Written by Steven Burns
From his column To Your Health
You wake up with sniffles, sneezing, and a runny nose. Might be a cold, but this one feels different—your eyes are itchy, they sting a bit. There’s crust on the lids, and one of them is hard to open. Your vision is blurry, then clears when you blink or wash your face. Then you remember—the 4-year-old grandchild you babysat 2 days ago, is now home with pink eye. Oh, nooooo…
Conjunctivitis is the most common eye disease we see in primary care. Three million cases are diagnosed yearly in the U. S. Most are viral, with no effective treatment other than saline eye drops and warm compresses. The infection resolves itself in 1 to 2 weeks. Some cases are bacterial, which is hard to distinguish from viral. As a result, most cases are treated with antibiotic drops, sometimes with a steroid added. The third type of pink eye is allergic, and it is very different, with symptoms that include pale mucous membranes, swelling, and marked itching. Allergic conjunctivitis improves with antihistamine eye drops. Pink eye will not impair vision (other than with mucus) or cause significant discomfort, so if there is eye pain or blurring that does not clear with simple treatment, see your doctor. Your primary care physician can usually take care of pink eye.
Bleeding in the white part of (usually) one eye is called a subconjunctival hemorrhage. It can be confused with pinkeye, but the redness is impressive, in the white (sclera) of the eye. Such bleeding is caused by the rupture of a small vessel in the clear lining over the sclera, and it is not dangerous. It will disappear in a week or so. If vision is impaired, however, then it is something else and requires medical care.
Another common eye problem is “short-arm syndrome.” At least, that’s what some of my patients call it. Presbyopia blurs near vision as we grow older. People complain that they have to hold reading material farther and farther from their face. The lenses in your eyes become stiff and can’t refocus for near vision. The treatment is usually glasses, either “cheaters,” (those you get on the rack at the store for $5), or bifocals for those who already wear glasses. One warning—if your eye professional sells glasses and writes a prescription for expensive near-vision glasses, go somewhere else. Expensive glasses are no better than low-cost ones for simple presbyopia. Just go to your corner drugstore and try on a few pairs until you find the diopter value that makes reading comfortable. Then buy six of them, so you can leave a pair in every room of your house.
Dry eye syndrome is common as we grow “more mature.” This problem includes burning or itching and commonly watering of the eyes. That sounds paradoxical, but when the thicker, mucus-like tears that moisturize the lining of the lids and sclera are missing, one can experience watery tears that can roll down the cheeks. One treatment is using artificial tear solutions. There is also a medication, cyclosporine, that causes increased mucus-like tears to form. It can be prescribed by an eye physician. Also, plugs can be placed in the nasolacrimal duct, the tube that drains tears from your eyes into your nose. The plugs keep tears in the eye longer. They can be placed temporarily and, if they work well, permanent plugs may be inserted.
Diplopia (double vision) is another eye problem that occurs more frequently with age. The eye muscles can become weak, or a nerve problem (neuropathy) can cause the eyes to not track together. This happens most commonly in people with diabetes, but there are other serious diseases, such as myasthenia gravis, and ALS (Lou Gehrig’s disease), that result in diplopia. Most cases have no specific cause, but when double vision occurs, careful diagnosis is needed by an ophthalmologist or neurologist. If diplopia is minor and there is no underlying disease, the condition can be treated with a prism in the spectacles.
Sudden visual changes called “auras” can occur at the onset of migraine headaches. For those with history of migraine, sometimes headaches stop happening but auras continue. Auras can manifest as sparkly areas in vision, loss of part of the visual field, tunnel vision, or even as photographic negatives. While frightening, they are not dangerous. However, if they start suddenly and you have no history of migraine, emergency treatment is needed, as strokes can start that way.
Sudden loss of vision in one eye can be caused by retinal artery or vein occlusion. Some people refer to vascular vision loss as a “stroke in the eye,” and the description is an apt one. Treatment for these conditions must occur within a few hours, for vision to be recoverable. High blood pressure, high cholesterol, and diabetes are risk factors for these conditions.
Everyone over the age of 50 should have an eye examination by an ophthalmologist or optometrist every year or two. Often they can spot problems early enough to prevent vision loss. Controlling other medical problems, such as hypertension, high cholesterol, and diabetes, is also critical in maintaining good vision. Since loss of vision can be devastating to one’s lifestyle, smart preventive care is a small price to pay. Just do it.
Dr. Steven Burns is board-certified in family medicine and has been in practice for more than 30 years.