Eyes: Three Eternal Themes

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.

 I didn’t know, by the way, that people could be allergic to dogs.  Cats are a common allergy.  What’s the difference?

 Allergies to cats are caused by their saliva, but with dogs it is typically on the skin.  If we suspect allergic conjunctivitis, we conduct a very safe and effective 20-minute test.  Thanks to a special applicator, we learn what the patient is allergic to and how to avoid certain stimuli.

So say goodbye to Fido?  Picasso once got rid of his dachshund, thinking he was just a burden. 

 Even if Fido or Max is causing an allergic reaction, it doesn’t mean that you have to get rid of your beloved pets, but knowing why it is occurring is key.

On a side note, about drops…  One of your employees mentioned that things like Visine are not ideal, “to put it mildly.”  I shuddered, because I had bought some just the day before.  This wasn’t because I read something good about them, but because they were the cheapest.  Are the best drops the most expensive, or are there other considerations?

 All drops that you buy in the store constrict conjunctival vessels, but they do not like to be in this compressed state.  They love to expand.  So it goes like this:  the drops narrow those vessels and life is good.  But within 4 hours, they expand even larger than before and the eyes are still red.  You apply the drops again, and now the effect only lasts 3 hours, then 2, and then only 1.

So they work like narcotics, where you have to take more to get the same effect?

 Yes.  The end result is that people often come in with bloodshot eyes from constantly using namebrand drops.  This is called rebound.  However, sometimes redness is caused by drug allergies or from rosacea, which is a skin disease with symptoms that include reddening of the skin and the formation of sores on the face.  Bill Clinton, for example, suffers from rosacea.  This is often accompanied by lesions in the eye.  All of this can be sorted out and controlled if your ophthalmologist is experienced and has adequate facilities.

So would you advise not to buy drops at the store?

 We are often approached by people to whom it is important to have cosmetically-appealing eyes.  Someone might have an important meeting and needs to come across as an upbeat person, for example, but this is hard to do with bloodshot eyes.  And again, we have to determine the cause.  If it is blepharitis, it needs to be treated; it is the same with allergic conjunctivitis.  Store-bought drops just cover it up, rather than stopping it where it originates.

Then does it matter if they cost $6 or $26?

 If you buy shoes that aren’t your size, then it isn’t important if they’re real crocodile or faux leather.  I usually recommend buying artificial tears, but we must remember that drops vary in quality, much like toothpaste or shampoo.  Glaucoma drops may contain preservatives, for example, so if you use them 6-8 times a day, you are irritating your eyes each of those 6-8 times.  More than 3-4 times a day will negate its benefits.

Manufacturers include this information on their labels, but only microbes can read it, or those who just got laser correction. 

 No one advertises the side effects.  There are drops without preservatives sold in disposable pipettes, but they are very expensive.  We have some prescription-only drops from Germany at our office that are watery, oily, and mucin, and of course have no preservatives.  One pipette is enough for an entire day.  Dry eyes can be treated in different ways, as well, with vitamins, compresses, and different types of “tears”, including tears that are made from the patient’s own biological material, as well as placental contact lenses loaded with stem cells. These really rejuvenate the eyes.

Placentas?!?  That’s the topic of another conversation. 

 Let’s talk about it separately, then.

GLAUCOMA

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)

Interview and photos: Sebastian Varo