We have all been touched by cancer; we all have a friend, coworker, family member, or personal experience with cancer and the havoc it can bring to our lives. There are over one hundred types of cancer, many of which can be devastating in the damage they cause. Cancer is characterized by an abnormal growth of cells. Many cancers are detected through routine self-examinations, but often are not noted until a medical professional’s examination or screening. Treatments can include chemotherapy, radiation, and surgical intervention. While we all may be aware of more common systemic cancers (like breast, colon, prostate, and skin cancers), we would like to focus on two types of eye cancers: retinoblastoma and melanoma.
While eye cancers may be less common, but they are no less potentially deadly; routine eye examinations are a key factor in the screening for many eye conditions, including ocular cancers. The American Cancer Society estimates that there are 2,800 new cases of cancers (primarily melanoma) of the eye and orbit annually: 1,490 in men and 1,310 in women; 320 people with an active ocular cancer will die annually.
The most common type of ocular cancer in adults is melanoma (followed closely by lymphoma). Ocular melanoma may begin on the lid, the brow, the iris (the colored part of the eye), or, most often, in the choroid, a vascular area of the eyeball which sits between the retina and the sclera. While cancers of the iris, lids, and brow are often very easy for patients to visibly see (many times they will start as a pigmented spot, bump, or lesion that grows over time), choroidal cancers require a medical examination to be fully viewed.Signs of cancers of the skin surrounding the eye (lids, brow, etc) are often very easy to note as they are frequently visible to the naked eye. Lid cancers may begin as a discoloration on the lid and progress to a raised bump or active lesion, or they may remain as a discolored area of the lid. In either case, evaluation and treatment is required; evaluation of the affected area should occur as soon as you notice a change, have a concern, or are referred by another doctor, friend, or family member for ophthalmic evaluation. Cancers of the skin surrounding the eye are highly treatable, especially when caught early on in the disease.
Signs of intraocular melanoma include a pigmented spot on the eye, blurred vision, a change in vision, loss of vision, headaches, and a change in the shape of the pupil. Intraocular tumors may cause glaucoma as they can cause tension and separation on the retina; patients with active glaucoma caused by a tumor (not “normal” glaucoma) may note eye pain, redness, nausea, headaches, and blurred vision. If you notice any of the above symptoms, an examination with your ocular medical professional is essential. Your exam may consist of: dilation of the pupil (this gives the doctor a better view of your eye), ultrasound exam of the eye (which uses sound waves to provide a picture of the inside of the eye), and transillumination of the eye (wherein a light is used to examine the eye).
There are many factors which increase the risk of developing intraocular melanoma, but the most common are age and extensive sun exposure. Further risk factors include having fair skin, having blue, green, or light-colored eyes, and being caucasian. Patients with a previous history of skin cancer are also at a higher risk. Understanding the signs and symptoms of ocular cancers is a crucial factor in the cancer’s treatment and resolution; treating ocular cancers early may save your vision and your life. Treatments for ocular melanoma include: surgery, watchful waiting, and radiation therapy.
Surgical method may vary depending on the type and severity of eye cancer present. Removal of the tumor and a small amount of the healthy tissue surrounding it is often performed in eye cancers which haven’t spread significantly. In larger, more aggressive tumors, unfortunately the eye is not able to be saved and aggressive surgical intervention is required; this can include either enucleation or exenteration. Enucleation removes the affected eye and part of the optic nerve; patients may be fitted for an artificial eye after this procedure. Exenteration removes the eye, the lid, muscles, nerves, and fat of the eye socket; patients may be fitted for a facial prosthesis or artificial eye after this procedure.
Retinoblastoma is an almost predominantly childhood cancer; it will usually occur in children younger than five and is a rapidly developing cancer affecting the retina. The most obvious sign of retinoblastoma is an abnormal pupil, often visibly noted as a “white eye” reflection. Children with retinoblastoma may also present with a strabismus (crossed eye), proptosis (bulging eye), and a red, irritated eye. Often, parents will note a defect in “red eye” noticed in photographs; an affected eye will continue to show a whitish appearance while an unaffected eye will react normally with a reddened appearance.
Caught early, retinoblastoma is highly treatable; treatments can include chemotherapy, radiation, and/or enucleation (removal) of the affected eye. Left untreated, retinoblastoma is vision and life-threatening. Almost all untreated patients die of intracranial extension and disseminated disease within two years.
While any type of cancer is serious and potentially deadly, cancers of the eye are, fortunately, relatively rare. Routine examinations with your eyecare professional and being an active part of monitoring changes in your vision and eye appearance are the best methods for continued eye health and early treatment if a concern is noted. If you suspect or are concerned about any of the above conditions, please make the earliest appointment with an eye care professional.
