Allergies and the Eyes
Approximately 22 million people in the US suffer from seasonal itchy, swollen, red eyes. Airborne allergens, such as house dust, animal dander and mold constantly bombard the eyes and can cause ocular allergies at any time. But when spring rolls around and the plant pollen starts flying, it seems like everyone starts crying.

Seasonal allergic conjunctivitis, or hay fever, is the most common allergic eye problem. Various antihistamine and decongestant drops and sprays can soothe irritated eyes and nose.

Make every effort to avoid allergens. An allergist can help determine what you are allergic to so you can stay away from it. Staying away from outdoor pollen may be impossible, but remaining indoors in the morning when the outdoor pollen levels are highest may help control symptoms. If you are allergic to house dust, open windows and keep household filters clean.

Cool compresses decrease swelling and itching. Artificial tears dilute the allergens and form a protective barrier over the surface of the eye. Avoid rubbing the eyes. It makes the symptoms worse.

If seasonal allergic conjunctivitis is a problem, see an ophthalmologist. There are several new safe and effective anti-allergy drops that can be prescribed. An ophthalmologist can also make sure symptoms are not being caused by a more serious problem.
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Chalazion
A chalazion is a swelling in the eyelid caused by inflammation of one of the small oil producing glands located in the upper and lower eyelids. A chalazion is sometimes confused with a stye, which also appears as a lump in the eyelid, but is an infection of a lash follicle that forms a red, sore lump. Chalazions tend to occur farther from the edge of the eyelid than styes and tend to "point" toward the inside of the eyelid. Sometimes a chalazion can cause the entire eyelid to swell suddenly, but usually there is a definite tender point.

When a chalazion is small and without symptoms, it may disappear on its own. If the chalazion is large, it may cause blurred vision. Chalazions are treated with any or a combination of the following methods:

Warm compresses
The simplest way is to hold a clean washcloth, soaked in hot water, against the closed lid. Do this for five to ten minutes, three or four times a day. Repeatedly soak the washcloth in hot water to maintain adequate heat. The majority of chalazions will disappear within a few weeks. Sometimes antibiotic ointments are used in combination with warm compresses.
Surgical incision or excision
may be used to remove large chalazions which do not respond to other treatments.

Chalazions usually respond well to treatment, although some people are prone to recurrences. If a chalazion recurs in the same place, your ophthalmologist (Eye M.D.) may suggest a biopsy to rule out more serious problems.

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Conjunctivitis (Pink Eye)
Pink eye, the common name for conjunctivitis, is an inflammation or infection of the conjunctiva, the outer, normally clear covering of the sclera, the white part of the eye. The eye appears pink in conjunctivitis because the blood vessels are dilated. Pink eye is often accompanied by a discharge, but vision is usually normal, and discomfort is mild.

Either a bacterial or a viral infection may cause conjunctivitis. Viruses, which are more common and last several weeks, may cause an upper respiratory infection (or cold) at the same time. Unlike viruses, bacterial conjunctivitis is treated with a variety of antibiotic eye drops or ointments, which usually cure the infection in a day or two.

Conjunctivitis can be very contagious. People who have it should not share towels or pillowcases and should wash their hands frequently. They may need to stay home from school or work and should stay out of swimming pools.

Not everyone with conjunctivitis has an infection. Allergies can cause conjunctivitis too. Typically, people with allergic conjunctivitis have itchy eyes, especially in spring and fall. Eyedrops to control itching are used to treat allergic conjunctivitis. It is important not to use medications that contain steroids (they usually end in "-one" or "-dex") unless prescribed by an ophthalmologist.

Finally, not everyone with pink eye has conjunctivitis. Sometimes more serious diseases, such as infections, damage to the cornea, very severe glaucoma, or inflammation on the inside of the eye cause the conjunctiva to become inflamed and pink. Vision is usually normal if the pink eye is really conjunctivitis. If vision is affected, or if the problem does not get better in a few days, see an ophthalmologist

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Eyecare Facts and Myths

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Herpes Zoster
One's first encounter with the herpes zoster virus is usually childhood chicken pox. Later in life, the virus may reactivate, causing a characteristic rash of small blisters, frequently on the chest or forehead, which form crusts and may leave scars. This second encounter is known as shingles.

