What is Bell’s Palsy?

Bell’s palsy is a weakness or paralysis of the facial muscles which is innervated by the seventh cranial nerve. It is usually temporary and unilateral. Between 40 and fifty thousand people in America develop Bell’s palsy. It is much more common in diabetics. It was first described in 1829 by Sir Charles Bell (surgeon in Scotland). It is the most common type of acute facial paralysis.

What Causes Bell’s Palsy?

There are many different causes for Bell’s palsy though none definitive. Viruses are thought to be a major cause of Bell’s palsy. It is thought to be an inflammatory condition causing swelling of the facial or seventh cranial nerve as it exits from the skull. Lyme disease can cause facial paralysis. Tumors and strokes can also cause a facial paralysis. Patients with a known cause for the paralysis are not really considered to have Bell’s palsy.

Signs and Symptoms of Bell’s Palsy

Patients with Bell’s palsy present with facial weakness or drooping of the face. The facial nerve innervates the muscles of the face. It also controls or innervates taste buds anterior 2/3 of the tongue, lacrimation, salivation, and the stapes muscle of the middle ear. Patients will have problems with tasting, tear film production, smiling, blinking, mouth drooping with drooling,   and unable to close their eyes.

Other symptoms include headache or pain, tingling, weakness, balance problems, and neck pain. The forehead is spared from the paralysis as there is innervation to the forehead from both sides of the brain.

Eye Symptoms

Ectropion of lower lid (eyelid turns out away from the eye)

Exposure keratitis ( due to the eye not able to close or blink the eye gets very irritated from constant expose to the air or environment)

Tearing (secondary to exposure keratitis, poor or no blinking, and ectropion of lower eyelid)

Blurred vision (due to altered tear film)

Diagnosis of Bell’s Palsy

The diagnosis is made by excluding other possible causes.

Treatment of Bell’s Palsy

The treatment depends on the severity of the paralysis. Mild cases may need no treatment and severe or complete paralysis may need a variety of treatments.

Corticosteroids

Corticosteroids have been shown to improve the recovery of Bell’s palsy.

Surgery

Smile or reconstruction surgery may help people who have permanent paralysis.

Eye Treatments

Patients need to use artificial tears as often as necessary to keep their eyes comfortable. If the ectropion and exposure keratitis is severe enough then a lateral tarsorraphy or ectropion repair may be indicated. The tarsorraphy can be released if the lid function returns.

I doubt there’s an article written that says that smoking is good for you….and this isn’t one either.  But many patients are not aware of the link between smoking and vision loss, as well as other eye issues.  If you or someone you love needs one more reason to quit smoking, then this article may help you out.  Starting from the outside of the eye and working back, here are some of negative effects of smoking when it comes to your vision.

Eyelids

Smoke is drying agent.  It also discolors the skin.  The smoke from cigarettes dries the skin around the eyelids making them more wrinkled.  The smoke can also turn the skin of the face and around the eyes more yellow or grayish.  Just not a good look.

Dry Eyes

The cornea is the clear portion on the front of the eye.  This is where contact lenses are worn.  Since the smoke dries up the tear film, it’s very common to experience symptoms of dry eye syndrome.  Some of the problems are listed below:

• Gritty or sandy feeling
• Chronic redness
• Excessive tearing.  This is often how the eye responds to dry irritation.  The emotional tear gland turns on the eye actually tears up.
• Difficulty in wearing contact lenses

Cataract

Cataract is a clouding of the lens of the eye.  Free radical can bring on this clouding.  Since smoking reduces the presence of anti-oxidants which prevent damage from free radicals, the risk of cataract is greatly increased.  Several years ago, a Harvard Medical School study determined that as many as 20 percent of all cataract is the result of smoking.

Macular Degeneration

The same pesky free radicals also cause damage in the retina.  The center of the retina where everything focuses can be damaged by free radicals and result in macular degeneration.  This condition can lead to the permanent loss of central vision.  To complicate matters, smoking reduces blood flow in the smallest vessels of the body, the capillaries.  This results in poor circulation and less oxygen delivery to the macula which depends on small blood vessels for survival.

So, there you have it!  A virtual laundry list of additional reasons to stop smoking.

