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The most common ocular surface disorders stem from Tear Film Abnormalities and Blepharitis, each of which may lead to ocular surface disease. Most common eye lid problems that can cause watering include Ectropion and Entropion.

Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly. In addition, inflammation of the surface of the eye may occur along with dry eye. If left untreated, this condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision. However, permanent loss of vision from dry eye is uncommon.

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Drainage System

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Tear Layers

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Punctal Plugs

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Blepharitis

Blepharitis is a common condition that causes inflammation of the eyelids. The condition can be difficult to manage because it tends to recur.

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Ectropion is the turning out of the eyelid (usually the lower eyelid) so that the inner surface is exposed.

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Entropion is the turning in of the edges of the eyelid (usually the lower eyelid) so that the lashes rub against the eye surface.

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Blepharitis

Glaucoma

Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. Glaucoma occurs when the normal fluid pressure inside the eyes slowly rises. However, with early treatment, you can often protect your eyes against serious vision loss.

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How Eye Sees

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Open Angle Glaucoma

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Closed Angle Glaucoma

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Nerve Fiber Layer

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Visual Field Testing

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ALT / SLT Laser

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Iridotomy

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Trabeculetomy Surgery

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Setons

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How to use eye drops

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Normal Vision

The same scene as viewed by a person with cataract

Cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all people either have a cataract or have had cataract surgery. A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

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How Eye Sees

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What is cataract?

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Cataract Surgery

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YAG Laser

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IOLs Implant

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Monofocal Lense

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Presbyopia

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Monofocal Correction Options

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Multifocal Lense

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Normal Vision

The same scene as viewed by a person with cataract

AMD (Age-related Macular Degeneration) is a condition that can affect your eyes as you get older. In fact, in the over 50s, AMD is the leading cause of sight loss in Ireland, with over 7,000 new cases in Ireland every year. AMD affects the macula - a small part of the eye responsible for central vision which allows you to see detail. AMD usually starts in one eye and is highly likely to affect the other eye at a later stage. There are two types of AMD, dry AMD and wet AMD.

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How Eye Sees

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Dry Age-related Macular Degeneration

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Amsler Grid

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Wet AMD

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Fluorescein Angiography

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Diabetic Retinopathy

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes.
All can cause severe vision loss or even blindness.

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How Eye Sees

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NPDR (Non-Proliferative Diabetic Retinopathy)

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Macular Edema / schemia

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Fluorescein Angiography

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OCT

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Laser for Macular / Edema

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PDR (Proliferative Diabetic Retinopathy)

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PRP (Pan-Retinal Photocoagulation)

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PDR & VEGF

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Anti VEGF Injection

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Vitreous Hemorrhage

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Ultrasound

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Vitrectomy

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Facts About Macular Hole

This information was developed by the National Eye Institute to help patients and their families search for general information about macular hole. An eye care professional who has examined the patient's eyes and is familiar with his or her medical history is the best person to answer specific questions.

Macular Hole Defined

What is a macular hole?

A macular hole is a small break in the macula, located in the center of the eye's light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail.

A macular hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60.

Diabetic Retinopathy

Are there different types of a macular hole?

Yes. There are three stages to a macular hole:

The size of the hole and its location on the retina determine how much it will affect a person's vision. When a Stage III macular hole develops, most central and detailed vision can be lost. If left untreated, a macular hole can lead to a detached retina, a sight-threatening condition that should receive immediate medical attention.

Frequently Asked Question About Macular Hole
Is a macular hole the same as age-related macular degeneration?

No. Macular holes and age-related macular degeneration are two separate and distinct conditions, although the symptoms for each are similar. Both conditions are common in people 60 and over. An eye care professional will know the difference.

Causes and Risk Factors

What causes a macular hole?

Most of the eye's interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. Natural fluids fill the area where the vitreous has contracted. This is normal. In most cases, there are no adverse effects. Some patients may experience a small increase in floaters, which are little "cobwebs" or specks that seem to float about in your field of vision. However, if the vitreous is firmly attached to the retina when it pulls away, it can tear the retina and create a macular hole. Also, once the vitreous has pulled away from the surface of the retina, some of the fibers can remain on the retinal surface and can contract. This increases tension on the retina and can lead to a macular hole. In either case, the fluid that has replaced the shrunken vitreous can then seep through the hole onto the macula, blurring and distorting central vision. Macular holes can also occur from eye disorders, such as high myopia (nearsightedness), macular pucker, and retinal detachment; eye disease, such diabetic retinopathy and Best's disease; and injury to the eye.

Is my other eye at risk?

If a macular hole exists in one eye, there is a 10-15 percent chance that a macular hole will develop in your other eye over your lifetime. Your doctor can discuss this with you.

Symptoms

What are the symptoms of a macular hole?

Macular holes often begin gradually. In the early stage of a macular hole, people may notice a slight distortion or blurriness in their straight-ahead vision. Straight lines or objects can begin to look bent or wavy. Reading and performing other routine tasks with the affected eye become difficult.

Treatment

How is a macular hole treated?

Although some macular holes can seal themselves and require no treatment, surgery is necessary in many cases to help improve vision. In this surgical procedure--called a vitrectomy--the vitreous gel is removed to prevent it from pulling on the retina and replaced with a bubble containing a mixture of air and gas. The bubble acts as an internal, temporary bandage that holds the edge of the macular hole in place as it heals. Surgery is performed under local anesthesia and often on an out-patient basis.

