As the H1N1 Swine Flu continues to spread pinkeye (conjunctivitis) is still uncommon and very mild. Rare cases have been showing up involving neurological complications that sometimes do manifest other eye problems. Encephalopathy is a neurological syndrome that disrupts large areas of the brain. This has been seen in a limited number of patients and can result in eyes turning up or to the side, usually accompanied by a seizure. Other problems that may be seen in the future with encephalopathy are photophobia (light sensitivity) and nystagmus (eyes rapidly moving in a tremor like manner). By this point the patient would normally be hospitalized from the other problems so it is highly unlikely to be seen in a home setting.
An unknown at this point is if the influenza can be transmitted from the tears in the eye. The normal routes of transmission are through airborne droplets created by coughing or sneezing or touching a surface that has been contaminated. While the HIV virus is present in tears there are no known cases of transmission by this route. It is unknown if this will be the same with the new Flu virus. Also, airborne droplets could contact the eye, drain into the sinuses and possibly result in infection. Until more is known it is probably best to err on the side of caution and wear some form of protective eyewear if you are around someone with flu symptoms.
Contact lens solutions will soon be required to have two new additions to their labeling. Although most manufacturers no longer label solutions “no rub” the F.D.A. will require rubbing lenses as part of disinfecting cycle on labeling for all multipurpose contact lens solutions. The other change will be to add a discard after opening date in addition to the expiration date already required..
Two separate incidences of outbreaks of serious eye infections the last several years have prompted theses changes. While the evidence points to non compliance with manufacturer recommendations of product use, it is felt that a higher error of margin needs to be built into the solutions regimens.
Testing of solutions is not as simple as you would think at first glance. Historically, the FDA has required two different methods of testing. Simplifying the process it can be viewed as primarily two different tests. The first is adding bacteria and fungal microorganisms to samples of the solutions and after the manufacturers specified time period for disinfecting they must reduce the number of bacteria by 99.9% and the fungi by 90%. The second method of testing involves soaking the contact lenses in the microorganisms and then being disinfected as the manufacturer recommends. The lenses are then used to grow the bacteria and fungus on a special type of growth media. After a specific time period the number of live organisms are counted. These are referred to as colony forming units and less than 10 gives a passing grade. Tests must also be done to show that the solutions are not toxic or irritating to the eyes.
Bacteria chosen for testing in the past include Pseudomonas aerginosa, Serratia marcescens, and Staphylococcus aureus. The first two are in a category called gram negative bacteria and the third is gram positive. Bacteria can be classified gram negative or positive by how their cell wall retains dye, and gram negative bacteria tend to be responsible for more serious infections. While most tropical and semi tropical climates show gram negative bacteria and fungal eye infections are more prevalent, temperate northern climates tend to have more gram positive bacterial infections associated with contact lens related eye infections. Pseudomonas is present almost everywhere in humid climates. While these three bacteria do cause a high incidence of contact lens related eye infections, there are numerous other bacteria that cause infections. While fungal eye infections are rare, Candida albicans and Fusarium solani are the two tested for. One of the recent outbreaks was caused by Fusarium.
We can’t test for every possible microorganism, the time and cost would be prohibitive. This is the best mix determined in the past. With Acanthamoeba being the organism resulting in the other recent outbreak it may be added to testing procedures in the future.
Reducing microorganisms to a level that the eyes immune system can handle is one assumption for test requirements. Bacteria are present at low levels at any given time in most peoples eyes. Many variables are left out of the testing protocols. The age of a lens may effect how well bacteria adhere. The condition of the contact lenses case, the wearers personal hygiene and individual variation in immune response, all factor in bacterial growth. The therapeutic dose of a disinfecting agent shows individual variation. Some bacteria mutate and become resistant to disinfectants, and also can develop coatings on the lens to render the solutions less effective. Some microorganisms may become more common, virulent, or our daily exposure to them may increase for various reasons. For example, hot tubs have increased our exposure to acanthamoeba. The use of antimicrobial hand soaps may result in mutations to bacteria that were not a problem for the eyes in the past. Incomplete use and under dosing of antibiotic treatment may result in the same problem. The microorganisms used for testing are standardized and not necessarily representative of the current existing strain of that microorganism. Even the culture media used is standardized and different from the eye contact lens environment presented for the bacteria to develop in.
