Transcript

[00:00:00] Today’s episode is brought to you by Dax Co Pilot from Microsoft. Dax Co Pilot is your AI assistant, you know, like a little Jonathan in your pocket for automating clinical documentation and workflows that help you be more efficient and reduce the administrative burden that leads to feeling overwhelmed and just burned out, learn more about how Dax Co Pilot can help improve healthcare experiences for both you and your patients by visiting aka.

ms slash knock, knock high. Again, that’s aka. ms slash knock, knock. Hello, everybody. Welcome to knock, knock.

I with me, your host, Dr. Glaucoma, your one stop shop for all things eyeball. Accurate eyeball [00:01:00] information. Like you can, you can trust what I say. I I’ve been doing this. I all day I go, I see eyeball patients. I’m in the clinic. I’m in surgery. I come home, I make videos and podcasts and silly skits. And then I go back and I, I see more patients about what the eyeballs.

And so, uh, uh, I want to, I want to impart all of the knowledge I have to all of you. So what we’re going to do today is I’m just going to, I’ve got a lot of answers. For to a lot of questions. So we’re going to do, it’s like a kind of a potpourri, like a grab bag of, of, of patient and family questions. All right.

So I, I, I brainstormed as many questions that I’ve, uh, that I could think of that I’ve, I’ve received recently. Uh, in some, I just kind of made up because they are questions I think I’ve gotten in the past, but, or just, just, just important topics I think we should discuss, uh, and, and the, the, the goal of this is to educate.

The general public, in case you didn’t know, like you don’t have to have a medical [00:02:00] background, I think to enjoy these episodes, to learn a thing or two about eyeballs. Uh, uh, so I, I, my approach to all of these is like, let’s just, let’s make it for everybody because nobody knows, even in, even in medicine, you guys, I know all of you, like cardiologists are listening, all the general surgeons, the radiologists, the pediatricians, like none of you know anything about eyes and that’s like, you just don’t get that, not that, that education.

I received, I think, one lecture about ophthalmology in med school. That was it. One, it was just a kind of an afterthought. And then, and then that was, and then that was it until like residency. So you kind of had to, I had to figure out, that’s why I actually had to take an extra year in med school because I didn’t know what I wanted to do until I finally, in my fourth year, I got to do an ophthalmology rotation and I was like.

Wow. I get to go home like at a reasonable hour and develop meaningful relationships with my family and friends. I think I [00:03:00] want to do this, but at that point I didn’t have any research. I didn’t have all the things you got to have to, uh, you know, any letters of recommendation from any ophthalmologist. So I ended up having to do an extra year.

Uh, to get my application in order, but, um, uh, but it’s, uh, I don’t even know why I’m talking about this. The, the point is, uh, I, I want, I want everybody to, to, to learn as much about their eyes as possible. Before we get into, uh, some of those questions though, I want to address some of the, some of the comments I’ve received on recent, uh, uh, podcast videos, all of these episodes you can find on our YouTube channel at Glockham plugins.

Check it out. We just recently passed a 10, 000 subscribers, which is great. This is because this is just the podcast. Uh, this is separate from my, my regular channel. And so I appreciate all of you who go there and subscribe and like, and watch all the videos, uh, and watch these episodes, I’m doing this for you guys.

So, [00:04:00] uh, a couple of, so the, the most recent, uh, um, episode that was published, uh, was what really happens to your eyes in space, the most recent knock, knock guy, uh, and. A couple of comments. So at Jeremiah Walgren said, have you ever had to visit another ophthalmologist for anything or had another ophthalmologist visit you for something?

I’ve always wondered how doctors at the same specialty would handle one of them also being the patient. This is a great question. I personally haven’t, and if you’ve listened to a lot of this podcast and knock knock, hi, when I talk with Kristen, um, she always makes fun of me because I’ve never had a dedicated eye exam.

Weird to become an ophthalmologist and never having done any kind of like dilated exam. Uh, I do feel like a bit of a hypocrite. It’s coming. I, I need to do it. I, I, I’m due, I’m due for it. Um, I just, I’ve, what can I say? I’ve got perfect eyes, you guys. And so anyway, um, It’s [00:05:00] uh, uh, the, the, the, the, the exam by an ophthalmologist for an ophthalmologist.

