9/11

Walking to my office on East 25^th Street in Manhattan on the morning of September 11, 2001 I was struck by the beautiful clear sunny sky.  Like everyone else enjoying the fall weather I did not know how terrible this day would be for my city and my country. Office hours started at 9:00am.  The first patient of the morning called us at 9:20am and told us that she saw a plane crashing into the World Trade Center and was afraid to leave home.  We put on the radio and listened in horror to what was happening downtown.

I felt the ceiling rumble at some point and wondered what the upstairs occupants could be doing that was so loud. When I heard the news that the Towers had come down I realized that I had felt the Twin Towers crumbling.

I decided to close the office early so everyone could get home. Normally there are several lanes of traffic going North and South on Park Avenue South. When I walked to the corner all I saw were throngs of people walking north. There was no car or bus traffic on Park Avenue South at 25^th Street. Looking downtown smoke was visible over the horizon.

After getting to my apartment near the office I called the New York Eye & Ear Infirmary to see if they needed medical staff for emergency care.  I was told that very few patients were there. I packed a knapsack with medical supplies and walked to the Beth Israel Hospital ER to volunteer. Doctors and nurses were waiting outside but no ambulances or emergency patients arrived.

The streets and avenues had very little motorized traffic. I walked the blocks and saw people walking quietly, dazed, covered in white soot. A soldier with an M-16 was directing traffic on 23^rd Street and Park Avenue. I could not believe this was really happening. It was surreal.

But this was not a dream. In the following days and weeks as life in the neighborhood started to take on some semblance of normality the attacks of 9/11 were impossible to escape. The pervasive smell of burning rubber was a constant reminder as was the black column of smoke that rose from the horizon downtown.

Walking to work was an ordeal for months because the Armory on Lexington Avenue between 25^th and 26^th Streets was a center for those searching for loved ones they were never to find. The light posts, bus shelters and the storefront windows of the Staples store on 26^th Street and Park Avenue were plastered with pictures of missing people.  The streets around the Medical Examiners at 1^st Avenue and 30^th Street were surrounded by refrigerator trailers for holding body parts.

The New York Times had a two-page spread of pictures of the 343 brave firefighters who died that day. My office manager Susan mounted the pages on a poster board and hung them on the wall of my waiting room. The homemade poster stayed on the wall until a few weeks ago when I was given a wonderful gift from a patient who on 9/11 was an FDNYEMS. He volunteered for service after 9/11, served in the Iraq war and was awarded a Purple Heart.

He and his wife gave me a framed poster of these brave FDNY heroes. Their memory will be forever honored in my office.  I also want to thank and remember the service of the American men and woman in our armed forces whose sacrifice is keeping us safe and free.

Here are photos of the original tag board poster and the new framed one:

New York Times 2001

New Poster

G-d Bless America

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When a patient complains of eye pain asking the right questions often helps determine the cause of the pain. This makes the diagnosis and treatment easier. It is helpful to distinguish between eye pain caused by external factors such as a foreign body on the surface of the eye and internal pain caused by elevated intraocular pressure or internal ocular inflammation.

External Causes of Eye Pain

Material such as dust particles, metal fragments, cat hairs, and eyelashes feel like there is a particle in the eye. These are easy to find and remove. They can cause a scratchy feeling in the eye. Sometimes a foreign body is lodged under the inside surface of the upper lid and can only be removed by everting the upper lid. If the foreign body is embedded in the cornea it can cause a corneal abrasion.  A corneal abrasion feels like there is something in the eye. Dry eye can also cause external irritation and dry eye patients often complain of burning and feeling something in their eyes. Dry eye, superficial corneal or conjunctival foreign bodies rarely cause blurred vision or photophobia (light sensitivity). External irritation associated with photophobia and/or blurred vision suggest a more serious condition such as a corneal ulcer. A sty can also cause a foreign body sensation.

Internal Causes of Eye Pain

Episcleritis is an inflammation of the outer layer of the sclera, the white of the eye. This often presents with localized redness and tenderness to touch. Uveitis, an inflammation of the inner eye is associated with eye pain. The pain is usually felt inside the eye and does not feel like there is something in the eye. Inflammation of the front portion of the inner eye is called iritis and causes photophobia. Optic neuritis, an inflammation of the optic nerve, is associated with pain on eye movement.

Other Causes of Eye Pain

Migraine, sinus disease, and glaucoma can also cause eye pain. Even eye strain from wearing the wrong eyeglass or contact lens prescription can cause eye pain. Pain following eye surgery can be a sign of infection and requires immediate attention. Pain following trauma to the eye can also indicate a serious condition.

causes light sensitvity

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Eye pain, redness, light sensitivity and decreased vision can be caused by a corneal infection called an ulcer. A corneal ulcer is a collection of white blood cells in the cornea which is sometimes visible as a white dot in the cornea. You can get more information here. If you suspect that you have a corneal ulcer then do not delay getting an Ophthalmological evaluation. Prompt diagnoses and rapid treatment are key to successful treatment and raise the odds of preserving vision. This is an Ophthalmological emergency.

