A Pair of Eyeballs Walks Into the Office


Sounds like the opening of a comedy routine, doesn’t it?  Yet it’s a very serious subject.  One of the maxims that we teach optometric interns and residents is that “a pair of eyeballs never walks into your office”.  That’s generally held to mean that when taking a patient history or following diagnostic leads, don’t limit yourself by looking at the eyes in isolation.  Rather, look at the patient as a whole person.  You’ve likely heard that the eyes are windows to the soul or to the body.  Clues to systemic disease or neural disease often reveal themselves in the vascular or neural networks of the eye.


Consider this pair of eyeballs.  The left eye looks normal by the right eye in contrast looks a little red and glazed.  Chemotic is the fancy term we use.  But take a look around and you’ll notice that the redness is much more intense in a circumscribed region, leaving the circumferential area around the limbus relatively white.

Red Eye

In this instance there was no reason to suspect anything other than an isolated episcleritis, and the eye was totally clear within two days of using Lotemax eye drops to quell the inflammation with no recurrence.  I say that because this young girl’s twin sister had an episode four years ago which proved to be a preseptal cellulitis that required use of IV antibiotics for treatment (you can read about that here).

Acute inflammatory episodes in and around the eye, when infectious in nature, warrant aggressive use of antibiotics.  Are antibiotics sometimes overused and over prescribed?  Absolutely, and this is part of the concern that overuse may be contributing to the breeding of superbugs resistant to antibiotic treatment.


But what about the flip side?  What about chronic inflammatory conditions for which antibiotics may be underutilized or mis-utilized rather than over prescribed?  Four years ago I co-authored an article together with our colleague, Dr. Carole Hong, on Visual Factors in Childhood Behavioral Disorders.  In that article we noted that developmental pediatricians were integrating allopathic (Western) and complementary or alternative medicine to treat children holistically. Behavioral disorders can be caused by the unique way in which a child’s biochemical and genetic makeup interact with his/her daily environment, from environmental pollutants and toxins to thoughts.  Using an integrative approach to a child’s health concerns, developmental pediatricians strive to understand the root causes of a child’s condition, correcting underlying biochemical imbalances to heal the child.  We cited PANDAS (Pediatric Autoimmune Illness Associated with Streptococci) as one example.

The chronic inflammatory condition that has drawn significant attention in the Northeast is Lyme Disease, but it is no longer just in the Northeast, nor is it limited to Lyme.  Dr. Richard Horowitz is a leading proponent for multiple strains of Lyme and co-infections in tick-borne diseases.  Dr. Horowitz has coined the acronym MSIDS, for Multiple Systemic Infection Infection Diseases Syndrome.  I like the terminology used by doctors and patients working in the field, who refer to open-minded and knowledgable physicians and patients as being Lyme Literate.  Take a look at this video clip:

What does this have to do with a pair of eyeballs walking into the office?  Stay tuned for Part 2.

One thought on “A Pair of Eyeballs Walks Into the Office

  1. Hi Len,
    Happy New year.
    I am happy the red eye cleared with Lotemax gel as it looked more like an anterior scleritis which is treated with pred forte 1% qh and NSAID qid with a return office visit in 7 days. I also use motrin and sometimes dilate as well. Must have been an autoimmune reaction.
    Thanks. August

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