Red Eye: The cause of this condition must be correctly diagnosed for the best outcome. Unfortunately, the family physician usually does not have the equipment, a slit lamp, to do this accurately; antibiotics are effective against bacteria only, and are sometimes prescribed needlessly. Some antibiotic eyedrops also cause mild irritation which is acceptable if their is indeed a bacterial eye infection. Ironically, it is in fact rare for an adult to have a bacterial eye infection; a majority of infectious pink eye is viral in adults. Delaying the proper treatment can be disastrous in the case of iritis or shingles. Iritis is an inflammation of the iris producing extreme light sensitivity in addition to red eye. It is caused by trauma, a systemic inflammatory condition such as arthritis or Crohn's disease, or, as in 50% of cases, no known cause. Untreated, it can lead to acute glaucoma and vision loss. It can only be diagnosed by the eye doctor using a slit lamp. Other causes of red eye are viral pink eye, allergies and corneal abrasion. Dr. Workman can recommend which eyedrops or treatments would be best.

Embedded Corneal Foreign Bodies: Typically from grinding metal, these are removed under local anesthetic with special instruments in conjunction with the slit lamp. With a large welding industry in the area, Dr. Workman has extensive experience removing these, and is better equipped than the local hospital. Patients are usually accomodated promptly for quick relief. Those with ingrown eyelashes are also accomodated promply.

Glaucoma: Part of the regular eye exam involves tests for glaucoma: intraocular pressure, optic nerve assessment, visual fields, pachometry, and a new test, HRT. Patients diagnosed with glaucoma can have their condition monitored by HRT, measuring pressure and visual fields. The visual field analyzer in our office is the latest technology and is easier and quicker for patients to do.

Cataracts: Everyone will eventually develop cataracts as a natural part of aging as the lens behind the iris gets more opaque with age. The average age for cataract surgery is 72. Dr. Workman can determine when the cataract is "ripe enough" to warrant referral to a reputable surgeon. He can counsel you on the procedure and provide the post-op care, which includes monitoring for complications and secondary cataracts. Our office sets up the referral appointment which includes reports to the surgeon. When cataracts are "ripe" new glasses will not improve vision.

Retinal Detachment & Floaters: If you are experiencing flashes of light, a shower of black dots, changes in vision in one eye, especially if associated with head trauma - this is urgent and could be a retinal tear. By examining your retina, Dr. Workman can distinguish between a tear and a benign formation of floaters. Natural changes in the back of the eye cause floaters typically around age 50; however, the symptoms are similar to a retinal tear. If a tear is found immediate referral to the retinal specialist will be arranged. (Note: regardless of whether you are seen by an optometrist or ophthalmologist for this, a retinal tear is ultimately referred to a retinal specialist.)

Diabetes and Cardiovascualar Diseases: The eye is the only part of the body where the small internal arteries can be viewed. Thus, it is imperative that patients suffering from these systemic diseases receive annual visits. Diabetes is one of the leading causes of blindness, yet a majority of cases could be prevented with regular eye exams. If retinal hemorrhages typical of diabetes are detected, your family physician will be informed to improve blood sugar control medically. If the blood vessel leakage reaches critical levels then referral to the retinal specialist is necessary. Again, regardless if you see an independent optometrist like Dr. Workman, or an ophthalmologist instead, you will be still be referred to the retinal specialist, of which there are only a few.

Macular Degeneration: This leading cause of blindness usually affects the central vision of the elderly. The macula is the small central part of the retina which provides our 20/20 vision. In ARMD this area becomes distorted or swollen reducing vision. These patients have difficulty reading or seeing detail. There is no cure; treatment merely attempts to limit the damage. Macular degeneration is monitored until it requires referral to the retinal specialist for fluorescein angiography and laser treatment. Photodynamic therapy using Visudyne is effective for the wet form of macular degeneration and must be repeated. OHIP now covers it (at over $2000 per treatment), however, in the fine print, only classic cases are covered. Thus, only about 50% of the patients who need it are covered, saving the government money while allowing them to claim to cover it. A new treatment for Dry ARMD has now been developed called Rheophoresis, which filters out the molecular risk factors in the blood which contribute to ARMD. However, as with Visudyne when it was first available, it is not covered by OHIP and costs about $2000/treatment with the average patient requiring 8 sessions. It has been proven to prevent further progression and vision loss. At NDEC, patients can find out if they would be candidates for the therapy and be referred to the Rheo Clinic. In addition, Vitamin Therapy has proven to be effective at slowing the disease down, preserving remaining vision. Our office now dispenses Vitalux at $23/2 bottles which is usually less than the drug stores.

Dry Eye: Typically patients complain of burning, watery eyes. This is typically an age-related problem, but can also be caused by contact lens wear, medications such as anti-histamines, dry environments, and arthritis. There is no cure for dry eye. Artificial Tears, available at our office, need to be used regularly to lubricate the surface of your eyes - like hand lotion for the skin. Do not confuse these with eye-whiteners such as Visine, Clear Eyes, Murine; this will make your eyes look nice & white, but worsen your dry eye. Another treatment is punctal plugs in which the tear ducts are blocked to keep the natural tears on the eye longer. Dr. Workman has these in his own tear ducts for improved comfort. A trial with plugs that dissolve in 1 week can easily determine if you would benefit from the procedure. However, this is not covered by OHIP.

Styes and Blepharitis: An infection of the eyelid margins - blepharitis - is typical in young children and people who work in dusty environments (farmers, dry-wallers). Patients have a red-rimmed appearance and dandruff on their eyelashes. Lid care needs to be instituted to control the disease; antibiotic ointment may also be needed. Blepharitis can lead to a stye, which is an infection of a tear gland. Antibiotic drops and ointment are ineffective since they cannot penetrate the lid tissue. A warm compress (or hot tea bag - it has nothing to do with the tea) is first recommended. The best warm compress can be made by placing a moist wash cloth in a ZipLoc bag and microwaving it for 15-20 seconds. Remove the cloth from the bag and apply it to the lid with force for 15 minutes. The more often you treat, the faster it will improve. If there is no improvement after 1 month, antibiotic pills may be required.

It is important to see the eye doctor soon after symptoms start. For many conditions there is minimal pain or change in vision in the early stages. With prompt diagnosis & treatment, and regular follow-up eye exams, loss of vision can be prevented.