A year ago (March 27, 2016), a new law came into effect regarding patients medication prescriptions.

E-Prescribe is a government mandated use of an e-prescribing system. The system transmits your prescription electronically, directly to your pharmacy. The systems warn prescribers about potential allergic reactions and if there are generic alternatives, if the patient was already given the medication by another physician (duplication), or if they still have refills left on an original prescription.

Your name, address, date of birth, sex are sent on the electronic prescription which takes the place of a paper prescription. You no longer receive a paper prescription to take with you to the pharmacy.

Within 10 minutes of the prescriptions transmission, it arrives at your drug store and depending on the speed of the pharmacist, your prescription may be waiting for you when you arrive.

Recently, we were lucky enough to be able to watch a solar eclipse here in the Northeast part of the United States.

Unfortunately, quite a number of people did not pay attention to the warnings given and actually looked up at the sun. I saw a number of new patients with eye problems caused by doing just this.

Solar retinopathy is when the retina receives ultraviolet light and is actually burned, much like a rapid sunburn. Patients were reporting seeing blurry after the exposure, or seeing a small spot in the middle of their vision that made it hard or impossible to see what was directly in front of them.

The other problem that comes from having looked at the eclipse is photokeratitis which is like a sunburn of the cornea. This is a very painful condition because of the huge number of nerve endings in the cornea. This can also occur when you look at a large area of snow on a very sunny day.

If you or a loved one has looked at the eclipse and is suffering from any of the above mentioned symptoms, you see an ophthalmologist as soon as possible.

What Do I Need To Know About Glaucoma?

From: “The Eye of A Surgeon”, by Dr Cynthia J MacKay

What is glaucoma?

You will damage your tire if the pressure is too high. The same is true of your eye. If your eye has a pressure that is too high, it will start to go blind. The higher the pressure, the faster you will lose your sight.

What determines the pressure inside my eye?

Your eye is like a tiny bathtub with a tap that is always on. Night and day, a clear fluid, called aqueous humor or, simply, aqueous, is produced by your ciliary body. This aqueous circulates constantly through the anterior chamber of your eye. Its task is to nourish your cornea and lens by bringing in sugar and oxygen, and taking away wastes.
Aqueous humor leaves your eye by going through a slot between the front of your iris and the back of your cornea, called your angle, into a tiny sieve, called your trabecular meshwork. This leads into a small drain, called Schlemm’s Canal, which finally empties into the small veins on the surface of your eye.

Why would the pressure in my eye go up?

Normally, inflow equals outflow, so that the pressure inside your eye, which is measured in millimeters of mercury, will be maintained between 8 and 22. (In some people, “normal” can be as high as 24 or 25).
Glaucoma is caused by a bad drain. If the aqueous humor does not drain out of your eye as fast as it is produced, your eye pressure will go up, and you will develop glaucoma.

What causes glaucoma?

Most glaucoma is hereditary.
If you have a close relative with glaucoma (a parent, or grandparent, a brother or sister) your risk of getting glaucoma doubles.

How common is glaucoma?

Glaucoma is the number two cause of blindness in the U.S. It is the number one cause for African-Americans, who tend to get the disease younger and more severely.
At least 2 million Americans have glaucoma. At least 80,000 have been blinded by it.

How does glaucoma make people go blind?

When your eye is struck by light, your optic nerve carries a signal from your eye up to your brain. This allows you to see. You can think of your optic nerve as an electric cord running to a lamp: the lamp could be working, but unless the cord is also functioning the lamp will not give out any light.
Your optic nerve is very sensitive to pressure. If the pressure inside the eye is too high, your nerve will begin to die. Like all nerves, once it is damaged it never completely recovers. As it dies, you will begin to go blind; first you will lose your peripheral vision, and, finally, your central vision will disappear.

How will I know if I have glaucoma?

You will not.
Glaucoma has been called the“sneak thief of sight”. If the pressure inside your eye goes up gradually, which is the case at least 95% of the time, you could have a pressure that is 2 or 3 times normal and not feel a thing.
Remember: peripheral vision is the first to go in glaucoma. By the time you begin to notice blank areas in your sight, 85 to 90 percent of your optic nerve will have been destroyed.
Only your ophthalmologist can tell you whether or not you have glaucoma. If you visit your ophthalmologist every 2 years when you are under the age of 40, and every year after you are 40, if you develop glaucoma it will be diagnosed at an early stage, and your sight will be saved.

What are the most common types of glaucoma?