Modern antibiotic drops can treat bacterial corneal ulcers successfully if the diagnoses is made early and the drops started promptly. Corneal infections caused by a fungus or an organism such as an amoeba can be devastating and may require a corneal transplant.

REMEMBER

• Avoid sleeping in contact lenses,
• always wash hands prior to handling contact lenses,
• wash and replace contact lens cases, and sterilize the lenses in a good sterilizing solution.
• Replace the lenses on schedule.
• Do not try to “stretch” the wearing interval beyond the lens specifications.

The risk of getting a corneal ulcer is not worth it.

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WHAT IS GLAUCOMA?

Glaucoma is a disease of the optic nerve often associated with increased intraocular pressure (IOP).

Elevated IOP alone is not enough to make the diagnoses of glaucoma. Some patients may have glaucoma when their IOP is within normal limits. This is called Normal Tension Glaucoma (NTG). Conversely many patients have IOP elevation and never develop glaucoma. This is called Ocular Hypertension (OHT).

If you are confused by this, don’t worry, you are not alone. Most patients and many physicians have difficulty understanding glaucoma. We are used to concentrating on numbers. Hypertension is defined as blood pressure above 140/90. Diabetes is followed by measuring the blood sugar and the hemoglobin A1C (HgbA1C). So it is natural for the IOP measurement to be the focus of glaucoma diagnoses and treatment.

But glaucoma is different from hypertension and diabetes.  Aside from intraocular pressure measurements the function and structure of the optic nerve must be evaluated when evaluating glaucoma. Calling IOP measurements a “glaucoma test” and the use of IOP measurements in “glaucoma screenings” is inadequate and misleading.

The best way to evaluate a patient for glaucoma is:

1. - Obtain a complete medical history including a review of systems and family history concentrating on a family history of glaucoma and a history of migraine.
2. - Visual acuity, slit lamp exam, IOP measurement and careful examination of the optic disc are the minimum examination techniques required in glaucoma evaluation.

If the medical history is negative and the physical eye exam normal then this is an adequate “glaucoma screening.” IOP measurement alone is not good enough.

If the medical history is positive or the eye exam suspicious then further testing is necessary, such as ultrasonic pachymetry – measurement of corneal thickness, computerized visual field testing and photographic imaging of the optic disc. The optic disc is the portion of the optic nerve that is visible when looking at the ocular fundus, the inside of the eye.

I have only touched on the surface of glaucoma evaluation. More information is available here, here, here and here.

Noah Klein, MD

Noah Klein, MD, PC

August 13, 2009

January 3, 2010

This is another good link about glaucoma:

http://www.travatanz.com/High-Eye-Pressure.aspx

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Dr. Noah Klein

Noah Klein, MD, PC

August 4, 2009

Red eyes with itching, tearing, clear discharge and a foreign body sensation (feeling of something in the eye) can be caused by a virus. This is called viral conjunctivitis or “pink eye” and can be quite uncomfortable.It may be difficult to differentiate between a viral conjunctivitis and an allergic conjunctivitis. Here are some tips.

Viral conjunctivitis is likely if:

1. The patient recently had an upper respiratory infection (URI), a cold. If so then most likely the same virus has caused the conjunctivitis.
2. There is a tender pre-auricular lymph node on the same side as the conjunctivitis.  If yes then a virus is the likely cause. This lymph node is just in front of the tragus of the ear. The tragus is the bump before the external auditory canal (the ear opening).
3. The pink eye started in one eye and then went to the other eye, but in a milder form. This is characteristic of viral conjunctivitis.
4. The patient had contact at work or home with someone who has a pink eye. If so then the viral infection which is very contagious has spread from that other person.

<!–noadsense–>

Allergic conjunctivitis is likely if:

<!–noadsense–>

• The patient has a history of allergy and it is now allergy season.
• Symptoms are relieved by anti-histamine drops or pills.
• Aside from itching and red eye none of the above criteria exist.

<!–noadsense–>

Treatment

Unfortunately, aside from relieving symptoms, there is no treatment for viral conjunctivitis. It should resolve in 7-10 days just like the common cold. Antibiotic drops do not cure a viral conjunctivitis and nothing but good hygiene can prevent it from spreading to others. Lubricating eye drops and cool compresses help the symptoms.

<!–noadsense–>

Most of the time the condition resolves with no permanent effects. Rarely, a few weeks after the infection is gone the patient experiences photophobia (light sensitivity), foreign body sensation and possible blurred vision. Corneal infiltrates cause this and the patient must be evaluated by an ophthalmologist right away. These may require treatment.

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