Alamo Optometry Blog

October 5, 2014

I Don’t Know What Insurance I Have…

Filed under: Insurance — gkblog @ 4:13 pm

(As appeared in Alamo Today, October, 2014)

Insurance benefits these days have become quite confusing.  We are finding that a lot of patients are either unaware and/or misinformed regarding their medical and vision benefits.  Vision insurance and the difference between vision and medical benefits are something that is confusing for a lot of our patients.

When making an appointment for a comprehensive exam at the office, we need to know which vision insurance carrier you have so we can make sure you have benefits prior to the exam.  The plans we are in-network providers for include Vision Service Plan (VSP), Eyemed, and Medical Eye Services (MES).  These are stand-alone plans that have exam coverage and material benefits (towards either glasses or contact lenses).  These plans vary greatly in material benefits and coverage terms, but all have exam benefits.  Some of these vision plans are associated with your medical insurance, but are usually administrated differently.  For example, Cigna health insurance is associated with VSP and Aetna coordinates some of their vision plans through Eyemed.  Even though they are related, your medical insurance and vision coverage are usually separate entities.

That being said, sometimes medical plans do have routine vision coverage.  The problem we have found with plans such as Anthem Blue Cross and United Health Care is that patients are confused as to whether their benefits apply towards medical eye visits or routine care.  The main difference is that for a medical benefit, a medical diagnosis must apply.  Such things as conjunctivitis, cataracts, allergies, glaucoma, diabetes, dry eyes, etc. are medical diagnoses.  Myopia and astigmatism are not considered medical and therefore would not be covered.  For instance, a patient who comes to the office with only a vision issue and does not have an ocular medical condition, medical coverage alone cannot be used.  So when a patient calls the office and tries to use their medical insurance for a routine exam, we have to assume there will not be a medical diagnosis.  Therefore, we need to know what coverage there is for routine vision and materials.  If a patient is calling to schedule an office visit for a red eye, infection, allergies, etc. the opposite is true.  The medical insurance is now primary because the routine vision plan will not pay for a medical eye visit.

Now that we all understand the difference between medical and vision insurance, it is important to understand what benefits you have before calling the office to schedule an exam or office visit.  If you are not sure, the human resources department through your employer should be able to help you navigate through the chaos that is insurance.  If you don’t have any vision insurance through your employer or are self-employed, VSP now has individual plans available for purchase.  These plans have exam coverage along with material benefits.  For patients that need contacts annually or need glasses, the individual plans have basic frame and lens coverage, and then discount any upgrades to the frames and lenses.  For patients who don’t need any materials, it probably doesn’t pay to purchase these plans, but for those who need glasses and/or contacts, your out-of-pocket costs will be much less than paying privately.

September 7, 2014

School and Children’s Vision

Filed under: Children's Vision — gkblog @ 5:39 pm

(As appeared in Alamo Today, September, 2014)

It is hard to believe that most of summer vacation is behind us and school is back is session.  August and September are usually the months where most parents prep their children for the upcoming school year.  The list usually includes school supplies, clothes, backpacks, etc. and yearly physicals are done with their pediatrician to ensure a healthy start to the year.  Even though most of you realize the importance of vision and eye health, it is vitally important for your child to be able to see well at all distances and have good eye-teaming skills to be able to learn and prosper at school.  I will cover some of the main eye issues related to difficulty at school.

I would say the most common diagnosis I find at the office is myopia, or near-sightedness.  For students that sit far away from the board or in the back of a large lecture hall, having uncorrected or under-corrected myopia will lead to blurry vision and an inability to see the material on the board, screen, or overhead.  I have found it common for younger children with this situation to have classroom issues in addition to lower grades due to the fact that they tend to be disruptive in class because they can’t see clearly more than a few feet in front of them.  These students are unable to take notes off of the board and therefore often fall behind in class and miss assignments.