I think it depends on your personality. I personally, I see several retired ophthalmologists. Now I have never had to do eye surgery on an ophthalmologist because that, that brings up a different conversation about the different types of lenses and what, what you, because. You can’t, you can’t separate your own experience from something like that.

And I think it probably helps if you’ve been retired for like 30 years, and then you come back and need cataract surgery, because probably a little bit out of the loop in terms of what technology is out there, what types of lenses are available. Um, I would say like thinking about it right now. I would be kind of like a mess if I, as an ophthalmologist had to go and get like a surgical procedure on my eye, just because I know too much.[00:06:00] 

We know too much. I know the things that can go wrong and it’s, it’s, it’s not those fears. They’re real, but they’re not rooted in reality. Like, there’s, I am irrationally afraid of getting LASIK. The risk of a complication from LASIK is extremely low, but the, the things that have gone bad that I’ve seen in patients that have gone bad, of course, I’m going to see more of those because I’m an ophthalmologist.

We see things that go bad. We see all of those things. And so, our, our, my, my mindset is skewed. And I think that’s probably the same way for any Physician, uh, in a, in a particular specialty, a nephrologist, they see all the bad kidney things that happen. And so it’s going to be at the front of their mind and, and there’s, it might be a little bit of irrational fear about insets.

I don’t know, but that’s, that’s kind of the way it is in my head. Um. But hopefully there, there are probably many [00:07:00] ophthalmologists that don’t have the level of anxiety that I have. And so they, it might be easier for them, but, um, yeah, it’s just knowing all the, all the potential complications. Um, Would make it, that’s the thing that would make it challenging.

So, but I, I already do have an idea in my head. Some of my partners who I would love to, I would let them operate on my eyes because they’re fantastic surgeons. Um, uh, that doesn’t mean I won’t be nervous about it and I’d want, um, as much verse said as, uh, they’re able to give me for, for the surgery. So, um, but I’ve, you know, I’ve had multiple surgeries already in my life.

So, uh, surgery itself doesn’t scare me. It’s just. Um, like I said, just knowing, knowing what could go wrong, but it is. An irrational fear, I would say, because I don’t want other people to be nervous about eye surgery because we’re very good at what we do. Cataract surgery in particular is just, it’s the most common surgery performed.

You [00:08:00] should not be scared. And speaking to that, another comment at Pat gun. Says, there’s no way I would want to be awake while someone is doing surgery on my eyes. A lot of people feel that way. I just did surgery this morning and I heard that exact statement from Zahid. Can you please put me to sleep? I don’t think I can do this.

But you can. Trust me, it’s so fast. We are so efficient with cataract surgery. Six minutes. I did a five minutes cataract surgery today, which is even fast for me, like six, seven minutes. That’s typical and you’re done and you get a little bit happy juice. You get a couple glasses of wine through your IV, make you feel nice and comfortable.

And then before you know it, it’s over just as often as I hear, I’m really scared about this surgery. I also hear it’s over already. I didn’t even know you started doc. Will you marry me, doctor? Goes back to, I think, a [00:09:00] couple episodes where I mentioned the patient that proposed to me, uh, while I was in the eye removing the cataract update, she did not remember asking me that.

So, um, I don’t think it was a real sincere proposal, which is fine. I don’t need a proposal. Another question. Oh, so in this, in this episode, I’m where I’m seeing these comments. Uh, I talked about reversing dilation and how I’d make a whole bunch of money if I could figure out a way to do this. Because people hate being having their eyes dilated.

So that’s, that’s why some people don’t never come in to see the eye doctor because they’re going to have to have their eyes dilated. Uh, and so I found out through these comments that there is a medication, an FDA approved medication. This is from at

There’s an FDA approved medication called Rizumvi, R Y Z U M V [00:10:00] I, I never heard of this medication, for reversing pupil dilation. I asked my optometrist about it at my last appointment because pupil dilation gives me really bad migraine. If you have a chance to look into it, I’d love to hear your thoughts.

