When I'm examining the front surface of the eye in the slit lamp microscope, I'm carefully evaluating your eyelids, lashes, conjunctiva, and cornea.  The cornea is the clear tissue that acts as the window for light entering your eye -- because it is clear light penetrates unobstructed through your pupil and onto the retina for visual processing.  But when the cornea is not clear, this can greatly impact vision and ocular health long term.  Scars, corneal degenerative conditions, inflammatory events, or oxygen deprivation can all permanently cloud the cornea.  These areas of cloudiness generally aren't reversible, but  if it has happened already to you, it's your doctor's job to make sure that you know everything you need to do to prevent further corneal opacification (cloudiness).  A real common finding I see in the exam chair looks like this:

The above picture shows pannus caused by contact lens overwear/abuse.

Do you see that whitened spot at the bottom of the cornea?  There are little blood vessels inside which you can faintly see within the whitened portion.  This is a mild case of corneal pannus, about 1 mm in size which is what I will often see in my patients.  Pannus is growth of vascularized tissue within the otherwise avascular cornea -- to make that simpler, you have blood vessels growing into your cornea which causes a cloudy/whitened area within a tissue that is ideally perfectly clear for maximum light penetration.

What Causes Pannus?

1. Oxygen Deprivation From Contact Lens Wear: When you wear contact lenses, the material each lens is made from has a certain number of oxygen particles that can pass through the material in a given time.  This breathability score is called Dk/t and a quick google search can tell you what the oxygen transmission is for your current contact lens brand.  Most of today's most popular multiple wear lenses have really high Dk/t scores -- many over 100 units which is very highly breathable.   But if you don't throw your lenses away at the appropriate time, or you sleep in your contact lenses when you don't have the proper lens to do so, you are risking starving your cornea of that vital oxygen it needs. If the body let's your cornea starve for oxygen underneath your lenses, your cornea will die -- that means blindness!  Instead, it tries to save you by shooting blood vessels from the conjunctiva or the white of the eye into the cornea to help get by, but the result is pannus -- a permanent cloudy place that you will never be able to see through again.   When your doctor sees pannus they know that your contact lens habits aren't working for you -- that means changing to a higher oxygen lens material, changing your wear schedule, or if severe enough you may have to permanently change to glasses wear only.

   Much more severe pannus in a patient with limbal stem cell deficiency via

2. Chronic Inflammation: Not all of my patients with pannus are contact lens abusers.  Many of them suffer from chronic inflammatory conditions like dry eye, previous severe viral infections of the cornea, or injuries like burns.  Pannus is like scar tissue, showing areas that have been damaged by acute events or chronic irritation.  What's going on in dry eye that could cause this kind of damage?  Your tear film is the cornea's only protection from the harsh outer world -- ceiling fans, vents, bright sun, staring at the computer or your cell phone for hours at a time.  It's a hard world out there.  When you don't have an adequate tear film, your cornea is exposed to these harsh environments, and additionally the tissue begins to become inflamed.  Dry eyes are red and irritated because of the inflammation they are associated with -- the lower tear volume on your eye's surface means an excessive amount of inflammatory mediators hanging out on the eye.  Their job is to trigger your eyes to start watering to put moisture onto the eye when it is needed, but with that watering comes more inflammatory mediators and you enter a feedback circle of continuous eye irritation.  When I see pannus in a patient with ocular rosacea or dry eye, it means that we need to significantly increase lubrication with eye drops or gels, and it's probably a great time to consider a topical anti-inflammatory like Restasis or pulses with steroids like Lotemax or Alrex.

You've probably heard of Latisse, the eyelash growing serum that was discovered when glaucoma patients taking prostaglandin analogue eye drops had the desirable side effect of longer, thicker eyelashes.  But there's new research showing that not only can prostaglandins make your eyelashes fuller, they can also penetrate the skin and reduce under eye puffiness too.  XAF5 is a topical ocular ointment made by Topokine Theraeutics derived from prostaglandins that specifically targets under eye bags. XAF5 breaks down subcuntaneous (under the skin) eyelid fat that causes those pesky puffy under eye bags, or steatoblepharon in the dermatological world.  The ointment works by penetrating through the skin and binding to fat cells, shrinking them in size and also preventing new fat cell formation.

via 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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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

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

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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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

The biggest trend for eyewear this year?  Make a statement.  There's no denying the most buzz-worthy eyewear this year has been daring and different.  Eyewear collections for 2015 have been all about pushing your fashion limits and taking a chance on glasses that will start a conversation.  I've rounded up the top trend-setting designer looks for 2015 so if you are thinking it's time to invest in the next generation of eyewear, here's a good starting-off point.

Miu Miu Rasoir Sunglasses via

Valley Eyewear "A Dead Coffin Club" via

Gentle Monster Trinity Sunglasses via  (unfortunately the Trinity model is out of stock but check out their other reimagining of classic eyewear shapes below!!)

Dior So Real Sunglasses via

Round Ray Ban sunglasses via

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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.