Knock Knock Eye: The Weirdest Eye Questions You’ve Always Wanted to Ask
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Hello everybody, welcome to Knock Knock I with Dr. Glockenflecken. That's me, your host. This is your one-stop shop for eyeball stuff, eyeball questions, eyeball answers. That's what we're here for. I hope you all had a wonderful holiday season. I hope it was safe. And by safe, I mean that you opened your champagne bottles on New Year's Eve and

without the cork hitting you in the eye. I've made a video about this. It is a thing that happens. It happens enough to where on many ophthalmology websites around the new year, there will be like an editorial about not poking yourself in the eye. Poking, that's putting it mildly. Shooting yourself in the eye with a cork on New Year's.

It happens. People don't pay attention. They just either it bounces off something and comes back and hit you in the eye. It's the one of the laws of the universe. Projectiles will find your eyeball. It's a fact. I think Neil deGrasse Tyson talked about it. It's a universal thing. It's physics. I don't know. Whatever. Don't fact check me on that.

Anyway, I hope it was wonderful. And I apologize to all of you who are watching me right now on YouTube. All these episodes are posted on at Glockenfleckens on YouTube. I apologize because I look a little bit haggard. Whenever I have time off around the holidays...

I tend to let myself go a bit. All right, so I need a haircut. It's getting pretty bad. Probably should shave. But you know what? That's okay. Let's have some fun. Let's talk about eyeballs. I have something a little different today. No cases today.

no particular thing. This is going to be just a Q&A, Q&A. And I brought with me some of the more frequently asked questions and some of the more infrequently asked questions that I get from patients. So these are not questions from all of you listeners. All right. I'm going to take a break from that for an episode. And these are like, I just, I brainstormed

And occasionally I'll write down like questions that I get asked in my line of work if I think they're interesting questions because I can use them as content later like today. And also just did a little brainstorming session on what people are wondering about. And some of these are hopefully some questions that many of you have had at some point in your life. So we'll get to as many of these as I can over the next half hour. All right. Should we dig into it? Let's do it. All right. Let's see.

These are like, some of these are like, you know, when your family's home for the holidays and your aunt starts asking you questions about eyeballs just because you're an eyeball doctor. Like everybody, that's a universal experience for physicians. Anybody...

Honestly, probably anybody in any particular line of work. Like if you're an accountant, I'm sure you probably, when you go home, you have family gathering, family reunion. You're going to get someone you barely know coming up and asking you whether or not you should start a business.

backdoor Roth IRA. I don't know, like stuff like that. So anyway, it happens a lot in medicine. Everybody's got something wrong with their body or some question that they're wondering about. And so some of these questions might remind you of that. All right, number one,

Are pink eye and conjunctivitis the same thing? This is a good question. So pink eye has grown into this term that really describes infection. Like when someone says, I have pink eye, everyone automatically thinks infection, which would be viral conjunctivitis or bacterial conjunctivitis. And so it's kind of like this more specific term, pink eye.

But that doesn't equate to conjunctivitis because when we say as ophthalmologists, we say conjunctivitis,

That can mean a whole lot of different things. That can mean infectious conjunctivitis, and that can also mean non-contagious forms of conjunctivitis, allergic conjunctivitis. You got all that itching and you just want to rub the heck out of your eyes. Don't do that, by the way. You can permanently change the shape of your cornea and that can cause problems. A little bit of eye rubbing is okay. I do it sometimes too. Like this morning, I just woke up and just

rubbed my eyes. Just give it a good rub for like two seconds and then don't touch them the rest of the day. That's okay. You can do that. I'm willing to work with you on the eye rubbing, okay? Because I get something. It feels good, doesn't it?

Sometimes a good eye rub just really sets you up for the next few hours. So just don't go crazy with it, all right? Just be gentle. I have seen a patient who actually gave themselves a traumatic optic neuropathy from severe eye rubbing. This is more like a psychiatric type of situation. But yeah, it can happen apparently. It's something I didn't even know you could do. But eye rubbing that's so severe that it caused damage back in the optic nerve.

