We all experience the occasional eyelid twitch, which is when the muscle of the eyelid spasms involuntarily. Usually, it comes and goes without intervention and while sure, it can be irritating, is a twitching eyelid ever something to be concerned about?

An eyelid twitch, also known as a myokymia, can affect the upper or lower lid and usually lasts for at least a few seconds and then may continue off and on for a few minutes. Usually unpredictable, twitching episodes can last several days and sometimes they may go away and then return weeks or months later.

Causes of Eyelid Twitching

Although they may be bothersome, most eyelid twitches are nothing to cause concern and usually resolve on their own. However, in some rare cases, they may be a sign of a more serious problem, especially if they are accompanied by other symptoms – we will discuss this further below.

Some known causes of eyelid twitches include:

• Fatigue or lack of sleep
• Stress
• Eye irritation or dry eyes
• Medications
• Alcohol or caffeine
• Physical exertion
• Allergies
• Eye strain (such as with extended digital device use)
• Poor nutrition

Preventing and Treating Eyelid Twitching

Usually eyelid twitching will resolve itself within a couple of days or weeks but if it persists try to determine the cause in order to speed up the process. Consider going to bed a little earlier, cutting out caffeine or alcohol or finding ways to reduce or manage your stress. You can also try lubricating eye drops to add moisture to your eyes. If you take notice of when the spasms are happening and what else is going on in your life at that time (time of day, food intake, stress level, exhaustion) you can make some changes that will stop or prevent eye twitching from occuring.

If you notice eye twitching in addition to vision disturbances or eye strain, contact your doctor for a vision assessment as it could be a sign of a refractive change.

When is Eyelid Twitching a Concern?

If the eyelid spasms don’t pass and become chronic it may be a sign that you have a condition called benign essential blepharospasm. This condition is when the eye muscles blink uncontrollably and it usually affects both eyes. While the cause of blepharospasm is not known, it is more common in middle age women and there are a number of conditions that can exacerbate symptoms including:

• Eye inflammation (blepharitis) or infection (pink eye)
• Dry eyes
• Fatigue
• Stress
• Alcohol, caffeine or tobacco
• Irritants or allergens in the environment

Blepharospasm is usually a progressive condition that can eventually lead to spasms in other muscles in the face, blurred vision and light sensitivity. The condition is sometimes treated with medication to temporarily reduce the spasms and in severe cases, surgery may be performed to remove some of the muscles that are affected.

On very rare occasions eye twitching can be a symptom of a more serious disorder affecting the brain or nervous system, however, usually it will be accompanied by other symptoms. Examples of such conditions include: glaucoma, hemifacial spasms, Parkinson’s disease, Bell’s palsy, multiple sclerosis, dystonia, and Tourette’s. A corneal scratch or abrasion can also be a cause of the eyelid muscle spasm.

If you experience any of the following symptoms along with your eye twitching, see your doctor as soon as possible:

• Twitching that continues for more than a few weeks
• Twitching that spreads to other areas of the face
• A drooping upper eyelid
• Red, irritated or swollen eyes
• Discharge coming from the eye
• Spasms that cause the eyelid to close completely or difficulty opening the eyelid.

In most cases, eye twitching is not something to worry about, but when you do experience a spasm it is worthwhile to take note of the circumstances so you know when your body is trying to tell you that something is out of balance.

What Exactly Is a Black Eye?

A black eye, also known as a periorbital hematoma, is usually not an injury of the actual eye (which is why it is called “periorbital”- around the eye). It typically occurs when there is an injury to the face or the eye socket which causes bleeding beneath the skin and bruising. The term, “black eye” comes from the dark coloring of the bruising that occurs underneath the skin around the eye.

When a blunt force hits the eye socket, this can cause capillaries in the area to burst, causing hemorrhaging, also known as a hematoma. This blood can accumulate in the eye socket and as it begins to be reabsorbed into the surrounding tissues, the colors of the bruising begin to change. That’s why you will often notice the coloring of the black eye to go from a dark purplish-red color to brownish and then yellow.

Sometimes along with the external bruising, you might also notice a small amount of bleeding on the white surface of the eye, which is called a subconjunctival hemorrhage. This is when the tiny blood vessels on the white sclera are broken and leak blood. It’s generally harmless but sometimes looks scarier to the patient than the black eye does. This condition will also reabsorb on its own and is nothing to be concerned about.

While most black eyes can look pretty serious due to the dramatic color, an uncomplicated black eye will typically heal within a week to ten days. If it doesn’t, there could be a more serious issue such as a bone fracture or an orbital blowout fracture.This could present with restricted eye movement, especially if looking up or down, and numbness of the cheek and/or upper lip on the same side as the black eye. The eye may even appear sunken in. Further, if there is bleeding within the actual eye (called a hyphema) or floaters or flashes in the vision, then it is definitely advisable to see your eye doctor as soon as possible. These could be signs of more serious damage such a corneal or retinal damage and can lead to vision loss.

