Dynamic oil analysisOctober 22, 2020Manual expression of meibomian glands Manual expression of meibomian glands is not just an important therapeutic option for #mgd, but it is a critical diagnostic component of a dry eye exam. Manual expression is a dynamic assessment of oil color, turbidity, and viscosity. This dynamic assessment is not seen in[...]Read More
Trichiasis masquerading as dry eye diseaseOctober 20, 2020Trichiasis masquerading as dry eye disease What is it? Trichiasis is a condition where eyelashes (one or many) are misdirected onto the cornea or conjunctiva. The mechanism of injury is from friction and the constant rubbing over months and years can cause severe corneal abrasions, infections (ulcers) and can result[...]Read More
Iris flocculiOctober 15, 2020Iris flocculi is a benign condition but can be associated with familial TAAD (Thoracic aortic aneurysm and dissection). Patients with these findings should be seen by a cardiologist especially if there is a family history of early cardiac event. #ophthalmology #iris #systemicdiseaseRead More
Asteroid HyalosisOctober 1, 2020asteroid hyalosis Spectacular video of asteroid hyalosis. The asteroid bodies are made up of hydroxylapatite which consists of calcium and phosphates or phospholipids. It is remarkable that it rarely affects the patient’s vision but it can make examination challenging. From an ocular standpoint , asteroid hyalosis is relatively benign but[...]Read More
Recurrent corneal erosion: a comprehensive review by Miller et.al.September 30, 2020Fishman Comments: Recurrent cornea erosions (RCE) can be a tough condition to treat. One particularly frustrating cause is LASIK or PRK. I see a number of patients who have been diagnosed with "dry eye" and/or neuropathic pain syndrome after refractive surgery. However, a careful examination of the cornea in many[...]Read More
Dynamic OCT of a FloaterSeptember 18, 2020Dynamic OCT of a floater. At FishmanVision, Dr. Fishman will often personally perform the testing (giving his techs a much needed break). The OCT doesn’t record the “taking” of the test , but as shown here , watching the test in progress can be very revealing and super helpful to[...]Read More
Periocular BoTox on Tear Film HomeostasisSeptember 16, 2020Fishman comments: The effect of Botox on ocular surface disease is seriously under appreciated. While the cosmetic benefit of Botox is widely known, Botox use was actually "invented" by an Ophthalmologist (Dr. Alan Scott) to treat strabismus (eye muscle misalignment) in kids. BoTox does have some other less well known[...]Read More
4 dead DemodexSeptember 12, 2020The below video snippet is an example of dead Demodex mites on a lash. We see no leg movement on video microscopy and presume mite death. Demodex mites are parasites with a length ranging from 200-400 microns (1) . One study suggests that six or more Demodex mites per 16 lashes[...]Read More
Lash PluckingAugust 29, 2020Epilation. Sometimes it’s the small things in life that can really make a difference in the patient’s life. However don’t forget to consider eyelid carcinoma in any misdirected lash. #squamouscellcarcinoma #basalcellcarcinoma #trichiasis #sebaceouscellcarcinoma #rosacea #dryeyes #ipl #blepharitis #demodex #mgd #meibomianglanddysfunctionRead More
Dry eye and MenopauseAugust 29, 2020Prevalence of ocular surface disease symptoms in peri- and postmenopausal women Garcia-Alfaro, Pascual MD; Bergamaschi, Luciana MD; Marcos, Celia MD, PhD; Garcia, Sandra BSc; Rodríguez, Ignacio MScAuthor Information Menopause: September 2020 - Volume 27 - Issue 9 - p 993-998 Conclusions: Sixty-four percent of the pre- and postmenopausal women studied[...]Read More
Meibomian Gland IncisionAugust 25, 2020An obstructed meibomian gland that becomes acutely inflamed is called an internal hordeolum. It is typically the result of infectious inflammation and the organism most commonly involved is Staphylococcus. Antibiotic therapy is thus the typical first step along with relief of the obstruction which can be achieved by using warm[...]Read More
Live View of a Retinal HoleAugust 22, 2020Shown here in this video snippet is an operculated hole in the periphery of the retina. Clearly seen is the operculum floating above the pigmented edge of the hole (a lattice spot). This hole occurred in response to a posterior vitreous separation pulling on the retina. Retinal hole Holes can[...]Read More
Glaucoma and dry eyeAugust 13, 2020Patients with dry eye disease need to be screened for glaucoma. It is not uncommon for steroids to be used in dry eye disease and is often used in a "pulsed" type fashion. As a result, while the pressure may be measured as "normal" in the office, the intra-ocular pressure[...]Read More
Multifocal lenses and dry eyeAugust 13, 2020Multifocal intraocular lenses are particularly sensitive to small irregularities on the corneal surface. Dry eye disease in its many different manifestations can alter the ocular surface and significantly degrade the image quality for the patient.Read More
“Review. Neuropathic Pain and Dry Eye” by Dr. Anat GalorAugust 4, 2020Fishman comments: Dr. Galor continues to be one the TOP academic physician/ researchers in the area of dry eye and neuropathic pain. This article from 2017 by Dr. Galor et al. does a terrific job of summarizing the mechanisms, treatments and challenges of neuropathic pain and dry eye and how[...]Read More
Conjunctivochalasis Displacing TearsJuly 29, 2020Shown here is a segment of video showing conjunctivochalasis. Conjunctivochalasis (CC) as described by EyeWiki is "redundant, nonedematous conjunctiva that causes a wide variety of symptoms ranging from completely asymptomatic, to worsening of an unstable tear film, and when severe, a real mechanical disruption of tear flow." As a part[...]Read More
Derm Findings in Complex Regional Pain SyndromeAugust 31, 2020Title: "Dermatological Findings in Early Detection of Complex Regional Pain Syndrome" JAMA Dermatology June 2014 Volume 150, Number 6 Authors: Rameez Kabani, BSc; Alain Brassard, MD, FRCPC Fishman comments: This is an extremely complex condition and the question for dry eye specialists is whether some of the eyelid and eye[...]Read More