At the opposite end of myopia is hyperopia, or far-sightedness.  These students are in a constant state of focusing to allow clear vision.  The closer the point of focus the more work that is necessary to clear the image.  That is why distance objects are easier than near ones.  A low amount of hyperopia is actually desirable, since near-sightedness tends to evolve as the child enters adolescence, so it gives them a little head start.  However, in larger prescriptions, hyperopia can cause near avoidance, headaches, fatigue, eye turns, and an overall indifference to sustained up-close tasks.  This can easily be diagnosed in the office as part of a comprehensive examination.

The last prescription issue that can be a hindrance to vision is astigmatism.  This is caused by the cornea, the clear front surface of the eye, not being completely round.  An easy analogy is that it is shaped more like an egg than a ball.  Astigmatism will generally degrade both distance and near vision; however, distance is usually a little more affected.  It is important to note that this is not a disease; it is just the way the eye is shaped and can be treated with glasses or contact lenses just like myopia and hyperopia.

In addition to having a prescription, all patients including children should have their binocular vision status evaluated.  It is quite possible to not have any of the above-mentioned prescription issues, but have poor eye teaming skills.  If the eyes are not aligned properly and do not work well as a team, there will be learning and reading issues.  These tend to present themselves more for reading than distance, but can definitely affect both.  When the eyes do not work as a unit, a child might experience double vision, “stretching” or “ghost images” of letters, skipping of letters or lines of text, eyestrain, headaches, near avoidance, or any combination of these.  Depending on the exact diagnosis, the condition can be treated with glasses or vision therapy.

I recommend having your child’s vision checked by an eye care professional instead of just relying on a school or pediatrician screening.  Most children that need to be evaluated are generally picked up by these screenings, but the comprehensive evaluation I give at the office not only encompasses vision and binocular vision, but also includes neurological testing, color vision, peripheral vision, and an ocular health examination of both the front and back portions of the eye.  We look forward to seeing your students in the office soon.

Flashes and Floaters

Filed under: Common Eye Concerns and Questions — gkblog @ 5:38 pm

(As appeared in Alamo Today, August 2014)

Thankfully in my field of practice there are very few ocular emergencies.  However, one of them is sudden onset of flashers and floaters.  This can be a potentially serious eye condition that warrants immediate attention, so I will discuss some of the causes and symptoms and what to do if you experience any of the effects.

When patients call the office complaining of sudden onset of flashes and floaters, the most common diagnosis is a posterior vitreous detachment or PVD.  Most patients will notice in their field of vision squiggly lines, small dots, a “spider-web” appearance, or any combination of these.  Most of the time the cause of floaters is idiopathic, meaning it just happens; other causes include trauma and age.  The vitreous gel, which fills the posterior 2/3 of the eye, is made of tightly-packed translucent collagen fibers.  Over time, the fibers that make up the gel liquefy and condense, causing it to move forward and pull away from the retina.  Since there is now an area of fibers that are situated in front of the retina, as light enters the eye it goes through this area and casts a shadow onto the retina; this is what the patient perceives as floaters.  This situation alone is completely benign and might cause slightly decreased vision but will have no long term effects on the eye.  However, as the gel pulls away from the retina there are tractional forces that develop and can pull a part of the retina away causing a retinal hole and/or detachment.   This is what needs immediate surgical intervention by a retina specialist.

If the retina is detached from the back of the eye, it is not receiving any oxygen and will die like any other tissue or organ in the body.  Generally speaking, the prognosis for visual recovery is directly related to how quickly the diagnosis and treatment is initiated and the location of the detachment.  This is why it is absolutely imperative that if you notice a sudden onset of floaters, flashes of light, decrease in vision, a veil or curtain coming over your vision, or any combination of these that you have your eyes dilated as soon as possible.  If you have any of these symptoms, we will always squeeze you in for a same day appointment.  If the diagnosis is a PVD, there is no treatment.  We will discuss some precautions and some things to watch for and do a repeat dilation in 4 weeks.  Most studies have shown that if a retinal complication is going to occur, it is going to happen within the first 4 weeks, most likely sooner.  If there is a retinal hole and/or detachment a prompt referral to a retinal specialist is ordered.  Many treatments now can be done in office; however, outpatient surgery is sometimes indicated.  The retinal surgeon will discuss your options with you and recommend the procedure and treatment plan with the greatest likelihood of success.

