Warm compresses can be applied. The simplest way is to hold a
clean washcloth, soaked in hot water, against the closed lid. Do this for
five to ten minutes, three or four times a day. Repeatedly soak the
washcloth in hot water to maintain adequate heat. The majority of chalazions
will disappear within a few weeks. Sometimes antibiotic ointments are used
in combination with warm compresses.
·
Surgical incision or excision may be used to remove large
chalazions which do not respond to other treatments. The procedure is done
in the office with local anesthesia. Young children with large chalazion may
require surgery in the operating room.
Chalazions usually respond well to treatment, although some people are prone
to recurrences. If a chalazion recurs in the same place, your ophthalmologist
(Eye M.D.) may suggest a biopsy to rule out more serious problems.
Champagne Corks
A flying champagne cork is an unguided missile capable of ruining anyone's
party. Since they are small enough to pass by protective facial bones and can
travel at high speeds, corks can be very dangerous projectiles and have been
known to blind people.
It is important to handle champagne bottles correctly and safely. Be sure the
bottle is cold before opening the champagne. The cork in a warm bottle is more
likely to pop unexpectedly. Chilling champagne to 45 degrees Fahrenheit also
improves its taste.
After removing the cork's foil covering, carefully remove the wire hood while
holding the cork down with the palm of your hand.
Point the bottle away from yourself and others. Place a towel over the top of
the bottle and tilt it at a 45-degree angle. Grasp the cork, and slowly and
firmly twist it to break the seal.
Keeping the bottle at a 45-degree angle, hold it firmly with one hand and use
the other hand to slowly turn the cork with a slight upward pull. Continue
twisting until the cork is almost out of the neck of the bottle. Counter the
force of the cork using slight downward pressure just as the cork breaks free
from the bottle.
Conjunctivitis (Pink Eye)
Pink eye, the common name for conjunctivitis, is an inflammation or infection
of the conjunctiva, the outer, normally clear covering of the sclera, the white
part of the eye. The eye appears pink in conjunctivitis because the blood
vessels are dilated. Pink eye is often accompanied by a discharge, but vision is
usually normal, and discomfort is mild.
Either a bacterial or a viral infection may cause conjunctivitis. Viruses,
which are more common and last several weeks, may cause an upper respiratory
infection (or cold) at the same time. Unlike viruses, bacterial conjunctivitis
is treated with a variety of antibiotic eye drops or ointments, which usually
cure the infection in a day or two.
Conjunctivitis can be very contagious. People who have it should not share
towels or pillowcases and should wash their hands frequently. They may need to
stay home from school or work and should stay out of swimming pools.
Not everyone with conjunctivitis has an infection. Allergies can cause
conjunctivitis too. Typically, people with allergic conjunctivitis have itchy
eyes, especially in spring and fall. Eye drops to control itching are used to
treat allergic conjunctivitis. It is important not to use medications that
contain steroids (they usually end in "-one" or "-dex") unless prescribed by an
ophthalmologist.
Finally, not everyone with pink eye has conjunctivitis. Sometimes more
serious diseases, such as infections, damage to the cornea, very severe
glaucoma, or inflammation on the inside of the eye cause the conjunctiva to
become inflamed and pink. Vision is usually normal if the pink eye is really
conjunctivitis. If vision is affected, or if the problem does not get better in
a few days, see an ophthalmologist.
Eye Care
Facts and Myths
Myths
1.
Reading in dim light is harmful to your eyes.
2.
It is not harmful to watch a welder or look at the sun if you squint, or
look through narrowed eyelids.
3.
Using a computer, or video display terminal (VDT), is harmful to the
eyes.
4.
If you use your eyes too much, you wear them out.
5.
Wearing poorly-fit glasses damages your eyes.
6.
Wearing poorly-fit contacts does not harm your eyes.
7.
You do not need to have your eyes checked until you are in your 40s or
50s.
8.
Safety goggles are more trouble than they're worth.
9.
It's okay to swim while wearing soft contact lenses.
10.
Children outgrow crossed eyes.
11.
A cataract must be ripe before it can be removed.
12.
Cataracts can be removed with lasers.
13.
Eyes can be transplanted.
14.
All eye care providers are the
same.
Facts
1.
Although reading in dim light can make your eyes feel tired, it is not
harmful.
2.
Even if you squint, ultra-violet light still gets to your eyes, damaging
the cornea, lens and retina. Never watch welding without wearing the proper
protection. Never look directly at an eclipse.
3.
Although using a VDT is associated with eyestrain or fatigue, it is not
harmful to the eyes.
4.
You can use your eyes as much as you wish-they do not wear out.
5.
Although a good glasses fit is required for good vision, a poor fit does
not damage your eyes.
6.
Poorly fit contact lenses can be harmful to your cornea (the window at
the front of your eye). Make certain your eyes are checked regularly by your
ophthalmologist if you wear contact lenses.
7.
There are several asymptomatic, yet treatable, eye diseases (most notably
glaucoma) that can begin prior to your 40s.
8.
Safety goggles prevent many potentially blinding injuries every year.
Keep goggles handy and use them!
9.
Potentially blinding eye infections can result from swimming or using a
hot tub while wearing contact lenses.
10.
Children do not outgrow truly crossed eyes. A child whose eyes are
misaligned has strabismus and can develop poor vision in one eye (a condition
known as amblyopia) because the brain turns off the misaligned or “lazy” eye.
The sooner crossed or misaligned eyes are treated, the less likely the child
will have permanently impaired vision.
11.
With modern cataract surgery, a cataract does not have to ripen before it
is removed. When a cataract keeps you from doing the things you like or need to
do, consider having it removed.
12.
Cataracts cannot be removed with a laser. The cloudy lens must be removed
through a surgical incision. However, after cataract surgery, a membrane within
the eye may become cloudy. This membrane can be opened with laser surgery.
13.