So I did look into it, uh, because I don’t know anybody, I never heard of this. It’s not, um, it actually got FDA approved in 2023. So it’s, it’s been around a while and I looked into, okay, so if it’s been around a while and everybody’s clamoring for something that reverses pupil dilation, why is it not more prevalent, uh, in ophthalmology circles?

And, uh, I, I think it’s just because of cost. you know, a lot of practices run on pretty small margins, private practices in particular, actually private practices to a lesser extent. Uh, but academics, yeah, they’re, they’re, they’re a little bit more penny pinchers, uh, because they have, uh, smaller margins. Um, and so you’re asking a practice to [00:11:00] stock a medication that what, from what I saw, like you could get like an.

eight individual doses. That’s like 200 bucks total for, for those eight, which, which is, that’s an expensive medication and it’s mainly because it’s a brand name, right? So maybe in 10 years when there’s a, um, a generic version of this, you might be, you might be able to find it over the counter who knows because it’s just, it’s a medication called Fentolamine.

Which I’m not real. I mean, it just it counteracts the sympathomimetic and parasympathetic blocking properties of, um, of pupil dilation and allows the pupil to come back to normal. Now, it’s not immediate. From what I could tell, Rizumvi, whoever makes this medication, uh, markets it as rapid. Acting, but it can take up to 90 minutes for it to happen.

Is that faster than [00:12:00] dilating drops than the length of dilation? Yeah, but it’s even 90 minutes like dilation with the typical drops we use will last about 4 hours. I can use a half dose of tropicamide. Which will decrease the amount of dilation to about two, two and a half hours. So, what are you really getting?

Yeah, it, it, it works, but it might still take a while. Depends on how strong your dilation is. Um, and so, the, the rapid acting is not as rapidly acting as you probably want. Because I think when people think of rapid act, they like instantly, like that would be a different story. That would be pretty impressive to have like an instant, you know, resolution to your dilation to back to a normal pupil.

So the, the, the, the, the length of time it takes for the drop to work combined with the cost. It’s going to be hard. You’re going to be hard pressed to [00:13:00] find a practice or an ophthalmology department at a university that’s willing to put up that cost because the alternative is just, you know, wait a couple more hours for the dilation to wear off on its own.

So I just don’t think it’s cost effective. Um, it’s cool that they have it. I did not know that. So I appreciate, uh, um, uh, Alk. I’ll see for, uh, for bringing that to my attention. Uh, but I, I just, I don’t think it’s, um, it’s a viable product until it’s cheaper and it works a little bit faster, but then you’re talking about concentrating the drop and now you’re talking about potential side effects.

And it already says on this medication that you shouldn’t use it. In any eye that has an inflammatory condition, which could include blepharitis, dry eye, which almost everybody over the age of 60 has some degree of it. So it could end up just causing more discomfort for patients because you’re talking about another drop [00:14:00] and potential side effects.

So I don’t know, I’m not sold. By any means. Um, but it’s cool that it’s there, that, that, that, that exists. I just don’t want everybody to be asking their eye doctor for it because there’s lots of reasons why it, it might not be ideal. A bit underwhelming, a bit expensive with some side effects. Alright. Good question though.

Um, what else? What else? Uh, let’s do. Oh, here’s a good comment at Norn IEA says, when my mom had her cataract surgery, the office had a small viewing room with a big window where we could see her in the operating room. We had a TV so we could watch the surgery very up close. Super cool. Super cool for you.

Some people don’t like that. Some people have. Have a big phobia of eyeballs and anything related to eyeballs and don’t want to see a big eyeball being operated on in front of their face. But I, I see that mostly now we don’t really do that for cataract surgery as [00:15:00] much, or at least I’m not aware of a practice that does that, um, partly because like, Yeah, you never, you never know what’s going to happen during cataract surgery, right?

And you don’t want to scare people. You don’t want, um, people to, they’re going to be watching their family member being operated on and, and often they won’t know what things mean. They don’t know what’s going on. They, and so it’s, you might get into issues there. Um, I’ve seen it mostly with LASIK actually.

So when I, where I went to residency in Iowa, there was a, uh, um, in the LASIK, the refractive surgery suite, uh, family members could sit there and watch their family member having LASIK or PRK. I don’t know what it is. The, it’s a cosmetic procedure, maybe, I don’t know. But then again, we don’t have people watching you get a bluff.