70% of all adult glaucoma is PRIMARY OPEN ANGLE GLAUCOMA, or POAG. In POAG, the drain is open, and looks completely normal, but it does not work well.
We have recently discovered the abnormal protein that progressively clogs the drain in certain families with hereditary glaucoma.
There are two variants of open angle glaucoma where the drain does not look normal. In pseudoexfoliation glaucoma, common in Scandinavia, flakes of abnormal material shred off the lens and collect in the drain. In pigmentary glaucoma (which can occur in near-sighted people) the drain is blocked by pigment that rubs off the back surface of the iris.

In LOW, or NORMAL TENSION, GLAUCOMA (LTG or NTG), the pressure is consistently below 21, yet the optic nerve suffers damage, probably because it is unusually susceptible. In these patients, the pressure must be reduced drastically, to the low teens, to prevent further damage.

About 5% of glaucoma is ANGLE CLOSURE GLAUCOMA. This usually occurs in far-sighted people, who have small, short eyes and therefore shallow front chambers of their eyes.
In angle closure glaucoma, your angle is narrow, but open, at birth. As you get older, your lens gets bigger and bigger. Eventually, it pushes your iris so far forward that it blocks your trabecular meshwork, just like a washcloth might block the drain of a bathtub, causing your drainage angle to close.
The angle usually closes suddenly, so your eye pressure shoots up quickly. This high pressure causes acute, severe pain, so bad that you may vomit. Your vision gets cloudy, because your cornea fills with fluid. The eye gets red, especially right around the iris. This is a true eye emergency.
Ideally, a dangerously narrow angle should be detected on your routine exam, and laser iridotomy performed before your angle closes. This is yet another reason why you need to get regular eye check-ups.

Glaucoma which is non-hereditary, which develops because your drain has been damaged in some way so it no longer works well, is called SECONDARY GLAUCOMA.
One example of secondary glaucoma is ANGLE RECESSION GLAUCOMA. Here, severe blunt trauma to your eye rips the ciliary body away from the trabecular meshwork so that it no longer drains well. Angle recession is extremely common in boxers.
If you have ever had a significant blow to your eye, for example from a squash or tennis ball or racquet, you should be checked for angle recession. If you have an angle recession, you are at high risk for developing glaucoma later in life. Make SURE to get your pressure checked regularly.
Another secondary glaucoma is STEROID-INDUCED GLAUCOMA.
Most people can take steroids, either by mouth or drops, without having their eye pressure go up, but certain susceptible people, who usually have a family history of glaucoma, can not. If they are given steroids, their eye pressure will rise.
If you have a family history of glaucoma, and you must take a significant amount of steroid for more than a few weeks, you should get your eye pressure checked.

NEO VASCULAR GLAUCOMA occurs when new abnormal blood vessels, caused by conditions such as diabetes and central vein occlusion, block your drain.

How will your ophthalmologist diagnose your glaucoma?

When your ophthalmologist dilates your pupil with those annoying drops that blur your vision and make you sensitive to light for an hour or two, one of the structures inside the eye that he or she will examine carefully is the head of the optic nerve.
Normally, this nerve has a healthy pink color, with a small shallow depression in its center called the cup. In glaucoma, your nerve becomes pale (called optic atrophy), and your cup gets wider and deeper (called excavation). Another important clue is the pressure in your eye, which is usually elevated if you have developed glaucoma. There may or may not be a small dash of blood at the margin of your nerve, called a flame hemorrhage.
If your pressure is high, and if your optic nerve has pallor and excavation, the diagnosis of glaucoma will be confirmed by further testing.
Your ophthalmologist will schedule a visual field test, to see if you have blank areas (scotomas) in your peripheral vision.
Since eye pressure in glaucoma notoriously fluctuates widely at different times of day, your ophthalmologist will probably tell you to come back to have your pressure taken every two hours over an entire day: 9:00, 11:00,1:00, 3:00, and 5:00.This is called a diurnal curve. This will tell your ophthalmologist how high your pressure goes, what time of day it runs the highest, and how much it varies. You should schedule all future visits at the time your pressure runs highest.
Your ophthalmologist may or may not order an ultrasound scan of your optic nerve, using Heidelberg Retinal Tomography, or HRT. HRT gives your ophthalmologist a 3 dimensional image of your optic nerve. This test can be repeated, and these images will show the smallest changes to the tissue of your nerve, allowing the ophthalmologist to detect even the slightest progression of your disease.
The accuracy of your pressure measurement will be checked by measuring the thickness of your cornea using a quick (1minute) painless technique called pachymetry.

How will my glaucoma be treated?

Glaucoma is treated by lowering eye pressure. This can be accomplished by drops, by pills, by laser surgery, and/or by knife surgery.