The sixth cranial nerve (abducens nerve) is responsible for innervating the lateral rectus muscle which pulls the eye laterally (abducts the eye). A sixth nerve palsy is a weakness or decrease in innervation to the lateral rectus muscle. The result is the loss or decrease in the ability of the eye to turn outward and the eyes will typically turn in towards the nose.

A sixth nerve palsy is unilateral in most cases and rarely bilateral.

What are the Symptoms of a Sixth Nerve Palsy?

RIGHT EYE TURNED IN TOWARD NOSE

Horizontal double vision (images are doubled side by side) is the main symptom of a sixth nerve palsy. When unilateral, the double vision will be worse or the images farther apart when the patient looks laterally to the side of the sixth nerve palsy. Many people turn their head toward the side of the sixth nerve palsy to decrease the double vision. Children under age six or seven will not have double vision as their brains can suppress an eye and not see double vision causing amblyopia.

What Causes a Sixth Nerve Palsy?

The sixth nerve has a long course from the brainstem to the lateral rectus muscle. Therefore, there are many causes of a sixth nerve palsy occurring along its pathway.

Diabetes is the most common cause

High blood pressure

Atherosclerosis

Trauma

Increased intracranial pressure

Temporal arteritis

Cavernous sinus mass

Multiple sclerosis

Viral

Hydrocephalus

Chiari Malformation

Brainstem tumors

Other Causes of Double Vision That Mimic Sixth Nerve Palsy

Thyroid eye diseases (Graves’ disease)

Myasthenia gravis

Diagnosis of a Sixth Nerve Palsy

The workup for a sixth nerve palsy includes blood test, MRI, and workup by a neuro-ophthalmologist or neurologist to determine the cause. This will lead to the proper treatment of the sixth nerve palsy. Many cases of sixth nerve palsy are temporary as with diabetes and will resolve in a few weeks or months.

Temporary Treatment of Sixth Nerve Palsy

Fresnel Prisms

Fresnel prisms are thin flexible prisms that can be attached to a patient’s glasses or glasses can be made without a prescription to hold the prisms. Prisms bend light so that the double vision can be decreased or treated while the patient is recovering from the sixth nerve palsy. The Fresnel prisms are easily attached to the glasses.

Long Term Treatment

If after a year and the palsy has not resolved, other forms of treatment may be considered.

Prisms

If the deviation is not too large, permanent prisms can be placed in regular eyeglasses.

Surgery

The surgical procedure will be determined by the level of function of the sixth nerve. Complete loss of function will require a transposition surgery such as Jensen’s or whole muscle transposition.

Blue Eyes

There are no blue pigments in the iris to make eyes blue. Blue eyes have low levels of melanin or brown pigment in the stroma of the iris (front portion of the iris) and the pigment epithelium (back surface of the iris).Just like when we see a blue sky, longer wavelengths of light do not reflect and are absorbed by the back pigment layer of the iris. The shorter wavelengths of light (blue) are reflected and results in a blue iris which can change in appearance depending on lighting conditions.

Who has Blue Eyes?

Blue eyes are more common in Scandinavia, Northern Europe, and Western Asia and their descendants. In America, one out six children is born with blue eyes. Approximately two percent of the world’s people have blue eyes.

Green Eyes

Green eyes are due to low levels of melanin pigment in the stroma with a combination of amber and/or light brown pigment in the stroma with light being scattered or reflected from the stroma of the iris. Green eyes are the least common eye color.

Who has Green Eyes?

Green eyes are most common in Northern Europe, South America, Iceland, North Africa, and Central Europe. Green eyes are more common in women than men.

Hazel Eyes

Hazel eyes are due to a moderate level of melanin pigment in the stroma. Hazel eyes consist of brown and green colors. It can appear as a multicolored eye and the eye color can appear to change in different light conditions.

Amber Eyes

Amber eyes have a yellowish or golden color and are due to the deposition of a yellow pigment called lipochrome. Amber eyes are different from hazel eyes as hazel eyes have more than one color.

Grey Eyes

Grey eyes are similar to blue eyes in that there is a low level of melanin pigment in the epithelium and iris stroma. The grey color may be due to a difference in the thickness of the stroma or different levels or pattern of pigment in the stroma.