Patients will invariably ask if there is anything that can be done to remove the floaters, and unfortunately the answer is no.  The only way to clean out the floaters is to do a procedure called a vitrectomy, which involves going into the eye and removing all of the vitreous and replacing it with clear fluid.  However, the risk of retinal complications is relatively high with this procedure.  Therefore, retinal surgeons will not do surgery for a benign condition, albeit an annoying one, to risk loss of vision.  Thankfully, your brain learns to “tune out” the floaters over time so they are not as noticeable.  They never actually go away or disappear; your brain just learns to suppress them.  If you actively look for them, are out in the sun, or around a lot of light or glare it is relatively easy to find them.

If you have had a recent episode of floaters with or without flashes of light, please have your retina evaluated as soon as possible.  I would rather you come in for an office visit and the diagnosis is floaters versus waiting for the symptoms to go away and having possible decreased vision from a retinal complication.

Systemic Diseases

Filed under: Eye Diseases and Disorders — gkblog @ 5:36 pm

(As appeared in Alamo Today, July, 2014)

As many of you may or may not be aware, almost every systemic disease can have ocular effects.  Most patients are aware that common conditions such as diabetes and high blood pressure can have severe visual and ocular consequences.  However, any disease including lupus, colitis, leukemia, and high cholesterol can affect the eye.  The eye is no different from any other organ in the body; it needs blood and oxygen to survive.  If this is affected or reduced, vision and/or ocular health will definitely be compromised.  These changes can vary from a prescription change, cataract formation, or retinal disease, to name a few.  That is why it is very important to let us know of any systemic ailments and medications on the patient questionnaire, as these can have a profound effect on the eyes.  Many times patients don’t report having some conditions and medications to us because they feel it is not important or that “it has nothing to do with my eyes”.  You can safely assume that any medication you take or ailment you have can alter vision and ocular health.  For the purposes of this article I will just cover the two most prevalent diseases, diabetes and high blood pressure.

Diabetes affects about 10 percent of the population in the United States and is characterized by either a deficiency in insulin production (type 1) or insulin resistance (type 2).  The main ocular effect of diabetes is retinopathy, which is a disease of the retina. Diabetic retinopathy can lead to poor vision and even blindness.  At first the integrity of the blood vessels breaks down which can lead to blood leaking into the retina.  If blood sugar levels stay high or fluctuate, diabetic retinopathy will keep getting worse. Due to the poor retinal blood flow through these damaged blood vessels, new blood vessels grow on the retina because insufficient amounts of oxygen are reaching the cells within the retina. This may sound good, but these new blood vessels are weak. They can leak very easily, even while you are sleeping. If this happens, blood can leak into and around the macula, which will cause decreased vision.  Retinopathy can also cause swelling of the macula; macular edema reduces vision as this specialized area of the retina is compromised.  The only way to diagnose this is through a comprehensive dilated optometric examination.  Annual exams can help detect retinopathy and monitor retinopathy before it affects your vision.

High blood pressure, or hypertension, is another vascular disorder that forces your heart to work harder to pump blood through your arteries.  This can lead to hardening of the arteries and subsequent heart failure.  In addition to all of the other body organs it can affect, the eye can also be compromised.  The blood vessels of the retina over time can narrow and cause a decrease in blood to the retina.  Compromised blood flow can cause swelling of the optic nerve and macula, which over time can lead to decreased vision and possible stroke in the eye.  Since this is something that cannot be self-monitored, an annual dilated examination can help in the detection and monitoring of this potentially blinding disease.

To help combat these diseases, the absolute best thing you can do is to keep the disease under control.  The more your blood sugar and blood pressure are under control, the less likely eye consequences will be an issue.  That means visits to your doctor and taking your medications, life-style changes, etc. as prescribed.  Keep in mind that just because you “feel” fine and have your diseases under control, the fact is you still have the disease.  Along with your regular doctor visits, annual eye exams should be on your list to keep these diseases monitored and under control.

