Alamo Optometry Blog

April 27, 2014

Happy Holidays 2013

Filed under: Uncategorized — gkblog @ 1:46 pm

(As appeared in Alamo Today, December 2013)

Now that 2013 is almost done, I think it is always good to review the past year, and at the same time look forward to the coming year.  First and foremost we need to thank our patients and community for supporting the office.  Without family and friend referrals, our office would not be what it is.  We strive to provide the best care, services, and products and we are extremely grateful that our efforts are appreciated by the community.  Our staff commitment is to continue our superior service and hospitality for all of our patients and family members.

We are constantly being asked during this time of year about flexible spending accounts (FSA) and how to use them at the office.  The government has a wide range of specified expenses that qualify as a medical expense.  These include any office co-pays, any necessary or elective surgical procedures (including LASIK), and many medical devices.  Included in that list is any vision correction device (glasses, computer glasses, contact lenses, sports goggles, etc.) and sunglasses.  As long as your purchase is made by the end of the year, it will count on your 2013 account balance.  It is also recommended to fully utilize any vision benefits you have either through your medical or vision insurance.  We are happy to look up your benefits for you.  We just need to know which insurance you have, and some information about the primary member on the account.  Vision insurance benefits can be found online and it takes only a few minutes.

This past year brought about 2 new daily disposable contact lenses to the market.  Vistakon’s Tru-Eye and Alcon’s Total Vision1 are adding more options to the popular daily disposable modality.   Both of these lenses add a new dimension in health profile, comfort, and vision.  We have found that patients are adapting and appreciating the benefits of daily disposable contacts and these additions make the transition from monthly lenses very easy.

Looking forward to 2014, there are insurance changes that are going to affect us all.  We definitely don’t have all of the answers but we are working towards complying with the new requirements.  Regarding using insurance at the office, most if not all group vision insurance is not going to change.  For those who have VSP, Eyemed, and Medical Eye Services through your employer, those plans will remain the same as in 2013.  Assuming your employer decided to keep the same plan for 2014, it will be the status quo.  Most individual medical plans will also have benefits, but that will vary from plan to plan.  Through these individual plans, the big change will be pediatric benefits.  Qualified plans will cover the exam and basic materials for dependents under 19.  Again, the allowances will be different depending on the plan, but kids will have frames to choose from to have their prescription filled for no cost to the patient. 

Finally, in this holiday season and all year round, it is important to think about those who could use our help.  We always collect old frames and sunglasses and donate them to a local charity in January.  They are distributed to people who cannot afford quality glasses.  As long as the glasses are wearable, the condition does not matter.  Regardless of appearance, they will definitely assist a person in need to help them see well.  We wish everyone a happy and healthy holiday season and look forward to seeing you in the years to come.

Common Eye Myths

Filed under: Uncategorized — gkblog @ 1:45 pm

(As appeared in Alamo Today, November, 2013)

When patients ask me questions regarding vision and the eyes, most of the time they are related to eye myths, or things “that they have heard” and would like a firm answer from a professional.  Obviously I cannot address all of them here, but I will tackle some of the more common questions.

 Myth:  Wearing glasses or contacts will make my vision worse.

Fact:  If your vision is going to change, it is going to change regardless of whether you wear glasses, don’t wear glasses, or wear them part-time.  Most of the prescription changes that occur are secondary to genetics and our environment.  I tell most patients that if this was true, prescriptions would hardly change and that the “eye exercises” that are advertised would work all of the time therefore negating the need for glasses or contacts.  If there was something that worked a high percentage of the time, the need for eye correction would lessen dramatically.  As of now, that does not exist.

 Myth:  Older patients develop a “second sight” which means their vision is improving.

Fact: As patients age, cataracts develop.  This is a clouding of the lens inside the eye.  As the cataract matures, most often patients will become more near-sighted.  Depending on the person, this could allow them to read better, but possibly make the distance vision worse.

 Myth:  You only need an eye exam if you notice your vision deteriorating.

Fact:  Many eye diseases and conditions will not cause decreased vision.  A great example is glaucoma.  The patient will start to notice changes only near the end of the disease process.  Other systemic conditions such as diabetes, high blood pressure, and high cholesterol can initially not have any vision changes but can be diagnosed during a routine eye exam.

 Myth:  Eyes can be transplanted.

