Knock Knock Eye: Is There a Way to Reverse Eye Dilation?
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Today's episode is brought to you by Dax Copilot from Microsoft. Dax Copilot is your AI assistant, you know, like a little Jonathan in your pocket, for automating clinical documentation and workflows that help you be more efficient and reduce the administrative burden that leads to feeling overwhelmed and just burned out, right?

Learn more about how Dax Copilot can help improve healthcare experiences for both you and your patients by visiting aka.ms slash knock, knock, hi. Again, that's aka.ms slash knock, knock, hi. Knock, knock, hi. Hello, everybody. Welcome to Knock, Knock, Hi. With me, your host, Dr. Glockenflecken, your one-stop shop for all things eyeball.

accurate eyeball information. Like you can, you can trust what I say. I I've been doing this. I all day. I go, I see eyeball patients.

I'm in the clinic. I'm in surgery. I come home. I make videos and podcasts and silly skits. And then I go back and I see more patients with the eyeballs. And so I want to impart all of the knowledge I have to all of you. So what we're going to do today is I've got a lot of answers to a lot of questions. So we're going to do, it's like a kind of a potpourri, like a grab bag of patient and family questions.

So I, I, I brainstormed as many questions that I've, uh, that I could think of that I've, I've received recently. Uh, in some, I just kind of made up because they are questions I think I've gotten in the past, but, or just, just, just important topics. I think we should discuss, uh, and, and the, the, the goal of this is to educate the general public in case you didn't know, like you don't have to have a medical background, I think to enjoy these episodes, to learn a thing or two about eyeballs. Uh,

Uh, so I, I, my approach to all of these is like, let's just, let's make it for everybody. Cause nobody knows, even in, even in medicine, you guys, I know all of you like cardiologists are listening, all the general surgeons, the radiologists, the pediatricians, like none of you know anything about eyes and that's okay. Like you just don't get that, not that, that education. I received, I think one lecture about ophthalmology in med school. That was it.

one, it was just a kind of an afterthought. And then that was, and then that was it until like residency. So you kind of had to, had to figure, that's why I actually had to take an extra year in med school because I didn't know what I wanted to do until I finally, in my fourth year, I got to do an ophthalmology rotation. And I was like, wow, I get to go home like at a reasonable hour and develop meaningful relationships with my family and friends.

I think I want to do this. But at that point I didn't have any research and have all the things you got to have to, uh, you know, any letters of recommendation from any ophthalmologist. So I ended up having to do an extra year, uh, to get my application in order. But, um, uh,

But it's, I don't even know why I'm talking about this. The point is, I want everybody to learn as much about their eyes as possible. Before we get into some of those questions, though, I want to address some of the comments I've received on recent podcast videos. All of these

episodes you can find on our youtube channel at glockenfleckens check it out we just recently passed uh 10 000 subscribers which is great this is because this is just the podcast uh this is separate from my my regular channel and so i appreciate all of you who go there and subscribe and like and watch all the videos uh and watch these episodes i'm doing this for you guys

So a couple of it. So the most recent episode that was published was what really happens to your eyes in space? Most recent knock knock eye and a couple of comments. So at Jeremiah Walgren said, have you ever had to visit another ophthalmologist for anything?

or had another ophthalmologist visit you for something. I've always wondered how doctors at the same specialty would handle one of them also being the patient. This is a great question. I personally haven't, and if you've listened to a lot of this podcast and knock, knock, hi, when I talk with Kristen, she always makes fun of me because I've never had a dedicated eye exam before.

Weird to become an ophthalmologist and never having done any kind of dilated exam. I do feel like a bit of a hypocrite.

It's coming. I need to do it. I I'm due. I'm due for it. Um, I just, I've, what can I say? I've got perfect eyes, you guys. And so anyway, um, it's, uh, uh, the, the, the, the, the exam by an ophthalmologist for an ophthalmologist. I think it depends on your personality. I personally, I see several retired ophthalmologists, um,

Now, I have never had to do eye surgery on an ophthalmologist because that brings up a different conversation about the different types of lenses and what you... Because you can't separate your own experience...

from something like that. And I think it probably helps if you've been retired for like 30 years and then you come back and need cataract surgery because probably a little bit out of the loop in terms of what technology is out there, what types of lenses are available. I would say like thinking about it right now, I would be kind of like a mess if I, as an ophthalmologist,

had to go and get like a surgical procedure on my eye just because I know too much. We know too much. I know the things that can go wrong. And it's not those fears. They're real, but they're not rooted in reality. Like there's I am irrationally afraid of getting LASIK. The risk of a complication from LASIK is extremely low, but

The things that have gone bad that I've seen in patients that have gone bad, of course, I'm going to see more of those because I'm an ophthalmologist. We see things that go bad.

