Tuesday, May 21, 2013
I recently had an elderly patient who had some eye lashes that started growing the wrong direction inwards toward the surface of her eye. She point blank asked me "doctor, WHY did this happen to me?" My response was "bad luck". She was dumbfounded, and somewhat miffed. "YOU MEAN YOU DON'T KNOW!!?", she replied incredulously. No, I don't know. Nobody does. "Was it my make up?" No. "Was it from rubbing my eyes?" Probably not. "Was it from allergies?" Unlikely. "So that's all you have? it's just BAD LUCK?" Yes. Sometimes there is no "reason" for some medical conditions. Some patients have a very difficult time with this concept, but it is fact. Sometimes there is no one and nothing to "blame" and there is nothing to do to "prevent" it from happening or prevent it from reoccurring. Occasionally it really, really is just bad luck.
Tuesday, May 14, 2013
Despite someone posting on one of my old sites that ortho-k was "nothing but a girdle", we now have yet more evidence that ortho-k does, in fact, slow myopia progression in children. Instead of blogging about it, I am going to link another good blog to follow, and let you read their excellent comments about it over there: THE EYE DOC BLOG - Study Shows Orthokeratology Effective in Reducing the Progression of Nearsightedness in Children
Wednesday, April 24, 2013
I just realized today I've never blogged about this before, and it's so common I feel I need to. RCE is a condition where a patient has an eye injury that causes a corneal abrasion, HEALS completely from it...then later (weeks, months, years) that area of "healed" cornea just spontaneously falls off again, basically just like the initial "abrasion" w/o the associated eye INJURY. What happens is...in some people when they re-grow their top layer (corneal epithelium) from an abrasion, the new epithelial cells don't anchor themselves very well to the layer below them (Bowman's membrane). Consequently that area is forevermore "fragile" and easily comes off, which is painful. Again this is not EVERY ABRASION. Only SOME people are unlucky enough to have RCE. Most people heal fine from a corneal abrasion and never have another problem ever again. The hallmark symptom of RCE is WAKING UP with pain and excessive tearing in an eye that has a previous history of a pretty severe corneal abrasion in the PAST. Of course if you go to the doctor and you show them your eye, they may diagnose "corneal abrasion", which is technically not incorrect. EXCEPT THAT people with a corneal abrasion REMEMBER the injury that caused the abrasion! It's not a mystery. They got poked in the eye and it hurt and they showed up to the doc complaining of eye pain. That's an abrasion. An EROSION happens when the patient WOKE UP with eye pain. They don't remember an eye injury immediately preceding the pain (but they had an OLD abrasion in that eye that they healed from). Those are different. One has an obvious, immediate cause, one does not. Short term treatment of RCE is the same as that of an abrasion: bandage contact lens and a short course of prophylactic antibiotic eye drops. "Pressure patching" has not been recommended by the American Optometric Association since the year 2000, so if someone is taping a patch to your eye...well that's a bit old school. The problem with treating RCE, of course, is that they're RECURRENT! Although the condition is generally not sight-threatening, it can sure be annoying to wake up every 6 weeks in excruciating eye pain! There have been many attempts in the past to try and "prevent" an RCE from recurring...here are a few terrible/stupid ones that don't work (from Wikipedia): sleeping with a humidifier (worthless), wearing glasses (what?), drinking plenty of fluids (worthless), "not sleeping late" (ha!), steroids (no), "learn to wake up with your eyes closed" (what?), "rubbing" your eyes before waking (getting stupider here), punctal plugs (treats dryness, but is this a dryness problem?)...none of those will work. Using eye ointments at night probably helps some IMO. Using "hyperosmotics" (Muro, etc) might help but has not been proven I don't think. Some surgeons used to recommend Anterior Stromal Puncture, a procedure where a needle is used to punch a bunch of holes in the Bowman's layer, the idea being to create places where epithelial cells can anchor. It's not being used much anymore...I don't think it ever really caught on b/c I don't think it ever really worked great. Some surgeons recommend PTK or phototherapeutic keratectomy, a laser procedure to remove corneal epithelial cells and hope they regenerate properly. In the last TWO of these cases of RCE that I had, I treated them with LONGER TERM extended contact lens wear. These 2 were patients who were in here literally every 4-6 weeks with a new, fresh RCE and they were miserable. On the advice of another O.D. (heard this at a conference in San Antonio in 2012, wish I could remember who said it, sorry) I placed these patients on TWO MONTHS of extended bandage contact lens wear. Basically I put an Alcon Night & Day lens on their eye (even if they didn't wear contacts) and told them not to remove it for EIGHT WEEKS. That's a long time. Neither of them had a problem during the 8 weeks (that's not an endorsement for wearing contacts that long, BTW)...and to date NEITHER of them have had an RCE since we did that. Now is that a "cure?" Who knows? but anecdotally I'm 2-for-2 with this cheap, easy method. I will be treating all of my known RCE's this way for the foreseeable future until I have one that recurs. I'll skip telling them to use a humidifier and never sleep in.
