Alamo Optometry Blog

July 1, 2013

Foreign Bodies

Filed under: Uncategorized — gkblog @ 8:17 pm

(As appeared in Alamo Today, July 2013)

          Ocular foreign bodies happen often and are usually pretty annoying or painful to the patient depending on what the foreign body is and where it is located.  Most of these are easy to remove in the office and bring immediate relief to the patient.  Most foreign bodies that we see in the office are either located on the cornea or under the top eyelid.  If there is a more serious accident where the object has penetrated the eye, more specialized care will be needed than can be provided at our office. 

            In our office, the majority of corneal foreign bodies are metal.  These usually involve working in the garage or at work with some type of metal and not wearing proper eyewear.  If someone can see the piece of metal on the cornea (the clear front surface of the eye), then the piece of metal is large.  Most times the fragment is very small and can only be seen using the equipment at the office.  If there is any type of insult to the cornea, it results in the eye being red, painful, teary, and light sensitive.  Patients will usually contact the office quickly after the incident due to the pain.  Vision will not be compromised, especially in the early stages.  Depending on how deep the foreign body is embedded in the cornea determines how easy it is to remove.  In general, most are not that difficult to remove.  If they are on the surface of the cornea, a simple tool or Q-tip will do the trick.  The patient is given a topical anesthetic so they do not feel anything and it is very simple to remove.  If the foreign body has been present for a few days, some of the corneal tissue has now grown over it, and this now requires a little more work to remove some of the outer cells to get to the foreign body.  If the piece is metal, a rust ring starts to develop around the metal fragment and that also needs to be completely removed.  We have the equipment in the office to do this and it only takes a few minutes to complete.  Depending on the amount of tissue that needs to be removed, a bandage contact lens will be applied to promote healing along with an antibiotic drop and proper follow-up management will be determined.

            The other likely place for a foreign body to be found is under the top eyelid.  Anything from a piece of dirt, metal, a contact lens fragment, to a loose eyelash can be found there.  Most times when something comes in contact with the eye, it is trapped by the lid during blinking and remains adhered to the underside of the lid.  As with corneal foreign bodies, these are very small and difficult for the patient or family member to find.  As a consequence of this situation, the foreign body now typically scratches or irritates the front part of the eye every time you blink.  Removing these particles is again very easy to do in office.  The hardest thing is being to invert the lid to be able to look at the underside surface.  The eyelid is usually irritated and swollen which makes manipulating it more difficult.  However, once that is done, visualizing the offending agent and removing it takes a very short period of time.

            As always, for situations like this, we try very hard to have a same-day appointment slot available.  Anything foreign in the eye can be potentially serious and should be seen soon after the incident.  As a reminder, anytime you are working on any project at home or work that could have fragments flying in the air, please wear proper eye protection to help avoid the situation in the first place.

Polarized Lenses

Filed under: Uncategorized — gkblog @ 8:16 pm

(As appeared in Alamo Today, June 2013)
           I think by now most people that wear sunglasses are familiar with polarized lenses.  However, I find it odd that there are many people who are not aware of the benefits of polarized lenses and the availability of these specialized lenses in all types of prescriptions and lens styles including single vision, bifocals, and progressives.

            First we should discuss the definition of a polarized lens.  When light bounces off a surface (water, road, dashboard, etc.), it is mostly reflected horizontally.  That means that reflected sunlight does not bounce off a surface equally in all directions; it comes at the eyes in a horizontal plane causing glare and distortion.  Since reflected sunlight comes at the eyes in this predictable manner, we can combat this annoying glare with a polarized lens.  This lens contains a properly oriented filter that specifically eliminates this harmful glare.  This filter does not impact the appearance of the lenses, but it selectively eliminates glare.  People with polarized lenses now see the world more clearly and with more vibrant colors because glare is not present to compromise your vision.

            Polarized lenses have many everyday applications that make them the lens of choice for your next pair of prescription or non-prescription sunglasses.  While driving, those annoying reflections from your hood and dashboard would be eliminated.  While walking or biking, the glare off the road on a sunny day is removed.  For those who are on the water fishing or boating, like to go to the beach or like to ski, the glare off of the water or slopes can be debilitating.  Assuming the water is clear, you will be able to see through the water to the life beneath the surface.  While skiing, the vision will be a lot easier will the glare from the snow removed.

          These lenses come in gray and brown and are available in several materials including plastic, polycarbonate, and high-index and in single vision, bifocal, and progressives.  However, there are now multiple color options in single vision lenses.  These include colors in the yellow, green, and orange ranges.  These are mainly used for specialized activities such as fishing, boating, and golf.  As an additional benefit, all polarized lenses come with a UV coating, so all harmful ultraviolet radiation is blocked from getting to the eyes. 

          Keep in mind that the most important thing about sunglasses is the ultraviolet protection.  A pair of sunglasses without a UV block is relatively useless.  If you choose to not have the lenses polarized, please ensure that ultraviolet protection is added to your lenses.  However, all polarized lenses come with a UV filter, so all of your sun wear needs are addressed with one lens.  Our sunglass collection including Maui Jim with their new collection of Maui Jim Readers all comes with clear optical quality polarized lenses.  We look forward to seeing you in the office this summer.

Iritis

Filed under: Uncategorized — gkblog @ 8:14 pm

(As appeared in Alamo Today, May, 2013)

           Since I enjoy writing about cases I see at the office, I thought this was an interesting topic to cover.  The cause of iritis can be numerous and is usually a consequence of an ocular or systemic condition.  The symptoms the patient experiences are often pretty similar but can vary in severity.