We see all of those things. And so our, our, my, my mindset is skewed. And I think that's probably the same way for any physician, uh, in a, in a particular specialty and nephrologist, they see all the bad kidney things that happen. And so it's going to be at the front of their mind. And there's, it might be a little bit of irrational fear about inseds. I don't know, but

But that's kind of the way it is in my head. But hopefully there are probably many ophthalmologists that don't have the level of anxiety that I have. And so it might be easier for them. But yeah, it's just knowing all the potential complications would make it, that's the thing that would make it challenging.

But I already do have an idea in my head. Some of my partners who I would love to, I would let them operate on my eyes because they're fantastic surgeons. That doesn't mean I won't be nervous about it. And I'd want as much Versed as they're able to give me for the surgery. But I've had multiple surgeries already in my life. So surgery itself doesn't scare me. It's just...

Like I said, just knowing what could go wrong. But it is an irrational fear, I would say, because I don't want other people to be nervous about eye surgery because we're very good at what we do. Cataract surgery in particular is just, it's the most common surgery performed. You should not be scared. And speaking to that,

Another comment at Pat Gunn says, there's no way I would want to be awake while someone is doing surgery on my eyes. A lot of people feel that way. I just did surgery this morning. I heard that exact statement from, can you please put me to sleep? I don't think I can do this.

but you can trust me it it's so fast we are so efficient with cataract surgery six minutes i did a five minutes cataract surgery today which is even fast for me like six seven minutes that's typical and you're done and you get a little bit happy juice you get a couple glasses of wine through your iv make you feel nice and and comfortable and then before you know it it's over

Just as often as I hear, I'm really scared about this surgery, I also hear, it's over already? I didn't even know you started, doc. Will you marry me, doctor? That goes back to, I think, a couple episodes where I mentioned the patient that proposed to me while I was in the eye, removing the cataract. Update, she did not remember asking me that, so...

Um, I don't think it was a real sincere proposal, which is fine. I don't need a proposal. Another question. Oh, so in this, in this episode, I'm where I'm seeing these comments. Uh, I talked about reversing dilation and how I'd make a whole bunch of money if I could figure out a way to do this because people hate being having their eyes dilated. So that's, that's why some people don't never come in to see the eye doctor because they're going to have to have their eyes dilated.

And so I found out through these comments that there is a medication, an FDA approved medication. This is from at ALK5440. Thank you, ALK. Probably ALC, I'm guessing. There's an FDA approved medication called Rizumvi.

R-Y-Z-U-M-V-I. I never heard of this medication for reversing pupil dilation. I asked my optometrist about it, my last appointment, because pupil dilation gives me really bad migraine. If you have a chance to look into it, I'd love to hear your thoughts. So I did look into it because I don't know anybody. I never heard of this. It's not...

It actually got FDA approved in 2023. So it's been around a while. And I looked into, okay, so if it's been around a while and everybody's clamoring for something that reverses pupil dilation, why is it not more prevalent in ophthalmology circles? And I think it's just because of cost.

you know, a lot of practices run on pretty small margins, uh, private practices in particular, actually private practices to a lesser extent. Uh, but academics, yeah, they're, they're, they're a little bit more penny pinchers, uh, because they have, uh, smaller margins. Um, and so, uh,

You're asking a practice to stock a medication that, from what I saw, you could get eight individual doses. That's like 200 bucks total for those eight. That's an expensive medication. And it's mainly because it's a brand name, right? So maybe in 10 years, when there's a generic version of this, you might be able to find it over the counter. Who knows?