Monday, March 25, 2013
Here in East Texas it's already allergy/itch time. I know, most of you still have snow...but here our cars are literally covered with a visible not-so-fine yellow (pollen) dust. Ew. Everyone is itchy, red, watery and rubbing. OH NO PINK EYE IS CATCHING! No, more like allergic conjunctivitis. I blog about this every year and here's my 2013 edition: 1) really bad, swollen lid eyes get steroids. Alrex and Lotemex. 2) itchy and watery eyes that are red get Rx antihistamines. Current favorite is Lastacaft. 3) best OTC/home remedies are Alaway (Bausch & Lomb), Zaditor (Novartis) and the knock offs like Wal-Zyr (Walgreen's)...as well as CHILLED ARTIFICIAL TEARS. No hot compresses for allergy eyes, people. Also skip the "homeopathic" remedies like Similisan & putting "local honey" in your eyes. Please stay away from the "A-Team": Visine-A, Opcon-A, Naphcon-A. Ok that about does it! Stop rubbing your eyes and make an appt with your O.D.!
Wednesday, February 20, 2013
Monday, February 18, 2013
Wednesday, February 13, 2013
So says a NEW STUDY. "Many parents assume that frequent headaches mean their child needs glasses, so they ask their doctor to refer their child for an eye exam. But, according to a new study, vision or eye problems are rarely the cause of recurring headaches in children, even if the headaches usually strike while the child is doing schoolwork or other visual tasks." I completely AGREE, and have said this for years. MOST children who SEE FINE and go to their pediatrician complaining of headaches get a referral for an eye exam...and almost none of them need new glasses. Ok, I'm not mad about getting a referral (who would be?). But I often feel like the pediatrician is just "punting" the problem off on me b/c headaches in children are common and famously hard to diagnose and treat. I also feel like the parents are HOPING it's "their eyes" b/c that would be an easy/fast/cheap solution to their problem. It's almost never the case, and so the parents are often disappointed. Throw in that the kid feigns blur during the exam and I get the "are you sure?" and "how do you know?" questions from the parents. It is especially errr annoying (wish I had a better term here) to me for a patient who already has glasses (known refractive error) and sees 20/20 thru them to get referred back to me for another eye exam b/c they have headaches. It is really, REALLY unlikely that the glasses are the problem in those cases. In my opinion the vast majority of children do not need "reading glasses". I see this posted all over the net as if it were fact for children who complain of reading problems, headaches, etc etc. I even see a LOT of other O.D.'s (one in the article above) expounding on the need to test accommodation, etc. Ok does that exist in medicine? Sure. Is it COMMON, though? No...in my opinion it is probably NOT COMMON to have a pediatric lag of accommodation so great that reading glasses or bifocals are indicated. Somewhere in New York, some of my vision therapy teaching docs at S.U.N.Y. are having steam come from their ears haha. As I always say: "I am not the 'headache doctor'". If the MAIN COMPLAINT of your child is headaches, in the ABSENCE of blur...glasses are probably not the answer. Just my opinion, and it's my blog so I'm entitled!