Eye Health

Age-Related Macular Degeneration (ARMD or AMD)

Age-Related Macular Degeneration (AMD) is a chronic disease of the central part of the retina, the macula. The macula is important for clear vision and color vision. Any change in the macula will significantly impair vision. AMD is the leading cause of blindness in the Western world.

There are two forms of AMD:

Dry AMD is the most common form of AMD. It occurs when cells in the macula begin to break down, causing thinning of the macula and a gradual decrease in vision. In addition, the retina becomes unable to rid itself of its metabolic waste, called lipofuscin. Lipofuscin accumulates in the retina as drusen, which block the normal function of the retina.

Wet AMD is much less common than dry AMD. It is caused by the growth of abnormal blood vessels in the choroid, which provides the blood supply to the retina. These new blood

vessels grow into the macula through breaks in the membrane that separates the choroid from the retina. These weak blood vessels leak fluid into the retina, leading to a decrease in vision that is more rapid and dramatic than dry AMD. The photo on the right shows an example of significant leakage and bleeding in the macular area and surrounding retina.

Neither dry AMD or wet AMD causes total blindness, but it can decrease central vision profoundly. People with AMD may notice changes in their ability to read books, to see street signs or see details on a person’s face; fortunately they maintain peripheral vision and can walk and move around independently.

Symptoms of AMD:

Gradual or rapid loss of central vision
Distortion of straight lines
Blurry vision when reading
Blind spot in or near the central vision
AMD can be asymptomatic too.

Risk Factors of AMD:

Age
Smoking
Family history of AMD
UV light exposure
Blue light exposure (short wavelength visible light)
Diet high in sugar and refined carbohydrates
Excess weight or obesity
Gender, women are at higher risk than men
Eye color, light colored eyes have a higher risk
Race, caucasians are at a higher risk
Diabetes
Cardiovascular disease

If I see changes in the macula or am concerned about risk factors, I will often recommend taking supplements with specific antioxidants, zinc and omega-3. This is not a replacement for a healthy diet. In fact, consuming the nutrients as whole foods has a beneficial effect on our bodies that a supplement cannot replicate.

Prevention through Diet:

Foods rich in the carotenoids, lutein and zeaxanthin (brightly colored fruits and vegetables and eggs)
Ensure diet is high in vitamin C, vitamin E, beta carotene and zinc
Fish with high levels of omega-3 fatty acids

Non-Diet Actions:

Stop smoking
Wear sunglasses
Engage in physical activity and exercise
Have regular dilated eye examinations

Treatments:

The treatment for dry AMD is diet and lifestyle modification.

Current treatment for wet AMD is injection of anti-VEGF (vaso-endothelial growth factor) which block protein that is responsible for new and abnormal blood vessel growth.The injections slow the progression of damage and slow loss of vision. Repeated injections are necessary. The photo on the left is the same eye pictured above after a year’s worth of treatment. Central vision is significantly compromised, but treatment has protected surrounding tissue. To date the other eye has not needed any treatment but the retinologist and I are monitoring it very closely.

Eye Anatomy

I’m going to give you a tour of the human eye. When I do cow eye dissections for children, I identify structures from the front of the eye to the back of the eye, the same way light goes through the eye.

First and most visible are the eyelids and eyelashes. The eyelashes work like a screen to deflect debris and dust from our eyes. The eyelids provide a barrier to foreign objects. The eyelids also work like windshield wipers to smooth tears across the eye and move debris off of the surface.

The cornea is the clear part of the eye and most sensitive to pain. It is important that the cornea maintain it’s clarity for us to see clearly. If it becomes scratched or scarred, our vision becomes obscured. The cornea is the window to the eye.

The conjunctiva is the white of the eye and the protective covering in the front of the eye. The sclera is the protective layer that covers the whole eye.

Directly behind the cornea is a fluid filled space called the anterior chamber. It is filled with aqueous humor, a watery solution.

The colored part of the eye or the iris is next. It can be different colors depending on the amount of pigmentation. The iris constricts or dilates to decrease or increase the size of the pupil. The pupil is actually a hole or aperture.

The crystalline lens is behind the iris. It adjusts to focus the light before it reaches the retina.

