Ординатура / Офтальмология / Английские материалы / The Eye Book A Complete Guide to Eye Disorders and Health_Cassel, Billig, Randall_2001

310 / THE BIG PROBLEMS FOR AGING EYES

pendence and the burdens it often creates for family, friends, and society.

But even though there’s no cure, yet, for age-related macular degeneration, there are many things patients can do to retain independence and quality of life. For one thing, there are visual aids: glasses, magnifiers, low-vi- sion devices, and large-print materials (see chapter 19). There are agencies and services whose whole purpose is to help people with “low vision.” You owe it to yourself and your family to see what they have to offer.

And finally, there’s counseling, which really can help. The tremendous value of counselors and support groups is often underestimated because too often the enormous psychological impact of vision loss is overlooked by doctors as well as patients. For many patients and their families, simply knowing that they’re not alone can mean a world of difference.

P A R T I V

Other Eye Problems:

Diagnosis and

Treatment

10

The Eyelids

Their job seems simple enough: Open, shut. Blink—and in the process protect the eye from foreign particles, keep it from becoming too dry. What could possibly go wrong here? Well, there are several problems that can occur in the eyelids, ranging from benign dermatitis to malignant tumors. Here are some of the most common.

Allergic Dermatitis (Red, Scaly,

Itchy Eyelids)

We all know what “allergy eyes” are: inflamed, itchy, and watery (see chapter 12). But an allergic reaction can also cause scaly, red, itchy skin outside the eye, and on the eyelids.

Allergic dermatitis is what happens when the skin of the eyelids becomes inflamed by an allergic reaction. It usually involves a miserable cycle of itching, rubbing, and dryness—followed by still more itching, rubbing, ir-

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ritation, and even peeling and cracking of the skin. (Note: Another condition with a similar name, infectious dermatitis, is a different problem altogether. As its name suggests, the trouble here is an infection in the skin, and you can tell the difference between these two forms of dermatitis pretty easily: allergic dermatitis itches; infectious dermatitis hurts. The treatment differs as well: infectious dermatitis is treated by antibiotics and warm compresses.)

Treatment: To break the unpleasant cycle of itchiness and peeling, you’ll probably be told to apply cold compresses (to decrease swelling of tissues) four times a day (or more often, if possible), and to use topical drops or ointments as well as oral drugs such as antihistamines. Your doctor might also prescribe a steroid-containing ointment for use in and around the eye. Note: Because ointments and creams used near the eye almost always work their way into the eye, make sure that whatever you’re putting on your eyelids is specifically for eye problems. (If your allergic dermatitis is just on your face but not near your eyes, you can use mild over-the-counter steroid skin creams. But beware of long-term use of any steroid preparation—even one prescribed for short-term use by your eye doctor. Using a steroid cream regularly for months or years—even when it’s just applied to your eyelid and not technically in your eye—can lead to elevated eye pressure and glaucoma.)

Hives: Eat the wrong food, and you may experience yet another allergic reaction on the eyelids: hives. Like hives elsewhere on the skin, these crazy dots or bumps seem to

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appear out of nowhere. They’re red, extremely itchy mounds that can be as small as a kernel of corn or as large as a quarter (or even larger). Their only redeeming feature is that they usually don’t last long and tend to go away on their own, or with the help of cold compresses and antihistamines.

Blepharitis (Inflammation of the Eyelids)

Have you ever looked into the mirror and noticed that your eyelashes had crust or flakes in them—especially near the bottom, where they grow out of the eyelid? Or perhaps you’ve noticed a perennial dusting of flaky particles inside your eyeglasses. Maybe you’re prone to recurrent sties, or the edges of your eyelids seem chronically red or pink. Do your eyes sometimes feel gritty and your eyelids heavy, especially when you read—even a spellbinding novel? All of these problems can be associated with blepharitis, or inflammation of the eyelids—a distinctly unglamorous condition that can be summed up as “eyelash dandruff.”

