Eye Problems

. Posted in SYMPTOMS OF DISEASE

Many of us have experienced irritated, itchy, watery eyes during the allergy season. These very noticeable symptoms occur as a primary result of the allergic response. In addition, patients with allergies often have allergic shiners (especially noticeable in children) which are dark circles under the eyes. These shiners can also be caused by infection.

Aside from an allergic response, infection in the sinuses can cause myriad other eye complications, including facial swelling, eye protrusions, or an intraorbital (in the space of the eyeball) abscess. More drastically, tears forming in the tear glands in the upper eyelid flow down to the lower lid, drain into the inner aspect of your eye, and empty into the nasolacrimal duct into your nose. Inflammation of this tear duct (known as dacrocystitis) can lead to problems, including excessive tearing. When the infection backs up the duct into the corner of the eye, you may find yellow or green crust in the corners of your eyes. You might think that this is sleep dust, another “normal” part of life. However, it is a clear sign of an eye problem. Very often an ophthalmologist will diagnose dacryocystitis and keep dilating the duct without ever

considering that the recurrent dacryocystitis may be caused by a sinus infection. This treatment will not produce results until the sinus infection has been properly treated.

If this infection goes farther into the eye, you can develop conjunctivitis, and your eyeball will appear red. Meibomitis is an inflammation of the meibomian glands (glands that form your tears). When this happens, you can see redness in the upper eyelids where the meibomian glands lie. The infection can lead to a sty, a small pimple forming in your eyelid. When the infection backs up the nasolacrimal duct, a film can cover the eye, causing the sensation of temporarily blurry vision.

Because of the position of the sphenoid sinuses, inflammation in this area can cause pain in the eye and in the top and back of the head. If the infection spreads to the area behind the eye, including the fat pad and the muscles that move your eye you may experience blurry vision, a limitation of eye movement, pain in your eye during movement, or a protrusion of your eye (called proptosis). The optic nerve, responsible for vision, and the oculomotor and trochlear nerves, responsible for controlling eye movement, also lie close to these sinuses; and an infection in the sphenoid sinuses can lead to double vision, reduced eye movement, and loss of vision - although this is very rare.

In some instances, an infection beginning in the sinuses can affect your overall vision. For example, I once had a patient named Mary, who was a 38-year-old accountant when she came to see me. She had chronic sinus infections, and her symptoms included yellow-green discharge, nasal obstruction, postnasal drip, swollen glands, decreased sense of smell, and sinus headaches. She had been on various medicines, including antibiotics, steroid nasal sprays, and antihistamines, yet her sinus problem was just getting worse.

After a careful examination, I knew that Mary required endoscopic sinus surgery to alleviate her symptoms. Immediately after surgery, Mary noticed a major change in her vision. Along with an immediate improvement in her breathing, her blurry vision disappeared. Mary explained that before the surgery she always had problems with her vision and often couldn’t focus her eyes easily. Mary had always felt that there was a gauze film covering her eyes. She had never mentioned any eye
problem to me before the surgery because she didn’t think it was related. Yet after the surgery, her vision was completely clear.

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