Filling the eyeball between the lens and the retina is a gel-like substance called the vitreous humor. This is where “floaters” are located.

The retina is composed of an intricate nerve layer. It has a super sensitive area called the macula. Most of the cones (photoreceptors) are located in this small area to provide the clearest vision and color vision. All the nerves come together at the optic nerve head. From the optic nerve head in the eye, impulses travel through the optic nerve to the brain.

Your Eyes and Allergies

Your Eyes and Allergies
Your eyes can develop allergic reactions just like your body does. You may experience symptoms such as itching, burning and watering eyes. Here is a look at some of the most common ocular allergies and their symptoms.

Hay Fever or Dust Conjunctivitis
Conjunctivitis is an inflammation of the conjunctiva, the thin, transparent mucous membrane draped over the eye. Conjunctivitis is commonly called “pink eye.” Plant pollen, house dust and animal dander may trigger a reaction in sensitive eyes and people. The reaction usually starts a short time after your exposure, and may include tearing, itching and swelling. Your symptoms may be worse at the end of the day.

Giant Papillary Conjunctivitis
Contact lens wearers know this allergy more commonly as GPC. Among the things that may cause GPC are improper cleaning of contact lenses, infrequent contact lens replacement, and wearing contact lenses for too many hours. You have a greater risk of this allergy if you have asthma, hay fever or animal allergies. GPC may occur months or even years after you begin contact lens wear. GPC’s symptoms are itchy eyes after removing your lenses, mucus discharge in the morning, sensitivity to light and uncomfortable lenses. Your vision may blur due to deposits on the lenses or lens movement caused by tiny allergic bumps (papilla) on the inside of your upper eyelid.

Contact Dermatitis
Allergic contact dermatitis occurs when you come into contact with something that irritates your skin. Your eyelids and conjunctiva are very sensitive. Signs of this reaction include swelling, redness, scaly skin and blistering. Symptoms are itching and pain. The reaction usually develops about 12 to 72 hours after you are exposed.

Recommendations to Reduce Allergic Reactions

Avoid exposure to allergen
Rinse eyes with sterile saline solution
Cold compresses – a couple of ice cubes in a clean washcloth
Maintain contact lens integrity by replacing and cleaning the lenses as prescribe
Reduce irritation with proper eyelid and eyelash hygiene
Control ocular dryness with artificial tear drops, proper hydration and supplement
Begin prescription allergy drops at the first signs of a reaction
If you wear contact lenses, use your allergy drops before inserting your lenses or after you’ve removed them.

Dr. Griffith can help you manage your ocular allergies.

Cataracts

A cataract is a clouding of the lens in your eye that affects vision. Most cataracts are related to aging. To understand how a cataract can affect your vision, it helps to understand a little about the structure of your eye. The lens is clear and lies between the iris and the pupil. It works much like a camera lens, focusing light, or an image, onto the retina. The retina is the light-sensitive tissue at the back of the eye. Once the light or image reaches the retina, it is changed into nerve signals that are sent to the brain. Besides focusing light on the retina the lens also adjusts the eye’s focus, letting us see things clearly both up close and far away. The lens must be clear for the retina to receive a sharp image. The lens is made of mostly water and protein. The protein is arranged in a precise way that allows light to pass through it without distortion. But as we age, proteins in the lens clump together and darken, causing a cataract. If the lens is cloudy from a cataract, the image you see will be blurred and colors may appear faded.

How is the cataract removed?

A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. The surgeon inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called “small incision cataract surgery.”

After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL into the retina, improving your vision. You will not feel or see the new lens. Depending on your vision and needs, you may be a candidate for a special type of IOL that either corrects astigmatism or acts like a bifocal.

Cataract removal is one of the most common operations performed in the United States. It is also one of the safest and most effective types of surgery. In about 90 percent of case, people who have cataract surgery have better vision afterward.

Computer Vision

Adults are exposed to screens – TVs, cell phones, computers, etc – for nearly 8 1/2 hours on any given day. And children, 8 to 18 years old can spend 7 1/2 hours a day using smart phones, computers, TV or some other electronic device. Is it any wonder so many of us suffer from visual stress?