Following surgery, patients must remain in a face-down position, normally for a day or two but sometimes for as long as two-to-three weeks. This position allows the bubble to press against the macula and be gradually reabsorbed by the eye, sealing the hole. As the bubble is reabsorbed, the vitreous cavity refills with natural eye fluids. Maintaining a face-down position is crucial to the success of the surgery. Because this position can be difficult for many people, it is important to discuss this with your doctor before surgery.

What are the risks of surgery?

The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment either during surgery or afterward, both of which can be immediately treated.

For a few months after surgery, patients are not permitted to travel by air. Changes in air pressure may cause the bubble in the eye to expand, increasing pressure inside the eye.

How successful is this surgery?

Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery. Vision recovery can continue for as long as three months after surgery.

What if I cannot remain in a face-down position after the surgery?

If you cannot remain in a face-down position for the required period after surgery, vision recovery may not be successful. People who are unable to remain in a face-down position for this length of time may not be good candidates for a vitrectomy. However, there are a number of devices that can make the "face-down" recovery period easier on you. There are also some approaches that can decrease the amount of "face-down" time. Discuss these with your doctor.

Floaters Defined
What are floaters?

Floaters are little "cobwebs" or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like spots, thread-like strands, or squiggly lines. They move as your eyes move and seem to dart away when you try to look at them directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.

Most people have floaters and learn to ignore them; they are usually not noticed until they become numerous or more prominent. Floaters can become apparent when looking at something bright, such as white paper or a blue sky.

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Retinal Detachment

The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

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Floaters Flashes

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Scleral Buckle

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Pnenomatic Retinopexy

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Vitretomy

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The retina at the back of the eye requires a constant blood supply. This blood supply makes sure that the cells of the retina get all the nutrients they need to continue working. The blood supply also removes any waste material that the cells have finished with. Like the rest of the body there are two types of blood vessels concerned with the blood supply to the retina, arteries and veins,

A blockage in either a retinal vein or artery is medically known as a 'retinal vessel occlusion'. Occlusion means closing or blocking up. They can happen in any of the blood vessels in the body, including the retinal arteries and veins. A retinal vessel occlusion can affect sight.

Retinal artery Occlusion

Branch Retinal Vein Occlusion

Central Retinal Vein Occlusion

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Facts About Vitreous Detachment

This information was developed by the National Eye Institute to help patients and their families search for general information about vitreous detachment. An eye care professional who has examined the patient's eyes and is familiar with his or her medical history is the best person to answer specific questions.

Vitreous Detachment Defined

What is vitreous detachment?

Most of the eye's interior is filled with vitreous, a gel-like substance that helps the eye maintain a round shape. There are millions of fine fibers intertwined within the vitreous that are attached to the surface of the retina, the eye's light-sensitive tissue. As we age, the vitreous slowly shrinks, and these fine fibers pull on the retinal surface. Usually the fibers break, allowing the vitreous to separate and shrink from the retina. This is a vitreous detachment.

In most cases, a vitreous detachment, also known as a posterior vitreous detachment, is not sight-threatening and requires no treatment.

Risk Factors

Who is at risk for vitreous detachment?

A vitreous detachment is a common condition that usually affects people over age 50, and is very common after age 80. People who are nearsighted are also at increased risk. Those who have a vitreous detachment in one eye are likely to have one in the other, although it may not happen until years later.

Symptoms and Detection

What are the symptoms of vitreous detachment?

As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina that you may notice as floaters, which appear as little "cobwebs" or specks that seem to float about in your field of vision. If you try to look at these shadows they appear to quickly dart out of the way.

One symptom of a vitreous detachment is a small but sudden increase in the number of new floaters. This increase in floaters may be accompanied by flashes of light (lightning streaks) in your peripheral, or side, vision. In most cases, either you will not notice a vitreous detachment, or you will find it merely annoying because of the increase in floaters.

How is vitreous detachment detected?

The only way to diagnose the cause of the problem is by a comprehensive dilated eye examination. If the vitreous detachment has led to a macular hole or detached retina, early treatment can help prevent loss of vision.

A squint a problem when the eyes stop working together as a pair and therefore do not look in the same direction. One eye may turn inwards (most common in children), outwards or even upwards or downwards.

The medical term for squint is 'Strabismus' A squint that turns inwards is called a 'convergent squint' or 'esotropia' and one that turns outwards is termed a 'divergent squint' or 'exotropia'.

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Argon Laser for Retinal Disorders

What happens during laser treatment?

Both focal and scatter laser treatment are performed in your doctor's office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort.

The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable. You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.

For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment. Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

Normal Fundus Fluorescein Angiography

This is a diagnostic procedure, when a dye is injected into a vein in your arm or hand and sets of digital photographs are taken to display the blood vessels at the back of your eye. It shows any abnormal blood vessels and any leaking spots causing your eye problems.This information is essential for the eye consultant to find the problem and plan your treatment.

You are advised NOT to drive for the rest of the day after you have had this procedure.

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Fluorescein Age-related Macular Degeneration

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Fluorescein Diabetic Regeneration

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