Spironolactone is a type of diuretic often used to treat excess fluid accumulation in the body, which may occur in cirrhosis or congestive heart failure. It also has an effect on hormone balance and therefore is sometimes used in females for the treatment of acne. It has been shown to be helpful in the treatment of central serous retinopathy, a condition of fluid leakage in the eye, which is probably mediated by hormones.
What side effects might be encountered?
While you are taking this medicine, you may experience drowsiness or a washed-out feeling. Only rarely may this medicine cause rash, stomach upset, tender or enlargement of the breasts, temporary impotence, or menstrual disorders. These side effects disappear when the medicine is stopped. Severe reactions are rare. To be safe, this medicine is avoided in pregnant or breast-feeding women. High blood potassium levels may occur.
What other medicines might interact with spironolactone?
Other drugs may interact with spironolactone. Care should be taken in patients with known kidney disease or when using this medicine with other drugs that increase serum potassium levels (some blood pressure pills, called ACE inhibitors and related medications). Patients should avoid foods rich in potassium such as bananas, tomatoes, potatoes, and low-sodium salt replacements. In some cases, the serum potassium may be monitored. Be sure to inform your internist that you are on spironolactone for your eye condition.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.
Artistic illustration of migraine aura (click on image to enlarge)
What is migraine?
Migraine is a common cause of headache that affects 10% of the population. Migraine may also cause unusual visual symptoms that occur with or without a headache.
What causes migraine?
The cause of migraine is unknown, but heredity may play a role. Many people with migraines have family members who also have had migraine. Migraine may be caused by abnormal episodes of blood vessel constriction within the brain. A number of events may trigger a migraine (ref): emotional stress, hunger, lack of sleep, hormonal changes (puberty, menopause, and hormone pills), bright lights, loud noises, a change in altitude or weather conditions, exercise, and certain foods (including caffeine, chocolate, alcohol, and red wine). Sometimes eye problems can worsen or bring on migraine. Such problems include improper eyeglasses, eye dryness, double vision, past eye injury or eye surgery. There is evidence that links migraine with a defect in the wall of the upper chamber of the heart (patent foramen ovale). It has been theorized that small particles (e.g. platelet-thrombin emboli) may originate in the venous circulation and pass through the defect in the heart wall into the arterial circulation and on to the brain. This might explain small defects in the brain sometimes seen on MRI scans in patients with migraine.
What are the symptoms of a migraine?
Migraine is associated with a great number of symptoms. Hours or days before a migraine episode occurs, subtle symptoms may be noticed. These symptoms include depression, fluid retention, and stomach disturbances. Visual symptoms can occur before a headache or be the sole symptom of a migraine. These visual symptoms occur without warning when the vision is impaired just off to the side of central vision. A jagged light (“like cracked glass”), which appears to shimmer or repeatedly flash, borders the area of impaired vision. The jagged light causes a missing area of vision and gradually works away from the center to the peripheral vision, taking on a C shape over a period of 15 to 30 minutes. It sometimes is described as heat waves, bubbles, tunnel vision, or a kaleidoscope, and it may be silver and white or in color. Objects may appear too small or too big (This is called the Alice in Wonderland Syndrome). In middle-aged patients a brief loss of vision may occur in one eye resembling a stroke-like symptom. It usually involves both eyes but may appear more prominently in one eye. In younger patients, nausea and a throbbing headache often follow the light flashes. In older patients, the visual symptoms may occur without headaches. Keep in mind that there are many types and causes of flashing lights.
Migraine may also cause other symptoms that do not involve the eyes. Such symptoms include tingling of the face and hands, weakness, or trouble with speech. If this occurs, it may be helpful to call a neurologist for consultation.
The headache may be described as a deep, penetrating pain or a painful stretching sensation. The headache often begins on one side of the head, but it may spread over the entire head. It may be throbbing nor non-throbbing.
Simulation of migraine aura (click on image to enlarge)
What treatment is available?
