RX for Readers: Seeing things

What is floating around in my eye? Medical experts provide advise to your health queries.

By JUDY SIEGEL-ITZKOVICH
An eye illustrative 521 (photo credit: MCT)
An eye illustrative 521
(photo credit: MCT)
I am a 60-year-old woman in generally good health. I do checkups once a year with my family physician and ophthalmologist, and I last visited by eye doctor three months ago; everything was OK. Suddenly, a few days ago, I saw through my left eye what looked like a big black, wriggling worm. Over the next few hours, it turned into lots of floating black spots, as if they were flies. It really gave me a scare. Within 15 hours, they were all gone. What was it, and should I go to my ophthalmologist again? T.M., Tel Aviv
Dr. David Varssano, a senior ophthalmologist and head of the cornea clinic at Tel Aviv’s Sourasky Medical Center, answers:
Although such a thing is very scary, there is no reason for alarm. It is probably a condition called a posterior vitreous detachment (PVD). A PVD is an eye condition in which the vitreous membrane separates from the retina. It is common among older people, and about three-quarters of people aged 65 and over have had it. It also occurs more often in women and can take place in younger people as well.
The vitreous is a gel that fills the eye behind the lens.
As the years pass, the vitreous changes, shrinking and developing pockets of liquefaction, in a way very similar to the shrinking of a gelatin dessert, causing it to peel away from the bowl. Sometimes, the vitreous membrane may suddenly separate from the retina – the “screen” at the back of the eye on which images appear; it may occur suddenly and take months for the symptoms to appear.
People who are significantly nearsighted are more likely to have it. PVD does not directly threaten vision, but it could be a sign of future vision problems. It may also appear weeks or months after cataract surgery.
Among the symptoms, including what you described, are flashes of light and seeing floating objects, including what look like translucent hairs.
Go to your ophthalmologist within a few days of the event just in case, even though PVD does not require treatment; the situation will get better on its own. But the doctor should examine your eyes to make sure there is no sign of detachment of the retina – which is a medical emergency that requires going immediately to a hospital emergency room.
Symptoms of retinal detachment include seeing a distinct black curtain, red bands or a heavy fog.
My husband, 81, has developed an awful rash on parts of his body and especially his legs, where his skin is dry. He has consulted a few skin specialists who have prescribed various creams and body washes, such as Betacorten ointment, Dermasilk cream, Dermax and Amol wash. The Betacorten helps but does not clear up the problem, and he has been advised not to use it in the long term. His skin is also itchy – it is apparently part eczema and some other rash. He also has large red ugly blotches on his body, mainly his arms, which look like bruises as if there is bleeding under the skin. He has asked doctors and no one seems to have an answer as to what it is. He does not take blood-thinning pills, but he does take medication for hypertension and high cholesterol. R.S., Tel Aviv
Jerusalem dermatologist Dr. Julian Schamroth replies:
The aging process is most noticeable in the skin, where several changes occur.
First, the elastic fibers in the skin tend to fragment and degenerate. This loss of elasticity manifests as wrinkles and thinning of the skin. Excessive sunlight exposure during the early and middle-age years will make the wrinkling more severe, especially on the face and arms. A similar effect can be seen by leaving a rubber band in the sun: it also eventually loses its elasticity and begins to crumble.
It is important to note that the thinning affects not only the skin, but also the elastic fibers in the blood vessels of the skin. This results in very fragile blood vessels that can rupture even from mild trauma or scratching. Hence, the common occurrence of large bruises (or ecchymoses) on the forearms of the elderly. There is nothing much that can be done to treat this. Creams containing tretinoin may – with prolonged use – cause a mild reversal in the degeneration of elastic fibers.
Women who use such creams over several years probably have less wrinkling than women who don’t.
The second main effect of skin aging is that the natural oils in the skin tend to dry up. This causes dry skin, especially on the face, forearms and lower legs. And dry skin is often itchy. Excessive washing does not help, and might even exacerbate the condition by washing off any small traces of oil that are on the skin.
Unfortunately, we do not have a drug or cream that will stimulate the production of skin oil, but moisturizers will often be of considerable help. There are literally hundreds of moisturizers available from the pharmacy, and it is often best to try a few to see which works best for you.
If the itching is severe, your dermatologist might recommend a cortisone cream. However, since cortisone creams are also a cause of skin thinning, such therapy should be with a very mild concentration of cortisone, and for a short period only.
Rx for Readers welcomes queries from readers about medical problems.
Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@ jpost.com. Provide your initials, age and place of residence.