Because it's a medication called Phentolamine, which I'm not real. I mean, it just counteracts the sympathomimetic and parasympathetic blocking properties of pupil dilation and allows the pupil to come back to normal. Now, it's not immediate. From what I could tell, Rhizome V, whoever makes this medication, markets it as rapid acting.

but it can take up to 90 minutes for it to happen. Is that faster than dilating drops, than the length of dilation? Yeah, but it's even 90 minutes. Like dilation with the typical drops we use will last about four hours. I can use a half dose of tropicamide, which will decrease the amount of dilation to about two, two and a half hours.

So what are you really getting? Yeah, it, it, it works, but it might still take a while. It depends on how strong your dilation is. Um, and so the, the rapid acting is not as rapidly acting as you probably want. Cause I think when people think of rapid act, they like instantly like that would be a different story. That would be pretty impressive to have a, like an instant, you know, resolution to your dilation to back to a normal pupil. So the, the, the, the,

The length of time it takes for the drop to work combined with the cost, it's going to be hard. You're going to be hard pressed to find a practice or an ophthalmology department at a university that's willing to put up that cost because the alternative is just

You'll wait a couple more hours for the dilation to wear off on its own. So I just don't think it's cost effective. It's cool that they have it. I did not know that. So I appreciate Alc for bringing that to my attention. But I just I don't think it's it's a viable product until it's cheaper and it works a little bit faster.

But then you're talking about concentrating the drop, and now you're talking about potential side effects. And it already says on this medication that you shouldn't use it in any eye that has an inflammatory condition, which could include blepharitis dry eye, which almost everybody over the age of 60 has some degree of it. So it could end up just causing more discomfort for patients because you're talking about another drop and potential side effects. So

I don't know. I'm not sold by any means, but it is cool that it's there, that it exists. I just don't want everybody to be asking their eye doctor for it because there's lots of reasons why it might not be ideal. A bit underwhelming, a bit expensive, with some side effects.

All right. Good question though. What else? What else? Let's do, oh, here's a good comment. At Norn IEA says, when my mom had her cataract surgery, the office had a small viewing room with a big window where we could see her in the operating room.

We had a TV so we could watch the surgery. Very up close. Super cool. Super cool for you. Some people don't like that. Some people have a big phobia of eyeballs and anything related to eyeballs and don't want to see a big eyeball being operated on in front of their face. But I see that mostly now. We don't really do that for cataract surgery as much, or at least I'm not aware of a practice that does that. Partly because like,

You never know what's going to happen during cataract surgery, right? And you don't want to scare people. You don't want people to, they're going to be watching their family member being operated on and often they won't know what things mean. They don't know what's going on. And so you might get into issues there. I've seen it mostly with LASIK actually.

Where I went to residency in Iowa, there was in the LASIK, the refractive surgery suite, family members could sit there and watch their family member having LASIK or PRK. I don't know what it is. It's a cosmetic procedure, maybe. I don't know. But then again, we don't have people watching you get a bluff.

a little bit bloodier, a little bit more, a little bit more difficult. Uh, so I don't know. I don't say, I don't see it very often anymore, but yeah, that's cool that you, some people like it obviously. Um, but, uh, yeah. So if you want to, if you want to see cataracts or just Google, there's like thousands and thousands of cataract surgery videos you can find on YouTube. All right, let's take a quick break. Hey, Kristen. Yeah. I've got some friends. I'd like you to meet. I see that.

You seem a little too friendly with them, I have to say. Aren't they cute? Sure. With the little beady eyes and their little hands. The hands? The claws? I don't know. Appendages. Okay. How about that? That works. Anyway, they just like, they'd like to say hi. Okay. They like to say hi. Okay. Wonderful. They're not, they, oh, look, the one's sticking around. It sure is. Right on my mic. These little guys are demodex and they live on your eyelashes. Yeah.

And they can cause flaky, red, irritated eyelids. See, that's not cool. That's a party foul. You just kind of want to rub them. You're not welcome here if you're going to do that. And it's caused sometimes by these little guys. Yep, that's rude. Demodex blepharitis. But you shouldn't get grossed out by this. Okay. All right, you got to get checked out. Yes, get checked out. To find out more, go to eyelidcheck.com. Again, that's E-Y-E.com.

