July 31, 2013

Obesity has become an epidemic in the US; it has progressed to the point where it is an acceptable medical diagnosis! Not only can obesity shorten your lifespan, decrease your quality of life, and increase your risk for heart disease, cancer, liver disease, polycystic ovarian syndrome, and diabetes, it can increase your risk for ocular disorders, including cataracts, diabetic retinopathy, retinal vein occlusion, and pseudotumor cerebri, which we’ll focus more acutely on below.

Definitive Diagnosis of obesity can be somewhat difficult; BMI calculators alone are insufficient as they do not make allowances for muscular body weight or skeletal frame. It is important to follow closely with your primary doctor, especially if you are concerned that you are overweight or obese. Losing weight can be difficult, but it is by no means impossible! Reducing simple carbohydrates and sugars, increasing exercise within your capabilities, and adhering to an overall healthy diet can aide in helping you achieve a healthy weight!

Pseudotumor cerebri is an idiopathic increase in your intracranial pressure, giving the symptoms of a tumor, without actual tumor presence. While it can occur in people of any age, weight, or nationality, it is most commonly noted in obese women of childbearing age (obese women under the age of 40 are about 40 times more likely to develop pseudotumor cerebri than the general public). Symptoms include moderate to severe headaches, ringing in the ears (pulsing in time with heartbeat), nausea, vomiting, dizziness, blurred vision, temporary and brief episodes of blindness (may be unilateral or bilateral), decreased peripheral vision, double vision, flashes of light, and neck, back, and/or shoulder pain. While pseudotumor cerebri is relatively uncommon, it is a serious condition which bears treatment and close monitoring; as many as 10% of affected people will experience progressively worsening visual symptoms which can lead to eventual blindness. This can occur years after initial onset or diagnosis; weight loss is essential for obese or overweight patients with the condition, and regular eye exams are vastly important for the most quality care. Treatments include the use of glaucoma drugs, diuretics, migraine medications, and surgical intervention (often at optic nerve or spine).

As with any treatment, following closely with your primary medical doctor is advised prior to beginning any weight loss treatment. Adhering to an overall healthy diet and including moderate amounts of exercise can be easy and beneficial to just about anyone! While weight loss is no guarantee of ocular or even overall health, prolonged obesity can increase your risk for complications in the eyes and the rest of your body. If you’re worried about your weight, or would like more information on how to control your weight in a healthy manner, speak to your primary doctor.

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Corneal Ulcers

July 24, 2013

A corneal ulcer is a severe condition which requires IMMEDIATE treatment from your eye care provider. Untreated (and, unfortunately, even with treatment), corneal ulcers can permanently scar the eye, rob vision, and can even cause loss of the eye itself. If a concern for a corneal ulcer is raised, through your primary doctor, acquaintance, or even by self estimation, evaluation and treatment by an eye care professional is essential to treating the condition and providing you the best prognosis available.

What is a corneal ulcer?

Corneal ulcers are inflammatory or infective conditions of the cornea. They are often caused by bacterial infection following contact lens overuse or misuse, eye injury or trauma, severe dry eye, chlamydia infection (trachoma), or herpetic eye infections; they may also be caused by viral infection, fungi, or parasitic infection of acanthamoeba (parasite found in tap water, swimming pools, hot tubs, and other bodies of water).  Ulcers may occur in any portion of the cornea (the clear cap of the eye); they can be much more vision-threatening, however, when they occur in the central cornea, often over the pupil.

Symptoms of a corneal ulcer include, but are not limited to:

Blurry/hazy visionA red or bloodshot eyeA visible white or discolored spot on the eye.Sensitivity to lightItching and dischargePainful eyesTearing


How can I avoid corneal ulcers?

When your optometrist, ophthalmologist, optician, or primary doctor tell you not to sleep in your contacts, they mean it!! Contact lenses are a very common cause of corneal ulcers; sleeping in contacts, poor contact hygiene, and over-wearing contact lenses are habits which can lead to this very severe, possibly vision-destroying condition. Extended wear contacts (those that are approved for overnight wear) still need to be taken out on occasion; if you can tolerate “daily wear” lenses (lenses which you use only once and discard afterwards) provide less risk of complications from over-wear, provided you adhere to the restrictions given on the lenses.

How are corneal ulcers treated?

Treatment depends on the severity of the ulcer. Topical antibiotics are usually advised and the area may be cultured for evaluation; follow-up appointments range depending on the aggressiveness of the ulcer, some specialists may recommend daily follow-ups, while others may suggest visits every other day or every three days. Unfortunately, severe corneal ulcers, even with treatment, may lead to permanent corneal scarring. While immediacy in treatment gives the best chance for avoiding severe complications from ulcers, ulcers may still cause severe and sometimes irreparable damages. Even with the best care and management of this condition, some patients with corneal ulcers may require a corneal transplant to achieve any amount of vision after this severe infection. Corneal transplants, while a very significant and serious surgical treatment, can be very effective in allowing compromised eyes to regain some semblance of usefulness; transplants replace affected corneas with healthy, cadaver donations.

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July 17, 2013

What is Toxoplasmosis?