Rubbing a contact lens helps remove surface films and debris and allows the disinfecting solutions to work better. In the imperfect world of solution testing it is expected to help reduce eye infections.
The second change is more questionable. Solutions do have a lifespan when the disinfecting action drops below an effective level. They also could remain unopened until close to this date and then be used, resulting in usage past the time the solution was effective. Alternatively, once opened, the solution is subject to environmental contamination from bacteria that could exceed its capacity over time. The problem is putting two different dates on a bottle can be confusing. Proper wording can help, but one glance in any refrigerator will likely reveal we all aren’t very good at the two date dilemma. Time will tell, but short expiration dates on all solutions might be a better approach. Best of all would be a solution that changes into a horrible color after it has been open for a month. Of course with teenagers, that unfortunately might be an incentive to continue using it.
Contact lens solutions will soon be required to have two new additions to their labeling. Although most manufacturers no longer label multipurpose solutions “no rub” the F.D.A. will soon require adding a rubbing step to the care instructions. The other change will be to add a discard after opening date in addition to the expiration date for multipurpose contact lens solutions.
Two separate incidences of outbreaks of serious eye infections the last several years have prompted theses changes. While the evidence points to non compliance with manufacturer recommendations of product use as the cause, it is felt that a higher error of margin needs to be built into the solutions.
Testing of solutions is not as simple as you would think, with multiple requirements specified by the Food and Drug Administration. Simplifying the process it can be viewed as primarily two different tests. The first is adding bacteria and fungal microorganisms to samples of the solutions and after the manufacturers specified time period they must reduce the number of bacteria by 99.9% and the fungi by 90%. The second method of testing involves soaking the contact lenses in the microorganisms and then being disinfected as the manufacturer recommends. The lenses are then used to grow the bacteria and fungus on a special type of growth media. After a specific time period the number of live organisms are counted. These are referred to as colony forming units and less than 10 gives a passing grade. Tests must also be done to show that the solutions are not toxic or irritating to the eyes.
Bacteria chosen for testing in the past include Pseudomonas aerginosa, Serratia marcescens, and Staphylococcus aureus. The first two are in a category called gram negative bacteria and the third is gram positive. While most tropical and semi tropical climates show gram negative bacteria and fungal infections are more prevalent, temperate northern climates tend to have more gram positive bacterial infections. Pseudomonas is present almost everywhere in humid climates. While these three bacteria do cause a high incidence of contact lens related eye infections, there are numerous other bacteria that cause infections. While fungal eye infections are rare, Candida albicans and Fusarium solani are the two tested for. One of the recent outbreaks was caused by Fusarium.
We can’t test for every possible microorganism, the time and cost would be prohibitive. This is the best mix determined in the past. With Acanthamoeba being the organism resulting in the other recent outbreak it may be added in the future.
Reducing organisms to a level that the bodies immune system can handle is one assumption for test requirements. Many variables are left out. The age of a lens may effect how well bacteria adhere. The condition of the contact lenses case, the wearers personal hygiene, individual; variation in immune response, all factor in. The therapeutic dose of a disinfecting agent shows individual variation. Some bacteria mutate and become resistant to disinfectants and also can develop coatings on the lens to render the solutions less effective. Some microorganisms may become more common, virulent, or our daily exposure to them may increase for various reasons. This is probably the case with acanthamoeba. The use of antimicrobial hand soaps may result in mutations to bacteria that were not a problem for the eyes in the past. Incomplete use and under dosing of antibiotic treatment may result in the same problem. The microorganisms used for testing are standardized and not necessarily representative of the current existing strain of that microorganism. Even the culture media used is standardized and different from the environment the eye contact lens environment presents for the bacteria to grow in.
Rubbing a contact lens help remove surface films and debris that allow a the disinfecting solutions to work better. In the imperfect world of solution testing it is expected to help reduce eye infections.
