Eyelash glue is typically applied externally at the natural eyelash base.  Additionally, liquid eyeliners are often used to mask excess glue from the lashes, along with mascara for adding volume.  During the day, these layers will collect grit from the air and collect along the lash line.  By allowing dirt to fester on the eyelashes at night, you are begging for an infection.

There are approximately 50 meibomian oil glands on the upper lid margin, along with the follicles within each of the eyelashes.  Each on of these orifices can become inspissated with oil and become inflamed.  In my general ophthalmology clinic, I often see clogged oil glands presenting as styes, external blepharitis, meibomitis, and cellulitis.  Most times, these infections can be managed using warm compresses and topical medications.  Rarely, the infections can become so severe that inflammation tracks behind the orbital septum–in these cases, both vision and livelihood can be threatened.

False eyelashes during sleep? No way. Vanity should have limits too.

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.

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.

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.

Wrong.

In some cases, it is obvious that someone is myopic by the disproportionate size of the eye. To me, most of the cases are not obvious at all.

Years ago when I was still a medical student, Harry Knopf, one of the private attendings at WashU had told me to look at the temples, not the eyes. The refractive error can be estimated by looking at the temple border.Look at this example:

The border of the face behind the glasses is shifted medially, as shown by the dotted lines. This is a myopic correction.

In contrast, look at this photo of Ryan, from The Office:

The line behind the lens is continuous with his face. This joker is wearing a plano lens (no correction). Likewise, if the face behind the lens appears to extend outside of glasses, then there is hyperopic correction present.

This finding is not entirely obvious, yet intuitive. However with practice, you may be able to approximate an exact dioptric power. Try it out, and you will impress.

The full link to the website is here.

Me: This is ophthalmology returning a page.

Consultee: You have to see this consult…

Others are even more direct:

Me: This is ophthalmology returning a page.

Consultee: Five-One-One-Eight… [reading medical record number of presumed patient needing consult]

On other occasions, the interaction becomes insulting:

Consultee: (At 3 am) Sorry to wake you. This isn’t an official consult yet, but can I borrow your Tonopen? (Device to check eye pressure). This guy with a history of glaucoma fell and hit his head last night….

I suppose that direct blow to the eye could cause an eye pressure spike, but there are a few other incongruities in this consult request (We take home-call).

The ultimate insult:

Me: Can I borrow your stethoscope?

Consultee: Do you even know how to use one? (I was one year senior to this guy in medical school, and I taught him about renal failure in a review group)

Sometimes I just want to scream.

The optics behind retinoscopy is elegant. In a perfectly round cornea without refractive error, light entering the eye is focused directly onto the retina. The reflection of light appears as a homogeneous red reflex to the examiner. In a hyperopic eye, the cornea is underpowered–light becomes focused behind the retina. As the examiner streaks the light through the pupils, the retinal reflex moves in the same direction as the light beam from the retinoscope–this appearance is dubbed “with motion”. With-motion is created from uncrossed light rays traversing the surface of the retina.

Conversely, myopic eyes focus light in front of the retina. Light rays on the retina are crossed, and produce a red reflex that moves in the opposite direction of the the streak (against motion).

For many people, against motion is difficult to discern, especially if there is with motion in another axis. I have probably overlooked this finding in dozens of kids with small amounts of myopic astigmatism, hopefully without dire consequences.

Last week, however, I successfully identified myopia through retinoscopy in a 5 year-old. The refraction was -1.00 + 4.50 x 085 in the right eye.

A celebration for this momentous event is in hand…