A little bit bloodier, a little bit more, a little bit more difficult. Uh, so I dunno, I don’t say, [00:16:00] I don’t see it very often anymore, but yeah, that’s cool that you, some people like it obviously. Um, uh, but, uh, yeah. So if you want to, if you want to see cataracts or just Google, there’s like thousands and thousands of cataract surgery videos you can find on YouTube.

All right, let’s take a quick break.

Hey, Kristen. Yeah. I’ve got some friends. I’d like it. I mean, I see that you seem a little too friendly with them. I have to say, aren’t they cute? Sure. But the little beady eyes and their little, little hands, the hands, the claws, I don’t know. Appendages. Okay. How about that? That works. But anyway, they just like, well, they’d like to say hi.

Okay. Like to say hi. Okay. Wonderful. They’re not, they, Oh, look, one’s sticking around. Sure is right on my mic. These little guys are, uh, Demodex and they live on your eyelashes. Yeah. Uh, and they can cause flaky, red, irritated eyelids. See, that’s not cool. [00:17:00] That’s a party foul. You just kind of want to, like, rub them.

Mm hmm. You’re not welcome here if you’re going to do that. And it’s caused sometimes by these little guys. Yep. That’s rude. Uh, Demodex blepharitis. But you shouldn’t get grossed out by this. Okay. All right. You got to get checked out. Yes. Get checked out. To find out more, go to eyelidcheck. com. Again, that’s E U I E.

L I D check. com for more information about these little guys and Demodex blepharitis.

All right, here we go. Rapid fire questions. I don’t, I should, I need to have like a, a term for this where I just, I go through as many patient questions, patient questions. That’s not interesting. That’s not fun. It’s just, these are just like random questions. Isn’t there not just for ophthalmologists for everybody.

Okay. So I’ll just, I’ll just get into it. Here’s a good question that I get asked. Why do my eyes hurt after I [00:18:00] remove my contact lenses? This is always a bad sign. You don’t want this to happen. All right. So the question, my eyes hurt after I’ve taken my contact, it feels like something’s in it, but there’s nothing there.

It hurts until I wake up in the morning, or it just hurts for hours after I take out my contacts. And then what people end up doing is they don’t like that feeling. And so what do they do? They put their contacts back in or they sleep in them or they wear them for more hours of the day. But the reason is contact lenses.

They create this environment under the lens. Which your eye becomes tolerant to, right? Maybe there’s a little bit less oxygen in there. Maybe there’s some, uh, you know, just contaminants underneath there. Your eye just gets used to having this contact lens, this little micro environment that it’s, it’s become accustomed to.

So when you remove the lens, whoa, [00:19:00] all of a sudden, because you’re spending more hours in the lenses than without. All of a sudden, the eye is exposed to the air, the atmosphere, heat, cold, wind, who knows anything that’s in the air, pollen. And for most people, this is a quick adjustment. If you just wear your contacts like you’re supposed to, generally, for what, 8 hours, 10 hours, then your eyes spend just as much time out of context than it is in context.

A lot of you, though, you wear your contacts for 15, 18 hours and When you first start wearing them, you can probably tolerate that for quite a while. But after you’ve been doing this, wearing contacts for 30 years, your eyes just start tolerating not wearing them less and less. So you take out the contacts, your eyes not used to having an environment on it where you don’t have a contact.

And so you start having pain, [00:20:00] discomfort, redness, irritation, feeling like there’s something in the eye. And part of this might just be The eye becomes a bit ischemic, uh, you start having blood vessel growth into the cornea, which, which, uh, you know, brings inflammatory factors into the cornea. If the contact lenses over time, your, the shape of your eye changes, maybe the contact lens doesn’t fit on your eye like it used to, it fits differently.

Maybe you haven’t gone in to see the optometrist and have them check the contact lens position on your eye in a while. And what can happen is you can get dry spots on your cornea. You can get little specks of, of dryness. And that feels like there’s something in your eye. It’s called foreign body sensation.

