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points covering the entire cornea. The procedure is carried out in seconds and is completely painless.
Tear breakup test: Sodium uorescein dye is added to the eye, and the tear lm is observed under the slit lamp while the patient avoids blinking until tiny dry spots develop. The longer it takes, the more stable the tear lm. A short tear breakup time is a sign of a poor tear lm. Generally, greater than 10 seconds is thought to be normal, 5 to 10 seconds, marginal and less than 5 seconds, low (with high likelihood of dry eye symptoms). An unstable tear lm can explain dry eye symptoms in patients who have a normal quantity of tears. Unstable means the com-position of the tears is imbalanced, resulting in tears evaporating too quickly or not adhering properly to the surface of the eye.
A Schirmers Test measures aqueous tear production. A premeasured strip of test paper is placed in your lower eyelid and measures how much tears are soaked up in ve minutes. A measurement less than 10 indicates inadequate tear production or dry eye syndrome.
Fluorescein staining: This test is very useful for detecting injuries or abnormalities on the surface of the cornea as well as the t of a rigid contact lens. A piece of blotting paper containing the dye is wetted with saline and touched to the surface of the eye. As the patient blinks, the dye is spread around and coats the surface of the cornea. A cobalt light is then directed at the eye. Any problems on the surface of the cornea will be stained by the dye and appear green under the blue light.
The health care provider can determine the location and likely cause of the cornea problem depending on the size, location and shape of the staining.
FIVE STEPS TO SAFEGUARD MATURE EYES
• Recommend regular physical exams with their primary doctor to check for diseases/ conditions that affect eye health.
• Recommend a complete dilated eye exam every one to two years for the early detection of eye diseases such as glaucoma that have no early signs or symptoms.
• Take a thorough history. Does any family member have a history of diabetes or eye disease? If so, recommend a dilated eye exam every year.
•Advise the patient to see an eyecare professional at once if they have any loss or dimness of eyesight, eye pain, uid coming from the eye, double vision, redness or swelling of the eye or eyelid.
•Advise them to always wear sunglasses and a hat with a wide brim when outside. This will protect their eyes from sun damage which can raise the risk of getting cataracts. Also advise eyewear protection whenever needed.
Conclusion
If any of your older patients wear contact lenses, chances are they have done so for a decade or more. This is a great time to upgrade them to the new breathable materials or perhaps to try a multifocal design. For some, it may be their rst time trying contact lenses, and we should be aware of any dry eye issues as this is a common complaint in this age group. Reduced wearing times and a moisturizing eye drop may be part of every successful t. Dailies may be especially appealing as cost may not always be the deciding factor. In any case, have varieties of trial lenses on hand—as we well know, eyes come in all sizes and all ages.
Source: 20/20 Magazine. Published here under license and reprinted with permission of Jobson Medical Information.
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EYEZONE Issue 91-92 May / August 2020 46