Most likely from like just when you smash on the eye, it's going to increase pressure in the eye and similar to glaucoma, right? High eye pressure for an extended period of time is going to cause damage to the optic nerve. But anyway, I'm getting off topic. I'll try not to do that. Conjunctivitis is more of a general term that can mean anything that causes inflammation of the conjunctiva, including allergy and...

autoimmune conditions are another one. You know, you can get like rheumatoid arthritis and, and, but obviously infection is like a big part of this. All right. Glaucoma, you can get a conjunctivitis from that too. His eye gets all red and irritated. All right. Next question. This is kind of a piggyback off the first question. How long is pink eye contagious? And when can I send my kid back to school? I get this question a

Pretty commonly, I don't see a lot of kids, but when I do see a kid with pink eye, this question always comes up. And so bacterial conjunctivitis, there's no hard and fast rule with this, but generally it lasts about a week. And if an antibiotic is given, it's shorter. And kids are much more likely to have bacterial conjunctivitis over viral conjunctivitis. We see a lot more in children.

Because kids are just kind of gross, you know. I love them. I love kids. They're a little bit disgusting. That's just the way it is. So kids and anybody who lives in like a nursing facility, that's your, my antenna is going up with bacterial conjunctivitis. Everyone else, most likely viral.

So with bacterial conjunctivitis, you give an antibiotic drop that's going to shorten the duration. And in general, a kid can return to school or daycare once symptoms of like discharge and tearing have improved. That's the biggest thing. Like redness, discharge, and tearing. Because all that discharge, those tears...

Because the eye, when something's happening to it, it's going to tear up. It's a defense mechanism because the tears contain antibodies and growth factors that are going to help to heal the eye.

But all those things also have like infectious particles in them, bacteria, viruses. So you want to wait once all that stuff really is like almost completely gone. That's when you can send the kid back to school.

Viral conjunctivitis, on the other hand, it can last a little bit longer. It can last up to two weeks. Viral conjunctivitis is nasty. It's really bad. The worst offender is something called adenovirus. Adenovirus causes the diseases called epidemic keratoconjunctivitis, EKC.

You get just severe, ultra-red eyes, really painful, often more painful and distressing to patients than bacterial conjunctivitis. To be honest, I'd rather have a bacterial conjunctivitis than a viral conjunctivitis because you can treat that easier. Viral conjunctivitis, you've just got to let it run its course.

And there's no curative treatment for viral conjunctivitis. But the same principle applies in terms of return to school or return to work. I mean, as an adult, you're a little bit better at avoiding people touching your eye or transmitting infection, keeping your hands clean, not rubbing your eye. Kids, they can't do that. But once the tearing and the discharge greatly improves, back to school. Go learn long division, something my kid is learning right now.

Alright, another question. How can I keep cataracts from getting worse? I get asked this question a lot because every day I'm talking about cataract surgery. I'm signing up people for cataract surgery. As the population gets older, everybody's getting cataracts. So, question.

I have been diagnosed with mild to moderate cataract and was told that I need surgery, but I don't want to do it. Can I prevent the increase and progression of cataract? I don't want it to get worse. What can I do? Well, the short answer is nothing. Cataracts are a part of getting older. Everybody over 60 has cataracts. A lot of people over 50 have cataracts. If you have something like diabetes, you're going to get cataracts even sooner.

But there is one thing you can do. Obviously, to the best of your ability, you can avoid diabetes, but not everybody can do that. But the other thing you can do is avoid ultraviolet light from the sun by using UV blocking glasses. Don't listen to any of the crackpot social media influencers out there that are trying to sell you on avoiding ultraviolet light.

any kind of light-related things. No, ultraviolet light has no uses. You don't need to sun gaze. You don't need to stare at the light. You can block the light. Block the UV light. It doesn't do anything for your eyes. All it does is increase your risk of cataract, macular degeneration,

uh eyelid cancers you thought about that you can get basal cells squamous cell carcinomas of the eyelid and if you are getting the habit especially in an area that's got a high uv index southern united states australia i'm talking to you but you guys know all those in australia they're all over this they're all over this wear your sunglasses block the uv light you don't need it not on your eyes

But otherwise, no, you cannot keep cataracts from getting worse. They are going to gradually progress and cause more and more problems related to glare issues, trouble seeing road signs, trouble with fine print, trouble with your day-to-day activities. That's when we decide on doing cataract surgery. Most people, I would say, are in their early 70s. That's probably the most common time to get cataract surgery. But you can slow it down. You're not going to stop it, though. All right, let's take a break.

