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A retinal detachment occurs when the retina is pulled away from its normal position in the back of the eye. The retina sends visual images to the brain through the optic nerve . When detachment occurs, vision is blurred. A detached retina is a very serious problem that almost always causes blindness unless it is can be from tears or holes in the retina, or from fluid accumulation between the retina and underlying layers. When there is a tear of the retina, liquid from the vitreous may pass through the tear, and detach the retina. As the fluid accumulates, the retinal detachment becomes larger. Detached areas of the retina lose their vision. Most people notice floaters and flashes before the retina detaches. As the detachment occurs, a gradually enlarging dark area may be seen. Anyone with flashes or the sudden onset of a new floater (or floaters) should be examined promptly by an ophthalmologist . The ophthalmologist will search carefully for retinal tears.

7. Treating Demodex mite infestation: Ivermectin and Metronidazole tablets
I prescribe short courses of these agents to treat Demodex infestation of the eyelashes and meibomian
glands. Metronidazole is a commonly used antibiotic. Ivermectin is an effective antiparasitic agent
whose discoverers were awarded the Nobel Prize for Medicine in 2015. It has been very widely
used since 1981 to treat many parasitic diseases. The use of Ivermectin tablets to treat blepharitis is
unlicensed in the UK, but this does not mean it is ineffective and Ivermectin tablets have an excellent
safety profile. You will be interested to learn that Ivermectin cream is licensed to treat Demodex in
Rosacea (the trade name is Soolantra).
8. Cleaning the eyelid margin: Blephex
This is a cleaning device whose soft ,foam-tipped rotating head is soaked in detergent and used to
gently scrub heavily crusted eyelashes and eyelid rims and open the pores of the meibomian glands. I
use it on its own in clinic or immediately before Lipiflow.

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