Q&A on Miscellaneous
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Q: Whenever I go out in sunlight on bright sunny days, my left eye starts hurting and sometimes causes me to vomit so that I can't eat and drink anything. The pain starts on the upper portion of the eyeball of my left eye. Can you please tell me why this happens? Is there any cure for it? Please help. D.A.
A: Please see your eye doctor immediately. You are describing a serious condition that requires evaluation by your own doctor. There are a variety of causes of eye pain, photophobia, and associated nausea, such as elevated eye pressure. Some of these conditions require urgent treatment to avoid complications. So, again, please see your doctor. Dr. Trattler
Q: Around six months ago I started having pain on my eyelids. Sometimes it's very painful and light is hard to stand. Do you know what could be causing this? D.H.G.
A: There is no way anyone can know what is causing the pain in your eyelids without an exam. Please see your doctor to determine the cause of the pain. Your complaint of sensitivity to light is of great concern, so please see your eye doctor ASAP. Best of luck. Dr. Trattler
Q: What is accommodation esotropia? B.R.
A: Accommodative esotropia is a condition that usually affects farsighted people. There are two systems that must work together in the brain for the eyes to work together and see properly: accommodation (focusing) and convergence (eye turning). When the eyes turn in to point at something up close, keeping it single rather than double, they also focus for that same distance to make the object clear.
Vice versa, when the eyes focus on a near object (print in a book or on a computer screen, for example), they also must turn inward to keep the object they are focusing on single rather than double.
Sometimes, really farsighted people focus (accommodate) too much to make things clear, which causes the eyes to turn in too much (esotropia). This is commonly called crossed eyes.
Not all people with esotropia (eyes that turn in) have accommodative esotropia. Those who do usually wear glasses or contact lenses to compensate for the farsightedness, which allows the system to work properly and keep the eyes straight. Surgery is not usually a good option for accommodative esotropia, but sometimes people with this condition are helped by vision therapy. Dr. Dubow
Q: I have heard that high blood pressure can be detected by opticians when your eyes are being examined.
My question is: If you have had high blood pressure but it returned to normal (like my father's), would the optician still be able to tell and maybe believe you still have it? Mike, England
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A: Eye care practitioners can look through the pupil and see the arteries and veins on the back of the eye (the retina). High blood pressure can cause changes in the size and pattern of the arteries, but this usually only occurs when the pressure is raised for quite a while or when it goes up really high and causes immediate damage. In your father's case, it is unlikely an eye doctor could see any changes in the retinal arteries.
But eye exams are truly a great way to monitor your health. Retinal exams can help find not only high blood pressure, but also diabetes, kidney problems, multiple sclerosis, brain tumors, and other health conditions.
Looking into the eyes is like looking into a window to the body! Dr. Dubow
[In the United States, eye exams are performed by an optometrist or an ophthalmologist.]
Q: I have crossed eyes (strabismus), and I am 23 years old. Is it too late to correct them? W., Massachusetts
A: No, it is not too late. I recommend you see an eye care practitioner, typically a doctor of optometry, who specializes in vision therapy. He or she can evaluate your condition and recommend either a course of treatments or surgery, whichever would be best for you. Contact the College of Optometrists in Vision Development to find a practitioner near you. Dr. Dubow
Q: I leaned down by a yucca plant and accidentally got stuck by one of the fronds in my eye. I thought it was just irritated, but the next morning I felt as though I had a wood chip in my eye. I went to an eye surgeon to have it looked at. He concluded that I had gouged my cornea. I immediately began the antibiotic drops and pain killer drops. All the while, my vision was completely unaffected.
The second day after starting the drops, I started to have blurred vision in that eye. I have never worn glasses and never experienced this type of symptom before. Do you know why two days later all of a sudden my vision would blur? I am scared and concerned. Could my eye just be healing and forming a "scab/scar" type of film while it heals? B.S., New Jersey
A: Your explanation is most probably the best answer for your question. Post-traumatic inflammation associated with cornea swelling (edema) and haziness is not uncommon in the initial days of the healing process. Please check with your eye care practitioner to be sure. Dr. Slonim
Q: With all the new research being done on the importance of vitamins, minerals and natural herbal remedies, is there nothing out there that can prevent or reverse presbyopia? I just recently started noticing it, and I'm not a happy camper. Would vision therapy help? D.D., New Jersey
A: Presbyopia is a fact of life for everyone. There are no vitamins, herbal remedies or eye exercises that make it go away. It usually becomes bothersome between the ages of 40 and 50. There is some research being done on surgical cures, but, to the best of my knowledge, the results are still pending. Dr. Dubow
Q: I want to get new frames, but I'm happy with my prescription, which is about two years old. Should I go for an examination even if I'm not having any problems with my glasses? K.F., Florida
A: Yes. What if you are developing cataracts, glaucoma, diabetes, macular degeneration, etc.? It is a good idea to have your eyes checked yearly whether you need new glasses or not. Dr. Dubow
Q: My son was involved in a serious eye accident. Vision was lost in the bottom half of the eye, along with a reduction in peripheral vision and a reduction in sight of the remaining working portion (from 20/20 to 20/25). His optic nerve was hit by a metal spike used in soccer. My understanding is that the remaining eyesight cannot be corrected through prescription eyewear. Is this correct? S.M., Massachusetts
A: A damaged optic nerve cannot, typically, be corrected with glasses or contacts. Dr. Slonim
Q: I heal with keloids. Will this affect my eye surgery? A.A., Ohio
Q: I had a stubborn corneal ulcer approximately 20 years ago. It required a great deal of medication and hospitalization to cure.