Social Media

Filed under: Our Office — gkblog @ 5:33 pm

(As appeared in Alamo Today, June 2014)

As an office we are always trying to tinker with how we do things to make ourselves and our product better.   Whether that is adding new technology to the office, offering our patients new contact lenses to the market, or finding better ways to make visits to our office more enjoyable, our goal is to enhance our office and services to be able to meet and exceed the needs of our patients.

Regardless of the type of business, that company has to continue to grow and gather new clients, patients, etc. to be able to succeed.  If a company does not alter the way they conduct business to meet market changes and demands, they will definitely not prosper.  Since we took over the office almost 7 years ago, we have made several changes including adding new frame lines and office instruments, introduce new lens products as they come to market, and changing some of the décor in the office.  Our new project is to better connect our office to our current patients and the members of our local community.  Thankfully, we have our current patient base talking and recommending our office to their friends and family members.  In conjunction with our loyal patient base, we are trying to enter the 21st century regarding social media.   Even though I am not personally into the social media sites such as Twitter, Instagram, and Pinterest, taking selfies, nor mastering the use of the hashtag, many of our current and potential patients use them all the time.

The main goal of utilizing these sites is to help share information with our patients and the community.  Whether it is an interesting article about cataracts or a new treatment for macular degeneration, new daily disposable contacts for astigmatism, or just a random good vibe, the purpose of these sites is to help educate people about good vision and eye health, and the procedures, products, and treatments that make that happen .  We are encouraging those who are so inclined, to engage the office and the community by using Twitter, Instagram, and Facebook, by posting their selfies of their new sunglasses, or their new look wearing daily disposable contacts, or to tweet any eye-related issues or questions that you have.  This will start threads about eye-related subjects or products that can shed some light on a topic of interest to you or introduce you to a new sunglass frame.

Up to this point we have had a blog on our website and a Facebook page for several years now, where we (mostly my wife) would post interesting articles or things going on at the office.  Even though that has been successful, we are trying to expand our reach to our patients and the local community about our office and services.  It is probably going to take a while for us to master the use of these sites but we are learning.   And to be honest, when you see a post, tweet, or a re-tweet, you can be pretty sure it was done by my better half.  Come follow us on Twitter @Alamo Optometry and we are Alamo Optometry on Facebook and Instagram.

Why Do I Need to Get My Eyes Dilated?

Filed under: Uncategorized — gkblog @ 5:32 pm

(As appeared in Alamo Today, May 2014)

As you can imagine, I get this question at the office on a daily basis.  Most patients understand that it is part of the comprehensive examination, but they don’t always know the reasoning behind it.  Therefore, they are always trying to get out of doing it.  The dilation is a very important (some would argue the most important) part of the exam, which helps determine the status of your ocular and systemic health.

The most valuable asset of the retina is that it is the only place in the body where neural tissue (the optic nerve and retina) and blood vessels can be directly viewed without an invasive procedure.  Trying to evaluate the retina through an undilated pupil is very difficult because as light is used to see into the eye, the pupil constricts to a pinhole.  Looking through a very small aperture does not allow the entire retina to be viewed.  The dilating drops will open up the pupil and will not allow it to constrict.  Since the muscles within the eye control the focusing power of the eye and the opening and closing of the pupil in response to light levels, paralyzing these muscles is why patients will experience light sensitivity and poor reading for a few hours after the drops are instilled.  The typical timing for the drops to wear off is between 2 and 3 hours.

