Posted by Dr. J. R. Lacey, Therapeutic Optometrist
What is Pink Eye?
How do You Get Pink Eye?
Pink eye is actually a non-medical term that is commonly used to describe the medical condition called conjunctivitis. Some actually define pink eye as a certain type of conjunctivitis, such as an acute epidemic type of bacterial conjunctivitis; however, most eye doctors would probably assume any reference to pink eye as one of the various types of conjunctivitis.
Pink eye (conjunctivitis) is inflammation of the conjunctiva (a layer of the white part of the eye) where the blood vessels in the white part of the eye, or on the underside of the eyelids dilate making the eye appear pink or red.
What Causes Pink Eye?
There are many causes of pink eye/conjunctivitis but the main ones are listed below:
Viral conjunctivitis
Viral conjunctivitis is caused by a virus usually during or after someone acquires an upper respiratory infection or some sort of ailment caused by a virus. Viral pink eye can be acquired through contact from a contaminated individual or surfaces such as a doorknob or shopping cart via hand to eye contact.
Bacterial conjunctivitis
This type of conjunctivitis is caused by bacteria such as Streptococcus pneumoniae or Staphylococcus aureus and can affect one or both eyes. Like viral pink eye, bacterial conjunctivitis can be acquired through contact from a contaminated individual or contaminated surfaces through hand to eye contact.
Allergic conjunctivitis
Allergic conjunctivitis is due to an allergic response that occurs within the eye. More often than not individuals who suffer from eye allergies also suffer from systemic allergies. The main allergens that cause this type of conjunctivitis are pet dander, pollen, mold and dust mites.
Symptoms of Pink Eye?
Viral conjunctivitis Symptoms
The main symptoms will include red, irritated, and watery eyes. It can affect both eyes at the same time or one eye initially, but then the infection often quickly spreads to the other eye. Viral conjunctivitis/pink eye is highly contagious so good hygiene is recommended. Eyes can feel sandy and gritty and almost have a foreign body sensation in the eyes.
Some viral conjunctivitis can be severe and cause definite life complications with substantial discomfort. Epidemic keratoconjunctivitis (EKC) if treated promptly can be minimized and reduced or eliminate severe discomfort and loss of productivity and work days.
Bacterial conjunctivitis Symptoms
Most people will experience redness, discharge (usually mucous-like and green or yellow in color), irritated eyes. When the infection is bad, the eyes can be crusted or eyelashes matted shut upon waking after sleep making it difficult to open the eyes. Like viral conjunctivitis, eyes can feel sandy and gritty and almost have a foreign body sensation in the eyes.
Allergic conjunctivitis Symptoms
The main symptoms of allergies in the eye will be intense itchy and watery eyes. Burning eyes and puffy eyelids can also occur.
What is the Treatment for Pink Eye?
Viral conjunctivitis Treatment
Depending on the type of virus and severity level the treatment ranges. In some very mild cases the viral conjunctivitis is self-limiting and no treatment is necessary. This mild form can resolve in about five to seven days. Artificial tears can be used on an as needed basis to give the eyes temporary moisture and relief.
However, for most viral pink eye cases, the patient is quite miserable and wants and needs medical care ranging from antibiotic-steroid combination eye drops to an initial one time treatment of betadine for EKC that must be administered by an eye doctor.
Bacterial conjunctivitis Treatment
An antibiotic eye drop is prescribed for about seven to ten days to eliminate the infection.
For both viral and bacterial conjunctivitis it is important to maintain good hygiene in order to prevent the infection from spreading. Make sure hands are being washed regularly, and anything that has come into contact with the eye is washed or thrown out (specifically make up) until the infection has resolved.
Allergic conjunctivitis Treatment
Sometimes oral anti-histamine medicines such as Claritin or Zyrtec can eliminate the symptoms. When that fails, topical anti-histamine eye drops are available. Depending on the nature of the conjunctivitis the eye drops can be used on an as needed basis for seasonal conjunctivitis or everyday for year-around or chronic allergic conjunctivitis. Corticosteroid eye drops (such as Lotemax) can also be used for short-term therapy for a more severe form of allergic conjunctivitis if no relief is given with anti-histamines.
Prognosis for Pink Eye Patients
With proper treatment, all types of pink eye usually can be cured without permanent vision loss.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Exercise with Some Limits is Believed to be Beneficial for Glaucoma Patients
In most cases exercise is good for glaucoma patients if performed properly. Although there are a few exceptions, some research supports the benefits of moderate exercise for glaucoma patients. The exercise should be moderate and not extreme since there is now research showing extreme exercise creates large amounts of free radicals within the body, which can have its own set of problems.