The eye cannot be transplanted. It is connected to the brain by the optic
nerve, which cannot be reconnected once it has been severed. The cornea-the
clear front part of the eye-can be transplanted. Surgeons often use plastic
intraocular lens implants (IOL's) to replace natural lenses removed during
cataract surgery.
14.
An ophthalmologist is a medical doctor (M.D.) or doctor of
osteopathy (D.O.), uniquely trained to diagnose and treat all disorders of the
eye. An ophthalmologist is qualified to perform surgery, prescribe and adjust
eyeglasses and contact lenses, and prescribe medication.
15.
An optometrist (O.D.) is not a medical doctor, but is specially
trained to diagnose eye abnormalities, and prescribe, supply and adjust
eyeglasses and contact lenses. In most states, optometrists can use drugs to
treat certain eye disorders.
16.
An optician fits, supplies, and adjusts eyeglasses and contact
lenses. An optician cannot examine the eyes or prescribe eyeglasses or
medication.
Fireworks
Fireworks rupture the
eyeball, burn the eye and face, cut eyelids, and cause corneal abrasions in
approximately two thousand people every year in the US. One quarter of these eye
injuries result in permanent loss of vision or blindness.
The single most dangerous
type of firework is the small, explosive bottle rocket. Their erratic flight
causes injuries to users and bystanders alike. Sparklers, often given to young
children, burn at 1800 degrees Fahrenheit, nearly hot enough to melt gold.
To avoid the dangers of
fireworks, attend public firework displays instead of using fireworks at home.
Amateur backyard displays are dangerous to the person lighting the fireworks and
to nearby family members, friends, and neighbors. Celebrate safely by letting
the professionals put on the show.
At a public fireworks
display, follow these safety tips to keep you and your family safe:
·
Leave the lighting of fireworks to
trained professionals-not only is it safer, it is also cheaper and more
spectacular.
·
Respect safety barriers set up to
allow the pyrotechnicians (or firework professionals) to do their jobs safely.
·
For the best and safest view,
stand at least 500 feet, or up to a quarter of a mile, away.
·
Follow directives given by event
ushers and public safety personnel such as police and fire fighters.
·
If you find unexploded fireworks
remains, do not touch them. Immediately contact local fire or police
departments.
·
Most importantly, never let your
child play with fireworks. Ever.
If a fireworks injury to
the eye does occur, do not touch the eye. Get medical attention immediately.
First Aid for Eye Injuries
The most common type of eye injury that needs
immediate action is a chemical burn. Alkaline materials (lye, plasters, cements,
and ammonia), solvents, acids, and detergents can be harmful to the eye. Eyes
should be flushed liberally with water if exposed to any of these agents.
If sterile solutions are readily available, use
them to flush the affected eye. If not, go to the nearest sink, shower or hose
and begin washing the eye with large amounts of water. If the eye has come in
contact with an alkaline agent, it is important to flush the eye for ten minutes
or more. Make sure water is getting under the upper and lower eyelids.
Abrasions or scratches of the eyelids or cornea,
the clear covering of the eye, occur frequently and can be quite uncomfortable.
If the abrasion is dirty, gently cleanse the area with a stream of clean water.
Do not attempt to treat severe blunt trauma or
penetrating injuries to the eye. Tape a paper or Styrofoam cup over the injured
eye to protect it until proper care can be obtained.
In the case of a blow to the eye, do not assume
the injury is minor. The eye should be examined thoroughly by an ophthalmologist
because vision-threatening damage could be hidden.
First aid is only the first step for emergency
treatment. If you experience pain, impaired vision, or any possibility of eye
damage, call your ophthalmologist or go the emergency room immediately.
Herpes Zoster
One's first encounter with the herpes zoster
virus is usually childhood chicken pox. Later in life, the virus may reactivate,
causing a characteristic rash of small blisters, frequently on the chest or
forehead, which form crusts and may leave scars. This second encounter is known
as shingles.
Unlike chicken pox, this condition is usually
quite painful. Although this disease often occurs in normal, healthy people, it
occurs more frequently in elderly or immune-compromised individuals.
It is important to see an ophthalmologist when
herpes zoster occurs on the face because the virus may invade the eye. An
ophthalmologist looks for elevated pressure in the eye, inflammation, and herpes
zoster lesions on the surface of the eye. All these problems can be treated but
they are sometimes difficult to manage. Therefore, careful treatment and
follow-up are required. New oral antiviral medications are providing sufferers
with a quicker, more complete recovery.
How To Insert Eye drops
Infections, inflammation, glaucoma, and many
other eye disorders are treated with eye drops. Surprisingly, even the small
amount of medication in an eye drop can create significant side effects in other
parts of the body. It is important to remember that all medicines have side
effects. There are ways to decrease the absorption of the eye drop into the
system, and to increase the time the eye drop is on the eye, making the medicine
more safe and effective.
Inserting eye drops may seem difficult at first
but becomes easier with practice. To put in an eye drop, tilt the head back. Then
create a pocket in front of the eye by pulling the lower lid down with an index
finger or gently pinch the lower lid outward with the thumb and index finger.
Let the drop fall into the pocket without touching your eye or eyelid (to
prevent contamination of the bottle).
Immediately after instilling the drop, squeeze
the bridge of your nose for two to three minutes with your thumb and forefinger.
This prevents most of the drop from traveling down the tear duct to the rest of
the body.
Keep your eyes closed for three to five minutes
after instilling the drop. Because the volume of a single drop exceeds the
capacity of the surface of the eye, it serves no purpose to use two drops at the
same time.
Before opening your eyes, dab unabsorbed drops
and tears from the closed lids with a tissue.
If you are taking two different types of eye
drops,
wait at least five minutes before instilling the second drop.
How to View an Eclipse
Looking at an eclipse is as dangerous as staring
at the unblocked sun, and can cause damage to the retina, the light sensitive
nerve layer at the back of the eye. The damage affects the macula, the part of
the retina responsible for central vision.
