Bell's Palsy

Bell's palsy is the most common cause of facial paralysis, affecting up to 30,000 - 40,000 people each year in the United States. It develops when the nerve that controls facial muscles (7th cranial nerve) becomes inflamed and swollen in the area where it travels through the bones of the skull.

What causes Bell's palsy? More often than not, the cause of Bell's palsy is never determined. Many cases appear to be related to a herpes simplex virus infection, the same virus that causes cold sores and genital herpes, although there may be no evidence of an active infection. Lyme disease, a bacterial infection transmitted through tick bites, is a less common cause, affecting up to 10% of untreated victims. A neurological complication of diabetes mellitus known as "mononeuropathy" has also been implicated as a cause in diabetics.

What are the symptoms of Bell's palsy? Weakness or paralysis on one side of the face, making it difficult to smile or close the eye, is the most common feature. In addition, Bell's palsy may have one or more of the following features:

• Up to half of people affected with Bell's palsy will complain of pain behind the ear, often prior to the development of the facial weakness.
  
  
• Drooling from the corner of the mouth or difficulty eating or drinking
  
  
• Increased sensitivity to sound
  
  
• Difficulty closing the eye with decreased tearing
  
  
• Decreased ability to taste
  
  
• Facial numbness or twitching

Typically, the facial paralysis begins suddenly, reaching its peak within 48 hours. This sudden onset of the paralysis can be frightening, with many people mistakenly thinking that they have had a stroke.

How is Bell's palsy diagnosed? There is no specific laboratory test to confirm the diagnosis of Bell's palsy. Doctors make a tentative diagnosis of Bell's palsy by noting the facial asymmetry and asking patients to move the facial muscles by smiling, closing the eyes, and showing the teeth. Usually, no specific testing is required. If the diagnosis is uncertain or the paralysis lasts longer than 6-8 weeks, testing to confirm the underlying cause could include:

• Nerve conduction study/Electromyelogram to assess the severity of nerve damage by measuring electrical activity in the facial muscles.
  
  
• CT/ MRI Scan to evaluate the possibility that a brain tumor or stroke is responsible for the paralysis.
  


• Blood sugar testing to check for diabetes
  


• Lyme disease titers

What is the initial treatment for Bell's palsy? Even though many patients recover without treatment, the most widely used treatment involves the use of corticosteroids (e.g. prednisone), typically given in a 10-day, tapering dosage. Corticosteroids are strong anti-inflammatory agents that help to reduce swelling of the facial nerve, decreasing pressure on the nerve as it passes through a bony canal in the skull. With the knowledge that many cases of Bell's palsy are due to a herpes virus infection, antiviral drugs, such as acyclovir have been tried. These have not been shown to speed recovery unless there is convincing evidence that a herpes virus infection is actually present. Eye care is highly important in Bell's palsy since the inability to close the eye tightly can lead to scratches or ulcers of the cornea. Use of artificial tears, eye patches, or taping the eye closed at nighttime is recommended to help avoid these problems.

Can surgery help? Rarely, surgery to remove bony impingement of the facial nerve may be considered. This is only appropriate in those cases involving complete paralysis and markedly abnormal electrical testing of the facial muscles.

What is the outlook for recovery? Whether specific treatment is given or not, 85% of individuals with Bell's palsy begin to get better within 2 weeks, and most recover completely within 3 months. In some instances, long-term changes can persist, such as weakness or spasms in the facial muscles, excessive tearing ("crocodile tears"), or persistent changes in taste.

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Sunglasses: merging fashion with function

New sunglasses are usually selected for their frames, the size of the lenses, or for a particular coating on the lenses, rather than considering the amount of protection that they afford. It is important to remember that the most important job for sunglasses is to prevent damage to the eyes from the sun’s harmful rays. Fortunately, with a little knowledge about Ultraviolet (UV) radiation and sunglasses technology, fashion does not have to take a backseat to safety.

What does UV protection indicate? The amount of UV protection is the single most important factor to consider when shopping for sunglasses. The three types of invisible high-energy UV rays are UVA, UVB, and UVC. For the time being, UVC waves

are being blocked by the earth’s ozone layer and are not a factor in causing eye damage. UVA and UVB rays are the ones that are most damaging to the eyes. Fortunately, even inexpensive sunglasses can provide complete protection against these rays. Always select sunglasses with labeling that indicates that they block "99 to 100% of UVA and UVB rays" or that provide "UV 400 nm protection". If this is not indicated on the label, pass them up. If you are concerned about the degree of protection that they provide, most Optometrists will test your lenses for UV protection without charge.

What other features provide help protect the eyes? In general, larger lenses provide more protection than smaller lenses. In addition, "wraparound" style sunglasses help prevent sunlight from reaching the eye from the sides of the glasses.

Why are some sunglasses more expensive than others? This has to do with a number of factors, such as the optical clarity of the lenses, the exclusivity of the frames, or the special coatings that are applied to the lenses. So long as they are both providing complete UV protection, however, a twenty-dollar pair of sunglasses can be just as protective as a two-hundred dollar pair. In general, however, a more expensive pair of sunglasses, will provide you with a higher quality lens producing a clearer, sharper, image with less distortion.

Does being darker mean that the lens is more protective? How deeply tinted the lenses of sunglasses has no bearing on the amount of protection that they provide. Lightly tinted sunglasses that block 99 to 100% of UV rays are more protective than a darker pair with a lower UV rating.

What about the protection provided by Transitions^® sunglasses? Transition lenses are also known as "photochromic lenses" since they darken on exposure to UV light. Their manufacturer indicates that they provide 100% UV protection whether they are clear or as dark as regular sunglasses. Not all manufacturers of photochromic lenses offer complete UV protection, so be sure to check the product label.