Current treatment for glaucoma strives to lower intraocular fluid pressure (IOP) within the eye using eye drop medicine, laser procedures or specialized glaucoma procedures. Lowering the IOP helps maintain the health and integrity of the optic nerve. Glaucoma is a disease of the optic nerve and anything that helps the optic nerve can help a glaucoma patient. The optic nerve requires sufficient blood flow to maintain proper function and avoid neuronal degeneration. Poor blood circulation or low blood pressure can create damage to the optic nerve especially when the IOP is high. Therefore, anything a glaucoma patient can do to improve circulation can aid the health of the optic nerve.
In general, exercise tends to lower IOP and certainly improves blood circulation. So, if you have glaucoma or are one of the millions of Americans that are glaucoma suspects, try moderate exercise!
Exercise Guidelines for Glaucoma Patients
- Exhale during periods of maximum exertion such as when lifting
weights. Inhale when lowering the weight. This will help you avoid the Valsalva effect, which is when a person exhales forcefully with a closed mouth or held nose and the windpipe is blocked by the closed epiglottis. The Valsalva effect can increase pressure dramatically sometimes up to 300% of the normal IOP. The same also applies to playing a musical wind instrument, which can substantially raise IOP.
- Yoga and Pilates participants must be extremely careful and will need to limit their scope of movements. Holding breath going into or out of a pose raises IOP significantly.
- Avoid all inverted positions including headstands and inversions for back relief, etc. since all inverted positions raise IOP substantially.
The long term effect of exercise on glaucoma progression is not known, but anything that improves overall health and helps in maintaining the integrity of the optic nerve is a positive benefit.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Selective Laser Trabeculoplasty (SLT) - Glaucoma Laser Eye Surgery
Selective Laser Trabeculoplasty is an Alternative to Medicine for Treating Glaucoma
Selective Laser Trabeculoplasty (SLT) is a type of laser eye surgery used to decrease intraocular pressure (IOP) in open-angle glaucoma patients. This is achieved by increasing the drainage of aqueous fluid from the eye through the trabecular meshwork. After SLT, the IOP drops quickly the first day and stabilizes over the first two months. SLTs are usually performed in cases where glaucoma and IOP are unable to be controlled with glaucoma medical eye drops; however, this procedure can be performed at anytime during the management of glaucoma. Recent studies have suggested that SLT is the same, if not better, than current eye drop medications as a first line treatment and SLT is gaining popularity as a first line treatment instead of or in addition to medicine eye drops.
SLT is similar to ALT (argon laser trabeculoplasty), but is a newer, more selective procedure and uses shorter laser pulses. SLT only targets cells in the trabecular meshwork that contain melanin, while ALT targets all cells in the trabecular meshwork. This allows SLT to result in less damage and less scarring of the surrounding tissue than ALT. This is a significant difference because the damage caused by ALT may prevent use of some newer types of glaucoma procedures such as iStent or the Hydrus (not yet approved in the U.S.).
Steps of the SLT Procedure
SLT is an in-office procedure. Prior to the surgery, anesthetic eye drops will be instilled on the eye. The procedure is performed at the slit lamp (microscope) while the doctor holds a special type of lens against the eye. The patient may see light flashes and hear a beeping sound during the laser surgery. Prescription eye drops will be applied after the SLT procedure to help reduce inflammation and/or infection. The patient may experience mild ocular irritation and discomfort following SLT.
The laser used in SLT targets only pigmented cells in the trabecular meshwork of the eye. There is virtually no effect or damage to surrounding tissue. The laser pulse is so short that any heat generated does not transfer to nearby tissue. ALT however does cause damage to surrounding tissue. The wavelength of light generated by SLT targets the melanin of the pigmented cells and stimulates the eye’s natural mechanism to increase aqueous outflow out of the eye and lower intraocular pressure.
Multiple follow up visits will be required in order to monitor IOP and the success of the
procedure. Follow up visits typically occur 1 day, 2 weeks, and 2 months after SLT is performed. If both eyes require treatment, the procedure will be performed on two separate visits. Multiple treatments may also be required. In some cases, IOP lowering eye drops may still be needed after SLT is performed in order to control glaucoma. Most patients can stop at least one of their eye drop medicines.
Side effects after SLT can include inflammation, bleeding, change in glasses prescription and increase in IOP. These side effects are rare and can be managed effectively.
Patient Selection for Selective Laser Trabeculoplasty
SLT can only be performed on patients with open-angle forms of glaucoma. This is a successful option for both first line treatment and adjunct therapy with topical medications.