Once it had been healed, my ophthalmologist said that it looked as though I had never had a corneal ulcer.
My question is, would this predispose me to infections, if I were to have LASIK? A.
A: No, an old corneal ulcer doesn't predispose you to future ones unless you continue to create a scenario in which the incidence of corneal ulcer formation is increased (for example, sleeping in contact lenses). Dr. Slonim
Q: The whites of my eyes are not white. They often become red when I work hard (such as read a book or use a computer). I am 39 years old. I'm Thai, but now I stay in Belgium to study. Could this be caused by the change in climate? Should I go to buy eye drops? R.M., Belgium
A: Your redness could be a sign that you are having trouble focusing comfortably. Have your eyes examined to see if you should wear glasses to alleviate near vision stress.
It's not a good idea to use over-the-counter eye drops for red eyes on a regular basis without talking to your eye doctor first. Depending on how often you use them, your body can develop a tolerance to the eye whitening effect of these drops, causing even more redness. Dr. Dubow
Q: What is the influence of TV screens on our eyes? I.V.V., Belgium
A: None, but television can rot your brains... be careful out there! Dr. Dubow
Q: Is it possible to change the color of one's eyes (or at least accentuate their color) sans using contact lenses? For example, my eyes are predominantly green, but there is a ring of brown immediately around the pupil; the brown dominates the green. Is there any way to emphasize the green color and de-emphasize (or even completely remove) the brown color without using colored contact lenses? Thank you for your time. B.O., Florida
A: Nope. Dr. Dubow
[Read more about color contact lenses.]
Q: What is microcornea? An ophthalmologist after checking my baby daughter born in February has mentioned this in the report for both the eyes. I am deeply worried. Could you help please? R.S., India
A: Microcornea is a cornea with a smaller than average diameter (less than 11mm). These corneas tend to be a bit steeper than normal and, therefore, produce myopia (nearsightedness). It can occur as a part of other congenital abnormalities, including the rubella (German measles) syndrome. If the corneas are not opaque, then treatment is usually not necessary, except to eventually correct the nearsightedness. You should ask your ophthalmologist whether treatment is necessary for your child, if only to put your mind at ease. Dr. Slonim
Q: What can I do for excessively dry eyelids? They are cracking open. Also, I am experiencing a good bit of puffiness under my eyes. J.W., Georgia
A: Cracking eyelids can be a sign of a staphylococcal blepharitis (inflammation of the eyelids), especially when the cracking occurs at the outer corners of the eyelids. If the cracking is really scaling, this could represent a type of psoriasis of the skin of the eyelids. If it is just dryness, try an eyelid moisturizing cream found at a makeup counter. If none of this describes the condition, see your eye care practitioner. Dr. Slonim
Q: The optic nerve behind my right eye is a pale pink in color; the eye doctor told me part of the nerve is not functioning. Can this be corrected, and how? My vision is getting worse as time goes on. My peripheral vision in my left eye is good, but in my right eye, not so good. R.H., Florida
A: There are many reasons why the optic nerve may be damaged. If the damage is due to an acute process, then treating the primary disease (such as glaucoma) will many times reverse the damage. If the damage is due to a degenerative disease, then the damage may not be reversible. Peripheral visual field loss is commonly associated with glaucoma. Dr. Slonim
Q: Do people dream in color? Erik, West Virginia
A: Yes. Dr. Dubow
Q: I have retinitis pigmentosa. My question is, are there any forms of eyewear that could help with my peripheral vision? Also, does vitamin A palmitate help to slow down the loss of vision? J.C., British Columbia, Canada
A: The use of high-dose vitamin A is still somewhat controversial. There are no forms of eyewear that I am aware of to improve the peripheral vision in RP. Dr. Slonim
Q: My daughter is one year old and has one pupil that is larger than the other. What is the cause? Her doctor says it should become normal. J.G., Pennsylvania
A: Approximately 10 percent of people have different-sized pupils (anisocoria). There are tests to rule out certain causes of an anisocoria. These tests usually involve the use of drops. Sometimes the abnormality is not the larger pupil but the smaller one. Without knowing the cause, I can't say whether it will eventually become normal. Dr. Slonim
Q: Why does the optic lens project an upside down image? N.M., California
A: Because the retina perceives the upside down image and turns it right side up in the brain. Just think, if the retina flipped a right side up image upside down, you'd feel like you were walking on the ceiling! Confused? Me too!
Actually, the crystalline lens, which is just behind the pupil, is so strong that it focuses images upside down. The brain then turns the images right side up. Dr. Dubow
Q: Does the eyeball have blood in it? P.A., Florida
A: The eye has a blood supply through a normal series of ophthalmic arteries, veins, and capillaries. However, the eye itself doesn't contain blood outside of the vessels. Dr. Slonim
[See also: our detailed diagram of eye anatomy.]
Q: Can the eyes' muscle move the eyeballs to the opposite direction I mean to the left and to the right at the same time? If yes, can the muscle be injured? Adi, Israel
A: I had a classmate in optometry school who could move his eyes independently in and out. It was really freaky! No, this will not hurt the eye muscles but it's good for a laugh! Dr. Dubow
Q: When I leave the house I can't see for a few minutes. It's like when you come out of the movies. Is there anything I can do? H.S., Florida
A: There are certain types of dark-to-light adaptation conditions that can make this sort of transition visually disturbing. It can occur from light to dark as well. There are certain neuro-ophthalmological tests to determine these conditions. You might try to find a neuro-ophthalmologist in your area and relate your problems to him or her. Dr. Slonim
Q: I am a paramedic student and remember an ophthalmologist telling me that one can now look into an eye and get very close to the right prescription for corrective lenses. This would obviously be useful with children or people that cannot communicate verbally.