L I D check.com for more information about these little guys and Demodex blepharitis. All right, here we go. Rapid fire questions. I don't, I should, I need to have like a, a term for this where I just, I go through as many like,

patient questions patient question that's not interesting that's not fun it's just these are just like random questions isn't they're not just for ophthalmologists for everybody okay so i'll just i'll just get into it here's a good question that i get asked why do my eyes hurt after i remove my contact lenses this is always a bad sign you don't want this to happen

All right. So the question, my eyes hurt after I take in my contact. It feels like something's in it, but there's nothing there. It hurts until I wake up in the morning or it just hurts for hours after I take out my contacts. And then what people end up doing is they don't like that feeling. And so what do they do? They put their contacts back in or they sleep in them or they wear them for more hours of the day. But the reason is contact lenses are

They create this environment under the lens, which your eye becomes tolerant to. Maybe there's a little bit less oxygen in there. Maybe there's some contaminants underneath there. Your eye just gets used to having this contact lens, this little micro environment that it's become accustomed to. So when you remove the lens, whoa, all of a sudden, because you're spending more hours in the lenses than without,

All of a sudden, the eye is exposed to the air, the atmosphere, heat, cold, wind, who knows, anything that's in the air, pollen. And for most people, this is a quick adjustment. If you just wear your contacts like you're supposed to, generally, for what, eight hours, ten hours, then your eye spends just as much time out of contacts than it is in contacts.

A lot of you, though, you wear your contacts for 15, 18 hours. And when you first start wearing them, you can probably tolerate that for quite a while. But after you've been doing this, wearing contacts for 10, 15, 20, 30 years, your eyes just start tolerating not wearing them less and less. So you take out the contacts. Your eye's not used to having an environment on it where you don't have a contact that

And so you start having pain, discomfort, redness, irritation, feeling like there's something in the eye. And part of this might just be the eye becomes a bit ischemic. You start having blood vessel growth into the cornea, which brings inflammatory factors into the cornea.

If the contact lenses over time, the shape of your eye changes, maybe the contact lens doesn't fit on your eye like it used to. It fits differently. Maybe you haven't gone in to see the optometrist and have them check the contact lens position on your eye in a while. And what can happen is you can get dry spots on your cornea. You can get little specks of dryness there.

And that feels like there's something in your eye. It's called foreign body sensation. We call it superficial care. It can be superficial keratitis, SPK, punctate epithelial erosions. There's different terms for this, but it's basically just dry eye, severe dry eye. And when you take out a contact lens, all of a sudden that dryness is exposed to the elements and it hurts. So you put the contact back in because it's like a little bandaid. You cover it.

But you're just making the problem worse. The eye has to heal. And so you need a contact lens holiday. You need to just step away from the contacts. I know it's hard. But if you take out your contacts and your eyes hurt, that's a bad sign. That immediately you need a break. You need to be out of contacts for an extended period of time for as many hours as you can. Any eye doctor will tell you that.

And you need to go in to see the optometrist, have them check the fit of your contacts. That's the other thing. All right. All right. Next question. I actually got asked this one recently. How soon can I take Viagra after cataract surgery? Well, the question, that's not really the question you should be asking. It should be like, how is it okay for me to have sex? And I'm not saying you have to ask this question. I don't, most of my patients are in their 70s and 80s. Not to say some people in the 70s and 80s don't have sex, but...

It's less frequent, I would say. And so I don't get asked this question a lot, but I have had it recently. You know, is it okay to have, because Viagra itself doesn't really affect the eyes too much. It can give you like a blue tint to your vision, but that's pretty uncommon. And in the context of cataract surgery, here's the only restrictions. This is what I tell people. We don't want you rubbing your eye.

Because when we make an incision on the eye, it's a self-sealing incision. It's like a tri-planar, a bi-planar incision where you take the instrument out and it automatically seals shut. So we don't have to put a stitch in your eye typically. And unfortunately though, if you do rub your eye hard enough or something hits your eye,

then that incision could open up. And that's what we're trying to avoid by telling you not to rub your eye, at least like for a week after surgery. It's never really a good idea to rub your eye. Rubbing it a little bit. It's okay. I know it feels good sometimes, doesn't it? Give your eye a little rub. I get it. I get it. I'm with you.

But really, you don't want to do it after cataract surgery. All right. After about a week, the incisions healed up enough that it's just a little sturdier and it's not going to open up as easily. And so I have people, I just give me a week. Don't touch your eye for a week.

