Eyedolatry: January 2016

There's a Bump on My Eyelid: Molluscum Contagiosum

multiple white growths on eyelid 7:00 AM

A new white-colored, painless bump appears on your eyelid margin. You've rubbed at it, and now there are more. What could it be?

image via

Molluscum contagiousum is a viral infection that is most commonly seen in children or adults with weakened immune systems. Less than 5% of children in the US are infected each year. The virus spreads from direct contact, so it is possible for you to spread the virus to different parts of your skin and to others.

Classic appearance of a molluscum lesion photographed by Dr. Dovie at Blacksburg Eye

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You can spot molluscum skin lesions by their appearance: they are round, dome shaped growths with a depressed center and are typically white in color. They are most commonly found right along the lid margin, but can be seen anywhere on the skin around the eyes.

Like most viruses, there is no treatment for this infection. For patients with a healthy immune system, the lesions will resolve by themselves given time. A typical course of infection is two to seven weeks. As long as the lesions are visible throughout the various molluscum contagiosum stages development you are still contagious, so careful hand washing and avoiding direct contact with others is advisable to prevent spreading the virus. In children and adults with a short course of presentation, typically just monitoring for improvement is the only needed treatment. For patients that aren't improving, or show signs of multiple lesions, it is best to order blood work to rule out a systemic health condition that would compromise the immune system. Inflammatory conditions like rheumatoid arthritis and sarcoidosis (and the medications that treat them!) can cause depressed immune systems, as can systemic infections like HIV or AIDs and sexually transmitted diseases. In some persistent cases where the patient has a depressed ability to fight off the molluscum virus, the contagious lesions can last up to a year. In these instances it is possible to perform curettage, where a doctor removes the lesion and treats the area with anti-septic. Controlling the health condition that is causing immune system depression is the best way to prevent further molluscum infectious lesions after performing curettage to remove them.

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Trending: Rose Quartz and Serenity Eyewear

blue tinted lenses 10:02 PM

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What You Need To Know Before Cataract Surgery in 2016

Dr. Isaac Porter 9:19 AM

There are a few things in life that are inevitable. As a colleague of mine likes to phrase it, "If you live long enough, you will get a cataract." But developing cataracts is not a diagnosis of doom and gloom. Today's cataract surgery is as much a refractive procedure to bring you back to clear vision (maybe even without glasses!) as it is a medical one. Some of my patients are actively hoping for that cataract diagnosis from year to year so we can correct their high nearsightedness or reduce their dependence on reading glasses. And cataract surgery itself has changed so much, even in the last decade. Now there are ways to reduce healing time, and achieve more precise vision refinement. There are implants that can correct even high amounts of astigmatism, and that can help you read again free from those OTC readers. If you are about to undergo cataract surgery, here are the two questions you need to ask yourself to prepare for the best procedure for your needs:

1) Should I Get Laser Assisted Cataract Surgery?

Laser assisted surgery can have many benefits, but it is not covered by medical insurances. It's an extra expense and you need to decide if it's worth the cost for you. The laser does not do the actual removal of your cataract; you will still have to undergo surgery in the operating room to remove the cloudy lens inside your eye. Using the laser has these advantages:

Makes a more precise incision (capsulorhexis) so that the optical implant (IOL) placed inside your eye to correct vision is more likely to center perfectly and stabilize there for best vision. Without a laser cutting the capsulorhexis, your doctor will use a traditional manual cut, which even with a skilled surgeon will not be perfectly symmetric. That imperfection increases the risk of shifting and decentering of your IOL, reducing the possibility that you will get perfectly corrected vision from your implant.

This is an excellent maunual capsulorhexis, but you can see even with a great technique there is imperfection being created. via

Notice the more precise circular incision of the laser assisted capsularhexis. A more precise incision will hold the IOL (seen here with a bluish outline) perfectly centered in the visual axis.via

Breaks up the cataract prior to being physically removed in the operating room. Using the laser to break down the cataract first reduces the time of your operation, which in turn makes for less exposure to high energy phacoemulsification techniques that can increase internal inflammation and increase the risk of operative side effects like cystoid macular edema, iritis, and corneal edema (swelling).
Places more precise limbal relaxing incisions to reduce low amounts of astigmatism. If you have astigmatism left over after your cataract is removed you may still be reliant on glasses for clear vision. The laser assisted surgery can help reduce your astigmatism by placing more precise laser markings in the cornea that counteract the astigmatism present in that tissue post-operatively.
Want to learn more? Check out this great podcasts from cataract surgeon Dr. Isaac Porter:

Who is not a candidate? Dr. Porter states that most patients are great candidates for laser assisted surgery, but he would likely be unable to use the laser procedure for patients with dense corneal scars. If it is hard to visualize the eye through the scars it would be hard to align the laser properly which reduces it's usefulness.

2) Should I Get a Specialty IOL?