After studying the eye, it is not clear what a doctor would be looking at the focal length (tough), the shape of the lens, etc. I would appreciate your thoughts. C.R.S., Idaho
A: What we call retinoscopy, which allows us to come up with a pretty close prescription, has been around for more than 100 years. In fact, there are now computerized retinoscopes that can take a reading in seconds!
Retinoscopy uses the reflection of light bounced off the retina through the eye's optics to measure farsightedness, nearsightedness and astigmatism. This is done by looking at the reflection in the pupil. And, in fact, you are correct: it is focal length that is being measured. Good going! Dr. Dubow
Q: I have been wearing prescription colored contacts for three years, and recently I heard that there was a surgery able to change your color of your eyes. I've considered surgery because I have astigmatism and have trouble seeing. G.G., Illinois
A: I know of no surgery that changes eye color. The color of your eyes is determined by the pigment in your iris, which is a muscle surrounding the pupil. The iris muscle opens and closes the pupil in reaction to how much light is hitting the eyes. What's wrong with colored contacts? They can be fun! And there are brands that correct astigmatism as well. Dr. Dubow
Q: I am concerned about my boyfriend's condition, for he has been seeing blinking dark spots in the sides of his eyes. I have heard these are called floaters. He does work on computers almost all hours of the day, but today he had great trouble seeing out of his right eye. He has also had problems with even keeping his eyes open at times, and frequent head- and neck aches. He went to the hospital, and they said for him not to drive or work or do anything strenuous to his eyes, but they think it could be retina damage. Do you have any advice or suggestions as to what it might be? Sarah, New York
A: Certainly sounds like vitreous floaters, which are small floating particles of vitreous gel (gel inside the back of the eye) that are floating in the liquid portion of the eye (the gel liquefies over time). He needs a complete eye examination to rule out any other possible problems. Dr. Slonim
Q: I have wavy lines in the upper part of my eye part time, which make me dizzy and sick to my stomach. Could this be serious? B.C., Indiana
A: Wavy lines can represent a number of different visual phenomena. They may represent vitreous floaters (floating particles of the gel portion of the eye within the liquid portion of the eye). They may represent an irregularity within or in front of the retina. They could also be a part of an ocular migraine, which is a vascular phenomenon not necessarily associated with migraine headaches. Dr. Slonim
Last week I experienced an ocular migraine, diagnosed after a stroke/TIA were ruled out. I had no headache associated with my symptoms of a blind spot with a jagged edge on one side that flashed. It lasted for 30 minutes.
I had been exposed to a strobe light two days beforehand. Could this have precipitated my optical migraine? G.D.
A: There are various ways of classifying headaches and specifically migraine headaches. Migraines without aura (common migraine) are by far the more common type of migraine. Migraines with typical aura (classic migraine) are much less common.
The visual auras may be in the form of flashes (zigzag lights), blurred vision or visual field defects, which can last from 15 to 50 minutes and precede the migraines. Typical aura without headache (acephalgic migraine) consists of visual or sensory symptoms without a subsequent headache.
There may be numerous associations or precipitating factors, such as foods containing tyramine or phenylalanine (red wines, chocolate, cashew nuts, aged cheese, etc.), nitrites, nitrates, monosodium glutamate, alcohol, fatigue, stress, bright lights, birth control or hormonal pills and hormonal changes as in menopause. Many other factors may precipitate migraines as well.
A change in the pattern of migraine may well require a neurological consultation.
Migraines may be precipitated by a source of light pulsing at a certain rate. Fluorescent lights may cycle at a rate that can cause migraine. Strobe lights may cause migraines or even seizures. In 1997 in Japan a TV cartoon broadcast that had a strobe effect caused hundreds of seizures in viewers.