If you have narrow angle glaucoma, your ophthalmologist will use a YAG laser to create a tiny (1/4 of a millimeter) hole (IRIDOTOMY) in the periphery of your iris. This will open your angle by creating a “trap door” for your aqueous to flow into your trabecular meshwork.
This procedure takes about 5 minutes. You will experience a trivial amount of discomfort. You will need to take steroid drops for a short while afterwards.
If your laser iridotomy is done early enough, before your angle is scarred shut, there is an excellent chance that you will be cured by that procedure alone. If the diagnosis is made late, you will probably need to take drops to keep your pressure normal.
You should stop all blood thinners (Coumadin, aspirin, vitamin E, Echinacea, Ephedra, Ginkgo Biloba, Garlic, Ginseng, Kava, St. Johns Wort, Valerian) one week before your iridotomy, to minimize bleeding.

If you have open angle glaucoma, you will be treated by drops, and/or a laser procedure called selective laser trabeculoplasty(SLTP).
Glaucoma drops are of several different types. Some work by decreasing the production of aqueous humor; some work by increasing its outflow. You will probably have to experiment with several different types to find what works best for you. Each drop has its advantages and disadvantages. For example, betablockers cannot be used in people who have various lung diseases (asthma, smoking damage), or heart conditions (e.g., a slow heart rate).
If you cannot remember to take your drops, or if you are unable to manipulate the bottle properly, or if all drops have bad side effects for you, laser trabeculoplasty can be done.
In SLTP, a special laser is used to treat the trabecular meshwork so it will drain more freely. This is usually painless. SLTP is done on an outpatient basis. It will take about 10 minutes. You may resume normal activities immediately. It has a success rate of around 85%, and very few side effects, It will wear off with time, at a rate of about 10% each year, but it is repeatable.
If all else fails, various surgical procedures can be used to create an artificial passage from the inside of the eye to the outside.

Will I go blind if I have glaucoma?

Glaucoma is like any other chronic disease.
If you have diabetes, or high blood pressure, and you take your medication faithfully, your health will be just fine.
If you have glaucoma, and you take your drops every day as directed, and come back faithfully every 3 months to get your pressure checked, you will save your sight, drop by drop.
Just remind your siblings and children to get regular eye checks.

Is My Eye Problem An Emergency?

From: "The Eye of A Surgeon", by Dr Cynthia J MacKay

Some eye conditions are true emergencies, and it is vital that you seek eye care immediately. Some eye conditions need to be seen promptly, but not on an emergency basis. Some eye conditions are harmless. How do you tell which is which?

• Rule number one: See your ophthalmologist as soon as possible if you ever experience PAIN or LOSS OF VISION in an eye.
• Rule number two: If one of your eyes has been struck forcefully or penetrated, seek care even if the eye is comfortable and the vision is unchanged.
• Rule number three: If any chemical, such as cleaning solutions or garden products, gets into your eye, immediately flush that eye for 15 minutes with running tap water, before you seek eye care. Alkaline solutions (lye, drain cleaner) are even worse than acid solutions.

If you do not have an ophthalmologist, or if you are away from home, find a teaching hospital that has a training program in ophthalmology, go to their emergency room, and ask to see the eye resident on call.

This chapter describes several examples of each type of eye problem.

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TRUE EYE EMERGENCIES

1. Angle closure glaucoma

Symptoms:

• SEVERE eye pain.
• Decreased vision, with halos around lights.
• You feel nauseated, and might even vomit.
• The eye is red, and your cornea is grey-white instead of clear.

Treatment:

• Drops and pills will lower your eye pressure and constrict your pupil.
• A laser iridotomy will be performed as soon as your cornea clears (for further details, see glaucoma chapter).

Why is this an emergency?

• If there is high pressure inside your eye, it will go blind quickly unless the pressure is returned to normal fast.

2. Retinal tear/detachment

Symptoms:

• Floaters (bits of debris that fly around like gnats).
• Brief, strong flashes of light, which are especially obvious whenever you move your eye, and when you are in dim light.
• A persistent blank area in your field of vision.

Treatment:

• If your retina is only torn, and not detached yet, you can be treated as an outpatient, either with laser or with cryopexy (freezing), depending on the location and size of your tear.
• If your retina is truly detached, your ophthalmologist will chose among several different treatment options, depending on the type of detachment, your age, and whether or not you have had previous cataract surgery.
• You might have an outpatient procedure called pneumatic retinopexy, or one of several inpatient procedures, such as scleral buckle or vitrectomy (see retina chapter).

Why is this an emergency?

