Exophthalmos, I have a question please

[Gio111ca]

Hi all,

Was diagnosed with Graves a week ago and am on Tapazole 5mg 1 and 1/2 pills per day.

I have also been diagnosed with exophtalmos and have puffy bags under my eyes.

I have an appointment with an ophthalmologist in only 1 month and 1/2, and was wondering if there is anything I can do in the meantime to reduce the bags under my eyes as they are really showing now and are quite puffy.

Thank you.

NEW MEMBER.

[Andros]

Hi all,

Was diagnosed with Graves a week ago and am on Tapazole 5mg 1 and 1/2 pills per day.

I have also been diagnosed with exophtalmos and have puffy bags under my eyes.

I have an appointment with an ophthalmologist in only 1 month and 1/2, and was wondering if there is anything I can do in the meantime to reduce the bags under my eyes as they are really showing now and are quite puffy.

Thank you.

NEW MEMBER.

I am sorry to hear this. Welcome to the Board.

Yes; cooling ice packs help, sleeping w/ head slightly elevated helps and may I suggest that you try to get on a cancellation list so perhaps you can get in sooner?

Do your eyes hurt? Are you using moisturizing drops? Does the light bother you?

[Gio111ca]

Hi Andros, thanks for replying.

The ophthalmologist I was referred to will be attending a conference in the US and will only be available in 1 month 1/2. However, I did manage to get an appointment with another entomologist (fond through internet) in 2weeks. The secretary already told me there would be a $30 charge because those eye tests are not covered by medicare in Canada, no problem.

No, my eyes don't hurt and the light doesn't botter me. I use Visine drops sometimes in the morning because I get up at 5AM (have used them many times in the past for red eyes when getting up early, prio to Grave's).

It's actually all fine except for the puffy bags under my eyes. I will post a pic here if permitted. They are really showing.

SO I am wondering then if I should go see this ophthalmologist in 2 weeks and let him do his eye tests (which I'm not crazy about).

My endo said the ophthalmologist would give me a steroid for my puffy eyes, maybe I'll just ask for that and avoid all those tests as I am scheduled for a Tomo Orbit test at the hospital in 1 month ?

Thanks again.

[Andros]

Hi Andros, thanks for replying.

The ophthalmologist I was referred to will be attending a conference in the US and will only be available in 1 month 1/2. However, I did manage to get an appointment with another entomologist (fond through internet) in 2weeks. The secretary already told me there would be a $30 charge because those eye tests are not covered by medicare in Canada, no problem.

No, my eyes don't hurt and the light doesn't botter me. I use Visine drops sometimes in the morning because I get up at 5AM (have used them many times in the past for red eyes when getting up early, prio to Grave's).

It's actually all fine except for the puffy bags under my eyes. I will post a pic here if permitted. They are really showing.

SO I am wondering then if I should go see this ophthalmologist in 2 weeks and let him do his eye tests (which I'm not crazy about).

My endo said the ophthalmologist would give me a steroid for my puffy eyes, maybe I'll just ask for that and avoid all those tests as I am scheduled for a Tomo Orbit test at the hospital in 1 month ?

Thanks again.

Oh, I see!! Well then; wait is what you will do. In the meantime if I may share what my Ophthalmologist told me? He said, "Do not use products like Visine as they have an antihistamine and have a tendency to make the eyes worse." So, I followed his advice and use lubricating drops only (I use Refresh, don't know what you have in Canada) and Lacrilube Ointment at night.

That test sounds like Computed Tomography which would be like an MRI where they do grids of the orbits.................I think?? I am not 100% positive but it sounds like it. This would provide a baseline for future proptosis and/or improvements.

Yes; they can give steroid drops which help a lot and if not, oral steroids and there are Kenalog injections also. Let's hope you respond well to the drops.

Please keep your appt. with the ophthalmologist. It's what you don't see or don't experience that should be of a concern right now.

[Gio111ca]

Hi Andros,

Thanks again for responding.

May I ask about those steroids, are they eye drops or a pill ? Sorry, don't know much about that. Also, will they meae the puffy bags under my eyes go away, or what is the purpose?

Like I said, my vision is fine and I started taking Tapazole.

The only thing that is bothering are those puffy bags, and I'm not convinced they will go away on their own or with my Hyper condition stabilizing, then again I might be wrong.