            Iritis is a broad term that describes an inflammation in the anterior chamber of the eye (the area between the iris and the cornea).  During an episode of iritis, there are a lot of inflammatory cells that leak through the blood vessels in and around the iris.  These cells that are floating in the eye cause the eye to become red, painful, and light sensitive.  There is usually not major vision loss associated with a particular episode, but the vision is usually temporarily decreased; however, recurrent episodes in the same eye can lead to permanent vision loss.  The origin of the inflammation can be from the eye itself and is associated with trauma, surgery, or infection.  When the eye itself is the likely source, prophylactic treatment is started at that time to prevent the exacerbation of the symptoms.  However, the cause of iritis is usually caused by another systemic cause that at times can be difficult to pinpoint.

            Any type of inflammation in the body can manifest itself in the eye and cause an iritis.  These can include any surgical procedure, trauma, or systemic disease.  The most common systemic causes are auto-immune diseases such as lupus, Chrohn’s disease, and arthritis. This is one of the reasons to tell your eye doctor about your entire medical history as something that you might not think has any relevance to the eye might in fact be extremely important.  These conditions cause inflammation among other symptoms at their site(s) of affliction, and these chemicals then travel in the blood stream and wind up in the eye.  There are also a lot of cases where the person is not feeling any symptoms from the systemic condition, but will have an effect in the eye.  Sometimes a patient will come in stating that they have a specific disease causing the eye flare-up, but often a patient will come in without a prior diagnosis.  After the eye has calmed down, these patients should be sent to their primary care doctor for a work-up.  There are instances where a cause will not be found, but if there are more episodes, a systemic cause is usually found.

            Standard treatment for iritis is steroids.  The frequency and duration of the dosing is dependent on the severity of the condition and how well it responds to treatment.  In certain cases, dilation of the eye might be necessary.  Since the blood vessels in and around the iris are the cause for the inflammation, the movement of the iris (which controls the size of the pupil), further aggravates the situation.  By dilating the eye, the iris is now fixed and allows the amount of inflammatory chemicals entering the anterior chamber to slow down, so that the steroid drops can be more effective.  Even though more light will enter the eye, it is much more comfortable for the patient.  These patients should be followed every few days (more often in the beginning) to make sure the drops are working and to make sure the pressure in the eye is not elevated.  In some cases, either the drops and/or the condition causes the pressure in the eye to become elevated, which would further complicate the treatment plan and possibly require additional drops.

            Since the early symptoms are similar to an infection, it is very important that the correct initial diagnosis is made and that it is made in a timely manner as the treatment is very different.  In the case of an infection, an antibiotic would be used and heavy dosing of a steroid would be the exact wrong thing to do.  So it is very important to know that every red eye is not the same, and that just because a particular drop worked one time does not mean it will be the correct treatment the next time.

Women’s Eye Health

Filed under: Uncategorized — gkblog @ 8:12 pm

     (As appeared in Alamo Today, April 2013)

           Since April is Women’s Eye Health Month, I thought it would be a good idea to tackle this issue.  Unfortunately, most of the sight-threatening conditions affect women more than men; and in some cases, women are twice as likely.  Every year, more women are diagnosed with cataracts, macular degeneration, diabetic retinopathy, and glaucoma.  The main reasons are women generally live longer than men, hormonal fluctuations, and women are more likely to suffer from auto-immune diseases.

            Eye diseases such as cataracts and macular degeneration, which usually affect the elderly, are going to be more prevalent in women due to a longer life span.  The likelihood of being afflicted with these diseases does increase with age.  For example, for macular degeneration, 1 in 5 over 70 years old are affected and 1 in 3 over 85.  Cataracts affect everyone equally, but again is age dependent.  In most cases, the longer a person is battling cataracts, glaucoma, and macular degeneration, the worse the vision tends to get.

            Hormonal levels can also affect vision.  Changes in hormone levels associated with pregnancy and menopause can lead to dry eyes.  Hormones such as estrogen and testosterone are vitally important for tear production and consistency of the tears.  Dry eye is a condition when the eye does not manufacture enough tears and/or the composition of the tears is poor.  When the eyes are dry they tend to burn and sting, and become red, which leads to blurry vision.  Any disruption in the tear layer will lead to the situation where the cornea does not adequately provide a clean and clear refracting surface for the eye.  Since the cornea is the first thing light encounters as it enters the eye, if the cornea is disrupted in any way, vision will be compromised.

          In addition to age and hormone levels, women are also more likely to suffer from auto-immune diseases such as lupus, multiple sclerosis, and Sjogrens syndrome, all with ocular side effects ranging from dry eyes, optic nerve disease, and vision loss.  Since there are no cures for these ailments, treatment is aimed at lessening the symptoms.  Medications such as anti-inflammatories and lubricating drops (including Restasis) can definitely keep redness, irritation, and dryness under control.

            Since most of these ailments are either genetic or age-related, the only thing that can be done is lifestyle modification.  This includes eating well, stop smoking, and monitoring and treating any systemic issues that arise.  As of now, the only cure for any of the above-mentioned ailments is cataract surgery.  Removing the cataract will restore brightness, color quality, and vision.  All other conditions therefore require early diagnosis.  However, between systemic medications and ocular drops, many of the side-effects of the conditions can be managed.  As always, proper eye care can lead to diagnosis, treatment, and if necessary, a referral to a specialist.

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