Snooki is an idiot. I was recently made aware of her quote in Ok! magazine that false eyelashes are functional even during sleep.  This statement is absurd for many reasons, but false eyelash use during sleep certainly raises concern about one’s hygiene.  It does not require much knowledge of science to realize that these eyelashes must attach to the eyelid somehow using an adhesive.  Common eyelash glues consist of latex, gum, and a touch of formaldehyde as a fixative.   Given this composition, I’d imagine that I would not want this material on my skin or near my eyes longer than necessary.  Many companies market these glues as certified as waterproof–to me this just means that more dirt will be able to stick to them from the longer duration of use.

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medicine oculoplastics, ophthalmology, rant

I’m often asked by my non-ophthalmology friends, “I am near sighted, and I also have astigmatism. My eye doctor tells me that my eye is shaped like a football instead of a basketball. I sort of get it, but what does that mean? Am I deformed?”

Indeed, this explanation captures the essence of the problem, but for most people, having astigmatism does not mean that you have been cursed with a football-shaped eye.  For those my Chinese readers, astigmatism is written as, “散光”. (Mandarin: sǎn guāng; Cantonese: saan2 gwong1)

Again, for MOST people, astigmatism is a condition OFTEN completely correctable with contact lenses, glasses, or refractive surgery, assuming that there are not other underlying issues in your eyes.

In order for the eye to transmit a clear image of what is in front of us to our brain, light travelling into our eye must be focused directly onto the retina.  There are many conditions that can prevent light from reaching the retina, and astigmatism is one of them.  For most issues, astigmatism involves the cornea, a clear structure in the front of the eye that is responsible for bending light entering the eye onto the retina.  For those of use that are near-sighted (myopic), light is focused in front of the retina. For far-sighted folks (hyperopic), light is focused behind the retina (optically speaking). When we visualize this system in the two or three dimensional planes, light at different axes can be bent at different angles, resulting in a variable focus onto the retina. This is astigmatism.

One can have myopia or hyperopia with astigmatism. These two categories are not mutually exclusive.  Your ophthalmologist can accurately diagnose astigmatism and offer treatment recommendations.

medicine ophthalmology

Last week our departmental chairman suckered me into being the test subject for a pneumatic retinopexy demonstration. The near-horizontal angle portrayed in this photo allows for withdrawal of vitreous to create space for injection of an intraocular gas. After adequate removal of vitreous, the syringe is tilted up at a 45-degree angle to inject the gas. This procedure allows for repair of a superior detachment in the office.

medicine ophthalmology

I have always believed that only a single refraction and its spherical equivalents can produce the best-corrected visual acuity (BCVA) for any given person. Assuming that human intelligence allows for accurate estimation of Snellen acuity even without crisp vision, there should only be a narrow range of refractions that can be tolerated. After reviewing some refraction notes from a clinician’s office, I’m shocked:

2006: OD: -1.00 -1.50 x 080 OS: -7.00 -0.50 x 040

2007: OD: -1.25 -1.00 x 099 OS: -8.50 +1.00 x 160

2008: OD: -1.00 – 0.75 x 095 OS: -7.50 – 1.00 x 060

Even at first glance, there are multiple inconsistencies in these notes. The refractions came from a large academic practice, and the 2006 and 2007 refractions even came from the same optometrist. The patient had never undergone any eye surgeries, but was an elderly person.

Why the hell was the OS examination from 2007 written in plus cylinder notation? The conversion doesn’t even match up with either of the other two exams. If you look only at the right eye, the axis changed every year, as did the cylindrical power. As far as I understand, there are published tables on the tolerated range of axes for a given astigmatic correction. A correction of 1D with an axis fluctuation of up to 19-degrees (80 to 99) does not seem tolerable.

Unfortunately, I don’t have the acuity for each refraction to verify the results.

medicine ophthalmology

This photo is from a guy who ended up having a penetrating corneal injury from a thorn. Apparently he was running through the woods in the dark, and came across a brier patch. Lesson learned…

A few issues to note when repairing corneal lacerations with foreign bodies:

• Make note of the direction of entrance. In some instances, it is easier to remove the foreign body from the direct it enters the globe.
• Composition of foreign body. If plant matter is involved, think of Bacillus cereus. You’d want to cover this organism with the appropriate antibiotics.
• Do not inject gentamicin intracamerally. You will kill the retina if anything greater than 100-ug goes intraocular.
• Make note of the tension of the sutures passed. At times it is tempting to tighten the knots as much as possible, but that is often unnecessary. You just want a water-tight seal without inducing too much astigmatism.

medicine ophthalmology