Fact:  The technology does not exist at this time to transplant eyes.  The neural connections between the eye and brain are just too numerous and sophisticated to be able to transplant.  Between the over 125 million rods and cones, the optic nerve, and the immense blood supply to the eye, there is too much complexity to tackle this at this time.  However, a cornea can be transplanted.  Since the cornea does not contain any blood vessels or the complexity of the retina, it makes it easier to transplant.

 Myth: Reading in dim light will harm your eyes.

Fact:  Reading in poor light will cause eye strain, squinting, fatigue, and possible headaches, but it will not damage the eyes.  It is recommended to have good lighting and proper prescription correction whenever you are doing near tasks such as using the computer, reading, and your phone.

 Myth:  Eating carrots and other vegetables will improve your vision.

Fact:   Carrots are rich in vitamin A which is essential for retinal health, but it will not improve your vision.  In addition, the vitamins and anti-oxidants found in green vegetables such as spinach and broccoli help in the health and function of the macula.

 Myth: Eye conditions like macular degeneration and cataracts are hereditary.

Fact:  Diseases such as macular degeneration and glaucoma can have a hereditary component.  However, just because a parent or sibling has one of these does not mean you will.  If the genetics are present for these diseases, then at this point there is very little that can be done to offset that.  To help their cause, patients should not smoke and maintain their overall health and keep any vascular conditions such as diabetes and hypertension under good control, as that can contribute to a worsening of those conditions.  Cataracts are an age-related finding and assuming you live long enough, you will get them.  They might not get to the point of needing surgery, but they will affect a person as they age.

Retinal Detachments

Filed under: Uncategorized — gkblog @ 1:43 pm

(As appeared in Alamo Today, October, 2013)

           Thankfully there are very few ocular emergencies that we deal with at the office; however this is one of them.  Whenever someone calls into the office with the possible signs of a detachment, that person is usually seen in the office the same day. 

            There are several signs and symptoms that a patient needs to know to be able to correctly assess the situation.  Most patients will experience an increase in the amount of floaters, flashes of light, possible loss of vision, and areas of gray or black in their visual field.  Most patients have floaters; but in this case, there is a large change in the quantity and/or size of them.  In addition, there is usually accompanying flashes of light.  These floaters and flashes are consequences of the forces of the retina pulling away from the back surface of the eye.  Even though a patient can have an increase in their floaters with flashes and not have a detachment, it is extremely important to have this evaluated as soon as it happens.  In addition, there will be loss of vision in the affected eye; this can vary from a very little change to severe vision loss.  Vision loss in a detachment is determined by whether or not the macula is still attached.  Since the macula is the only area of the retina where sharp 20/20 vision is achieved, if the detachment does not include the macula, the vision loss will be minimal.  However, if the detachment is very near or including the macula, vision will be less than 20/400, or the equivalent of the big “E” on the eye chart.  Lastly, a person will notice an area of gray or black in their vision that corresponds to the area of the retina that is detached.  It is also important to note that a person will not experience any pain from a detachment because there are no pain receptors in the retina.  Patients often note that they either just woke up with the symptoms or it happened in the course of a normal day. 

            After a dilated evaluation reveals a detachment, the patient is then referred to a retinal specialist that same day or the next day.  It is advisable for the patient to go straight to the specialist because they are already dilated and the sooner treatment is initiated, generally the better the prognosis.  Surgical repair can either be done in office or will require an outpatient procedure.  This is determined by the surgeon and the evaluation is based on the location, vision loss, size, and duration of the detachment.  In addition, other factors include age, other associated medical conditions such as diabetes, and if there has been a hole or detachment in the other eye.  Even though the surgery is delicate, the recovery from the surgery can be tedious.  Patients often have to lie face down for a period of time to help ensure the retina remains attached. 

            Some detachments just “happen” and there is not necessarily a cause.  However, conditions such as trauma, high myopia (near-sightedness), diabetes, and other systemic conditions can increase your likelihood.  In the end it doesn’t necessarily matter how the retina became detached, it just matters how quickly you can have your retina checked via dilation and be referred to a specialist in a timely manner.  It is important that if you experience flashes of light, floaters, loss of vision, or an area of black or gray in your vision that you are checked that day.  I would much rather see a patient with these symptoms and not have a detachment than a patient waiting a period of time for the symptoms to “go away” and then possibly have permanent decreased vision because they waited too long.