However, the migraine side effect of these light sources is usually around the time of exposure and not so delayed as to be noticed several days later, as you mentioned in your question. Dr. Jovkar
Q: Sometimes during the day I have a throbbing feeling behind my left eye. Can you tell me what that means? P.S., New York
A: The most common cause of intermittent throbbing behind the eye is probably sinus-related. Also, it is always wise to have the pressure in your eyes checked out to rule out glaucoma. Dr. Slonim
Q: I wear contacts, and I am very nearsighted. Recently I got new ones. Some days I see perfectly, and other days I have very blurred vision for most of the day. I am 40 years old and do not spend much time looking at anything close up or intently. Do you have any ideas as to what may be causing the blurriness? M.A., Tennessee
A: I love playing detective, but this is a tough one there are so many things that could be happening here. You didn't say whether you wear soft or RGP contact lenses. That makes a big difference. Off the top of my head, you should think about dryness, lid problems, lens quality, medication usage, allergies or lens care problems. Go back to your eye care practitioner he or she can sort this out for you. Dr. Dubow
Q: Is there any new information on recurring uveitis? Are there any dietary/supplement or other care aspects that might help speed recovery or prevent relapse? M.U., Vermont
A: I am not aware of any dietary supplements for chronic uveitis. There is some fascinating research on the horizon that involves inserting time-release, steroid-containing implants into the eye to prevent and treat this condition. Dr. Slonim
Q: What are the chances of recovering 20/40 or better far vision after macular hole surgery? D.J., Texas
A: Depends on how early the macular hole was found and how big the hole is. 20/40 is considered a great surgical result. Dr. Slonim
Q: When I was young I was diagnosed with a disorder called Thygeson's. This was followed by my ophthalmologist, mainly by touching dye onto my sclera and noting "infiltrates." I was treated with short courses of prednisolone as well (drops). I was also told this would prevent me from wearing contacts in the future and have been fearful of trying them in lieu of my eyeglasses. Is there such a disorder, as now I seem to have no problems (and have not seen an ophthalmologist for many years... I'm 27). Need I be fearful of contact lenses? P.R., Illinois
A: Thygeson's keratitis represents an immune reaction in the cornea. The etiology is unknown, as is the triggering mechanism. Contact lenses can cause a flare-up, and some docs will not allow patients to wear lenses as a result. Some docs will allow patients to wear daily wear lenses and see if it creates frequent flare-ups. The treatment is, as you mentioned, steroids. Dr. Slonim
Q: I was born with Duane's Syndrome. My left eye cannot move to the left. I also have an astigmatism in both eyes. Can LASIK surgery help? My right eye seems to be taking up the slack for the weakness in my left eye. Linda, Texas
A: Duane's Retraction Syndrome, as you pointed out, prevents your left eye from moving to the left. You don't say if both your eyes can be corrected to 20/20 vision. LASIK would probably help you see 20/20 if you are capable of doing so, but it would not help you with the Duane's Syndrome. By the way, it is very common for a "good" eye to help compensate for a "bad" eye. Dr. Dubow
Q: My contact lens prescription is -9.00. Is that the same as saying my vision is 20/900? J.T., Minnesota
A: Your estimate is probably pretty close. A person's visual acuity can also vary with the amount of astigmatism, the pupil size and other individual variables. By the way, 20/900 means that what an average person sees at 900 feet, you'd have to move to 20 feet to see it at the same clarity! Dr. Dubow
Q: I have a key-hole shaped pupil. I've had this since birth. What causes this, and should it affect my vision? Also, would this affect my chances of getting laser surgery to correct my vision? M.K., North Carolina
A: Sounds like an iris coloboma. It is simply a congenital defect where the iris didn't close all the way at birth. Typically it's harmless. It is not a contraindication to laser vision correction surgery, but it depends on the size of the coloboma and on the surgeon. Dr. Slonim
Q: For six to eight months now, my vision in my right eye has become increasingly worse, especially when night driving. Approximately two to five times a week it acts up as if there is something in it; turns red; waters; feels irritated; and sometimes gets a stringy-like substance inside the upper and lower lid. Yet five minutes later it feels fine and the redness goes away.
I assumed the redness, etc., is allergies, but the stringy substance seems more like thin layers of my eyeball rather than pus. (I have had pink eye before, and it's not the same at all.)
And with my vision getting worse mainly just in that eye, I am very sensitive to lights when I am driving at night, so much in fact, I am afraid to drive after dark most of the time.
What could this be? I am asking you because I have no money to really spare on an eye exam if it is not potentially serious. T.L., Arizona
A: Difficult to say without an exam. Contact EyeCare America, a public service program of the Foundation of the American Academy of Ophthalmology, regarding a free eye exam by participating ophthalmologists. In allergic conjunctivitis there can be an increase in mucous secretions, which may be what you are describing. Dr. Slonim
[See also: free eye exams and eyeglasses for qualifying individuals.]
Q: Have you ever seen an eye that has an arc of white at the top quarter of the iris? Is this a sign of early cataracts? C.S., New Jersey
A: This is called arcus senilis and represents a benign degenerative change in the periphery of the cornea and is not related to the iris. It has nothing to do with a cataract. Dr. Slonim
Q. A friend of mine has brown eyes. Lately he has developed a kind of gray ring around the outer pupil. What is it? Thank you. J.
A. That ring is called arcus senilis. It is commonly found in the elderly and represents a lipid deposition in the periphery of the cornea. It is totally harmless and of no clinical significance. Patients with familial hypercholesterolemia (high cholesterol) have a higher incidence of arcus senilis. Dr. Slonim
Q: I was recently diagnosed with keratitis. Can you give me more information on this? L.K., United States
A: Keratitis is an inflammation of the cornea (clear portion in the front of the eye). It can be caused by an infection (bacterial, fungus, viral, parasite, etc.) or a non-infectious agent (e.g., certain types of auto-immune diseases are associated with a variety of non-infectious keratitises). Dr. Slonim
Q: I was born deaf due to maternal rubella. I was told that my iris color has flaked off because of the disease. I would like to know more information on that. C.E.M., Georgia
A: Typically rubella causes a retinitis (inflammation of the retina) with a "salt-and-pepper" appearance in the retina, which represents a mottling of the retinal pigment epithelium (pigmented layer below the retina). This condition may not affect vision at all. I am unaware of iris color changes as a result of rubella. Dr. Slonim
Q: Is there a remedy for a stye? Jerry, Canada
A: Best remedy for a stye is a warm wet compress. Dr. Slonim
Q: My left eye has what looks like two bumps filled with pus on the inner side of the eyelid. On the outside, I can easily feel the bumps. I have no irritation, nor do they hurt in any way. My right eye has one very little bump, almost like a pimple but with no pain. My vision is fine other than my left eyelid being swollen. M.R.