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More questions. Oh, this is a fun one. This is one I hear a lot from patients who come in with urgent appointments. They say, my eyes are hurting, especially after I take out my contacts. So I've been just living in my contacts. I've worn them for five days straight because every time I take them out, my eyes hurt. So why would I not wear contacts? I got to keep the contacts in. This is a very bad sign.

If your eyes hurt after you take out your contacts, you're wearing them too much. Because contact lenses, and when people say their eye hurts, usually it's like foreign body sensation. It's like they feel like someone's poking them in the eye. Or they got a hair in their eye or a piece of dirt, gravel, a rock. A rock is in there. No, you don't have a rock. You've been wearing your contacts too long. Contact lenses, they create a...

environment underneath underneath that contact lens on the surface of the eye and the the eye becomes tolerant to it and and then and when you take out that lens then you are exposed to the atmosphere and the eye is not used to that

You create this environment where maybe you can even get like little micro abrasions on the cornea from contact lens rubbing against the eye because it's been there for so long. But the contact lens is also covering those little scratches. And so when you take it out, all of a sudden, oh, the air hits it or your eyelid blinking hits it and it starts to hurt. And so you're like, oh, I got to put my contact back in. But no, you need to actually let your eye heal from the contact's.

And so that's why we're always talking about people, don't sleep in your contacts. Don't use them too often. Take a break from time to time. Take a weekend and stay out of your contacts. Especially if you're the type of person, you're working hard, you've been wearing them 18 hours a day. Yeah, I'm looking at all of you. All you contact lens wearers, you're wearing them too much. I promise you. Take a break from time to time. Take a day. Take a couple days. Don't wear your contacts. Let your eyes...

Heal a little bit. Get used to not having a contact lens in. You're going to be able to wear them longer and you're not going to have as many problems going forward because years and years, I've seen it time and time again, people that come in, they've been wearing contacts for 30 years, they start having severe dry eye issues and they just can't wear contacts anymore. It gets to the point where even a day in contacts is painful. All right, so don't do it. Next question.

That's a common one. I get that all the time. All right, here's a good one. Can chlamydia conjunctivitis spread from the eye to the sexual organs? Can it go backwards? So, first of all, chlamydia conjunctivitis, it's a sexually transmitted disease. Chlamydiotrachmatis. And transmission from direct contact of the eye...

The transmission to the eye is from direct contact with infected genital fluids. This is a serious topic. Honestly, I have had questions about chlamydia before. It happens. And if you don't want to hear about this, maybe fast forward about three minutes. I'll try to keep it short. Eye-to-eye transmission is extremely rare. I don't know anybody who's ever actually like

bumped their eyeball with another eyeball from another person or from their own other eyeball. It just doesn't, anatomically, that can't happen. And so it would be very unlikely for eye secretions, like from the eye, to go backwards and infect the genitals because generally people don't rub their eyes on genitals. I'm not aware of that concept.

for sexual activity. I don't know if there's a thing that people do. I certainly hope not. That would not be sanitary. That's not safe. Don't do it. Keep your eye away from other body parts, generally. Eyes don't like to be touched from genitals or anything else.

It always works the other way around, this infection, genitals to the eye. Topical antibiotics are used to treat chlamydia trachomatis, by the way. So erythromycin ointment's a good one. Doxycycline by mouth, we always give that when we have a case of chlamydia because obviously if it's in the eye,

you're worried that this person who was having sex with someone with chlamydia also has like genital chlamydia. So you want to treat oral antibiotics, tetracycline, doxycycline for a couple of weeks and all the sexual partners as well. So there you go. That's the rundown of chlamydia.

