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ms slash knock, knock high. Again, that’s a k a. ms slash knock, knock. Knock,

knock. Hi.

Hello everybody. Welcome to knock, knock. I with me. Dr. Glockham Flecken. Thanks for joining me. This is one of my favorite times of the week. [00:01:00] Uh, getting to just talk eyeballs with, with, with all of you. And, um, uh, today has been an interesting day so far. I, again, this is my surgery day. It’s usually when I record these episodes and had a good morning, everything went smoothly.

And I just, I want to say how much I love the way we do cataract surgery. So it’s a bit unique. With cataracts and there’s other specialties that do surgery this way. But one of the more unique things about eye surgery, most types of eye surgery is that you can do it when the patient is awake. So we give the patient, uh, uh, you know, a little bit of Versed, a little bit of fentanyl just to help them feel relaxed, uh, and they don’t have any discomfort, any pain, it’s a painless surgery.

And it just, it, it releases a little bit of the inhibitions. That people have when they get a little bit of Versed on board. Uh, and it’s, it’s just a whiff. It’s like one milligram. It’s a small amount, but it’s [00:02:00] enough to make people say and do some funny things sometimes. Um, so it, it’s, and I’ll, I’ll tell you a story.

So from today, but, um, generally it, it, everything goes fine. You know, it’s. It’s sometimes people really start freaking out during cataract surgery. We have to give them a lot more sedation, or sometimes even canceled the surgery if we can’t get someone called because you have to be still, as you can imagine, any kind of movement in your body is going to move your eyes.

It’s going to move your head. And it’s, uh, you know, when I’m looking. Through at the eye through a microscope, any kind of movement, it’s, it looks like an earthquake under the microscope. So it’s very hard to do cataract surgery when someone’s moving and can’t sit still. The medications that are wonderful.

CRNAs provide, uh, are, are very helpful for that. Um, and then it makes people a little bit loopy, you know, it’s like they’ve had a couple of glasses of wine. It’s so today, uh, this, uh, [00:03:00] some people get are really quiet during surgery. Even though they, even with the sedation, some people just fall asleep. We actually prefer that they don’t fall asleep.

And some people get very talkative. Oh, they got a lot of things to say just about their day, about what they’re going to do afterwards, how excited they are about their vision. Uh, a trip they went on. Some of them are listening to some of the conversation happening in the room, which is a lesson to anybody coming into an, an, a cataract surgery room, like.

The patient can hear you, like they are awake. All right. They may, they may have a couple of glasses of wine on board. They will hear you. And, uh, and so sometimes they’ll just out of the blue, just pipe, pipe in with, you know, some comment about something we’re talking about. Um, and, uh, And so this patient today, very talkative, just right off the bat.

And I think part of it was she was very nervous for surgery. Some people, when they get [00:04:00] nervous, they get really talkative. And, uh, and so I was in a good mood. Surgery was very routine. So I just was, I was chatting with her. Cause I think it does help for people who are very nervous. Uh, whenever I just sit there, I’m doing their surgery and I’m talking, I’m just having a conversation with them.

I’m distracting them basically from the surgery that’s make the eye surgery, that’s making them so nervous. Um, and then out of the blue, this person, um, this woman proposed to me. Now people have told me jokes in the middle of surgery. Uh, some of them inappropriate, some of them appropriate. I never really, I never hold anything against anybody whenever, uh, what they’re saying under minimal sedation, because you know, it’s releasing your inhibitions.

This was the first time I have received a marriage proposal, wonderful 60, [00:05:00] 70 year old woman. I was like, you know what, I really appreciate it. Uh, but. I am taken, I am, I am happily married. And, uh, and so I, uh, finished the cataract surgery and I guarantee you when she comes back for her post op later this afternoon, she will not remember any of that.

She may be like, did I say anything? And I’ll be like, eh, nothing important. So it’s always a fun thing. Oh man. The, the, the adventures you get into when you do cataract surgery on awake. Patients and, you know, I had my mentor and residency program director, Dr. Tom Oding on the podcast, uh, probably about a year ago, he told a story which I had heard before, but, um, we have a thing in, in, in ophthalmology that’s called malignant glaucoma.