We call it superficial care. It can be superficial keratitis, SPK, punctate epithelial erosions. There’s different terms for this, but it’s basically just dry eye, severe dry eye. And when you take out a contact lens, All of a sudden [00:21:00] that dryness is exposed to the elements and it hurts. So you put the contact back in because it’s like a little bandaid.

You cover it, but you’re not, you’re just making the problem worse. The eye has to heal. And so you need a contact lens holiday. You need to just step away from the contacts for, I know it’s hard, but if you take out your contacts and your eyes hurt, that’s a bad sign that immediately you need. a break. You need to be out of contacts for an extended period of time for as many hours as you can.

Any eye doctor will tell you that. And you need to go in to see the optometrist, have them, have them check the fit of your contacts. That’s the other thing. All right. Next question. Uh, I actually got to ask this one recently. How soon can I take Viagra after cataract surgery? Well, the question that’s not really the question you should be asking.

It should be like, how is it okay for me to have sex? And I’m not [00:22:00] saying you have to ask this question. Um, uh, I don’t, most of my patients are in their seventies and eighties, not to say if the people in the seventies and eighties don’t have sex, but, um, It’s less frequent, I would say. Uh, and so I don’t get asked this question a lot, but I have, uh, had it recently, uh, you know, is it okay to have, because Viagra itself doesn’t really affect the eyes too much.

It can give you like a, a, a blue tint to your vision, but, um, uh, that’s pretty uncommon and in the context of cataract surgery, the all here’s the only restrictions. This is what I tell people. We don’t want you rubbing your eye because when we make an incision on the eye, you have a, it’s a self-sealing incision.

It’s a, it, it’s, it’s a, like a three, a tri, we call it a tri planer. A biplanar incision where you take the instrument out and it automatically seals shut. So we don’t have to put a stitch in your eye typically. And, uh. Unfortunately though, if you do rub [00:23:00] your eye hard enough or something hits your eye, then that incision could open up.

And that’s what we’re trying to avoid by telling you not to rub your eye, at least, like, for a week after surgery. It’s never really a good idea to rub your eye. Rubbing it a little bit, it’s okay. I know, it feels good sometimes, doesn’t it? Give your eye a little rub. I get it. I get it. I’m with you, but really you don’t want to do it after cataract surgery.

All right. After about a week, the incisions healed up enough that it’s just a little sturdier and it’s not going to open up as easily. Uh, so I have people like, give me a week. Don’t touch your eye for a week. Uh, so. No, I rubbing, um, uh, we, we have people wear a shield at night for a week. I don’t want you to swim in for two weeks after cataract surgery.

I don’t want things in that incision. All right. That’s a fast track to getting an infection. You’re going to go to swim in a Lake after you had cataract surgery. Bad idea. Don’t swim for two weeks after cataract surgery, please. But you can take Viagra question is, can you, can you have [00:24:00] sex after it? Which I don’t know why else you would take Viagra.

Uh, I would say actually I, it’s probably okay, but the thing is, it’s not really psych, it’s the activity it’s, it’s the Valsalva maneuver, the, uh, uh, the, the bearing down, like whether, whether you’re having sex or you’re having a bowel movement. Hopefully not both of those things at the same time. Uh, it’s the bearing down, you’re just, you’re, you’re like, you’re pulling something, you’re lifting something heavy.

That’s the, the action that we’re trying to avoid with cataract surgery because it increases your blood pressure and all of a sudden it kind of pushes all the blood into your head and that can actually put pressure on the eye on the incision. So that’s why we have people avoid. Avoid heavy lifting, and by extension, things that simulate heavy lifting, which could be sex, I suppose.

Uh, and so, yeah, you want to take it easy for a week, alright, if you’re going to [00:25:00] have sex, because you need to take a Viagra, um, I would, I would convince your partner to do all the work for you. How about that? Not a bad, not a bad trade off, I’d say. Okay, there you go. Sex and cataract surgery. That’s where we’re at with this episode right now.

Oh, here’s a good one. Why does my vision get blurry after reading for 30 minutes? I hear this all the time. My vision, people come up with blurry vision. I always ask, okay, well, these are the questions. But I, cause the vision is usually like fine. 2020 measures just great. I was like, okay, well, when do you have this blurry vision?

