Problems during surgery

[annamd1234]

Hi!

This is a bit embarassing but I have to ask. I am a first year ophthalmology resident and every time I spend more than 5 minutes on the operating microscope my eyes tear up and my nose starts running like crazy. I sometimes have the same problems when I concentrate too hard to view a fundus.
I have this problem even if I set the intensity of the light on min possible. Are there any tips to not get this problem.

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[Super66]

Hi!

This is a bit embarassing but I have to ask. I am a first year ophthalmology resident and every time I spend more than 5 minutes on the operating microscope my eyes tear up and my nose starts running like crazy. I sometimes have the same problems when I concentrate too hard to view a fundus.
I have this problem even if I set the intensity of the light on min possible. Are there any tips to not get this problem.

ATs QID OU, WCs, LH, RTC 6-8 weeks, consider punctal plugs

 

[Dusn]

Haha. Brilliant! Ophtho EMRs should automatically paste that line at the bottom of the plan section on every a patient note. I definitely don't want to see them back in 6-8 weeks though.

Yeah, remember to blink when you concentrate. Your eyes are drying up. Be careful if you wear contact lenses because if your eyes dry up too much the contacts will fall out while you're operating.

 

[Pink Eye]

P: Artificial tears 2-3x per day. Discuss computer eye strain. Return 1 month for undilated follow up


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[LightBox]

"Recommend Lipiflow and IPL... collect 3k"

 

[The Doctor]

You are tearing plenty, so punctal plugs could worsen the epiphora, not to mention they lead to nasty canaliculitis sometimes. I have fairly severely dry eyes, but I prefer wearing contacts on my OR days so that my glasses don't fog up. I personally carry Refresh Mega-3 (comes in a gold box with clear plastic vials). I put a drop in both eyes right before I scrub for each case. The flaxseed oil lasts a bit longer and helps to make it through. You can consider improving your tear quality by taking 3000 mg of omega-3 fats by mouth daily, and doing warm compresses in the morning. If no improvement with this, consider asking an attending to look at you and consider xiidra 1 drop twice a day OU. Sometimes my tear film dies during a YAG so I purposefully look away for a second and forcefully blink a few times. This may help during longer cases. Good luck.

 

[MstaKing10]

Also have you had a detailed and thorough refraction? Are you straining too much due to refractive error? Check the oculars on the scope to assure they are at zero. Also make sure your PD is correctly dialed in. As others have suggested, dry eye may be an issue. Get your eyes checked out, you have plenty of colleagues to choose from.

 

[Dusn]

What about the large NIH funded study that recently showed that Omega-3s were no better than placebo for dry eye (the DREAM study)? I had taken fish oil for a long time myself based on the early research but now it seems that every large study from the cardiology to the ophthalmology literature seems to show it doing a whole lot of nothing.

 

[Alekaptonuria]

What about the large NIH funded study that recently showed that Omega-3s were no better than placebo for dry eye (the DREAM study)? I had taken fish oil for a long time myself based on the early research but now it seems that every large study from the cardiology to the ophthalmology literature seems to show it doing a whole lot of nothing.

This may be nit picky and off topic, but did the DREAM study really compare Omega 3's to placebo? In my humble opinion a true placebo would have been a sugar pill or some kind of water filled capsule. Olive oil has several studies touting it's own dietary/health benefits including modest reduction in markers of inflammation. In fact, in the study both groups showed improvement and the Omega 3 group did show a higher reduction in the OSDI than the olive oil group (though the placebo effect could account for much of this).

In my opinion that the DREAM study showed that consuming of healthy fats is beneficial for dry eye, but that suggesting patients purchase expensive supplements is probably not worthwhile.

 

[The Doctor]

I studied polyunsaturated fats for several years in a research lab. I do believe there is value to high dose omega-3 supplementation, primarily with regard to their downstream byproducts, resolvins and protectins, which aid in resolution of chronic inflammation but I think these benefits are mild and are best realized with long-term supplementation. The DREAM study conclusions I felt were not accurate as olive oil was not an appropriate control group; both treatment and control groups improved. Ultimately dry eye is a recalcitrant and complicated disease, and multimodal treatment seems to help my patients: environmental modification/humidifiers, anti-inflammatory meds / restasis, oil-based lubricant drops, warm compresses, PO omega-3, occasionally plugs, treating blepharitis with antibiotics as appropriate. I think most dry eye sufferers know that none of these are a magic bullet by themselves but can help in combination.