That’s a, it’s a, that’s one term for it. Uh, Aqueous [00:06:00] misdirection is another term. So there’s a couple different ways to say it, but basically it’s something that can happen during surgery where the flow of fluid, because we’re constantly like we’re using fluid to inflate the eye. Uh, and so there’s always fluid being put into the eye and being removed from the eye during cataract surgery.

It’s called irrigation aspiration. Uh, well, sometimes that fluid can start heading the wrong direction. It can actually get. Around the lens and start, start hydrating the back part of the eye. And you don’t want that to happen because what can happen is. That fluid that’s accumulating in the back of the eye, it’ll just start pushing everything forward and, and, and decreasing the amount of space that you have to operate on someone’s cataract.

It’s called aqueous misdirection. Malignant glaucoma is a less descriptive term. It’s like kind of a, just a term that’s been around for decades. And, and it really is not, we don’t really say that much [00:07:00] anymore, but it is, it is something that I have heard many times. And it was during a surgery that, uh, Dr.

Oding, uh, they were trying to figure out why there was so much, what we call posterior pressure during a cataract surgery. And, uh, at one point, Dr. Oding was like, uh, you just talking back and forth to the resident that was operating with him, uh, you know, it could be malignant glaucoma. Surgery went great.

They finished everything. And then it was like two weeks later, that patient came back and was very concerned. And he said to Tom Oding, he was like, uh, doctor. What are you going to tell me about my malignancy?

Poor guy for two weeks. He heard the term cause he was awake. He heard the term malignant glaucoma, and he just assumed he had some kind of horrible cancer of the eye, man. So that’s a learning lesson right there. Just the patient is awake. And then there, so there’s some surgeons, some ophthalmologists [00:08:00] who were like.

Have strict orders, like nobody talks in the room. And, uh, I’m not like that. I, I, I run a pretty relaxed operating room. I think, you know, people know not to, you know, just to be a little bit more careful with what they say. And there’s not like a ton of conversation happening in the room because you don’t want that, but you know, there’s, you know, talking from time to time and just, you know, pleasantries and, and you know, what are people going to do over the weekend or the holidays or whatever?

And that’s fine. So, um, But as a patient, here’s something important as a patient, you can always request that, that you don’t want your surgeon to talk to you. In fact, most of the time we take our cues from the patient and, uh, and I’ve had patients tell me, I just, I got just, can it be just be quiet? I don’t like it stresses me out when there’s, when there’s conversation.

And that’s, that’s, that’s great. That’s fine. We’ll just, we’ll shut the hell up and we’ll just continue on. Trust me. I’m totally fine with [00:09:00] that. Uh, just, uh, that it makes for an interesting surgery day. So anyway, that was everything else went fine though. It was good. And we got a good show, a good knock, knock I for you today.

Uh, I got some good questions. Uh, from the last week’s episode, where he talked about ortho K. This is the most recent one that was published. I record these like a day before the next one publishes. I’m like a week behind by the time you hear this. On, on like monitoring all the questions on the YouTube channel at Glock and Fleckens, that’s where you’ll find all these episodes, all the comments section.

I got some good comments, some good topics we’re gonna talk about. So I’m going to address some of the comments about Ortho K and a couple other things, uh, also we’re going to talk about eyeballs in space. This is a good question came in what happens to eyes in space. So we’re going to talk about that here in a little bit.

Uh, and also, uh, ocular rosacea, because there’s a, um, uh, thing, a couple of patients I’ve [00:10:00] had recently with, uh, something called ocular rosacea, uh, which is something that is pretty common. And maybe some of you listening have, have had that before. So let’s take a quick break. We’ll come right back with some questions.

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

Okay. Okay. Wonderful. They’re not, they, Oh, look, one’s sticking around. Sure is right on my mic. These little guys are a demodex and they live on your eyelashes and they can cause flaky, red, irritated eyelids. See, that’s not cool. That’s a party foul. You just kind [00:11:00] 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 ilitcheck. 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. Some good comments coming in. Uh, Here’s one at tank guy three said, could ortho K theoretically be a treatment for keratoconus? I don’t think I addressed this. So ortho K just as a quick recap is a, a contact lens treatment of. Mild to moderate myopia. So you put a contact lens on the eye.

When you go to sleep, it like reshapes your cornea [00:12:00] and, um, and it’s, it, it can, it can take out some of your nearsightedness, it flattens the cornea to take away your myopia a little bit. Uh, but you have to keep. Wearing it, you know, it’s expensive and also it does carry some risk of infection and corneal abrasion and other things.