The second change is more questionable to me. Solutions do have a lifespan when the disinfecting action drops below an effective level. They also could remain unopened until close to this date and then be used, resulting in usage past the time the solution was effective. Alternatively, once opened, the solution is subject to environmental contamination from bacteria that could exceed its capacity over time. The problem is putting two different dates on a bottle is confusing. Proper wording can help, but one glance in any refrigerator will likely reveal we all aren’t very good at the two date dilemma. Time will tell, but short expiration dates on all solutions might be a better solution (pardon the pun). Best of all would be a solution that changes into a horrible color after it has been open a month. Of course with teenagers, that unfortunately might be an incentive.
SIX SIGNS YOU MAY HAVE GPC
FROM YOUR CONTACT LENSES
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Itchy eyes as contact lenses get older
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Lenses that slide and stick under the upper eye lid
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Irritation Every Time You Blink
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Mucous Discharge and Foggy Vision
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Lenses That Discolor and Develop a Film
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Intermittent Red Eye With Feeling Something is Scratching Your Eye
In the early years of soft contact lenses there was one choice, the Bausch & Lomb Soft Lens. The cost of a single pair of these miraculous new soft, comfortable lenses was between $300 and $400 when first introduced in 1971. Accounting for inflation, today that would be almost $2000. There was a very strong financial incentive to make the lenses last as long as possible. Using enzyme cleaners and sending lenses off for a special factory cleaning were common procedures. Lenses were often used for 3 to 4 years until they were yellowed and covered with numerous deposits from components of the tear film. Lipid bumps, calcium and mineral deposits, protein deposits and frequent tears and little missing chunks of the lens edges were tolerated well past the healthy tolerance of the eyes.
A new eye problem begin to show up in a number of the wearers of these new soft contact lenses. As lens technology progressed and prices came down lenses were replaced more frequently and the mystery red eye syndrome seemed to drop off. Then in 1981 the Hydrocurve soft contact lenses was introduced as the first contact lens for over night wear, the advent of extended wear contact lenses. Cases of this new eye problem started to show up again and become common enough to recognize and diagnose.
The typical patient would come in to see the optometrist complaining about eyes that were red and irritated, possibly itching, and contact lenses that would slide around on the eye, sometimes falling out with blinking. On further questioning the lenses usually were sliding up as they would occasionally adhere to the underside of the upper eyelid. Frequently there would be some clear mucous or discharge from the eye, and some contact lens wearers would tell their eye doctor they kept seeing little spots on the surface of the lenses when they were handling them.
People have often admitted to me they turned their upper eyelids inside out as kids. For some unknown reason, girls more than boys, at least by admission. What was found in the 1980′s when inverting the upper eyelid is now referred to as Giant Papillary Conjunctivitis, or GPC. Usually it is referred to as GPC. There is a clear tissue that covers the white scleral part of your eye and extends underneath the eyelids as their surface lining. In GPC, giant papillae (bumps of swollen tissue) form under the upper eyelid. These are described as giant but actually are about 1/3 millimeter in diameter. They do feel giant due to the highly sensitive nature of the clear tissue on the front of your eye, the cornea. Every blink rubs these bumps across the cornea and creates discomfort.
The cause of GPC has been disputed for years but most eye care providers agree there are two components, a mechanical irritation and an immunological reaction.
The lens edge constantly engages the underside of the eyelid with each blink that results in a form of low grade irritation and inflammatory reaction in a small percentage of contact lens wearers. There are probably multiple reasons such as how taunt or floppy the lid is, how the secretions make it more prone to slide over or stick to the lens, the variations in lid curvature that apply pressure to the lens at different areas, and if the conjunctiva tissue has a higher number of inflammatory mediators already present. Deposits on the lenses can also cause a mechanical type of reaction.
The immunological reaction is related to deposits that build up on the lenses. These can be your own tear lipids,proteins, preservatives in contact lens solutions that build up in the lens matrix, environmental allergens that build up on the lens, and in rare cases possibly the material the lens is made of. Since soft lenses are about half water they act like a sponge absorbing larger molecules and retaining them resulting in increasing levels over time.