Many people think they can protect themselves by
looking through filtered binoculars, sunglasses, neutral density filters or
exposed photographic or radiographic film. A retinal burn can occur in spite of
all these barriers. In a 1970 solar eclipse in the eastern US, 145 retinal
burns were reported. Forty percent of the injured were using protective filters.
Parents must caution children not to look
directly at the sun. Not only are children more tempted to watch an eclipse; the
damage is more severe because the child's natural lens is so clear that it lets
more U-V rays reach the back of the eye.
There are safe ways to watch an eclipse. Attend a
display at a planetarium or university astronomy department where optical
instruments are used to project an image of the eclipse from a telescope to a
screen for your viewing. Watch the eclipse on television. Or use the simple
device described below.
Take two sheets of white paper. Make a pinhole in
the center of one of the pieces. Then stand with your back to the sun and hold
the sheet with the pinhole so that the sun shines through the hole and onto the
other sheet of paper. An image of the eclipse will be visible on this sheet. It
is amazing how well you can observe a solar eclipse with this device.
If you suspect you or a family member has
suffered a solar injury to the eye, consult an ophthalmologist.
Jump-Starting Your Car
Many people suffer severe eye injuries every year
because they do not take proper precautions while jump-starting their car. A
spark caused by hooking up the jumper cables can ignite fumes and cause the
battery to explode. Battery acid and flying battery parts can blind you.
Here are few simple precautions to avoid a
serious injury:
·
Wear protective goggles during all
phases of the procedure. Keep a pair attached to your jumper cables.
·
Put out cigarettes before opening
the hood. Use a flashlight, not a match, to look under the hood at night.
·
Be certain the vehicles are not in
contact with each other.
·
Do not allow the cable clamps to
touch each other.
·
Attach the positive (+) cable (red)
to the positive terminal of the dead battery first. Then attach the other end of
the positive cable to the good battery.
·
Attach the negative (-) cable
(black) to the negative terminal of the good battery. Then attach the other end
of the negative cable to the engine block away from the negative terminal. Do
not attach a cable to the negative terminal of the dead battery.
·
Once the engine is started,
carefully remove the cables in reverse order, again not allowing the clamps to
touch.
·
Do not lean over the battery during
the jumping process.
If an injury does occur, contact your
ophthalmologist or go to the emergency room immediately.
Legal Blindness
Normal vision, or 20/20, means a person sees the
smallest letters or pictures on an eye chart when standing 20 feet away from the
chart. Some people cannot see normally, even with glasses or contacts, because
a medical condition affects their vision. These people are called visually
impaired or visually handicapped.
If a visual handicap limits vision to 20/200, or
one-tenth of normal, a person is legally blind. Legally blind does not mean
totally unable to see. Someone legally blind cannot see the line below the
second big E at the top of the eye chart. People with 20/20 vision but less than
20 degrees of side vision can also qualify as legally blind. People who see well
with only one eye are not considered legally blind, nor are people who wear
glasses to see better than 20/200.
Most legally blind people function quite well,
especially if they have been visually handicapped since childhood. Older
children and adults with visual handicaps may need magnifying lenses for reading
and telescopes for distance viewing. People with very poor vision may need to
learn Braille and walk with a seeing-eye dog or a cane.
Young children with visual impairments should
have help from a teacher of the visually impaired and should be evaluated for
developmental problems by professionals experienced with visual handicaps.
Parents may need to be advocates for their child to obtain needed services
through the school system.
Visually handicapped people of all ages benefit
from social service, occupational therapy, and orientation and mobility
training. Many new devices are available to cope with vision loss, including
books on audio tapes, scanners that turn print into Braille, watches that can be
"read" with the fingers, and talking computers and calculators.
Lid Margin
Disease
Lid margin disease is a
common, persistent inflammation of the eyelids. Symptoms include irritation,
itching, and occasionally, a red eye. This condition frequently occurs in people
who have a tendency towards oily skin, dandruff, or dry eyes.
Bacteria normally reside on
everyone's skin, but in some people they thrive in the skin at the base of the
eyelashes. Nearby oil glands may be overactive, causing dandruff-like scales and
particles to form along the lashes and eyelid margins, which can cause redness,
stinging or burning.
Lid margin disease may not
be cured, but it can be controlled with a few simple daily hygienic measures:
·
At least twice a day, place a
warm, wet washcloth over the closed eyelids for a minute. Rewet it as it cools,
two or three times. This will soften and loosen scales and debris. More
importantly, it helps liquefy the oily secretions from the eyelids' oil glands
that help prevent the development of a chalazion, an inflamed lump in an eyelid
oil gland.
·
With your finger covered with a
thin washcloth, cotton swab, or commercial lint-free pad, gently scrub the base
of the lashes about 15 seconds per lid.
When medications are
necessary, they may include:
·
Artificial tears to relieve
symptoms of dry eye. (These are eye drops that are available without a
prescription.)
·
·
Antibiotics (oral or topical) to
decrease bacteria on the eyelids.
·
Occasionally steroids (short-term)
to decrease inflammation.
Medications alone are not
sufficient; the application of warmth and detailed cleansing of the lashes daily
is the key to controlling lid margin disease.
Living With One Good Eye
People who lose vision in one eye because of an
injury or a medical condition must adapt to a narrower field of vision and loss
of depth perception. They still see small objects as well as before, assuming
the other eye is normal.
People often think children with strabismus
(misalignment of the eye) or amblyopia (lazy eye) have poor depth perception
because they have trouble using two eyes together. Although these children do
poorly on tests of depth perception in an ophthalmologist's office, they have
learned to adapt from an early age. In real-world circumstances, they do not
have trouble with depth perception.
At first, adults who lose vision in one eye tend
to have a few fender-benders, and reach out next to the hand they want to shake.
But with patience and time, they learn to use clues to depth perception that do
not require both eyes.
