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Eye Allergy Sufferers: Rubbing Your Eyes Is The Number One No-No

I’m afraid this is one of those do-as-I-say, not-as-I-do blog posts. I must confess that when my eyes are itching from pollen exposure I can rarely resist rubbing them. So I absolutely empathize with those of you who also fall victim to the sweet lure of eye-rubbing when allergies flare. But as a responsible physician, I must tell you that rubbing those itchy eyes is like pouring water on a grease fire. It only makes things worse.

Allergens (including foreign substances including pollen) like to stick to moisture-rich surfaces such as eye lids, eye balls, noses, and throats. Our bodies’ immune cells recognize these allergens and launch an attack to break down their proteins and remove them from the tissues. Specialized allergen removers, called mast cells, flock to areas that are heavy laden with pollen (or mold, pet dander, dust mite feces, etc.) Once they are near the allergens they break apart, spilling their acidic chemicals and histamines onto the invaders to break them down to remove them. These chemicals can cause stinging and itching sensations in the eyelid edges and other sensitive areas.

When we rub our eyes, we actually rupture mast cells at a faster pace due to mechanical traction. The result is that massive loads of acid and histamine are released into the already-sensitive tissues and the itching and burning often increases exponentially. So we rub harder!

As you can see, this is a vicious cycle that is best avoided. When your eyes become red, watery, and itchy from allergens the smartest course of action is to wash the area that has been exposed, flush the eyes with artificial tears, and try anti-histamine drops for itch relief. If you’re a contact lens wearer like me, try daily disposable lenses. A fresh pair every morning prevents possible allergens (that can cling to contacts from the day before) from being re-introduced into your eyes.

Let’s hope that pollen counts are more manageable next year, and until then we should all try our very best to remember the alternatives to eye-rubbing. I’m putting a bottle of artificial tears in my purse right now!

For more eye-allergy tips, please check out my recent interview with ABC News:

For further information about general eye health, please check out my Healthy Vision podcasts at Blog Talk Radio.

Disclosure: Dr. Val Jones is a paid consultant for VISTAKON® Division of Johnson & Johnson Vision Care, Inc.

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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