Wearing the same pair of lenses for several years obviously caused an increase in this condition. The hard lenses worn prior to soft contact lenses can still cause GPC, but because they are inert and do not absorb any water the incidence is very low. With the advent of extended wear, the eyes were given constant exposure to the mechanical and immunological irritants with no recovery time so the incidence started climbing again.
In the first era of contact lens technology lenses were frequently machined on a lathe when dry then re-hydrated. Bausch & Lomb developed spin casting the liquid material in a mold. Today automation and molding manufacturing techniques allow for much more precise and smooth lens edges. Lens that were hand inspected under a microscope in the past are now quality controlled by automated systems. These have been quantum improvements in lens quality that have helped decrease lens edge induced GPC problems. Extended wear contact lens materials are starting to be designed today to help resist deposits better. For a number of years now the major contact lens manufacturers have been using large molecule preservatives that exceed the pore size of soft contact lenses. This greatly reduces the possibility of toxic preservatives inside the lens over time. Unfortunately, many generic solutions appear similar but often contain the older small molecule preservatives that can lead to GPC.
Even though the occurrence is much lower today, GPC can still be a major eye irritant and contact lens problem. There are several approaches to managing GPC. Switching to daily disposable lenses eliminates coating reactions completely since the lenses are thrown away daily and never exposed to disinfecting solutions. Usually, contact lens wearers with GPC have been wearing their contacts well beyond the suggested replacement cycle and become lax in cleaning the lenses. Returning to a normal 2-4 week replacement cycle and discontinuing or decreasing overnight wear may be all that is required to return the eye to normal health.
Prescription eye drops are also a large part of treating GPC. A class of eye drops called mast cell stabilizers work to stabilize the cells membranes from releasing histamine that starts the inflammatory cycle. These eye drops are very safe and can be used year round when needed. Other options are available and today GPC is no longer the end of your contact lens career, only a small bump in the (eye) road. Vision Insurance like Vision Service Plan Frequently offer plans that include medical treatment for conditions like GPC. You should do an annual review of all of your medical and vision coverage to make sure you are providing the best benefits you can for your family.
Swine Flu (H1N1) is starting to creep back into the news and will probably reach TV hysteria by September. I believe it will be a mild version and not have a large impact in the U.S. Even so, we are planning to continue serving your eye care and eye doctor needs if it should become a severe pandemic.
The first thing to consider is isolation as the number one, proven method to stop the spread of flu. During the Spanish Flu Epidemic of 1918 Western Samoa was devastated with 90% of the population infected and high mortality rates. American Samoa was barricaded closed and was flu free. Here in Gunnison, Colorado the train station was closed with similar results.
Isolation works. Flu cycles typically occur for about 6 weeks, returning after months for a few more cycles. That means planning on restricting activities for about 6 weeks. If needed, we have plans to extend refill times on prescriptions and mail glasses or contact lenses directly to your house. For office visits we plan on scheduling every visit, even pick ups, adjustments, or any type of office visit. By reducing the number of people in the office at the same time as you we can greatly reduce exposure. We can also perform more limited exams during the 6 week cycle. We will request you come in alone if at all possible to reduce exposure to our employees. By scheduling all visits we can reduce the number of employees in the office at any given time reducing exposure.
Obviously, if you feel like you might have the flu we would request rescheduling your appointment. While we do have some face masks, there are still questions if they have any effect on preventing transmission. As you might know, most masks are manufactured overseas and difficult to obtain. We may request patients to wear them instead of us to extend the supply we do have. As you may have heard there will be a shortage of vaccine. Unfortunately, in years past most production was moved offshore. The last several years there has been a move to correct this but only 40 million vacines are expected from initial production in October.
Additional measures will be placing hand washing stations by the doors for everyone entering the office, and requesting keeping a three foot distance away from anyone else.
Pinkeye is not a common complication of the H1N1 Flu and there are reports of a number of cases with low or no fevers.
Again, I personally so not expect this to be a serious problem in the U.S. and don’t expect we will need to change our normal procedures, but we are prepared to if needed. Less developed parts of the world have the potential to face a much more grim prospect due to crowding, hygiene, and lack of health care. Probably the worst thing we can expect is the possibility of being stuck at home with kids when the internet or cable goes down!
