Looking into a mirror, you will easily be able to see your pupils.
They are the round dark centers of the eye or the gap within the
iris, the coloured part of the eye. Health care professionals
assessing a patient’s pupils can provide insight into the health of
not only the eye but also the rest of the body.
The size and shape of the pupil is controlled by nerve impulses
from the brain. There are actually two different classes of nerves.
The first class is responsible for making the pupil larger (dilated),
while the other makes the pupil smaller (constricted).The dilating
group of nerve fibres originates from the lower portion of the
brain. They travel down to the thoracic region of the spinal cord
then back up to the head along the internal carotid artery and
eventually through the back of the eye. The constricting group of
nerve fibres originates from the lower portion of the brain, but
travels into the head and enters through the back of the eye. The
balance between these two types of nerve fibres determines the
size of your pupil.
The amount of light entering the eye can change the size of the
pupil. This is called the light reflex. Increasing the amount of light
will cause the pupil to constrict. In dim light conditions, the pupil
will dilate. When focusing on an object that is close to your face,
the pupils will constrict. This is called the near or accommodative
When assessing a patient’s pupils, we look at the pupil size, shape,
reaction to light, and any asymmetry between the pupils.
The normal size of pupils ranges from 3mm to 8mm in diameter.
Normally pupils are round however they can take an oval or
distorted shape due to previous eye inflammation, trauma,
intraocular eye surgery or congenital defects.

Abnormalities in pupils to the reaction of light can be caused by
optic nerve disease due to inflammation or reduce blood flow.
Significant arterial occlusions in the retinal blood vessels can also
cause pupil reaction changes as well.
Usually the pupils have the same diameter between left and right.
On occasion there can be a difference in the size between the eyes.
This is referred to anisocoria. For some people this can be normal.
In other instances this can be caused by certain eye drops, trauma,
intraocular surgery, tumours or blood vessel damage near the
pathways of the nerve fibres responsible for controlling the size of
the pupil.
The next time you look in the mirror, pay particular attention to
both your pupils. If anything should appear out of the ordinary
regarding your pupil size or shape, do not hesitate to consult the
care of your local optometrist or ophthalmologist.

For anyone over the age of forty, you can likely recall the
frustration of having to hold your reading material further from
your face in order to read the print clearly. For those of you who
are near-sighted, you likely have had to remove your spectacles in
order to read a newspaper or label. Perhaps after reading for only a
few minutes, fine print became blurry or eyestrain and headaches
became unbearable. All of these symptoms are due to a
phenomenon called presbyopia.
Presbyopia typically begins between the ages of forty and forty-
five. It becomes progressively worse until the approximate age of
sixty. It is a natural aging process and it is not reversible. The exact
mechanism as to how it occurs is not completely understood.
Generally, the focusing capabilities of the eye dissipate over time.
As of now, reading spectacles and bifocal glasses or contact lenses
are the only forms of treatment.
Reading glasses are the first option I will discuss. Since they are
focused for reading only, they need to be removed when looking at
a distance. For some people, having to put their glasses on and off
repeatedly can become a nuisance. Reading spectacles are easy to
adapt to and relatively inexpensive.
The second option is bifocals and there are two types. The first
type of bifocal is the traditional lined bifocal. They allow distance
vision through the top of the lens and up-close viewing through the
lower or bifocal portion of the lens. Lined bifocals are relatively
easy to adapt to and are the lower priced bifocal type. Some people
find intermediate distances such as the car dashboard or computer
monitor difficult to focus on with the standard lined bifocal. This
visual problem can be solved by lined trifocals which incorporate
two bifocal lines on the lenses.

Most people do not like the visible bifocal line on the lenses for
cosmetic reasons. Therefore, the second type of bifocal available
is the progressive or “no line” bifocal. This type does not have a
visible bifocal line on the lens which is much more appealing.
They correct for far away, intermediate and up-close distances.
Progressive bifocals can take longer for the patient to adapt to and
are more expensive than lined bifocals.
Some people have trouble adapting to progressive bifocal lenses
due to the distortion areas on the outer edges of the lenses. This
produces a “swim-effect” for some people causing an unsettled
feeling. Recently there have been technical advancements in the
design of progressive lenses. Digitally manufactured progressive
lenses are now available. These lenses have smaller distortion
areas and more precise prescription control than traditional
progressive lenses. The shape and size of the frame is taken into
account when the lenses are fabricated.
There are also options available for contact lens wearers who are
over the age of forty and are having trouble reading. One option is
monovision contact lenses. This involves wearing a distance
contact lens on one eye and a reading contact lens on the other eye.
They are relatively inexpensive however depth perception may be
hindered. A second option available is bifocal contact lenses.
There is a highly variable success rate with these types of lenses.
Much like death and taxes, presbyopia is unavoidable. As it stands
now, there is no proven method to prevent, reverse, or surgically
correct the process of presbyopia. Consult your local optometrist
or optician to determine which type of presbyopic correction fits
your particular lifestyle.