[Andros]

Hi Andros,

Thanks again for responding.

May I ask about those steroids, are they eye drops or a pill ? Sorry, don't know much about that. Also, will they meae the puffy bags under my eyes go away, or what is the purpose?

Like I said, my vision is fine and I started taking Tapazole.

The only thing that is bothering are those puffy bags, and I'm not convinced they will go away on their own or with my Hyper condition stabilizing, then again I might be wrong.

Hi!! Firstly, if the situation is not to bad (and I pray not), the doc will try you on steroid drops. They will slow down the infiltration of the antibodies to the orbits of your eyes and my help the periorbital edema (puffy around the eyes.)

Sometimes, the use of mild diuretics help.

Systemic drugs have been used to treat different symptoms: Diuretics may help to temporarily decrease periorbital edema. Anti-inflammatory agents, particularly corticosteroids, have been used when ophthalmopathy is progressing rapidly. In the past, immunosuppressive agents such as Azathioprine or cyclophosphamide were used to treat Graves' disease. The success of such treatment is uncertain but it is still occasionally used for recalcitrant cases. (Feldon)

http://webeye.ophth.uiowa.edu/dept/DIAGTRT/Graves/graves.htm

[Gio111ca]

Thanks for all your help Andros appreciate it.

[Gio111ca]

But do you think a full eye examination would be necessary, meaning eye drops and pressure verification and so on ... or would an experienced ophthalmologist just look at me and know exactly what the problem is once he would know I have Grave's disease ?

Meaning he would conclude that my eyes are ok and the puffiness as being a result of it (never had any bags under my eyes my whole life) and recommend stereoid ?

I'm asking because I don't really like doctors playing with my eyes for no reason even more-so as I saw my optometrist a few months ago and everything was ok after the eye and prescription test.

[Andros]

But do you think a full eye examination would be necessary, meaning eye drops and pressure verification and so on ... or would an experienced ophthalmologist just look at me and know exactly what the problem is once he would know I have Grave's disease ?

Meaning he would conclude that my eyes are ok and the puffiness as being a result of it (never had any bags under my eyes my whole life) and recommend stereoid ?

I'm asking because I don't really like doctors playing with my eyes for no reason even more-so as I saw my optometrist a few months ago and everything was ok after the eye and prescription test.

Sadly, it does not quite work that way. He/she has to see what is going on inside the orbits. They cannot tell just by looking at you.

A good example is that there are other reasons for proptosis. Graves' is not the only reason.

[Gio111ca]

Andros,

In the meantime, would ice packs or something cold on my eye bags relieve the swelling ?

Thanks again.

[Andros]

Andros,

In the meantime, would ice packs or something cold on my eye bags relieve the swelling ?

Thanks again.

Oh, yes. Ice-packs help and sleeping w/ your head elevated helps. A lot.

[Gio111ca]

Hi Andros,

I have put ice packs yesterday for a good 15 minutes on my eyes, but they are still puffy, I don't see any change ? Even put cucumbers 10 minutes, I see no change.

Also, should I just use 2 pillows to sleep to keep my head elevated ? Did not know that would make a difference.

Thanks again.

[Andros]

Hi Andros,

I have put ice packs yesterday for a good 15 minutes on my eyes, but they are still puffy, I don't see any change ? Even put cucumbers 10 minutes, I see no change.

Also, should I just use 2 pillows to sleep to keep my head elevated ? Did not know that would make a difference.

Thanks again.

Well; that ice pack thing "is" touch and go. It depends of course on the severity of the periorbital myxedema.

If you sleep on your back, 2 pillows should suffice. Some folks raise the mattress a bit. I did that because I can't sleep on my back.

I feel bad for you right now. But take heart. With proper medical intervention you will be okay. You just hit a rough spot in your life. It will get better.

[Gio111ca]

Thanks for all your help Andros, will keep you posted on updates.

[Andros]

Thanks for all your help Andros, will keep you posted on updates.

I just hope and pray I am helpful and you are most welcome. We are all here for you if you need us.

This is one disease where I believe following medical protocul is the best option.

[Gio111ca]

Hi Andros,

I noticed my eyes have been watering up a bit for the past 2 days, never had that before (and it's not the cold).

Is this a symptom of something ?

Thank you again.

[Andros]

Hi Andros,

I noticed my eyes have been watering up a bit for the past 2 days, never had that before (and it's not the cold).