Stay Well
Dr David Kisling, Optometrist
Today the World Health Organization officially recognized the World Pandemic of H1N1 Flu. This is not really a cause for concern as there are no significant changes in the situation, only an acknowledgement of what has been occurring for a while. This is still a mild flu virus but has spread geographically and been transmitted person to person in different zones of the the world thus meeting the criteria of a pandemic. While the conditions could change dramatically in the fall, at this time there is no indication of a serious pandemic. We have seen no signs of pinkeye or eye symptoms related to H1N1 flu to date in our office but as always, we take preventative measures to prevent the transmission of any eye or systemic diseases.
Summary of Situation
Updated June 11, 2009, 12:30 PM ET
A Pandemic Is Declared
On June 11, 2009, theWorld Health Organization raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. A Phase 6 designation indicates that a global pandemic is underway.
More than 70 countries are now reporting cases of human infection with novel H1N1 flu. This number has been increasing over the past few weeks, but many of the cases reportedly had links to travel or were localized outbreaks without community spread. The WHO designation of a pandemic alert Phase 6 reflects the fact that there are now ongoing community level outbreaks in multiple parts of world.
WHO’s decision to raise the pandemic alert level to Phase 6 is a reflection of the spread of the virus, not the severity of illness caused by the virus. It’s uncertain at this time how serious or severe this novel H1N1 pandemic will be in terms of how many people infected will develop serious complications or die from novel H1N1 infection. Experience with this virus so far is limited and influenza is unpredictable. However, because novel H1N1 is a new virus, many people may have little or no immunity against it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against novel H1N1 virus.
In the United States, most people who have become ill with the newly declared pandemic virus have recovered without requiring medical treatment, however, CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this pandemic in the coming days and weeks. In addition, this virus could cause significant illness with associated hospitalizations and deaths in the fall and winter during the U.S. influenza season.
Background
Novel influenza A (H1N1) is a new flu virus of swine origin that first caused illness in Mexico and the United States in March and April, 2009. It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread, mainly through the coughs and sneezes of people who are sick with the virus, but it may also be spread by touching infected objects and then touching your nose or mouth. Novel H1N1 infection has been reported to cause a wide range of flu-like symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, many people also have reported nausea, vomiting and/or diarrhea.
The first novel H1N1 patient in the United States was confirmed by laboratory testing at CDC on April 15, 2009. The second patient was confirmed on April 17, 2009. It was quickly determined that the virus was spreading from person-to-person. On April 22, CDC activated its Emergency Operations Center to better coordinate the public health response. On April 26, 2009, the United States Government declared a public health emergency and has been actively and aggressively implementing the nation’s pandemic response plan.
Since the outbreak was first detected, an increasing number of U.S. states have reported cases of novel H1N1 influenza with associated hospitalizations and deaths. By June 3, 2009, all 50 states in the United States and the District of Columbia and Puerto Rico were reporting cases of novel H1N1 infection. While nationwide U.S. influenza surveillance systems indicate that overall influenza activity is decreasing in the country at this time, novel H1N1 outbreaks are ongoing in parts of the U.S., in some cases with intense activity.
CDC is continuing to watch the situation carefully, to support the public health response and to gather information about this virus and its characteristics. The Southern Hemisphere is just beginning its influenza season and the experience there may provide valuable clues about what may occur in the Northern Hemisphere this fall and winter.
CDC Response
CDC continues to take aggressive action to respond to the outbreak. CDC’s response goals are to reduce the spread and severity of illness, and to provide information to help health care providers, public health officials and the public address the challenges posed by this new public health threat.
CDC is issuing updated interim guidance in response to the rapidly evolving situation.
Clinician Guidance
CDC has issued interim guidance for clinicians on identifying and caring for pateints with novel H1N1, in addition to providing interim guidance on the use of antiviral drugs. Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) with activity against influenza viruses, including novel influenza H1N1 viruses. The priority use for influenza antiviral drugs during this outbreak is to treat people hospitalized with influenza illness, and to treat people at increased risk of severe illness, including pregnant women, young children, and people with chronic health conditions like asthma, diabetes and other metabolic diseases, heart or lung disease, kidney disease, weakened immune systems, and persons with neurologic or neuromuscular disease.