And usually what I hear is, well, after I’ve been reading a lot, when I’m driving, it gets worse or I’m watching TV or I’m on my phone. My vision starts blurring up. I always ask people, do you have fluctuating vision? Is that what’s happening? Or is it like a constant blurriness, which is, those are two totally different things.

If you have fluctuating vision. I am much [00:26:00] less concerned. That’s a dry eye. That’s not a serious problem. Dry eye can be a serious problem, but generally it’s, it’s not something that requires surgery. It’s something we can manage. And so the reason your vision gets blurry after reading is because when we do stuff that holds our attention, whether it’s reading, watching TV on our phones, whatever there, we have studies that show we do not blink as much.

Our blink rate goes down and blinking. Remember That’s how you lubricate your eyes, that those windshield wipers, that’s what you, that’s your windshield wipers. All right, your eyelids, they just, they, they redistribute your tear film and your eyes love it. Your eye, if you had no eyelids, you’d go blind pretty quick.

Your cornea would melt away and you would not see anything. So we need our eyelids. They do great work. But when we’re on screens, when we’re reading or we’re doing driving. Things that hold our attention very [00:27:00] well, like those things, we don’t blink as much, so our eyes will dry out. Now this doesn’t affect everybody, but as you get older, your tear film isn’t as good.

And so you need to blink more frequently. And so we’re telling people take breaks while you’re reading, you know, you shouldn’t be reading for 30 minutes straight after 20 minutes, you should be taking a break, 20 seconds. Look 20 feet away and blink, blink, blink, blink, dry eye. That’s where you have it. You have dry eye when you have that fluctuating vision, especially when doing vision intensive activities, which when are we not doing those things?

Honestly can’t think of a thing, but usually I hear it more mostly with reading and on your phone. How long can pink eye live on surfaces? Uh, so I get, I get a lot of questions about pink guy. Everybody thinks they got pink guy and they come in. I usually, I tell them they don’t have pink guy because pink guy, the [00:28:00] connotation for pink guy is that it’s a viral infection.

You have a viral conjunctivitis. That’s what people think. When they say pink eye, most of the time is not a viral infection. People with viral conjunctivitis, they’re very miserable. If your eyes are just a little bit red, it’s probably something else, but sometimes you don’t know. So you come in to see the eye doctor, but pink eye, how long does it quote unquote live on surfaces?

Uh, so considering, so if it’s, it’s bacterial, you know, you know, the bacteria that affect the eye and give you conjunctivitis. They may be survived for a couple hours on surfaces, maybe like a day. Viruses are much more hardy. They, they can survive for two to three days sometimes. Uh, and so, um, or even longer.

And, uh, so cleaning with properly with bleach or the antimicrobial cleaner is very important. I’m always telling people this when they come in, they have a family [00:29:00] at home that doesn’t have it, and they clearly have a viral conjunctivitis. You’re cleaning surfaces. You’re washing your hands. You’re not sharing bedding.

You’re washing, you’re doing laundry, laundries in your future. And a lot of it because viral conjunctivitis can last a week, sometimes two weeks. That sucks. That’s like, talk about like an ophthalmologist biggest fear, like, yeah, there are some like rare diseases that I would hate to have, but man, I really don’t want viral conjunctivitis.

I don’t want pink eye because it’s feels bad. It’s painful. And it, it’s a, it’s a, it’s difficult to get rid of because you really just gotta let it run its course. Like there’s nothing I can give you that’s going to make you less contagious. I wish I really do, but there’s not. So it sucks. And every time I see a patient that has a viral conjunctivitis in the clinic.

I’m like telling myself [00:30:00] while I’m examining, don’t touch your face. Don’t touch your face. And I just, I washed my hands like twice before I leave the room. And then we just nuke the room. We just, we get the, we get the, the, I said, touch my face. I start touching my face. Probably I made you touch your face too.

Hopefully you don’t have somebody in the house with. Pink guy. Uh, we’re like, we’re taking bleach. We’re like all the wipes. We’re just wiping on every surface because this is contagious as hell. It’s, it’s terrible. All right. Try to avoid that. All right. Let’s see. Let’s do a few more here. Oh, here’s one. Are large pupils normal in children?

