I'm trying to collect my best images from patients seen in clinic this month to share with optometry students or curious patients.  Here's a photographic review of January at the office:

Conjunctival Cyst

Typically these resolve on their own, often with encouragement from frequent artificial tears and or steroid drops or ointments.  For more information, see this post.

Herpes Simplex Keratitis
This virus typically presents (in my experience) as a dull persistent irritation.  Your eye has been mildly red, mildly uncomfortable, and vision seems a little off.  Often I am seeing it after you have been bothered for a few weeks.  With an incubation of that long, herpes simplex's tell-tale corneal disruption (called dendrites) is easily visible.  If your doctor sees the virus too early in its life span, these dendrites may not have yet formed, making it harder to diagnosis.  It is also true that if it incubates too long, the cornea is just a complete mess and the dendrites will have merged into something that can look like a bacterial or fungal ulcer.  The point here is, if you have an irritated eye that just isn't healing or responding to your doctor's treatment, you need to be seen again!  Sometimes herpes will reveal itself only after an initial misdiagnosis.

Herpes Simplex Dendrites with NaFL staining

Herpes Simplex Dendriteis with Rose Bengal staining

Peripheral Corneal Infiltrate; Marginal Ulcer
See that white spot near the pupil of this image?  It is actually located on the superficial cornea, and is a small infiltrate or ulcer.  Technically this particular patient had an infiltrate since the overlying epithelial defect was much smaller than the size of the stromal opacity.  But I have heard these called marginal ulcers just as often as peripheral infiltrates. The real treatment for a sterile infiltrate is steroids, but I usually just do a antibiotic combo with Zylet or Tobradex.  Kill the inflammation and any bacteria in just 1 drop!  A small stromal scar will often remain after treatment, so that is why getting these diagnosed and treated quickly is important.  They are most commonly associated with blepharitis and meibomian gland dysfunction, and not necessarily in just contact lens wearers where the cornea is more susceptible to infection.

Posterior Blepharitis
It wouldn't be January without a lot of meibomian gland issues.  This time of year the cold weather constricts the meibomian glands in the upper and lower eyelids, limiting the amount of tear film leaving the gland opening with every blink.  As those tears get backed up inside the gland, they harden and become even more difficult to blink out normally!  The result: a thick, milky tear film that leaves the eyes dry and blurry between blinks.  Your best relief is to get those tear glands working again, encouraging the glands to open and express with daily warm massage.  Aim for the eyelash line with a gentle circular motion, and you will see results in the way your eyes are feeling within a week or two (depending on how long your glands have been clogged for).  Sometimes medication is needed to get the glands working again at their best level, so steroid ointments and oral minocycline are common treatments.

Don't you just want to get all that thick, milky, hardened tear film junk out of those glands?  If you do, you will make a very happy optometrist because I do this all day long for a living.

All-day computer users are typically unhappy in my experience via

Let me first preface this by saying, this particular post may be overwhelming.  It certainly was when I was writing it.  If you have any of the common computer-related complaints listed below, this post is just meant to help show you that your eye doctor is the BEST way to figure out what is causing your complaint and how to solve it.  With that being said, let's take a look at the most common ocular complaints in the world of computer users, and what may be causing those problems!

Tired eyes, eye strain, dull pain behind the eyes

When your eyes are looking at the computer, for most people their eyes have to work to see.  Most people who have perfect distance vision (or have their distance vision made perfect by wearing glasses or contact lenses) have a natural focus point at 20 feet (distance vision).  That means that when they look in the distance, their eyes have to do no work to focus.   When you shift your vision to a near task (like the computer), your eyes will have to use their focusing ability.  This "work" or focusing ability for the eyes to see up close is called accommodation.  I like to compare it to lifting weights:  when you look at the computer, your eye is "lifting weights"; when you look in the distance, it is as if you are putting the weight down.  No surprise, looking at the computer screen all day long is tiring!

BEST RELIEF: 

 20/20/20 rule - this is a popular ergonomic strategy for taking breaks to let your eyes refocus.  Every 20 minutes, look 20 feet away (down the hall or out a window), and break to blink for 20 seconds.

Computer Glasses - Your doctor can prescribe a pair of glasses to help your eyes focus at your computer distance.  Some people benefit from a low amount of plus power (typically less powerful than you would find with over-the-counter reading glasses).  Think of these glasses as aids to let your eyes do less work when they are at the screen

Anti-reflective coating or yellow tint - if your screen or workplace has a ton of glare, your eyes could be suffering from that excess reflecting light.  Coatings can help minimize that light bounce-back.  A yellow tint in your glasses increases contrast on the screen and cuts even more glare.