Uh, and so, uh, this, this, this person asked, could ortho K theoretically be a treatment for keratoconus? And, uh, I say, no, it’s not. And, uh, the reason for that is because keratoconus it, you’re already, when you have keratoconus, it’s a weakening of your cornea and it also results in irregular astigmatism. So typically, you know, ortho keratology, it can treat myopia.

It can probably, it can treat some astigmatism as well, because you’re reshaping the cornea. But when you have irregular astigmatism, it’s a little bit harder to do that. Plus. An eye that has [00:13:00] keratoconus is already at risk of corneal scarring, of, uh, of having, um, breaks in, uh, some of the structures within the cornea that cause what do we call corneal hydrops, which is a severe sudden swelling of the cornea.

So you really don’t want to cause a lot of trauma to an eye that has keratoconus. Keratoconus, uh, which is, uh, just a, it’s a, it’s a, it’s a corneal ectasia, the, the, the cornea is not healthy. It’s weak in certain, in certain places, mostly inferiorly on the cornea. And so you don’t want to go mucking around.

Uh, putting, uh, contact lenses that tried to reshape the cornea, a lot of trauma, fingers in and out of the eye. Um, it’s always a little bit dangerous, uh, you know, even when people with keratoconus play, play sports, because any kind of trauma to the eye could very easily cause a rupture of the cornea. Uh, and so, no, I would say, you know, you don’t want to [00:14:00] do.

Ortho keratology, the only type of contact lenses that are reasonable in people with keratoconus would be what’s called a scleral contact lens. This is a specialty contact lens that actually it’s bigger, much bigger because it, the point of contact on the eye is the white part of the eye. So what that contact lens does is it vaults.

Completely over the cornea. So it’s a big, big contact. Not everybody can tolerate these, but it vaults itself over the cornea. It doesn’t even really, that’s not really supposed to touch the cornea and it neutralizes irregular astigmatism, which can include. Keratoconus. So that is an option and you have to go to a specialty.

Usually it’s an optometrist that does this type of work. Um, and it can do amazing things for people, really change people’s lives. Scleral contact lenses, but that’s the only type of lens that I think is safe for someone with [00:15:00] keratoconus. Good question. All right. I, this is another comment and, uh, about ortho K that I, that kind of made me laugh here.

I don’t know if it was intending to make me laugh, but it did. So it’s a long comment. I’m just going to pick and choose certain parts of it. This is, uh, from at John C 4 4 0 3 said, uh, ortho case sounded really tempting until you said the price. Okay. Yep. Uh, it’s like 1000, maybe 1500 bucks for a set of ortho K lenses.

And often insurance doesn’t cover that kind of thing. It’s considered a cosmetic. Um, uh, but at those, he says, at those prices, he goes on to talk about, uh, his history with myopia at those prices, I’ll just keep sleeping in my regular contacts. Yep. You heard me, doc. You’re not going to scare me out of it.

I’ve been sleeping in my contacts for about 40 years now, and I’m not going to stop. I figure if I didn’t hurt my eyes wearing contacts for a month at a time, back when they were approved for that marketing ploy, they were never supposed to be approved for that. [00:16:00] I’m not likely to hurt them just wearing contacts for less than a week.

And yes, those horrible daily thin disposables are right out. I can’t wear them. I appreciate the honesty, John. I really do. Um, but this, this reads very much like, uh, you know, I’ve been driving for, for 10 years without wearing a seatbelt. I’m not going to stop now. It’s probably safe. Like that, that’s the thinking here.

It’s like, uh, I don’t know. There’s some, probably some kind of fallacy name for this. Um, but. Just because nothing’s happened to you, which I’m so thankful that you’ve been able to sleep in your contacts for like however many years and you haven’t had any issues. I mean, it only takes one and we know that increases your risk of infection.

So John, you do you all right. If you come in to see me though, I’m still going to read you the riot act and tell you that you shouldn’t be doing it. Medical advice is, is just advice and you don’t have to [00:17:00] take it. So, but I appreciate your honesty just because you have it. Had anything bad happened to your eyes, uh, doing something a little bit foolish.