Toxoplasmosis is a parasitic disease that can affect warm-blooded animals, including humans. The primary hosts are members of the feline family; often, transmission from cat to human occurs with the handling of unsanitary feline waste. Symptoms of the illness can differ depending on the phase of toxoplasmosis; typically, the first few weeks after exposure are characterized by a mild, flu-like illness. Initial symptoms may include swollen lymph nodes in the neck, under the chin, in the armpits, and/or in the groin area.

Fatalities, though uncommon, may occur in any infected host, but are more common in those with susceptible or weakened immune systems (young children, fetuses, patients with AIDS, patients on chemotherapy, or pregnant women). Serious illnesses, such as encephalitis (brain inflammation), necrotizing chorioretinitis (choroidal inflammation), disorders of the liver, heart, and ears, learning disabilities, epilepsy, and neurological diseases may be caused by this parasite. Further, studies indicate that toxoplasmosis may cause or contribute to psychiatric disorders, including depression, anxiety, and schizophrenia. 

How is Toxoplasmosis Transmitted and Treated?

Transmission may occur via ingestion of raw or undercooked meat (especially pork, lamb, or venison) or ingestion of contaminated cat feces (possible via hand-to-mouth contact after gardening, cleaning a litter box, contact with sandboxes, or touching a leech); the toxoplasmosis parasite can survive in the environment for over one year. Pregnant women are advised not to be exposed to cats during the course of their pregnancy, avoiding fecal exposure if this is not feasible.

Diagnosis of toxoplasmosis can be difficult and often is made by therapeutic drug trials, followed by a brain biopsy if no clinical improvement is noted with repeat imaging. Blood samples can aide in definitive diagnosis. Treatments include antibiotics, steroids, and/or antimalarial drugs. Treatment is especially important for pregnant women, as this is an important preventative measure to avoid fetal infection.

 How Does Toxoplasmosis Affect the Eyes?

This parasite can be severely detrimental to fetal visual development. While a possibility, new development of ocular toxoplasmosis is relatively rare in adults. In fetuses, the most common part of the eye to become affected by toxoplasmosis is the retina, more specifically, the choroid. This can lead to retinal scarring, vision impairment, and even blindness; these impairments may be unilateral (affecting one eye only) or bilateral (affecting both eyes). Other ocular conditions caused by toxoplasmosis include nystagmus (uncontrollable, fast ocular movements), congenital cataract, microphthalmia (one eye smaller than the other), optic atrophy, and cerebral visual impairment. Scarring and retinal damage from toxoplasmosis cannot be repaired; however, it usually does not worsen, though relapse from dormancy may occur later in life, causing a new active infection and further damage, if not treated accordingly.

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Allergies and Your Eyes

July 10, 2013

Do you feel like your eyes burn every time you walk outside during the spring or summer? Are your eyes itchy, watery, or otherwise irritated? You may be suffering from ocular allergies. Ocular allergies can cause the eye to be itchy, irritated, swollen, and may cause significant tearing. Swollen eyelids are also a possible result of eye allergies.

The causes of ocular allergies are as varied as the causes for systemic allergies, but may include: dust, mold, pollen, mold, and pet dander. In addition, the preservatives found in artificial tears may cause rebound inflammation, especially in patients who overuse the drops. Ocular allergies can have a severely negative impact on your daily life; they can be so severe that you avoid activities you enjoy, including: gardening or yardwork, walking or biking outdoors, swimming, having pets, or cleaning (though that last one I think we all may wish we could avoid!). 

Treatments for ocular allergies include topical drops (such as anti-inflammatory drops, steroid drops, and/or antihistamine drops), specifically allergy-related drops like Pataday, Alaway, Lastacaft, Bepreve, or over-the-counter Zatidor, oral allergy medications, and/or using a preservative-free artificial tear, as needed. If you notice that your eyes are irritated, tearing, uncomfortable, or if you feel you have to avoid activities you love to avoid eye irritation, any of our caring medical professionals would be happy to evaluate your condition and determine the most effective treatment for you!

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Fireworks and Eye Injuries

July 3, 2013

Celebrating our nation’s independence should not come with an added trip to your primary or ophthalmic doctor! Every year, 9,300 serious injuries are sustained from fireworks; of that number, up to 2,000 people on average suffer some form of eye injury.

Of the injuries sustained by fireworks annually in the United States, eye injuries can be some of the most life-changing. Approximately one quarter of the eye injuries sustained from fireworks (averaging about 500 of the 2,000 reported) cause permanent loss of vision, blindness, or loss of the eye completely. Other complications to the eyes include torn irises, corneal ruptures, hyphema (blood in the front of the eye), eyelid lacerations, subconjunctival hemorrhages, and severe burns to the ocular surface.

While the majority of fireworks injuries seem to stem from firecrackers and “bottle rockets,” seemingly harmless sparklers can be potentially dangerous to the eyes and your overall health as well. Children should NEVER be allowed to handle any type of pyrotechnic equipment, nor should any individual under the influence of drugs or alcohol. Safety glasses and gloves should be worn by the adult setting off fireworks and the entire group watching the display should be an adequate distance away from the “launch” site; ideally at least 40 feet for consumer products, 500 feet for professional products. Professional fireworks are provided by your county of residence in New York State; there are many wonderful, free showings annually, especially in the period surrounding the Fourth of July. Check your local listings for dates and times in your county!

Remember, consumer fireworks are illegal in New York State, unless you have a permit. Do not, under any circumstances, use fireworks if you are not licensed to do so, or it is legal in your state of residence.

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