Dr. Jorge Camara is reporting new findings on a common eye condition prevalent in Asians. His display shows some pictures of how the eyes are affected.

Honolulu doctor’s research
helps Asians see pain-free

By Helen Altonn

Asians who suffer from tearing, pain and red eyes because their eyelashes turn inward may benefit from a Honolulu ophthalmologist's research on the disease and treatment.

Dr. Jorge Camara, chief of ophthalmology at St. Francis Medical Center, described the condition in Asian patients for the first time in the December issue of Archives of Ophthalmology, published by the American Medical Association.

Elizabeth Aguda, who is waiting for surgery for the condition she has had for three years, said she was thankful when Camara diagnosed it. "I was scared that something was wrong with my eyes ... It's like something is inside. My eyeball is so sore."

The condition is called involutional lateral entropion, meaning an inturning of the outer part of the upper eyelid, causing eyelashes to turn inward and rub on the cornea.

This can cause scratches and scarring on the eye's surface and if it isn't treated, ulceration of the cornea may occur, potentially threatening sight, Camara said.

"We believe that the unique anatomical characteristics of the upper eyelid of Asians predispose them to involutional entropion," he reported in his paper.

Inturning of the lower eyelid has been reported extensively, Camara said. However, doctors miss the upper eyelid condition because it can't be seen when they lift the eyelid manually to examine the eye, he said.

Camara said he began working on the problem about 10 years ago. "At that time, I didn't really put it all together." As he saw more patients with the condition, "it started to click."

He and colleagues at St. Francis Medical Center and the University of Hawaii Department of Surgery studied 53 Asian patients with involutional lateral entropion, including 37 women and 16 men ranging from 31 to 88 years old. Twenty-one were Filipinos, eight Chinese, 18 Japanese, four Koreans and two Hawaiians.

The most frequent sensation they reported was "something poking them in the eye" when their eyelashes rubbed against the cornea, Camara said. Other symptoms were tearing, redness, pain and itchiness.

Treatments by doctors for the undiagnosed condition have ranged from taping lids up and curling eyelashes to drops and ointments, he said.

He developed a surgical treatment that involves removing the excess skin to get the eyelashes away from the cornea. Insurance covers the outpatient procedure, which takes less than an hour, he said.

Kwang Hark Paik, one of Camara's first patients to undergo the surgery, said his eyes used to always tear. Looking in a mirror, he saw that his eyelashes were growing upward and he tried to pluck them, he said.

After Camara diagnosed the problem and did surgery, Paik said, "No problem."

Camara said he sees five or more patients a day with the condition in his reconstructive surgery practice.

Myrna Austria, who anticipates getting the procedure, said one doctor told her she had chickenpox in her eye.

Camara said drooping eyelids aren't always associated with the condition, and surgery isn't always necessary. Some cases are treatable with ointments or drops, he said.

But the condition usually isn't diagnosed because it hasn't been described until now, he said. "I'm hoping this brings greater awareness of it and help for patients and other physicians in taking better care of patients."

Dr. Susan Senft, a Big Island ophthalmologist and Hawaii Opthalmological Society president said when she learned of Camara's findings, she said she thought she might see three to five patients a month in her Kailua-Kona practice but "it's more like three patients a week and it might even be more.

"It's more prevalent in the Asian population over 60 and also applies to other regions and Asia and the Pacific as a whole."

St. Francis Healthcare System
Archives of Ophthalmology

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