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A cataract is a clouding, opacification, yellowing, or accumulation of fluid in the lens of the eye that results in a loss of vision that interferes with your lifestyle. Most cataracts are related to aging, and by the time you reach the age of 70 it is almost universal to have some early signs of cataracts.
Age related cataract may occur in one eye first but with time will usually be present in both.
The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye that is lined with the photoreceptor cells registering light.
A healthy lens is transparent and passes most of the light to the retina, filtering out some UV. The retinal photoreceptor cells change light into nerve signals that are sent to the brain area in the back of the head.
When the lens becomes cloudy from a cataract, the image you see will be blurred.
Most cataracts are related to aging, but some are have other causes such as trauma, eye diseases,and developmental abnormalities. Eye surgery for glaucoma and other conditions can lead to cataract formation. Certain health conditions like diabetes can also cause cataracts, occasionally very rapidly and in some instances reversible. Prescription steroid medications used long term can result in cataract development. Traumatic cataracts result after serious eye injuries but usually will not progress over time like age related cataracts. Infants occasionally are born with cataracts or develop them in early childhood, often in both eyes. These cataracts may be so small that they do not affect vision. While technically a cataract, I feel opacities need to cause lifestyle interruptions before they should be labeled as a cataract. If they do, the lenses may need to be removed. Radiation exposure can result in cataracts if the dose is high enough or accumulates over repeated exposure.
The lens lies behind the iris and the pupil, the black opening you see in the eyes. The lens adjusts the eye’s focus like the zoom on a camera, allowing us to see things clearly both up close and far away. The lens is made of mostly water with small amounts of protein and other substances. The protein is arranged in precise layers that keep the lens clear and lets light pass through it. When this pattern is disrupted vision becomes hazy and blurry.
There are steps you can take to reduce your risk of developing cataracts. Smoking is a major risk factor for cataract development as well as most causes of blindness. Reducing your UV sun exposure by wearing quality sunglases that meet A.N.S.I. standards is helpful. Sunwear that wraps and blocks sun exposure from the side is even more helpful.
Although research studies have given mixed results, time will probably bear out a protective effect of antioxidants on the lens tissue. Supplementation with vitamin C, lutein, zeaxanthin, and vitamin E likely will be shown to reduce cataract development. Eating foods that are complex carbohydrates such as whole grains and less refined foods with a lower glycemic index are associated with a decreased risk of cataract formation. Leafy green leafy vegetables, fruit, and other foods with antioxidants are always the best source of supplements.
Annual comprehensive dilated eye health exams are vital to monitor for cataracts and allow your optometrist to check for signs of macular degeneration, glaucoma, and other eye diseases. Early treatment and detection of eye disease may save your sight and life!
The most common symptoms of a cataract are:
- Cloudy or blurry vision.
- Colors seem faded.
- Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
- Poor night vision.
- Frequent prescription changes in your eyeglasses or contact lenses as your eyes become more nearsighted.
Cataracts do not require surgery until they interfere with your lifestyle. In rare cases, the lens can rupture causing serious problems. This is almost unheard of today as eye doctors are widely accessible in all areas of the United States. A new eyeglasses prescription, brighter lighting, anti-glare sunglasses, or magnifying lenses can all be used to help in the interim period. Cataract surgery has a success rate over 95% today and replaces the lens with an artificial implant. Frequently your prescription for distance will be significantly reduced after surgery. Many patients find they have only occasional need for glasses for distance. Some lens implants available today provide some reading capacity also. Most of the time delaying cataract surgery will not cause long-term damage to your eye so you should not feel a need to rush into surgery.
Cataract removal may become essential when other eye diseases in the eye such as macular degeneration or diabetic related complications need to be visualized well to be followed. Even if your eye doctor tells you you have a cataract, your cataract may never develop to the point where surgery is required.