According to the American Optometric Association, Computer Vision Syndrome (CVS) consists of blurred vision, dry eyes, eyestrain, headaches, double vision, color distortion, light sensitivity and neck, should and back pain due to prolonged computer use. These symptoms have been associated with poor digital display lighting, display glare, poor seating posture, improper viewing distances from one’s face to the digital display and uncorrected vision problems, such as hyperopia, astigmatism and inadequate eye focusing. In addition, presbyopia, due to its accommodative issues, can contribute to CVS symptoms as well. Those at greatest risk for developing CVS are those who generally use a computer three or more continuous hours daily. CVS occurs because computer work challenges the visual system in the following ways:

The letters on a computer display are often not as precise or sharply defined as a printed letter.
The level of contrast of the letters to the background on the display is decreased.
A digital display often has glare and reflections, challenging one’s view.
The viewing distances and angles associated with using a computer require certain focusing and eye movement needs.

As a result of the aforementioned causes, computer users who already wear spectacles or contact lenses may find they are not helpful. For instance, the spectacle wearer may tilt his head at an odd angle because his lenses aren’t designed for viewing a digital display. Or he may bend toward the display to achieve clarity. These body positions can cause muscle or neck, shoulder and back pain.

If you are 40 years of age or older, the stress of viewing a computer screen is probably compounded by presbyopia: your eyes no longer accommodate, or focus, to read. (You may have noticed that your arms seem shorter.) Bifocals are often prescribed between the ages of 40 and 50, to allow you to see a distant object and also focus downward and close-up.

For someone who spends more than a couple of hours a day in front of a computer screen, a pair of glasses designed specifically for that task is the best solution. Do you wear cleats for golf? Flip-flops at the beach? Old tennis shoes to wash the dog? Do you have special shoes for special events? One pair of shoes can not fill every need; a single pair of glasses does not either.

A lens designed especially for the computer is recommended. It may be a single vision lens or a specifically designed multifocal.

For some computer users, CVS symptoms are temporary and abate once ceasing computer work. If the symptoms aren’t addressed, they can continue and may worsen upon further computer use.

Ways to alleviate eyestrain from computer use:

Adjust your environment so the room isn’t as bright
Lower your monitor so you are looking downward
Increase awareness of your blinking. Blink more frequently to keep vision clear and eyes moist.
Wear appropriate visual correction. A small prescription can have a large impact on your eyes with visually demanding computer work.

Diabetic Eye Disease

Diabetic Eye Disease
True or False? People who have good control of their diabetes are not at risk for diabetic eye disease.
True or False? Diabetic eye disease usually has early warning signs.
True or False? Cataracts are common among people with diabetes.

Complications from diabetes can affect many systems in the body, such as the heart and kidneys. Diabetes-related eye diseases can also affect vision. Diabetic retinopathy accounts for 12 % of all new cases of blindness each year for people between 20 and 74 years of age. While there are other eye complications associated with diabetes, we address diabetic retinopathy here because patients are not often aware of it until quite late in its progression.
In diabetic retinopathy the blood vessels in the back of the eye leak fluid or blood, which seeps into the retina and causes it to swell. Retinal blood vessels may also close, preventing blood and nutrients from reaching areas of the retina. This causes those areas to die. New blood vessels may grow to compensate for the closed blood vessels, but they always bleed and create scarring. The scarring may even cause the retina to detach or wrinkle.
Early detection and appropriate treatment significantly reduces the risk of vision loss from diabetic retinopathy. Diabetic patients should perform an easy vision test every day to detect subtle changes in their vision. However this is not a complete guarantee that the eyes are healthy. There are usually not obvious symptoms of the disease until the advanced stages. Pain, blurred or shadowy vision, and redness may only occur when treatment is more difficult and less successful. A variety of laser treatments may be used in order to prevent further vision loss.
Not everyone with diabetes develops diabetic retinopathy, but the chances increase after being diabetic for several years. In fact, sometimes the diagnosis of diabetic retinopathy leads to the diagnosis of diabetes. Evidence also suggests that such factors as pregnancy, high blood pressure and smoking may cause diabetic eye disease to develop or worsen.