I think I did that in three minutes. Not too bad, huh? All right. I think that's the only sexually transmitted disease type thing I've got for you. Oh, maybe a little bit on genital herpes. I don't know. We'll see. We'll see what we get to. I chose a bunch of... I've got a bunch of questions written down here. All right. Oh, here's one. Here's a good one. So...

patients with high myopia so i'm talking to all of you out there with a all you probably contact lens wearers who are like a minus six or higher that's uh those of you that are technically high myopes maybe even less than that even like a minus four um pathologic myopia is when you get above like a minus eight minus nine so there are some of you out there like that as well with patients like that

What exercises should I avoid? This is a fantastic question. So it's true that head trauma, eye trauma, any major jarring activity, getting hit can result in a retinal detachment, particularly people who are nearsighted. Because as I've talked about this before, high myopes are

you have longer eyes, you have larger eyes. And the structures inside the eye, like the retina, which is like the wallpaper that lines the back of your eye, it's stretched a little bit tighter. And so you have areas of the retina that are weaker because it's stretched. That tissue is thinner. It's more prone to tears and holes that can progress to a retinal detachment.

Now, the incidence of a retinal detachment during your life is for a normal eye, so like me, I'm normal. I've got perfect eyes as far as I think. If you've heard Kristen tease me on Knock Knock High, you'll know that I have never actually had a dedicated dilated exam before.

I'm not proud of it, folks, but it's true. I have never had both eyes dilated and someone look back there, but I do know that I don't need glasses. I'm a bit of a hyper-ope, opposite of myope, a small one. So my risk is the risk of anybody who's not myopic for retinal detachment. And my risk is about 1 in 20,000 over the course of my life. Very, very unlikely that I'm ever going to have a retinal detachment.

But the risk of a highly myopic person is about 10 times higher than that. All right. So you're going to have a, what is that? One in, I don't know how probabilities work. It's still a low risk, but it's much higher than it is for the average person. But it's still, it's less than 1%, right? So I don't want to scare all of you high myops that you're going to get a retinal detachment. It's still less than 1% in your lifetime you're going to get a retinal detachment, but it's higher than the average person.

By the way, PRK, LASIK, refractive surgery, because a lot of you have had that, that does not increase your risk of retinal detachment. It's still the same because your eye is still the same size overall. We just changed the shape of your cornea. So exercise, there's really not much you have to limit yourself from doing if you're a high myo. But there are certain things you might want to reconsider. You might not want to be a boxer. UFC, kickboxing.

anything where you could get hit even like football um basketball like contact sports i would say you can't do those things because those are very common people love doing those but um uh you might want to consider wearing eye protection for certain things you know you can wear sports glasses um

You just don't want to get hit directly in the eye. Anything where you could get hit directly in the eye is concerning for inducing a retinal detachment. And if that ever does happen...

Even if you're, whether you're playing sports or anything, whatever you're, you know, someone shoots a rubber band from across the room and hits you in the eye. Go see an ophthalmologist or an optometrist. Have them take a look back there. Make sure you don't have any retinal tears, retinal detachments. Lots of new floaters all of a sudden. Big flashes of light. A curtain coming over your vision. Those are all concerning signs of a possible retinal tear, retinal detachment. If you're at high risk, if you're a high myope, go see somebody.

Please. Okay. Moving on. Why are my pupils so naturally large? I get this from time to time. People come in. They're like, somebody said I had really big pupils. Is that true? Or they just acknowledge, oh, I know I have like super large pupils. So...

What contributes to pupil size? Because, yeah, some people, the average pupil size, like the normal pupil size, can range between about 2 millimeters. So some people have very small, naturally small pupils up to about 8 millimeters. I've seen people with big, big pupils.

And so the pupil size is regulated by the muscles in the iris. All right, so they expand and contract to light, to different amounts of light. And those muscles will fire and relax. And there are certain medications that can make you have a little bigger pupil. Like, you know, if you're on like cold medicine, like I am right now. I have not been feeling good lately.

Getting better. But that can be a factor. And so people with larger eyes, people who are highly nearsighted, they do tend to have a larger pupil because everything's just a bit larger. And what can happen with this is those people can be a little bit more light sensitive. You naturally have large pupils naturally.

Well, more light is coming in your eye and you can. I have people that come in, they're like 70 and I ask if they've had any increased light sensitivity because that can be a sign of inflammation in the eye. It can be a sign of cataract. But they tell me, yeah, I'm light sensitive, but I've been like that all my life. And you look at their exam, they have big pupils. Makes sense. Like they've just been a little bit more light sensitive. It's not something you have to treat. It's usually something that people just end up living with.

