Metal lodged in the cornea

  We frequently see patients with small pieces of metal lodged in their cornea.  Very often these are people who work as machinists, welders, or mechanics.  The epithelium, or outer layer of the cornea, is soft and metal fragments easily become stuck within the cornea.  There is usually immediate pain when the foreign body gets into the cornea.  Then they start to rust and the pain slightly decreases because the outer surface of the metal fragment becomes less jagged and sharp.  Then the pain worsens the next day as the entire eye becomes red and inflamed.  Eventually a severe inflammation called uveitis may develop and this complicates the treatment.

     We anesthetize the cornea with eye drops and then can remove the foreign body using a small tool and  a high-powered biomicroscope to allow for easy visualization.  But if the metal fragment has been in the cornea for much more than one day, the rusting  increases and permeates deeper into the cornea.  We must remove this rust or the eye will not heal properly.  We use a low intensity spinning burr to remove this rust, but this necessarily leaves a corneal scar and lengthens the healing time.

    The important point I am trying to make is that the sooner we get to remove the metal,  the less chance there is of complications  and the quicker the healing process.  It is much better when we see these patients the same day they get the foreign body into their eye.  We have an emergency phone number listed on our answering machine.  We will see established patients in the evening or on the weekends who have these types of problems.  We would much prefer to fix this problem on  a Saturday then deal with a more complicated problem on Monday morning!

 

Why eye exams are so important at age four or five

Why you need to get your child’s eyes examined before kindergarten

Four or five years of age is an important age for a first eye examination.  There are two especially important problems we look for at this age.  Amblyopia (“lazy eye”) must be detected at a very young age so it can be treated.   Children with amblyopia rarely complain about their vision (because one eye still works well) and they usually show no signs of problems to their parents.  We can treat amblyopia with eye patching therapy and/or eyeglasses at a young age, but treatment is generally  ineffective in children eight years or older. Amblyopia is often caused by a large imbalance in prescription between the eyes, normally from hyperopia (farsightedness).  It can also be caused by a slight misalignment between the eyes.  If there is a slight inward crossing of the eyes, one of the eyes will become amblyopia and will never see well unless we treat it at an early age.

The other problem we frequently see in young children is moderate or large amounts of farsightedness (hyperopia).  These children will often see 20/20 on a standard eye chart but they will suffer from problems with reading and sometimes headaches.  This problem frequently gets overlooked for many years because children often get screened with distance eye charts.  These children will pass a standard distance visual acuity screening but they will not perform at their best in school or with reading.

I have seen many children suffer for years with hyperopia and their parents thought they had no problems because they had seen well on a distance visual acuity chart.  I have also had very upset parents when I tell them their 12 year child will never see well out of one eye because of amblyopia, but that we could have treated this problem had the child been much younger.

We are certainly willing to see children younger than four if the parents are concerned about their eyes.  One  important condition I want to stress is it VERY important that we see a child if their eyes cross inward, even if it only happens occasionally.  We have see children as young as one or two with one inward crossing eye.  This is called esotropia or strabismus.  This is often caused by a large amount of farsightedness and often leads to permanent vision  impairment in one eye and permanent eye crossing unless treated early.  It is important to treat this as soon as possible, with excellent results in two -four year old children.

Some parents ask how can we measure the prescription in a young child.  We have invested in sophisticated equipment for this purpose.  We have two autorefractors, including a hand-held version that works very well with children to measure their prescriptions wit h  good accuracy.  We  also use retinoscopes to further evaluate their vision.  We have a computerized visual acuity chart called Acuity Pro, that uses randomized pictures that works well to determine the  visual acuity in young children.  We also sometimes use potent eye drops called cycloplegic agents that in conjunction with retinoscopy or autorefractors can give us a very accurate determination of prescriptions even in a two or three year old.

frame allergies - why your eyeglasses temples turn green

Some people have allergies to the metal used in eyeglass frames.  These are  usually frames containing nickel.  The temples become pitted, rough and green  and the skin touching the frame can become quite irritated.   You can prevent this problem by getting frames made of pure titanium.  Titanium will never react with your skin or cause any allergies. It is also a very strong and light metal.  Stainless steel frames are also available, and they rarely cause allergies.  And of course, plastic frames preclude this problem.

What are eye vitamins for macular degeneration?

      Macular degeneration is a serious disease of the macular area of the retina.  The macula  is where your eye focusses your central vision.  The macular tissue sometimes deteriorates as we get older and we gradually lose the ability to drive, read, and function normally.
      There is some evidence that certain vitamins and dietary nutrients can reduce the chance of macular degeneration.  A large scientific study called the AREDS study identified a number of nutrients that might reduce the risk of macular degeneration. These formulations are available over-the-counter in most drug stores. Typical brands include Ocuvite, ICaps, and PreserVision. There are not many difference between these formulations, as they all use the AREDS recommendations.
     There is also some evidence that omega-3 fatty acids help reduce the risk of this disease. Good sources of Omega-3 fatty acids include fish like salmon, flax seed, and fish oil capsules.  Another helpful nutrient is lutein. There is a lot of lutein in dark, green, leafy vegetables like spinach, collards, turnip greens, and kale. Cooking these vegetables does not hurt lutein.
     Studies show Vitamin D seems to lower the risk of getting this disease, but does not help much once the disease has begun.  Smoking makes macular degeneration about 2-3 times more likely.  
     We always look at your macula during your yearly eye exam. We also take digital retinal photographs to help look for macular degeneration. This also lets us evaluate any changes that occur from year to year. The first sign of macular degeneration is a color change in the macula. We usually see that before you see any problems with your vision.
A good source of information about macular degeneration is  http://www.amd.org