Posts Tagged ‘Punctal Occlusion’

Medication Side Effects Review: Accutane

Tuesday, February 7th, 2012

Medications Review Logo e1312299174236 Medication Side Effects Review:   AccutaneAccutane or isotretinoin is a medication that is used to treat certain, severe cases of acne that do not respond to other forms of treatment.     The medication is widely known to cause birth defects, and the medical community does a good job educating women they should not take Accutane while pregnant or when they believe they may become pregnant.    But Accutane also results in some significant ocular side effects.

The most common ocular side effect of Accutane is Dry Eye Syndrome.   In most cases, the ocular dryness is severe and can cause very significant discomfort or pain for the patient.    When dryness results, it may be so significant that artificial tears are not effective.   In these situations, a person may benefit from a prescription eye drop called Restasis, which would cause the eyes to produce more moisture.   Restasis does require 4-6 weeks of continual use before relief may be felt.   Given this, punctal plugs or “tear savers” may be a preferred and more immediate way to provide accutane patients with relief.   These tear savers prevent moisture from leaving the eye through the natural tear ducts and they can be removed if necessary.      When a person discontinues accutane, the Dry Eye Syndrome tends to slowly improve over a period of up to several months and may still require monitoring during this time.

Another potential ocular side effect of Accutane is decreased night vision.    Accutane is actually a form of vitamin A, which plays a direct role in the function of certain elements in your retina.    Disrupting the delicate balance of Vitamin A and other chemicals in the body may cause patients to notice significant decreased vision in dark rooms or while driving at night.   Discontinuation of the medication, unfortunately, may not always improve night vision to its original state.    Some case reports have shown this to be a much longer lasting side effect than the Dry Eye Syndrome.

Research also indicates other potential side effects of the medication may include:   blurred vision, fluctuating vision, corneal deposits, cataracts,  sensitivity to light, and color deficiencies.

While Accutane may not be as widely used as it once was, it does have its place in certain situations.    Be sure to visit your optometrist once you start the medication, and it may be necessary to monitor your eyes frequently while you remain on the medication.

As always, I’d love to hear your comments or questions.  Give us a shout over on Facebook or on Google+.    And, remember, you can now request your annual eye exam appointment at our office by clicking here.

Dr. Beach

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Blinkrate: Why It’s Important.

Thursday, January 19th, 2012
parker reading 006cropped 248x300 Blinkrate: Why Its Important.

even 2wk old Parker Beach forgets to blink while reading

Have you ever noticed how often you blink your eyes?   You might now that I’ve planted the seed, but most of us go about our daily lives and never realize that we may blink our eyes as many as 17,000 to 20,000 times a day.   This amounts to a normal blinkrate of about 12-14 blinks per minute.

Why do we blink so often?   Really, the purpose of the blink is to redistribute moisture across the surface of the eye.   As the eyelid blinks down on the eye, it spreads tears secreted by the lacrimal gland from the upper outside corner of the eye down towards the inner nasal side of the eye.   This brings new moisture onto the surface and pushes older moisture towards the drainage ducts.

This should occur about 12 times a minute.   But, when we visually concentrate on something this blink rate can be cut in half or more.   This is certainly the case when we are working on computers or reading books.   (click here to see out posts on Computer Vision Syndrome).   We simply concentrate more and blink less.   And this means less moisture being introduced and spread across the surface of the eye.

This leads to Dry Eye Syndrome, which can be felt as redness, dryness, sandy-feeling, itching or moderate pain.    The dryness can also cause fluctuating or blurry vision.

It would be great if we could set up a “blinking alarm,” that would go off every 5 seconds to remind us to blink while we’re on the computer.   But that would probably be a little annoying and impractical.   Yet, there are some ways to compensate for a lowered blink rate.   Artificial tears are a great supplement.    Prescription eye drops, such as Restasis, may also be very effective.    And, tear savers or punctal plugs are another great option for retaining ocular surface moisture to combat the effects of a lowered blink rate.   The best plan is to discuss your computer use and related symptoms with your optometrist so that a treatment can be tailored to your individual needs.

As always, thanks for reading and don’t forget to blink!