To help prevent the development of diabetic retinopathy and minimize vision complications:
Take prescribed medications as instructed.
Follow a proper diet
Exercise regularly
Perform a simple visual test daily
Have your eyes examined annually

Answers to quiz:
1. False; good control of blood glucose is very important in over-all management of diabetes, but may not prevent diabetic eye disease. All people with diabetes should have an eye examination through a dilated pupil.
2. False; often there are no early warning signs of diabetic eye disease. Vision may not
change until the disease becomes severe.
3. True; people with diabetes are twice as likely to develop cataracts and to develop them at
an earlier age than those without diabetes.

For a printable version of Diabetic Eye Disease, click here.

Dry Eye Syndrome

Red, gritty and scratchy eyes can have a number of causes and possible treatments. In addition to discomfort and fluctuating vision, dry eyes can lead to styes and infection. At Westside Optometry we consider dry eyes a symptom of ocular surface disease (OSD). Regular eye examinations can prevent complications and provide the opportunity for you to get help with treatment.

If you have ocular surface disease, you may notice discomfort any time of the day. For some people with lack of tear production the eyes are gritty and sore first thing in the morning. For others the symptoms worsen as the day progresses. Air conditioning, smoke, drafts, and cold temperatures become difficult to tolerate. Vision may fluctuate with poor tear quality and prolonged screen time. It may feel like there’s a foreign body in your eye, or your eyes may have a sandy feeling. You may find that your eyes are watering constantly or that strands of mucous are accumulating in spite of the fact that you are suffering from “dry” eyes.

What’s Going On? Normal tear film consists of three layers: mucin, aqueous, and lipid. Abnormalities in production, content, or distribution of these three layers or in eyelid function will cause the various conditions commonly known as dry eye.

Lipid Problems: These are the most common cause of dry eye. Glands in the eyelid produce lipids. Greasy lotions, incomplete removal of makeup, or skin conditions like dandruff can plug the glands and prevent lipids from secreting.
Aqueous Deficiency: This can be a side effect of certain medications you’re taking. The culprits include antihistamines, diuretics, hormones, and psychotropics.
Mucin Deficiency: Chronic infection or trauma to the eye can cause a lack of mucin. Autoimmune diseases (Sjorgren’s syndrome, Rheumatoid Arthritis and Lupus) negatively effect the mucin layer too.
Eyelid Problems: The eyelid may turn in or out as a result of the aging process or of scarring. Tears then spill over the eyelid, allowing the eye to become dry. Depending on the severity of the situation, this problem may need plastic surgery to repair the eyelids.
Acne Rosacea can negatively effect the eyelids and tear quality in more than 20% of Rosacea sufferers.

Also, ocular surface disease can be aggravated by inflammation of the eyelid margin due to poor blinking, excessive make-up and blepharitis. In this case, the whites of the eyes and rims of the eyelids will be red and irregular.

It usually takes multiple approaches to control OSD. A combination of the following may improve comfort: good eyelid hygiene, the use of artificial tears and lubricating ointments, newer agents designed to heal tissue such as Cyclosporine, omega-3 supplements and punctal occlusion (the insertion of a silicone plug into the tiny opening that drains the tears). Examining controllable factors such as medications, topical creams and lotions, and minimizing environmental influences like wind, smoke and screen time can enhance treatment success.

At Westside Optometry, we use Thermal Expression and BlephEx procedures in the office for longer term relief and treatment of dry eye symptoms. Ocular surface disease can be a chronic problem but continued care and maintenance of the eyelids will minimizes symptoms and future complications.

Epiretinal Membrane

An Epiretinal Membrane is also known as Cellophane Maculopathy or Macular Pucker. Sometimes it is simply referred to as a “wrinkle”. In most cases, a Posterior Vitreous Detachment (PVD) has occurred. This vitreous activity causes the macula to generate cells and create a scar-like membrane. This thin tissue layer can contract and cause a wrinkle.

In the above picture of the inside of an eye, the whitish irregularities on the left side is the membrane. The photo below shows a normal macula, note the the smooth and regular color on the left side. The dark spot to the left in each photo is the macula.

The macula provides sharp, central vision and allows us to see details. Any change in the surface, like a wrinkle, will cause distortion and blur. ERM usually occurs in one eye only. The initial onset of the blur and distortion can be very alarming, but most people get used to it depending on the extent. Sometimes it resolves on its own, but mostly it stays the same. If you are noticing this type of vision change it is very important to have an examination for a correct diagnosis. Blur and distortion can be symptoms of other conditions, such as a macular hole.

