SURGICAL PROCEDURES, PRE-OPERATIVE & POST-OPERATIVE INSTRUCTIONS
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CORNEAL DAMAGE OR DISEASE
One cause of reduced vision is damage to or disease of the cornea. The cornea is the dome shaped clear part at the front of the eye. Injuries & sometimes disease can cause this to become cloudy rather than clear. When this occurs a corneal transplant may help to correct this & restore useful vision.

Dr. Howell performs corneal transplant surgery on patients when needed. A thorough eye examination must be performed to determine that need. If you suspect a corneal problem for you, a friend, or someone you love, call Amarillo Eye Care Center at 358-7558 or 800-658-6662 to make an appointment for an examination.

Below are the pre-operative & post-operative instructions relating to corneal transplant surgery.

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PRE-OPERATIVE INSTRUCTIONS FOR CORNEAL SURGERY
Pre-admit on Monday or Tuesday (the week of surgery) at the hospital between 8 AM and 5 PM.

START THE DAY BEFORE THE SCHEDULED SURGERY

• Erthrocin 250 mgm, one tablet four times daily, with food.

• Vigamox eye drops -- use one drop in the operated eye four times daily.

• Tobradex eye drops -- Use one drop in the operated eye every hour while awake.

• Nothing to eat or drink starting at midnight.

ON THE DAY OF SURGERY

• Take early morning medication with only a sip of water.

• Continue all of the above.

• Go to the hospital at hour you were told.

• Bring the Erthrocin tablets, Vigamox, & Tobradex drops to the hospital with you.

• Be sure to make plans for someone to drive you home from the hospital.

• If there is anything you do not understand, call 358-7558.

POST OPERATIVE INSTRUCTIONS FOR CORNEAL SURGERY

ON THE DAY OF SURGERY

• Continue to take the medication (antibiotics) by mouth that you were taking when you came to the hospital. Take this until it is gone but no refill is necessary.

• Do not remove the patch from your eye and therefore no drops will be put in your eye until after you are seen by the doctor.

• If pain occurs try Tylenol or aspirin (two tablets) for relief. If pain persists and is severe, call the office number, 358-7558. The doctor will prescribe something stronger.

• Return to the Amarillo Eye Care Center tomorrow at the hour assigned to be seen by Dr Howell.
  In the morning bring with you the sack of medication and other things that will be sent home with you today.

BEGINNING THE DAY AFTER SURGERY

• When you leave please make an appointment to be seen on the date told by Dr. Howell.

• Continue to take the medication, antibiotics, by mouth that you were taking when you came to the hospital. Take all of the pills. No refill is necessary.

• Use Vigamox drops four times daily for one week. Wait five minutes between drops used four times daily.

• Use the Tobradex drops in your operated eye four times daily.

• When you run out of this medication switch to the drops in the case and use it four times daily until it is gone.

• Your vision may or may not be very good. If it is not, do not be alarmed about your vision. It is too soon to be alarmed.

• Wear your old glasses during your waking hours. Cover your eye at bedtime with the shield. Use tape sent from the office. It is not necessary to use a gauze patch under the shield.
  Wear the sunguard dark glasses any time you are outside in the daylight. They will fit over your own glasses.

• If you have any problems, call the office (806-358-7558) and speak with Rosella Curry, the office nurse. If necessary you may be asked to come in for an additional examination.

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DIABETIC EYE DISEASE (RETINOPATHY)
Every person who has diabetes is at risk to lose their vision because of changes that occur in the eye caused by diabetes. There are other potential risks to the kidneys & legs as well. The eye disease can be treated but timing is very critical. Because of this the American Academy of Ophthalmology recommend a yearly dilated examination by an Eye MD (Ophthalmologist) for every person who has diabetes. Persons who have to use insulin for control are more at risk but the disease known as "diabetic retinopathy" can occur in any diabetic person.

If diabetes is found in the eyes, then more frequent eye exams are necessary. If certain changes occur, treatment with a special "laser" is indicated. Before treatment, a test is performed. A dye called fluorescein is injected in an arm vein. Using a special kind of camera, photographs are taken of the inside of the eye as the dye circulates in the arteries & veins of the eye.

