3 days ago i was playing soccer with my friends and accidentally, the ball hit me in the left eye. The eye turned a little red and it was like i'm seeing a grey thing at the bottom of my vision for a few minutes. It eventually disappeared. That night i noticed that when i'm in a dark place or dim in light. I would have a grey like blind spot covering the bottom corner of my vision.. This only happens when I'm in the dark.When in day light my vision would be back to normal. Is this blind spot thing in dim light temporary? would it go away?
Hyphema is bleeding into the anterior chamber of the eye, and since it sounds like that is what happened to your son, that is what I will discuss in today's column.
The anterior chamber of the eye is the space between the iris (the colored part of the eye that opens and closes as needed to allow more or less light in) and the cornea (the clear covering of the eye). It is filled with clear fluid called aqueous humor, which allows light to enter the eye so we can see.
Trauma, most commonly blunt trauma from a projectile - like getting hit by a baseball - can cause bleeding into the anterior chamber of the eye. This is felt to be due to rupture of some of the small blood vessels directly from the impact or possibly by an increase in pressure in the eye from the blow, which then causes the blood vessels to break. Either way, there is bleeding into the clear aqueous humor of the eye.
Although it is not uncommon at all to get hit in or close to the eye, hyphema is uncommon, with only about 2 per 10,000 people per year affected. Not surprisingly, this injury is more common in people age 10 to 20; this age group is at higher risk to get hit in the eye because of the activities they do. Sickle cell patients or people with a tendency to bleed more easily, such as hemophiliacs or people with von Willebrand disease, are at greater risk of developing a hyphema if they have blunt trauma to the eye.
Getting hit in the eye will usually cause pain, as will a hyphema. However, hyphema may also cause changes in vision, excessive tearing and sensitivity to light, and these symptoms after eye trauma should raise a red flag that something more serious may have occurred.
Hyphema is diagnosed by a health care provider seeing the blood in the anterior chamber of a patient's eye. Although the blood in the anterior chamber can form a clot (this happens 40 percent of the time), it remains liquid (unclotted) most of the time, so it will usually "layer." Layering means flattening at the top due to gravity; the iris is circular, like the face of a clock, so with the patient sitting upright a layered hyphema will look like the arc of a circle on the bottom and a straight line at the top.
The treating clinician will consider other injuries of the eye and surrounding structures, such as fractures of the bones around the eye socket, in a patient with a hyphema. The patient's visual acuity will be measured (this is 20-20 vision in a person with "perfect" vision) and the eye and structures around it will be examined. The eye will likely be evaluated using a slit lamp (an instrument like a small telescope, used to get a closer look at the eye), and the pressure of the eye (the intraocular pressure) will be measured.
The treatment and prognosis of a hyphema depends on how severe the bleeding is. A grade 1 hyphema fills less than one-quarter of the anterior chamber, and this accounts for 55 percent to 60 percent of all hyphemas. Grade 2 hyphemas have blood filling one-quarter to one-half of the anterior chamber, and accounts for 20 percent of hyphemas. Grade 3 has over half the anterior chamber filled (10 percent to 15 percent of all hyphemas), and grade 4, also called an "eight-ball eye" since the blood-filled anterior chamber appears black like an eight ball, accounts for 5 percent to 10 percent of hyphemas.
The complications that are most worrisome from a hyphema include increased pressure within the eye (glaucoma) in up to 30 percent to 50 percent of patients, optic atrophy (loss of some or all of the optic nerve fibers) and staining of the normally clear aqueous humor (which can interfere with vision). The treatments for hyphema aim to minimize or prevent these, and possibly other, complications.
The first step in treatment is to minimize how much of the anterior chamber has blood in/around it by having the patient remain upright. Other treatments to minimize bleeding and the negative effects from the bleeding may include oral medications, eye drops and even surgery. Eye drops, intravenous and/or oral medications will be used to prevent or treat increases in intraocular pressure. Treatments to minimize swelling and inflammation, such as steroid eye drops and ice packs, will also be used. For more severe cases and/or cases with increased eye pressure, hospitalization may be required.
