Eyedolatry

Five Things You Didn't Know About Pink Eye

AdenoPlus 7:00 AM

1. You probably don't have a bacterial infection. If you've been diagnosed with pink eye (acute conjunctivitis) the far and away most likely cause of your infection is a virus. Research suggests that as much as 80% of acute conjunctivitis episodes are viral. Bacterial conjunctivitis is significantly less likely, which is why the use of antibiotics when diagnosed with pink eye is very controversial (using antibiotics when you don't have bacterial infections increases the risk of resistant bacterial strains).

2. Yes, you should see an EYE doctor. Your eye doctor can tell the difference between viral, bacterial, and other types of conjunctivitis, but getting the proper diagnosis elsewhere will be a challenge. A 2008 review study reported that in primary care facilities conjunctivitis is correctly diagnosed less than 50% of the time. In order to determine the nature of your eye infection, a doctor needs specialized equipment that just won't be found at your primary care or urgent care facility. The good news: your eye doctor can tell which type of infection you have by using the slit lamp microscope and sodium fluorescein dye staining to assess the conjunctiva and cornea. They may even have a test for viral ocular infections called AdenoPlus that confirms adenovirus strains found in many viral infections with a quick n-office sample. Head to this post to learn more about the difference between the appearance of viral and bacterial conjunctivitis.

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Viral infections classically have follicular reactions in the palpebral conjunctiva. With a slit lamp microscope your eye doctor can tell the difference between follicles (a lymphatic reaction) seen here above, versus papillae (an allergic or bacterial sensitivity reaction) seen below that is more classic for allergies or bacterial conjunctivitis. Can you see the difference?

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3. If you are feeling miserable, puffy, and swollen during your battle with pink eye, you aren't being dramatic! This MRI of a patient with viral conjunctivitis in his right eye shows there is significant swelling of the soft tissue around the eye's orbit. The top and bottom eyelids, the lacrimal gland (which rests just under your eyebrow), and the nasolacrimal duct (the eye's drainage system) all show marked inflammation on this imaging. No wonder viral conjunctivitis feels so miserable. Due to the significant swelling seen on this imaging, doctors consider treating the symptoms of viral conjunctivitis with steroid eye drops more warranted in patients with significant complaints.

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4. You'll get better (eventually) without treatment. Viral conjunctivitis infections are typically self-limiting, resolving full within 1-2 weeks. Your body's immune system fights off the infection just like when you have a common viral cold. That's why the most common treatments for conjunctivitis involve cool compresses and frequent artificial tear use. The infection itself is highly contagious, so frequent handwashing and avoiding directly touching others for the first 7 days is the best way to prevent spreading the virus to family, friends, coworkers, and your other eye. Because the symptoms can be so severe (see Bob Costas' epic pink eye debacle from the 2014 Winter Olympics as a case in point), many doctors do offer treatment with topical steroids to reduce the swelling and redness, but these drops won't fight the viral infection or make you less contagious in any way. Additionally, treating viral infections with antibiotics won't help treat the virus you have, but some doctors will prescribe these if they feel your risk for a secondary bacterial infection is high (lowered immune system, patients at risk, etc).

Many people wondered why Bob Costas didn't get treatment for his eye infection and missed a good amount of his Olympic broadcasts. Viral infections have no anti-viral treatment so he was forced to wait it out, but perhaps steroid eye drops would have made him more comfortable during the ordeal. via

5. Not all viruses are created equal, and not all are self-resolving. In 1.8 to 2.3% of acute red eye infections, the underlying culprit is the highly dangerous herpes simplex virus. This type of viral infection does necessitate prompt treatment -- permanent corneal damage and blindness is a possibility. So how do you know if you have the more common, self-limiting viral conjunctivitis that just needs palliative treatment, or this much more aggressive viral infection? This is where a trip to your eye doctor is essential! Herpetic infections typically have tell-tale corneal and eyelid lesions that will allow your doctor to prescribe the proper medication. If you have scabby, crusty lesions along your eyelid or face or blurry vision and a concurrent red eye, you need to see a doctor immediately!!