Several things can make this happen. By far the most common is seborrhea, a disorder of the oil-making sebaceous glands—in this case, the ones at the base of the eyelids—that causes them to secrete more oil than usual. People who have seborrhea elsewhere—on the scalp, brow, or face—and/or oily skin may also be prone to this form of blepharitis, which is not infectious.

People with seborrheic blepharitis often have a secondary bacterial infection on their eyelids, however. Be-

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cause more than one problem is at work here, this is called a mixed blepharitis. This infection, in turn, can cause trouble of its own—namely, chronic conjunctivitis (see chapter 12), with recurrent corneal infections. Its symptoms may include extra sensitivity to bright light, pain, tearing, redness, blurred vision, and mucous discharge from the eye. Worse, the bacteria can infect the glands of the eyelid margins and lead to recurrent sties and chalazia (see below). Misdirected, broken, and missing eyelashes are also common with this infection.

Treatment: Blepharitis is often a chronic condition, so our two goals are to get it under control and then to keep it that way. Lid hygiene and warm compresses (see box) are the mainstay of treatment for blepharitis, especially the seborrheic form. Cleaning the eyelash bases and applying warm compresses regularly will cut the buildup of secretions by the overactive sebaceous glands. Over- the-counter dandruff shampoos, which control seborrhea of the scalp, eyebrow, and face, also may help—al- though again, because these may inadvertently get into the eye, they should never be used directly on the eyelid.

If you’re dealing with a bacterial infection on the eyelid margin (as in a mixed blepharitis, described above), you may also need antibiotic and/or steroid drops or ointments. Many people with blepharitis must use some combination of treatment for months or even years to keep this condition under control—especially those with chronically recurring chalazia (see below). Even so, eye makeup and contacts can still be worn.

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Angular Erosion (Chapping of the Eyelids)

Eyelids can get chapped too—just like lips. This painful breakdown of the skin occurs at the outer angle of the eye, where the upper and lower lids meet. A form of blepharitis, often associated with a bacterial infection, angular erosion tends to persist if it’s not treated.

Treatment: Fortunately, angular erosion can be cured with an antibiotic and/or a steroid ophthalmic ointment. Again, though, steroids should not be overused on the eyelids. Note: Redness and pain are symptoms your doctor should assess; make an appointment, and go see him or her.

Bell’s Palsy (Weakness in the Facial Muscles)

A sudden weakness in all or part of the facial muscles is called Bell’s palsy. Although its onset—which often has no apparent cause—is sudden and terrifying, Bell’s palsy often goes away by itself within a few weeks. But sometimes during its stay Bell’s palsy affects the orbicularis muscle, the muscle that closes the eyelids—hampering the eye’s ability to close all the way. Then, because the eyes are constantly exposed to the air, they become dry and irritated.

Treatment: Lubricating eye ointments can help, although they do tend to cause smeary or blurred vision; some people must also tape their eyelids shut at night to relieve the dryness.

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If Bell’s palsy lasts longer than a few weeks, your eye doctor can perform a procedure called a tarsorrhaphy, which involves partially closing the lids with sutures. This can be a temporary or a permanent step toward alleviating the symptoms and potential complications associated with a dry eye. (For more on dry eyes, see chapter 13.)

Blepharospasm (Tight Squeezing of

the Eyelids)

The key word here is spasm. Like a spasm of any other muscle—in the hand, for instance, or the heart—bleph- arospasm is an involuntary tight squeezing of the eyelids. This may be a symptom of Parkinsonism, or a result of eye irritation. Or there may be no apparent cause (this is called essential blepharospasm). In minor cases, it’s mainly a nuisance; but in its more serious form, blepharospasm can be disabling.

Treatment: Of the many different treatments that have had some success, the most promising is an injection of botulinum toxin directly into the muscle, which usually gives good relief for several months and can be repeated after it wears off.

For more information on benign essential blepharospasm, contact the Benign Essential Blepharospasm Research Foundation, Inc., P.O. Box 12468, Beaumont, TX 77726-2468, (409) 832-0788.