A dilated examination can both diagnose and evaluate the progress of many systemic diseases;   in addition, assuring the patient that the eyes and retina are healthy and free of any conditions.  The main ocular conditions found during dilation include cataracts, diabetic and hypertensive retinopathy, glaucoma, macular degeneration, and retinal holes, tears, and detachments.  Systemic ailments such as diabetes, high blood pressure, multiple sclerosis, brain tumors, and heart and carotid artery disease can be diagnosed in the course of a dilated evaluation.  For otherwise young and healthy patients, dilation should be done about every 2 years.  For patients who are diabetic, have cataracts, glaucoma, or are taking certain medications, dilation should be done annually at the minimum.  For these patients, in addition to visiting your internist, endocrinologist, rheumatologist, etc. an annual dilated examination should be conducted.  Most physicians realize the importance of dilation and will require it of their patients.  When these patients come into the office, a letter to the doctor will be sent to update him/her on the condition of the eyes.

When an eye professional needs to assess the health of the back portion of the eye, dilation is still the standard of care.  There are new digital imaging systems that take relatively good views of the retina.  However, they are generally not able to reach the far periphery of the retina, and they are only able to give a 2-dimensional view of the retina as viewed on a computer monitor.  Dilation using an instrument called a binocular indirect ophthalmoscope (BIO) allows the doctor to see all around the retina in 3-dimensions.  Keep in mind that although reading ability will be impaired for a few hours, distance vision remains the same.  Light sensitivity might make it harder to see outdoors, but the actual vision does not change.  Please bring your sunglasses with you to the exam; if you don’t own any, we have some shields that will help protect you from the sun.

April 27, 2014

Seasonal Allergies and Daily Disposable Contacts

Filed under: Uncategorized — gkblog @ 1:51 pm

(As appeared in Alamo Today, April 2014)

            If there is one thing we can count on this time of year, it is seasonal allergies.  Speaking from a personal point of view, I know dealing with the running nose, sneezing, itchy eyes, and tearing are no fun.  I am already having patients come into the office with complaints similar to my own.  The treatment plan for each person is different, but the drugs, drops, and contact lens modalities we use are similar.

            To tackle the allergies, most of us take either a prescription or over-the-counter antihistamine.  These usually help alleviate some of the systemic symptoms of runny nose, congestion, etc.  However, the main side effect of these medications is ocular dryness.  If the eyes are dry, it can actually worsen some of the ocular symptoms because there are now fewer tears to wash away the allergens in your eye.  So instead of flushing those allergens out of the eye, they now stay on the ocular surface and exacerbate the symptoms of itching, swelling, and tearing.

            For this reason, I also recommend topical drops to help in the fight against allergies.  These drops do not solve the problems, but generally enable the patient to function in the spring months.  There are several types of drops that can be used depending on the severity of the symptoms.  For a mild case, I usually recommend non-preserved artificial tears and an antihistamine drop like Bepreve or Lastacraft; these are only two of the several prescription drops to utilize.  These drops are site-specific; they only have their effect on the histamine-releasing cells on the eye and therefore do not have the broad systemic effects of oral antihistamines.  For the more advanced case, I recommend a short-term use of a topical steroid, which will calm the eye down relatively quickly.  Because of the potential side effects of a steroid, a drop of this kind should only be used for a relatively short period of time.  I usually instruct my patients to use the drop for about a week, and then use the topical antihistamines to keep the allergic reaction at bay.  I believe the use of steroids should only be used when indicated, but is a wise treatment choice in those patients that are really suffering.

            For those contact lens wearers, this is the time of year that leads to decreased wear time, build-up on the lenses, and overall intolerance of wear.  Most patients wear their lenses for less time, and/or dispose of them more often.  For all of my potential contact lens patients including those with allergy issues, I recommend daily disposable contacts.  These lenses are thin, easy to adapt to, do not require any cleaning or solutions, and are always comfortable because you put a fresh lens on every day.  Whether you are a recreational wearer for sports or weekends or wear them every day, these lenses are best for convenience, lens hygiene, and lens comfort.  A new lens leads to better vision and eye health because of no lens build up and a decreased risk for infection.  Even though wearing contact lenses during the spring months might be difficult, having a fresh lens every day provides the possibility of longer and comfortable wear. 