Herpes Simplex Keratitis has tell-tale corneal dendritic lesions that your eye doctor can find when they use sodium fluorescein dye staining. Just one of the tools that your eye doctor has the probably won't be found at urgent care. via

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MyDay: New Daily Disposable Contact Lens Review

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For the last few years if you wanted the ultimate contact lens for all day comfort, you've probably been wearing Dailies Total 1. There have been several new lenses to launch since then, but in my opinion none of them came close to competing with Dailies Total 1... until now. CooperVision's new MyDay daily disposable lens offers fantastic comfort and clarity, and will definitely become an active competitor to Dailies Total 1's current spot on the top of the contact lens heap.

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The Lens:

MyDay is a silicon hydrogel daily disposable lens, meaning it has higher oxygen transmissibility than many other daily disposable lenses on the market. This is a great health point for people with previous history of eye infections or corneal neovascularization or scarring from prior contact lens issues. The health benefits of this higher breathability puts this lens in a top lens safety category with Dailies Total 1 and Acuvue TruEye. The lens material itself is incredibly thin and lubricious -- when placed on your eye it truly does have that "I don't feel like I'm wearing contact lenses" feel.

Base Curve: 8.4 mm

Diameter: 14.2 mm

Power Range: +6.00 to -10.00

Dk/t: 100

Head to head this lens fits very similar to Dailies Total 1 with a steeper base curve and typically very little movement on the eye with blink (creating excellent comfort). A big pro for MyDay is that it is available in plus powers; Dailies Total 1 is still currently only available in -0.50 to -10.00. Another real advantage to MyDay is its' aspheric optic design, meaning that the lens corrects for the average cornea's "higher order" aberrations -- irregularities that bend and bounce light, disrupting the crispness and clarity of your vision. Corneas with low amounts of astigmatism or corneal irregularity could potentially achieve better vision in a lens with aspheric optics. Update: I wore this night driving recently on a dimly lit highway and was really impressed with the quality of my vision compared to my other two favorite contact lenses for comfort, Dailies Total 1 and Acuvue 1 Day Moist. Just remember, aspheric optical designs can give better vision to some by adjusting for the normal light bouncing aberrations coming off an average cornea , but if your cornea is not average, then it may not give you noticeable vision changes.

My Review:

If you read my rave reviews about Dailies Total 1 back in 2013, you know what a big fan I am. I honestly didn't think that my contact lens wearing experience would be matched by any new product. But in my personal wearing experience, MyDay was at least as good on comfort, and just a little better on clarity than Dailies Total 1. The lens stayed comfortable well into my 16 hours of wear, and I never had to use moisturizing drops or manipulate the lens under my eyelids to rehydrate. I found the lens material to feel very similar to Dailies Total 1, so if you are someone who had difficulty with removing Dailies Total 1 lenses, it is possible that you may have the same experience with MyDay. Both of these lenses have low modulus materials (meaning they are very flexible and bend to the shape they are touching) and very high lubricity -- your fingers will glide right over them if they are wet when you try to remove the lens. You also won't be able to easily slide the lens around on your eye -- your fingers are more likely to slide on the lens surface than you are to move the lens around without the proper amount of force. If you are having difficulty with removal it is best to let your doctor know so they can help teach you the proper technique for removing these more "slippery" lenses. The real pro to this more lubricious lens texture is that on your eye, your eyelids will glide right over the lens surface too, meaning that you will have that fantastic "am I wearing a contact lens??" feeling.

I thought the "Instantly Forgettable" marketing campaign is a cute touch -- and at least in my experience, it definitely held true :) via

I tried to think of at least one potential con about the lens, and the only thing that really comes to mind is that the handling tint is really faint. It will be a challenge to see the edges of this lens (especially if you have a high prescription!) to determine if the lens is inside out, and it will be hard to spot this lens if you drop it by mistake.