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A: Your first step is to see an eye care professional for a complete exam. I have not had the opportunity to examine you, so I can provide only general information. One common condition that can appear as "bumps" are chalazia, which are essentially clogged oil glands. These can be uncomfortable, but they also can be painless. A chalazion does not typically affect vision. Please see your doctor to confirm this diagnosis. Once the condition is confirmed, your doctor should be able to recommend some excellent treatment options. Dr. Trattler
Q: Are there studies available on scintillating scotoma and aging? Is it primarily neurological or vascular? Who specializes in this area of eye care? F.S., New York
A: I am unaware of any study relating scintillating scotoma with aging. The phenomenon can be both neurological and/or vascular. Look for a neuro-ophthalmologist who specializes in this area. Dr. Slonim
Q: My eyes are allergic to cats and dogs. Is there any chance to change that? Sonya, Texas
A: To the best of my knowledge, there is no way to cure eye allergies. However, there are some very good eye allergy drops that can be prescribed to help you control the problem. See your optometrist or ophthalmologist. Dr. Dubow
Q: I was born with a condition called nystagmus. My eyes involuntarily move back and forth. I rarely notice it, but sometimes it makes it difficult to read. Are there any treatments or suggestions that can help with this? Could I be a candidate for a LASIK type surgery for nearsightedness? S.M., Texas
A: One of my best friends has nystagmus, which is typically a back and forth jerkiness of the eyes that hinders clarity of vision and one's ability to focus. Nystagmus is neurologically based, and to the best of my knowledge, there are no effective treatments for it.
Many people with nystagmus have a null position, which is usually achieved by turning your head and looking to the side, which sort of pins the eyes into the corners of their sockets and lessens their movement.
I have found that prescribing contact lenses for patients with nystagmus can help with their vision, because rather than panning back and forth over the optical centers of their prescription, they are always looking through the lens centers when the contacts move with their eyes.
I imagine there might be some eye surgeons willing to immobilize the eyes of a nystagmic patient to perform refractive surgery, but I don't recommend it. The surgery would not help the nystagmus at all, and the risks are too great, in my opinion. Dr. Dubow
Q: I have an eye disease called juvenile X-linked retinoschisis, plus congenital horizontal nystagmus. Could you give me any information on it? R.R., Ontario, Canada
A: Retinoschisis is a splitting of the internal layers of the retina. The disease juvenile X-linked retinoschisis refers to a condition that is hereditary and usually presents with decreased vision during the first decade of life. Frequently the splitting of the retinal layers occurs in the central retina (foveal area) and also in the periphery.
A nystagmus is a rhythmic (sometimes jerky) movement of the eyes. Congenital horizontal nystagmus refers to a movement which is in the horizontal plane (to the left and right) that is present at birth or found very early in life. Dr. Slonim
Q: What is myopia? L.K., Washington
A: Myopia is our fancy, scientific name for nearsightedness. Nearsightedness is when a person sees better at near than at far in other words, faraway objects are blurry.
In today's world, nearsightedness is the most common vision disorder we diagnose. And if one or both parents are nearsighted, their children have a much greater chance of being nearsighted. Most nearsighted people have eyeballs that are too long, so entering light focuses in front of the retina. Corrective lenses refocus the light back to the retina. This can easily be accomplished with glasses or contact lenses.
Some people feel that their nearsightedness gets worse if they wear a correction. This is not true in most cases, but some folks who don't focus up close very well can read much more comfortably without their nearsightedness correction. Dr. Dubow
Q: Many times I have this double vision experience. The only way to eliminate this is to cover up one eye and then it is gone. I almost feel a sort of dizzy feeling when this happens. Laurie, Indiana
A: Diplopia (double vision) can present as a symptom for a number of ophthalmic and neurologic conditions. You need to see an ophthalmologist or your primary care physician to rule out these conditions and find out what is truly causing your double vision. Dr. Slonim
Q: I have worn soft contact lenses on and off for 15 years, and I chronically have red, bloodshot eyes. I've gone for periods of weeks and months wearing only my glasses and avoiding contacts, but honestly my eyes seem less bloodshot when I wear my contacts.
What can I do to clear up my eyes so they are not bloodshot? And does the fact they are chronically bloodshot indicate any eye health problems or disease? M.A., Georgia
A: The known causes of red eyes take up volumes in the ophthalmic literature. It sounds like you need to obtain a diagnosis for your condition so that the appropriate treatment can be prescribed.
Allergies and dry eye syndrome are probably the two most common causes of red eyes. Wearing contact lenses on top of an already inflamed eye can only lead to further problems. A thorough examination to determine the etiology of your bloodshot eyes is needed. Dr. Slonim
Q: About four years ago I had a light stroke. I have since recovered except for my vision. My vision is completely blank in the right side of both eyes. Is there any treatment or special glasses for this problem? Unable to get any encouragement locally. W.D., South Carolina
A: I'm sorry to hear about your stroke. Unfortunately, it is extremely unlikely your vision will return. You have what we call a bilateral hemianopsia half your visual field is missing. I recommend you see a specialist in low vision who can possibly prescribe glasses with prism to help expand your remaining visual field. You can call your state optometric association to find a low vision specialist near you. Dr. Dubow
Q: Can we classify those with 20/70 best corrected visual acuity under low vision, even without ocular pathology and history of refractive error? A.R., Philippines
A: Yes, 20/70 would be classified as low vision. However, in most of the United States, you must have 20/200 best-corrected visual acuity to be classified as legally blind. Dr. Dubow
Q: What is my condition? From overuse of contact wear, I was told by an eye doctor that my blood vessels are growing into the color of my eyes (behind the color). The employees who work at the vision centre would not prescribe contacts for me again. What should I be expecting to happen within the next few years? T.R., Ontario, Canada
A: When a contact lens is overworn we find that the cornea has been starved for oxygen during overnight wear. This oxygen deprivation stimulates the growth of new blood vessels (neovascularization) from the conjunctiva (the membrane that covers the white of the eye) to grow into the cornea where blood vessels typically don't exist. The farther into the cornea they grow, the more problematic they can be.