• If your detached retina is repaired early, before your macula becomes detached, you will retain normal sight.
• If your macula has been detached for more than 24 hours, you will probably never again have 20/20 vision, even if your surgery is “successful”, unless you are very young, or very lucky.

3. Central retinal artery occlusion

Symptoms:

• Sudden, painless, non-progressive, complete or near-complete loss of vision in one eye.
• The eye looks normal.
• You feel well.

Treatment:

• No treatment is effective if your occlusion is more than 24 hours old.
• If you have lost your vision within the last 24 hours, immediately start rebreathing into a paper bag.
• Get help immediately. Your doctor will lower the pressure in your eye with eye massage, drops and pills. He may also remove some aqueous from your anterior chamber.
• He will arrange for you to be worked up, with some blood tests, and some studies of your heart and carotid artery.

Why is this an emergency?

• Your retina, like your brain, dies quickly if its blood supply is lost. Your sight can only be saved if your artery is re-opened quickly.

4. Inflammation of the artery that feeds your optic nerve (this is called “ischemic optic neuropathy”)

Symptoms:

• Sudden, painless, non-progressive vision loss on one eye.
• The eye looks normal.
• You feel poorly. You have headaches, jaw pain when you chew, scalp tenderness when you comb your hair, and aches in your muscles and joints.

Treatment:

• Your doctor will immediately order some blood tests, including an ESR.
• Your will almost certainly be treated immediately with high-dose steroids, both intravenously and by mouth.
• You will need to take steroids by mouth, at tapering doses, for at least 3 months and possibly for as long as a year or more.
• Your doctor will schedule you for a biopsy of the artery in your temple within the next day or two.

Why is this an emergency?

Your headache and joint pain are caused by a disease called Giant-Cell Arteritis. All the arteries in your head are at risk. If the inflammation is not immediately treated with steroids, your other eye may also lose its sight, or you may suffer a stroke.

5. Wet Macular Degeneration

Symptoms:

• Blurred vision.
• Distortion of straight lines, e.g. window blinds or floor tiles.
• Small blank spots around the centre of your sight.

Treatment:

• See a retina specialist promptly.
• You will have a dye test called a fluorescein angiogram.
• You will be treated either with a laser, or with a drug that inhibits blood vessel growth (Lucentis or Avastin), which will be injected directly into your eye. (See retina chapter)

Why is this an emergency?

Abnormal blood vessels are growing underneath your retina. If they bleed, you will have irreversible scarring, and your sight cannot be restored.

6. Uveitis

Symptoms:

• Red eye(s)
• Painful and sensitive to light
• Blurred vision
• Dark spots floating around
• Flashes of light

Treatment:

• See an ophthalmologist immediately.
• Dilation and anti-inflammatory drops.

Why is this an emergency?
Uveitis is a serious inflammation inside the eye that can cause glaucoma or cataract if not treated. Most of the time it is not associated with disease elsewhere in the body but it may sometimes be associated with infections such as Lyme Disease, or inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, lupus or herpes.

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NEED TO BE SEEN PROMPTLY

1. Corneal ulcer

Symptoms

• Your eye feels as if there is sand in it.
• It hurts when you look at bright light.
• You have a discharge.
• Your eye is slightly red.
• Your vision is slightly blurry.
• These symptoms can also be caused by a corneal abrasion or a corneal foreign body. If you have an ulcer, you can often see a tiny white spot on your cornea if you look in the mirror.

Treatment

• Corneal ulcers are small dead spots on your cornea that have become infected.
• Bacteria are the number one cause of corneal ulcers. People who wear contact lenses are especially at risk, especially those who over-wear their lenses, do not sterilize them as directed, or sleep or swim in them.
• Standard treatment for bacterial ulcers is to take antibiotic drops every hour while awake for a day or two, then 4 times a day until told to stop.
• Viral corneal ulcers are usually caused by the Herpes simplex virus. After you have a herpes infection as a child, this virus remains throughout your life in the nerves in your brain. Occasionally, it can reactivate, and grow down the nerves to infect the cornea. This virus also causes cold sores on your lips.
• Standard treatment for a Herpes simplex ulcer is an anti-viral drop, such as Viroptic, taken every hour for the first day, then 4 times a day until your doctor tells you it is safe to stop.
• Rarely, ulcers may be caused by fungi or protozoa. These are more serious, and more difficult to treat

2. Conjunctivitis

Symptoms:

• Red, irritated eye(s).
• Swollen lids.
• Discharge.