Bell’s palsy is a common condition that results from the paralysis
of the facial nerve. This condition is quite common. It usually
affects one side of the face in the forehead and lower facial areas.
Several physical manifestations of Bell’s palsy include difficulty
closing one eye, slurred speech, drooping of one corner of the
mouth, inability to whistle, drooling when drinking, or a wrinkle-
free forehead on one side.
Bell’s palsy can occur very rapidly. Men and women are affected
equally. Most cases occur between the ages of twenty and forty. It
usually takes close to three weeks for it to reach its maximum
effect. From the maximum effect, most cases recover within three
weeks. Severe cases can take up to six months to resolve
completely. Typically, recovery results in very few if any
permanent manifestations. Patients over the age of sixty are at a
greater risk of being left with long term effects of Bell’s palsy.
Incomplete recovery is more likely with repeated attacks.
What causes Bell’s palsy? That is difficult to answer. It is thought
to be caused by inflammation of the facial nerve. The facial nerve
is the cranial number seven. It is responsible for the controlling the
muscles of the forehead, eyebrows cheeks, eyelids, lips and the
lacrimal gland (which secretes the water for your tears). Several
conditions can be linked to Bell’s palsy such as herpes simplex
infections, bacterial infections, shingles, Lyme disease, upper
respiratory tract infections, diabetes, fever, dental surgery,
exposure to extreme cold, or menstruation. A stroke can also cause
the same type of facial paralysis however there is also weakness in
other parts of the body.
Blinking is required to spread fresh tears across the eye and to
reduce the evaporation of tears into the atmosphere. Since patients
affected by Bell’s palsy cannot blink one eye, the cornea (clear

cover of the eye) becomes dry resulting in ocular discomfort. The
lack of tears covering the cornea can lead to corneal scarring and
eventually severe vision loss in the worst cases.
Treating the ocular effects of Bell’s palsy requires frequent use of
artificial tears drops during the day and artificial tear ointments at
bedtime to keep the cornea moist. Some patients need to wear an
eye patch or tape their lids shut while sleeping for added relief. In
more severe cases of dry eye due to Bell’s palsy, there are a couple
of surgical options available. The first one involves implanting a
tiny gold weight into the upper lid to pull the lid down. The second
option is called a partial tarsorrhaphy. This involves the upper and
lower lids to become partially sutured together to reduce corneal
exposure. There is some debate in the medical community
regarding the role of oral antiviral and corticosteroid medications
in treating Bell’s palsy.
Bell’s palsy can be a very frustrating and painful condition to
endure. For those where recovery is not complete the change in
the appearance of one’s facial features can be a dramatic change.
Fortunately, most recover completely with no increased chance of

As August winds down there is usually a mad rush go get in that
last swim in the pool or camping trip. For many Essex County
residents, this is also a time where seasonal allergies can cause
problems with our eyes and respiratory systems.
Seasonal allergies are caused by specific allergens such as
ragweed, grass or tree pollen. They can start at any age. When
these allergens come in contact with your body, they are
considered foreign particles. The allergens bind themselves to mast
cells which are loaded with histamine. In response, your immune
system starts to release large quantities of histamine and other
chemicals from these mast cells to combat the allergens. It is the
histamine action that produces the symptoms of sneezing,
coughing, nasal congestion, scratchy throat and red, itchy, and
watery eyes. Seasonal allergic reactions can begin at any age.
Areas that have poor air quality (such as Essex County) can result
in more intense symptoms.
Unfortunately, seasonal allergy symptoms can be difficult to
completely eradicate. The first step in the management of this
condition involves avoiding the specific allergen you are allergic
to. This can be difficult especially if you are active outdoors in the
summer. There are simple ways to get some relief, such as
keeping the windows of your home and car closed and turning the
air conditioner on, remembering that pollen release is at its peak in
the morning and early afternoon, and making sure the filters in
your furnace are clean. Washing your hair before bed can help to
wash away allergens that are stuck in your hair. Additionally
regularly replacing your pillow can help with seasonal or perennial
allergies. Other more aggressive allergy relief remedies involve
oral over-the-counter anti-histamine medications taken during your
particular allergy season. Talk to your doctor or pharmacist to
determine which brand is best for your needs. For those who suffer

from severe seasonal allergies, allergy shots may be the treatment
of choice. This is usually preceded by tests performed by an
allergist to determine exactly what substances you are allergic to.
In addition to the above remedies to relieve ocular symptoms of
seasonal allergies, further comfort can be achieved by placing a
clean face cloth soaked in ice water over closed eyes. Over-the-
counter artificial tear drops and anti-histamine eye drops can also
help reduce red, itchy, and watery eyes although not a preferred
option of eye doctors.
Prescription eye drop medications may be considered with more
severe allergic symptoms. Eye drops that combine an antihistamine
and a mast cell stabilizer work best by providing immediate and
long term relief. There are prescription-only anti-inflammatory
drops that can be used to provide relief for allergy sufferers.
I suffer from terrible allergies from ragweed that began in my early
twenties. It took me a few years but with some trial and error, I
have found an effective treatment plan to greatly reduce my
symptoms from seasonal allergies. My symptoms usually begin the
second last week of August. I use an oral over-the-counter
antihistamine daily (which took three years to find the best brand
for me) beginning the first week of August along with a
prescription only antihistamine/mast cell stabilizer daily eye drop.
I also use a prescription only anti-inflammatory eye drop on days
that my eyes flare up.
With the above treatment plan, my symptoms are not nearly as
harsh as they were when I first developed seasonal allergies. Mind
you, I still have some bad days but not like I used to. Starting my
medications a few weeks prior to my season has worked wonders
for me. However, everyone is different. You need to experiment to
find the best therapy for yourself.

For those who suffer from seasonal allergies, the ocular symptoms
can be very uncomfortable. Despite all the different remedies out
there to deal with seasonal allergies, there is no cure. It is not
recommended to diagnose and treat your symptoms yourself.
Consult your optometrist to recommend the best therapy to provide
relief from seasonal allergies.