Because of the very low material modulus, the lens should properly fit a variety of corneal curvatures despite the steeper base curve. Lower modulus materials drape and form easily to surrounding surfaces, meaning that even though the lens comes in only one base curve and diameter, it can potentially properly fit many different corneal shapes and curvatures. Your doctor will carefully assess to make sure this lens is a proper fit for your cornea during your contact lens evaluation.

Have you tried MyDay yet? I'd love to hear your opinions and thoughts about this exciting new product!

I am not affiliated with CooperVision in any way, and this is not a sponsored post. All opinions provided are from my own personal wearing experience.

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Weird /Eye/ Science

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Rounding up some interesting new research published this week!

Can a Glaucoma Eye Drop Help Treat Tuberculosis?
New research out of Michigan State University found that ethoxzolamide, a carbonic anhydrase inhibitor found in glaucoma eye drops like Azopt (brinzolamide) may reduce the virulence of Mycobacterium tuberculosis. The drug makes it difficult for the TB bacteria to grow in it's host environment, and prevents it from being to grow within our body's immune system white blood cells -- increasing our body's ability to fight off the infection. When coupled with existing antibiotic treatments, the use of ethoxzolamide could potentially reduce the risk of drug-resistant TB strains, and shorten the duration of antibiotic treatment needed to fight the infection. All carbonic anhydrase inhibitors carry the potential risk for cross-sensitivity in patients with sulfa allergies.

Can an Eye Drop Dissolve Cataracts?
This article has been taking the internet by storm! Researchers studied a family in China with three children who were born with severe cataracts and found that the children lacked a gene to produce a steroid called lanosterol. Theorizing that the absence of lanosterol could be the cause of their cataract formation, the researchers then put the steroid to work on rabbit cataracts. Rabbit lenses with various stages of cataract severity were incubated in a lanosterol solution for 6 days. In that time significant improvement in clarity or resolution of cataract altogether was observed. With such promising results in vivo testing was then performed on dogs with cataracts receiving lanosterol drops -- again with statistically significant improvement in lens clarity on the test subjects. Lanosterol plays a role in preventing protein aggregation, which could help reduce the cloudiness and vision distortion associated with cataract formation. We are still a long way from having human results to know if this is truly an efficacious and safe way to approach cataract care, but perhaps in the next few decades prescribing eye drops for cataracts will be a common treatment?

Dog cataract before (left) and after (right) lanosterol treatment via

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Trend-Setting Sunglasses 2015

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The Truth About Mascara

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I stumbled across a recent blog post on Man Repeller that posed a simple question: does mascara make your eyelashes fall out? The piece kind of jokingly implies the concept is a con used by the author's mother to make her wash her face before bed. But guess what, our mothers were right and there is science to support that all those terrible things you've been told about mascara, well they aren't just old wive's tales after all.

A study published in 2013 followed 130 students (average age around 23 years old) over the course of 12 months of mascara wear. Study participants ranked themselves as either daily mascara wearers or occasional users. No brand of mascara was specified but patients were asked whether their brand of choice was normal or waterproof. The patients also were asked to record the products they used to wash their mascara off at night, and any eye symptoms that they experienced (itching, redness, irritation, etc). 31% of all study participants had eye irritation during the course of the 12 month study, and 19% of all study participants had eyelash loss or fall out during the course of the 12 month study. There were several behaviors that were significantly more associated with eyelash loss (milphosis):

30% of daily mascara users experienced eyelash loss or fall out; only 13.6% of occasional mascara users reported lash loss
60% of daily mascara users experienced ocular irritation or discomfort (redness, itching, pain, etc) versus only 27% of occasional mascara wearers
there was no increased incidence of eyelash fall out between waterproof and normal mascara
using water to clean off waterproof mascara did increase the risk of lash fall out (26.6% of participants using this combo had lash loss)

We use mascara to help augment short of missing eyelashes,
but studies do show that the more often you wear mascara,
the more likely you are to experience eyelash fall out! via

Looking at the data, it was clear that daily mascara use was associated with significantly higher risk for eyelash loss and eye irritation. Not surprisingly, participants wearing waterproof mascara that tried to clean their eyes with water based cleansers had a lot more lash loss, likely due to the excess mechanical rubbing the user had to use to clean away this more resistant product. If you prefer waterproof mascara, using specific eye makeup removers or oil based cleansers will cause a lot loss irritation and lash trauma, and could help save you from excessive eyelash loss.