Who has Grey Eyes?

Grey eyes are more common in the Middle East, Pakistan, Northern Europe, and Eastern Europe.

Brown Eyes

Brown eyes are the dominant eye color in humans around the world. Brown eyes are due to the high levels of melanin in the stroma and pigment epithelium of the iris.

Associated Risks of Eye Color

Lighter colored eyes such as blue or green have a higher incidence of age-related macular degeneration. Melanoma of the iris and uveal layer of the eye is more common in people with blue, green, or grey.

How is Eye Color Determined?

For years everyone thought that eye color was a simple genetic process of brown eyes are dominant and blue eyes are recessive. Each parent has two pairs of genes on each chromosome. Blued eyed parents had to have blue eyed children. Brown eyed parents would have a seventy five percent chance of browned eyed children and twenty five percent chance of a blue eyed children. We now know that it is not that simple.

Factors that Determine Eye Color

Eye color in humans is due to three factors and is a variation of pigmentation of the iris from light brown to nearly black.

Iris Pigment Epithelium

The amount of melanin pigment in the iris pigment epithelium located on the back side of the iris contributes to the iris color..

Iris Stroma

The amount of melanin pigment in the iris stroma located on the front of the iris contributes to the iris color.

Density of the Stroma

The cellular density of the stroma also contributes to the eye color. Blue eyes have thinner irises and brown eyes have thicker irises.

The appearance of blue, green, and hazel eyes results from less brown pigment and the scattering of light in the stromal layer of the iris.

Genetics of Eye Color

Eye color is not just a simple dominant and recessive genetic result. The genetics of eye color is determined by multiple genes. More than fifteen genes have been found to be associated with determining eye color. The OCA2 gene contributes the most in eye colors genetics. The genetic controller next to the OCA2 gene controls its action and therefore the amount of pigment produced in the eye.Eye color can vary from the most common color of brown to the least common green. Many scientists think that a mutation caused the lighter colors and that originally everyone had brown eyes.

Eye Color Change in Babies and Children

Most babies who are Caucasian have blue or light colored eyes when they are born. As the child develops, the melanocytes found in the iris begin to produce melanin pigment. As the child approaches age one, the iris begins to change and continues up to age three or four before the final eye color will be known in many cases.

Diseases that Effect Eye Color

Heterochromia

Complete Heterochromia

Complete Heterochromia is an iris condition where the iris of one eye is totally different from the other eye.

Partial Heterochromia

Partial Heterochromia is an iris condition where a portion of the iris in one eye is different from the others portions of the eye.

This is caused by the increase or decrease in the amount of pigment in the iris.

Other Possible Causes for Changes in Eye Color

Injury to the eye with a loss of pigment

The use of prostaglandin drugs in the eye for treatment of glaucoma

Horner’s’ Syndrome

Waardenburg syndrome

Wilson’s disease

Ocular Albinism

There are plenty of places to donate your old eyeglasses.  For example:

• Ask your eye doctor if they take them.  Many doctors are involved in medical missions or support groups that serve on mission teams.  They can usually forward your eyeglasses on to a group needing them for mission trips.
• Local service clubs like the Lions, Kiwanis, and Rotary may collect eye wear for mission work as well.
• Many faith-based programs have collection bins for donating eyeglasses.
• Check out your bank and grocery store.  In some areas, service groups and faith-based groups have collection bins at the bank or grocery, making donating easy and convenient.

How are the donated eyeglasses used?

When eye wear is donated, the collecting group separates out eyeglasses that they are unable to repair, or for other reasons may not be usable.  The eyeglasses prescriptions are then measure on instruments and the eyeglasses are sorted by power, gender, single-vision or bifocal, children or adult.  Many of these organizations then supply eye wear to various medical mission teams headed in the U.S. or overseas.  In most cases, these groups only provide eyeglasses to organizations that have an optometrist or ophthalmologist on the team to ensure patients receive the correct eye wear.

Relatively new to the market are eyeglasses that can be made on-site on mission trip experiences.  The advantage these eyeglasses have is the ability to accurately prescribe just what the patient needs.  The drawback is the price, even low, may be too much for mission teams to use on their trips.  So, donated eyeglasses are still in great need.  In many cases, the donation is tax deductible as well.