I’ve gotten asked this a couple of times. So you have a two year old, very large pupils. They always look dilated even when they’re inside and it’s bright. Um, When we’re outside, they get a little bit smaller, but they’re, they’re mostly the same size. They don’t change very much. Is this a problem? So large pupils when [00:31:00] you’re young are very normal, and you can expect that.

Uh, it’s very, it’s unlikely to be any kind of problem. If the pupils Um, yeah, I would say even, even not just children, but going like into young adulthood, like I’ve, I’ve known, you know, I’ve had people come in with, with concern about people’s size. Uh, and I’ve talked about this before, the biggest impact this would have is someone, um, would be.

I would say, like, well, general light sensitivity, but night driving. Because if your pupils are larger and you’re myopic, you tend to become more myopic. You have something called night myopia. So you’re driving at night, you want good crystal clear distance vision, but you’re looking in the dark. Your pupils are going to be bigger than average.

And if they’re already big, then that’s, that’s even more of a problem, but you have large pupils that cause more refraction of light and causes your focal point in your eye to move forward for [00:32:00] making you more myopic. So people say I’m terrible. I’m like a 25 year old. Like I can’t drive at night. It might be because they have night myopia.

Their pupils are really large. What can you do about that? You could give a medication that like lightly constricts the pupil. Uh, actually things like, um, uh, Lumify will, will gently constrict the pupil because it’s bromonidine, which has alpha, uh, which has, um, some, uh, pupil constricting. Sorry, I said that wrong.

No, not bromonidine, there’s a medication that increases, um, I’m blanking on the name of it now, but it’s a medication that increases accommodation, uh, and can constrict the pupil. Obviously there’s pilocarpine, but we, we would never prescribe that for someone for this purpose. In fact, I don’t usually prescribe anything for someone who’s experiencing nymyopia.

I just explained to them what’s happening and it’s usually not debilitating enough to cause problems and people just appreciate. [00:33:00] Having a reason why they have a little bit more trouble seeing road signs at night. So normal pupils, uh, large people can have really large pupils though. And, um, uh, but it’s really common to see that in young people and children, young adults.

All right. Let’s take a, let’s take one more quick break and then we’ll do, I got three more questions.

All right, here we go. Why are my eyes bloodshot when I wake up? Well, we’ve already talked about this a little bit. It’s dry eye because what’s, what’s not happening when you’re sleeping, you’re not blinking. We’ve already established the eyelids are the windshield wipers of the human body. Okay? So you’re sleeping, you’re not blinking.

Your eyes have a tendency to, to dry out. And people who are already prone to dry eye syndrome, maybe you have Sjogren’s. autoimmune condition. Maybe you have blepharitis. You get [00:34:00] clogged up oil glands in your eyelids. Um, maybe you have sleep apnea, and you use a CPAP machine. You have air blowing up into your nostrils.

Well, guess what? Your eye tear drainage tube, it empties into your nose. So, yeah, you could blow air up into your eye. With a CPAP machine, uh, all those things can cause more dry eye and you wake up with redness, uh, and, uh, there’s lots of things we can do about this, but, um, treating the underlying issue, which is if you have blepharitis, we treat the blepharitis, have you do the hot compresses, artificial tears, ointment at night, this is where we will often prescribe ointment at night for people.

So you go to the drugstore, all the major brands, Sustane, Refresh, Genteel. Uh, they all have, um, [00:35:00] nighttime formulations of the, over the, over the medications they use. So refresh PM, just thicker, just as an ointment, uh, comes in a little tube. You just pull lower eyelid down. You put it on the inside, refresh PM, all these things, genteel gel.

So yeah, your eyes are bloodshot when you wake up because they’re dry. That’s what’s going on. Unless you’ve all of a sudden come down with a case of bilateral viral conjunctivitis, in which case wash your hands, can you have an MRI with a corneal transplant? I’ve received this question once before, uh, there are no reasons why you cannot have an MRI.

Absolutely. It’s fine. That’s fine. Sorry. There’s no metal in a corneal transplant. It’s just cornea. That’s just corneal tissue. Um, and, uh, you know, we do. You know, there are some older devices, uh, carotid prosthesis that, uh, that do have some metal. But even those, I think you can, those are very, very rare though.