This procedure is beneficial in patients who are concerned about the cost of medications, side effects associated with medications, and/or those who have difficulty using eye drops.
SLT patients are still eligible to have iStent surgery in the future. ALT patients often do not benefit from iStent due to fibrosis and scarring and destruction of many cells in the trabecular meshwork.
SLT is covered by Medicare and virtually all medical insurance companies. Even without insurance the procedure is very affordable.
Prognosis after SLT
SLT results in a decreased intraocular pressure similar to an amount achieved by the typical first line medicine used by most eye doctors. Unfortunately, most people will still need to use some eye drop medicine even after having the SLT procedure.
SLT can be performed multiple times on the same eye. This is important because the effects of SLT diminish after a few years and it becomes necessary to perform the procedure again and again over the course of 7-8 years. Unfortunately, SLT is not a one and done procedure. It will have to be repeated several times over the years and ultimately the benefits of IOP lowering will be reduced and further SLT will not be used at some point due to its diminished results.
An advantage of SLT vs. medical treatment is that there is no possibility of patient non-compliance or forgetting to use the eye drops. SLT also works constantly 24 hours per day with no high and low pressure periods that often occurs with eye drop medicine. There are also no systemic side effects or ocular side effects with SLT like there is with medicine.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
The iStent is a Promising New Treatment for Glaucoma Patients that also Need Cataract Surgery
It is a promising era for glaucoma patients. On June 25, 2012, the Food & Drug Administration (FDA) approved the iStent Trabecular Micro-Bypass Stent System, Model GTS100R/L. The iStent is the first device ever approved to be used in conjunction with cataract surgery for adults with moderate open angle glaucoma.
What Causes High Intraocular Pressure in the Eye?
In typical open angle glaucoma, aqueous fluid is continually created in the epithelium (outer layers) of the ciliary body in the eye and then circulates through the anterior part of the eye. The aqueous fluid normally drains from the anterior chamber of the eye. This fluid flows out of the eye through a tissue meshwork called the trabecular meshwork that encircles the iris. After filtering through the trabecular meshwork the aqueous fluid exits the eye via Schlemm’s Canal, which flows into the bloodstream.
When the trabecular meshwork doesn’t function properly it slows the drainage and exit of the aqueous fluid so the pressure builds higher inside the eye. The higher intraocular pressure can damage the fibers of the optic nerve (glaucoma) and lead to vision loss.
iStent Increases the Outflow of Aqueous from the Eye and Lowers Eye Pressure
The iStent is an extremely small titanium tube about 1 mm in length with an opening of only 120 microns. It is so small that it is believed to be the smallest implant of any kind ever
placed in the human body. The iStent is placed directly through the trabecular meshwork creating a tube-like opening for aqueous to flow into Schlemm’s Canal to help reduce intraocular pressure.
Worldwide Studies Prove the Effectiveness of the iStent
FDA studies proved the safety and effectiveness of the iStent. However, numerous other studies in Europe and Canada provide even more proof of its effectiveness. Discussions with a leading glaucoma specialist in Canada, who is very experienced with the iStent, reveal that using 2-3 iStents per eye is his procedure of choice for moderate glaucoma patients that also need cataract surgery. There is a moderately steep learning curve implanting the iStent and complications can occur because of that need to truly know how to implant the iStent. Therefore, it is advised to seek only a glaucoma specialist experienced with the iStent.
The iStent Trabecular Micro-Bypass Stent System is manufactured by Glaukos Corporation of Laguna Hills, Calif. The author has no financial interest in the iStent device or in the manufacturer of the device.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Herpes Simplex Keratitis Eye Infection
Herpes Simplex Keratitis or simply herpes keratitis (sometimes referred to as dendritic keratitis) is an infection of the cornea of the eye by the herpes simplex virus type 1 (HSV1), which can cause serious vision loss including blindness. It is estimated that 80% of the U.S. population harbors this virus! At least two thirds of those infected do not have outbreaks and recurrences or they are too mild to notice.
This article does not refer to Herpes Varicella Zoster virus that causes chickenpox or shingles or herpes zoster ophthalmicus. Please scroll the left side column to locate herpes zoster if you are searching that subject.
Cause of Herpes Keratitis
After a primary herpes infection the herpes virus is not destroyed and does not leave the body. The herpes simplex 1 virus simply remains dormant in the trigeminal ganglion in the area of the ears. The trigeminal ganglion is a mass of nerve cell bodies of the trigeminal nerve. The trigeminal nerve (fifth cranial nerve) provides sensory information for the face and some motor functions (chewing, swallowing). There are two trigeminal nerves, one on each side of the pons. Each trigeminal nerve has three major branches, the ophthalmic nerve , the maxillary nerve and the mandibular nerve.
