Opias and
Itises and Phobias Part
II
|
Last month we learned of the causes, signs and symptoms, and usual treatments for some of the most common maladies that patients ask front-line ECPs about every
day.
 |
ARMD, glaucoma, allergies, styes and chalazia, pterygia and pinguecula, cataracts, and diabetic retinopathy were among the topics covered. By way of reminder: In no way is this information promulgated in an effort to encourage a dispensing optician to exceed the scope of his or her practice. Rather, it is intended to help us more intelligently discuss, offer further insight to, and ultimately refer our patients to optometrists or ophthalmologists when appropriate. This month we will delve into the more obscure… |
One of the most common inquiries I receive on the front lines of opticianry comes from people who are obviously suffering from some form of conjunctivitis, more commonly referred to as pink eye. The pink eye itself, along with a feeling of grittiness, itching, burning, and light sensitivity are all common symptoms. Contagious forms of conjunctivitis are caused by viral or bacterial infections. Non-contagious forms of pink eye are usually caused by things like dust or smoke. While adults can also suffer from it, pink eye will usually spread like wildfire in schools – it is that contagious. While there is no special treatment for the viral form (it will usually clear up on its own within a week or two), bacterial forms usually require treatment with topical antibiotics. Since we can never be sure what has caused it, an ECP faced with a “pink” eye should strongly recommend the patient see an eye doctor as soon as possible.
Here in the Sunshine State, many of my clients are senior citizens. Though they do not call it ptosis, at least once a month I am asked about it. It is usually something like, “Is there anything I can do about these drooping eyelids?” Fifty years ago an eye care professional might have suggested a ptosis crutch – an appliance attached to the patient’s eyeglass frame that would physically lift the lid, thus allowing in more light and achieving better visual acuity. These days, minor surgery would be a more acceptable way of correcting this physical and cosmetic problem. Although it can be congenital, usually with age the muscles that lift the eyelids (levators) lose their ability to function. A front-line optician who can inform the patient that the procedure is not solely cosmetic, but will also provide a visual improvement, will perhaps motivate the patient to seek further medical consultation.
If a patient is experiencing an ability to blink one eye, if the lower lid is starting to turn out, and/or she is having difficulty controlling the lips and face on the affected side, she may be experiencing a bout of Bell’s Palsy. While the cause of Bell’s Palsy is a mystery, in most cases (80% or more) the patient will fully recover with no special treatment in less than six months. This can be a scary experience for a patient, as they sometimes think they have suffered some form of stroke. This patient should always be referred to a physician, because without proper care and management of symptoms by patching lids during sleep, applying ocular lubricants, addressing the ectropion (the turning out of the eyelid) unnecessary, permanent consequences may be suffered.
Dermatitis, poor hygiene, allergies, bacterial infection, and lice may all be causes of blepharitis. If your patient has eyelids that are red, swollen, itchy, or crusty, or complains of the feeling of sand or grit in the eye when blinking…congratulations he has probably won the blepharitis sweepstakes! Believe me, this is not his lucky day. Loss of eyelashes may also occur, and if left untreated, styes, corneal ulcers, chalazia, and scarring may appear. Very diligent daily eyelid cleansing and scrubbing with baby shampoo or other specialized cleaners is often recommended, although this should be performed under the care of an OD or MD, who may also prescribe antibiotic ointment to help control the bacteria. Unfortunately, blepharitis is usually a chronic condition that is very difficult to control.
If you are ever faced with a patient who has a red, painful eye that is accompanied by a mild to severe discharge, immediately refer that patient to an ophthalmologist or even an emergency room. Why? This patient may be developing a corneal ulcer, which is due to a localized infection of the cornea, not unlike an abscess. This phenomenon is usually the result of a bacterial infection that invades the cornea following a traumatic event or eye injury. If poor hygiene is involved, contact lens wearers are much more susceptible. Fungi and other parasites may also be the culprits. Depending on its cause, a physician may treat the ulcer with antibiotics or antifungal medications. A quick referral is indicated because if left untreated, permanent, irreversible damage to the cornea may occur. If that happens, the only possible treatment is a corneal transplant.
While many people have harmless vitreous floaters, their sudden appearance may be the sign of something more serious – namely a retinal detachment. These never-before-seen floaters will usually be accompanied by spots or flashes of light, and perhaps decreased or blurry vision. Seeing what appears to be a curtain moving across (or more likely, descending upon) the eye is another classic sign of a detachment. While there is usually no pain involved, this is a serious, referable event. This event can be caused by an injury to the eye or face, extreme myopia, and can even be triggered by other optical procedures such as IOL surgery or LASIK. The eye surgeon must somehow attempt to reattach the retina, with either surgery or a process known as photocoagulation. With a detached retina, time is of the essence – the sooner it is treated, the more likely that the damage can be reversed. Waste no time in referring this patient to an eye doctor.
Sometimes customers will complain of a foreign-body sensation, persistent dryness, burning, or itching, along with insufficient tear production. Though it is not our place to diagnose, this sure appears to be a classic case of Dry Eye Syndrome. Ironically, another symptom of this ailment may be “watery” eyes. In an effort to deal with the lack of tear production, the eye begins to overproduce other ocular liquids, as an ineffective way of dealing with the problem. D.E.S. can be a side effect of many medications, caused by age, environment, and especially may be caused by long-term contact lens wear. If an optician is faced with this condition in one of his or her patients, a referral is in order. The eye doctor has many options to deal with this problem: altering the patient’s environment, artificial tears, punctal or lacrimal plugs, and a relatively new drug, Restasis, that actually encourages production of natural tears. Without addressing the underlying causes, the patient will sometimes suffer unbearable irritation.
Armed with the information provided last month and herein, you should feel more comfortable discussing these conditions with your patients, and more confident and forceful in urging them to seek further treatment to avoid any serious consequences to their vision, eye health, or overall well-being.
|