But How Often Should I Really Be Tossing My Mascara?

This is one that many people seem to be unsure about and a quick internet search of beauty websites will have some people dangerously espousing using their mascaras for 6 months or even a year at a time. Doctors recommend 3 months as the proper lifespan for mascara, and this study explains why in very clear numbers. The study followed 40 women aged 18 to 39 who were randomly assigned to two different brands of simple (nonwaterproof) mascara with daily use. After 3 months, the mascara tubes used were collected and cultured for microorganisms. Over one third (36.4%) of the collected tubes were contaminated after 3 months, with the most common isolated microbes being Staphylococcus epidermis, Streptococcus, and even some species of fungus (really scary to have around the eyes because fungal eye infections can be so difficult to treat!!). Based on this study, researchers recommend that 3 months is the maximum lifespan to consider for a tube of mascara, but further data may suggest we should dispose of it more frequently in such high risk patients are contact lens wearers or the immune compromised due to the high risk of contamination in that time.

Take Home

Mascara is one of the most popular makeup products on the market, but it carries many real associated risk factors. Making sure that you dispose of your mascara regularly (at minimum every 3 months!) and using the right cleaning products with your mascara type can help reduce your risk for eye irritation and eyelash loss. But if you are someone that suffers from chronic eye infections, chronic redness, dryness, or irritation to your eyes or eyelid skin, or constant eyelash fall out, you may want to skip mascara all together to give your eyes the best chance for a healthy ocular surface.

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What's Happening to Our Vision? Light's Impact on Myopia

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If you are just joining us in our conversation of current working theories for why myopia (near-sightedness) is becoming so much more prevalent in modern society (an increase of 66% since the 1970s!) then check out our previous articles on peripheral defocus theory and near point stress theory. Remember all of these theories are not meant to stand alone -- our eyes develop over many years into adulthood, and in addition to genetics there are definitely strong environmental factors at play in determining the prescription we end up with. Today we're discussing some really intriguing research that is surprisingly simple; how can light change how our eyes develop?

The average US classroom is a dim place -- set around 500 lux on average,
but recommended light settings can be around 300 lux for activities like
computer and projector use. image via

More Time Outside is Correlated with Better Vision

For years we looked for an answer to why children became nearsighted in handheld activities. Book reading? Computer games? Cell phones? But study after study showed that these activities didn't strongly correlate with a child's prescription. In 2007 a study published in Investigative Ophthalmology and Visual Science opened up a new line of thought -- it wasn't the specific activity the child was doing that was associated with myopia, it was the amount of time they spent doing any activity indoors versus outdoors. Researchers followed 514 students from 3rd through 8th grade via surveys that asked parents to report the number of hours a child spent doing different activities and their yearly prescription found at an eye exam. Any Rx of -0.75D or more counted as myopia. 26% of the students followed became myopic by 8th grade, and the only survey target that strongly correlated with which children ended up nearsighted by the end of the study was the number of hours spent outside or in outdoor sports. Kids that didn't become myopic during the course of the study spent an average of 11.65 hours outdoors each week, while myopic kids spent an average of only 7.98 hours a week outdoors.

What's Going On in the Eye?

Why would spending more time outdoors and not specific activities affect how our eyes develop? Outdoor light exposure triggers release of retinal dopamine, a neurotransmitter that helps photoreceptor cells respond to light stimulus. When dopamine levels within the eye drop, studies in animal models show that the eye enters a cycle of growth or axial lengthening. The longer the eyeball grows, the more nearsighted the eye becomes. Chick model studies show strong relationships between eye development and dopamine amounts within the retina. When newborn chicks were raised with one eye covered for the first 7 days of life, that eye had significantly lower dopamine amounts within the retina than the fellow, open eye. Interestingly, if the goggle was removed dopamine levels rose to equal amounts as the fellow eye in just 2 days, leading to an idea that it may be possible to treat myopia by increasing dopamine levels within the retina if done early enough in development. Another study in chick models shows that changing dopamine levels within the retina can begin influending choroidal thickness within just 3 hours, meaning that dopamine levels can have a big effect on how quickly the eye lengthens in young and developing eyes.