In cases where the vision is significantly impaired a surgical procedure can be done. A vitrectomy is performed to remove the vitreous, then very delicately the surgeon peels the membrane off of the macula. This often reduces distortion and improves the vision, but not completely. Retinal surgery is not without risks, the most common risk is the development of cataracts, but any damage to the macula during the procedure can cause permanent visual impairment.

ERM is not the same as Macular Degeneration.

Eye Infections

“Pink Eye” is a common term referring to conjunctivitis. The conjunctiva is the outer white part of the eye and the inside lining of the eyelids. The conjunctiva is normally clear, but if it is inflamed it becomes pink or red. Conjunctivitis can be caused by allergies, bacteria, viruses or other irritants. The treatment depends on the cause.

Besides redness, other symptoms include tearing, itching, sensitivity to light, mucus and/or a gritty feeling.

Anyone can get pink eye, especially people in close contact with other. Viral conjunctivitis is like a cold and is highly contagious and spreads easily. And like a cold, it doesn’t respond to medicines, but usually resolves on its own in a few days. Artificial tears and cold compresses can make the eye feel better.

Bacterial conjunctivitis usually requires an antibiotic. This type of pick eye has a sticky discharge and the lids are usually stuck together in the morning. A warm wet washcloth applied to the closed eye will loosen the dried mucus.

Besides red eyes Allergic conjunctivitis causes itchy, watery eyes. This conditions requires treatment of the allergy and reducing exposure to the cause.

Contact lens wearers have a greater risk of pink eye because they tend to touch their eyes more frequently, potentially introducing viruses, bacteria and other causes of conjunctivitis to their eyes.

It can be difficult to tell one type of conjunctivitis from another and often requires a thorough examination with the biomicrosope to make the diagnosis. There are some serious conditions that mimic conjunctivitis.

How to Avoid Pink Eye

Wash your hands frequently and avoid touching or rubbing your eyes. Avoid sharing items that touch your eyes such as washcloths, contact lenses and make-up.

If your child has an eye infection, alert the school. Because viral conjunctivitis is very contagious, it’s a good idea to keep children with pink eye home until the condition resolves. The same is true for adults who work with others.

If you wear contact lenses and develop pink eye, remove your lenses and call the office immediately. Sometimes, more serious contact lens-related infections can mimic conjunctivitis, and appropriate treatment is required.

Flashes and Floaters

Most of us have seen floaters or spots when looking at a plain background like the sky. Floaters may appear as specks, strands, webs or shapes moving in your field of vision. You do not see the actual floater but the shadow it casts on the retina. Small clumps of condensed protein or cells that form in the vitreous, are suspended in the clear fluid that fills the interior cavity of the eye. Since the floater is within your eye, and moves with it, any effort to look directly at the floater causes it to instantly dart away as your eye turns.

In most cases, floaters are part of the natural aging process. As we grow older, the vitreous shrinks and pulls free of its attachments in the back of the eye. This event is called a Posterior Vitreous Detachment (PVD). When this happens, a large floater is usually seen which can resemble a cobweb. A PVD is frequently associated with the sensation of flashing lights as a result of the vitreous pulling free of the retina.

The onset of new light flashes, especially when accompanied by the appearance of many new floaters or the sensation of a curtain coming down may indicate a retinal tear or detachment. If you experience light flashes in combination with these symptoms, call the office immediately.

For a printable explanation of flashes and floaters click here

Glaucoma

How Does Glaucoma cause Vision Loss?

Doctors and researchers don’t know exactly how glaucoma damages the optic nerve. For many people, increased eye pressure seems to play an important role.

Your eye produces a watery fluid (aqueous humor), which goes into the eye and drains out. When your eye is healthy, the fluid drains through a mesh-like pathway and into the bloodstream. Aqueous fluid is produced by the ciliary body. It flows through the pupil and behind the clear cornea. Finally, it drains away through the trabecular meshwork.

For some people, fluid can’t drain properly because of a faulty drainage system. Drainage that once worked well may gradually slow down as you get older, like a sink that becomes clogged and backs up with water. When there is no place for excess fluid to go, pressure inside the eye builds up.