They get used to wearing sunglasses on bright sunny days. But one other thing it can do is people who have naturally large pupils can have a little bit more trouble driving at night. They have what's called night myopia because the pupil is so large that it gets even larger at night, obviously, because there's less light so the pupil is going to get bigger.

And it allows the light coming into the eye from the road while you're driving at night because that light can catch more of the periphery of your lens, which gets refracted more. And it causes your focal point to move forward in your eye, leaving you more nearsighted. So I have people that get a little bit more nearsighted. Maybe we have to adjust the prescription a little bit or just talk to them about this. Usually it's not enough.

that it really prevents someone from being able to drive, but just knowing that that's the reason can be helpful for people. Yeah, pupils can be naturally large. I've seen some big, big pupils, especially young people, as the pupil does tend to get smaller as you get older, but young people tend to have pretty large pupils. All right, let's take one more break.

Okay, will wearing sunglasses... We're back, I should say. I had to jump into that. All right, we're back with more questions. I got a few more here. Will wearing glasses for nearsightedness for too long damage my eyes? No. Emphatic. Absolute. No. Seeing the world clearly is a good thing. Do it.

in whatever way is required for you to do it. There's no evidence. Again, I don't care what anybody says on social media. There's no evidence. Even, by the way, even if you have an incorrect prescription, even if you're using like some of these glasses, I don't know why you would do this. That's not correct. That's not your prescription. That makes your vision even blurrier. Using that will not damage your eyes in any way. It might give you headache.

briefly, but then you just take them off and you're better. No, glasses do not damage your eyes in any way. Do they do not make you more dependent on glasses? It's just physics, everybody. It's just the way your eye shape is, the way it works. Your eye bends light onto your retina that allows you to see. Well, some of us don't bend light onto the right spot in the eye. And so we need glasses to help us get there. Wear your glasses.

Always really bothers me. I'm happy to answer this question for people, but I hate that this question has to be answered because people hear someone say something. I've been, this is a, if you're, if you've been around, if you've been with knock, knock eye for, for since the beginning, I've had this, I've done this rant like four or five times. All right. If you need glasses, you need glasses, wear them. All right. How about this? Can dry eye cause double vision?

Yes, that is actually one of the most common causes of dry eye and something that we have to drill down into by asking questions, getting more history on what exactly could be causing this patient's double vision. So double vision can happen basically when the brain gets two different images from each eye or from within the same eye.

So the drier your eyes get, the fuzzier the image can be. And most of the time people can interpret that fuzziness as double vision when really it's more of a ghosting of images. There's a shadow of the image. And I always use those terms because that's a great descriptor of what people are actually seeing. It's not like they're looking at somebody, they're looking at me in the exam lane and they're seeing two of my heads. No.

It's just like a slight separation that fluctuates. It comes and goes. So one of the tests we always do, and this is a test that I'm always, every time I talk to an emergency medicine group, I try to, when we're talking about eyeball stuff, I'm always telling them this. Have the patient cover an eye. Patient with double vision, have them cover an eye. If it goes away,

Okay, say the double vision goes away when the patient covers their right eye. Have them do the same thing with the other eye. Cover the left eye. If the double vision always goes away when the patient covers an eye, that is what we call binocular diplopia.

They have a misalignment to their eyes. That's when you're starting to think about, okay, something going on in the brain that's causing them to have a misalignment or something in the orbit. Something in the visual axis is causing this. Most likely some kind of nerve palsy or a stroke or tumor or something. So you need to investigate the brain and orbits. But if the patient covers an eye, say they cover their right eye, like, yep, I still see it. I still see like that double, but it's just in one eye.

9,999 times out of 10,000, that's going to be dry eye. So you talk about artificial tears, lubricate the eyes, do hot compresses, all that stuff. That one other time is going to be a dislocated lens. So because the lens, if it dislocates, if it's not in the right spot in the eye, then it's going to bisect the pupil. Potentially, it caused them to see like a doubling. Could also be an epiretinal membrane.