How Are Ophthalmologists, Optometrists and
Opticians Different?
Ophthalmologists (Eye M.D.s) are different from optometrists and opticians in their
training and in what they can diagnose and treat.
As a medical doctor, an ophthalmologist is
licensed to practice medicine and surgery. He or she diagnoses and treats all
eye diseases, performs eye surgery, and prescribes and fits glasses and contact
lenses.
Ophthalmologists complete:
- 4 years of college;
- 4 years of medical school;
- 1 year of internship;
- 3 years, at least, of residency
(hospital-based training) in the diagnosis and medical and surgical treatment of
eye disorders.
After four years of college and eight additional
years of medical education and training, an ophthalmologist must pass a rigorous
examination given by the American Board of Ophthalmology.
While all ophthalmologists specialize in eye
problems and can treat all conditions, some decide to concentrate in a specific
area of medical or surgical eye care. These doctors are called sub specialists.
They usually complete a fellowship, which is one or two more years of training
in the chosen area. Some sub specialists focus on the treatment of a disease,
such as glaucoma. Others subspecialize in a particular part of the eye such as
the retina. Pediatric ophthalmologists subspecialize in treating eye disease in
children.
An optometrist is a doctor of optometry,
licensed to practice optometry. Optometrists determine the need for glasses and
contact lenses, prescribe optical correction, and screen for abnormalities of
the eye. They attend two to four years of college and four years of optometry
school.
In some states, optometrists can prescribe a
limited amount of drugs to help diagnose and treat certain eye conditions.
Optometrists generally do not perform surgery.
An optician-licensed by a state to make
optical aids-fits, adjusts and dispenses glasses, contact lenses and other
optical devices on written prescriptions of a licensed ophthalmologist or
optometrist. Training for an optician varies from a preceptorship to two years
of opticianry school.
Preventing Eye Injuries
Any activity
where something is flying at the eye puts the eye at risk for an injury. Over
one million people suffer eye injuries each year in the United States. Almost
50% of these accidents occur at home and over 90% of them could have been
prevented.
Minor
injuries to the cornea-the clear, protective covering over the front of the
eye-can be quite painful. A corneal abrasion is a scratch. Appropriate treatment
may include an antibiotic drop or ointment and an eye patch for comfort. Sand or
other particles can stick to the cornea. Such foreign bodies may be removed with
a moistened Q-tip, usually by a doctor. Do not rub the eye.
Regular
prescription glasses or contact do not protect eyes from injury. Some glasses
and some types of contact lenses shatter if the eye is hit. People who play
sports and wear prescription glasses can have special glasses or prescription
goggles made.
Unfortunately, many people do not think they are at risk for an eye injury until
the injury occurs. The majority of eye injuries are easily prevented. Follow
safety precautions and use common sense to reduce the risk.
·
Wear safety goggles
when using powerful chemicals. Goggles should fit properly to prevent chemicals
from getting under them, but still allow air to circulate between the eye and
the lens.
·
Polycarbonate sports
goggles are recommended for all participants of high-impact sports or activities
where there is a high risk of eye injury.
·
Never use fireworks. Attend public
firework displays instead of using fireworks at home. Amateur backyard displays
are dangerous to the person lighting the fireworks, near by family members,
friends, and neighbors.
·
Supervise children
when they are handling potentially dangerous items, such as pencils, scissors
and penknives. Be aware that even common household items such as paper clips,
elastic cords, wire coat hangers, rubber bands and fishhooks can cause serious
eye injury.
·
Avoid projectile
toys such as darts and bows and arrows. Do not allow children to play with
air-powered rifles, pellet guns and BB guns. They are extremely dangerous and
have been reclassified as firearms and removed from toy departments.
·
Wear eye protection
while mowing the lawn or using a weed eater. Stones and debris thrown from
moving blades can cause severe eye injuries.
·
Always check to make
sure any spray nozzle faces away from the face.
·
Use grease shields
to cover frying pans and protect eyes from splattering liquids.
·
Wear opaque
eyeglasses or goggles to shield eyes and block UV light in tanning booths.
·
Read instructions
before using tools, chemicals, ammonia, etc.
·
Be sure you read the
instructions while jump-starting a car. Attach the negative ground of the dead
battery last. This cable should be attached to the engine away from the dead
battery terminal. Never attach a cable to the negative terminal of the dead
battery.
·
Never use a match or
lighter to look under the hood of a car.
When an eye
injury does occur, have an ophthalmologist (eye physician and surgeon), or other
medical doctor examine the eye as soon as possible. Although the injury may not
look or feel serious, it could cause serious damage to your eyes. If you have
blurred vision, partial loss of vision, double vision, or sharp pains in your
eye after an accident, see an ophthalmologist or go to a hospital emergency room
right away.
Pterygium and
Pinguecula
A pterygium is fleshy tissue that grows
over the cornea (the clear front window of the eye). It may remain small or may
grow large enough to interfere with vision. A pterygium most commonly occurs on
the inner corner of the eye, but can appear on the outer corner as well. The
exact cause is not well understood. Pterygium occurs more often in people who
spend a great deal of time outdoors, especially in sunny climates. Long-term
exposure to sunlight, especially ultraviolet (UV) rays, and chronic eye
irritation from dry, dusty conditions seem to play an important causal role. A
dry eye may contribute to pterygium.
When a pterygium becomes red and irritated,
eyedrops or ointments may be used to help reduce the inflammation. If the
pterygium is large enough to threaten sight or grows rapidly, it can be removed
surgically.
Despite proper surgical removal, the pterygium
may return, particularly in young people. Protecting the eyes from excessive
ultraviolet light with proper sunglasses and avoiding dry, dusty conditions and
use of artificial tears may also help.
A pinguecula is a yellowish patch or bump
on the white of the eye, most often on the side closest to the nose. It is not a
tumor, but an alteration of normal tissue resulting in a deposit of protein and
fat. Unlike a pterygium, a pinguecula does not actually grow onto the cornea. A
pinguecula may also be a response to chronic eye irritation or sunlight.