Treatment for a Black Eye

Usually, the best treatment for a black eye is to apply a cold compress (or even better, a bag of frozen vegetables, which is more flexible and can conform to the contours of the face) directly on the area. The cold will reduce swelling and constrict capillaries to reduce internal bleeding as well. Apply the cold for about 15-20 minutes every hour. If there is pain, over the counter pain medications can help.

If however, you experience any of the following symptoms, you should seek medical attention:

• Blood on the surface of the eye or a visible incision on the eye
• Vision changes such as double vision, blurred vision, loss of vision or the appearance of floaters
• Loss of consciousness, dizziness or fainting
• Loss of eye movement
• Persistent headaches
• Blood or fluids coming from the ears or nose
• Vomiting
• Signs of infection such as excessive swelling, pus, redness or a fever
• Severe pain

In addition to blunt trauma, black eyes can be caused by sinus infections, nasal or eye surgery or other infections in the area such as the teeth infections or cellulitis (a serious infection that can occur around the eyes). A skull fracture can also cause both eyes to turn black, sometimes known as raccoon eyes.

Unless you notice any severe symptoms you can rest assured that your black eye is a bruise just like anywhere else on the body and with a little care, rest and patience, it will clear up in no time.

Got a Shiner!

Jun 26, 2017

A black eye, also known as a periorbital hematoma, is usually not an injury of the actual eye (which is why it is called “periorbital”- around the eye). It typically occurs when there is an injury to the face or the eye socket which causes bleeding beneath the skin and bruising. The term, “black eye” comes from the dark coloring of the bruising that occurs underneath the skin around the eye.

When a blunt force hits the eye socket, this can cause capillaries in the area to burst, causing hemorrhaging, also known as a hematoma. This blood can accumulate in the eye socket and as it begins to be reabsorbed into the surrounding tissues, the colors of the bruising begin to change. That’s why you will often notice the coloring of the black eye to go from a dark purplish-red color to brownish and then yellow.

Sometimes along with the external bruising, you might also notice a small amount of bleeding on the white surface of the eye, which is called a subconjunctival hemorrhage. This is when the tiny blood vessels on the white sclera are broken and leak blood. It’s generally harmless but sometimes looks scarier to the patient than the black eye does. This condition will also reabsorb on its own and is nothing to be concerned about.

While most black eyes can look pretty serious due to the dramatic color, an uncomplicated black eye will typically heal within a week to ten days. If it doesn’t, there could be a more serious issue such as a bone fracture or an orbital blowout fracture.This could present with restricted eye movement, especially if looking up or down, and numbness of the cheek and/or upper lip on the same side as the black eye. The eye may even appear sunken in. Further, if there is bleeding within the actual eye (called a hyphema) or floaters or flashes in the vision, then it is definitely advisable to see your eye doctor as soon as possible. These could be signs of more serious damage such a corneal or retinal damage and can lead to vision loss.

Treatment for a Black Eye

Usually, the best treatment for a black eye is to apply a cold compress (or even better, a bag of frozen vegetables, which is more flexible and can conform to the contours of the face) directly on the area. The cold will reduce swelling and constrict capillaries to reduce internal bleeding as well. Apply the cold for about 15-20 minutes every hour. If there is pain, over the counter pain medications can help.

If however, you experience any of the following symptoms, you should seek medical attention:

– Blood on the surface of the eye or a visible incision on the eye
– Vision changes such as double vision, blurred vision, loss of vision or the appearance of floaters
– Loss of consciousness, dizziness or fainting
– Loss of eye movement
– Persistent headaches
– Blood or fluids coming from the ears or nose
– Vomiting
– Signs of infection such as excessive swelling, pus, redness or a fever
– Severe pain

In addition to blunt trauma, black eyes can be caused by sinus infections, nasal or eye surgery or other infections in the area such as the teeth infections or cellulitis (a serious infection that can occur around the eyes). A skull fracture can also cause both eyes to turn black, sometimes known as raccoon eyes.

Unless you notice any severe symptoms you can rest assured that your black eye is a bruise just like anywhere else on the body and with a little care, rest and patience, it will clear up in no time.

This year, make healthy eyes and vision your resolution. Find out if you or a loved one is at risk for glaucoma, and take steps for prevention.

Glaucoma is a leading cause of preventable vision loss and blindness in adults in the United States and Canada and the second leading cause of blindness in the World. Projections show that the number of people with the disease will increase by 58% by 2030. These facts however could change with proper awareness.