It's another thing that can cause like shadowing. But generally, almost always, it's dry eye. So yeah, dry eye can cause double vision. Next question. How does diabetes cause cataracts to form? This is a good one. So cataract, I mentioned before that when you have diabetes, you tend to develop cataracts a little bit sooner. And the reason this happens is because, this is at least what we think, that high glucose levels

accumulates in the aqueous humor in the front of the eye. It's between the cornea and the iris, that front chamber. The glucose accumulates in the aqueous humor and that glucose accelerates buildup of proteins on the lens that can lead to cataract, which is why we get a very specific type of cataract

with patients with severe diabetes is you get more of a cortical cataract. So it's closer to the surface of the lens because we think that that glucose is causing proteins to malfunction on the lens itself, giving you more of a surface cataract. So controlling blood sugar is the greatest way to slow the development of cataracts. Already addressed, you can't stop cataracts, but you can slow them down. All right, let's do, how about one more?

How about just what is a normal eye exam? Like what is like a 2020 vision? So when people, this is a question people always ask me, I hand them their prescription. They're like, okay, what are the numbers mean? Which is always a tough question because it's a loaded question. There's a lot to explain to someone about those numbers. And so I try to do my best. In the US, we think of normal vision is 2020 vision.

Although you can have even better vision. 2015, we checked that. We even have a 2010 vision thing. But 2020 is standard. And so on a glasses or contact lens prescription, there's going to be a sphere.

You'll see SPH, sphere. And there's going to be either a, on that value next to sphere, there's going to be either a plus, which indicates hyperopia, farsighted, or there's going to be a minus, which indicates you're nearsighted. We talked about nearsightedness. The next number after the SPH, after the sphere, is the CYL. You'll see C-Y-L. That's your astigmatism. Astigmatism just describes the shape of your eye.

And people with astigmatism, their eye is shaped more like a football. It's steeper on one side and flatter on the other versus a basketball, which would be like a perfect sphere. Nobody has a perfect spherical eye, but some people have close to a perfectly spherical eye. Some people have way more astigmatism than others.

So C-Y-L, CYL, and then you're going to see either a plus or a minus number next to that C-Y-L. And that depends, honestly, on whether or not you're seeing an ophthalmologist or an optometrist. For reasons I don't really quite understand, I think it's just a historical thing. You can measure cylinder in plus or minus. I think it has something to do with just how glasses are made.

I'm not a good, any of my optometrist colleagues out there could probably answer this a lot better than me. But we always use plus sill. It makes sense in my brain. But optometrists often will use minus sill. It just, all you have to worry about is just, and you don't even have to worry about it. It's just describing the particular shape and severity of your astigmatism.

And then the number on the end, you'll have like SIL plus 1.0. And then there's a number next to it that goes from 0 degrees up to 180 degrees. And that's just the orientation of that cylinder, of that astigmatism. There you go. That's your prescription. I did the best I could. So, you know.

And, you know, 20-20 vision, that's what we're always striving for. But that doesn't necessarily mean you have normal vision. Just because your vision is 20-20, you can have other problems. You can have problems with color blindness. You can have reduced contrast, glare issues that we see in cataract surgery. So just because you have 20-20 vision, that's always a good thing.

But it doesn't mean you don't have something wrong with your eyes. And so, you know, you don't have to let someone say, oh, your vision is perfect. You're 20-20. You can still have symptoms. And it's important for you to describe those things to your eye doctor. That's it. That's all the questions I have for you today. If you liked these, these are... I tried to think of things that were just...

more general thing, not so in the weeds that people wouldn't really understand what I'm talking about because I feel like I do that a little bit too much, especially in all like the neuro-ophthalmology, getting into details about surgeries and stuff. And so every now and then I'll try to do something like this where you kind of

Bring it back. Bring it back to just very basic things. Explain a little pathophysiology, but not get too complicated. And hopefully teach all of you a little bit more about your eyes and how to take care of them. That's the goal here.

So thank you all for listening. Again, leave comments on my YouTube channel at Glockenfleckens. All these episodes are going up there. I read the comments. I'll have some comments to address next episode for sure. And thank you to my producers, Aaron Corny, Rob Goldman, and Shanti Brick. Editor-engineer Jason Portiz. Our music is by Omer Binzvi. We'll see you next time, everyone. Knock Knock I is a human content production. Take care. Bye. Knock Knock. Goodbye. Bye.

You've been caught, Dent.