Doesn’t mean it’s never going to happen, but you know, you do what you got to do. Um, glasses are also a wonderful thing, but not for everybody. Sometimes contacts really high myopia. In fact, in this comment, I think John says he’s, uh, Oh, only a minus three. You could do glasses, John. You really could like glasses are fashionable.

Now you guys know that. They’re, they’re in glasses are in, uh, got some very, very nice glasses. Everybody’s wearing glasses these days. You got some great frames. It plus also, I don’t know how old you are. Any of you are, but glasses, they can hide your wrinkles, your eye wrinkles a little bit. I could probably benefit from, I might one of these days, I’m just going to show up.

For those of you who watch the podcast on YouTube, I’m going to show up wearing glasses and you’ll know if I do that, it’s probably just because I’m [00:18:00] getting way too many wrinkles. Uh, there’s no beauty filter on YouTube. I, I can’t hide those any other way. So anyway, uh, all right. A couple other fun comments I had, uh, about the most recent episode that was put out there.

Oh, this is, we, we talked about, um, uh, I forgot what we were talking about or why we were talking about this, but talking about placenta, uh, donating your placenta. For, um, anyway, just how, how that works. So, oh, oh, for, that’s right. For amniotic membranes, that’s what it was. We’re talking about amniotic membranes and how that tissue is procured, uh, and whether or not patients are paid for their placenta.

So this is from at Amanda, a two, two, four, four said they take the entire placenta. When you donate it, it’s literally plopped into a five gallon bucket. The patients I’ve had that have donated their placentas were not compensated. It was considered a donation. So there you go. You’re not going to get paid for your placenta.

It’s not a [00:19:00] gold mine sitting there in your, in your uterus. Uh, but, uh, it, it is probably is a very wonderful thing to do, um, because. At least in ophthalmology, that amniotic tissue, it really, it helps treat a lot of things, severe dry eye, neurotrophic keratopathy. Uh, you can help give the gift of sight honestly, just by donating your placenta.

Uh, let’s see a couple other questions here, uh, before we take a break. And then when we come back, um, We’ll talk actually, no, we’ll do this now. Let’s do this now. So the question from at save the piece. Now, my eyeball question, how does going to space affect the eyeballs? Do the massive G’s to get there hurt your eyes?

Does being a weightless do anything the longer you are there? Will that cause long term issues? This is a fantastic question. And there’s actually been a lot of research. Into what happens to the eyes over time and a weightless environment. So [00:20:00] talking about the, the G forces to get to, um, the, uh, uh, to get to space.

Uh, I don’t think that causes any trauma. Now, if you have enough. G forces that are probably more like lethal G forces. It can cause severe trauma to the eyes. And what I’m thinking of is a, is a disease called, um, either traumatic optic neuropathy or something called sclopateria, which is basically severe tearing of the retina and cord, very delicate structures that can occur when a bullet or other projectile passes very close by.

Okay. To the retina. Uh, and, um, and so it’s, it’s like a shockwave effect. Maybe that something like that can happen if you pull enough Gs, but you don’t hear about that with like fighter pilots. And if that’s the case, you’re not going to hear about it on a, you know, going up to space either. [00:21:00] So I don’t think that’s what happens, but, um, there is some very severe trauma that can happen to the optic nerve, to the retina, uh, just with like a shockwave effect from something going very fast.

Very close to those structures. Um, but as far as in space weightlessness, yes, we, we actually do know a lot. NASA has done a lot of work, um, and, and, and looking at, um, uh, what can happen. In fact, there’s a condition that’s actually known as space flight associated neuro ocular syndrome. And this, uh, I think it’s a relatively new.

Condition, at least the name of the condition, uh, but, uh, it refers to a visual impairment and intracranial pressure that can occur from spending a long period of time in space. Some people call it, which is a much cooler term, space blindness. We have snow blindness. [00:22:00] Why not space blindness? I love it. So this condition.

Uh, occurs because you have changes in the cerebrospinal fluid of the brain and the spine, um, uh, as you get into a microgravity or, uh, uh, a vacuum of space, uh, where the fluid that’s normally circulating through your entire cerebrospinal tract, um, kind of just starts moving up toward the head. You don’t have gravity pulling everything down.

And so what can happen is. You can start to get swelling over time of the optic nerves because when we often in fact today or yesterday, I had a patient that was referred to me just to be to be evaluated. They’re having headaches. They’re, uh, they wanted me to evaluate for the presence of optic disc edema, which can indicate.

