neuropathy. Amiodarone also causes deposits in the cornea that rarely reduce vision, but may cause glare (Fig. 1.12).

Allergies to medications

Inquire about drug allergies before eye drops are placed or medications prescribed. Neomycin, a popular antibiotic in eye drops, may cause conjunctivitis and reddened skin (Fig. 1.13).

Family history of eye disease

Cataracts, refractive errors, retinal degeneration, and strabismus—to name a few—may all be inherited. In glaucoma, which normally affects 1% of the population, family members have a 10% chance of acquiring the disease. Eighty percent of people with migraine have a relative with the disease.

A special question should be directed to the smoking of cigarettes since it doubles the rate of cataracts, macular degeneration, and all types of uveitis. It also worsens exophthalmos in thyroid disease. Cigarette smoking and smokeless tobacco use among American adults is about 20%. At age 70, 80% of Americans have high BP and 15% have diabetes. It is predicted that 1 in 3 children born after the year 2000 will develop type II diabetes. One third of Americans are obese and 1/3 are overweight. Remind patients that a major change in lifestyle is needed to stem the pandemic of these chronic diseases. Patients should be reminded about avoiding tobacco and minimizing consumption of red and preserved meats, salt, sugar, and saturated fats. Recommend instead a diet rich in fruits, vegetables, beans, nuts, fish, and whole-grain cereals. Staying thin with a routine daily exercise program should also be advocated.

Fig. 1.12 Epithelial deposits radiating from a central point in the inferior cornea. They occur in almost all patients with Fabry's disease, which is an x-linked systemic accumulation of a glycosyphingolipid. Easily seen on slip lamp exam, it can be the first clue in recognizing the presence of this disease which is amenable to therapy. Indistinguishable deposits eventually appear in almost all patients using amiodarone and with hydroxychloroquine. Courtesy of Neal, A., Sher, M.D. and Arch. Ophth., Aug 1979, Vol 97,

p. 671–676. Copyright 1979, Amer. Med. Assoc. All rights reserved.

Fig. 1.13 Neomycin allergy occurs in 5–10% of population.