A glass classroom in Yangxi City, China via

The idea has taken off so well that in Asian countries where myopia occurs at a rate of as much as 90% of school age children, outdoor classrooms with glass walls and ceilings are being implemented to extend the number of hours kids are outside without sacrificing learning time in the classroom. In Taiwan, a small study yielded promising results -- kids that spent 80 minutes outdoors had a rate of myopia development of only 8% while a cohort group under normal classroom environment conditions had an 18% rate of myopia development that year.

How much sunlight does your child need?

This is a question that we are far from answering, but studies are suggesting a good starting place. Dr. Ian Morgan is the lead researcher behind China's outdoor classroom project, and recommends 3 hours per day of light at least 10,000 lux for children to help prevent myopia. 10,000 lux isn't full, mid-day sun -- it's equivalent to a shady spot under a tree or an overcast day. But by comparison, an average classroom or office workspace only has around 500 lux. That's a huge difference in ambient light level, even though we often imagine that a lit room indoors would be brighter than reading a book outside in the shade. As larger and more investigative studies are performed, we may even see changes in classroom lighting requirements to better mimic the luminance of natural, outdoor light. Some research is even being done to investigate the use of 10,000 lux lamps commonly used to help treat Seasonal Affective Disorder, but there are always worries about the danger of UV exposure and its risk for retinal damage. We don't yet know how much light is safe without permanently damaging the eye, so at this time it is best to recommend spending more time outdoors, but also being proactive about UV protection with sunscreen and sunglasses. A study of over 1,000 young adults aged 19 to 22 in Australia confirmed that eyes that were more myopic had statistically significant less sun damage found via UV photography of the conjunctiva than the persons whose eyes had better vision. Right now researchers are having to balance the pros and risks of increasing exposure to UV light, so more studies are definitely needed before we see a blanket recommendation for hours in the sun.

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Restasis More Effective Than Doxycycline for Ocular Rosacea

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Does this look like your eye? A little red, a little irritated, red rims along
the lash margin? That's the calling card of chronic inflammation caused
by ocular rosacea (a type of chronic dry eye). via

Do you have red rimmed eyes and eyelids? Suffer from recurrent styes? Watering? Burning? Foreign body sensation? Puffy eyelids? Light sensitivity? If you answered yes to a few of these questions, chances are you have a type of inflammatory dry eye condition we refer to as ocular rosacea. Ocular rosacea is a very common finding; studies suggest the incidence of ocular rosacea could be as high as 72% of patients with rosacea, and many of us with rosacea are undiagnosed (Chronic facial redness and flushing? You've probably got it and just haven't been formally diagnosed!). For years we've been treating ocular rosacea-related dry eye with lid hygiene, artificial tears, and more recently pulsing doses of oral doxycycline used to target inflammation more-so than for any antibacterial properties. But a new study published in the International Journal of Ophthalmology last month suggests that Restasis, an anti-inflammatory eye drop used for treating dry eye, may be even more effective than our current gold standard treatment of oral doxycycline pulsed for months at a time.

The study followed 38 patients with diagnosed rosacea and ocular rosacea signs and symptoms. The group was split evenly with 19 patients being started on Restasis eye drops taken twice daily for 3 months, and the other 19 patients being placed on 100 mg oral doxycycline taken twice daily for one month, then once daily for the two months. All patients were instructed to use daily eyelid hygiene and artificial tears 4 times a day throughout the study period. Before the study began and then monthly thereafter, patients were scored on symptoms (burning? watering?) and clinical signs (eyelid redness? corneal staining?) by a group of ophthalmologists. Standard protocol dry eye testing was also performed at these visits, including OSDI surveys, Schirmer's Test and tear break up time.