Increased intracranial pressure called papillodema papillodema [00:23:00] is when you have swollen optic nerves as a result of increased intracranial pressure. And so they’ve seen that in some astronauts coming back from long periods of time and spaces that their optic nerves are a little bit swollen. And because you don’t have gravity pulling the fluid down, pulling the blood down, then everything’s just going to be a little bit more congested.

Now, I don’t think we have a lot of evidence to suggest that. It’s, it’s bad enough that it’s, it’s causing permanent damage to the optic nerve, but it is notable that there is congestion there because if you already have small optic nerves and then you start, you know, increasing the congestion and pressure inside the.

Inside the, the, the, the tissue of the optic nerve, could you get an ischemic optic neuropathy? Could it cause, uh, you know, enough pressure on the blood vessels that supply the optic nerve that it kind of closes them off? [00:24:00] Maybe, I guess we don’t know, but I mean, it’s never a good thing to have optic disc edema.

Um, but I don’t think we have a good evidence to suggest that. It’s, it’s, uh, at least in a, in a micro gravity environment that it’s, it, uh, causes, you know, any permanent vision loss, but other issues, um, that, uh, uh, that you see are globe flattening. So people can actually have a, a change in their. Um, uh, in their refractive error.

So if you flatten the eye and a lot of this is probably the same mechanism, right, you don’t have gravity that’s pulling everything down. So you have more congestion in the vasculature and the space around the orbit, uh, and it can kind of push on the eyeball a little bit, flatten it, just kind of constrict the eye a little bit.

If you flatten the eye. You, that’s basically what you’re doing with LASIK for nearsightedness. [00:25:00] So if you’re nearsighted, you’ll become a little bit less nearsighted. If you have perfect vision, all of a sudden you’ll become a little bit farsighted. Let’s say you’re a 30 year old in space. You have perfect vision.

Well, all of a sudden you might start needing reading glasses because your eyeball is getting flatter. When we do LASIK, what we’re doing is we’re creating a flap for people who are nearsighted and we’re just flattening the cornea and that will take away. The myopia that moves the focal length from. In front of the retina back onto the retina, or for people who are of perfect vision, flattening, the eye will take the focal point from the retina to all of a sudden behind the eye.

And then you have to try to focus, strain your eyes, people who are presbyopia, who need reading glasses, they’ve been dealing with this. So anyway, that’s, that’s one of the effects that we’ve seen. Um, And there’s, you know, other structural changes in the [00:26:00] brain that, and I’ve gotten, I got this all from, you know, uh, NASA and certain research studies that have been done.

Um, they’ve seen, um, uh, shifting in the, the position of the brain. In astronauts, uh, enlargement of the ventricular volume, which also would, you know, be because you have this increased pressure changes in the pituitary gland, and that can also cause changes in your vision, your peripheral vision, bi temporal hemianopia.

You’re starting to lose some of the vision out peripherally that can happen if you have any pressure on, uh, the pituitary gland, because that’s where your optic chiasm is. So, uh, yes, there are certain things I. I have not heard, and everybody can correct me if I’m wrong in any of this. Um, but from what I’ve read and what I’ve learned, um, there’s, there’s no like immediate risk.

And we’ve had of blindness or vision loss, and we’ve had astronauts be up in space for six months, a year, maybe even, [00:27:00] you know, more than that, a couple of years and, um, and we haven’t, uh, seen any, any major issues. Now, what about when you start talking, you know, sending people to Mars? Elon’s going to have to get on this, figure out what to do.

Maybe some special glasses. That kind of help redirect the pressure, decrease the pressure around the optic nerve in the back of the eye. I don’t, I don’t know how people are going to smarter people than me are going to have to figure this out. Is it, I mean, is it possible to prevent quote unquote space blindness?

You know, um, there are certain strategies to try to reduce, uh, this, uh, space flight associated neuro ocular syndrome. So again, these very smart people, um, they’re trying to use like specialized diets, uh, Exercises, you know, sleep may, I don’t think any of this has, has really, you know, come about to actually do anything for the eyes, but the point is people are working on it.

So at save the piece now, [00:28:00] thank you for your comment. People are working on it, which is, I, I love that. I love that. It’s, it’s a, it’s a thought that people are having like, Oh wait, could, I mean, we’ve all, we’ve all heard about space madness, like that, that’s always featured in like sci fi movies. I’ve never heard seeing sci, uh, space blindness be featured in a sci fi movie.