Uh, so no eye rubbing. Um, uh, we, we have people wear a shield at night for a week. I don't want you swimming for two weeks after cataract surgery. I don't want things in that incision. All right. That's a fast track to getting an infection. You're going to go to swim in a lake after you had cataract surgery. Bad idea. Don't swim for two weeks after cataract surgery, please. But you can take Viagra. Question is, can you, can you have sex after it? Which I don't know why else you would take Viagra. Uh,

I would say actually it's probably okay, but the thing is it's not really sex. It's the activity. It's the Valsalva maneuver, the bearing down, like whether you're having sex or you're having a bowel movement.

Hopefully not both of those things at the same time. It's the bearing down. You're just, you're like, you're pulling something, you're lifting something heavy. That's the, the action that we're trying to avoid with cataract surgery because it increases your blood pressure. And all of a sudden it kind of pushes all the blood into your head and actually put pressure on the eye, on the incision. So that's why we have people avoid cataract.

avoid heavy lifting and by extension things that simulate heavy lifting which could be sex i suppose uh and so yeah you want to take it easy for a week all right if you're gonna have sex because you need to take a viagra um i would i would convince your partner to do all the work for you how about that not a bad not a bad trade-off i'd say okay there you go

sex and cataract surgery that's where we're at with this episode right now oh here's a good one why does my vision get blurry after reading for 30 minutes i hear this all the time my vision people come with blurry vision i always ask okay well these are the questions

that I, cause the vision is usually like fine. 2020 measures just great. I was like, okay, well, when do you have this blurry vision? And usually what I hear is, well, I have to, I've been reading a lot or I'm driving. It gets worse or I'm watching TV or I'm on my phone. My vision starts blurring up. I always ask people, do you have fluctuating vision? Is that what's happening? Or is it like a constant blurriness, which is, those are two totally different things. If you have fluctuating vision,

I am much less concerned. That's a dry eye. That's not a serious problem. Dry eye can be a serious problem, but generally it's not something that requires surgery. It's something we can manage. And so the reason your vision gets blurry after reading is because when we do stuff that holds our attention, whether it's reading, watching TV, on our phones, whatever,

There, we have studies that show we do not blink as much. Our blink rate goes down and blinking. Remember, that's how you lubricate your eyes. That those windshield wipers, that's what you're, that's your windshield wipers are your eyelids. They just, they, they re distribute your tear film and your eyes. Love it. Your eye. If you had no eyelids, you're

You'd go blind pretty quick. Your cornea would melt away and you would not see anything. So we need our eyelids. They do great work. But when we're on screens, when we're reading, when we're doing driving, things that hold our attention very well, like those things, we don't blink as much. So our eyes will dry out. Now, this doesn't affect everybody, but as you get older, your tear film isn't as good.

And so you need to blink more frequently. And so we're telling people, take breaks while you're reading. You shouldn't be reading for 30 minutes straight. After 20 minutes, you should be taking a break. 20 seconds, look 20 feet away and blink, blink, blink, blink. All right, dry eye. That's what you're having. You have dry eye when you have that fluctuating vision, especially when you're doing vision intensive activities, which when are we not doing those things?

I honestly can't think of a thing, but usually I hear it more mostly with reading and on your phone. How long can pink eye live on surfaces? So I get a lot of questions about pink eye. Everybody thinks they got pink eye and they come in. Usually I tell them they don't have pink eye because pink eye, the connotation for pink eye is that it's a viral infection. You have a viral conjunctivitis. That's what people think when they say pink eye.

Most of the time it's not a viral infection. People with viral conjunctivitis, they're very miserable. If your eyes are just a little bit red, it's probably something else. But sometimes you don't know. So you come in to see an eye doctor. But pink eye, how long does it quote unquote live on surfaces?

So, if it's bacterial, the bacteria that affect the eye and give you conjunctivitis, they maybe survive for a couple hours on surfaces. Maybe like a day. Viruses are much more...

hardy, they can survive for two to three days sometimes or even longer. And so cleaning properly with bleach or the antimicrobial cleaner is very important. I'm always telling people this when they come in, they have a family at home that doesn't have it and they clearly have a viral conjunctivitis, you're cleaning surfaces.