Symptom, eyelid sign and corneal/conjunctival sign panel of patients in cyclosporine and doxycycline treatment groups at baseline and 3mo after treatments

Patients' signs and symptoms	Restasis (n=19)		Doxycycline (n=19)
Patients' signs and symptoms	Baseline	3mo after treatment	Baseline	3mo after treatment
Symptoms
Burning	19 (100.0)	4 (21.1)	19 (100.0)	14 (73.7)
Stinging	19 (100.0)	9 (47.3)	19 (100.0)	14 (73.7)
Itching	11 (57.9)	4 (21.1)	16 (84.2)	8 (42.1)
Photophobia	19 (100.0)	2 (10.5)	18 (94.7)	4 (21.1)
Redness	18 (94.7)	4 (21.1)	19 (100.0)	9 (47.3)
Blurred vision	8 (42.1)	1 (5.3)	6 (31.6)	1 (5.3)
Watering	17 (89.5)	6 (31.6)	17 (89.5)	6 (31.6)
Pain	11 (57.9)	1 (5.3)	7 (36.8)	4 (21.1)
Lid swelling	10 (52.6)	0 (0.0)	6 (31.6)	2 (10.5)
Eyelid Signs
Meibomian gland inspissation	19 (100.0)	8 (42.1)	19 (100.0)	14 (73.7)
Blepharitis	18 (94.7)	3 (15.8)	19 (100.0)	10 (52.6)
Lid margin telangiectasia	14 (73.7)	3 (15.8)	17 (89.5)	11 (57.9)
Hordeola/chalazia	4 (21.1)	0 (0.0)	5 (26.3)	0 (0.0)
Lid margin irregularity	12 (63.2)	3 (15.8)	11 (57.9)	5 (26.3)
Corneal /Conjonctival Signs
Conjuctival hyperemia	19 (100.0)	5 (26.3)	19 (100.0)	12 (63.2)
Punctate keratopathy	18 (94.7)	0 (0.0)	15 (78.9)	0 (0.0)
Corneal vascularization	3 (15.8)	3 (15.8)	2 (10.5)	2 (10.5)
Episcleritis/scleritis	17 (89.5)	2 (10.5)	18 (94.7)	3 (15.8)
Corneal infiltrates	3 (15.8)	1 (5.3)	2 (10.5)	1 (5.3)
Corneal ulceration/perforation	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)

The table above breaks down the results. Of note, 100% of patients prior to the study had burning and stinging complaints, redness of their conjunctiva (white of the eye), and clogged meibomian glands (inspissation -- see image below!). Based on the difference in signs and symptom scores from baseline to 3 months of treatment, Restasis users had statistically significant more effective relief of both their ocular symptoms and their eyelid signs as compared to the doxycycline group. Corneal signs did not differ between the treatment groups by a statistically significant amount. There was also no statistically significant difference in the improvement in Schirmer and TBUT scores between the two groups -- both groups showed improvement in scores from baseline, though the Restasis group did have a higher mean improvement in those scores.

Red, inflamed meibomian glands can't secrete tear film regularly as you blink,
causing dryness, burning, watering, and foreign body sensation. That's
why a vital part of dry eye treatment includes lid hygiene and chronic use of
anti-inflammatory medications, be they topical like Restasis or oral like doxycycline.

In addition to better performances in several categories of dry eye assessment, Restasis also has the luxury of having a better safety profile. The most common side effect of Restasis is burning upon instillation, while oral doxycycline has the risk of causing increased risk for sunburns and stomach upset. Neither Restasis or doxycylcine can be used in pregnant or nursing mothers. Because rosacea as a condition is chronic, using a drop like Restasis year round may be better suited than intermittent doxycycline pulses to control symptoms long term. Another point of interest is that studies repeatably show Restasis performs even better at month 6 and month 12 than it does after just 3 months of use, so if the study had been extended out it would be interesting to see if Restasis users continued to have larger and larger improvements.

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