This increased eye pressure may damage the optic nerve over time. Slowly, the nerve fibers that are essential for vision die.

For others, glaucoma damages the optic nerve without increased pressure. These people may be unusually sensitive even to normal levels of pressure. Their glaucoma may also be related to problems with blood flow in the eye. Doctors continue to study eye pressure and other possible causes of glaucoma.

Different people experience glaucoma differently. Usually, glaucoma affects side vision (peripheral vision) first. Late in the disease, glaucoma may cause “tunnel vision.” In this condition, the person can only see straight ahead. That’s why someone with glaucoma can have good central vision. However, even central vision can be seriously damaged.

How Does Dr. Griffith Check for Glaucoma?

There are three major signs that a person may have glaucoma:

Optic nerve damage
Increased eye pressure (elevated intraocular pressure).
Vision loss(visual field loss)

These are some of the tests I will use to look for glaucoma:

Dilated Eye Exam

The doctor will place a few drops in your eye to open or dilate the pupil. This allows Dr. Griffith a clearer view to inspect the optic nerve at the back of the eye using Ophthalmoscopy.

Photography may be used to show the appearance of the optic nerve inside your eye. Photography also provides a record to help the doctor see changes from one year to the next.

Tonometry measures pressure in the eye. Yellow colored drops are used to numb the eye. An instrument gently presses against the tear film on the surface of the eye. Pressure is shown as a number followed by the abbreviation “mm Hg.” This stands for “millimeters of mercury,” a standard measure for pressure. An average pressure is about 16 mm Hg. Still, a higher than average number doesn’t always mean you have glaucoma. Since the thickness of the cornea (the front window of the eye) may affect the pressure reading and the risk of glaucoma progression, Dr. Griffith may measure this as well. with a Pachymeter.

Perimetry evaluates your visual field. This tests your vision all around your field of view to see if any areas are have reduced sensitivity to light. It usually involves staring straight ahead at a target and trying to see lights that randomly appear in your periphery. This is generally done with a computerized system.

Optical Coherence Tomography or OCT scans the retina to measure the nerve fiber layer and ganglion cell complex. Both are indicators of the health of the optic nerve and amount of healthy nerve tissue.

Gonioscopy allows a more accurate diagnosis of the type of glaucoma. After numbing the eye, the doctor gently places a special lens on the surface to examine the area in the front of the eye that drains fluid. Gonioscopy allows a more accurate diagnosis of the type of glaucoma.

How is Glaucoma treated?

Glaucoma can usually be treated and controlled using medicine, surgery a combination of these treatments. Medicated eye drops are typically the first step in treatment. The treatment will depend on the severity of the glaucoma and how the eye pressure responds to treatment.

High Blood Pressure and the Eyes

High Blood Pressure (HBP) is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure and vision loss. “Blood Pressure” is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways.

About 1 in 3 adults in the United States has HBP. The condition itself usually has no signs or symptoms. You can have it for years without knowing it. During this time, the HBP can damage your heart, blood vessels, kidneys and eyes.

Blood Pressure tends to rise with age. Sometimes medication can control it. Following a healthy lifestyle helps people delay, prevent or control the BP.

Hypertension can cause damage to the blood vessels in the retina. This picture of the retina shows an eye with hypertensive retinopathy. The arrows point to arteries and veins crossing each other. In a healthy eye the vessels run parallel. The crossings are dangerous because one of the vessels can be occluded. If an artery is blocked, blood will not flow to the retina beyond the occlusion and the retina will die. This causes a permanent blind spot. If a vein is occluded there will be bleeding which may cause a chain of negative events including loss of vision, abnormal vessel growth and glaucoma.

Hypertensive retinopathy typically won’t have any symptoms. It is found during a dilated eye exam. The earlier it is detected the sooner the blood pressure can be controlled preventing vision loss, stroke and death.

The best way to prevent hypertensive retinopathy is by keeping blood pressure controlled by diet, exercise and taking medications as prescribed.