If you have cataracts in both eyes, the surgery may be necessary on one eye only for good vision. If surgery is required on both eyes it will be done at separate times several months apart. This is a much safer approach should complications occur, and allows for refinement of procedure if the first outcome is slightly off.
As with any surgery, cataract surgery does have some risks. Infection inside the eye is the most serious, but rare complication. Lenses may be displaced, cause damage to other tissues in the eye, and the retina tissue in the back of the eye may have swelling or detachments. Some prescription medications predispose you to problems during surgery so be sure to discuss all of your prescriptions with your eye doctor well in advance of eye surgery. Flomax, a prescription used to treat benign prostatic hyperplasia (BPH) has been associated with Intraoperative Floppy Iris Syndrome (IFIS). IFIS can cause problems during cataract surgery so you should be sure to inform your eye doctor if you are any prostate medications. Before cataract surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery. Over the counter drugs like aspirin and advil may fall in this category. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision.
Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase your risk of retinal detachment after cataract surgery. One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little “cobwebs” or specks that seem to float about in your field of vision. If you notice a sudden increase in floaters or flashes, call your optometrist immediately. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. Early treatment for retinal detachment often can prevent permanent loss of vision.
For a few days after surgery, your eye doctor may ask you to use several eyedrops to help healing and decrease the risk of infection. You will need to wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye. Sun glasses will be needed to protect your eyes from the bright glare we have in Fort Collins and Northern Colorado.
When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores.
In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress.
Problems after surgery are rare, but they can occur. These problems can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double vision, and high or low eye pressure. With prompt medical attention, these problems can usually be treated successfully.
Months or years after cataract surgery cell growth can occur on the artificial lens obscuring vision. This is frequently referred to as after cataracts. A simple, brief laser procedure done in the office quickly resolves this problem.
Cataracts surgery is one of the most successful procedures done today. While you don’t want to rush into any surgery you can rest assured knowing if your vision does become problematic you have a good treatment option available. Medicare will cover cataract surgery when your eyesight has degraded to a designated level. Many types of vision insurance, including Vision Service Plan, provide coverage of cataract surgery under some of their policies. You will need to check with your provider to find out what is covered under your plan. Some types of lens implants are usually excluded.
Conjunctivitis is rarely a specific indicator for Swine Flu. The CDC seems to indicate an abrupt onset of fever (100-100.5) in conjunction with typical flu symptoms is fairly indicative of influenza. There are a number of supposed cases in Mexico of mild H1N1 Flu with low or non recorded fever. It remains to be seen if these are mild cases of flu or Upper Respiratory Infections. Any case of conjunctivitis accompanied with the signs of flu such as dry cough, muscle aches, fatigue lasting more that a few days, loss of appetite, sinus congestion mild or moderate, and headaches should be considered a possiblre case of H1N1 Flu until proven otherwise or until the current outbreak gains clatity. This does not mean all possible cases need to be tested, merely that patients with a questionable diagnosis should stay away from public places a few days inside until it becomes clear they do not have H1N1 Flu. If you have all of the indications of Influenza your Family Optometrist may be willing to treat mild conjunctivitis with a telephone consult to avoid further spred of the virus. As a Fort Collins Eye Doctors Office, we are comfortable treating existing patients with a confirmed diagnosis of H1N1 Flu in this manner in conjunction with your primary care family doctor.
Pinkeye (conjunctivitis) is a rare reported symptom of Swine Flu. It is highly unlikely to be the initial symptom of Swine Flu so rest easy if you have pink eye, it is probably a simple viral or bacterial eye infection easily amendable to treatment.
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A number of years ago an outbreak of pink eye in a elementary school had all the moms frantic and half of the school would be missing in action shortly after the announcement was sent home. Those days were prior to the education parents and health care providers have been receiving in current times about preventive measures to help in ceasing the spread of pink eye. In the past if one child was infected by pinkeye it was not long before half the class ended up with it too. Now that personal hygiene is taught more extensively in the schools at an earlier age parents are becoming more aware of how to prevent further infection of pink eye at home. This has helped seclude outbreaks so they occur less frequently than previously. It is still not unheard of to occasionally see a major outbreak spread rapidly through a school. Pink eye can cause any parent concern when they see their child come home from school with a pink to extremely red eye. Hemorrhagic forms of pinkeye cause small amounts of blood to spread out over the white part of the eye and the appearance exceeds their actual capacity to damage eyesight. The first scare is eye damage. Thankfully, pink eye rarely causes any long-term eye vision damage and some types of pink eye can resolve without any treatment in a week or so.