Obviously, every patient and situation is different.  Some patients don’t like taking drops and some patients are in love with their current lenses so daily disposables might not be an option.  At your visit, you will be evaluated on your particular signs and symptoms and be given the appropriate treatment plan.  The issues and treatments discussed have generally worked well for my patients in the past.  Most of the time, it will be a combination of these that will work best.

Macular Pucker

Filed under: Uncategorized — gkblog @ 1:50 pm

(As appeared in Alamo Today, March 2014)

Since I discussed the macula and macular degeneration last month, I decided to tackle another common finding regarding the macula.  A macular pucker or epiretinal membrane, results when scar tissue forms over the macular area of the retina.  This condition usually does not progress to the point where surgical intervention is necessary, but I have had several patients recently who required surgery.              

                An epiretinal membrane usually develops secondary to trauma/surgery to the eye, but more commonly by posterior vitreous detachment.  A posterior vitreous detachment, or PVD, occurs when the viscous gel that is in the back portion of the eye pulls away from the retina and causes a sudden onset of floaters.  This sudden onset of floaters is the usual cause of patients calling the office to schedule an office visit.  A PVD is quite common and is completely benign; however, if this does occur, a dilated examination needs to be done to rule out any retinal tears or detachments.  As the gel contracts away from the macula, it can leave a layer of scar tissue on the surface of the retina.  This membrane that is left is similar to cellophane and over time it can crinkle and tug on the macula causing it to bulge.  The main complaint of a macular pucker from patients is decreased or distorted vision.  Some may notice that images are cloudy or filmy because they are looking through this cellophane-like membrane.   In a percentage of cases, the epiretinal membrane does not contract and the patients’ vision is not affected much.   A macular pucker is diagnosed through a dilated exam and does not require a specialist referral until vision decreases.  If needed, another test called Optical Coherence Tomography (OCT) can take highly sensitive images of the macula to ascertain the exact amount of macular bulging and if there is a macular hole.  However, monitoring is all that is required for most patients.

                In those patients who experience a drop in vision, surgery is required.  When vision becomes compromised, the forces of the membrane on the macula cause severe bulging of the tissue or a macular hole develops.  A macular hole occurs when the membrane contracts so much that part of the macula is not fully attached to the retina.  If surgery is needed, the retinal surgeon will remove the vitreous gel in the posterior portion of the eye and will also remove the membrane.  This surgery is very delicate as it is difficult to remove the thin membrane without damaging any of the retina tissue underneath, which is why surgery is not performed until the drop in vision becomes too symptomatic for the patient.   The procedure is done as outpatient, and depending on the severity of the condition, special head positioning or tilting might be required after the surgery to help the eye heal properly.  Vision improves after surgery, but it generally does not completely return to pre-macular pucker level. 

                As is usually the case, routine eye exams can help diagnose and manage a macular pucker.  If needed, we can refer to a retinal specialist if further testing or surgery is required.


Filed under: Uncategorized — gkblog @ 1:49 pm

(As appeared in Alamo Today, February 2014)

               The macula is probably the most talked about and questioned structure in the eye.  Patients are constantly asking about the macula and macular degeneration because they either have someone in their family or a friend that is battling this disease.  I will discuss the macula, some new treatments for the disease, and what you can do to help decrease your chances of getting macular degeneration.

                The macula is located in the central part of the retina (the back surface of the eye).  As light enters the eye, it is focused directly onto the macula, which is centrally located and is 5-6 millimeters in diameter.  It is comprised of cones, which are the photoreceptors that allow sharp vision and color vision; there are no cones elsewhere in the retina.  These cells then transmit the image through ganglion cells that form the fibers of the optic nerve.  The images travel via the optic nerve to the brain.  The macula has a yellowish color which is different from the normal red color of the retina.  The retina is red from all of the blood traveling through it.  The macula has certain pigmented materials such as lutein and zeaxanthin; which are derived from diet alone as these are not made by the body.  These components are vital to the health and maintenance of the macula and they act as an ultraviolet filter for the macula and are also believed to help protect the macula from macular degeneration.