Is this a symptom of something ?

Thank you again.

Sometimes that can be a symptom. The light could bothering your eyes (photophobia) which can cause extreme watering, dry eye (due to proptosis) which can cause copious tear production and in general, just plain irritation.

If you are in doubt about any of the above, please see a board certified ophthalmologist.

Let me know how you are doing.

[Andros]

Hi Andros,

I noticed my eyes have been watering up a bit for the past 2 days, never had that before (and it's not the cold).

Is this a symptom of something ?

Thank you again.

Wondering how you are doing and if you made an appt. w/ the ophthalmologist? If you are around, please let us hear from you.

[Gio111ca]

Hi Andros,

Sorry for the delay to respond, have this tab opened up always in my Firefox.

I have an appointment with a ophthalmologist on Friday but just want to see if he can give me something in the meantime until I see the one I was originally scheduled with which has a great reputation (en of November).

It seems my eyes are getting better slowly and the puffiness seems to be slowly dissipating since is tarted taking tapazole, which was the same day I completely quit smoking (sorry, I think I had forgotten to add that).

Will keep you posted. Thank you again.

[Andros]

Hi Andros,

Sorry for the delay to respond, have this tab opened up always in my Firefox.

I have an appointment with a ophthalmologist on Friday but just want to see if he can give me something in the meantime until I see the one I was originally scheduled with which has a great reputation (en of November).

It seems my eyes are getting better slowly and the puffiness seems to be slowly dissipating since is tarted taking tapazole, which was the same day I completely quit smoking (sorry, I think I had forgotten to add that).

Will keep you posted. Thank you again.

Good for you and thank you for getting in touch. Sounds like you are making some "very" positive steps here. I smoked for 44 years. I quit. I am glad.

[Gio111ca]

Hi Andros,

Because my referred ophthalmologist is only available at the end of November, I took the liberty to go and see another one in the meantime.

Well, this one said the eye pressure in my left eye was to high (22), and that I probably have Glaucoma.

I am 41 and got my eye test last year before the eye prescription and pressure was fine, not too sure about this doc, he said I can go back next week and maybe it would be back to normal ,,,

Awaiting to see the suggested ophthalmologist at the end of November.

[Andros]

Hi Andros,

Because my referred ophthalmologist is only available at the end of November, I took the liberty to go and see another one in the meantime.

Well, this one said the eye pressure in my left eye was to high (22), and that I probably have Glaucoma.

I am 41 and got my eye test last year before the eye prescription and pressure was fine, not too sure about this doc, he said I can go back next week and maybe it would be back to normal ,,,

Awaiting to see the suggested ophthalmologist at the end of November.

Glaucoma is caused by interocular pressure. Sadly this one did not wish to address the cause. So.......................I sure hope the November guy/gal is a whole lot better than this one.

See if you can get on a cancellation list for the November one, why don't you?

How have you been feeling otherwise?

[Gio111ca]

Hi Andros,

Hope all is well. I have been feeling great.

I am already on a cancellation list for that November appointment, but the secretary told me he is in a seminar in the US ...

And you might know how hard it is to get an appointment here in Quebec (don't know where you are located).

I also have an Orbit tomo scheduled in 3 weeks.

This doctor told me today that nothing could be done with the bags under my eyes, unless I wanted surgery, so will see how it goes as I have noticed the bags diminishing.

I was thinking to myself, that if they took 9 months to grow (approximatelly), and I have been on Tapazole 3 weeks, I got to give my body a chance to recover.

[Andros]

Hi Andros,

Hope all is well. I have been feeling great.

I am already on a cancellation list for that November appointment, but the secretary told me he is in a seminar in the US ...

And you might know how hard it is to get an appointment here in Quebec (don't know where you are located).

I also have an Orbit tomo scheduled in 3 weeks.

This doctor told me today that nothing could be done with the bags under my eyes, unless I wanted surgery, so will see how it goes as I have noticed the bags diminishing.

I was thinking to myself, that if they took 9 months to grow (approximatelly), and I have been on Tapazole 3 weeks, I got to give my body a chance to recover.



I am doing well and thank you for asking. Yes and yes. My Ophthalmologist would not do surgery for 18 months after I had the radiation. He said healing should be as complete as it is going to get in that amount of time and then a better "assessment" of what had to be done was made. When it comes to surgery, you don't overkill because it is hard to correct that kind of mistake.

