Author: Carl T. Blanton

The ability to see the world using a pair of eyes is something that is often taken for granted. Many people will not take care of their eyes seriously until the eye is affected by certain conditions. While some eye disorders occur throughout lifetime, some may already have eye problems since they were young. In this DoctorOnCall’s article, we will learn about one of the many eye problems known as hypotropia.

To understand what is hypotropia, it is best to know what strabismus is first. This is because hypotropia is associated with strabismus. Strabismus is known as misalignment of the eyes. Strabismus is thought to affect around 5% of the general population. Strabismus usually develops in infants and young children. However, older children and adults may develop this condition. To understand how strabismus affects a person, knowing the basics of the eye movement can be a great help.

There are around 6 muscles attached to the eyes. These muscles control the eye movement. Muscles receive signals from the brain before it is able to move accordingly. In a normal setting, the eyes muscles work together to enable proper eye alignment. Thus, when there is a problem in the muscles controlling the eye movement, the eyes will look disproportionate to the normal eyes such as the eyes turning inwards or outwards. This is what happens in strabismus.

While it is true that strabismus can be caused by the problems with eye muscles, it may also be caused by the problem of the nerve controlling the eye muscles. It may also be caused by the brain problem being the control centre that signalling eye movement. These causes can be mediated by various issues such as family history with strabismus, refractive error that goes uncorrected or severe and medical conditions such as cerebral palsy or Down syndrome.

Back to our main focus, what is hypotropia exactly? Hypotropia is the term used to describe the eye moving downwards. Hypotropia is a form of vertical strabismus, beside  hypertropia (eye deviated upwards). Hypotropia can be restrictive when it causes restriction of the full movement of the eye’s globe. This can occur from trauma such as fracture to the orbit floor or walls holding the eyes in place. In less common cases, restrictive hypotropia can be caused by thyroid disease.

Symptoms of hypotropia are most obvious with the appearance of one eye gazing in a downward position. It usually occurs in one side of the eyes. Symptoms may also be double vision (diplopia), headaches, reading difficulties especially for a long period of time and blurred vision. In some cases, patients may have amblyopia. Amblyopia is a big issue as it can cause decreased vision over time as the brain starts to rely on the one eye with clear vision.

In order to fix hypotropia, through evaluation or assessment is needed before diagnosis can be made. Similar to many other eye problems, apart from eye examination, presence of family history with strabismus or amblyopia can be a great clue to a person developing hypotropia. If there is an event occurring before hypotropia happens, this information will be taken into account too. Beside routine eye examination, other tests may be needed to detect hypotropia such as corneal light reflex test and cover-uncover test. Vision test, slit-lamp exams, fundus examinations, ocular alignment test, extraocular muscle movement evaluation and cycloplegic refraction test, may be done as these are tests for strabismus in general.

Fixing hypotropia is important, especially in children because symptoms can cause the child to have difficulty learning effectively. Initial treatment is with the aid of prism lenses. Vision therapy can be helpful to improve eye focus and coordination. In some patients, correcting refractive error by eye glasses or contact lenses is enough to improve the symptom. Should all of these fail to improve the eye condition, surgery may be recommended. Surgery to the eye muscle can change the length or position of the muscle around the eyes. This is done to ensure the eyes appear straight. Injection of botulinum toxin or botox may help with eye misalignment. Cases of hypotropia caused by health conditions such as trauma or diabetes, will correct the hypotropia when the underlying condition is tackled.

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It can be concluded that hypotropia is a type of strabismus. It is a misalignment of eyes characterised by the eye turning downward when the other eye appears normal when looking straight. Hypotropia can occur as early in childhood due to neuromuscular problems affecting the eye muscles but may also be in adults such as from trauma or certain health conditions. Hypotropia needs to be treated or fixed appropriately to avoid complications such as amblyopia and asthenopia. This is especially true for children as it can cause them to have learning difficulties. Treatment will depend on the severity of the hypotropia but most are well managed with non-surgical methods.

Cheek fat removal (ตัดไขมันกระพุ้งแก้ม, which is the term in Thai), or Buccal fat removal, contributes to surgically constructing a slimmer face. In surgical terms, the face pads are removed from the lower cheek. To briefly talk about the surgery, buccal fat removal eliminates the lower cheek fat so that your face can get the needed narrow shape, concentrating more on the jawline and cheekbones of the face.

Potential Benefits Of Buccal Fat Removal

If you want to get cheek fat removal, you must be familiarised with the below-mentioned benefits:

· Enhanced Facial Definition

This is the primary benefit of the surgery that everybody wants to enjoy, and you get the same benefit. After undergoing a successful journey, you enjoy a defined cheekbone bone and jawline. As a result of this, you get a sculpted face.

· Permanent Results

After the surgery, once the buccal fats are removed from your face, you will witness permanent results since they don’t regenerate. Thus, with buccal fat removal surgery, you enjoy a long-term effect.

· Easy And Simple Procedure

Just like the name, the surgery is uncomplicated and simple. The best thing about this surgery is that you can go home the same day after a successful surgery. After that, you should be able to do your usual activity within a few weeks.