When detected in the early stages, glaucoma can often be controlled, preventing severe vision loss and blindness. However, symptoms of noticeable vision loss often only occur once the disease has progressed. This is why glaucoma is called “the sneak thief of sight”. Unfortunately, once vision is lost from the disease, it usually can’t be restored.

Risk Factors

Prevention is possible only with early detection and treatment. Since symptoms are often absent regular eye exams which include a glaucoma screening are essential, particularly for individuals at risk for the disease. While anyone can get glaucoma, the following traits put you at a higher risk:

• Age over 60
• Hispanic or Latino descent, Asian descent
• African Americans over the age of 40 (glaucoma is the leading cause of blindness in African Americans, 6-8 times more common than in Caucasians.)
• Family history of glaucoma
• Diabetics
• People with severe nearsightedness
• Certain medications (e.g. steroids)
• Significant eye injury (even if it occurred in childhood)

What is Glaucoma?

Glaucoma is actually a group of eye diseases that cause damage to the optic nerve due to an increase in pressure inside the eye or intraocular pressure (IOP). Treatments include medication or surgery that can regulate IOP and slow down the progression of the disease to prevent further vision loss if detected early. The type of treatment depends on the type and the cause of the glaucoma.

What are the Symptoms?

Most times glaucoma does not have symptoms. There is no pain unless there is a certain type of glaucoma called angle closure glaucoma. In this case, the channel of outflow gets crowded then blocked, causing foggy, blurred vision, halos around lights, headache and even nausea. This is a medical emergency and should be assessed immediately as the intraocular pressure can become extremely high and cause permanent damage within hours.

Most forms of glaucoma have an “open angle”, which is not so urgent, but does need compliance with the treatment plan (which is sometimes difficult as some of the glaucoma drops have uncomfortable side effects). Once vision loss develops it typically begins with a loss of peripheral or side vision and then progresses inward.

What Can You Do To Prevent Glaucoma?

Because there are no symptoms, regular eye exams are vital to early detection. If you have any of the above risk factors or you are over 60, make a yearly comprehensive eye exam part of your routine. Make sure that your eye doctor knows your family history and any risk factors that are present.

A comprehensive eye exam can determine your risk of developing glaucoma; if you have been diagnosed with glaucoma and have concerns about your treatment, it is best to speak openly with your doctor. Remember, a simple eye doctor’s appointment on a regular basis could save your vision for a lifetime.

The most well-known part of a comprehensive eye exam is the basic vision test. When you have a general vision test, one of the main conditions the eye care practitioner is checking for is a refractive error. A refractive error means there is an abnormality in the shape of the eye, changing the eye’s ability to focus light directly onto the retina.This causes blurred vision and can usually be corrected by wearing prescription eyeglasses, contact lenses and possibly, alternate treatments such as vision therapy, ortho-k, LASIK or refractive surgery such as LASIK.

The term, “refractive error” refers to a problem with the process of refraction that is responsible for sight. Normally, light rays that enter your eye are refracted or bent through the cornea and the lens, and ultimately converge or are focused onto a single point on the retina. From the retina, messages are sent through the optic nerve to the brain which then interprets these signals into the image that we are seeing.   

In order for this process to work effectively, the anatomy of the eye including the length of the eye and the curvature of the cornea and the lens must be just right to be able to focus the light onto the retina. When this is not the case, a refractive error will occur.

There are several different types of refractive errors, depending on which part of the eye is affected, and it is possible to have multiple refractive errors at the same time:  

Myopia or nearsightedness:

In myopia the length of the eyeball is too long which results in light coming to a focus in front of the retina, rather than on the retina. This allows the individual to see well when objects are close but not clearly when looking at objects at a distance.

Hyperopia or farsightedness:

Hyperopia is when the eyeball is shorter than normal and can result in near objects being blurry. However, people experience hyperopia differently. Sometimes distant objects are clear while other times people may experience overall blurred vision near and far or no problems at all. In children particularly, the lens may accommodate for the error allowing for clear vision but may cause fatigue and sometimes crossed eyes or strabismus. Hyperopia causes eyestrain or fatigue especially when looking at near objects for a period of time. Often people with 20/20 vision may still need glasses at their desk to relax their eyes and improve concentration.

Astigmatism:

Astigmatism is usually the result of an irregularly shaped cornea (although it can sometimes also be due to a misshapen lens). The cornea, which is normally round, is more football-shaped in an eye with astigmatism, resulting in multiple focus points either in front of the retina or behind it (or both). People with astigmatism usually have blurred or distorted vision to some degree at all distances, near and far.

Presbyopia:

Presbyopia is an age-related condition which usually begins to appear sometime after 40.  As the eye begins to age, the lens stiffens and can no longer focus clearly on objects that are close.  