Making the correct diagnosis is the most important step. Light flashes may be caused by other problems such as retinal detachment. Therefore the eye doctor is often called on to make this important distinction. If migraine symptoms occur infrequently, no treatment is needed. Establishing regular sleep, meal, and exercise programs may help. Riboflavin and magnesium supplements may be of benefit as well. Prescription medication is available if headaches are severe or frequent. They are usually prescribed by a neurologist.
If there is any significant change in symptoms or if permanent loss of function occurs, please contact your doctor without delay. In rare instances, a brain aneurysm or tumor may cause unusual light flashes and headache. Your doctor will decide whether further examination or testing is required.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.
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With all of the technological advances in eye care, there are many ways to visualize the eye and a retina scan is often offered during an eye examination. A retina scan is another name for a photograph of the retina. Is it really needed? Is it worth the money? The answers to these important questions depend on the circumstances of the eye exam.
Is a retina scan really needed?
For routine eye exams in which the patient has no symptoms of a retinal condition, a retina scan may not be necessary. Important symptoms of retinal problems include: straight lines looking crooked, a blind spot or missing area in the vision, a loss of peripheral vision. If these symptoms are present, a retina scan or a referral to a retinal specialist may be in order.
What types of retina scans are available?
The following are scans that may be ordered by the eye doctor:
Color Fundus Photography: an image of the retina as seen by the examining eye care specialist. It may be helpful to monitor and compare lesions from visit to visit.
Fundus Autofluorescence Photography: an image of the fluorescence of the retinal layers taken with a short-wave light. Helpful in diagnosis of many degenerative conditions such as age-related macular degeneration.
Optical Coherence Tomography (OCT): a cross-sectional image of the retina (or other part of the eye). This test is helpful to diagnose fluid leakage in or under the retina and to assess macular hole.
Fluorescein Angiography: a specialized image of the retina taken after an organic dye is injected into the vein of your arm. It shows blood flow and sites of abnormal leakage.
Indocyanine Green Angiography: similar to fluorescein angiography, but with a different dye that is used to see deeper into the eye to examine the choroid. Useful in macular degeneration and posterior uveitis.
Is a retina scan worth the money?
An examination of the retina is included in a complete eye exam without further charge. A retina scan is sometimes used as an additional step (with additional charges) if the examining doctor is not comfortable with his/her ability to diagnose a retinal condition. The cost of a retina scan may be avoided in some cases by choosing an eye doctor who is comfortable examining the dilated eye for retinal problems without the use of a scan.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.
Increasingly, medicines are injected into the eye to treat a variety of conditions including macular degeneration, diabetic retinopathy, and retinal vein occlusion. Many different medications are injected including Lucentis, Avastin, Eylea, Beovu, Vabysmo, Syfovre, Izervay, and steroids. Especially, because these medicines may require repeated injections over time, it is essential these injections cause no pain. Therefore, we go out of our way to provide painless eye injections.
What choices of anesthesia is available?
There are currently many different ways to anesthetize the eye before an injection. Most doctors use an anesthetic eye drop. Additional local anesthesia is usually given with either a pledget, a gel, or a painless injection. A pledget is a small piece of cotton or other absorbent material that is soaked in anesthetic and placed inside the lower lid to numb the eye in preparation of an injection. Rarely, an anesthetic injection is needed. While an anesthetic injection sounds worse, it causes no pain (due to the anesthetic drops) and works better in some patients to avoid pain with the intraocular injection of medicine.
What needles are used for injecting medicine?
Fine needles are used for injection to minimize discomfort. The standard needle size for injections into the eye is 30 gauge. However, most medications may be injected with much finer 33 gauge needles. There are some medications, such as Syfovre, that require larger bore needles due to viscosity.
What are other causes of pain with eye injection?
In rare instances pain may occur due to an increase in the eye pressure. When medicine is injected into the eye it takes up space. Because the eyeball does not enlarge like a balloon, the pressure inside the eye increases. Usually, this increase in pressure is well tolerated. However, in some patients the increase in pressure may cause pain. In this situation the doctor may elect to remove a small amount of fluid from the eye before injecting the medicine in order to avoid the pressure increase and the associated pain.
Measures can be taken to avoid pain with most eye injections. Another issue is pain after an eye injection. Please see link for more information.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.