Double Vision

If you experience double vision (or diplopia as it is called in the medical world), it is likely because your eyes are having a hard time working together.Your eyes may not naturally focus together equally.  This does not necessarily mean you have an eye turn, but many people's eyes over or under focus.  These conditions are typically termed convergence insufficiency (eyes underfocus) or convergence excess (eyes over focus).  Either can lean to strain, ache behind the eyes, and potentially double vision.  Only your eye doctor can determine if your eye muscles are working together properly.  Treatments include glasses, prism (to move the image to your eye's natural focal spot), and vision therapy.

• uncorrected astigmatism:  A lot of my patients have astigmatism (curvature of the eye) that they have never needed glasses for before, but due to their long hours of eye work, their eyes can no longer compensate for their natural imperfect eye shape.  If you have astigmatism, it is just the shape of your eye -- it typically is present from early childhood. But if it is a low amount, your eyes can "squint" or focus, and see clearly without you needing glasses.   At the computer, your eyes are being asked to squint and focus more than ever, and sometimes they will finally give up.  Blurry vision results.  
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• uncorrected hyperopia:  Hyperopia means that the eyes have to work harder to see up close than they do to see in the distance (far-sighted is the other word for this).  Most people that are far sighted do not need any glasses until after 40 when the normal aging change of the eyes kicks in.  But computer users sometimes need help earlier in life because their eyes are doing so much more work!
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• uncorrected myopia:  Sometimes years of near work, either computer use, studying, or both, can result in late-onset myopia (typically in our 20s).  In the optometry world, we call this graduate school creep -- your eyes typically stop changing in college, but for people doing long near work hours later into life, it may keep changing! Myopia or near sightedness means that is it easier to see up close than it is in the distance.  For these patients, a pair of night driving glasses can be beneficial for driving home after a long day.  Since their eyes are made to see better at near, computer glasses wouldn't be beneficial in this case (unless they also have astigmatism of course).

Take Home Point:  Your eyes may be blurry driving home because they were working too hard at the computer, or because they need glasses to see at the distance.  Either of these conditions have night driving blur as a complaint!  Your eye doctor will be able to determine which of these conditions is your culprit, and prescribe what you need depending on the underlying issue.

I usually don't bombard you with so many fashion posts, but there was such a great showing for eyewear at this year's Globe awards Sunday night, I have to post about it.

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Thursday night's Project Runway All-Star finale had all a girl could want:  lots of clothes, at least one of Elena's high pitched panic-squeals, and a polarizing winner.  And it had a lot of glasses too:

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Seth Aaron's winning collection above was inspired by the drama of Spain, but obviously the designer's personal appearance as well.  Seth has been no stranger to a bold pair of oversized black zyl frames.

Seth Aaron in center sporting his trademark look of the season via

 While the look may not be suited for everyone, you have to admit it makes a bold statement.  And that's what glasses are all about looking at 2014.  This is not the tame to have your glasses fade into the background.  Color, proportions, details -- they are all about "too be noticed" this season.  I look forward to featuring some of the best looks of 2014 with features from fashion bloggers, and fashion forward optometrists over the coming months. In 2014 there is only one rule in glasses -- embrace your glasses; make them bold and make them you!

Interested in finding a similar look?  Tom Ford's collection offers several stand-out options:

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via Eye See Euphoria

Have you ever noticed that when you use a computer in a dark room, a faint blue glow is emitted from the screen?  That blue glow emanates from most electronic devices:  your phone, your computer, your tablet, your TV, and any LED or fluorescent light source.  Blue light is an increasingly large part of our world, but what is it potentially doing to our bodies?

How does your body know when it is time to sleep?  The body's sleep cycle is governed by melatonin; higher levels in your body induce sleep.  Melatonin release is triggered to a large degree by light -- darkness causes an increase in melatonin, and light reduces the amount in circulation.  But different wavelengths of light seem to have different potency.  Blue light (like that emitted from electronic devices) has a more potent effect than other wavelengths, dampening the melatonin response more than longer light wavelengths like red (which you would find in firelight).

What does all this mean to you?  The longer you are exposed to light, and especially blue light levels, the less your body will signal to sleep.  Sleep is important to repair the bodies daily wear and tear, and we don't know all the benefits that really occur for brain function (so much for us to still understand).  But we all know how much a good night's sleep can mean for the next day's performance.  Reduced sleep has been linked to depression, obesity, heart disease, diabetes and even cancer!

Blue light may have an even bigger impact on eye health specifically.  Short wavelength light (like blue) has a higher impact on damage to ocular tissue like the retina and the lens.  This increases the rate of cataract formation, and is associated with higher rates of macular degeneration in studies performed with rats.   We all know the dangers of UV light, and the importance of wearing sunglasses, but are any of us thinking to wear sunglasses while on the computer for long hours?  New studies are showing us it is time to rethink our eyes' health needs and what we can do to protect the eyes from blue light damage.