No treatment is necessary unless it becomes
inflamed. A pinguecula does not grow onto the cornea or threaten sight. If
particularly annoying, a pinguecula may on rare occasions be surgically removed,
but the postoperative scar may be as cosmetically objectionable as the
pinguecula.
Recycling Eyeglasses
The World Health Organization
estimates that corrective lenses can improve the eyesight of one-fourth of the
world's population. Unfortunately, for many people a pair of glasses is both
unaffordable and unobtainable. The donation of old but useful eyeglasses to the
needy in the US and abroad can help solve this problem.
The Lions International and local
Lions Clubs conduct eyeglass-recycling programs. Used glasses are cleaned,
repaired and classified by prescription, then distributed free to needy people
in developing countries around the world.
Contact a local Lions Club or call
Lions Club International at (630) 571-5466 to find a local recycling center.
Chapters collect the used prescription eyeglasses, reading glasses, and even
sunglasses, and then package and ship them to the centers.
Community services for the visually
impaired often have names of those needing glasses. Many ophthalmologists and
optometrists accept donations. Donating your glasses to any charitable
organization will improve the eyesight of those in need.
Smoking and Eye Disease
Tobacco smoking is directly
linked to many adverse health effects, including high blood pressure, heart
disease and cancer. Smoking is also linked to specific eye disease.
How does smoking affect the eyes?
People who smoke cigarettes
are at increased risk for developing cataracts, a clouding of the
naturally clear lens of the eye. Cataracts cause a variety of vision problems,
including blurry distance vision, sensitivity to glare, loss of contrast and
difficulty seeing colors. When glasses or magnifiers are no longer helpful for
someone with cataracts, or when cataracts develop in both eyes, surgery is the
only option.
Tobacco smoking is also one
of the preventable risk factors for age-related macular degeneration (AMD).
Studies have shown that current smokers and ex-smokers are more likely to
develop AMD than people who have never smoked. AMD has two forms: dry (called
atrophic) AMD and wet (called exudative) AMD. In dry AMD, your retina gradually
thins. There is no proven cure for this type of degenerative disease. In wet
AMD, new blood vessels grow in the retina, leaking blood or fluid, damaging the
macula, the part of the retina responsible for your central vision. The two
types of treatment currently available for specific forms of wet AMD are
standard laser surgery and photodynamic therapy, both of which may stabilize the
disease.
In people with high
blood-sugar levels, some studies suggest that smoking may be linked to
diabetic retinopathy, or damage to the blood vessels in the retina. The
optic nerve is also susceptible to damage from smoking. People with poor diets
who smoke heavily and drink excessive amounts of alcohol run the risk of
developing optic nerve-related vision loss (called tobacco-alcohol
amblyopia). Certain optic nerve problems run in families (called Leber's
hereditary optic neuropathy). People with this condition who smoke have
increased risk of vision loss. In some patients with thyroid disease (called
Graves' disease) who also have eye involvement, smoking can cause the eyes to
become worse, with vision loss possible.
People who do not produce
enough tears to keep their eyes comfortably lubricated have a condition called
dry eye. For these people, smoking is a significant irritant, worsening
the symptoms of scratchiness, stinging or burning of the eyes, and excess
tearing from irritation.
How does smoking affect
fetal/infant eye health?
Studies have also shown a
strong association between smoking during pregnancy and the risk of invasive
meningitis during early childhood. The risk of bacterial meningitis
is five times higher among children whose mothers smoked during pregnancy. In
addition to other severe health problems, childhood meningitis can cause
inflammation of the cornea and pink eye. Smoking during pregnancy is also
associated with low birth weight and premature birth. And finally, oxygen
therapy given to sustain the lives of premature infants can cause retinopathy
of prematurity, causing permanent vision loss or blindness.
There are resources to help you quit
smoking.
There are numerous
community organizations committed to helping people quit smoking. The American
Cancer Society (ACS) offers smoking cessation classes around the U.S. Contact
ACS at 1-800-ACS-2345 or online at www.cancer.org
<http://www.cancer.org> to find the chapter near you.
Sports Eye Injuries
Every year,
hospital emergency rooms treat nearly 40,000 victims of sports eye injuries. All
professional and recreational athletes participating in eye-hazardous sports
need to wear eye protection. To help prevent sports eye injuries, protective
polycarbonate eyewear should be worn whether or not prescription eyewear is
needed.
The sports
that cause the most eye injuries are basketball, baseball and racket sports, but
any sport where something flies at the eye is considered hazardous. Unbreakable
glasses, goggles or facemasks are required when there is a potential for eye
injury. Polycarbonate lenses are unbreakable and make excellent protection for
the eyes.
Helmets with
eye shields are recommended for football and other contact sports. Many sports,
such as baseball, hockey and men's lacrosse require a helmet with polycarbonate
face mask or wire shield. Face guards can be worn over glasses, and are used
primarily for football, ice hockey and similar high-risk sports. Some sports at
the national level, such as hockey, have established standards for eye
protection.
Goggles or
sports glasses protect eyes while playing basketball, racquet sports, handball,
and soccer. These goggles should be made of polycarbonate, which is 20 times
stronger than ordinary eyeglass material. Prescription eyewear used during
sports should be made from polycarbonate.
For
high-speed sports such as skiing, wear special frames sturdy enough to protect
the eyes from any impact. Wear ultraviolet absorbing goggles or sunglasses while
skiing to protect the eyes from glare, ultraviolet rays and exposure to weather.
Boxing
presents a high risk for eye injury, and unfortunately, there is no adequate
protection available.
Contact
lenses are not a form of protective eyewear. Contact lens wearers require
additional protection when participating in sports.
People with
only one eye should carefully consider the risks of contact sports. Wearing
adequate eye protection is essential for people with only one eye.
