What is this condition?

Retinal detachment occurs when the layers of the retina become separated, creating a subretinal space that then fills with subretinal fluid Retinal detachment usually involves only one eye, but it may involve the other eye later.

Surgical reattachment treatment is often successful. However, the prognosis for good vision depends on the area of the retina that’s affected.

What causes it?

Any breach of the retina allows the liquid vitreous humor of the eye­ball to seep between the retinal layers, separating the retina from it’s blood supply. In adults, retinal detachment usually results from age­related degenerative changes, which cause a spontaneous retinal­opening.

Predisposing factors include nearsightedness, cataract surgery, tumors, systemic diseases, and traumatic injury. The influence of traumatic injury may explain why retinal detachment is twice as com­mon in males. Retinal detachment is rare in children.

What are its symptoms?

Initially, the person may complain of floating spots and recurrent flashes of light. But as detachment progresses, gradual, painless vision loss occurs. This vision loss may be described as a veil, curtain, or cobweb effect that eliminates a portion of the visual field.

How is it diagnosed?

Ophthalmoscopy reveals the usually transparent retina as gray and opaque; in severe detachment, it reveals folds in the retina and ballooning out of the area.

How is it treated?

Treatment depends on the location and severity of the detachment. It may include restricting eye movements and positioning the person’s head so that the tear or hole lies below the rest of the eye. Retinal detachment usually requires scleral buckling to reattach the retina and, possibly, replacement of the vitreous humor with silicone, oil, air, or gas. A hole in the peripheral retina can be treated with cryothermy; in the posterior portion, with laser therapy.

What can a person with retinal detachment do?

• Learn the proper method for instilling eyedrops.
• Be sure to comply with prescribed therapy and follow-up care.
• Wear dark glasses to compensate for light sensitivity.

Swimmer’s Ear - Symptoms and Treatment

What do doctors call this condition?

External ear infection, otitis externa

What is this condition?

Swimmer’s ear is an inflammation of the skin of the external ear canal and the folds of skin and cartilage known as the auricle or pinna (this is the part of the ear we see). It may be acute or chronic and is most common in the summer. With treatment, acute swimmer’s ear usually subsides within 7 days. This disorder tends to recur.

What causes it?

Swimmer’s ear usually is caused by bacteria, such as Pseudomonas, Proteus vulgaris, streptococci, and Staphylococcus aureus. Sometimes, swimmer’s ear is caused by fungi, such as Aspergillus niger and Candida albicans. Fungal swimmer’s ear is most common in the tropics.

Occasionally, chronic swimmer’s ear is caused by dermatologic conditions, such as seborrhea or psoriasis.

• Predisposing factors include:
• swimming in polluted water, after which earwax creates a culture medium for the waterborne organism
• cleaning the ear canal with a cotton swab, bobby pin, finger, or other foreign object, which irritates the ear canal and may introduce the infecting microorganism
• exposure to dust, hair care products, or other irritants, which causes the person to scratch the ear, excoriating the auricle and ear canal
• regular use of earphones, earplugs, or earmuffs, which trap moisture in the ear canal, creating a culture medium for infection
• chronic drainage from a perforated eardrum .

What are its symptoms?

A person with acute swimmer’s ear will have moderate to severe pain that is exacerbated by manipulating the external ear, clenching the teeth, opening the mouth, or chewing. Other symptoms may include fever, foul-smelling discharge from the ear, regional cellulitis, and partial hearing loss .

Fungal swimmer’s ear may not cause symptoms, although A. niger produces a black or gray, blotting paper-like growth in the ear canal. In chronic swimmer’s ear, itching replaces pain, and may lead to scaling and skin thickening. Discharge from the ear may also be present.

How is it diagnosed?

Physical exam confirms swimmer’s ear. In acute swimmer’s ear, otoscopy reveals a swollen external ear canal (sometimes to the point of complete closure), periauricular lymphadenopathy (tender lymph nodes in front of or behind the external ear, or in the upper neck), and, occasionally, regional cellulitis.

In fungal swimmer’s ear, removal of growth shows thick red epithelium. Microscopic exam or culture and sensitivity tests can identify the causative organism and determine antibiotic treatment. Pain on palpation of external ear structures distinguishes acute swimmer’s ear from middle ear infection.

In chronic swimmer’s ear, physical exam shows thick red epithelium in the ear canal. Severe chronic swimmer’s ear may reflect underlying diabetes, underactive thyroid, or kidney infection.

How is it treated?

To relieve the pain of acute swimmer’s ear, treatment may include heat therapy to the region around the external ear (heat lamp, heating pad, or hot, damp compresses) and drug therapy with codeine and aspirin or Tylenol. After cleaning the ear and removing debris, the doctor may prescribe antibiotic eardrops (with or without hydrocortisone). If fever persists or regional cellulitis develops, a systemic antibiotic is necessary.

As with other forms of this disorder, fungal swimmer’s ear requires careful cleaning of the ear. The doctor will prescribe a cream to treat swimmer’s ear resulting from candidal organisms. Using slightly acidic eardrops creates an unfavorable environment in the ear canal for most fungi, as well as Pseudomonas. No specific treatment exists for swimmer’s ear caused by A. niger, except repeated cleaning of the ear canal with baby oil.

In chronic swimmer’s ear, primary treatment consists of cleaning the ear and removing debris. Supplemental therapy includes antibiotic eardrops or antibiotic ointment or cream (neomycin, bacitracin, or polymyxin B, possibly combined with hydrocortisone).

For mild chronic swimmer’s ear, treatment may include antibiotic eardrops once or twice weekly and wearing specially fitted earplugs while showering, shampooing, or swimming.