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Vol 16 | No 2 • Autumn 2021 SA Ophthalmology Journal
Clive’s Cor ner
Potpourri 1. Face mask-associated ocular issues Some face masks interfere with the airflow around the eyes. If the top of the mask is not sealed properly, expired air is diverted upwards towards the eyes. If the mask is sealed but the seal is too high up on the cheeks, interference with lower-lid function can occur. This can all lead to ocular irritation, dryness and even keratopathy. Patients should be instructed to take breaks from mask wear, use lubricants, and do blink exercises. Blink exercises are performed by pressing the index fingers just outside of the lateral canthi and then consciously blinking ten times without feeling muscle contraction with the finger. It has also been suggested that face masks can predispose patients to ocular infection and postoperative or post-intravitreal injection endophthalmitis by redirecting
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airflow, together with microorganisms, towards the eyes. Face masks can also cause artifacts on visual field testing either by directly blocking a part of the visual field or by fogging up the lens. I also instruct patients having YAG to remove the mask or to tape it down at the top as it often causes fogging of the YAG contact lens.
her thanking me profusely for this advice. She had been to a physiotherapist who, over a one-month period, had treated her back and neck. This is what she said on the email: ‘All the ocular symptoms were relieved gradually as the spasm was worked out of my back and neck.’
3. Reverse pupil block
tr. 2. Neck problems Several months ago, I saw a patient (who is an optometrist with a PhD) with ocular discomfort and a foreign body feeling in the one eye. It had been going on for a few months. She had seen two other optometrists who could find no FB and nothing wrong. She was given Alrex drops plus lubricants, which helped little. I also could find no FB and no cause for the irritation. I then asked her about her neck, and she did indeed have neck spasms. Now it is well known that neck spasms and other neck abnormalities can cause ocular pain (especially retrobulbar pain). But I never thought that ocular discomfort and FB feeling could be caused by neck issues. However, as I had no other treatment to offer her, I advised her to see her GP about her neck problem. A few days ago, I received an email from
Broke the reverse pupil block ? IOL in the sulcus? Watch out for reverse pupil block (RPB). The mechanism for RPB is thought to be the passing of aqueous from the ciliary body via the choroid and angle into the AC. The IOL blocks the aqueous from going back through the pupil and pressure builds up in the AC. Another mechanism is thought to be the forming of a flap valve between the IOL and the posterior iris. This one-way valve lets fluid through anteriorly but blocks its flow posteriorly. You can suspect RPB at the slit lamp if you see a deep AC, concavity of the iris, and iris transillumination defects. Regardless of the mechanism, a peripheral iridotomy is usually curative. RPB can also lead to pigment dispersion glaucoma and the UGH syndrome. Making a PI with the YAG laser or surgically during phaco should help to avoid these nasty consequences. RPB is more common in myopic eyes and post-vitrectomised eyes. Therefore, a surgical PI should definitely be cut if a sulcus IOL is to be placed in these eyes.
4. Azomid Be careful when prescribing Azomid tablets! Azomid is the generic for Diamox – but it’s also the generic for the antibiotic azithromycin.