Tanning Beds
Tanning beds produce high levels of ultra-violet
(UV) light that tan the skin and burn the cornea, the clear covering of the eye.
The burn is not felt until 6-12 hours after exposure, so you can suffer a severe
burn without realizing it. UV light may also cause cataracts, and be a factor in
the development of macular degeneration.
Of course, an ounce of protection is worth a
pound of cure, so always use protective eyewear while using a tanning bed.
Closing your eyes, wearing regular sunglasses, and using cotton pads on your
eyelids does not protect your cornea from the intensity of the UV radiation in
tanning devices.
Tanning facilities are required by the Food and
Drug Administration (FDA) to provide goggles, but it is best to obtain your own
pair so you will always be prepared. Make sure your goggles fit snugly and cover
your eyes properly. If you borrow the salon's goggles, be sure they are
sterilized after each use to prevent infection.
Since you do not usually burn under tanning
devices, most people do not realize the potential damage to their eyes. If you
experience eye pain after UV exposure, contact your ophthalmologist.
Viagra
Ophthalmologists are cautioning patients about
visual side effects caused by Viagra, an oral therapy for impotence. Viagra
relaxes smooth muscles in the penis by interfering with the action of a special
enzyme. A nearly identical enzyme in the retina, the layer of light-sensitive
cells lining the back of the eye, may also be affected by Viagra, causing a mild
disturbance of color vision in approximately 3% of people taking a higher than
recommended dose.
Because of this unusual side effect, doctors
recommend people with retinitis pigmentosa (an inherited disease affecting the
retina) use Viagra with caution. People with other retinal problems should
discuss their condition with their ophthalmologist before taking Viagra.
Until more data is available, physicians strongly
recommend people stay at the lowest dose possible. Presently 50 mg is the
recommended amount.
Video Display Terminals
Complaints of eye discomfort and
fatigue are becoming more common as use of video display terminals (VDTs)
increases. While it is true that VDTs can cause eyestrain, there is no
convincing evidence that VDTs can harm the eyes.
Some people fear VDTs emit damaging
ultraviolet light or radiation. The amount of ultraviolet light emitted by VDTs
is a fraction of what is emitted from a fluorescent light. Radiation levels from
VDTs are so low a lifetime of exposure will not damage the eyes. After
prolonged use of a VDT, black and white objects may appear colored, but this is
not a sign of eye damage.
Symptoms of eyestrain are eye
irritation (red, watery or dry eyes), eye fatigue (tired, aching heaviness of
the eyelids or forehead), difficulty in focusing, and headaches. However,
eyestrain does not result in permanent eye damage.
Eyestrain, backache and muscle spasms
may improve with proper arrangement of the VDT and seating area. The
Occupational Safety and Health Administration (OSHA) provides helpful
suggestions on workstation arrangement.
It is important to wear appropriate
glasses adjusted for the distance from the VDT. Most VDT users prefer to
position the screen farther from where they normally read. Prescription glasses
should be adjusted accordingly.
Take periodic rest breaks. Using a
VDT requires an unchanging body, head, and eye position that can be fatiguing.
Lubricate the eyes by blinking frequently or using artificial tears (lubricating
eye drops.) Keep workstation clean to minimize eye irritation from dust.
Minimize light glare by adjusting
office lights or using hoods or filters on the video screen. Standard office
lighting is too bright for comfortable VDT use.
Workplace Eye Safety
Eye injuries
at work are common. Every year about 70,000 workers injure their eyes. Luckily,
90 percent of all workplace eye injuries are preventable with the use of proper
safety eyewear.
The
Occupational Safety and Health Administration (OSHA) provides regulations which
employers and employees must follow. OSHA reports that nearly three out of every
five workers injured were not wearing eye protection at the time of their
accident. The American National Standards Institute (ANSI) provides these
standards of eye protection for any workplace task.
·
Unprotected workers
will not knowingly be subjected to environmental hazards.
·
Protective eyewear
is required whenever there is a reasonable probability eye injury may occur.
·
Employers must
provide the type of eye protection best suited to the task to be performed.
·
Employees are
required to use the eye protectors provided.
The Bureau of
Labor Statistics reports that eye injuries in the workplace cost over $467
million annually. A written eye safety program should be implemented in the
workplace to help prevent workplace eye injuries. Employers should consider
these tips in developing their safety plan:
·
Determine potential
of eye injury for the tasks performed.
·
Decide how best to
protect against the injury, e.g., dark lenses for welding, face-shield for
flying objects, tight seal for chemical spills, etc.
·
Identify the visual
needs of the job, e.g., magnification, dark lenses, etc.
·
Post rules requiring
when and how eye protection should be used.
·
Provide adequate
supplies of eye protection and have them readily available at the work site.
·
Instruct employees
on appropriate treatment if injury should occur.
·
Require vision
screening for new employees to determine any eye disease.
Cataract
Cataract
A cataract is a loss of transparency, or
clouding, of the normally clear lens of the eye. As one ages, chemical changes
occur in the lens that make it less transparent. The loss of transparency may be
so mild vision is hardly affected or so severe that no shapes or movements are
seen, only light and dark. When the lens gets cloudy enough to obstruct vision
to any significant degree, it is called a cataract. Glasses or contact lenses
cannot sharpen your vision if a cataract is present.
The most common cause of cataract is aging. Other
causes include trauma, medications such as steroids, systemic diseases such as
diabetes and prolonged exposure to ultraviolet light. Occasionally, babies are
born with a cataract.
Reducing the amount of ultraviolet light exposure
by wearing a wide-brim hat and sunglasses may reduce your risk for developing a
cataract but once developed there is no cure except to have the cataract
surgically removed. Outpatient surgical procedures can remove the cataract
through either a small incision (phacoemulsification) or a large incision (extracapsular
extraction). The time to have the surgical procedure is when your vision is bad
enough that it interferes with your lifestyle.
Cataract surgery is a very successful operation.