When the contact lens wear is stopped, the blood vessel growth stops. The vessels themselves remain, though the blood within them may disappear (referred to as ghost vessels).
Depending on the severity of this neovascularization, resuming contact lens wear may not be possible. Sometimes returning to daily wearing of soft lenses with a higher oxygen permeable lens material, such as silicone hydrogel contact lenses, or wearing rigid gas permeable contacts is an option. Dr. Slonim
Q: I am 58 years old. My last examination showed my eyesight has improved dramatically. What would be the reason for this? B.C., Virginia
A: You don't say if you are nearsighted or farsighted. If you are nearsighted, it is really common for nearsightedness to decrease (get better) in the 50s and 60s. If you are farsighted, there are several medical conditions that can cause a dramatic decrease in prescription, including cataracts and diabetes. Please ask your eye doctor to explain why your eyes changed in this manner. It's probably normal aging (what an awful concept!). Dr. Dubow
Q: My left eye is seeing straight lines as wavy. The vision in that eye also tends to have blind spots come in and out, like things are morphing. What is this condition, and is there a treatment for it? R.Z., California
A: If straight lines are wavy, then you need to see an ophthalmologist (probably a retinal specialist) to rule out a problem in your macula or other ocular structures. Dr. Slonim
Q: On one of my eyes I have a yellow spot approximately 3/16" in diameter. I was told it was a cowlas(?) from wind and cold air, I can feel it after a long day. What is it, and should I worry about it? Ron, Kansas
A: What you have is probably a pinguecula, which is a fatty deposit that occurs on either side of the colored part of the eye on the white part of the eye, due to wind, sun, dust, dryness, etc.
Pingueculas are harmless but can become irritated, red and sore. They can occasionally grow over the colored part of the eye into the cornea (the clear window-glass covering of the eye).
You can help protect your eyes and decrease irritation by wearing good-quality, wraparound sunglasses and a hat with a brim. If your pingueculas become irritated and sore, use a lubricating eye drop. If the soreness doesn't go away, or if they begin to grow into your cornea, see your eye doctor right away. Dr. Dubow
Q: I was once diagnosed with an eye condition and can't remember the name. I was told that the nickname was "farmer's disease." I have "pimple-like" bumps on the white part of my eye. Do you know the correct term for this condition? T.D., New Mexico
A: I'm not familiar with "farmer's disease," but it sounds like you have pingueculae. These are degenerative changes in the conjunctiva (membrane over the white of the eye called the sclera). Dr. Slonim
Q: Today I went to see a doctor about a mass on my eye. She said that I have pingueculae. She also said that I have a star-shaped cataract on my eye. I am only 30. Are these two things related? Is this something that may progress quickly? L.
A: A pinguecula is a harmless, degenerative change of the conjunctiva located on the surface of your eye. A cataract is an opacification in the lens inside your eye. The two are not related. Typically, both are slowly progressive, although some varieties of cataracts can progress rapidly. Dr. Slonim
Q: Why do you not tell people that simple exercises can restore their sight in many circumstances? The Chinese do! Kendra, Massachusetts
A: If this were true, all of us eye doctors would be selling simple exercise programs instead of glasses or contacts. Eye exercises are useful in treating some vision conditions and in improving visual performance (athletes, for instance, can benefit from sports vision training). Unfortunately, they are not a cure for most common vision problems. Dr. Dubow
Q: If I look cross-eyed for too long, will my eyes get stuck that way? M.L., Minnesota
A: According to my mother, yes. But according to my optometry school professors, no. In fact, eye doctors sometimes prescribe exercises that force a patient to cross his or her eyes to teach them to work together better.
When you cross your eyes, you probably see double. This is normal as well, and will not hurt you. But just think... two mothers? Ah well, one can never have too much of a good thing! Dr. Dubow
Q: Years ago, while testing for an FAA 2nd class medical certificate, I was diagnosed with exophoria, not quite bad enough to disqualify me. The diagnostic test involved looking into an instrument and seeing a vertical line superimposed on a horizontal scale from -10 to +10. I saw the bar at about +5. There was a similar test with a vertical scale, but I saw that one centered at zero. I took the test after coming off a midnight shift and was told the condition gets worse as you get tired, and improves after sleep. I have often had a little difficulty determining how many similar characters are in a horizontal line of text for example, how many zeroes in 34700091, but if I turn it vertically, it's a snap. That does indeed get worse with fatigue. I assume this is a manifestation of my condition. What can you tell me about it? S.D., Kentucky
A: A phoria is a tendency for the eyes to not work perfectly together. Exophoria means your eyes tend to turn out and away from each other, especially when you are tired or stressed. Esophoria would mean your eyes would tend to turn in and toward each other. Phorias can be dealt with by including prism in your glasses prescription or by having vision therapy to teach your eyes to work better together. Sometimes simple home exercises can help control an exophoria. Turning a line of numbers vertically simply allows your eyes to work better together... unless you have a vertical phoria! For more information on vision therapy for phorias, contact the College of Optometrists in Vision Development. Dr. Dubow
Q: My right eye is much weaker than my left eye. Is it very important for me to wear glasses? N.D.P., Canada
A: I tell my patients that it is probable the weak eye will allow the stronger eye to take control of the vision system. This may cause the weak eye to begin shutting itself off in the brain we call this suppression. If you believe that two eyes are better than one, you don't want this to happen.
