Two Eyes Walk Into A Bar…

Two eyes walk into a bar – after sitting down, one eye says to the other “between the two of us, something smells!”

Alcohol is known to cause decreased visual performance with slow pupil reactions, less peripheral vision and lower contrast sensitivity. Most people assume that alcohol only affects your eyes while you’re drunk, but that hangover can be doubly tough when you wake up with sudden eye pain.

I have a patient who likes to have ‘fun,’ but this fun oftentimes comes with red painful eyes the next morning. After researching his condition, I learned that alcohol can cause and exacerbate a condition called “Drinker’s Eye,” a type of recurrent corneal erosion that leaves patients regretting last night’s decisions.

There is almost no literature linking late night drinking with eye pain, but the link is clear if you look at the evidence. First, a little background:

Often times I describe the cornea to a patient in simple terms they can understand. Basically, there are three layers to this clear front surface of the eye: an outermost ‘skin’ type later, a middle ‘meaty’ layer and the inside layer that pumps in nutrients. A condition called Recurrent Corneal Erosion (RCE) happens when the outermost ‘skin’ layer doesn’t adhere, or tack-down, to the ‘meaty’ tissue underneath.

Now, when we sleep, our eyes actually swell a bit and come into contact with the inside of our eyelids, and there is some level of ‘stickiness’ or adhesion between the eye and the lid. The dryer the eye, the more adhesion takes place. When an eye with a healthy cornea opens in the morning, the adhesion breaks off uneventfully. But when the top layer of the cornea isn’t tacked down properly, the ‘skin’ cells rip off when the eye opens- causing acute pain and discomfort lasting hours into the day.

What ultimately results is a corneal abrasion – a serious eye problem that may require antibiotics and an bandage.

RCE is a recurrent condition, meaning it usually doesn’t just happen once, but instead over and over with days, months or years in between. This all stems for some problem with the bond between the corneal layers – usually there was an underlying initial injury that just didn’t heal correctly. Another cause could be a corneal dystrophy called map-dot-fingerprint dystrophy.

So back to alcohol. We know alcohol causes dehydration and dehydration causes dry eyes. We also know that dry eyes leads to a higher eye-to-lid adhesion while sleeping. So it’s not a stretch to surmise that eyes with an underlying problem would be more prone to RCE after a night of drinking.

If this happens to you, there are a few steps you can take to avoid calling me on a Sunday with an emergency eye condition. First (and most obviously), don’t drink as much! Less alcohol will lead to less problems.

Secondly, if you can remember (keep in mind you’ve been drinking) put in a lubricating eye drop before bed. Preferably a gel or ointment that will lubricate your eye all night and cut down on the stickiness between the eye and the lid.

Lastly, drink more water to hydrate before you go to sleep. Pretty sound advice for any drinker, but even more so if your eye takes the brunt of the hangover.

More advice for suffers of RCE:

Environmental

• Ensure that the air is humidified rather than dry, not overheated and without excessive airflow over the face. Also avoiding irritants such as cigarette smoke
• Use of protective glasses especially when gardening or playing with children (to prevent injury)

General personal measures

• Maintain general hydration levels with adequate fluid intake
• Don’t sleep-in late as the cornea tends to dry out the longer the eyelids are closed

Pre-bed routine

• Routine use of long-lasting eye ointments applied before going to bed
• Occasional use of the anti-inflammatory eyedrop (prescribed by an ophthalmologist or optometrist) before going to bed if the affected eye feels inflamed, dry or gritty
• Use of a hyperosmotic ointment before bed reduces the amount of water in the epithelium, strengthening its structure

Waking options

• Learn to wakeup with eyes closed and still and keeping artificial tear drops within reach so that they may be squirted under the inner corner of the eyelids if the eyes feel uncomfortable
• It has also been suggested that the eyelids should be rubbed gently, or pulled slowly open with your fingers, before trying to open them, or keeping the affected eye closed while “looking” left and right to help spread lubricating tears. If the patient’s eyelids feel stuck to the cornea on waking and no intense pain is present, use a fingertip to press firmly on the eyelid to push the eye’s natural lubricants onto the affected area. This procedure frees the eyelid from the cornea and prevents tearing of the cornea

Shining Light on Your Baby’s Eyes

New research in Nature concludes the eye, which depends on light to see, also needs light to develop normally during pregnancy.

Scientists say the unexpected finding offers a new basic understanding of fetal eye development and ocular diseases caused by vascular disorders — in particular one called retinopathy of prematurity that can blind premature infants.