One and a half million people have this procedure every year and 95% have a
successful result. As with any surgical procedure, complications can occur
during or after surgery and some are severe enough to limit vision. But in most
cases, vision, as well as quality of life, improves.
Cataract Symptoms
Your eye works a lot like a camera. Light rays
focus through your lens on the retina, a layer of light sensitive cells at the
back of the eye. Similar to film, the retina allows the image to be "seen" by
the brain. But over time the lens can become cloudy and prevent light rays from
passing clearly through the lens. This cloudy lens is called a cataract.
The typical symptom of cataract formation is a
slow, progressive, and painless decrease in vision. Other changes include:
blurring of vision; glare, particularly at night; frequent eyeglass prescription
change; a decrease in color intensity; a yellowing of images; and in rare cases,
double vision.
Ironically as the lens gets harder, farsighted or
hyperopic people experience improved distance vision and are less dependent on
glasses. However, nearsighted or myopic people become more nearsighted or
myopic, causing distance vision to be worse. Some types of cataracts affect
distance vision more than reading vision. Others affect reading vision more than
distance vision.
Extracapsular Cataract Extraction (ECCE)
Extracapsular cataract extraction is a method for
surgically removing a cataract, which is a clouding of the eye's naturally clear
lens. A cloudy lens interferes with light passing through to the retina, the
light-sensing layer of cells at the back of the eye. Having a cataract can be
compared to looking at the world through a foggy window.
In extracapsular extraction, an incision is made
in the side of the cornea at the point where the cornea and sclera, the white
part of the eye, meet. Carefully entering the eye through the incision, the
surgeon gently opens the front of the lens capsule and removes the hard center,
or nucleus, of the lens. The soft lens cortex is then suctioned out leaving the
back of the capsule in place.
An incision requiring sutures is necessary
because the lens is removed in one piece. A plastic implant called an
intraocular lens, or IOL, is substituted for the original lens. The implanted
IOL allows light to be focused on the retina.
It may be up to six weeks before the sutures are
removed and best-corrected vision is achieved. During recovery, it may be
necessary to avoid bending over or lifting heavy objects.
Intraocular Lenses (IOLs)
An intraocular lens (IOL) is a tiny, lightweight,
clear plastic disk placed in the eye during cataract surgery. An IOL replaces
the focusing power of the eye's natural lens.
The lens of the eye plays an important role in
focusing images on the retina. If the lens loses its clarity, as it does when a
cataract develops, light rays do not focus clearly and the image one sees is
blurry. Glasses or contact lenses cannot sharpen vision if a cataract is
present.
The only treatment for a cataract is to remove
the lens and implant an IOL. Intraocular lenses have many advantages. Unlike
contact lenses, which must be removed, cleaned, and reinserted, the IOL remains
in the eye after surgery.
An IOL may be placed either in front of or behind
the iris. Behind the iris is the most frequent placement site. They can be hard
plastic, soft plastic or soft silicone. Soft, foldable lenses can be inserted
through a small incision which shortens recovery time following surgery.
Rapid evolution of IOL designs, materials, and
implant techniques have made them a safe and practical way to restore normal
vision after cataract surgery.
Cataracts in Children
A cataract is a clouding of the eye's normally
clear lens. The lens of the eye plays an important role in focusing images on
the retina, the light-sensitive nerve cells lining the back of the eye. If the
lens loses its clarity, light rays do not focus clearly and vision is blurry.
Just as it is hard to see through a dirty window, it is hard to see through a
cataract. Although most cataracts occur in older adults, they can appear in
children, in one or both eyes, often at birth. They look like a white or gray
spot in the pupil.
Cataracts in children may be inherited or develop
because of an infection or a disease acquired before birth, or as a result of an
injury. In most cases, no specific cause is found.
Children may lose vision permanently because of
amblyopia (lazy eye) if a severe cataract is not removed quickly. The better eye
may also need to be patched. Mild cataracts may not need treatment.
The focusing power of the original lens, removed
during cataract surgery, must be replaced to restore vision. Intraocular lenses
(IOLs), permanent plastic lenses placed inside the eye, are implanted in older
children much as they are in adults. In infants, IOLs are controversial because
the eyes grow and change their prescriptions during the first few years of life.
Many surgeons prefer contact lenses or even glasses for younger children.
Regardless of the type of correction, children
need follow-up exams to avoid possible complications, including glaucoma, scar
tissue forming in the pupil, and amblyopia. Often, children will need eye muscle
surgery because the eye turns or crosses.
Despite these problems, cataracts are the single
most treatable cause of childhood blindness. After surgery, most children can
see the blackboard in school (20/60-20/100). While some do not do as well, with
appropriate correction, many children see almost normally.
Phacoemulsification (Phaco)
Phacoemulsification is a surgical method used to
remove a cataract, which is a clouding of the eye's naturally clear lens. A
cloudy lens interferes with light passing through to the retina, the
light-sensing layer of cells at the back of the eye. Having a cataract can be
compared to looking at the world through a foggy window.
In phacoemulsification, an ultrasonic oscillating
probe is inserted into the eye. The probe breaks up the center of the lens. The
fragments are suctioned from the eye at the same time. A small incision that
often does not require sutures to close can be used since the cataract is
removed in tiny pieces. Most of the lens capsule is left behind and a foldable
intraocular lens implant, or IOL, is placed permanently inside to help focus
light onto the retina. Vision returns quickly and one can resume normal
activities within a short period of time.
Posterior
Capsulotomy
A posterior capsulotomy is
a surgical laser procedure that may be necessary after cataract surgery.
During cataract surgery
part of the front (anterior) capsule that holds the lens is removed. The clear
back (posterior) capsule remains intact. As long as that capsule stays clear one
has good vision. But in 10 to 30% of people, the posterior capsule loses its
clarity. When this happens, an opening can be made in the capsule with a laser
(posterior capsulotomy) to restore normal vision.