Dr. Beach

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50% of Diabetics may suffer from Dry Eye Disease

Monday, November 14th, 2011

getty rf photo of woman rubbing eye 300x203 50% of Diabetics may suffer from Dry Eye DiseaseAs we progress through American Diabetes Awareness month, I wanted to touch on how diabetes can commonly affect the outside or front surface of the eye.   In fact, one study suggests that nearly half of all people with diabetes suffer from Dry Eye Disease.   This is very significant because Dry Eye Disease can often cause reduced vision and noticeable symptoms of ocular discomfort.

The mechanism by which Diabetes causes Dry Eye Disease may be dual action.    The diabetic eye may secrete less volume of natural tears.   But, the quality of these tears may be sub par as well.   The result is the cornea, or front surface, loses its coating of moisture.     The cornea is packed with sensory nerves, and when they lose their protective moisture layer, they shoot back signals of burning, sandy, and dryness to the brain.   Also, when the cornea becomes dry it can lose it’s clarity and reduced or fluctuating vision can result.   Even worse, Dry Eye Disease may leave the eye more susceptible to infections.

How do we fix this?   A comprehensive eye exam is the best first step.   During the exam, the level of dryness can be fully evaluated.   Then, a treatment plan can be developed to reduce symptoms, stabilize vision, and reduce the long term effects of Dry Eye Disease.   These treatments may range from specific recommendations of a particular tear drop.   Or, the prescribing of eye drop medications may be necessary.   Also, tear-savers can be inserted in the tear ducts to prevent excess loss of tears.

All in all, there is a definite association between Diabetes and Dry Eye Disease.   Yet, the good news is that we do have ways to greatly reduce the symptoms and visual effects of the condition.

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‘Tis the Season…for Dry Eyes

Thursday, January 7th, 2010

With the holidays now passed, you can finally feel winter weather settling in—especially this past week.     And with this early January weather, you might start asking yourself a few questions:   Why did I eat so many Christmas cookies?   Can I retire my reindeer sweater till next year? … And why do my eyes feels so dry?

Although ocular dryness can be a year round issue for some individuals, for others it can be seasonal.  Several factors help create this problem in the winter:

  • Dry, gusty winds:  it seems this is a trademark of Hampton Roads’ winters.  What we lack in snow, we seem to make up for in wind.   If not wearing eye protection, these winds can disrupt the quality and quantity of the tear film that is needed to cover and comfort your eyes.
  • Home and Automobile Heaters:  these create constant circulations of dry, hot air that can wreak havoc on your eyes
  • Dehydration:  drinking water and keeping hydrated is just as important in the winter as it is in the summer
  • Cold Medicines:  winter weather brings winter sniffles and the use of over-the-counter cold remedies.   Many of these medicines will create varying levels of ocular dryness.

Thankfully, you have many options to treat seasonal Dry Eye Syndrome and get your eyes feeling comfortable again.

The most obvious option is over-the-counter artificial tears, with the warning that not all tear drops are created equal.   In fact, no one tear drop brand is best suited for every individual.   I take the approach of matching the tear brand (based on its preservatives, its thickness, and its chemical composite) to the patient’s individual symptoms, severity of dryness, and associated findings.   One of my most highly recommended brands is Systane Ultra, but there are several others that may be more appropriate based on the individual circumstances.

Yet, the one thing I’d recommend for everyone:   KICK VISINE AND CLEAR EYES TO THE CURB! Drops labeled “gets the red out” are typically constricting the blood vessels on the surface of your eye and creating the risk for more symptoms over the long term.

Often, over-the-counter tear drops may not alleviate all your symptoms.   This is where prescription eye drops earn their keep.  The type and dosing of these prescription drops will depend on the symptoms and findings, but they are often very effective in controlling the ocular dryness and/or stimulating extra tear production.    Yet another option is Punctal Occlusion, whereby the drainage ducts of the eye are temporarily occluded to prevent your tears from leaving the surface of the eye.   This is also quite effective in getting your eyes away from feeling the ‘winter blues.’

As always, I’d love to hear from you with any questions or comments.  Take care.

Dr. Beach

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