Unlike chicken pox, this condition is usually quite painful. Although this disease often occurs in normal, healthy people, it occurs more frequently in elderly or immune-compromised individuals.

It is important to see an ophthalmologist when herpes zoster occurs on the face because the virus may invade the eye. An ophthalmologist looks for elevated pressure in the eye, inflammation, and herpes zoster lesions on the surface of the eye. All these problems can be treated but they are sometimes difficult to manage. Therefore, careful treatment and follow-up are required. New oral antiviral medications are providing sufferers with a quicker, more complete recovery.
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How to Insert Eyedrops
Infections, inflammation, glaucoma, and many other eye disorders are treated with eyedrops. Surprisingly, even the small amount of medication in an eyedrop can create significant side effects in other parts of the body. It is important to remember that all medicines have side effects. There are ways to decrease the absorption of the eyedrop into the system, and to increase the time the eyedrop is on the eye, making the medicine more safe and effective.


Inserting eyedrops may seem difficult at first but becomes easier with practice. To put in an eyedrop, tilt the head back. Then create a pocket in front of the eye by pulling the lower lid down with an index finger or gently pinch the lower lid outward with the thumb and index finger. Let the drop fall into the pocket without touching your eye or eyelid (to prevent contamination of the bottle).

Immediately after installing the drop, squeeze the bridge of your nose for two to three minutes with your thumb and forefinger. This prevents most of the drop from traveling down the tear duct to the rest of the body.

Keep your eyes closed for three to five minutes after installing the drop. Because the volume of a single drop exceeds the capacity of the surface of the eye, it serves no purpose to use two drops at the same time.

Before opening your eyes, dab unabsorbed drops and tears from the closed lids with a tissue.
If you are taking two different types of eyedrops, wait at least five minutes before installing the second drop
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Legal Blindness
Normal vision, or 20/20, means a person sees the smallest letters or pictures on an eye chart when standing 20 feet away from the chart. Some people cannot see normally, even with glasses or contacts, because a medical condition affects their vision. These people are called visually impaired or visually handicapped

If a visual handicap limits vision to 20/200, or one-tenth of normal, a person is legally blind. Legally blind does not mean totally unable to see. Someone legally blind cannot see the line below the second big E at the top of the eye chart. People with 20/20 vision but less than 20 degrees of side vision can also qualify as legally blind. People who see well with only one eye are not considered legally blind, nor are people who wear glasses to see better than 20/200.

Most legally blind people function quite well, especially if they have been visually handicapped since childhood. Older children and adults with visual handicaps may need magnifying lenses for reading and telescopes for distance viewing. People with very poor vision may need to learn

Braille and walk with a seeing eye dog or a cane.
Young children with visual impairments should have help from a teacher of the visually impaired and should be evaluated for developmental problems by professionals experienced with visual handicaps. Parents may need to be advocates for their child to obtain needed services through the schoolsystem.

Visually handicapped people of all ages benefit from social service, occupational therapy, and orientation and mobility training. Many new devices are available to cope with vision loss, including books on audio tapes, scanners that turn print into Braille, watches that can be "read" with the fingers, and talking computers and calculators.
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Living with One Good Eye
People who lose vision in one eye because of an injury or a medical condition must adapt to a narrower field of vision and loss of depth perception. They still see small objects as well as before, assuming the other eye is normal.

People often think children with strabismus (misalignment of the eye) or amblyopia (lazy eye) have poor depth perception because they have trouble using two eyes together. Although these children do poorly on tests of depth perception in an ophthalmologist's office, they have learned to adapt from an early age. In real-world circumstances, they do not have trouble with depth perception.