Glad you are getting the Tomography. Good deal on that.

Thanks for checking in.

[Gio111ca]

Hi Andros,

Sorry I haven't been around in a while, will update soon.

[Andros]

Hi Andros,

Sorry I haven't been around in a while, will update soon.

Glad you checked in. Will be looking forward to hear how you are faring.

[Gio111ca]

Hi again,

Hope all is well. My numbers have come down somewhat but are still over/under the normal range. I have noticed in December that I am seeing blurry from my left eye.

The ophthalmologist says my eye pressure is high and he detects a problem with my optic nerves and is sending me to see another specialist for that; depending on the feedback, he claims he is ready to operate ???

I did not get much info about that as he was in a rush and requires other docs advice. My advice is I will not get eye surgery at 41, unless it is a live/die situation. On the contrary, I have a feeling things are improving as the bags under my eyes seem to be going down and might be in the remission phase. This ophthalmologist was quite rapid to jump to a diagnostic in my opinion, as any operation is irreversible + I have been told a few years back by the optometrist he noticed a slight variation in my optic nerves, but not to worry if that never cause any problems. I was told my field vision test shows a deviance, not too sure what that means as this doc does not explain much.

So will see how things go.

[Andros]

Hi again,

Hope all is well. My numbers have come down somewhat but are still over/under the normal range. I have noticed in December that I am seeing blurry from my left eye.

The ophthalmologist says my eye pressure is high and he detects a problem with my optic nerves and is sending me to see another specialist for that; depending on the feedback, he claims he is ready to operate ???

I did not get much info about that as he was in a rush and requires other docs advice. My advice is I will not get eye surgery at 41, unless it is a live/die situation. On the contrary, I have a feeling things are improving as the bags under my eyes seem to be going down and might be in the remission phase. This ophthalmologist was quite rapid to jump to a diagnostic in my opinion, as any operation is irreversible + I have been told a few years back by the optometrist he noticed a slight variation in my optic nerves, but not to worry if that never cause any problems. I was told my field vision test shows a deviance, not too sure what that means as this doc does not explain much.

So will see how things go.

While this is not "my" ophthalmologist, I cannot say I am pleased. It definitely sounds like TED/GED (Thyroid Eye Disease/Graves' Eye Disease.)

I would urge you to find another who has experience w/ the above.

[Gio111ca]

I was told this optha is actually very knowledgeable in Graves eye disease, but I know realize he's only in it for the money (why else would he have jumped the gun to the operation). It's actually kind of bad as I'm sure he's operating people who do not require surgery.

Will have to look for another one, thank you.

[Andros]

I was told this optha is actually very knowledgeable in Graves eye disease, but I know realize he's only in it for the money (why else would he have jumped the gun to the operation). It's actually kind of bad as I'm sure he's operating people who do not require surgery.

Will have to look for another one, thank you.

I am relieved. One would not want to have any eye surgery until the thyroid is completely and utterly under control. While the eyes have to be treated independently, as long as the antibodies and autoantibodies are running amok, the eyes will be attacked.

There are things to be done to stop this. Firstly and you may not want to hear this but getting rid of the thyroid is crucial. Secondly, you can have radiation to the eyes (I did; 2000 RADS for 6 weeks 3 times a week) with Prednisone concurrent.

THAT stopped the eye infiltration. I then had to wait 18 months to make sure of this and also for whatever swelling was going to go down did indeed do that so the surgeon could make a correct assessment of what needed to be done. I then had 8 hour orbital decompression to both eyes and about 6 months later had surgery to release the eyelid muscle that was so badly retracted from the exophthalmos.

I am very very pleased that I had the Ophthalmologist I had. You would never know unless I told you what all happened to my eyes. I am left w/ strabisimus which is corrected w/ prisms. We knew that would be the case going in. I had no surprises.............at all.

Today, there are "other" approaches but I am not so sure they work as well. Each person is different so what worked for me, may not for you.

Do your research; that is the best advice I can give at this point.

[Gio111ca]

Thx for the input Andros, I appreciate it.

I too agree on the fact that I will wait until my levels become under control, unless I see an urgency for my eyes, which I don't at this time.

Your case looked a bit more severe than mine, I am happy that it is for the most part behind you. Had it not been for the bags under my eyes, nobody would guess I have thyroid issues (even that last opt said my case isn't too bad), guess I'm lucky on that angle.