It’s important to note that presbyopia is often confused with hyperopia, as both cause problems focusing at near distances.  However, high hyperopia can also cause blur at far distances as well, especially in dim lighting, and depth perception problems can result in motor vehicle accidents.  In these instances people with hyperopia could use glasses at any distance.

If you are having trouble seeing, it is important to have an eye exam to determine the cause of the problem and to effectively correct your vision. Even if your vision is fine, you should schedule a routine eye exam on a regular basis to ensure that your eyes are healthy and that any potential problems are caught early.

‘Tis the season for giving, and parents, grandparents, family and friends need to know which toys and games to leave off the list because they can pose a risk to children’s health and eyesight. Last year nearly 252,000 emergency visits were due to toy-related injuries, almost half of which were to the head or face. Further, about 1 in 10 children’s eye injuries treated in the emergency room can be traced back to toys, most of which occur in children under 15 years of age.

The most common types of eye injuries that occur from toys can be anything from a scratch on the cornea (the front surface of the eye) to very serious injuries that can threaten vision such as traumatic cataracts, corneal ulcers, bleeding inside the eye and retinal detachment.

Most of these injuries can be prevented by taking the proper measures to evaluate the safety of gifts before they are purchased and to supervise children during any play with toys that could have the potential to cause damage or harm.

Here are some tips on how to select safe toys for children this holiday season:

1. Check age recommendations on all toys to make sure they are age appropriate and suitable for the child’s maturity level. If younger siblings are present, ensure that any toys made for older children are kept out of reach.
2. When possible, check toys for a seal of approval that the product meets national safety standards from a toy safety testing organization such as the American Society for Testing and Materials (ASTM) or the Canadian Toy Testing Council.
3. Do not purchase toys that have a projectile or sharp, protruding parts. Toys such as darts, guns, arrows or sharp propelling toys can cause serious eye injuries that can lead to permanent eye damage and even vision loss. Even high-powered water guns such as super soakers or soft foam dart guns can cause significant damage when shot at close range.
4. Purchase safety eyewear with polycarbonate lenses to accompany sports equipment, chemistry sets or woodworking tools. Speak to your optometrist to learn more about the best option for your child’s hobby of choice.
5. Check that toys with sticks or handles such as swords, fishing rods, pogo sticks, brooms or pony sticks have rounded edges or handles and avoid or supervise use with little children.
6. Any toys or devices that have a laser or bright light (such as laser pointers or flashlights which are sometimes used by kids to play laser tag) can be dangerous. Bright lights such as those produced by high-powered flashlights can cause temporary vision loss that can lead to a risk of a fall or accident. Further, laser pointers are not safe for use by children as the light intensity can cause permanent vision loss if shined in someone’s eyes.

When purchasing a toy for a child that is important to you, make sure you are considering what is most important – their safety. Ask us if you have any questions about the eye safety of a toy or gift you are considering.

Have you ever thought about how vision works? Seeing is an incredible gift made possible by a system in which the eye and the brain process visual information from the outside world. If any step of that process does not function properly, vision will be impaired.

Similar to a camera, the eye transmits light from the world around us into an image that we can perceive. Certain parts of the eye even function like the different parts of a camera such as the shutter, the lens and film (if we can hearken back to the days when we used film in cameras). Here is a quick breakdown of the fascinating way our eyes and brain enable us to see and experience the world around us:

The Vision Process

Light reflected from an object in our field of view is gathered by the cornea which is essentially the clear “window” to our eye. The cornea then refracts the light rays through the pupil (the center of the iris where light enters the eye). The iris, which like the shutter of a camera will enlarge and shrink based on how much light is coming in, then passes the image onto the crystalline lens. Just like a camera lens, the lens in the eye focuses the light rays, projecting them to a point at the back of the eye called the retina, where the image will appear upside down. The retina contains a thin layer of color-sensitive cells called rods and cones that perceive color.

From the retina, the visual signals travel to the brain via the optic nerve. The brain receives information from both eyes and must then converge the images (and flip them right side up) to get a complete picture.

Vision Problems

A breakdown in vision can happen at any point in this process. From the muscles that control the eyes, to the parts within the eye, to the pathway to the brain. Sometimes vision impairment is due to technical problems with the eye receiving the information and passing the signal on, such as convergence insufficiency (inability to coordinate the eyes to converge on one point), myopia (nearsightedness) or cataracts (clouding of the lens).

Other times, the eyes might work perfectly, but there is a problem with the brain interpreting the signals it receives. In these cases we can’t “see” in the traditional sense, because our brains aren’t able to properly “read’ the signals or we don’t know what we are looking at. This is the case for some learning disorders that are caused by the visual processes in the brain such as dyslexia.

As you can see, vision is quite a complicated process. A simple vision exam isn’t always able to determine vision problems, especially in children which is why it is so important to have regular comprehensive eye exams, to measure the health of the eye and all of its parts.