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.

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Allergic conjunctivitis is likely if:

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• 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.

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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.

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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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I examined a 50 year old healthy woman today who came in for stronger reading glasses.  Because she had not had a dilated eye exam (ophthalmoscopy) for years I dilated her pupils and found a melanoma in her left eye. I referred her immediately to an ocular tumor specialist.  With prompt modern treatment she stands an excellent chance of retaining her eyesight and surviving this cancer.

If I had not performed this “routine ophthalmoscopy” today she would not have been referred promptly to an ocular tumor specialist.  Instead the cancer in her eye would grow and perhaps lead to blindness in one eye, removal of the eye, or even death from metastatic disease.

I have seen many diseases of the back of the eye such as retinal detachments, macular degeneration and cancerous tumors. Many were detected with routine ophthalmoscopy.

Insurance companies refuse to pay ophthalmologists to perform “routine ophthalmoscopy.”  I suggest that when you see your ophthalmologist (Eye MD) you ask for this test and agree to pay for it out-of pocket. It could save your sight and maybe even your life.

There are 1400 new cases of ocular melanoma in the United States every year.

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Senator Barak Obama Has a Right Head Tilt 

Watching the Saddleback Church Forum with Pastor Rick Warren interviewing Senator Barack Obama on Saturday August 16, I was struck by the marked and obvious tilting of the Senator’s head Forum. The tilt is to the right side. This phenomenon has not been widely written about from a medical perspective.

A head tilt can be a sign that a patient has double vision also known as diplopia.  Diplopia can be benign if it is caused by a congenital (from birth) eye muscle weakness or it can be associated with autoimmune medical disorders such as thyroid disease or Myasthenia gravis.  Serious medical conditions such as a brain tumor or stroke can also cause it.

The value of looking and observing the entire patient not just their eyes is an invaluable tool for me as an ophthalmologist and doctor.

How does diplopia occur?

Both eyes must work together to create a single image in the brain called binocular vision. In order to avoid double vision both eyes must be focused on the same object and the eyes must perceive the object on the same vertical and horizontal plane. If this alignment is not perfect then the images sent to the brain are` dissimilar and the brain registers two different pictures simultaneously causing double vision.  Double vision is when the brain sees two copies of the same object at the same time. The two objects can be next to each other horizontally causing horizontal diplopia, one on top of the other causing vertical diplopia, or at an oblique angle.

Each eye has six muscles, called extraocular muscles, that control its movements, and those muscles are innervated by four different cranial nerves, the third, fourth, sixth and seventh nerves. Four of the muscles control simple movements such as up, down, right and left, and the other two the inferior and superior oblique muscles are responsible for tilting and rotating the eye. 

A muscle or a cranial nerve disorder can cause an extraocular muscle to be weak or not function at all. As a result the two eyes send dissimilar images to the brain causing the patient to complain of double vision.

A head tilt is frequently seen in patients who are trying to overcome diplopia by turning their head in such a way as to avoid using a certain extraocular muscle. 

Why SENATOR OBAMA’S HEAD tilt is  important

Senator Obama should have a medical evaluation, perhaps even an MRI to determine the cause of his head tilt.  Hopefully the cause is not serious, but early detection is always best.

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Dr. Noah Klein

Noah Klein MD, PC

Many patients present to my office complaining of eye redness, eye irritation,  and a foreign body sensation (feeling of grit or sand in the eye) when wearing their soft contact lenses. They feel this way even when they try on a brand new pair of contact lenses so they do not feel this is a problem with their contact lenses.

Often they’re right. The problem is not their contact lenses, it is their Contact Lens Solution! They are no longer able to tolerate a solution that they may have been using for months or even years. Even the solution that a fresh pair of lenses is stored in can be irritating.

Commercially available contact lens solutions provide excellent disinfection and lubrication for most people. But in order to do their job these contact lens solutions contain a lot of chemicals which can, over time, cause eye irritation, redness and foreign body sensation.  This can occur at any point in time, either as soon as a patient starts using the solution or after a period of time. They come to my office with “Contact Lens Intolerance Syndrome (CLIS).”

I often advise patients with CLIS to use chemical free contact lens care.  By switching to a hydrogen peroxide (H2O2) based disinfecting solution and employing a preservative free saline rinse just prior to inserting the lenses into the eye it is possible to BOTH sterilize the contact lenses and avoid all chemicals getting into the eye.  Often this simple change in the contact lens care system solves the problem. Get instructions here.

If you feel you are not as comfortable as you should be with your contact lenses, seek professional eye care help with an EYEMD, an Ophthalmologist. I practice Ophthalmology in Manhattan, New York City.  Noah Klein MD’s office telephone is 212-696-9013. Bring your contact lenses and contact lens solution along with any eye drops you use with you to the first visit.

If you are already using a chemical free system and still are not comfortable with your contact lenses, you may have a dry eye syndrome or a problem with the fit of the contact lenses.  These can be treated very effectively with various strategies to alleviate or even cure dry eye conditions and changing the brand of contacts.

Of course, these issues apply only to mild low grade eye irritation. Acute pain, redness, light sensitivity and/or loss of vision could indicate a serious eye infection which requires emergency eye care with immediate attention from an Ophthalmologist.

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