Uh, but [00:36:00] even those, I think you can get an MRI with those. Um, but yeah, corneal, any kind of corneal transplant, um, you can definitely get an MRI with. No metal involved, that would be really annoying if you could, because the brain, the brain is like the classic thing that you get lots of MRIs for, it’d be really annoying to have metal in your eye that you couldn’t, that would prevent that from happening.

Is it safe to use a sad light therapy lamp for insomnia? This is a particularly relevant this time of year. Everybody’s feeling a little sad, a little downtrodden. There’s especially residents. Hey, be nice to all the residents and med students, really any of the physicians that you see, uh, working long hours in the dead of winter.

with, without access to a lot of sunlight. Like there, I can’t tell you residency. How many [00:37:00] times you’d go in as it’s nighttime, you go into the hospital and you emerge from the hospital and it’s nighttime again, that sucks. Like February, January, February. It’s we’re almost through it. We’re so close. We’re getting there, but it’s, it’s a tough time.

And so is it safe to use a SAP that light therapy lamp for insomnia? So those therapy lamps. It gives you really bright It’s supposed to stimulate sunlight. Obviously it’s supposed to like, try to stimulate your, your serotonin production to just get you feeling a little bit better. I don’t, I honestly don’t know the data behind whether or not they work, but they do, they should have a UV filter on them, so you should not be getting UV light from those lamps.

If you are, then yes, they can cause problems to the eyes. That’s what snow blindness is. Light [00:38:00] reflecting off of the, the bright snow up into your eyes because we’re always, as we’re walking in the snow, you know, we’re looking down and so light reflecting off the snow up into your eyes can give you corneal erosions.

from the UV damage. And if you stare at the sun, obviously you can get solar retinopathy. You can burn little holes in your retina. So as long as whatever the light is that you have has a UV filter and is not actually bathing you in UV light, then you’re fine. Remember the, uh, the nightclub. That, uh, I think it was, um, some kind of, some kind of AI like tech bro conference thing, and they, uh, they had a nightclub like a big party and they, they used UV lights and everybody woke up with searing eye pain and all the, the, the media outlets all called it blindness, but it, they just, they had, [00:39:00] they basically had snow blindness, but in a nightclub setting because the club used UV lights.

And so all the people all night had their eyes bathed in UV light, woke up with corneal abrasions and it hurts like hell. It makes you feel like you’re going blind for sure. So, but no sad light. I don’t know if it works for insomnia or for depression or seasonal depression, or however you’re using, uh, those light, light therapy things.

But, uh, it is, um, those things are okay for your eyes. If they block the UV light, that’s it. That’s all I got. That’s all your eyeball knowledge. Hope you learned something. Maybe you can take things back to your, your coworkers and regale them with tales of viral conjunctivitis. And, uh, here’s what you can do.

Here’s your, your homework. Tell one person who wears contacts, uh, not to keep them in if their eyes hurt. Like that’s the, like a basic thing that everybody, like everybody should know CPR, everybody [00:40:00] should know like how to do chest compressions. Uh, everybody should know not to wear contacts when your eyes hurt.

I don’t care. Just your eyes hurt. Do not wear contacts. Leave your eyes alone. Maybe we’ll start if it were up to me, we would teach that during CPR class. Little out of context, but Hey, you know. Why not? But I don’t make those types of decisions. That’s our show. That’s knock knock. I thank you so much for listening again.

You can, uh, uh, if you want to leave a comment, if you want to bring up a topic for me to discuss on these episodes once a week, I’m here, um, then leave a comment on the YouTube channel at glock and Fletkins. All right. We’d love to see those. I love reading those comments. Um, and, um, yeah, so thank you all for, for giving me that.

There’s that feedback and for, for watching these episodes, listening, wherever you listen to podcasts. Uh, I’m your host, Will [00:41:00] Flannery, also known as Dr. Galakum Flecken. Thanks to my executive producers, Aaron Corey, Rob Goldman, and Shanti Brook. Our editor and engineer, Jason Portizzo. Our music is by Omer Binzvi.

Knock, knock, hi, is a human content production. We’ll see you all next time. Goodbye.

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