So, look around the house….you may very well have the eyeglasses someone else could really use.

The first step in trying to maintain the health of your eyes is to eat a healthy balanced diet.

Dark Green Vegetables

Dark green vegetables such as spinach, kale, mustard greens, collard greens, and broccoli contain high levels of phytochemicals, luteins, and zeaxanthin. Lutein and zeaxanthin help protect the retina from damage and aging. They are found in high concentrations in the macular area of the retina which is responsible for our clear central vision.

Vegetables Containing Beta- Cartenoids

Carrots, cantaloupe, sweet potatoes, yams, and yellow squash contain beta-carotene. Beta-carotene is absorbed and enters the liver where it is changed into rhodopsin which is the primary chemical in the retina.

Blue Eyed People

People with blue eyes need more of these nutrients as they have less protective pigment in their retinas.

Nutritional Supplements Reduce Progression of Macular Degeneration

There have been studies that have shown that certain nutritional supplements reduce the rate of progression of macular degeneration. The largest study is the Age-Related Eye Disease Study (AREDS).

AREDS

The AREDS showed that the use of supplements used in the study slowed the rate of progression of macular degeneration can be reduced by twenty or twenty five percent. The nutrients in the study:

Vitamin C – 250 mg

Vitamin E – 400 IU

Vitamin A (beta-carotene) – 15 mg

Zinc (zinc oxide) – 80 mg

Copper (cupric oxide) – 2 mg

AREDS 2

Age Related Eye Disease Study 2 was started which added to the original nutrients in the first AREDS. The study should conclude in the near future. The added supplements were doses of:

Lutein 10 mg

Zeaxanthin 2 mg

Omega-3 fatty acids (fish oil) 350 mg/650 mg

Commercially Available Eye Supplements

There are many commercially available eye supplements. It is best to chose one that is either liquid or capsule. Many people have problems digesting hard tablet-like vitamins and are not completely absorbed. Common supplements are:

Ocuvite®

PreserVision®

Macutrition®

Tozol®

Vitamins and Supplements that are Important to Include

Vitamin A or beta-carotene

Vitamin B complex

Vitamin C

Vitamin D

Vitamin E

Omega-3 fatty acids or fish oil

Phytochemicals- reseretrol, acai, blueberry, bilberry, ginkgo biloba

Lutein

Zeaxanthin

Summary

The proper diet containing dark green vegetables, vegetables containing carotenoids, whole grains, nuts, legumes, fish high in omega3 fatty acids, lean meats, and low fat is necessary for maintaining healthy eyes and good vision. Adding an eye supplement regimen to you diet gives you the best chance of maintaining clear vision.

Blephasteam Device

Blephasteam is a new device designed for the treatment of Meibomian Gland Dysfunction (MGD), dry eyes, and blepharitis. It was developed by Laboratories Thea and Dr. J.R. Fuller.

Meibomian Gland Dysfunction and Dry Eyes

The meibomian glands are located in the eyelids and produce the lipid material that forms the outer layer of the normal tear film. It is responsible for keeping the liquid portion of the tear film from evaporating from the surface of the eye. The evaporation of the tears results in the person developing dry eye syndrome. Meibomian gland dysfunction may be responsible for as much as eighty five percent of dry eye cases.

Blepharitis

Blepharitis is an inflammatory and/or infectious disease of the eyelids located around the area of the eyelashes. It is caused by seborrheic skin condition, inflammatory disease such as rosacea, and/or staphylococcus bacteria infecting the area around the eyelids. Blepharitis can be a chronic disease and contributes to the development of meibomian gland dysfunction and dry eyes.

Blephasteam Device

Blephasteam is a device that contains two eye pieces or goggle-like apparatus with water tight chambers that fits around the orbit or ocular area. A removable moistened ring saturates each chamber with humidity. This facilitates heat transfer from a controlled safe heat source. The patient is able to continue blinking which helps with the meibomian gland empty their lipid material. The patient is able to see out of the goggles while the treatment is in progress.

