What You Need To Know About Measles

Courtesy of the Gates Foundation

One of the more impossible-to-miss news stories right now is the measles outbreak that started at Disneyland. Since measles is an airborne virus that can last up to two hours, and because Disneyland attracts guests from all over the world, this was a perfect spot for the virus to spread. At this time, approximately 60-70 persons in California have contracted the virus.

Interestingly, if we take a trip back in time to the year 2000, the CDC declared that the United States had achieved measles elimination. So what happened and why are we hearing about a second outbreak in as many years? Well, in 1998 a study of 12 children by a former doctor, Andrew Wakefield, demonstrated a link between autism and the measles, mumps, rubella vaccination. Since then, this study has been shown to be fraudulent and Andrew Wakefield was stripped of his medical license. Despite evidence to the contrary, many well meaning and intelligent parents began declining vaccinations for their children. As a result, school districts in our state have up to 14.5% of students who are unvaccinated – the majority of whom are from affluent, coastal communities.

So what should we look out for in our friends, families and patients? First of all, a fever, head cold, and red rash are all signs of measles. Additionally, conjunctivitis (pink eye) is also very common as 65% of all measles patients develop this malady. Be especially careful if you have family members that are unvaccinated or have only received a single dose. Patients who have received two doses have less than a 1% chance of getting measles.

While measles is still relatively rare in the United States, 20 million people are infected worldwide and according to the World Health Organization 145,700 children died from measles worldwide in 2014. As a parent, I understand the apprehension many of us have about the numerous shots our kids get at such a young age. However, the evidence clearly demonstrates that vaccines save lives. So, I encourage every parent and unvaccinated person to do your part to eradicate this illness from the planet and get vaccinated or have your child vaccinated.

~ David C. Ardaya, O.D.
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

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The Low Down on Pink Eye

Just your luck, it’s Friday afternoon and you find that you or your loved one has a pink eye, it may be a little irritated or painful, and you are worried because the weekend is coming up.  Your optometrist’s office may be closing soon.  Should you call your optometrist, go to urgent care, or risk the weekend without seeing an eye doctor?

Photo Courtesy of Lone Primate on Flickr.com

Photo Courtesy of Lone Primate on Flickr.com

Pink eye is a term used to describe an irritated pink or red eye.  The medical term is conjunctivitis which is an inflammation of the thin tissue overlying the whites of the eyes.  However, there are a variety of eye conditions that can cause an eye to become pink or irritated, although conjunctivitis is the most common cause.  Conjunctivitis can often be categorized into 3 different categories:

Bacterial conjunctivitis – This form is caused by bacteria and can be transferred in a variety of ways ranging from airborne to direct contact on one’s fingertips.  Bacterial conjunctivitis can cause sticky, yellowish green discharge, occasionally resulting in the lids sticking shut in the mornings.  The eye may be pink, painful, and sensitive to light.  Usually only one eye is affected although the other eye can become infected by indirect contact.  It is contagious and is often treated with antibiotic eye drops.  Once you have been treated for 24 hours with antibiotics, you are no longer contagious.

If you are a contact lens wearer, an irritated, painful and pink eye is usually the result of a bacterial infection.  This needs to be treated right away because you may develop a corneal ulcer and risk permanent vision loss.

Viral conjunctivitis – Most instances of viral conjunctivitis will cause the eyes to appear red and glassy, and there may be a watery discharge.  It usually affects both eyes and may be accompanied by an upper respiratory infection.  The lymph nodes in front of the ears and along the neck may be tender and swollen.  These cases are highly contagious and cannot be treated with medication.  They will resolve on their own within 7 to 10 days.  Some may take as long as 3 weeks.  Until then, patients should avoid spreading it to others.  Some may find relief with cool compresses or artificial tears throughout the day.

Occasionally, an eye can become infected by the herpes simplex or herpes zoster virus.  Symptoms may include a pink eye, pain, decrease in vision, or blisters on one side of the face.  These patients need to be seen and treated immediately in order to prevent vision loss.