Treatment:

• If your discharge is thick and creamy, your conjunctivitis is usually due to a bacterium. Standard treatment is antibiotic drops (for example, Sulfacetamide, Polytrim, or Vigamox), four times a day for a week.
• If your discharge is watery, and there are tender lumps in front of your ears, your conjunctivitis is usually due to a virus. People who have an upper respiratory infection will often get some form of conjunctivitis.
• Antibiotics are useless, and can be harmful, if you have viral conjunctivitis. Use artificial tears and warm compresses for comfort.
• You can prevent transmission to family members by washing your hands after you touch your eyes. Do not share your wash clothes or towels, and wash them in very hot water after you use them.

3. Migraine

Symptoms:

• Sudden onset of a shimmering, horseshoe-shaped, jagged light, which resembles TV static, or moonlight on water.
• There is usually a blank area in the middle of this light.
• This light starts small, grows, and then fades away, over 15-30 minutes. It may move from top to bottom, or left to right.
• A throbbing headache may occur, and last for 2-3 hours afterwards.
• You may experience some nausea.
• Migraines are common. 1 in 10 people experience migraine at some point in their lives. Thomas Jefferson, Emily Dickenson, Elvis Presley, Charles Darwin, Julius Caesar and Sigmund Freud suffered from migraines.
• Migraines are hereditary, so it is likely that you will know a family member who has migraines.

Treatment:

• ERGOTAMINE (Cafergot, Ergomar), for acute attacks.
• To prevent recurrent attacks, the beta blocker Propranolol (Inderal) can be helpful, but you should not take it if you have a history of asthma.

4. Allergic conjunctivitis

Symptoms:

• Both eyes are red, scratchy, and extremely itchy.
• This same problem tends to occur during this same month in spring or fall every year.
• Stuffy nose and a cough.

Treatment:

• Anti-histamines by mouth will be helpful if you are sneezing and coughing.
• Effective eye drops to treat allergy include Patanol, Optivar, and Cromolyn.
• Cold compresses are also helpful.
• In severe cases, you can use steroid drops such as Alrex, for short periods only.

5. Blepharitis

Symptoms:

• Edges of lids are always red.
• Continual loss of eyelashes.
• Recurrent, frequent styes.
• Eyes feel irritated.
• Mild crustiness.

Cause:

• Flakes of skin have developed along the margins of your eye lids. These flakes are the eye equivalent of dandruff on your scalp. Both are caused by excessive production of normal tissue.
• These flakes of skin eventually become infected.
• You develop styes, because the openings of the tiny glands along your lid margins become blocked by inflammation and infection.

Treatment:

• Scrub your closed lids 30 times every night with a pad such as Ocusoft or Lid Scrub.
• Warm compresses.
• Antibiotic ointment may be used along lid margins for short periods.

6. Dry Eye Syndrome

Symptoms:

• Eyes chronically burning, sandy, slightly painful, dry and somewhat red.
• Condition gets worse in the summer, when you are in air conditioning; in the winter; at high altitudes; and after long trips on airplanes.
• More common in women, in the elderly, and in patients with autoimmune diseases, such as Sjogren’s syndrome;and scleroderma.
• Can be caused by medications, especially beta blockers and antihistamines.

Treatment:

• Artificial tears, such as Refresh, Tears Naturalle, or Hypotears, 2 to 3 times a day on a regular schedule, indefinitely.
• If your symptoms do not improve, switch to preservative free tears, such as Hypotears PF. Use them 5-6 times a day. Add a small amount of lubricating ointment at night. Humidify room air.
• If severe: consider punctual plugs and moist chamber glasses.

7. Episcleritis

Symptoms:

• Episcleritis is a mild inflammation of the surface of your sclera.
• Some people have only one attack; others have many attacks, in that eye and/or the other
• One side of one of your eyes is reddish in color.
• That area is slightly tender to touch.
• The eye feels irritated.
• Your vision is unchanged.
• The cause is usually unknown. It can-RARELY-be associated with inflammatory diseases such as Lyme disease and syphilis.

Treatment:

• Non-steroidal drops, if mild.
• Steroidal drops, if severe

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NOT URGENT. No need to see an ophthalmologist unless you want reassurance

1. Sub-conjunctival hemorrhage

Symptoms:

• One side of one of your eyes has become bright red.
• The eye is comfortable.
• Your vision has not changed.
• The redness is blood that has oozed out of one of the hair-thin blood vessels in your conjunctiva. Maybe you rubbed the eye too forcefully, or blew your nose too hard.

Treatment:

• No treatment is needed. The blood will disappear on its own within several days.
• Virtually everybody gets these.

