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Red, Itchy, swollen eyelids are often due to a condition called blepharitis. Blepharitis tends to be a chronic condition due to thick eyelid mucous gland production that sticks to the bases of the eyelashes. This adherent mucous can allow bacteria to overgrow and also attract and retain allergens. The standard treatment for blepharitis is doing warm compresses and cleaning off the eyelids with a mild baby shampoo and water solution. This treatment works for some people but there are many more sufferers who have chronic irritation and relapses despite this treatment. If the warm compresses and eyelid scrubs are not quite keeping the condition under control there are several other additional treatments that can be used to control the symptoms. One such treatment that your doctor may decide upon is to use an antibiotic/steroid combination drop or ointment. We usually use these for short periods of time to try to bring the condition under control. They are not good to use chronically because it can build resistant bacteria and the steroid component can cause other eye issues like cataracts and glaucoma. The treatment is very safe for short term use but chronic use is usually not a good option. There are also antibiotic eyelid scrubs such as Avenova which can be prescribed and used on a more long-term basis. Oral Doxycycline can also be used longer in very low doses. Doxycycline is an antibiotic that when used to treat infections is generally prescribed in a dose of 100mg twice a day. For chronic Blepharitis suffers we generally use a much lower dose of around 50 mg a day. At that dose we are using the Doxycycline to help thin out the mucous production from the eyelid glands more than for its antibiotic properties. In summary, blepharitis can be a chronic issue that requires some persistent “maintenance” work be done to keep it under control, with further intervention sometimes needed for flare-ups.

Article contributed by Dr. Brian Wnorowski, M.D.

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Choroidal nevus is the fancy term for a freckle in the back of the eye.

This lesion arises from a collection of cells that make pigment in the choroid, which lines the back of the retina and supplies the retina with nutrients. These choroidal nevi (plural of nevus) are usually grayish in color and develop in about 5-10% of the adult population. They are usually asymptomatic and detected during a routine dilated eye exam.

Just like any freckle on our body, we should monitor it for any change in size or growth.  This is usually done with a photograph of the nevus and annual exams are normally recommended to monitor any change.  

In addition to a photograph, other tests that can be used to monitor the nevus are:

• Optical coherence tomography - a test that uses light waves to take cross-section pictures of the retina. This test is used to detect if the nevus is elevated or if fluid is present underneath the retina.
• Ultrasound - uses sound waves to measure the size and elevation of the nevus.
• Fluorescein angiography - a dye test to detect abnormal blood flow through the nevus.

The concern is for transformation of the choroidal nevus into melanoma, a cancer in the eye. It has been estimated that 6% of the population have choroidal nevus and 1 in 8,000 of these nevi transform into melanoma.  Some factors predictive of possible transformation in melanoma are:

• Thickness of the lesion, greater than 2 mm.
• Subretinal fluid, observed on exam or optical coherence test.
• Symptoms that include decreased or blurry vision, flashes, or floaters.
• Orange pigment in the lesion.
• Located near the optic nerve.

Early detection of choroidal melanoma results in earlier treatment and better outcomes for the patient. Many times, a patient with choroidal melanoma may be asymptomatic, and so routine dilated eye exams should be performed to identify any suspicious choroidal nevus.

In general, there is no treatment for choroidal nevus other than observation and monitoring for change. Therefore, a visit to your eye doctor is recommended to detect any freckles in the back of your eye.

Article contributed by Dr. Jane Pan