Eyes: Three Eternal Themes
Recently, Dr. Benjamin cured a friend of mine of a rare but very dangerous eye infection. But we’ll talk about the rare stuff later on; right now, let’s talk more about the common problems. Diseases of the eye are the same from century to century, but ophthalmology never stops changing.
MY FRIEND, YOU HAVE CONJUNCTIVITIS
What do people complain about the most, besides seeing three moons (a “beautiful” effect of cataracts) or other troubles with their view of the world?
90% of the people that come in complain about a commonplace dryness of the eyes.
I’ve got a case of that. But I’m afraid of infecting it further by scratching, although it’s impossible not to. There’s something dog-like about it… What causes it?
The reasons are always different. They often ask, “Give me drops, so my eyes won’t itch anymore,” or “I have allergies; give me drops.” But drops aren’t a cure-all, and itching isn’t necessarily caused by allergies. The eyes react to stimuli in typical ways, by itching, reddening, or giving the sensation that there’s a foreign body in there, and the most common cause is dryness. Tears, without which the eye cannot survive, consist of three layers. And when any of these layers is defective, problems start to occur. It is important to determine which layer, as well, because it could be blepharitis, conjunctivitis…
Excuse me for interrupting you, but I already know that there will be many words ending in “-itis”, so let’s focus on one – conjunctivitis.
This is an infection of the mucous membrane. It’s simple; conjunctivitis can be traumatic, whether it is bacterial or viral. The latter is from a sneeze or cough, and enters through the eye or mouth.
So when you’re around someone with the flu, wear glasses?
Or a mask. It can be contagious or non-contagious, and sometimes seasonal. In countries with more distinct seasons, this often happens in the fall or spring. We have things thriving and growing year-round, so this can accumulate on top of the seasonal factors.
But allergies don’t just attack the eyes!
Right. There may be rhinitis, a stopped-up ears, a rash, etc. I see allergic conjunctivitis often, and for obvious reasons. When we have a drought, it’s less common, but then the rain comes and brings it back to life. You can use pills or drops, but it’s important to find out what’s causing it.
An old psychiatrist told me that he could diagnose a patient by the way they walked. Before they were even fully in the office, for example, he could tell they had schizophrenia. Do you also have a knack for knowing what’s wrong at first glance?
Often, there’s the “allergic salute”, a gesture typical in children. Trying to reduce the itching and ease breathing, they rub their nose from the bottom up, and that’s something an experienced ophthalmologist will see immediately.
How do you determine specific allergies?
There isn’t a psychiatrist that can help with that. We perform a special test in our office, which determines which of 60 common allergens you are reacting to. Cats, dogs, palm trees, different species of grass, olive trees, down pillows, cockroaches, etc.
It’s clear that glaucoma isn’t as serious as cancer, but at the same time there isn’t much positive about it. Remind readers the gist of it.
Glaucoma is an increase in intraocular pressure because outflow of intraocular fluid has been limited. Outflow passes through the trabecular meshwork, which acts like a sieve. If that liquid has trouble flowing through the sieve, that intraocular pressure increases and affects the sensory nerve fibers. This can be repaired in two ways. First, we can improve the drainage. Secondly, we can reduce the production of fluid. The majority of medications do the second, but that liquid is actually a vital part of the eye.
So the medication robs the eye of this much-needed fluid?
The eye maintains its durability by keeping this issue at a certain pressure. The ciliary body acts like a pump, bringing liquid from the bloodstream to the eyes, irrigating them and feeding the living tissues, after which it flows back into the bloodstream.
Hence, the liquid must be moderated, much like the other liquids in our lives. How does this occur?
(to be continued)
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Interview and photos: Sebastian Varo