If there are deposits of material (exudate) near the part of the retina where the best vision is located (macula), this can cause a loss of vision. Treatment can cause these exudates to absorb & prevent loss of vision. A much more serious occurrence is the development of abnormal blood vessels on the surface of the retina or on the optic nerve. Should this occur, a much more aggressive laser treatment is indicated. Before the laser treatment was available this complication usually resulted in blindness. With special laser treatment blindness can usually be prevented today. To determine if treatment is necessary the patient needs to examined by an Eye MD, (Ophthalmologist).

If you, a friend, or someone you love has diabetes, call Amarillo Eye Care Center at 358-7558 or 800-658-6662 for an examination.

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GLAUCOMA
Glaucoma is called the "sneak thief of vision". Because there are no symptoms until much of the vision is lost, patients must have a medical eye examination to be diagnosed with glaucoma. Symptoms are not present until the disease is in an advanced stage. Recording an elevated intraocular pressure may suggest that further testing is indicated. At many health fairs, Lions Club members & other groups may provide glaucoma screening using a measuring device. It must be emphasized that this procedure is only a screening. Some patients who have glaucoma may be overlooked. There are other tests that should be performed before a diagnosis of glaucoma is made.

Some persons are more at risk than others. Older persons (over 40 years), African-Americans, diabetics, & persons with a family history (blood relatives) have a greater risk of developing glaucoma than the general public. The older we are the greater the risk of having glaucoma. Therefore it is not necessary to have yearly exams when younger. Exams are necessary later in life. Probably the greatest risk factor is family history. Vision lost to glaucoma is permanently lost & will not be recovered even if the disease is brought under control.

Glaucoma is most often controlled with the use of medicated drops put in the eyes on a regular basis. The use of drops is usually necessary for the rest of that patient's life.

Just like diabetes & heart disease there is not a cure for most forms of glaucoma, only control. The one form that can be treated & "cured" is acute or angle closure glaucoma. This form occurs most commonly in people who are moderately or highly farsighted. It causes pain in the involved eye or just above it in the brow, usually causing a blurring of the vision, & frequently nausea or vomiting. During an attack the person may see a colored halo surrounding lights at night. This is a surgical problem. If properly treated it can be cured. This is not a common form of glaucoma. Its treatment must be instituted soon after the onset or vision will be permanently lost. Examination for glaucoma is a part of every complete medical eye examination at Amarillo Eye Care Center & yearly exams are recommended for patients over sixty years.

If you, a friend, or someone you love needs to be examined for glaucoma, call 358-7558 or 800-658-6662 for an appointment at Amarillo Eye Care Center.

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MACULAR DEGENERATION
Unfortunately a very common problem with the older population is a disease which affects the central vision, macular degeneration. This is a degeneration of the retina where the best vision is located (macula). In its final stage, the patients have a large hole in the center of their vision which prevents them from being able to read, watch TV, drive safely, recognize faces, & many other important things. There is no specific treatment for this disease at present. Researchers are working to discover the cause & then a treatment. There are frequently changes in the macular portion of the retina indicating early macular degeneration which may occur before the vision fails that may be treated with the anti-oxidants & delay or even prevent loss of vision. This is another reason people over 60 years age should have a dilated eye exam yearly.

Many Eye MD's (Ophthalmologists), Dr. Howell included, recommend the use of a group of vitamins & minerals called the "anti-oxidants" in addition to six other food supplements (the most important of which may be Lutein). If there is a benefit from these supplements, it is to prevent further loss of vision, Damage which has already occurred cannot be reversed, however, slowing down or arresting progress of the disease is of benefit to the patient.

If you, a friend, or someone you love has this problem or decreasing vision for which you do not know the cause, call Amarillo Eye Care Center at 358-7558 or 800-658-6662 to make a appointment to be examined.

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MISALIGNED EYES
Many children have eyes that are not straight; either turned in or out, or not on the same level. This is called strabismus. If this is noticed at any age, the child should be examined by an Eye MD (Ophthalmologist) as soon as possible. This is not an emergency but it is an urgent problem. Frequently, this is caused by a structural problem with the muscles of the eyes. It is possible that a much more serious problem is present. Only a thorough eye examination can determine the cause; then the reason for the misaligned eyes should be addressed. Some children with crossed eyes need glasses to correct some or all of the turning. If glasses will correct some or all of the problem, that is the treatment & surgery should NOT be performed for the portion corrected by glasses. If the cause is structural, surgery may be indicated. With turning out of the eyes, almost always surgical correction will be necessary. It is not unusual for glasses & surgery to be necessary.