Before the laser procedure,
the ophthalmologist does a thorough ophthalmic examination to make sure there is
no other reason for vision loss.
A posterior capsulotomy is
painless and takes five minutes. Eye pressure is taken a half hour after the
operation to make sure it is not elevated and antibiotic drops are usually
prescribed for three days following the procedure. Vision should improve within
hours.
Potential but rare
complications following laser posterior capsulotomy are increased intraocular
pressure and retinal detachment.
Glaucoma
Alpha
Agonists for the Treatment of Glaucoma
While there is no cure for
glaucoma, it can be controlled.
Elevated intraocular
pressure (IOP) may damage the optic nerve, which can lead to vision loss.
Treatment for glaucoma focuses on lowering the IOP to a level that is less
likely to cause further optic nerve damage. This is known as the “target
pressure” or “goal pressure.” The target pressure differs from individual to
individual. Your target pressure may change during your course of treatment.
If you have glaucoma, your
ophthalmologist (Eye MD) may prescribe medication to lower your eye pressure.
There are many more choices for topical treatment (eyedrops) today than there
were only a few years ago. Your ophthalmologist has chosen an alpha agonist
medication to treat your glaucoma.
How Do Alpha Agonists
Work?
Alpha agonist medications
are reliable for lowering the intraocular pressure. They work by decreasing the
production of the fluid that the eye continually makes, called the aqueous
humor.
What Are the Alpha
Agonists?
There are two alpha agonist
drugs:
·
Apraclonidine (Iopidineâ)
·
Brimonidine (Alphaganâ)
Generic versions of these
medications are not yet available.
Possible
Side Effects of Alpha Agonists
All medications, including
eyedrops, have not only benefits but may also have side effects. Some people
taking alpha agonist eyedrops may experience:
·
Dry mouth
·
Ocular allergy with a red eye and/or red eyelids
·
Headache, fatigue, irritability or sleep disorder
·
Low or high blood pressure and possible slowing of heart rate (less than with
beta blockers)
·
Joint aches
·
Upset stomach, nausea or constipation
For glaucoma medications to
work, you must take them regularly and continuously as prescribed by your
doctor.
Medication
Tips
With each new medication
that your ophthalmologist prescribes, make sure you understand the following:
·
The name of the medication
·
How to take it
·
How often to take it
·
How to store it
·
If you can take it with your other
medications (make sure each of your doctors knows about all the different
medications you take, including non-prescription medications)
·
What the possible side effects may
be
·
What you should do if you
experience side effects
·
What you should do if you miss a
dose
Beta Blockers for the Treatment of Glaucoma
While there is no cure for glaucoma, it can be
controlled.
Elevated intraocular pressure (IOP) may damage
the optic nerve, which can lead to vision loss. Treatment for glaucoma focuses
on lowering the IOP to a level that is less likely to cause further optic nerve
damage. This is known as the "target pressure" or "goal pressure." The target
pressure differs from individual to individual. Your target pressure may change
during your course of treatment if the progression of glaucoma is not arrested.
If you have glaucoma, your ophthalmologist (Eye
MD) may prescribe medication to lower your eye pressure. There are many more
choices for topical treatment today than there were only a few years ago. Your
ophthalmologist has chosen a beta blocker medication to treat your glaucoma:
How Do Beta Blockers Work?
Beta blocker (beta andrenergic antagonists)
medications are reliable for lowering intraocular pressure. They work by
decreasing the amount of fluid that the eye continually produces, called the
aqueous humor. For many years, beta blockers were the mainstay of treatment.
Hence, we have a lot of experience with this medication for the treatment of
glaucoma.
Types of Beta Blocker Medication
There are two general classes of beta blockers:
nonselective and selective. Nonselective beta blockers have more effects on the
body's beta receptors system-wide, and are associated with more side effects.
The nonselective beta-blockers are also more effective at lowering intraocular
pressure.
The nonselective beta blockers include:
·
Levobunolol (Betagan)
·
Timolol hemihydrate (Betimol)
·
Carteolol (Ocupress)
·
Metipranolol (Optipranolol)
·
Timolol maleate (Timoptic) and Timolol maleate
gel (Timoptic XE)
(Generic versions of Timolol are now available.
Check with your ophthalmologist to make sure that a generic product is an
acceptable alternative for you.)
The only available selective beta blocker
medication is:
·
Betaxolol (Betoptic-S)
While a selective beta blocker eyedrop has a
better safety profile, especially in terms of breathing symptoms, it still must
be used with caution in patients with asthma or emphysema. The eye pressure
lowering effect is slightly less with selective beta blockers. There is only a
minimal additive effect in terms of lowering eye pressure in patients already
taking oral beta blockers and there is the risk of further additive side
effects. If you are already taking a beta blocker medication by mouth or if
your primary care doctor newly prescribes a beta blocker, please notify your Eye
MD.
Possible Side Effects of Beta Blockers
All medications, including eyedrops, have
not only benefits but may also have side effects. Some people taking beta
blocker eyedrops may experience:
·
Increased or worse asthma or emphysema
·
Slow or irregular heart beat and/or decreased
response of heart rate to exercise
·
Increased risk for heart failure
·
Depression or change in sex drive (impotence)
·
Headache or dizziness or weakness
·
In diabetics, difficulty sensing blood sugar
changes
·
Eye irritation or allergy
Medication Tips
For glaucoma medications to work, you must take
them regularly and continuously as prescribed by your doctor. With each new
medication that your ophthalmologist prescribes, make sure you understand the
following:
·
The name of the medication
·
How to take it
·
How often to take it
·
How to store it
·
If you can take it with your other medications
(make sure each of your doctors knows about all the different medications you
take, including non-prescription medications)
·
What the possible side effects may be
·
What you should do if you experience side
effects
·
What you should do if you miss a dose
Carbonic Anhydrase Inhibitors (CAIs) for the
Treatment of Glaucoma