2. Stye (chalazion)

Symptoms:

• Tender lump on one of your eye lids.
• That lid is swollen and red.

Treatment:

• Warm compresses for 10-15 minutes, 3 or 4 times a day.
• You do not have an infection. You do not need to take antibiotic drops or pills.
• If this lump persists for more than a month, you may want to have it incised and drained by your ophthalmologist.
• See your ophthalmologist to find out whether or not you have blepharitis.

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How Can I Keep My Child's Eyes Healthy?

From: “The Eye of A Surgeon”, by Dr Cynthia J MacKay

Up to 10% of pre-school children, and up to 25% of school age children, have some form of eye problem. If your child is not seeing well, he will not complain to you because he will not know that anything is wrong. Parents will sometimes take their children to a dentist, but neglect to take them to an eye doctor. Your child’s eyes are more important than his teeth.

What is the most common cause of blindness in children?

An enormous amount of vision development takes place very early in your child’s life, especially in the first 6 weeks to 3 months. During that critical time, nerve fibers grow up his optic nerve to the visual cortex of his brain, where they make multiple connections that will let him see normally. If one, or both, of his eyes is not seeing clearly, for example, because it is out of focus or has a cataract, these connections will never be made, and his eye will be permanently “lazy” (AMBLYOPIA). If this problem is detected and corrected early, and the lazy eye is strengthened by patching the other eye, his eye can be saved.

How will I know if my baby can see normally?

Your baby will normally see as soon as he is born. His eyes may roam around, and even briefly cross in and out, but he should look at a human face longer and more intently than at anything else. By three months, his eyes should be straight, and he should be able to fix on an object and follow it when it moves. Take him to an ophthalmologist right away if he does not fix and follow by 3 months of age, or if his eyes cross in, out or up.

How will I know if my child can see normally?

While you are driving in a car, ask him about far-away objects, such as animals in fields, or road signs. If he is a boy, ask him the color of passing red and green cars. If he squints when he looks at objects in the distance, he may be nearsighted. If he complains of difficulty reading, he may have convergence insufficiency, or be farsighted, or have astigmatism.

When should my child’s eyes be examined?

A doctor should check your baby’s eyes before he is 6 months old, to make sure they are fixing and moving normally, and that they are aligned well. Usually, your pediatrician will do this.
When he is three years old, and again when he is five to six years old (i. e. before he enters kindergarten) he should be examined by an eye doctor. If his eyes are normal, bring him back every two years. Bring him back once a year if he wears glasses, if he was premature, if he is diabetic, or if eye problems run in your family, such as amblyopia, crossed eyes, childhood glaucoma or cataracts, or hereditary eye cancer.

What danger signals will tell me that my child needs to see an ophthalmologist right away?

• One of his eyes starts to turn in, or out, or up.
  If his eyes are not aligned normally, the eye that is turning may have a vision problem, for example, near- or far-sightedness or astigmatism, or even a cataract or an abnormality in the retina.
• His eyes begin to wiggle back and forth.
  This condition, called “NYSTAGMUS”, can be a relatively harmless condition that runs in families, but it can also mean that your child is not seeing properly, or that he has a neurological condition.
• One, or both, of his eyes are constantly tearing, with a chronic discharge.
  This probably means that the little duct that drains his tears into his nose has failed to open properly. If this is the case, your doctor will give you antibiotic drops, and tell you to massage that duct. Usually, that duct will open by itself by the time he is age one. If it does not, a minor procedure called a lacrimal probing may need to be done.
   Less commonly, this may be a sign that the eye has an infection, an allergy, or even a form of childhood glaucoma.
• The pupil of his eye looks white instead of black.
  There are many different eye problems that can cause a white pupil. They include cataracts, various developmental abnormalities, and a variety of retinal problems such as infections, abnormal blood vessels, and, extremely rarely, retinal detachments or eye tumors. It is important that you find out what the problem is. It could possibly save his life.
• He squints, holds books close while reading, rubs his eyes frequently, tilts his head to see, or complains that he cannot see the board at school, or gets headaches when he reads.
• One, or both, of his lids begin to droop.Even if this lid does not cover the center of his eye, the pressure from the lid may cause astigmatism, and decrease his sight.
  Rarely, a drooping lid can be a sign that he has developed a neurological problem.
• He seems to bump into things, and he always has bruises.
  This might be a sign that his peripheral vision is not normal.

What will happen during my child’s eye exam?