A very important aspect of this kind of problem is that children frequently start using one eye & let the other eye turn all the time. If this occurs, then an amblyopia or "lazy eye" can develop . This can usually be corrected with patching or blurring the vision of the straight eye. Patching has to be done when the child is very young. If one waits until the child is school age, patching may not correct the visual problem. In that case the child has permanent bad vision in the "lazy eye".

If you, a friend, or some family member have a child with this problem, call Amarillo Eye Care Center at 358-7558 or 800- 658-6662 to make an appointment for a thorough examination.

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EYELID SURGERY
We at Amarillo Eye Care Center do surgery for functional eyelid problems that affect the patient's vision instead of for cosmetic reasons. Droopy eyelids can affect the vision, just as can excessive skin sliding down on the upper lids. If the peripheral (side) vision is disturbed by this, it is a functional problem. Tests in the office can be performed to determine this. These problems are corrected surgically. If it can be shown that the vision is being affected, health insurance & Medicare will pay the major portion of the surgery.

Tumors & growths of the lids many times can be removed in the office with ease & little discomfort. Most often simple removal is all that is necessary. If the possibility of a malignancy is present, these samples are sent to a pathologist for examination. Sometimes more extensive removal is indicated when they are reported as malignant. Extensive removal is always done in an operating room setting.

If you, a friend, or someone you love is having these problems, call 358-7558 or 800-658-6662 for an examination & evaluation at Amarillo Eye Care Center.

The following are our post-operative instructions for patients having surgery on their lids.

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POST-OPERATIVE INSTRUCTION FOR EYELID SURGERY
When you get home, you should take Tylenol, two tablets every three hours for soreness. The worst discomfort is when the anesthesia begins to wear off. This may seem unpleasant, but it won't last long.
TONIGHT: Keep your head elevated (avoid bending over) and don't be too active tonight (sit quietly). You may watch TV, but reading will be blurry. Go to bed early and keep your head elevated on several pillows. Keep iced compresses on your eyelids for 30 minutes every hour. Put six ice cubes in the plastic bag, add one cup (6-8 oz) of water, roll it up and rest it on your closed lids while you lie back with your head elevated. Keep ice on it for at least 1/2 an hour then put it in the refrigerator for the next 1/2 hour, then start over. Replenish ice as needed. Go to bed with a fresh ice pack on and your head elevated. A little bleeding is normal, don't worry. Gentle pressure with a tissue will usually stop it if you recline quietly.

TOMORROW: Your lids will be swollen and perhaps a little black and blue. Stay quiet at home and watch TV or read. Use the cold compresses for 30 minutes every two hours (i.e.1/2 hour on, 1/2 hours off). Get some extra rest.

THEREAFTER: You may stop the cold compresses after the 2nd day, unless you want to use them. Soreness lasts about two days and itching may follow as a sign of healing. Use Visine if your eyes itch. You may wet your lids but don't use strong soap or rub or pick the tape or wound. Keep your head elevated for two weeks when you sleep, or until all swelling is gone. You may resume all normal activities after the sutures are removed (4-7 days). Wear dark glasses outdoors until swelling and discoloration are gone. Your lids or cheeks may get "black and blue" but this will disappear in three weeks. If you wish, use makeup to cover up your cheeks, but don't use any on your lids near the wound.

Always call us if you have excessive bleeding, soreness, eye pain or a change in vision.

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TEAR SAC DISEASE AND SURGERY
Some people have tearing so severe that tears run down their face most of time. There are only two causes for this tearing. One, the lacrimal gland (that makes tears) is producing an excessive amount of tears & the normal tear system cannot handle the increased amount. If the reason is irritation & the cause can be discovered and corrected, then tearing will no longer be a problem. The other cause of tearing is a blocked tear system. The tears cannot pass into the nose as they must. This may be caused by an active infection in the tear sac in the corner of the lower eyelid next to the nose or an infection may have been present in the past but no longer present. Frequently, this problem requires surgical correction. The surgery is performed in an operating room setting & usually under general anesthesia (patient put to sleep). This is usually paid for by health insurance or Medicare.

If you, a friend, or someone you love has this problem, call Amarillo Eye Care Center at 358-7558 or 800-658-6662 for an appointment for examination & consultation.

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