September 9, 2013

Back To School

Filed under: Uncategorized — gkblog @ 9:01 pm

(As appeared in Alamo Today,  September 2013)

Now that the summer is coming to a close, it is the time as parents where we start turning our attention to back to school for kids of all ages from elementary school to college and graduate school.  Besides stocking up on clothes and school supplies, this usually also includes visits to your child’s pediatrician, dentist, and optometrist.  School these days is difficult enough for our kids so we need to make sure they have the necessary tools and vision to start off the year on the right foot.

Vision at school requires several tasks to manage to be successful.  This includes sharp distance vision to be able to read the board and/or overhead, good near vision and binocular vision (eye teaming) to be able to read and study for long periods at a time, and depending on the class, the ability to go back and forth from the board or overhead to up close to take notes on paper or computer with ease.  In addition to these visual requirements, the eyes also need to be healthy to be able to sustain these demands.  Conditions such as dry eyes induced from allergies or medications, and the itching and tearing from seasonal allergies can hinder vision and thus needed to be diagnosed and addressed.

It is for these reasons that your child’s eyes should be checked by an eye care professional.  School and pediatrician screenings usually only test distance vision and does not address health issues of the eye and does not address near vision, depth perception, and binocular vision.  Many times a child (or adult for that matter) has “good vision” but is still having issues with near work which can include blurry vision, double vision, headaches, and overall difficulty sustaining up-close work for any period of time.  Obviously all reading issues are not caused by vision and/or binocular vision conditions, but that should be the first place you should check out to make sure all is well.

In addition to school and homework, most children are involved in school and/or recreational sports and extra-curricular activities.  Whether your child is involved in soccer, football, dance, or cheerleading, these all require good vision and ocular health to be able to succeed.  If there is vision correction required, many parents and kids are opting for daily contact lenses.  Activities are often difficult to fully participate in while wearing glasses, and contact lenses allow for good vision as well as peripheral vision, and you are not hindered by the frame.  Most patients are good candidates for contacts; however, since there is work to learn to adapt to the lenses and to be able to put them on and off, motivation on the part of the child is paramount.  If he or she is not really interested in contacts, I recommend starting the process of training and follow-ups when they are ready to tackle it.  It is also helpful if a family member already wears contacts to be able to help out as needed.  However, it is the child that needs to have the responsibility of keeping their hands clean, cleaning and storing the lenses as needed, and inserting and removing the contacts.

It is recommended for vision and ocular health changes that patients get an annual eye exam.  The testing we do at the office goes much more in depth and covers more than pediatrician and school screenings.  We hope that if you do not have any vision insurance that you take advantage of our back to school offer.  We are a family-centered practice and we look forward to seeing the entire family in the office soon.

Pinguecula and Pterygium

Filed under: Uncategorized — gkblog @ 8:59 pm

(As appeared in Alamo Today, August 2013)

Most people look at those two words and they probably ring a bell.  A patient will remember it being mentioned but can’t necessarily tell what it describes.  As I go through the definitions, most people will realize that they have these on their eyes and at times can cause a little redness or irritation.

A pinguecula (pin-GWEK-yoo-la) is a very common non-cancerous growth of the conjunctiva (the clear membrane over the front surface of the eye).  It is usually a yellowish round bump more commonly found on the side of the eye closest to the nose; and many times it can become inflamed with blood vessels running across the eye.  These do not cause any vision loss, but can cause some irritation and tend to cause patients to have a foreign body sensation.  Depending on how close it is to the cornea, it can cause increased contact lens sensation as the edge of the contact lens will rest on the pinguecula.  Regardless of how inflamed or irritated a pinguecula becomes, it will remain on the conjunctiva and will not grow onto the cornea.

A pterygium (tur-IJ-ee-um), however, can and often does extend onto the cornea.  These two conditions are very similar, but the difference is the tissue of origin and the shape.  A pterygium develops in the sclera, which is the white part of the eye underneath the conjunctiva.  These also take on a triangular shape with the wider base next to the corner of the eye and the narrower edge pointed towards the center portion of the eye.