At first, adults who lose vision in one eye tend to have a few fender-benders, and reach out next to the hand they want to shake. But with patience and time, they learn to use clues to depth perception that do not require both eyes.
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Pterygium and Pinguela
A pterygium is fleshy tissue that grows over the cornea (the clear front window of the eye). It may remain small or may grow large enough to interfere with vision. A pterygium most commonly occurs on the inner comer of the eye, but can appear on the outer corner as well. The exact cause is not well understood. Pterygium occurs more often in people who spend a great deal of time outdoors, especially in sunny climates. Long-term exposure to sunlight, especially ultraviolet (UV) rays, and chronic eye irritation from dry, dusty conditions seem to play an important causal role. A dry eye may contribute to pterygium.

When a pterygium becomes red and irritated, eyedrops or ointments may be used to help reduce the inflammation. If the pterygium is large enough to threaten sight or grows rapidly, it can be removed surgically. Despite proper surgical removal, the pterygium may return, particularly in young people. Protecting the eyes from excessive ultraviolet light with proper sunglasses and avoiding dry, dusty conditions and use of artificial tears may also help.

pterygium

pinguecula

A pinguecula is a yellowish patch or bump on the white of the eye, most often on the side closest to the nose. It is not a tumor, but an alteration of normal tissue resulting in a deposit of protein and fat. Unlike a pterygium, a pinguecula does not actually grow onto the cornea. A pinguecula may also be a response to chronic eye irritation or sunlight.
No treatment is necessary unless it becomes inflamed. A pinguecula does not grow onto the cornea or threaten sight. If particularly annoying, a pinguecula may on rare occasions be surgically removed, but the postoperative scar may be as cosmetically objectionable as the pinguecula.
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Smoking and Eye Disease
Tobacco smoking is directly linked to many adverse health effects, including high blood pressure, heart disease and cancer. Smoking is also linked to specific eye disease.

How does smoking affect the eyes?
People who smoke cigarettes are at increased risk for developing cataracts, a clouding of the naturally clear lens of the eye. Cataracts cause a variety of vision problems, including blurry distance vision, sensitivity to glare, loss of contrast and difficulty seeing colors. When glasses or magnifiers are no longer helpful for someone with cataracts, or when cataracts develop in both eyes, surgery is the only option.

Tobacco smoking is also one of the preventable risk factors for age-related macular degeneration (AMD). Studies have shown that current smokers and ex-smokers are more likely to develop AMD than people who have never smoked. AMD has two forms: dry (called atrophic) AMD and wet (called exudative) AMD. In dry AMD your retina gradually thins. There is no proven cure for this type of degenerative disease. In wet AMD new blood vessels grow in the retina, leaking blood or fluid, damaging the macula, the part of the retina responsible for your central vision. The two types of treatment currently available for specific forms of wet AMD are standard laser surgery and photodynamic therapy, both of which may stabilize the disease.

In people with high blood-sugar levels, some studies suggest that smoking may be linked to diabetic retinopathy, or damage to the blood vessels in the retina. The optic nerve is also susceptible to damage from smoking. People with poor diets who smoke heavily and drink excessive amounts of alcohol run the risk of developing optic nerve-related vision loss (called tobacco-alcohol amblyopia). Certain optic nerve problems run in families (called Leber's hereditary optic neuropathy). People with this condition who smoke have increased risk of vision loss. In some patients with thyroid disease (called Graves' disease) who also have eye involvement, smoking can cause the eyes to become worse, with vision loss possible.

People who do not produce enough tears to keep their eyes comfortably lubricated have a condition called dry eye. For these people, smoking is a significant irritant, worsening the symptoms of scratchiness, stinging or burning of the eyes, and excess tearing from irritation.

How does smoking affect fetal/infant eye health?
Studies have also shown a strong association between smoking during pregnancy and the risk of invasive meningitis during early childhood. The risk of bacterial meningitis is five times higher among children whose mothers smoked during pregnancy. In addition to other severe health problems, childhood meningitis can cause inflammation of the cornea and pink eye. Smoking during pregnancy is also associated with low birth weight and premature birth. And finally, oxygen therapy given to sustain the lives of premature infants can cause retinopathy of prematurity, causing permanent vision loss or blindness.