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Age Spots: You Can Lighten Them Up With a Chemical Peel
Freckles were cute when you were playing T-ball, but now you're thinking…What is that – an age spot?!? Although age spots really have little to do with aging, they do appear over time when the cells that produce melanin (skin pigment) go bad. You'll get a freckle, or more likely a blotch that's bigger than a freckle, and it just won't go away. If you think it's too early to be noticing age spots but you see them on family members – well, the bad news is, those darkened, discolored spots that appear on faces and hands over the years are hereditary, so you may be likely to get them.
The good news is that you can take steps now to minimize the appearance of this discoloration. Better yet, the science of dermatology keeps evolving with new cosmetic dermatology treatments. This means all of us, at any age, have options to fade skin discoloration. In this article, I'll give you the information you need on the treatment generally known as the chemical peel (or facial peel).
But first, let's talk about what you can do to try to avoid age spots: Sunscreen! (You knew I'd say that.) Sun damage brings out these spots and blotches, and for those of us already blessed with the unsightly marks, sun exposure will make them darker and more prominent. No question: wear protective clothing and use a UVA/UVB sunscreen marked at least SPF 30. Protect your skin from the sun – every day, even if it's cloudy!
But, what if the pesky age spots have already blossomed on your skin? Among the treatments cosmetic dermatologists offer, chemical facial peels provide effective fading of age spots and other skin discoloration, along with other benefits. The facial peel works by loosening the connections between surface cells and speeding up the "turnover rate," bringing new cells to the skin surface. Since these spots begin with defective pigmentation in deeper cells, this procedure lets your skin get rid of these cells, along with sun-damaged surface skin. A side benefit: the process also smoothes wrinkles and increases collagen production, thereby improving skin tone.
Chemical treatments offer an advantage over surface procedures like dermabrasion: peels work at a deeper level in your skin. Of course, you'll want to talk with your own cosmetic dermatologist about the best treatment for your unique needs. A few people have chemical-sensitive skin, so preliminary testing will make it clear if this treatment is right for you.
Your cosmetic dermatologist can also recommend the level of treatment appropriate for the condition of your individual skin type and schedule requirements. The procedure involves the carefully controlled application of an acid or other solution to the skin, and there's a range of chemical peel formulations, from heavy-duty to gentler. To start with the big guns, one popular combination includes fluocinolone, hydroquinone, and tretinoin. It's topical (applied to your skin) but does require a doctor's prescription. Fluocinolone is a steroid; hydroquinone blocks the production of melanin, the dark skin pigment; tretinoin is a form of vitamin A. Together they strongly stimulate skin cell turnover and prevent the formation of new pigment.
This combination is highly effective for heavier discoloration, but must be used carefully. Women of childbearing age should take a test to rule out pregnancy before having the procedure. Everyone should know that the skin will become more sensitive to other skin products and to sunlight during the series of treatments. The dermatologist may use an anesthetic, as your skin will likely feel hot, look red and peel. But, it will settle down in a few days to a week, and look very clear and even in tone – in other words, youthful!
Natural fruit acids provide the gentler (and less expensive) chemical peel treatments, especially glycolic acid, as well as lactic and citric acid. Each treatment is brief (15–20 minutes), and a series over a few months will gently renew the skin, fading those age spots right out. Again, you may have some redness, but it's less pronounced. These treatments are easier on your whole system than the stronger formulations mentioned above. There's also an intermediate treatment available using trichloroacetic acid (TCA). This one is particularly effective on darker-toned skin.
Next time, we'll look at two other kinds of help for age spots and other discolorations, crystal-free microdermabrasion and light treatments, including lasers. It's great to know that even though some skin discoloration may be inevitable, we do have options to reduce or abolish them. Lighten up the age spots, and you could wind up looking as young as you feel!
About the Author
James C. Fairfield, MD has established the oldest and most respected dermatology practice in the Delaware Valley. For more free cosmetic dermatology information and resources and to sign up for his free report, Erase the Years; visit his web site at www.cmderm.com