• Your child’s vision will be checked during every eye exam. If he does not know his letters, he will be asked to identify pictures, or taught to play the “E” game, where he will be asked to hold his fingers to indicate the direction an “E” is pointing.
• Both eyes will be checked for nearsightedness, farsightedness, and/or astigmatism by having him look into a special machine, or by studying the reflexes from the back of his eye with a RETINOSCOPE.
• If your child is a boy, his color vision will be checked (10% of males have red-green color-blindness or color-weakness).
• His pupils will be checked. They should be round, and equal (to within one millimeter), and they should both react briskly to light.
• His eye muscle balance will be checked, by having him look first at distance and then at near, covering his eyes alternately. He will be asked to look in 6 different positions. His convergence will be checked by asking him to follow an object that is brought from reading distance up to his nose.
• His eyes will be dilated with drops. These will burn briefly, but they are harmless. After dilation, his eyes will be sensitive to light, so you should bring dark glasses for him to wear home. Warn him that his sight will be blurry at near for a short time. He should not play sports that afternoon.
• He will be asked to put his head in a SLIT LAMP, which is a microscope on its side, so the doctor can check his lids, lashes, cornea, and anterior chamber under magnification.
• The doctor will look at his retina using an INDIRECT OPHTHALMOSCOPE, a special light strapped onto his head.

How can I protect my child’s eyes from injury?

It is estimated that up to 90% of all eye injuries in children can be prevented by proper eye protection. If your child is playing competitive tennis or squash, or boxing, he should wear three-millimeter-central-thickness polycarbonate eye protection glasses. Give him neutral gray, polarized sunglasses if he is sailing or skiing. Never let him stare into a laser pointer, or look directly at the sun. Do not let him play around working lawn equipment. Leave fireworks to professionals.

Can eye exercises help my child’s eyes?

Eye exercises with not get rid of nearsightedness, farsightedness, or astigmatism. They can not treat learning disabilities, or improve eye-hand coordination, or correct misaligned eyes. They are, however, effective in treating CONVERGENCE INSUFFICIENCY, where a child has difficulty pulling his eyes together while he reads.

What Are The Parts Of My Eye? (Excerpt from Dr. MacKay's forthcoming book " The Eye of A Surgeon")

What is my:

1. CORNEA?

Your CORNEA is the transparent, curved window in the front of your eye. All of the light that enters your eye comes through your cornea. Your cornea has three layers: the EPITHELIUM, the part that is exposed to the air; the ENDOTHELIUM, the innermost layer; and the STROMA, the layer in the middle.
Like every part of your body, your cornea needs nourishment, but it must be free of blood vessels in order to maintain its clarity, so, in place of blood, the epithelium is nourished by your tears, and the stroma and endothelium by your AQUEOUS HUMOR, the clear liquid that fills the front compartment of your eye..
Your cornea provides roughly 70% of the focusing power of the eye, the rest being provided by your LENS

2. LENS?

Your lens is a transparent structure the size and shape of an M & M candy. It is suspended by thin strands, called ZONULES, from a structure called the CILIARY MUSCLE, which runs around your eye immediately behind your IRIS.
Your lens has an inner, tougher center, called the NUCLEUS; a softer outer layer, called the CORTEX; and a skin, called the CAPSULE. When you want to focus up close, your ciliary muscle contracts, and your lens gets fatter; when this muscle relaxes, your lens gets thinner, and your eye focuses at distance.
Your lens grows all through your life, adding one layer each year.
As your lens gets larger, it gets stiffer, and harder to focus. By the time your are in your forties you will no longer be able to change the focus of your lens, so you will need magnifying glasses to read.
A cloudy lens is called a CATARACT.

3. IRIS?

Your IRIS is the part of your eye that gives it color. It is a muscle that has the shape of a lifesaver. Your iris acts like a window shade, opening and closing automatically to change the size of your PUPIL, the black opening in its center. This regulates the amount of light that is admitted into your eye.
The color of your iris-brown, blue, or green-is determined by the amount and distribution of a pigment, MELANIN. Brown eyes have more melanin than blue eyes, so they are less sensitive to bright light.

4. SCLERA?

Your SCLERA is the tough white outer covering of your eye.

5. CONJUNCTIVA?

Your conjunctiva is a flexible, clear mucous membrane that covers the inside of your lids, and the outside of your sclera. Hair-thin arteries and veins run through it. If these blood vessels become inflamed, you have CONJUNCTIVITIS.
Your conjunctiva keeps your eye moist. It is studded with GOBLET CELLS, which produce mucous, an important part of your tears.