There are resources to help you quit smoking.
There are numerous community organizations committed to helping people quit smoking. The American Cancer Society (ACS) offers smoking cessation classes around the U.S. Contact ACS at 1-800-ACS-2345 or online at www.cancer.orq <http://www.cancer.orq> to find the chapter near you.
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Tanning Beds
Tanning beds produce high levels of ultra-violet (UV) light that tan the skin and burn the cornea, the clear covering of the eye. The burn is not felt until 6-12 hours after exposure, so you can suffer a severe burn without realizing it. UV light may also cause cataracts, and be a factor in the development of macular degeneration.

Of course, an ounce of protection is worth a pound of cure, so always use protective eye wear while using a tanning bed. Closing your eyes, wearing regular sunglasses, and using cotton pads on your eyelids does not protect your cornea from the intensity of the UV radiation in tanning devices.

Tanning facilities are required by the Food and Drug Administration (FDA) to provide goggles, but it is best to obtain your own pair so you will always be prepared. Make sure your goggles fit snugly and cover your eyes properly. If you borrow the salon's goggles' be sure they are sterilized after each use to prevent infection.
Since you do not usually burn under tanning devices, most people do not realize the potential damage to their eyes. If you experience eye pain after UV exposure contact your ophthalmologist.
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Viagra
Ophthalmologists are cautioning patients about visual side effects caused by Viagra, an oral therapy for impotence. Viagra relaxes smooth muscles in the penis by interfering with the action of a special enzyme. A nearly identical enzyme in the retina, the layer of light-sensitive cells lining the back of the eye, may also be affected by Viagra, causing a mild disturbance of color vision in approximately 3% of people taking a higher than recommended dose.

Because of this unusual side effect, doctors recommend people with retinitis pigmentosa (an inherited disease affecting the retina) use Viagra with caution. People with other retinal problems should discuss their condition with their ophthalmologist before taking Viagra.

Until more data is available, physicians strongly recommend people stay at the lowest dose possible. Presently 50 mg is the recommended amount.
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Video Display Terminals
Complaints of eye discomfort and fatigue are becoming more common as use of video display terminals (VDTs) increases. While it is true that VDTs can cause eyestrain, there is no convincing evidence that VDTs can harm the eyes.

Some people fear VDTs emit damaging ultraviolet light or radiation. The amount of ultraviolet light emitted by VDTs is a fraction of what is emitted from a fluorescent light. Radiation levels from VDTs are so low a lifetime of exposure will not damage the eyes. After prolonged use of a VDT, black and white objects may appear colored, but this is not a sign of eye damage.

Symptoms of eyestrain are eye irritation (red, watery or dry eyes), eye fatigue (tired, aching heaviness of the eyelids or forehead), difficulty in focusing, and headaches. However, eyestrain does not result in permanent eye damage.

Eyestrain, backache and muscle spasms may improve with proper arrangement of the VDT and seating area. The Occupational Safety and Health Administration (OSHA) provides helpful suggestions on workstation arrangement.

It is important to wear appropriate glasses adjusted for the distance from the VDT. Most VDT users prefer to position the screen farther from where they normally read. Prescription glasses should be adjusted accordingly.

Take periodic rest breaks. Using a VDT requires an unchanging body, head, and eye position that can be fatiguing. Lubricate the eyes by blinking frequently or using artificial tears (lubricating eye drops.) Keep workstation clean to minimize eye irritation from dust.

Minimize light glare by adjusting office lights or using hoods or filters on the video screen. Standard office lighting is too bright for comfortable VDT use.
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Workplace Eye Safety
Eye injuries at work are common. Every year about 70,000 workers injure their eyes. Luckily, 90 percent of all workplace eye injuries are preventable with the use of proper safety eye wear.

The Occupational Safety and Health Administration (OSHA) provides regulations which employers and employees must follow. OSHA reports that nearly three out of every five workers injured were not wearing eye protection at the time of their accident. The American National Standards Institute (ANSI) provides these standards of eye protection for any workplace task.

The Bureau of Labor Statistics reports that eye injuries in the workplace cost over $467 million annually. A written eye safety program should be implemented in the workplace to help prevent workplace eye injuries. Employers should consider these tips in developing their safety plan:

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