You're washing your hands. You're not sharing bedding. You're washing. You're doing laundry. Laundry is in your future and a lot of it because viral conjunctivitis can last a week, sometimes two weeks. That sucks. Talk about an ophthalmologist's biggest fear. Yeah, there are some rare diseases that I would hate to have,

But man, I really don't want viral conjunctivitis. I don't want pink eye because it's, it feels bad. It's painful. And it, it's a, it's a, it's difficult to get rid of because you really just got to let it run its course. Like there's nothing I can give you. That's going to make you less contagious faster.

I wish I really do, but there's not. So it sucks. And every time I see a patient that has a viral conjunctivitis in the clinic, I'm like telling myself while I'm examining the patient, don't touch your face. Don't touch your face. And I just, I washed my hands like twice before I leave the room. And then we just nuke the room. We just, we get the, we get the, the, I said, touch my face. I start touching my face. Probably I made you touch your face too. Hopefully you don't have a paid, uh, somebody in the house with pink eye. Um,

Uh, we're like, we're taking bleach. We're like all the wipes. We're just wiping on every surface because that's, that is contagious as hell. It's, it's terrible. All right. Try to avoid that. All right. Let's see. Let's do a few more here. Oh, here's one. Are large pupils normal in children? I've gotten asked this a couple of times. So you have a two year old, very large pupils. They always look dilated even when they're inside and it's bright. Um,

When we're outside, they get a little bit smaller, but they're mostly the same size. They don't change very much. Is this a problem? So large pupils when you're young are very normal, and you can expect that. It's unlikely to be any kind of problem. If the pupils...

Yeah, I would say even not just children, but going into young adulthood. I've had people come in with concern about pupil size. And I've talked about this before. The biggest impact this would have is someone would be, I would say, well, general light sensitivity, but night driving. Because if your pupils are larger and you're myopic, you tend to become more myopic. You have something called night myopia.

So you're driving at night, you want good crystal clear distance vision, but you're looking in the dark. Your pupils are going to be bigger than average. And if they're already big, then that's even more of a problem. But you have large pupils that cause more refraction of light and causes your focal point in your eye to move forward for making you more myopic.

so people say i'm terrible i'm i was like a 25 year old like i can't drive at night it might be because they have night myopia their pupils are really large what can you do about that

You could give a medication that lightly constricts the pupil. Actually, things like Lumify will gently constrict the pupil because it's brumonidine, which has alpha, which has some pupil constricting. Sorry, I said that wrong. No, not brumonidine.

There's a medication that increases, I'm blanking on the name of it now, but it's a medication that increases accommodation and can constrict the pupil. Obviously, there's pilocarpine, but we would never prescribe that for someone for this purpose. In fact, I don't usually prescribe anything for someone who's experiencing night myopia. I just explain to them what's happening, and it's usually not debilitating enough to cause problems. And people just appreciate having a reason why they have a little bit more trouble seeing road signs at night.

So normal pupils, large people can have really large pupils though. And, um, but it's really common to see that in young people and children, young adults. All right. Let's take, uh, let's take one more quick break and then we'll do, I got three more questions. All right, here we go. Why are my eyes bloodshot when I wake up? Well, we've already talked about this a little bit. It's dry eye because what's, what's not happening when you're sleeping, you're not blanking. We've already established.

The eyelids are the windshield wipers of the human body. Okay? So you're sleeping. You're not blinking. Your eyes have a tendency to dry out. And people who are already prone to dry eye syndrome, maybe you have Sjogren's autoimmune condition. Maybe you have blepharitis. You get clogged up oil glands in your eyelids. Maybe you have sleep apnea and you use a CPAP machine.

You have air blowing up into your nostrils. Well, guess what? Your eye tear drainage tube, it empties into your nose. So yeah, you could blow air up into your eye with a CPAP machine. All those things can cause more dry eye and you wake up with redness. And there's lots of things we can do about this, but treating the underlying issue, which is if you have blepharitis, we treat the blepharitis.

Have you do the hot compresses, artificial tears, ointment at night. This is where we will often prescribe ointment at night for people. So you go to the drugstore, all the major brands, Sustain, Refresh, Genteel,

Uh, they all have, um, nighttime formulations of the, over the, over the medications they use. So refresh PM, just thicker, just as an ointment, uh, it comes in a little tube. You just pull lower eyelid down. You put it on the inside, refresh PM, all these things, genteel gel. So yeah, your eyes are bloodshot when you wake up because they're dry. That's what's going on. Unless you've all of a sudden come down with a case of bilateral viral conjunctivitis, in which case wash your hands.