6. TEAR FILM?

Tears protect, clean and lubricate your eye. All normal tears have three layers: an outer layer of OIL, which prevents your tears from evaporating; an inner layer of MUCOUS, which keeps your tears attached to your eye; and a middle watery layer, which is complex and fascinating. This middle tear layer is similar to your blood, but without cells. It contains most of the substances found in blood, including salts, sugar, hormones, and antibodies that protect against invading organisms. It is especially high in Vitamin C.
Most of your middle tear layer is produced by your LACRIMAL GLANDS, bean-sized glands which lie just above each upper eyelid. The oil in your tears is made by little bottle-shaped glands, called MEIBOMIANGLANDS, which are found along the margins of all four eye lids..

7. AQUEOUS?

AQUEOUS circulates steadily through the ANTERIOR CHAMBER of your eye, night and day, bringing oxygen and sugar to your cornea and lens, and washing away wastes. This clear fluid is produced by your CILIARY BODY, which runs around the eye just behind the iris, near the ciliary muscle.
Aqueous drains out of your eye through the TRABECULAR MESHWORK, into SCHLEMM’S CANAL and then into the veins around your eye.
Normally, inflow equals outflow, so the pressure inside your eye is maintained between 8 and 22 millimeters of mercury. However, if your eye has a drain that is not working properly, the pressure inside your eye will rise. This high pressure will eventually damage your OPTIC NERVE, and you will start to go blind. This is “GLAUCOMA”.

8. VITREOUS?

The VITREOUS is the transparent jelly that fills the POSTERIOR CHAMBER of your eye. The vitreous is firm and clear when you are young. As you get older, it gets less firm, and more watery. It eventually collapses on itself, like a tent folding, or a balloon that has lost its air. Because this process detaches the vitreous from the RETINA, it is called a VITREOUS DETACHMENT. After your vitreous detaches you will notice strands called FLOATERS.

9. RETINA?

Your RETINA is an extension of your brain. It is a light-sensitive nerve tissue that lines the inside of your eye, like the film inside a camera. It has 12 layers.
When light is focused by the cornea and lens onto your retina, millions of tiny PHOTORECEPTORS give off electrical signals. These signals feed into 1.2 million OPTIC NERVE fibers. The optic nerve acts as a cable, carrying this information up to the VISUAL CORTEX, which is in the OCCIPITAL LOBE, in the back of your brain.
Most human blindness is caused by diseases of the retina: in infants, amblyopia, or lazy eye; in adults, diabetic retinopathy; in the elderly, macular degeneration.

10. RODS AND CONES?

Photoreceptors come in two different types, 120 million RODS, and 6 ½ million CONES.
Your rods, mainly located in the periphery of your retina, are super sensitive. They operate only when the light is dim. They can only detect large forms and shapes, in black, white, and shades of gray.
Cones, located mainly in the center of the retina, operate in bright light. The ones in your MACULA enable your eye to see details. There are three different types of cones: red, green, and blue. This allows you to have color vision.

11. RETINAL PIGMENT EPITHELIUM?

The retina sits on top of a layer of darkly pigmented cells called the RETINAL PIGMENT EPITHELIUM, or RPE. The RPE is packed with melanin, which absorbs scattered and reflected light. The RPE acts as a nurse for the retina, trimming off the aging tops of the photoreceptors every day, and bringing the retina the chemicals it needs for vision.

12. MACULA?

The MACULA is a tiny area right in the center of your retina. Although it is only the size of the head of a pin, it is responsible for all of your detailed sight. 90% of the signals that go to your occipital lobe come from your macula.
If your macula is damaged, you will no longer be able to read, or drive, or recognize faces. You will, in fact, be legally blind, although you will still retain your peripheral vision.
The little indentation in the very center of your macula is called your FOVEA. The fovea provides your most detailed sight. There are no blood vessels, and no rods, in the fovea.

13. THE BLOOD SUPPLY OF YOUR RETINA?

The inner third of your retina is nourished by your CENTRAL RETINAL ARTERY (CRA) and CENTRALRETINAL VEIN (CRV). These enter and leave your eye at the OPTIC DISK, the place where the optic nerve originates. They fork, like the branches of a tree, as they run out to the periphery of the retina.
The outer two thirds of your retina is nourished by your CHOROID, a thick layer of blood vessels sandwiched between your RPE and your sclera.
The retina and the conjunctiva are the only parts of your body where your doctor can see your blood vessels. When a doctor looks at these blood vessels, he gets a lot of information about the health of your body.

14. THE EYE MUSCLE SYSTEM?

There are six tiny muscles connected to each of your eyes. They are the size of thick rubber bands. They pull the eye up and down, left and right, and clockwise and counterclockwise.
These muscles are commanded and coordinated by three nerves, located in the brain stem.