Medical insurances like Medicare pay for "standard monofocal IOLs", which means that only 1 aspect of your vision will be corrected. Most people will chose to correct their distance vision, which means they will need reading glasses full time after the surgery. If you have high amounts of astigmatism (typically greater than 1.00D of astigmatism), then a standard IOL will not correct for this either, and you will need full time glasses to see clearly after the surgery. Depending on your refractive needs, you can choose to upgrade to one of two types of premium IOLs:

Toric IOL: For patients with more than 1.00D of astigmatism it is unlikely that simply removing the cataract and placing limbal relaxing incisions will fully correct this. A better option is to correct your astigmatism within the implant itself. Many surgeons will recommend that you have laser assisted surgery if you chose to upgrade to a toric IOL because they can better increase accuracy for the way the IOL positions (and thus the vision you will achieve) by creating a more perfect capsulorhexis.
Multifocal IOL: Another inevitability about eyes? Around 45 you are going to lose your ability to read and do up close activities (called presbyopia). Standard implants cannot correct both your distance and your reading vision; you have to pick one. If you want to be able to see clearly again to read without reading glasses, you would need to upgrade to a multifocal IOL. These implants have rings of distance and near vision within the implant so that your brain receives both images on the retina for processing. Most people that get multifocal IOL implants may still need reading glasses under certain conditions (dim lighting, really small print, reading for long periods of time), but the need will be significantly reduced. There is also the risk for glare off of the implant because the rings in the implant will create more reflections. Your doctor will discuss the pros and cons with you, but if you want to avoid having to use full time reading glasses after surgery, this is an upgrade worth considering. You can learn more from Dr. Porter here.

A multifocal IOL via

Not everyone is a candidate for multifocal IOLs due to the possibility that the rings will reduce vision if you have an ocular condition that reduces vision or could potentially hurt vision in future. Patients with diabetes, macular degeneration, glaucoma, and other eye disease are typically excluded from multifocal implants because these conditions could lead to future vision loss that would make the ring design of the implant a hindrance to clear vision.

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Unisol 4 Discontinued; Your Best Replacement Options

contact solution sensitive eyes 11:03 AM

In fall 2015 Alcon very quietly discontinued their preservative free saline solution for contact lens rinsing and filling, the well-regarded Unisol 4. Most local pharmacies and box stores are now out of the product, and patients that have used the product loyally for years are scrambling for a replacement. If you don't think the panic is real, just check out the price gauging on ebay -- $50 for a 3 pack that would have run you under $10 just a few months ago. I've spoken with a rep from Alcon, and there was no official statement released as to why the product was discontinued, and there is no plan for reinstating the product in future. If you are in need of preservative free saline, here are a few doctor recommended solutions that can take it's place.

To Rinse Your Lenses

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Preservative free salines make a great rinse for both soft and hard (RGP) contact lenses. If traditional multipurpose solutions burn or sting, you can rinse off your contact lenses with a preservative free saline before inserting them in the morning. Just remember, these salines are not lens cleaners so you always have to use a cleaning solution with your lenses for disinfection/overnight storage. Your best options for a preservative free rinse are:

Arm & Hammer Simply Saline Sterile Saline Solution: This is an aerosol spray can that can be used to rinse off your lenses. The spray can design prevents contamination. If you fill your contact lenses with saline before putting them in your eyes, do NOT use this product because you will be left with tons of air bubbles! Update: this is also now discontinued!

Purilens Plus: This cleaning system uses a simple preservative free saline solution in combination with a special cleaning chamber that uses UV light to kill germs and bacteria. The saline solution component is very similar to Unisol 4 in chemical component and could be safely used to rinse or fill your lenses. You can buy Purilens Plus Ultra PF sterile saline separately from the rest of the cleaning system.

CLEAR CARE Rinse and Go: Alcon launched this "replacement" for Unisol in spring 2016, made specifically for rinsing contact lenses. It is a preserved saline so it is fine for rinsing, but not suitable for filling contact lenses.

To Fill Your Lenses

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If you wear Synergeyes or scleral RGP contact lenses you have likely been instructed to fill your contact lens with preservative free saline before inserting it into your eye. Never fill your lenses with cleaning products -- that means no multipurpose solutions and no conditioning solutions like Boston. The preservatives in these cleaners are made to kill bacteria, but they are non-discriminating in their toxicity and will kill your corneal cells too! Your best options for preservative free fill solutions are:

Addipak Saline Solution for Inhalation: These vials of saline are preservative free and buffer free so they are ideal for extended contact with the cornea.

Modudose Saline Solution for Inhalation: Also preservative free and buffer free; I've been using this brand for years and it is super affordable and easy to order in bulk on Amazon.

In a bind you can also use preservative free artificial tears like Refresh Optive Preservative Free but these over the counter lubricants do contain pH buffers which can be irritating to sensitive corneas with prolonged exposure.

The Purilens Plus Ultra PF saline mentioned above is also preservative free, so it could be used to fill contact lenses as well as rinse them. I strongly prefer the preservative and buffer free vials mentioned above, but if for some reason those aren't working well for you, the Purilens Plus is the most similar thing to Unisol on the market today.

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