What are the advantages of polarized glasses? Polarized glasses are best for preventing glare, particularly when near the water. That makes them particularly useful when fishing or boating. They can also prevent eyestrain from glare when driving. In most cases, polarized sunglasses will also provide complete UV radiation protection, but this is worth confirming before purchasing.

Are certain lens colors better than others? As long as the lenses are providing complete protection against UV radiation, the color becomes a matter of personal preference. Gray, green, or brown lenses are the most popular shades of lenses for sunglasses. For multiple uses, the American Academy of Ophthalmology (AAO) suggests green since they offer color contrast with little or no color distortion. Brown lenses provide very high contrast and depth perception, but can distort colors. Vermillion lenses are best on water to define water from other objects, but have the worst color distortion.

What about shaded lenses? These are popular with many designer sunglasses manufacturers. They are also known as "gradient lenses", since they are permanently shaded from top to bottom or top and bottom toward the middle. This variation in tinting of the lens does not affect the UV protection and can be as protective as sunglasses with a uniform tint.

From this discussion, it becomes clear that eye protection from the sun and stylishness can co-exist. The most important issue is to make sure that the sunglasses you choose provide complete protection against UV rays. Be aware that even though contact lenses can provide some UV protection, sunglasses should be worn outside since contacts do not cover the entire eye. Also, considering the amount of time that children spend in the sun, they need to wear UV-protective sunglasses also.

Endometriosis

Endometriosis is a condition affecting women in which cells similar to those that form the lining of the uterus (endometrium) grow outside of the uterus. Common locations for the abnormal growth of endometrial cells include the ovaries, Fallopian tubes, intestines, and the lining of the pelvic cavity. Unlike the normal endometrial cells lining the uterus that are shed each month during menstruation, endometriosis cells remain attached to the tissues to which they have spread. With each menstrual cycle, these cells can thicken, break down, and can even bleed. While not always symptomatic, endometriosis frequently causes pelvic pain (often associated with periods), irregular bleeding, and scarring (adhesions) on the ovaries, Fallopian tubes, and bowel.

How does endometriosis occur? Although the exact cause is uncertain, there are several theories as to how endometriosis develops. The most commonly held belief is that endometriosis occurs because of “retrograde menstruation”. This means that instead of the endometrial tissue exiting the uterus through the cervix during a menstrual period, some of it “backs up” through the Fallopian tubes into the pelvic cavity. If this tissue attaches and grows on nearby structures, endometriosis occurs. Endometriosis also appears to be related to having higher levels of estrogen, since it is most common in women during their childbearing years (teens to late 30s).

Who is most likely to develop endometriosis? Risk factors for the development of endometriosis include: 1) never having had a child, 2) having a mother or sister with endometriosis, 3) shorter menstrual cycles with bleeding lasting more than 7 days, and 4) starting menstruation at an early age.

What are the symptoms of endometriosis? The most common symptom of endometriosis is pain. The location of the pain depends primarily on where the endometriosis implants are growing. Many women with endometriosis experience severe pain during their menstrual periods, but it can occur at other times also, such as during intercourse or with bowel movements. Excessive or irregular bleeding with menstrual periods are other common features. Endometriosis can also be responsible for infertility, even without causing symptoms. Conditions that can mimic the symptoms of endometriosis include pelvic infection, ovarian cysts, and irritable bowel syndrome.

How is endometriosis diagnosed? The three primary measures used in diagnosing endometriosis are: 1) the pelvic examination, 2) ultrasound, and 3) laparoscopy. Although both the pelvic examination and transvaginal ultrasound can provide clues to the presence of endometriosis, the best way to confirm the diagnosis is by direct visualization with a surgical procedure known as laparoscopy. Pelvic laparoscopy is sometimes called "band-aid" surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

How is endometriosis treated? The decision of how to treat endometriosis depends on a number of factors including the age of the individual, the severity of her symptoms, and whether she hopes to become pregnant in the future. Although there is no cure for endometriosis, treatment options include:

• Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil) and naproxen (Aleve) may be helpful in milder cases by relieving cramping and pain.
  


• Birth control pills help to shrink endometriosis implants by controlling the hormones responsible for the monthly growth of endometrial tissue. Since symptoms of endometriosis typically improve during pregnancy, birth control pills are sometimes given continuously for several months to simulate pregnancy.
  


• Progestins are drugs that behave like the female hormone progesterone and provide benefit to some women with endometriosis. They are usually given as a long-acting injection (DepoProvera).
  


• Drugs known as gonadotropin agonists and antagonists block the production of ovary stimulating hormones, resulting in a marked lowering of estrogen levels. The gonadotrophin agonist, leuprolide acetate (Depo Lupron), temporarily causes ovulation or menstruation to stop. The resulting low-estrogen state, however, can cause side effects similar to those associated with menopause, such as hot flashes. The gonadotrophin antagonist, danazol (Danocrine), blocks the production of ovarian-stimulating hormones, but is associated with many androgenic (male) side effects, including weight gain, increased body hair and acne.
  


• If symptoms do not improve with medication or in women who want to become pregnant, surgery may be an option. In milder cases, surgery may be performed through a laparoscope. In more extensive cases an incision on the abdomen (laparotomy) may be required. In severe cases of endometriosis, a total hysterectomy (removal of uterus, cervix, and ovaries) is the treatment of last resort.
  


• Women who are near to menopause may want to try to manage their symptoms with medicines rather than surgery since endometriosis usually stops causing problems when periods stop.
  

Can endometriosis be prevented? Because its exact cause remains unknown, there are no confirmed ways to prevent the development of endometriosis. In some women, taking birth control pills does appear to prevent or slow down the development of the disease.