Dr. Jason Bacharach, MD

A properly working immune system identifies foreign substances in the body that might cause illness, such as bacteria and viruses. The immune system then creates antibodies which attack the foreign substances, neutralizing them and keeping the body safe. In people with autoimmune disorders, something goes wrong with this process. For reasons that are not fully understand, the immune system creates antibodies to attack the patient's own tissues.

Symptoms of an autoimmune disorder depend on which tissue is being attacked by the immune system, but common symptoms of autoimmune disease include fever, fatigue, and a general feeling of just not being well. Autoimmune disorders are more common in women than in men, and they may run in families. Autoimmune disorders can affect various parts of the body such as blood vessels, connective tissue, endocrine glands, joints, muscles, red blood cells, skin, and many others.

It is common to have more than one autoimmune disorder at a time. Most are chronic, or life-long illnesses, although they may come and go in flares. Treatment for autoimmune disorders depends on which part of the body is being attacked. For example:

• A type 1 diabetic whose pancreas has been damaged will need insulin.
• A person with Hashimoto's whose thyroid has been damaged will need replacement thyroid hormones.
• Someone with Sjogren's syndrome will need eye drops and mouth rinses to replace tears and saliva.

Many autoimmune disorders of all kinds are treated with immune-suppressing medications, such as corticosteroids (e.g. prednisone) to reduce the effect of the immune system.

Normally, the tears that constantly bathe the eyes are drained through two tiny holes in the eyelid, where they run through a duct into the nose. This tear duct can become clogged or blocked, causing tears to back up and leading to watery eyes. Common causes of tear duct blockages include trauma, a facial tumor, and inflammation due to certain medical conditions, but usually the cause is not known. Clogged tear ducts are especially common in young children. If the blockage is permanent and located lower in the duct, near the nose, DCR may be performed to create a bypass and allow tears to drain freely again.

During DCR surgery, a small hole is made in the bone and tissue between the upper part of the tear duct and the nasal passage. Usually, a tiny plastic tube called a stent is placed into the opening to protect it and keep it open during healing. DCR may be performed through an open incision on the upper cheek near the nose, or it may be performed endoscopically using tiny instruments that are passed through the nostril. Open surgery is more common, and has a slightly higher success rate, although endoscopic surgery causes less pain and bleeding during recovery. DCR is able to correct the blockage and watering eyes in nearly 95% of cases.

The surgery itself takes only about half an hour. It is usually done under general anesthesia, which may require a short hospital stay while patients recover. Small amounts of bleeding from the nose are not uncommon for the first 24 hours, and bruising and swelling are expected for the first two weeks. Don't be alarmed if the eye continues to water at first. Swelling in the area due to surgery can cause the eye to water, but this should go away as patients heal.

LASIK is generally considered an elective procedure (not medically necessary) since patients can wear glasses or contact lenses instead of undergoing LASIK. Nevertheless, many people still elect to undergo LASIK to have better vision without having to wear corrective lenses. Certain professionals, such as pilots, military members, firefighters, and athletes, might particularly benefit from LASIK.

Ophthalmologists (eye doctors) evaluate patients before surgery, measuring the cornea and checking for any eye irregularities that would disqualify patients from LASIK. A special eye scanner is used to create a map of the cornea. This map guides the surgeon in developing an individualized LASIK treatment plan. Once approved for LASIK, contact-wearers are advised to switch to glasses for the three weeks leading up to their surgery.

LASIK is a brief procedure, lasting for about half an hour, depending on the state of a patient's eyes and the corneal reshaping required. Patients lie down on a reclining chair and have numbing eye drops applied to one or both eyes to eliminate pain and discomfort during the procedure. While the eyes are held open by a device, the eye surgeon raises a fixation light where patients direct their eyes. The surgeon uses a femtosecond laser to cut a precise circular incision in the cornea's surface. The surgeon then manually folds back the corneal flap to access the stroma (inner cornea).

An excimer laser is then used to remove certain amounts of corneal tissue. For patients with farsightedness, the laser cuts tissue on the outer regions of the cornea, making the central cornea more prominent. For patients with nearsightedness, the opposite is done; central corneal tissue is removed while the outer tissue is left alone, flattening the eye. In patients with astigmatism, the laser is used to even out the surface of the corneal tissue, making the eye more spherical. When the lasering process is complete, the ophthalmologist folds the corneal flap to its regular position. The flap quickly begins to heal and naturally reattach itself to the eye.

LASIK patients need someone to drive them home from the procedure and cannot drive for the following 24 hours. Recovery from LASIK lasts about five days. Patients typically notice improved vision within a day or two of surgery. Prescription eye drops are given to patients to alleviate discomfort and promote eye healing. During this recovery time, patients must be incredibly careful not to touch or rub their eyes. Ophthalmologists often instruct patients to wear protective glasses during the day and night to prevent potential damage from eye rubbing.

LASIK can improve the experience of certain activities such as swimming or reading, and in some cases, LASIK can be a life-changing procedure for those with severe refractive vision errors. LASIK may also save patients money by eliminating the recurring need for updated corrective lenses.