Just saying. Like Hollywood, come on, let’s get some ophthalmology representation going here. Anyway, that’s space blindness. All right, let’s take a break.

All right. A couple more questions that I got or like comments. Uh, this one made me laugh from at M G J S eight BN. I don’t know if I want to know more about what can go wrong with your freaking eyeballs. Fair. You know, I, I don’t want this podcast to scare anybody. Uh, uh, I, I, [00:29:00] I, I’m somewhat of a protector of eyeballs.

So I’m, yes, I will tell you in the course of this podcast, all the things that can go wrong with your eyes, but you know, I I’ll, I’ll make them better. I don’t want you to go blind. And most of the really terrible things are pretty rare too. So, you know, I think you’ll be fine. All right. And the, the final question that I wanted to get to, uh, before the end of the episode here as at Mitchell Christensen.

5, 7, 8, 3 said your remarks about not being able to reverse dilation. Made me think about view ity and Culosi, which is, uh, they’re both types of pilocarpine. Pilocarpine is a sympathomimetic that helps to, um, constrict the pupil, but also it promotes accommodation. Which allows you to focus up close. So when we dilate someone’s eyes, we’re taking away both of those things.

We’re taking away your ability to focus up close. Um, we’re taking away your [00:30:00] pupils ability to constrict. So you’ll have a dilated people and you can’t read that’s the, you know, I always feel it’s always, it’s, it’s kind of secretly kind of funny whenever like teenagers will come in and they’ll get their like first eye exam and all of a sudden they can’t look at their phone anymore.

And it’s always, it’s temporary. It’s like three hours. Right. But you can, it’s like. It’s like, they have no idea what to do with their life. All of a sudden, like, this is, it’s like a whole new world. It’s, it’s the worst thing I think that’s happened to some of these people based on how they describe their experience.

Uh, but anyway, it’s temporary. It’s temporary. Um, so anyway, I, I, I talked about this reversing dilation because, um, one of my Go to jokey lines I have with patients is like, if I could figure out a way to effectively, uh, decrease, uh, you know, reverse your dilation, I wouldn’t be working anymore. I’d be on my own Island somewhere.

Uh, making, uh, with all my props, making Island related [00:31:00] Glock and Fleck in general hospital videos. Um, so no, that doesn’t exist. Uh, And then this comment goes on. I don’t know if you’ve already made an episode about them, but I’d be interested. Obviously the mechanism of those drops could theoretically reverse dilation, uh, but they don’t work in dilated eyes.

So basically asking about, you know, is there really an option? So I actually did some research on this. Um, and there have been a couple of studies over the years, not many that have looked at using pylocarpine, uh, as a way to reverse dilation and. Bottom line is, is not effective. Not only that, but it also increases some risk is one of the risk factors with one of the, one of the risks of pylocarpine is that in people who are nearsighted, it can actually, um, cause retinal tears.

Or retinal detachments, and that’s obviously not what we want. So to mitigate those risks, we’re just not going to do it, right? Because although dilation is [00:32:00] annoying, it will eventually wear off. It may take, you know, two to four hours, sometimes six hours, sometimes eight hours for certain people, it will wear off.

And so no, unfortunately the studies show that even using pylocarpine in patients with a tropicamide dilation, which is what we normally do, um, it doesn’t actually, it’s not effective at. At reducing, um, the time of dilation and it’s probably just because it’s just not, probably not just not strong enough.

You know, when we’re in the operating room, we will inject straight acetylcholine. Into the eye, uh, to, um, oh, sorry, not a sequel, epinephrine. So calling would be opposite. Uh, we will inject epinephrine into the eye that will very rapidly constrict the pupil, but that’s like in the eye. We are bathing the iris in adrenaline and causing it to, I got that backwards.

I got that backwards. See, it’s. [00:33:00] Okay. No, I had it right the other way around. It is a seat of calling my call. That’s what it’s called. Acetylcholine, uh, we will inject it. We’ll bathe the iris and acetylcholine causing it to constrict. Um, epinephrine would do the opposite fight or flight, right? Get big dilated pupil anyway.