Can you have an MRI with a corneal transplant? I've received this question once before. There are no reasons why you cannot have an MRI. Absolutely. It's fine. That's fine. Sorry. There's no metal in a corneal transplant. It's just cornea. It's just corneal tissue.

Um, and, uh, you know, we do, you know, there are some older devices, uh, keratoprosthesis that, uh, that do have some metal, but even those, I think you can, those are really very rare though. Uh, but even those, I think you can get an MRI with those. Um, but yeah, corneal, any kind of corneal transplant, um, you can definitely get an MRI with no metal involved. That would be really annoying. Um,

If you could, because the brain is like the classic thing that you get lots of MRIs for. It'd be really annoying to have metal in your eye that you couldn't, that would prevent that from happening. Is it safe to use a sad light therapy lamp for insomnia? This is a particularly relevant this time of year. Everybody's feeling a little sad, a little downtrodden.

There's especially residents. Hey, just be nice to all the residents and med students, really any of the physicians that you see working long hours in the dead of winter with, without access to a lot of sunlight. Like there, I can't tell you residency. How many times you'd go in at it's nighttime. You go into the hospital and you emerge from the hospital and it's nighttime again. That sucks. Yeah.

like February, January, February. It's we're almost through it. We're so close. We're getting there, but it's, it's a tough time. And so is it safe to use a sad light therapy lamp for insomnia? So those therapy lamps, it gives you really bright. It's supposed to stimulate sunlight. Obviously it's supposed to like, try to stimulate your, your serotonin, you know, production to just get you feeling a little bit better.

I honestly don't know the data behind whether or not they work, but they do. They should have a UV filter on them. So you should not be getting UV light from those lamps. If you are, then yes, they can cause problems to the eyes.

That's what snow blindness is, is light reflecting off of the bright snow up into your eyes because we're always, as we're walking in the snow, we're looking down. And so light reflecting off the snow up into your eyes can give you corneal erosions from the UV damage. And if you stare at the sun, obviously you can get solar retinopathy.

You can burn little holes in your retina. So as long as whatever the light is that you have has a UV filter and is not actually bathing you in UV light, then you're fine. Remember the nightclub that I think it was...

some kind of some kind of ai like tech bro conference thing and they uh they had a nightclub like a big party and they they used uv lights and everybody woke up with searing eye pain and all the the the media outlets all called it blindness but it they just they had they basically had snow blindness but in a nightclub setting because the club used uv lights

And so all the people all night had their eyes bathed in UV light, woke up with corneal abrasions. And it hurts like hell. It makes you feel like you're going blind for sure. So, but no, sad light. I don't know if it works for insomnia or for depression or seasonal depression or however you're using those light therapy things. But it is, those things are okay for your eyes if they block the UV light. That's it. That's all I got. That's all your eyeball knowledge. Hope you learned something.

Maybe you can take things back to your coworkers and regale them with tales of viral conjunctivitis. Here's what you can do. Here's your homework. Tell one person who wears contacts not to keep them in if their eyes hurt. That's a basic thing. Everybody should know CPR.

Everybody should know like how to do chest compressions. Uh, everybody should know not to wear contacts when your eyes hurt. I don't care. Your eyes hurt. Do not wear contacts. Leave your eyes alone. Maybe we'll start. If it were up to me, we would teach that during CPR class, a little out of context, but Hey, you know, why not? But I don't make those types of decisions.

That's our show. That's knock, knock. I thank you so much for listening again. You can, uh, if you want to leave a comment, if you want to bring up a topic for me to discuss on these episodes once a week, I'm here. Um, then leave a comment on the YouTube channel at Glocken fleckens. All right. We'd love to see those. I love reading those comments. Um, and, um, yeah. So thank you all for, for giving me that, those, that feedback. Um,

and for watching these episodes, listening wherever you listen to podcasts. I'm your host, Will Flannery, also known as Dr. Glock and Flecken. Thanks to my executive producers, Aaron Cordy, Rob Goldman, and Shanti Brooke. Our editor and engineer, Jason Portiza. Our music is by Omer Bensvi. Knock Knock High is a human content production. We'll see you all next time. Bye! Knock Knock, goodbye! Human content.