Both of these conditions are completely benign and share similar causes.  By far the biggest culprit is UV exposure.  It is important to realize that it is a cumulative effect of UV radiation, and a very large portion of that was done by the time you turned 18.  That is why it is very important for kids to wear sunglasses and hats when they are young.  The other contributors are dusty and chemical environments.  Farmers are notorious for having very large pterygia because they have the sun, the dust, and the fumes from the chemicals that are used on the vegetation.

Treatment of these conditions is also very similar.  Besides the need for UV-blocking sunglasses, lubricating drops help with the foreign body sensation and helps to keep the area moist.  If these grow large, they become very dry because as the lids come down over the eye during blinking, it is not able to reach the entire surface and therefore it becomes dry and inflamed.  The more red and inflamed these become, they quicker they tend to grow.  In advanced cases, an anti-inflammatory is needed in conjunction with the lubricating drops to get the redness and irritation under control.  These drops will not remove or shrink the area down; it will only reduce the associated swelling and irritation.

If and when a pterygium grows far enough onto the cornea, surgical removal needs to be considered.  If it continues to grow in front of your pupil, then vision will be compromised and when it is removed it will leave a central scar on the cornea that will reduce vision.  The need for this does not happen often, due to patients taking care of it with sunglasses and artificial tears.  As I tell most of my patients, the happier you keep the pterygium; it will return the favor and not grow as quickly.

If you have any questions about which treatment would be best for your situation, we would be happy to see you.

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.

March 11, 2013

Broken Blood Vessel

Filed under: Uncategorized — gkblog @ 9:00 pm

(As appeared in Alamo Today, March 2013)         

When patients call into the office with a concern of a broken blood vessel (subconjunctival hemorrhage) in the eye, they are usually pretty scared about what is happening to their eye.  In a very high percentage of times, this is a completely benign condition; it just looks a lot worse than it actually is.

            For patients who have never had this happen to them before, it can be a scary situation to see your eye extremely red.  We have found that patients generally think the worst when something goes wrong with their eyes and/or vision.  As I tell everyone, thankfully most of the time the condition is treatable and will not lead to permanent vision loss.  However, that is not the case all the time; therefore a visit to the eye doctor is prudent to come up with the correct diagnosis and treatment plan.

            A subconjunctival hemorrhage occurs when a very small blood vessel (capillary) bursts within the layers of the front part of the eye.  This bleeding will usually obscure the eye so you can’t see through to the white part of the eye and it can happen anywhere on the surface of the eye.  These small bleeds generally get larger after the initial incident because the outside layer of the eye has a cellophane look and feel to it; this tends to push down and spread out the blood.  I will tell patients that the eye will look a little worse in the initial 24-48 hours before the blood starts to get reabsorbed.  With a hemorrhage of this kind, the patient should have no other symptoms besides the red eye.  There should be no pain, discomfort, vision loss, or discharge.  Patients often do not even notice it until they look in the mirror or are asked by someone else, “What is wrong with your eye?”  It is at this point that a call is then made for an office visit. 

            The most common cause of this condition is “it just happens.”  Most of the time, a patient will go to bed fine and wake up with the hemorrhage.  Other typical causes are trauma to the eye, heavy lifting, coughing, high blood pressure, and secondary to some medications.  I have found that blood pressure is usually not the cause as it would require extremely high blood pressure to have an effect.  Some medications including aspirin, prescription blood thinners, and some OTC medications such as ginkgo biloba in some people can cause the blood to thin too much and be a reason for the hemorrhage.  However, these medications are usually prescribed for a heart condition and some blood disorders and are therefore necessary for the health of the patient.  I will always instruct the patient to not change their current medications, but that it might lengthen the time for full recovery. 

            Once the diagnosis is made, there is no treatment necessary.  The blood will reabsorb within 1-2 weeks depending on the size of the initial hemorrhage.  As the blood breaks down on the surface of the eye, it might start to change colors, similar to a “black and blue bruise”.  If the cause of the hemorrhage was a foreign body to the eye, then I will prescribe a mild antibiotic to cover against an infection.  Cool compresses will not hasten recovery, but I would avoid warm compresses as heat dilates your blood vessels, thus bringing more blood to the area.  I find most patients just need to understand what happened and reassurance that it is nothing to worry about and that it is not contagious.  Even though this condition is completely benign, it can be confused with other issues that require treatment.  You should have your eyes checked at the office to ensure that the eyes are healthy and that there is no need for treatment or referral.

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