This fundamentally changes our understanding of how the retina develops,”

says study co-author Richard Lang, PhD, a researcher in the Division of Pediatric Ophthalmology at Cincinnati Children’s Hospital Medical Center. “We have identified a light-response pathway that controls the number of retinal neurons. This has downstream effects on developing vasculature in the eye and is important because several major eye diseases are vascular diseases.”

Lang is a principal investigator on the ongoing research along with project collaborator, David Copenhagen, PhD, a scientist in the departments of Ophthalmology and Physiology at UCSF. The scientists say their current study, conducted in mouse models, includes several unexpected findings.
“Several stages of mouse eye development occur after birth,” says Copenhagen. “Because of this, we had always assumed that if light played a role in the development of the eye, it would also happen only after birth.”

But researchers in the current study found that activation of the newly described light-response pathway must happen during pregnancy to activate the carefully choreographed program that produces a healthy eye. Specifically, they say it is important for a sufficient number of photons to enter the mother’s body by late gestation.

Researchers were also surprised to learn that photons of light activate a protein called melanopsin directly in the fetus — not the mother — to help initiate normal development of blood vessels and retinal neurons in the eye.

One purpose of the light-response pathway is to suppress the number of blood vessels that form in the retina. These vessels are critical to retinal neurons, which require large amounts of oxygen to form and to function. When retinopathy of prematurity occurs in infants, retinal vessels grow almost unchecked. This continued expansion puts intense pressure on the developing eye and in extreme cases causes severe damage and blindness.

Lang said the research team is continuing to study how the light-response pathway might influence the susceptibility of pre-term infants to retinopathy of prematurity and also be related to other diseases of the eye.

Healthy Vision Starts With The Food On Your Plate

Your eyes are an important, and often overlooked, part of your overall health.

Eating right keeps you healthy and helps make healthy vision last a lifetime. The foods you eat play an important role in healthy vision and may even help prevent eye conditions such as macular degeneration, cataracts and glaucoma.

Although many eye problems do occur with age, the process that leads to them begins years before. Taking the right nutritional steps may reduce the risk of developing these sight-threatening conditions, or help to slow their progression if they’ve already begun.

Taking care of your eyes also may benefit your overall health. Studies have shown that people with vision problems are more likely to have diabetes, poor hearing, heart problems, high blood pressure, lower back pain and stroke, as well as have increased risk for falls, injury and depression.

Some staples of an ‘eye-healthy’ diet include fruits, vegetables and fish. Fruits and vegetables are a great way of getting vitamins and antioxidants that the whole body needs. Nutrients such as omega-3 fatty acids, lutein, zinc and vitamins C and E may help ward off age-related vision problems such as macular degeneration and cataracts.

One of the common foods associated with eye health are carrots. Beta-carotene is a form of vitamin A found in carrots and sweet potatoes, and plays a role in general eye health. The body cannot make beta-carotene, so it relies on getting it from food. And this vital nutrient is the backbone of our visual system.

Omega-3 fatty acids are commonly found in fish oil. These essential fatty acids are found in cold-water fish such as salmon, mackerel and tuna. Omega-3′s are the most abundant fatty acid in the eye and are associated with a lower risk of age-related macular degeneration, as well as decreased dry eyes.

Green leafy vegetables, such as spinach and kale, are very high in lutein and zeaxanthin, two pigments which are known to be protective to the eye. This pigment literally gets absorbed into the body and then planted into the eyes, acting as a bullet-proof vest, taking the brunt of light damage for our vulnerable eyes. Lutein is also present in egg yolks, corn and peas.

A recent study by Florida International University found that eyes containing higher amounts of lutein were up to 80% less likely to be suffering from Age-Related Macular Degeneration (AMD). Similarly, the age-related eye disease study determined that taking high levels of antioxidants and zinc reduces the risk of developing advanced AMD by about 25%.

Another study in the American Journal of Clinical Nutrition found that eating a teaspoon of green leafy vegetables with a small amount of fat raised blood lutein levels by nearly 90%. Meanwhile, eating a well-balanced diet also helps to maintain a healthy weight, which lowers the risk for type 2 diabetes. Diabetes is the leading cause of blindness in adults and having diabetes also increases your risk for glaucoma and cataracts.

Here are a few more tips to help ensure your vision lasts a lifetime:
• Know your family history. Some eye diseases are hereditary. Talk with your family members about their eye health history, then talk with your eye care professional to learn what you can do to protect your vision.

• Give it a rest. If you work at a computer all day, long give your eyes a break. Every 20 minutes, look 20 feet away for 20 seconds to reduce eyestrain and fatigue.

• Wear sunglasses. Look for ones that block out 100% of Ultra-violet radiation.

• Quit smoking. Smoking has been linked to an increased risk of cataracts, optic nerve damage, and macular degeneration.

• Use safety eyewear at home, at work and while playing sports.