How Marijuana Effects the Eyes

25 years ago a few patients asked if their marijuana use was preventative for glaucoma. In 1996, marijuana was legalized in California for medical use. While few people asked me for prescriptions as there were plenty of other sources to get a “medical card,” I still had plenty of conversations about the use of marijuana not being a therapy for glaucoma. Marijuana is a poor option to treat glaucoma and it will not protect you from developing glaucoma.

Jump to 2018, Marijuana is now legal for recreational use in California for those over 21 years of age. Marijuana is still not a viable treatment for glaucoma.

So what is Glaucoma?

Glaucoma is atrophy of the optic nerve which causes the permanent loss of vision. One of the causes of optic nerve atrophy or destruction of the nerve fibers is increased pressure inside the eye (intra-ocular pressure or IOP). The THC in marijuana does lower the intra-ocular pressure. The IOP reduction peaks at 30 to 60 minutes and the effect lessens over 3-4 hours. To successfully treat glaucoma, IOP needs to be maintained at a lower amount for 24 hours everyday. That would require a lot of marijuana consumption. Fortunately, there are eye drops and surgical procedures that can usually achieve that goal with more accuracy, consistency and less side effects.

What about Red “Stoned” Eyes?

The most obvious effect marijuana has on the eyes is the redness generated from smoking or ingesting marijuana. The THC in marijuana triggers the smooth muscles in the blood vessels to expand causing vasodilation. The blood flow through the blood vessels increases which contributes to many of the effects one experiences from marijuana. In the eyes it makes the blood vessels on the surface dilate and look redder. Selecting a strain with more CBD and less THC will lessen the redness, but also reduce the “high.”

And Dry Eyes?

THC crosses the blood brain barrier and is a vasorelaxant causing a decrease in blood pressure, intraocular pressure and visual processing. It also causes decrease in tear production and reduces the blink rate making the eyes feel dry. This vasodilation also effects the salivary glands causing a dry mouth.

Any Health Benefits?

The 2 most abundant components of the cannabinoid are CBD, which is non-psychotic and THC which is psychotic.

Studies show that CBD has antioxidant and neuroprotective properties. It can be helpful in relieving inflammation, pain and other symptoms.

Marijuana has both adverse health effects and beneficial therapeutic effects. The FDA has approved a CBD-based liquid medication for the treatment of 2 forms of childhood epilepsy. Two THC based medications have also been approved by the FDA. One drug stimulates appetite for wasting syndrome due to AIDS and the other reduces nausea for patients undergoing cancer chemotherapy.

According to the National Institute of Drug Abuse, a branch of the National Institute of Health, development of drugs from botanicals such as marijuana prove challenging due to the unknown active chemicals. Use of marijuana as medicine poses problems due to the adverse health effects and the THC induced cognitive impairment.

Swollen Eyelids

A swollen eyelid occurs when there is inflammation or excess fluid (edema) in the connective tissues surrounding the eye. Swollen eyes can be painful or non-painful, and involve one eye or two and top or bottom eyelids.

Symptoms of Swollen Eyelids

Swelling of the eyelids is a symptom of an underlying cause, such as allergy or infection. Swollen eyes usually are accompanied by one or more of the following:

Eye irritation, such as an itchy or scratchy sensation
Excess tear production, resulting in watering eyes
Obstructed vision (depending on the extent of the swelling)
Redness of the eyelid
Redness and inflammation of the white of the eye (conjunctiva)
Discharge from the eye
Pain, particularly when swollen eyelids are caused by infection

Puffy vs. Swollen Eyelids

The term “puffy eyes” is often used interchangeably with the term “swollen eyes.” Swollen eyes is generally used to describe an immune response to allergy, infection or injury. “Puffy Eyes” is more likely used to refer to the external characteristic of swollen eyes from water retention, lack of sleep or genetic traits like dark circles under the eyes.

Cause of Swollen Eyelids

Allergies – an allergic reaction can be caused by pollen, dust, pet dander, eye drops, contact lens solution, or make-up.

Conjunctivitis – Often called “pink eye,” conjunctivitis is an inflammation of the white tissue on the surface of the eye. Allergic, bacterial and viral infections can result in swollen eyelids.

Styes – Styes are located at the edge of the eyelid and appear as a swollen, red, painful bump.

Chalazion – Caused by a blocked meibomian gland, it can mimic a stye but is usually not on the edge of the eyelid.