Thx again for the feedback Andros and take care.

[Andros]

Thx for the input Andros, I appreciate it.

I too agree on the fact that I will wait until my levels become under control, unless I see an urgency for my eyes, which I don't at this time.

Your case looked a bit more severe than mine, I am happy that it is for the most part behind you. Had it not been for the bags under my eyes, nobody would guess I have thyroid issues (even that last opt said my case isn't too bad), guess I'm lucky on that angle.

Thx again for the feedback Andros and take care.

You are welcome; I am here for you and so are the other posters. Yes, my eyes were almost completely out of the orbits; very severe is an understatement.

[Gio111ca]

Maybe I'll take this opportunity to ask you a question Andros, if you don't mind.

I have been seeing fuzzy out of my left eye lately(ex:digital clock digits look a little fuzzy), never had that problem before, it's fin with my right eye. I do wear glasses, I am farsighted.

I have also noticed I am starting to have trouble in the evening focusing with my vision (ex: TV guide on screen), goto concentrate and focus on my vision to see letters on screen clearly. Was just wondering if you had any tips/suggestions/experiences on the subject? You know I quit smoking and eat good. I'm am scheduled to see a eye optic nerve specialist on March 1st.

Thank you again.

[Andros]

Maybe I'll take this opportunity to ask you a question Andros, if you don't mind.

I have been seeing fuzzy out of my left eye lately(ex:digital clock digits look a little fuzzy), never had that problem before, it's fin with my right eye. I do wear glasses, I am farsighted.

I have also noticed I am starting to have trouble in the evening focusing with my vision (ex: TV guide on screen), goto concentrate and focus on my vision to see letters on screen clearly. Was just wondering if you had any tips/suggestions/experiences on the subject? You know I quit smoking and eat good. I'm am scheduled to see a eye optic nerve specialist on March 1st.

Thank you again.

If it walks like a duck.................(you know the rest.) Yes; this is typical. One eye is always worse than the other and that usually is the left eye for whatever reason, I do not know. It sounds like things are happening and I am not happy to hear it.

It would be good to get a "baseline" measurment of your eyes so that if they start to protrude (even a little bit), this can be picked up.

Do you have photophobia (aversion to bright light?)

You might find this site helpful....... http://www.kellogg.umich.edu/patientcare/conditions/graves.disease.html

And the only suggestion I could give would be to stay under the care of a good Ophthalmologist who understands Thyroid Eye Disease.

Glad you were able to quit smoking. I smoked for 44 years and this Feb. will be 3 years smoke-free. Hubby too! :party0006:

[Gio111ca]

Hi Andros,

No, I don't have photophobia. I was able to schedule another appointment with another ophthalmologist, but only in April, hopefully he will have some cancellations, he also specializes in Graves. It is weird that I sometimes see like a little sun in my right vision at times (inwards), but that issue has been there for at least a year, will ask this new opth.

My focus is fine in the morning, it's at night that I must focus to see the TV guide and thingslike that; it's like I'M close to seing double, not sure. Can this condition go away on its own you think?

I am waiting for my latest test results by mail and will post results.

Regards.

[Andros]

Hi Andros,

No, I don't have photophobia. I was able to schedule another appointment with another ophthalmologist, but only in April, hopefully he will have some cancellations, he also specializes in Graves. It is weird that I sometimes see like a little sun in my right vision at times (inwards), but that issue has been there for at least a year, will ask this new opth.

My focus is fine in the morning, it's at night that I must focus to see the TV guide and thingslike that; it's like I'M close to seing double, not sure. Can this condition go away on its own you think?

I am waiting for my latest test results by mail and will post results.

Regards.

Good to hear from you. I have never heard of permanent unassisted remission of GED.

I believe that lying down at night lessens the inter-occular swelling and as the day wears on, the pressure builds up in the orbits. I had similar experience. Yes; I had strabisimus and still do. I had so much eye surgery, I just could not bear more plus, strabisimus surgery must be redone every 7 years or so. Few people know this. So I opted out on that and have prisms in my lens which correct that.

If you are having double vision now, your ophthalmologist can Rx paste ons for your lens that will help you a lot!

Glad you do not have photophobia!! Boy is that ever painful! Plus, you just plain can't see when that happens.

Good to hear from you!

