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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 10783
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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43 year old male. 20/10-15 depending on the day. Drink & smoke.

Resolved Question:

43 year old male. 20/10-15 depending on the day. Drink & smoke. Relatively high stress job. Sleep poorly. Over the last few months I've experienced evenings when my vision is shot. Meaning I can't read the menu of a TV 10 feet away. I'm guessing I'm getting old and fatigued. Should I be concerned?
Submitted: 5 years ago.
Category: Eye
Expert:  Dr. Rick replied 5 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Customer:

Doc,

Customer:

Doc, anything I should be concerned about?

Dr. Rick :

Does it come and go with blinking or does it seem to always be like this?

Customer:

Once it sets in, I'm done. Fortunately, I simply go to sleep and ALL is WELL in the morning.

Dr. Rick :

It sounds like a tear film/anterior segment issue. What could be causing this? Well, it could be a number of things however, the most common is a combination of dryness, allergies and blepharitis.

Dr. Rick :

What can you do about this? Well, when it comes to allergies it is almost impossible to pin down the offending agent(s) and, therefore, treatment needs to focus on controlling the symptoms. Dry eyes are very common and can be improved by a stepwise series of therapies. First, the use of natural tears 4-6+ times/day to augment your natural tear production, if this doesn’t work then you can try temporary punctal occlusion of the lower puncta, then, if needed, temporary occlusion of all 4 puncta then, if indicated, surgical ( non-reversible) closure of the puncta. The openings to your tear drainage system are called puncta and you have one opening on each lid, near your nose.


 


Blepharitis is a condition where glands in the eyelids are not functioning normally. They become plugged and instead of putting out their normal clear, oily secretions, they put out thick, toothpaste like gunk. You may not be able to see this “gunk” yourself, unless it is really bad, but it shows up clearly on slit lamp examination.


 


The best treatment for this condition daily lid scrubs combined with warm compresses. I like to use baby shampoo for lid scrubs. In the shower, place the shampoo on your index fingers, close your eyes, raise your eyebrows (to stretch the skin on your eyelids) and scrub back and forth along your eyelashes for 3 to 5 minutes. The hot water in the shower helps to soften the plugged oils in the glands while the mechanical scrubbing with your soapy fingers removes the oils.


 


Baby shampoo lid scrubs will also help to wash away allergens and stimulate tear production, thereby addressing all three of your issues. Remember, this is not an instant fix. While you are waiting for the lid scrubs to have affect you can use over the counter allergy pills such as Travist, dimetapp or Zyrtec.


 


Should your symptoms get worse, your vision become significantly affected or things just not get better in 3 weeks or so you should have a complete eye examination by your local ophthalmologist to look for other, less common, causes of your symptoms.


 

Dr. Rick :

Does that make sense to you?

Dr. Rick :

Another possibility is that you are suffering from accommodative spasm. This is more common as we reach the age where reading glasses are starting to become needed. Sometimes it can be brought on by watching TV in a dimly lit room.

Dr. Rick :

If this second condition is what is happening a quick visit to the ophthalmologist should sort it out. Glasses, many times just OTC readers, can help with this.

Dr. Rick :

I see that you are typing and that could mean a couple of things: 1. you are actually typing or, 2, the chat system has frozen up. I'll give it a few more minutes and if I've not seen anything from you I'll switch over to the Q&A system. That system works a lot like 'text messaging' but, unlike the chat system, it almost never freezes up. We can continue to work on your question there. :o)


 

Customer:

Definitely have the allergy problem, but this is different than I've ever experienced. This tends to be more of disoriented issue. Close one eye and things clear up. Not sure I get the blepharitis? Why does it tend to affect me

Customer:

...affect me towards the end of the day?

Dr. Rick :

These anterior segment issues tend to be worse at the end of the day since your eyes have been exposed to allergens, have been open and drying out and the gunk from the blepharitis has been squeezed into your tear film all day.

Dr. Rick :

I'd try the above treatment for a few weeks and if it doesn't resolve go see your ophthalmologist for a full exam. I do not believe you have to be concerned that this is a sign of some serious underlying condition......brain tumors never act this way :o)

Customer:

TV..dimly lit room.....sounds familiar!

Dr. Rick :

Ya...all of us older males are familiar with that set up, eh ;o)

Dr. Rick :

Does this make sense to you?

Customer:

Yep. I'll give both of your suggestions (wash & ophthalmologist) a try. In the mean time I won't panic......THANKS.

Dr. Rick :

My pleasure. Have a good evening.

Dr. Rick :

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