Eye Injuries – Any trauma to the eye area, including an eyelid contusion (black eye) and cosmetic surgery can trigger inflammation and swollen eyelids.

Contact Lens Wear – Improper care of contact lenses such as dirty lenses, old lenses or poorly fitting lenses can cause an eye infection and swollen eyelids.

Blepharitis – This is characterized by red, swollen eyelids due to inflammation. It appears like a dandruff on the eyelashes.

Orbital Cellulitis – This is rare but can become a serious bacterial infection of the tissues surrounding the eye, resulting in painful swelling.

Ocular Herpes – Transmitted by the common herpes simplex virus, it can cause inflammation of the eyelids and if it infects the cornea, herpes can cause permanent scarring.

Treatment of Swollen Eyelids

The first step in treating swollen eyelids is to identify the cause. The doctors at Westside Optometry may write a prescription, recommend an over the counter remedy or suggest hot or cold compresses depending on the diagnosis.

Tips for Preventing Swollen Eyelids

Control your allergies
Choose and use cosmetics, lotions and skin products carefully
Pay attention to eye drops you use, do not share them, check the expiration date and verify the intended use.
If you wear contact lenses, you can minimize your risk of eye infection or irritation by practicing proper hygiene, replacing contacts and contact cases as prescribed and not over-wearing your lenses.

Ultraviolet Protection

There are 3 forms of ultraviolet (UV) radiation – UVA, UVB and UVC. Each is identified by it’s wavelength. UVA penetrates deeply into the skin causing tanning and aging.

The UVB wavelength is a little shorter and doesn’t penetrate as deeply as UVA. UVB is more damaging though, resulting in sunburn, blisters and skin cancers.

UVC is the most harmful to the skin. It can result in skin cancer, but fortunately, is absorbed by the ozone and doesn’t reach the Earth’s surface.

How does UV affect the eyes?

One of the most common conditions I see due to UV radiation is pinguecula. This is a raised nodule that appears on the white of the eye. It can become inflamed, discolored, and dry with chronic sun exposure.

Pterygium is a similar condition to pinguecula, but is grows onto the cornea (the clear part of the eye). Pterygia can grow and affect the vision. Removal is possible, but there is a high recurrence rate.

Photokeratitis is like a sunburn on the cornea, also known as “snow blindness.” Photokeratitis is directly attributed to environmental UV radiation exposure and generally occurs 8 to 24 hours after being in the sun. It is more typical in individuals who have not used sunglasses or hats. The primary symptoms include photophobia (extreme sensitivity to light) and pain.

One of the causes of cataracts is UV exposure. The crystalline lens is made up of proteins. These proteins can be altered or denatured by exposure to UVB or UVC radiation.

Age Related Macular Degeneration (ARMD) is another eye condition associated with UV exposure. The worldwide prevalence rate of ARMD resulting in impairment and blindness is 8.7%, making it one of the most common causes of blindness in patients over age 60. Studies have shown that many individuals with macular degeneration have had greater UV exposure over their lifetime.

Skin Cancers can present on and around the eyelids. Removal and excision is complicated by the importance of proper blinking and eyelid closure. Malignant melanoma can appear in the choroid (under the retina), the iris (colored part) and the conjunctiva (white of the eye). These tumors can be very aggressive. In fact, malignant melanomas of the choroid are the most common intraocular malignancy.

UV Protection with Spectacle Lenses and Sunglasses

Photochromic lenses, polarized lenses, sunglasses and high index lenses block 100% ultraviolet A and B radiation. But they don’t account for exposure due to reflected light or the light that reflects off the back surface of a lens. When the sun is lower, exposure to UV light actually occurs when the light hits at an angle, thus reflecting off the back surface of the lens and entering into the eye. This is also the time of day when sunglasses are less likely to be worn.

Environmental factors can increase UV exposure to the eye. For example, snow reflectance transmits 94% of UVA light and 88% of UVB light.

New technologies can eliminate backside UV radiation reflection and particularly focus on the shorter wavelength light, UVA and UVB. These coatings reduce glare, and provide full-spectrum blocking technology on both the front and back surfaces.

Only 6% of Americans know they need sun protection for their eyes.