Will be looking forward to those results and ranges.

[Gio111ca]

Hi Andros,

I am hoping my GED stabilizes after my Thytoid levels do, but that might just be wishful thinking. I don't know of any other treatment, although I mentionned my opto is almost ready to operate, but I have no idea for what nor what the operation involves, and that is why I found a second opto. I find the first opeation will only bring others, so I really want to avoid all of that.

I am looking into Grave's diest, but not too sure what that involves, but seems to be avoiding fish and brocolli and cheese and yogourts ... all things I eat, so not to sure about that.

[Andros]

Hi Andros,

I am hoping my GED stabilizes after my Thytoid levels do, but that might just be wishful thinking. I don't know of any other treatment, although I mentionned my opto is almost ready to operate, but I have no idea for what nor what the operation involves, and that is why I found a second opto. I find the first opeation will only bring others, so I really want to avoid all of that.

I am looking into Grave's diest, but not too sure what that involves, but seems to be avoiding fish and brocolli and cheese and yogourts ... all things I eat, so not to sure about that.

A healthy diet and life-style is certainly going to help. And so does wishful and POSITIVE thinking!!

As I have stated, early intervention is most most helpful so do get it and do what the ophthalmologist says for you to do w/ one caveat............hold off on the surgery only "if" your optic nerve and eyesight are not being compromised. When the eyes settle down is the time to assess and do surgery.

Let me repeat though, if you have an emergency, of course you must submit to surgery.

[Gio111ca]

Hi Andros,
I am seeing great improvement day by day on my eyesight and I attribute it all to the fact I quit smoking. I still see blurry from my left eye but it is not worrying me much ...

But what do you mean by ¨hold off on the surgery only "if" your optic nerve and eyesight are not being compromised¨.

Just for the sake of it, what would the surgery involve? Thank you again for all you insight.

[Andros]

Hi Andros,
I am seeing great improvement day by day on my eyesight and I attribute it all to the fact I quit smoking. I still see blurry from my left eye but it is not worrying me much ...

But what do you mean by ¨hold off on the surgery only "if" your optic nerve and eyesight are not being compromised¨.

Just for the sake of it, what would the surgery involve? Thank you again for all you insight.

A lot of people get talked into eye surgery (corrective and plastic surgery) to soon and often find they have to have it done again, often w/ a very bad outcome because of previous surgery.

I am talking about orbital decompressions, Levator surgery, strabisimus surgery.

[Gio111ca]

I have a feeling my opth was opting for orbital decompression, will research it, thank you.

[Andros]

I have a feeling my opth was opting for orbital decompression, will research it, thank you.

Well, let us know and I hope and pray things are better for your eyes.

If your optic nerves are seriously compromised; of course you must have the surgery. But if you can quiet things down with radiation concurrent with prednisone, why not?

Anything I have to say here is based on experience and opinion only.

[Gio111ca]

Hi Andros, not sure what you mean by ¨If your optic nerves are seriously compromised¨.

I haven't posted my blood test results because I asked for the latest and the doctor never received them from the lab, seems they got lost .. good think I follow up cause one would think everything is ok if doctor does not call ... guess he can't verify results if he doesn't get them ... will report back.

[Andros]

Hi Andros, not sure what you mean by ¨If your optic nerves are seriously compromised¨.

I haven't posted my blood test results because I asked for the latest and the doctor never received them from the lab, seems they got lost .. good think I follow up cause one would think everything is ok if doctor does not call ... guess he can't verify results if he doesn't get them ... will report back.

If you have interoccular swelling (severe), that compromises the optic nerves and the resultant outcome is blindness. Also, when the globes exit the orbits, that stretches the optic nerves beyond their capacity.

I have several books on anatomy. They are a good thing to have. You can also Google the anatomy of the eye.

I will look forward to your blood tests and ranges. Are you feeling better these days? I sure hope so!

[Gio111ca]

I am lately waking up with my nose somewhat clogged up, and I know it is not a cold. It's as my sinuses are clogged up a bit. I blow my nose and I'm back to normal. Wonder what it might be as I was reading about the orbit decompression and it was mentioned the bone between the orbit and the sinuses is removed ...

I also saw the negative consequences of having that operation, which confirm the theory of ¨if it's not broken, don't fix it¨... as more serious complications can follow. I find it hard to believe that optho never even addressed these issues.