Author: Dr. Potthoff

Can I sleep in my contacts?

The short answer is “no”. Here’s a recent article that serves as a good reminder that sleeping in your contact lenses is a bad idea. Why? A few reasons. The biggest reason that sleeping in your contacts is a bad idea is because you can get a corneal infection. Check out this post from a few months ago when Today show host Craig Melvin had to wear glasses for the first time on air after developing a contact lens-related infection.

Our tear film is constantly defending our eyes against bacteria that are everywhere. When you sleep in your contacts you provide those little microbes a chance to set up shop and start growing in your cornea without having to worry about being washed away by your tears and blinks.

How can I tell if I have an eye infection after sleeping in contacts?

When these bacteria are able to start growing on the surface of your cornea, it is described by eye doctors as a “corneal infiltrate”. Think of it like a small ulcer. The symptoms of this type of eye infection include pain (it can be severe), eye redness, excessive tearing, and the feeling that something is stuck in your eye. If left untreated a corneal ulcer can develop, which can literally eat through your cornea. Even when treated a corneal ulcer will often leave behind a vision-limiting corneal scar. If you suspect you have an eye infection related to your contact lenses it is imperative that you see an eye doctor, either an optometrist or ophthalmologist, immediately. They can diagnose this infection as part of an eye exam and prescribe the appropriate antibiotic drops. Your eye doctor will keep a close eye (no pun intended!) on you over the next few days to make sure the eye is healing.

Are contacts bad for my eyes?

No. Contacts are a great optical solution for people who do not want to wear glasses and aren’t eligible for cataract surgery. However, in addition to the infection concerns detailed above, they can cause other problems. These other problems are often related to the contacts precluding an adequate amount of oxygen from reaching the cornea, despite the fact that nowadays contacts are manufactured to be highly oxygen permeable. CLARE (contact-lens-induced acute red eye) and limbal stem cell deficiency are two such problems associated with long-term contact lens use. Many of these problems can be prevented by wearing properly fitting contact lenses. Dr. Potthoff works closely with Traverse City optometrists to make sure they are wearing the right contact lenses.

Can a contact go behind my eye? Can you transplant a whole eye?

Check out this interesting article about eyes: http://mentalfloss.com/article/563242/parts-of-the-eye-facts

The article addresses some common misconceptions, such as “Can a contact get lost behind my eye”….spoiler alert, the answer is no. Contacts can move away from where they are designed to sit (the cornea) and become lodged in the conjunctival fornix, this is the little pouch of tissue formed under your eyelid. If you feel like a contact is stuck in your eye, dry using some lubricating drops and look under your upper eyelid.

Another good tidbit, that we are happy to see explained in the lay press, is that the length of your eye has a lot to do with determining your refractive error (glasses prescription) and ultimately how well you can see without glasses. Near-sighted people typically have eyes on the longer side, while far-sighted people often have shorter eyes. This is an important metric for a cataract surgeon to know when performing cataract surgery because eyes of various lengths can behave differently during surgery.

Perhaps the most interesting point in the article was the final one (Dr. Potthoff hadn’t even heard about this!)….a team of researchers in Pittsburgh is hoping to transplant whole eyes by 2026! That seems like an ambitious (but no doubt worthy) goal given the amazingly complex connections that the optic nerve makes with the brain, but hopefully they can do it!

Can an eye explode? Woman blinded at the Ryder Cup

What happened to that woman’s exploded eye at the Ryder Cup?

You may have heard about the recent tragedy involving a woman being blinded in one eye after it was directly struck by a golf ball hit by Brooks Koepka at the Ryder Cup in Paris last week. At some point the word “exploded” was used in describing what happened to the eye, and now every major news outlet is using this description. Given that it sounds like the woman also suffered an orbital fracture from the impact, it must have been quite a severe injury.

The more correct medical term would be “rupture”. And yes, an eye can rupture. In the field we call this injury a “ruptured globe”, and it is a surgical emergency that needs to be fixed by an ophthalmologist right away. Without getting in to too much detail, an eye exposed to the outside world is at a high risk for infection and further loss of the intraocular contents. Surgical repair is aimed at closing the wound and re-establishing the integrity of the eyeball. Subsequent surgeries are often required.

How can an eye rupture?

Ruptured globes are caused by trauma, either blunt or penetrating. The woman at the Ryder Cup would fall into the category of blunt trauma as it wasn’t a sharp, piercing injury that caused the injury. In contrast, penetrating trauma usually involves a sharp object, like a small projectile (think metal grinding accident) or something like a pencil (I’ve seen it). When an eye ruptures from blunt trauma it typically does so at the limbus and/or behind where the eye muscles attach to the white part of the eye, the sclera.

This is perhaps a good time to mention that the loss of an eye from an injury is almost always a freak accident. No mechanism of injury surprises me anymore. I’ve seen ruptured globes from sticks, pencils, and nails. I’ve seen eyes ruptured from cell phones (yes, a cell phone) and the corner of a nightstand (more than once). Just this year I’ve repaired ruptured eyes injured by a nailgun and also a firework. The takeaway is that you should always wear safety glasses or sunglasses when performing at-risk activities. Earlier today I drove by a road worker pulverizing asphalt without safety glasses… With that said, it’s impossible to prevent all injuries, especially such freaky ones.