· Minimum To No Scarring

This surgery leaves you with minimal scarring as the surgery is done on the cheek’s inner side. Even if there are scars, they will remain hidden and hence won’t be noticeable enough.

Eligible Candidate For Buccal Fat Removal

There are specific terms and conditions that you are required to meet to be eligible for cheek fat removal, and they are as follows:

1. Candidate should be mentally and physically fit and healthy
2. No matter what your body weight is, you must have a chubby or round face naturally
3. The candidate has a strong desire to get those refined and sharp cheekbones
4. Candidates should have a realistic vision and expectations from the surgery.

Winding Up!

After you are done with your surgery, your doctor will provide you with all the precautions that you need to take. So make sure you are all ears when he is reciting the preventions. One of the precautions he may ask you to take is rinsing your mouth to prevent any spread of potential infection because, let’s face it, nobody wants an infected face after getting the surgery. So, if you are planning to get buccal fat surgery, ensure you are thoroughly familiar with the whole concept, some of which are mentioned above.

Living in the modern world has made metabolic diseases such as diabetes and hypertension affect more people than in the past. Our ancestors may not have had metabolic diseases as much as they do nowadays. Metabolic diseases in the current world could be blamed for the unhealthy lifestyle of the modern world consisting of a sedentary way of living and poor eating habits. Hypertension is indeed one of the metabolic diseases that keeps on rising in number. Medications such as Exforge 5/80 mg are among the many antihypertensive drugs used to treat people with hypertension. In this article, we will be learning a bit more about essential hypertension and its treatment.

Hypertension is defined as the systolic blood pressure values of above 130mmHg and/or diastolic blood pressure more than 80mmHg. The systolic pressure is a result of a pressure from a force as the heart pumps blood into the arteries and diastolic blood pressure is a result of the heart resting between beats. Essential hypertension is defined as persistently high blood pressure with no identifiable causes. It is also known as primary hypertension. It is worth noting that a person is typically diagnosed with hypertension after three or more blood pressure readings show high blood pressure and the readings are taken at least three or more times on separate visits across weeks.

In hypertension, the smaller arteries or also called arterioles are tightened. The tightened or constricted arterioles will cause the heart to work harder in order to pump blood through the narrowed space inside the walls of the blood vessels. This results in the pressure inside the blood vessels becoming high. As time goes by, the high force from the blood pressure damages the wall inside of the arteries. Ultimately, this makes plaque which is deposited cholesterol to be formed on the damaged wall and cause further high blood pressure due to the narrowed arteries.

Hypertension is known as a silent-killer. A person with hypertension often does not have symptoms unless the hypertension has caused complications such as kidney failure or heart disease. This means that hypertension does cause damage to organs when it is left untreated. It is estimated that less than half of adults with hypertension are diagnosed and treated. Hence, the best thing a person should do is to get regular medical check-ups to identify this disease early on. A person with hypertension should get diagnosed properly so that they can receive treatment and prevent complications.

Treatment of essential hypertension not only relied on medication. In fact, the recommended initial treatment is better lifestyle management. This includes patients making adjustments to their lifestyle such as regular physical activity, eating healthy food emphasising on reduced sodium diet and to keep a healthy body weight. Lifestyle changes alone make up to 15% reduction of risk for heart diseases related to hypertension. Lifestyle change is often difficult to be done consistently although it is shown that continuous changes would be the effective treatment for hypertension. Smoking cessation may not have a direct effect on blood pressure but doing this can definitely reduce the risk for complications caused by hypertension.

Since it can be difficult to be dependent alone on lifestyle changes, doctors usually prescribed medication to help patients control blood pressure. There are many kinds of antihypertensive drugs available and patients may be surprised to find out that they may receive different drugs compared to other people. The common antihypertensive drugs include angiotensin-converting enzyme inhibitor (ACE inhibitors) like captopril, angiotensin II receptor blockers (ARBs) such as telmisartan, beta blockers like propranolol, calcium channel blockers (CCB) such as diltiazem and diuretics like furosemide. Antihypertensive drugs prescribed by doctors are highly individualised. This means drugs prescribed depend on the patient’s other medical conditions and the blood pressure goal. A person may receive more than one antihypertensive drug at a time.

It is important for people with hypertension to take antihypertensive drugs as instructed by doctors. They should take the medicine regularly although they do feel they are healthy because hypertension rarely causes any symptoms unless the hypertension itself has caused organ damage or the blood pressure is very high. Symptoms of hypertension that should be seen as an emergency are severe headaches, chest pain, breathing difficulty, vomiting, nausea, confusion, abnormal heartbeat, blurred vision and nosebleeds. If a person experiences any of these symptoms and does have hypertension, he or she should be getting immediate medical care as this could be an ongoing life-threatening event.

In essence, treatment of essential hypertension is both lifestyle changes and medications. There is no cure for hypertension but treatment available helps patients to reduce risk for complications and have a fulfilling life. It is necessary for people with hypertension to ensure their blood pressure is well controlled. Unfortunately, only 1 in 5 adults with hypertension have it under control. This number should be improved as there is no reason why a person with hypertension could not have it under control since healthcare facilities nowadays are good and medical knowledge is more accessible.

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