Pinkeye, otherwise known as conjunctivitis is an inflammation of the conjunctiva that can be caused by infections, allergies, viruses, colds, bacteria, or a substance that irritated the eye leading to an infection. Just because some pink eye types will fade away without intervention, never risk a your childrens sight with that thought process; always seek out medical eyecare from your family Optometrist immediately. Some forms of pinkeye can be debilitating for up to a year. Other more serious eye diseases may look like pinkeye but indeed may be a very serious type of eye disease. Most schools will not let your child return to school unless you can show proof that you have seen one of the Eye Doctors in your area. Your Optometrist can give your child a clean bill of health when they feel like they are no longer contagious. Unfortunately, this is not an exact science but a reasonable enough guess to significantly reduce the spread of pinkeye today. Typically a child will need to be out of school for 3-4 days.
Newborns born with pink eye is generally due to the mother passing on an STD (sexually transmitted disease) to the infant through the birth canal and can be serious if not caught at onset. Doctors have become more then vigil in checking birth mothers prior to birth for STDs that can cause serious side effects in their newborn well prior to delivery and treat those conditions during her term. Pinkeye presents with symptoms of eye discomfort, commonly relayed as feeling as if sand is in the eye. It can commonly cause the child to wake in the morning with a thick crust that seals the lids together resulting in the need of a warm towel to soften the mucus to be able to open the eye comfortably. Other common symptoms are sensitivity to light, itchiness, and excessive tearing. Pinkeye caused by bacteria or a virus are highly contagious and can be passed through touching an infected child, touching something an infected child has touched, coughing, and sneezing.
To prevent the spread of pink eye keep your child out of school or daycare until your doctor or Optometrist give the go ahead for them to return. Teach your children to wash their hands frequently and explain to them why it is so important. Washing hands while singing the happy birthday song twice to themselves is a good way to teach them correctly. Also, teach your children not to share personal care items with another student or child as well as if they are aware that another child is ill or has a case of pink eye. Do not use or touch anything belonging to that child until they have been given a clean bill of health. This is especially true in young contact lens wearers; your child should never try on another persons lenses or borrow their case or contact lens solutions. In your home, wash pillowcases regularly, especially anytime your child is ill as well as other bedding and linens. If your child has a case of the pink eye, separate their towels and washcloths items from the rest of the families and wash their items in hot water. If your child is at risks of coming down with pinkeye due to allergies, limit their pollen contact by keeping your child inside on heavy pollen days, keep your home closed up during them periods, dust and vacuum daily, and avoid subjecting your child to any other free radicals in the air such as cigarette smoke, smog, car exhaust, etc. If you suspect your child may have a case of the pinkeye or a school nurse has sent your child home, contact a qualified Optometrist to get treatment as needed for your child.
Alternative treatments for pinkeye in under developed countries include topical povidone-iodine (betadine) which is effective against most bacterial conjunctivitis at a fraction of the cost of standard antibiotic prescription eye drops. Povidone is sometimes used by optometrists to treat EKC, a special severe from of viral conjunctivitis. However, it does not appear to be a treatment for most viral forms of conjunctivitis. Homeopathic remedies include Similasan Pink Eye Relief eye drops. Similasan 2 Allergy Eye Drops have had one small study showing effectiveness and they do seem to work well for some patients with milder forms of allergic conjunctivitis. Any over the counter eye drop treatments should be used under medical supervision as some drops can induce angle closure glaucoma in susceptible patients. There have been cases where individuals have gone blind from self treating with over the counter eye drops. Chronic dry eyes can make you susceptible to recurring bouts of conjunctivitis. Treatment of dry eyes may be a very good preventative measure for chronic pinkeye