So what can we do?

f.lux is a free Windows download that changes your computer monitor's color display to match the surrounding light levels of the time of day.  The premise here would be to reset your body to normal melatonin secretion timing by matching your computer to surrounding daylight.  The computer screen will be brighter in morning, and reset to low and more red wavelength light in the evening to encourage melatonin release so that you can get a great night's sleep.

To protect your eyes from potential blue light/short wavelength UV radiation effects, we need a UV protective lens.  Sunglasses are typically much too dark to wear at the computer screen, but even clear lenses can be made with a large degree of UV protection.  Materials like polycarbonate have innate UV protection (and are shatter resistant).  In addition to most quality prescription glasses being made from polycarbonate, more and more electronic devices may be making the switch.  Nokia phones already use polycarbonate screens, and the iPhone 5c is slated to do so as well.

Gunnar Lenses are marketed towards computer and video game users to increase comfort and block out that detrimental blue light!

For maximum blue light protection, yellow tinted lenses are your best choice.  Yellow filters block blue light out of the spectrum and let yellow (lower wavelength light) pass through.  If you have had cataract surgery, you may notice that the implant that they put inside the eye often has a yellow tint for this protective reason.  And yellow tinted lenses also have an added plus of increasing contrast and decreasing glare at your computer screen, making them ideal for computer use!

The new year has started, and that means back to work for everyone.  For many of Americans, that means back to the computer screen, spending 8-12 hours a day with non-stop computer use.  And then, yes, we go home and typically unwind with computer use (or iPad or cell phone).  So what is all of that computer time potentially doing to your eyes?  This month I am devoting multiple posts to computer vision -- how to maximize your computer vision and comfort, and possible solutions for common computer complaints with the eye.

Look for posts in the next few weeks devoted to solutions for these common computer issues:

• Tired eyes, eye strain
• Dull pain behind the eyes
• Double vision
• Eyelid twitching
• Blurry vision, either at the computer screen, or driving home at the end of the day
• Blurry vision that clears between blinks
• Red eyes, burning, stinging, watering, dryness

It's been an exciting (and quickly growing!) year with Eyedolatry, and I just wanted to thank all my regular readers, and those who stumbled upon this blog just wondering what was wrong with their eye. Reading your comments and the search key words that brought you to my blog has been so enlightening and inspiring!  For all of my fellow optometrists (or optometry students) reading this blog, you may be surprised by the topics that most people are searching for.  Here's a review of the most popular search topics from Eyedolatry in 2013:

• Conjunctival Cyst -- That's right, out of all the life and vision threatening conditions that most optometrists would suspect patients are concerned about, conjunctival cyst is the most common medical search word bringing patients to the blog.  In fact, conjunctival cyst, and conjunctival cyst treatment are 2 of the top 10 most frequently searched entries!  Am I the only one that finds this amazing?
• Dailies Total 1 -- Since Ciba launched its revolutionary new water gradient lens material, this contact lens has been a consistent source of inquiry.  In fact, it has surpassed NBA Glasses as my most popular all time post.  People want to know what makes these lenses different, and what exactly are they going to cost them.  Bausch and Lomb's Biotrue One Day was the second most popular contact lens related post of the year.  It is great to see more people interested in dailies, and I hope that trend continues.  Currently only about 12% of Americans are enjoying the advantages of single use contact lenses. I would love for us to see Americans being fit in the safer, healthier, and more comfortable daily modality at the rate that Japan and European countries currently achieve (reported at around 40%)!
• Contact Lens Health and Safety -- Another popular search item is contact lens wear complications.  You don't know how many times I see "Can I sleep in Acuvue 2" pop up in my search item history report.  I am so glad that patients want to ask this, but I am guessing since Acuvue 2 is such an old contact lens (launched by Vistakon in 1999), that patients are searching this because they have been doing it for years, and are just now being told not to.  I wish there was a way I could contact Google and when someone typed that into a search engine, it would just give them an immediate pop-up answer, of "Please, please don't.  Your eye doctor begs you not to."  Congratulations to all those people though who are rethinking the amount of abuse their corneas have been taking for the last 14 years!  
• Enchroma Color Blindness App -- This was a huge surprise to me.  When I first posted about the Enchroma App I figured it would generate basically no interest (that's what I assume about most of my post topics haha).  But people are searching for color blindness testing at a surprising rate.  Maybe its just a fun thing to test out while you are sitting at home watching TV, but I may start pulling out my Ishihara plates more frequently in the exam room.
• Concussions and the Eye -- This is a topic near and dear to my heart, and if you are one of the thousands of people that have clicked on my post about the side effects of concussions, I encourage you to also click over to my colleague's website, See to Play.  Dr. Peters is the optometrist to the Carolina Hurricanes hockey team, and routinely posts about concussion rehabilitation.