Blephasteam Treatment

The Blephasteam unit should be plugged in fifteen minutes before use to allow for preheating. The Blephasteam rings must be moistened with mineral water or saline solution and placed inside the goggles. The rings are for single use and are thrown away after each use. New rings must be used for each treatment to ensure proper hygiene.

The Blephasteam treatment is recommended to be used twice a day. The unit has to be plugged into an electrical outlet. The temperature rise of the Blephasteam has been measured to rise to 42 degrees C. This temperature meets the melting point of the meibum (lipid) in the meibomian glands. This makes it easier for the glands to empty their contents.

The Blephasteam treatment is ten minutes in duration. The Blephasteam device is removed and the rings thrown away. Blephasteam is a single use device and must be cleaned carefully with the dry blue cloth or alcohol wipe after each use. The eyelids should be messaged and cleaned after the treatment is completed.

 Contacts should be removed before treatment and no eye drops for fifteen minutes after treatment.

Availability of Blephasteam

Blephasteam is available in the United Kingdom and Europe. At this time, it is not available in the United States.

Summary

Blephasteam is a simple safe and effective method of treatment for meibomian gland dysfunction and dry eye syndrome. The device delivers a controlled level of moist heat to the eyelids. This promotes the secretion of the lipid material from the meibomian glands providing improvement in the quality of the tear film, comfort of the eye, and visual acuity. Blephasteam should be considered as one of the treatment regimes for dry eyes and meibomian gland dysfunction.

Photochromatic Lenses

Corning Glass came out with Photochromatic lenses in the 1960′s.  The lenses are made of glass that darkens in the presence of outdoor light.  The lenses come in brown or grey and darken to a fairly dark tint when outdoors or in the car.  Since the lenses are made of glass, they can be heavy, especially for high prescriptions.  They are very durable however, and have great optics.

Transitions Lenses

Transition Optical first produced Transition Lenses in 1990 from their Florida laboratory.  Over the years, they have expanded globally, producing several generations of photochromatic lenses.  Transistion lenses are made in a variety of plastic materials, including polycarbonate which is the lenses recommended for children because of their safety.

Since they are made of plastic, the lenses are lighter and will fit in more frame options than glass lenses.  However, most transistion lenses will not darken up when you’re in the car.  The lenses darken in the presence of Ultraviolet (UV) which is nearly completely blocked out by the glass windows of the car.  In response to this issue, Transitions Optical came out with a new product for driving that will darken inside the car, but the tradeoff is that the lenses remain slightly tinted indoors as well.  For more information on Transistion lenses, visit their site by clicking here.

What about Polorized Lenses?

Polarized lenses block out all reflected light, also known as glare, therefore creating a more comfortable and clear view.  Up until recently, photochromatic lenses were not polarized.  However, in May of 2012, Transistions Optical will release it’s newest product, their Vantage Lens, which will be clear indoors but darkens outdoors into a polarized lens.

So, there are plenty of options.  Be sure to review your vision needs with your eye doctor and optician so that you can be advised on the best solution for you.

Once the decision is made for the child to where contact lenses, what are the best lenses to use? This article will review options for you without advertising one brand over another.  Of course, you’ll need to review all the options available to you from your eye doctor.  And you may want a second opinion as well – this is an important decision.

Daily Wear versus Extended Wear

All contacts can be removed at the end of the day, and some contact lenses are approved to keep in overnight, also called “extended wear”.  Extended wear poses higher risks of infections and other complications.  As such, most eye doctors are hesitant to prescribe extended wear modalities for children.  Even though there are contact lenses that are approved for up to 30 days of continuous use, many doctors believe this poses too much risk for children who may not bring up problems to Mom or Dad.  Daily Wear is a safer bet.

Daily wear lenses fall in to two camps – ones you clean and ones you don’t.  Lenses that are cleaned nightly are then discarded every one to four weeks, depending on brand and doctor recommendations.  Other lenses are thrown away every day, therefore never needing cleaning.  These lenses cost more but are considered to be the safest way to wear contact lenses.

To review…..meet with your child’s doctor to discuss when you both feel your child is ready.  Review with your child the increased responsibilities of contact lens care and wear.  In addition, ask your doctor for your child’s safest and clearest option for contact lens wear.