Allergic conjunctivitis – This form of pink eye is prevalent throughout the year, depending on a person’s allergies and the plants that are in bloom during that season.  Allergic conjunctivitis will typically cause itching, tearing, and sticky, thick and white discharge that affects both eyes.  Some may notice their symptoms are worse after being outdoors.  Many often complain of an itchy throat or runny nose.  Usually, oral allergy medications will alleviate the symptoms related to the eyes, but many require the additional use of topical allergy eye drops to relieve symptoms.

I have seen a number of patients on a Friday afternoon with complaints of a pink eye.  Many times, the symptoms are not severe enough to determine what form of conjunctivitis the patient has, which can make treatment a little trickier.  In those cases, we advise the patient to return for a follow-up visit to determine if the treatment was effective.

A good rule of thumb for whether or not you need to see an optometrist when you have a pink eye is that if you are experiencing pain, light sensitivity, are noticing reduced vision or wear contact lenses, then visit an eye doctor today.  Make sure you do not put on your contact lenses.  I often advise my patients to try seeing an eye doctor first, rather than visiting urgent care as they may not have all the tools required to adequately diagnose your eye condition.

So, keep your hands clean, don’t share towels and avoid touching your face and eyes!

– Cindy P. Wang, OD, FAAO

Dry Eye Disease

If you ever have stinging, burning, gritty or sandy sensation, excessive tearing or itchy eyes, you may have symptoms of dry eye disease.

Dry eye disease is a condition where you don’t have enough tears or have poor quality tears to lubricate and nourish the eye. Tears maintain the health of the front surface of the eye and provide good vision. Dry eye disease is a common and often chronic problem, particularly in older adults. Advanced dry eyes may damage the front surface of the eye and impair vision.

The front surface of the eye is called the cornea. With each blink of the eyelids, tears are spread across the front surface of the eye. Tears are produced by several glands in and around the eyes. The tear film is composed of nutrients, electrolytes, proteins and lubricants. Tears provide lubrication, reduce the risk of eye infection, clear the eye of foreign matter, and keep the surface of the eyes intact and clear. Tears drain from the eyes into small drainage ducts called puncta in the corners of the eyelids, which drain in the back of the nose.

Courtesy of Clearly Ambiguous on Flickr

Courtesy of Clearly Ambiguous on Flickr

If there are any irregularities in the tear film, symptoms of dry eye may manifest. Dry eye disease may limit daily activities including reading, driving, working on the computer or wearing contact lenses.

Many different factors cause dry eye. These are some of the most common:

1) Hormones: Dry eye disease is more common in people 50 years old or older. Hormonal changes that are common in women experiencing menopause can cause dry eye.

2) Systemic diseases: Other systemic diseases including diabetes, glaucoma, Sjogren’s syndrome, lupus and rheumatoid arthritis can exacerbate the symptoms of dry eye.

3) Medications: Medications including antihistamines, hormonal replacement therapy and androgen therapy may contribute to dry eyes.

4) The environment: Environmental factors such as pollen or allergies, working on the computer or contact lens wear can make dry eyes worse.

Dry eye disease is diagnosed by patient history. In diagnosing dry eye disease, your doctor of optometry will evaluate the symptoms, general health problems, medications or environmental factors that contribute to dry eye disease. Your doctor will perform an external examination of the eyes including the eyelid structure and blink dynamics. Your doctor will evaluate the eyelids, cornea and conjunctiva is performed using bright light and magnification. Measurement of the quantity and quality of tears is assessed for any abnormalities. From this information, your doctor of optometry can determine if you have dry eyes and advise you on treatment options.

Treatments for dry eyes include:

  • over the counter artificial tears,
  • punctal plugs (small plastic pieces that close the ducts that drain tears out of the eyes),
  • eyelid hygiene,
  • dietary supplementation,
  • or a prescription eyedrop called Restasis (cyclosporine 0.05%).

If you experience any of theses symptoms, contact your doctor of optometry and ask for a dry eye evaluation.

~ Melissa Barnett, OD, FAAO