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My client has glaucoma. What should I do?
Dr Charles Zwerling, MD writes: In regard to the glaucoma patient, there are many issues that should be considered. First what is the type of glaucoma narrow or open angle. Is the patient a steroid responder? The best advice would be to get clearance from the treating ophthalmologist. Certain medications like Benadryl can induce a narrow angle attack. Some preparations contain steroids which can induce a steroid response glaucoma. Some patients have had previous filtration surgery and undo pressure transmitted to the globe by pulling on the lid can cause problems with the stent or filtration bleb.
In the majority of simple open angle glaucoma there should be little problem in performing Micropigmentation; however, for the protection of the patient and the practitioner it would be wise to have medical clearance.
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Dr. Zwerling talks about risks of doing the "wetline"
I am not in favor of working the wetline concept. There are just too many things that could go wrong. In the hands of advanced well educated practitioners maybe but I am afraid of the average unexperienced practitioner trying to perform that technique.
Here is a list of risks:
Destruction of the meibomian glands which can lead to chronic dry eye syndrome
Scarring of the orifice which could lead to chronic chalazions
Disruption of the normal lid contour: exposure keratitis and chronic tearing
Potential for creating a chronic blepharitis syndrome
Potential harm to the Nasolacrimal duct orifice
The benefits? NONE. Use of the wetline actually makes the eye appear smaller.
 Dr. Dixon talks about "wetline"
Hi, it's me, Linda Dixon. I wanted to add my 2 cents on the wetline. I absolutely agree with Dr. Zwerling's expert assessment of the dangers of doing the "wetline". It is not a beginner's procedure and requires advanced training. I live here in beautiful Hawaii and culturally the wetline is fairly common here. My approach is to take my time and "underwork" the wetline which takes me about three visits. I don't want to give my patients a "dry eye" by damaging the vital Meibomian glands located in the "wetline". These glands produce a protein that coats tears and keeps the eye moist. Please inform the client (patient) that a "dry eye" can result. And, if you do proceed, take great care to not overwork the wetline. Call with any questions you may have about pigments or pain control that I use. *For sure, don't put your needle out too far or you will scar the tarsal plate (wetline).
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Vitiligo Update
 Click here for online vitiligo update. I tried very hard in my early years to treat vitiligo patients. Scalps, knees, cheeks, brows... you name it. With the predictable color changes of pigments I learned to NOT deal with vitiligo unless it was to replace an eyebrow "hair". The good news is that the excimer laser really helps "get the color back". Quote: Laser therapy Another innovation is therapy with an
excimer laser, which produces monochromatic rays at 308 nm to treat
limited, stable patches of vitiligo. This new treatment is an
efficacious, safe, and well-tolerated treatment for vitiligo when
limited to less than 30% of the body surface. However, therapy is
expensive. Localized lesions of vitiligo are treated twice weekly for
an average of 24-48 sessions. According to studies from 2004 and
2007, combination treatment with 0.1% tacrolimus ointment plus the
308-nm excimer laser is superior to 308-nm excimer laser monotherapy
for the treatment of UV-resistant vitiliginous lesions.25,26 |