Although small, there is a risk that the weaker eye will develop an amblyopia (lazy eye) or a strabismus (turned eye). And, if the weaker eye loses its ability to see clearly and the stronger eye develops a problem, you could be stuck with an eye that doesn't see well.
My recommendation to my patients is to try to make both eyes see as well as they can both individually and together. Dr. Dubow
Q: What is accommodative spasm disorder, and is there a treatment for it? R.A., Oregon
A: Accommodation is when your eyes increase their focusing effort to see near objects clearly. In other words, when you look from far away to up close, you accommodate.
An accommodative spasm is when your focusing muscles basically develop a charley horse, or get a cramp. This happens when your vision system doesn't work smoothly and comfortably, especially when you get tired or stressed. Some people get tired and stressed very quickly, while others can work for quite a while before this happens.
An accommodative spasm can cause tiredness, dizziness, headache, nausea, distance blurriness, near blurriness, difficulty in understanding what you read, and even double vision.
We treat this disorder with glasses, contact lenses, eye exercises or a combination of these things. The goal is to help you function better with fewer symptoms. Sometimes we even prescribe a bifocal-type lens to help you focus without so much strain... even if you are under 40! Dr. Dubow
Q: How does age affect vision? I've noticed as I grow older my sight is getting worse. How often should a person get an eye exam? C.D., Louisiana
A: Being 50, I can attest to the fact that the eyes do change with age! They actually change in a number of ways.
The most obvious change usually happens between the ages of 40 and 50 when we lose our ability to focus on near things. This is called presbyopia, and it happens to all of us at some time. Progressive lenses certainly are a wonderful invention to those of us in this category!
There are other changes as well:
- The liquid that fills the eyes (vitreous) changes in color and density, causing our vision to dim and colors to appear less bright.
- Our tears change, causing many of us to have dry eye problems.
- The skin around the eyes loosens, causing some droopiness.
- The pupils get smaller and don't move as fast, making it more difficult to adjust to lighting changes.
Sounds grim, huh? Well, in truth, most people do just fine with these changes.
The important thing is to have your eyes checked yearly to watch for diseases that can cause real problems with your vision (and your health), such as diabetes, high blood pressure, macular degeneration and glaucoma. Dr. Dubow
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Q: If I look straight ahead, close my left eye while viewing a scene with my right, then reverse the procedure, the scene appears to "jump" across to the right and downwards slightly. I'm 55, I use 1.75 glasses for reading only, I do a fair amount of computer work, but as far as I am able to discern, my vision appears to be okay. Looking forward to your comments as soon as you are able to process them. G.N., Australia
A: When covering one eye and then the other eye, it is normal for the image to move. Each eye is in a different physical location (unless you are a cyclops!) and therefore sees a totally different picture. This is actually why we have depth perception.
An image that moves vertically may indicate that you have a vertical imbalance, which is where one eye has a tendency to pull upward and the other eye has a tendency to pull downward. This can cause some vision symptoms, such as headaches, fatigue, etc. A thorough eye exam can discover whether or not you have this condition, which is quite common, and prism in your glasses can help relieve the symptoms it causes. Dr. Dubow
Q: About 12 years ago I had a corneal ulcer. I wore contact lenses at the time. Is there a type or brand of contact lenses that I may be able to wear? C.D., Ohio
A: Contact lenses have changed tremendously in the past 12 years. I don't know about your specific case, but many patients who have had corneal problems in the past can now wear contacts safely and successfully. Go see a contact lens specialist for more detailed information. Dr. Dubow
Q: What causes one eye to feel like it, or the eyelid, is twitching? It has been frequent recently. Dorothy, Ohio
A: I've had this problem myself in the past. Weird, huh? You feel like everyone can see the twitch and is staring at you.
An eye twitch, or tic, is caused by a nerve in the face not the eye. It is very often a response to stress or some other stimulus. Twitches usually go away on their own, but persistent tics can be treated by injecting botulism toxin (the brand name is Botox) into the offending muscle. Dr. Dubow
Q: What is congenital ptosis? L.J., New York
A: Congenital ptosis is when you are born with a drooping eyelid. This can usually be corrected by having plastic surgery to raise the lid. It is really important to see a surgeon who has done a number of these procedures and does not overdo the correction, which can cause the eye to become dry and damaged.
Your eye doctor can help you take care of this problem. Dr. Dubow
Q: My blepharitis is still bad, even though I wash my lids with a baby shampoo-soaked cotton ball twice a day, in addition to carefully washing my face at least twice a day and using daily throw-away contact lenses. Is there anything else I could do to stop this condition? Would LASIK surgery reduce its effect? Thanks. C.M., Rhode Island
A: Blepharitis is typically caused by having too many staph bacteria on your lid margins and in your lashes. Everyone has some staph, but too many is a problem. Lid hygiene procedures can help control the amount of staph you have, but they sometimes aren't enough. You may have to see your eye doctor for a prescription for antibiotics. These may be in the form of eye drops, oral pills, or both.
But don't stop your lid scrubs once the amount of staph is reduced, they will work to keep the condition under control. Also, when washing your face, use an antibacterial soap. Cream soaps and soaps with emollients and/or scents are not real useful against staph.
It is best to get your blepharitis under control before having LASIK. Dr. Dubow
Q: How can I improve my night vision? Jamie, Montana
A: Good night vision is partly hereditary. But you can do several things to have better night vision.
First of all, make sure you have your eyes checked on a regular basis (I recommend yearly), and wear your distance prescription at night. People tend to be more nearsighted at night because there is very little to focus on far away, so your glasses or contact lenses actually do more for your vision at night than during the day.