                Even though the treatments for macular degeneration are getting better, there is still no cure.  Injections into the eye of either Lucentis or Avastin have shown the ability to slow down, and in a lot of cases, halt the progression of macular degeneration.  Getting a direct injection into the eye is not necessarily fun; however the likelihood of having vision preservation far outweighs the injections.   Older treatments including laser are not current options because the side-effects are sometimes worse and the possibility of vision improvement is minimal.

                Unfortunately, as previously mentioned, there is no cure for macular degeneration.  There are no drops, pills, etc. that can prevent it.  Your likelihood for the disease does increase as you age; therefore it is very important to maintain your overall health.  It has been shown that smokers, diabetics, and those with poor diets are more likely to suffer from the disease.  That being said, there is a genetic component to the disease that cannot be altered at this point.  For the most part, if it genetically programmed, there is very little that can be done.  The things that can be done are lifestyle modification and maintaining your overall health; this includes smoking cessation, properly managing your diabetes and high blood pressure, and having a well-balanced diet.  If your intake of green vegetables, which is the main way to maintain lutein and zeaxanthin levels in the macula, then vitamin supplementation is a wise thing to do.  There have been several studies that have conclusively shown that adding these along with other minerals have slowed down the progression of macular degeneration. 

                As with most conditions of the eye, annual comprehensive eye exams are the best for early detection.  In the early stages of the disease, your vision might not be affected, but there are some macular clinical signs that are evident.  Early diagnosis and treatment is still one of the best ways to stretch out the course of the disease which will allow for good vision for a longer period of time.


Filed under: Uncategorized — gkblog @ 1:48 pm

(As appeared in Alamo Today, January 2014)

                Recently a patient came into the office with a red and inflamed eyelid.  These are relatively common; the most likely culprits are styes, trauma, allergies, or blepharitis (bacterial infection of the eye lashes).  However, this condition was different in that it was an infection of the eyelid and soft tissue around the eyelids, or preseptal cellulitis.  A cellulitis can be potentially dangerous and the correct diagnosis needs to be made between preseptal and orbital cellulitis. 

                Preseptal cellulitis is a bacterial infection of the eyelid and surrounding soft tissue.   The eyelid area becomes red, swollen, warm to the touch, and potentially painful.  In contrast to a stye, a cellulitis covers a larger area of the eyelid whereas a stye is more localized.  In preseptal cellulitis, the infection is contained in the anterior portion of the lid and has not penetrated the septum (a thin membrane within the eyelid to help prevent infections from spreading deeper into the lids) to the posterior portion of the eye.  It is usually caused by an upper respiratory infection (flu) or sinus infection that has spread to the eye.  Direct insect bites or scratches are also potential ways the bacteria can penetrate the eyelid.   It is much more common in children and it responds well to oral antibiotic therapy.    Vision is not affected and the eye is able to move unrestricted in all directions.  The patient is usually getting over an illness or has been around sick people, but does not actively have a fever.            

Differentiating between a preseptal and orbital cellulitis is very tricky because both clinically present the same.  In orbital cellulitis, the affected eye will appear bulging relative to the healthy eye, the vision will be decreased, and eye movements will be restricted.  The person is concurrently ill and is possibly running a fever.  Functionally, the difference between the two is that in orbital cellulitis, the infection has spread posterior to the back of the eye and to the surrounding structures in the facial area.  This can result in permanent vision loss, neurological problems, and potentially meningitis if it gets into the bloodstream.  Therefore, orbital cellulitis requires hospitalization with continuous IV antibiotics to help control the infection. 

                Granted a cellulitis does not happen very often, but it reiterates the need that sometimes the simple red eye might not be so mundane.  If you notice eyelid redness and swelling that is not localized or is spreading with an associated illness, a cellulitis should be considered.  Preseptal cellulitis is much more common than orbital and is very responsive to oral antibiotics and the symptoms start to resolve in a few days.  The patient should be followed just to ensure the infection is clearing.  However, if an orbital cellulitis is suspected, direct referral to the hospital is required.

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