What should I do if I think my eye is injured?

The most common symptoms of a ruptured globe (exploded eye) are a sudden loss of vision and onset of pain. It is rare for a patient to note any fluid coming out or onto their cheek, the amount of fluid in the front of the eye is very small. One of the more telling signs of a ruptured eye is a severely misshapen pupil. An irregular pupil is caused by a rupture injury whereby the iris (colored part of the eye) follows the flow of fluid and ends up plugging the wound. The least gory picture I could find is below, courtesy of the Cornea Academy via Twitter. If you ever suffer an injury and think you may have ruptured your eye it is important to see an eye doctor right away.

Will that French woman ever be able to see again?

I don’t know any more about her particular case than you, but based on the media reports it doesn’t sound like it. I say this because of the reports that she “lost her eye” and is now blind. This would suggest that the eye was removed, or enucleated. If the eye was incredibly damaged with minimal discernible anatomy at the initial surgery, thus suggesting no hope of ever having vision again, then the surgeon may have made the decision to remove the eye. This would be in part to prevent sympathetic ophthalmia (Google it). Going forward, one of the most important things for this woman to do is adhere to “monocular precautions”, which essentially means wearing glasses with a polycarbonate lens all the time, even if she doesn’t need them optically. This is basically like having a pair of safety glasses on all the time to prevent what would be another devastating freak accident. Also, using common sense and not engaging in high-risk activities should go without saying.

 

Today show host Craig Melvin’s Eye – What Happened To It?

Why is Craig Melvin wearing glasses?

This morning I was watching the Today show with my wife and kids before heading off to work. I was interested to see their segment regarding Today show co-anchor Craig Melvin’s recent eye issues. The segment started with discussing Craig’s choice of various trendy glasses frames as voted on by his Instagram followers. It then delved into why, exactly, Craig was wearing glasses in the first place….apparently this was his first time ever wearing glasses on air!

It turns out that over the last couple of days Craig’s left eye became red and painful. He wisely sought the advice of a nearby eye doctor. The ophthalmologist he saw diagnosed him with a corneal ulcer, in this case it was a contact lens-related corneal ulcer.

 

What is a corneal ulcer?

A corneal ulcer occurs when the top layer of the cornea, the epithelium (think of it like the cornea’s skin), is broken and the underlying tissue starts to degrade. Often this allows an infection to take hold. It’s like an abscess forming in your cornea! While some ulcers are sterile and aren’t related to infection, many are the result of either bacterial, viral, or fungal infection. Contact lens wearers in particular are susceptible to developing corneal ulcers and infections (sometimes called corneal infiltrates). Despite all of the advances in modern contact lens technology, contacts can still block oxygen from getting to the cornea and weaken it’s structure. This allows an infection to get started. This is often the result of poor contact lens hygiene.

 

How to avoid a contact lens-related corneal ulcer?

Good contact lens hygiene is key. This includes always washing your hands before handling your contacts. It’s also very important to change to a new pair of contact lens at the specified interval for your particular type. Cleaning and storing your contacts overnight according to the directions is also super important. Changing out your contact lens case at regular intervals can also help prevent an infection from growing in the case, which can then spread to the eye. If you are a contact lens wearer and notice one of your eyes becoming red and painful and possibly blurry, make sure to see a local eye doctor immediately. With prompt diagnosis and treatment these corneal ulcers can be readily treated, but left alone they can cause devastating eye problems, including blindness!

 

How is a corneal ulcer treated?

Depending on the location and severity of the corneal ulcer at diagnosis your eye doctor may choose to culture it. This means they take a sample of the infection and send it to a lab to see what type of infection is growing. This helps to tailor the therapy to the particular infection. Depending on the diagnosis, your eye doctor will likely prescribe antibiotic eye drops to treat the infection. These drops often need to be used very frequently (for example every hour) to initially treat the infection. In some cases your eye doctor may also recommend pills to be taken orally as well. These corneal ulcers require very close follow-up, in many cases the patient needs to be seen every day for a few days to make sure things are heading in the right direction.

Traverse City’s new eye educator

Exciting news! From right here in Traverse City, Potthoff Eye Care & Surgery will be welcoming a new contributor to our website, Paula! Paula is our wonderful office manager who helps out in a variety of roles, including scheduling and greeting patients, answering the phones, answering questions regarding the logistics of having cataract surgery in Traverse City , and helping our patients understand their insurance coverage.

Paula comes to us without any experience in ophthalmology or optometry, so she has been learning a lot about what goes on in an eye doctor’s office! Since I’ve been doing nothing but eyes for a number of years, we thought it would be fun and helpful to visitors for Paula to shed a newcomer’s perspective on her journey to learn about the eye. Paula will be writing  about anything she finds interesting about ophthalmology, from the optics of glasses, to how modern cataract surgery is performed, and more!

Stay tuned for her first post about basic eye anatomy and the various structures of the eye!