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Second, if you wear glasses, make sure you have an anti-reflective coating on your lenses. This helps cut down on glare and really improves your ability to see at night.
Third, eat a good diet with lots of fruits and vegetables. Even though your mom always told you to do this, it is not a myth! A good diet can help you see better. And carrots are not the only food that you should think about. Current research shows that dark green leafy vegetables, like spinach, kale, or collard greens, are very helpful in maintaining healthy eyes and good vision. Dr. Dubow
Q: Is it alright to read in dim light, or will this harm my vision in the future? My father thinks this practice is harmful, but I don't see how this can harm my vision. R.T., Canada
A: You and your dad are both right. How's that for diplomacy?
Reading in dim light does not actually harm your eyes. But, it can lead to your eyes becoming more nearsighted. Nearsightedness is a result of both nature and nurture this means that it is partly inherited and partly caused by how you use your eyes. A lot of near eye strain does tend to lead to being more nearsighted. So... get a light! Dr. Dubow
Q: The whites of my eyes are not white; they have brown pigmentation or yellow pigmentation to them. Is there something I can do as far as diet or drops to correct this problem? S.S.
A: As far as I know, nothing will help although perhaps improving your diet may do something.
The important thing is, do NOT use eye drops designed to "get the red out" too frequently. Your eyes can develop a tolerance to the eye-whitening agent in these drops, requiring you to use more and more drops to keep your eyes white. They also can cause pupil dilation, possibly making you more sensitive to light.
There are some diseases that can cause discolored scleras (the "white" of the eye), so if this is a recent development, see your eye doctor. Dr. Dubow
Q: After being in the sun all day I am unable to see well for weeks. I then have a problem of having enough light to see well. H.K., Illinois
A: I truly cannot tell you exactly what is happening to cause this problem. My guess is some form of ultraviolet burn, like snow blindness, affecting the sensitive areas of your retinas (the backs of your eyes) that see clear vision. I strongly suggest you see an eye doctor for a thorough evaluation.
Ultraviolet radiation (UV light) can cause permanent and very serious changes that can affect your ability to see clearly for the rest of your life. Readers: I recommend you wear very good sun protection when outside. This means 100 percent UV absorbing, optically ground lenses. Do NOT stare at the sun. Dr. Dubow
Q: I am 53, but this condition was first noticed when I was 24. My eyes and vision have been very good all my life 20/10 or so to about 20/40 today. At times, maybe twice a year, the center focus area of my vision will become obscured. If I look at an object, a can say, it will vanish. But my peripheral vision will still be intact. This state comes on suddenly, and will gradually dissipate over about 30 minutes. This occurs in an outdoor environment, most frequently when playing golf. There is no pain or discomfort other than watching my ball go awry. Any clue as to what is going on? C.D., Virginia
A: Whew, this is a tough one without actually seeing you. But, let's discuss some possibilities. I assume you are under the care of an eye doctor. Perhaps you could discuss these ideas with him or her for more information.
- Migraine. It is not uncommon for patients to experience a temporary loss of vision without getting a headache. This is called migraine without headache.
- Temporal arteritis. A condition where there is a blockage in the temporal artery due to inflammation, cutting off the blood supply to the eye. Do you have tenderness in your temples when you press on them?
- Hollenhorst plaques. Tiny cholesterol chunks that can float into the arteries in your eyes and get caught, causing a temporary loss of blood flow. These can be a forewarning of a stroke.
- Spastic retinal artery. Perhaps an artery on the back of your eye closes down and reopens, for whatever reason.
Whatever the cause, make sure you are seeing a trusted eye doctor and looking at all the possibilities so as to avoid a catastrophe. Dr. Dubow
A: Let me guess... you are just entering your 40s, right? Your arms are getting too short? This is not farsightedness, it is presbyopia, which means "aging eyes."
Presbyopia affects everyone, yes everyone, between about 40 and 55. The inner parts of the eyes simply lose their ability to focus for near even when you are nearsighted! Of course, nearsighted folks can take their glasses off to read, but this is not usually very convenient. So the answer is to get either glasses or contact lenses that help you read better, like bifocals, trifocals or progressives. Which is better? Keep your eye on this column surely someone will ask that question! Dr. Dubow
Q: What causes color blindness? J.L., Minnesota
A: Rarely is a person totally color-blind. Usually people have trouble recognizing certain colors, like red and green, or lighter shades of a certain colors. We call this a color deficiency.
Color deficiency is a sex-linked female trait, meaning it is passed on in the genes through the mother to her male children. What a dirty trick, huh? Very few women have a color deficiency. No wonder we guys can't pick out our own clothes!
A color deficient person is missing some of the chemicals in the cones of his retina (found in the macula), which are the only cells that see really clear vision and color vision. Color blindness does not cause any loss of visual sharpness, however. Dr. Dubow
Q: Could you give me information on choroidal effusion, iritis, and posterior vitreous separation, please? Thank you very much. I have bilateral IOLs. B.
A: Choroidal effusion is a condition where fluid leaks in the choroid, the layer between the retina and the sclera (white of the eye). Iritis is an inflammation of the iris commonly associated with a number of autoimmune diseases and conditions such as arthritis, lupus etc.
Posterior vitreous separation is where the vitreous gel inside the eye separates from the retina onto which it is intimately attached. This separation is usually harmless as long as the vitreous gel separates "cleanly" away from the retina. It carries a risk of retinal tear or retinal detachments if the vitreous gel tugs on an area of the retina from which it does not want to separate. Dr. Slonim
[Page updated June 2014]
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