The ophthalmic nerve provides neural sensation for the cornea of the eye as well as other surrounding structures. The maxillary nerve provides sensory signals for the upper lip, teeth, gums etc. The mandibular nerve provides the sensory signals for the lower lip, lower teeth and gums and other surrounding anatomical structures.
Therefore, when a stressor (fever, sunburn, injury, surgery) or reduced immune system allows the herpes virus out of latency and the virus becomes active and starts replicating, the virus usually travels from the trigeminal ganglion through the maxillary nerve to the upper lip or through the mandibular nerve to the lower lip. However, sometimes, the virus chooses the third option of the ophthalmic nerve and travels to the cornea of the eye where it can create a devastating infection with severe consequences.
Herpes Keratitis is usually NOT caused by genital herpes because that virus lies dormant in the sacral ganglion near the base of the spinal cord. However, it is worth noting that HSV1 can transfer to other parts of the body. For example, genital herpes (herpes simplex virus type 2) can be caused through oral sex when one’s lip is infected. Vice versa, genital herpes can be transferred to the lip during oral sex.
Signs & Symptoms of Herpes Keratitis
The following signs and symptoms occur in only one eye in a herpes simplex keratitis
infection:
- Photophobia – light sensitivity
- Excessive Tearing/watery eyes
- Irritation and gritty feeling
- Eyelid swelling
- Foreign body sensation
- Eye redness
Treatment and Management of Herpes Keratitis
Herpes keratitis is often difficult for an eye doctor to diagnose. It is often called the “great masquerader” because the appearance of herpes keratitis can be misleading and doesn’t usually take on a classic appearance.
Treatment usually consists of Zirgan ophthalmic gel (Bausch & Lomb) applied topically to the eye or Valtrex or Acyclovir tablets taken orally. In some cases both Zirgan and Acyclovir are prescribed simultaneously. In some cases a corticosteroid eye drop is prescribed to minimize corneal scarring along with the Zirgan.
Other treatment may consist of “debridement” or scraping of the outer surface of the cornea (epithelial cells) to remove the infected tissue.
If the condition worsens into stromal keratitis, which is an infection deeper into the corneal layers, it often results in scarring and possible blindness.
Because herpes keratitis can often recur many eye doctors prescribe a continued preventive dose of valtrex or acyclovir because the risk of a subsequent herpes eye infection is worse than the potential risk from continued use of acyclovir.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Arcus Senilis
Corneal Arcus
Description of Corneal Arcus (Arcus Senilis)
Corneal Arcus, sometimes referred to as Arcus Senilis in an older patient, is a greyish or yellowish opaque colored ring or arc around the peripheral cornea of both eyes. The corneal arcus ring consists of lipid/cholesterol deposits in the periphery of the cornea stromal layer. The lipid deposits (corneal arcus) typically start at 6 & 12 o’ clock on the cornea, but can eventually fill in to create a full ring. Arcus Senilis does not create any type of problem with vision. Corneal arcus is not considered much of a problem in
the older population; however, in patients 40 and younger there is a chance the patient has elevated blood lipid levels. When found in a younger patient the condition is often called arcus juvenilis.
Cause of Corneal Arcus
Corneal arcus (arcus senilis) is common in older patients as a fairly common age-related change and as previously stated is often then called arcus senilis. Many people develop the condition if they live long enough. Corneal arcus has been somewhat controversial over the years regarding its link to cardiovascular disease due to high lipid/cholesterol levels. In recent years, the National Institute of Health concluded that “corneal arcus reflects widespread tissue lipid deposition and is correlated with both calcific atherosclerosis and xanthomatosis* in these patients. Patients with more severe arcus tend to have more severe calcific atherosclerosis”. However, other studies have shown no correlation to cardiovascular disease.
Signs/Symptoms of Corneal Arcus
The signs of corneal arcus are a visible greyish ring around the cornea near the junction of the white of the eye and the colored iris. Although the arc/ring can be seen by the naked eye with careful observation, it is best seen under high magnification by your eye doctor.
Corneal arcus is asymptomatic. Quite simply the eye feels fine. In fact, if there are symptoms they are not related to corneal arcus.
Treatment/Management of Corneal Arcus (Arcus Senilis)
If corneal arcus is found in patients over the age of 40, no management is needed. However, it is recommended that the patient get blood tests to determine cholesterol and lipid levels if not known.