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April is Alcohol Awareness Month; it’s estimated that over half of Americans over the age of twelve are active drinkers of alcohol (2008 National Survey of Drug Use and Health by the US Dept of Health and Human Services). Alcohol is the third leading cause of preventable deaths in the United States. While a healthy diet can and often does include some alcohol consumption (namely, one glass of red wine per day with dinner has been accepted by many dietitians as appropriate), understanding and adhering to alcohol use in moderation is integral to avoiding its abuse. Raising awareness of alcohol abuse and providing education on appropriate approaches to alcohol are important year round, but are a great topic on which to focus this week’s blog!
Alcohol, in appropriate moderation, has a relatively low risk for ocular and systemic complications in otherwise healthy adults; a glass of red wine with dinner has long been accepted as a heart-healthy alcohol use and has even been included in the Mediterranean diet. In excess binge drinking or habitual alcohol abuse, we begin to see many health complications. While we all should be aware of the systemic damage alcohol abuse can cause (including cancers, liver disease, obesity, diabetes, brain damage, heart disease, and death), many people are unaware of the risks to eye health that are posed by habitual overindulgence in alcohol.
* Short term eye effects: dilated pupils, temporary decreased peripheral vision, blurred vision, and increased risk for ocular trauma (secondary to decreased hand-eye coordination and an increased propensity for “risky” behavior).
* Long term eye effects: optic neuropathy, decreased peripheral vision, reduced sense of color palette, increased risk of trauma, and increased risk of diabetic retinopathy, a potentially vision-threatening condition which can result in permanent blindness.
Although we do not specialize in substance abuse, we urge you to seek out a professional if you feel you are unable to set appropriate boundaries for yourself in regards to any substance.
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Styes and chalazia are similar, but distinctly different, eyelid conditions which can be painful and recurrent. Both will often affect the lid margins, the area where the inner lid meets the outer lid, but chalazia can often occur seemingly “underneath” the eyelid farther away from the lid margin while styes will often occur along the lash line. These conditions can warrant medical intervention, especially if they become recurrent or if they are especially painful, do not resolve, or become actively inflamed and tender to the touch. People with oily skin types can be at a higher risk for stye/chalazion development.
Styes are often the result of a bacterial infection. In appearance styes resemble small pimples and can be red and inflamed. Washing the lids and ensuring that makeup is properly cared for are two ways in which you can avoid putting yourself at undue risk for styes. Styes will usually self-resolve, but can last for a week or longer if left untreated. Treatments include topical ointments which your doctor would prescribe.Chalazia (the plural of chalazion) can occur much like styes; while styes appear similar to pimples, chalazia often look and feel like firm lumps under the lid. They can be tender to the touch or can be painless. A chalazion can resolve on its own but may need intervention from an eye care professional in the form of warm compress use, topical drops, topical ointment, surgical drainage, and/or surgical excision and biopsy.
You can reduce your risk for styes and chalazia by using warm compresses as often as you can (this is especially beneficial for patients with meibomianitis and/or oily skin), removing and storing contact lenses according to your eye professional’s recommendations, washing your hands prior to touching your eye area and/or applying makeup, avoiding makeup use while a stye or chalazion is active, and avoiding eye rubbing altogether. Above all, do NOT attempt to pop any bump which appears on or around the ocular area; this can worsen styes and chalazia by causing them to spread and affect a broader area of your eyelids.
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Makeup can certainly accentuate your beautiful eyes! With proper, hygienic use, makeup for your eyes can be a safe addition to your daily regimen. Unfortunately, many makeup users do not take the safest approach to makeup use and can end up with mild to severe complications, including corneal scratches, infections, and even blindness. This week, we’re offering some helpful tips to aide you in avoiding ocular complications when using makeup.
Tips For Makeup UseMake sure to replace eye makeup often.Never share your eye makeup!Do not apply makeup while driving or moving; use your best judgment when applying makeup to avoid potential vision-threatening injuries.Skip makeup use when you have an actively infected or irritated eye and throw away any makeup used around the time your eye first became infected/irritated. This can reduce reinfection and/or the spread of infection from one eye to the other.Wash your hands prior to doing anything around your eyes, including drop instillation and makeup application.Be sure to thorougly clean off makeup prior to going to sleep to avoid causing irritation. If you use a makeup remover, do your best to avoid getting it in your eye.Avoid store samples as there is less assurance that it is sterile.Remember that eye makeup can contribute to the following conditions: infections (some potentially blinding), pink eye, watery eyes, dry eye, trauma, chronic inflammation, and styes.
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