months old: diagnosis of strabismus.
• At 18 months old: diagnosis of retinoblastoma (most common malignant tumour in childhood).
• At four years old: visual acuity and refractive errors.
• Every two years until reaching 14 years old.

Refractive errors
They are commonly referred to as eyeglass defects. In a normal eye, rays of light converge on the retina and create a sharp image. Refractive errors make it so objects are not seen with clarity. There are three types: hyperopia, myopia and astigmatism.

It is important to detect them early on, since they can lead to poor performance at school. They must be corrected using eyeglasses or contact lenses and, after 20, when degrees of error are stabilised, it is possible to operate with a laser. A baby can be visited to check for these errors, even if he/she is not able to talk.

What strabismus is and how to treat it
It is the abnormal deviation of one or both eyes in one or more sight positions. It can be a horizontal deviation (the eye deviates inward or outward) or a vertical deviation (the eye deviates upward or downward).

All children that deviate an eye intermittently should be visited when they are six to seven months old. Children that have a permanent deviation should be visited even before this age.

Strabismus can be corrected using eyeglasses, surgery or both. Surgery isolates the muscles responsible for the eye’s mobility and it positions them in another place in order to weaken or strengthen their effect. General anaesthesia is required for children.

What is lazy eye?
Amblyopia or lazy eye is the eye that didn’t develop properly during childhood and, consequently, has worse vision than the other eye.

Amblyopia affects 4% of children and can only be treated before eight to nine years of age; otherwise, it can cause a severe and irreversible visual defect.

It is usually detected in routine vision checks by a paediatrician or by a paediatric ophthalmologist, since it causes very few symptoms and usually goes unnoticed by parents.

Its most common causes are strabismus, refractive errors and, less commonly, eye diseases that prevent light from reaching the retina in a normal way (cataracts).

Treatment consists of forcing the child to use the lazy eye by patching the good eye.

Lacrimal obstruction
Tears normally lubricate the surface of the eye and drain through the lacrimal points toward the nose.

Lacrimal obstruction is when the tear path from the eye to the nose is obstructed. In children, it causes tearing and secretion (rheum) from birth.

Ninety percent of the time, the problem is solved spontaneously during the first six months of a child’s life. Antibiotic eye drops and massaging the lacrimal sac are beneficial. If the condition is not cured in this way, it is necessary to carry out a tear duct probe.

Lacrimal pathology

• Epiphora, hypersecretion or excessive tearing.
• Hyposecretion or little tearing.
• Acute dacryoadenitis, inflammation of the principal glands.
• Chronic dacryoadenitis, obstruction of the tear ducts at the lacrimal sac.
• Displacement of the lacrimal points.
• Lacrimal pump failure.
• The lacrimal system can have malignant tumours that lead to exophthalmos (bulging of the eye outward) and diplopia (double vision).

Pathologies in children
The most common lacrimal pathology in children is obstruction of the tear duct, which can be seen in the form of epiphora and conjunctivitis, especially during the first year of life. The second most common lacrimal pathology is traumatic pathology, which usually occurs in older children (between four and five years old). Its most common characteristic is the laceration (injury) of the tear ducts, especially the lower duct, due to accidents with pets.

• It is when the retina detaches from the back wall of the eye.
• The retina stops being supplied blood and nutrients.
• The retina will degenerate and will stop performing its function.
• It causes flashes of light that do not disappear, blurry vision and loss of central vision if the detachment is not fixed.
• It is considered to be an urgent disease that needs immediate intervention.

Causes of retinal detachment

Rhegmatogenous retinal detachment

• Caused by a tear or break in the retina that allows the vitreous humour to pass through the torn zone, thus causing the retina to detach.
• Caused by trauma, age or for no specific reason.
• It is the most common type of detachment.

Exudative

• Caused by the accumulation of fluid (exudative) underneath the retina that causes the retina to detach.
• Tumours and inflammatory disorders can cause exudative detachments.

Tractional retinal detachment

• Caused by the fibrovascular tissue of the vitreous cavity pulling on the retina.
• Proliferative diabetic retinopathy usually causes this type of detachment.

Treatments for retinal detachment
Scleral buckle
It is the most commonly used technique to repair retinal detachment.
A solid silicone band is placed on the sclera to push the eyeball toward the detached retina, thus alleviating the traction on the retinal hole.

Vitrectomy
Before using the scleral buckle technique, it is possible to carry out a vitrectomy to seal the tears or holes in the retina.
It involves the extraction of blood and vitreous humour from the eye and replacing it with a saline solution.
Three small incisions are made on the flat part of the eye, behind the iris and in front of the retina. Trocars and miniature cannulas are placed on the eye in order to be able to access the areas with the surgical instruments.
The holes where the trocars were placed need to be closed at the end of the vitrectomy.