If corneal arcus is found in a patient younger than 40 (often arcus juvenilis), blood tests are definitely recommended to rule out lipid and cholesterol abnormalities. Studies show that male patients less than 40 who present with corneal arcus, have an increased relative risk of death due to coronary artery or cardiovascular disease.
Unilateral corneal arcus is a sign of decreased blood flow to the eye without the arcus due to carotid artery disease or ocular hypotony.
*Xanthomatosis is defined by Mosby's Medical Dictionary as "an abnormal condition in which there are deposits of yellowish fatty material in the skin, internal organs, and reticuloendothelial system".
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
FDA Approves a New, Effective Glaucoma Medicine
The first preservative free prostaglandin ophthalmic solution eye drop medicine used to treat glaucoma has been approved by the U.S. Food and Drug Administration. The new preservative free glaucoma medicine is known as ZIOPTAN™ (tafluprost ophthalmic solution 0.0015%). ZIOPTAN (pronounced zye-OP-tan), distributed by Merck (NYSE: MRK) is approved for reducing elevated intraocular pressure (IOP) in patients with open-angle glaucoma, the most common type of glaucoma.
ZIOPTAN is one of several prescription eye drops in a category called prostaglandin analogs. Other medicines in this glaucoma treatment category include Travatan Z, Lumigan and Xalatan. A prostaglandin analog is typically the first type of medicine prescribed by an eye doctor in the treatment of open angle glaucoma. The significance of Zioptan is that it is the first and only preservative free prostaglandin analog. It is often believed that preservatives in the eye drops can possibly cause side effects that cause problems with the outer ocular surface such as the cornea and conjunctiva.
ZIOPTAN and other Prostaglandin Glaucoma Medicines are Considered the Most Potent Eye Drops for Lowering Intraocular Pressure
Prostaglandin eye drops including Zioptan are typically prescribed to be used in the evening in the affected eye using only ONE drop per eye. In fact, prostaglandins may not work as well if more than one drop is used per day. However, it is acceptable to use other types of glaucoma eye drops along with the prostaglandin analog drops.
Because Zioptan is preservative free, the medicine is packaged in individual unit dose vials that are to be used once in each eye and then discarded. Extra vials are to be stored in the refrigerator. Once the vials are removed from the refrigerator they should be used or discarded within 28 days and any amount remaining in a used vial should be discarded because of sterility reasons.
Possible Side Effects of ZIOPTAN
ZIOPTAN may cause serious side effects just like other prostaglandin eye drops including:
Changes in the color of the eye (iris). The iris may become more brown in color while using ZIOPTAN. This color change may not go away if Zioptan is discontinued. If ZIOPTAN is used in one eye only, the color of that eye may always be a different color from the color of the other eye. The long term effects of increased pigmentation are not known. Iris color change may not be noticeable for several months to years. Typically, the brown pigmentation around the pupil spreads concentrically towards the periphery of the iris.
Darkening of the color of the skin around the eye (eyelid). These skin changes often go away when ZIOPTAN is discontinued.
Increasing the length, thickness, color, or number of eyelashes. These eyelash changes usually go away when you stop using ZIOPTAN. This is the effect that is caused by Latisse, which is used to thicken and lengthen eyelashes when the medicine is applied directly to the eyelashes. Latisse is the same medicine as the glaucoma drug, Lumigan .03%.
The most common side effect of ZIOPTAN is redness of the conjunctiva (clear tissue covering the white of the eye), which occurred in 4-20% of patients. Other ocular adverse reactions reported at an incidence of ≥2% in these clinical studies included:
- ocular stinging/irritation (7%)
- ocular itching including allergic conjunctivitis (5%)
- cataract (3%)
- dry eye (3%)
- ocular pain (3%)
- eyelash darkening (2%)
- growth of eyelashes (2%)
- blurred vision (2%)
Other adverse reactions in the clinical studies in patients treated with Zioptan (tafluprost 0.0015%) were headache (6%), common cold (4%), and cough (3%).
These side effects are very similar to the side effects of other eye drop medicines in the prostaglandin category.
Posted by David Zeledon
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Posted by David Zeledon
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We Are the Largest Group Practice of Optometrists in Austin
You will love our office when you visit and we will no doubt surprise you time and time again with our outstanding staff and service. At Master Eye Associates you aren’t just a number. We care about your eyes and will treat you as the most important person in the world because that is what you are to us! You can read more about us on our website at www.MasterEyeAssociates.com, and you can contact us at any of our locations listed on our website.
Posted by David Zeledon
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The Optometrist Austin TX That is the Future of Eye Care
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