All right. I’m glad we cleared that up. I should probably be wrapping this up by now. I did promise you a few thoughts about, uh, ocular rosacea. Uh, so, uh, ocular rosacea, um, is a. Disease associated, obviously with regular like skin rosacea. So that’s like a, it’s, it’s a chronic skin disease where you get, um, really red, rosy cheeks, nose, sometimes the forehead.

Uh, well, you can have that disease, which by the way, I don’t know if we have a really good idea of what causes rosacea, maybe there’s a genetic component to it, probably some environmental [00:34:00] factors, uh, something Um, dilation and swelling of blood vessels that causes you to look really red and have flushed cheeks and, uh, these big dilated vessels on the nose and on the cheeks, um, some people think it’s related to certain microorganisms that cause this dilated redness, uh, to the, to the, to the face.

Well, we do know. Is that this skin disease called rosacea can also affect the eye with a similar mechanism. And so what will happen is patients will come in with pretty severe redness and often they’ll have blood vessels that are starting to grow onto the cornea. And sometimes you can get infiltrates, you know, a little corneal infection just along the edge of the cornea.

It’s called a limbal infiltrate and, uh, kind of a classic appearance. Of someone that has ocular rosacea and it feels, what are the symptoms like? [00:35:00] Well, burning red, watery eyes, people feel like they have something stuck in their eyes. They got redness. They’re just really uncomfortable. Oftentimes a severe styes.

you might have some ocular rosacea. Uh, and so that goes along with this as well, because along with inflammation on the surface of the eye, you get a lot of inflammation on the eyelids. Cause it’s like a, it’s a skin disease, it’s a surface disease, and that can really make your, your meibomian glands unhappy.

And you end up with styes because those meibomian glands get, get thick and plugged up. So the way we treat this is hot compresses to try to make those glands happy or try to open up those glands. Usually I’ll prescribe an eyedrop that has a little bit of steroid. And an antibiotic combination tobra dex, which is tobramycin dexamethasone or maxitrol, which also has dexamethasone as well as neomycin polymyxin B.

Um, and so I’ll do that. I’ll [00:36:00] do eye drops, maybe even ointment. To the eye, because that lasts a little bit longer, even though it really blurs up the visions. People don’t really like going in as much. Um, and then also you can prescribe a course of doxycycline. My infectious disease colleagues, they love themselves.

Doxycycline. It’s a great, it’s a great antibiotic. Don’t take it on an empty stomach. Don’t take it with dairy because it reduces the effectiveness, but it’s a great medication can make you a little light sensitive as well. So you want to wear a hat, protect yourselves if you’re in a sunny environment, which is not where I live right now.

I’m looking outside. It is snowing in Portland, Oregon. Everybody, people are about to lose their minds. Anyway, doxycycline two week course that can help decrease the rosacea. So that’s the typical treatment for this gets better, but you can have flares throughout the year. There are certain causes of flare ups that we know just being outside and the heat, sun, wind, cold, that can give you a flare of ocular rosacea or just regular rosacea.

Some people get it when they’re [00:37:00] really active, doing a lot of aerobic activity. Uh, drinking alcohol can, can flare it up for people sometimes eating spicy foods, drinking coffee or tea. I don’t know if the caffeine has something to do with it or just getting stressed. We’re all kind of stressed. So you’re more prone to get an ocular rosacea if you’re prone to it.

So anyway, that’s the basic rundown of ocular rosacea. I’ll stop there. I think you’ve had enough eyeball stuff for the day. Uh, thank you all for listening again. I’m your host, Will Flannery, also known as. Dr. Glockenfleck. And, uh, thanks to our producers, Aaron Cordy, Rob Goldman, and Shanti Brick. Editor in General Jason Portizzo.

Our music is by Omer Benzveig. Uh, and once again, YouTube channel at Glockenfleckens. All the podcast episodes are posted there. Knock, knock, hi. Knock, knock, hi. I always read those comments. I’ll pick the best ones. The ones that I think, uh, we haven’t covered any topics, uh, in a while. And, you know, you guys always give me good ideas.

I [00:38:00] love it. I love reading those. Uh, so, so leave your comments there. Listen to the podcast, like the YouTube channel, uh, leave a comment. We love comments. Uh, feedback, give us some, uh, good reviews if you feel so inclined. All right, I would really appreciate that. Anyway, we’ll see you next time. Knock Knock High is a human content production.

See you next time, everyone. Goodbye.

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