May 182012

Conjunctivitis also known as Pink Eye, is caused by any number of things including bacteria, viruses, allergies and irritating agents that cause the covering of the eyeball known as the conjunctiva to become red. The eyes look blood-shot and may or may not itch. The eyelids may be stuck together in the morning due to tearing or drainage. Warm compresses to clean the eyes and ocular decongestants are the treatment of choice. A doctor may need to treat the underlying cause.

Conjunctivitis is an extremely contagious eye infection that should be treated promptly by antibiotics. Because it is so contagious extra care should be taken to avoid spreading of infectious organisms.

  • Wash your hands before and after touching near the eye or the eye it’s self.
  • Wear gloves to apply medication for others and then wash your hands. Gloves are never a substitute for hand washing, especially when dealing with eye infections.
  • Use medication exactly as ordered and for as long as ordered.
  • Instruct your parent to not rub their eye.
  • Use a single tissue or damp cotton ball to gently wipe drainage from each eye. Start at the inside corner and sweep outward then discard immediately. Never use the same tissue or cotton ball on both eyes to avoid cross-contamination. Wash your hands.
  • Warm or cool compresses, whichever feels better, will help to decrease discomfort and can be used several times a day. Keep cloths separate from other laundry and wash in hot water. Wash your hands.
  • Wash pillowcases in hot water and change them at least daily, more often if you see drainage. Once the infection is cleared up, wash all the bed linens. Wash your hands after handling linens.
  • Towels, face cloths, handkerchiefs or any other material that comes in the contact with the face should be kept separate from other clothing and washed in hot soapy water. Wash your hands after handling.
  • No swimming, no contact lenses and no eye makeup until your eyes have been clear for at least two days.
  • Discard any eye makeup, especially mascara and eyeliner, that might have become contaminated.

It is a bit of extra work but worth the effort to prevent the spread of this painful infection.

May 172012

Some eye problems can be treated at home but remember to use common sense. If it appears the problem is with the eyeball it’s self, see a physician immediately; if you use an over-the-counter (OTC) eye-care product for 72 hours and do not see improvement or if the condition worsens, seek professional help.

Blepharitis is a common eye condition that is caused by inflammation of the eyelid. It is caused by a bacterial infection, seborrheic dermatitis and is also associated with rosacea. It is characterized by red, scaly, and thickened eyelids. There is usually some loss of the eyelashes as well. The most common complaints are itching, flaking and burning. Treat by applying warm compresses, followed by an eye scrub. If the condition persists you may need to see a doctor for antibiotics.

Lice can get in your lids and cause symptoms similar to blepharitis. It is common in school-age children and with multi-generations living in one home, it is conceivable that an elderly person in the home may become infested. You can see the adult lice moving at the base of the lashes. Apply petrolatum or non-medicated ointment to the eyelid to suffocate the lice eggs. Do not use commercial lice preparations that are designed for the hair, near the eyes.

Contact dermatitis causes swelling, scaling, or redness of the eyelid with intense itching. It is usually triggered by an allergy to something new such as makeup or soap, or maybe exposure to a foreign substance. If both the upper and lower eyelids are affected, it is most likely an allergy. Treat with OTC antihistamines taken by mouth.

Foreign body such as lint, dust or an eyelash can become stuck in the eye. Try to wash it out with a saline eye wash or water or you can try to gently lift it out with your finger or a folded tissue. If unsuccessful, see a doctor. The eye may continue to feel as if something is in there for a while after removal if the cornea (the thin covering over the iris and pupil) becomes scratched or irritated. OTC artificial tears or lubricants should relieve the discomfort.

Burns can be caused by the sun’s UV rays causing minor damage. An eye lubricant can be applied to soothe the eye and lights should be dimmed. If the condition persists for more than 24 hours or the burn is more severe, such as from a welder’s arc, see a doctor immediately.

Dry eyes maybe mildly reddened and feel sandy, gritty and dry even though there may be increased tear production. Dry eyes may be associated with increased age, air pollution, dry mouth, autoimmune diseases and some medications. There are many OTC eye drops to treat dry eyes and prescription strength medications are also available.

Hordeolum or more commonly, a sty, is an inflammation of the glands within the eyelid. Characterized as a raised, red and tender nodule on the eyelid, the eyelid can become so swollen it appears to be completely shut. It is usually caused by the same bacteria that causes blepharitis. Treatment consists of applying warm compresses several times a day. Occasionally an antibiotic may need to be prescribed.

Chalazion is similar to hordeolum but without the tenderness. Treatment is warm compresses several times a day.

Blunt trauma to the eye, abrasions, and chemical exposures should all be evaluated by an ophthalmologist. Any chemical exposures should be flushed immediately with large amounts of water. Hold the eye open under running water for at least 2 minutes.

Seek prompt medical attention for sudden blurring, loss of vision, light flashes, halos around objects, or starbursts around lights, obvious pain, cut or torn eyelid, one eye that protrudes more than the other, one eye that does not move as completely as the other, abnormal pupil size or shape,something embedded under the eyelid that cannot be easily removed or something embedded in the eyeball.

Occasional floaters or small pinpoint flashes of light are normal, if somewhat annoying. Small cells or bits of fiber float between your lens and retina and you amuse other people as they watch you swatting at gnats that only you can see. If you suddenly see many more floaters than normal and they are accompanied by flashes of light, get to an ophthalmologist immediately since this could be the first sign of a detaching retina. This is a serious medical condition requiring prompt intervention to prevent loss of sight.

There is one more eye problem I want to cover but we will get to that tomorrow.

May 012012

Hearing loss affects not only the elderly but a large portion of the population and is frustrating for everyone. Because it interferes with their ability to communicate, those that are hard of hearing often feel cut off from the world around them. This is especially true of older adults who are often isolated due to mobility or transportation problems Not only is it frustrating and annoying but it can be dangerous since they may not hear smoke detectors going off, sirens, horns, barking dogs or other auditory warnings.

In the past older people were reluctant to wear hearing aids. They were large and magnified everything, including annoying background noises that we normally tune out. Today’s hearing aides are lighter, smaller and the quality has improved greatly. If you notice your parent is turning the television up louder and asking you to repeat things more, have their hearing checked out. They may just have a buildup of ear wax, an infection or some other obstruction. If that isn’t the case, your next step is to have an audiologist evaluate them.

Most complaints that people with hearing loss have is that people mumble. Speaking louder is not the answer, they can hear you but they just do not understand what you are saying. Clarity is the problem. Certain tones, usually high-pitched ones, are fuzzy. Some consonants such as “f”, “s”, and “z” may sound the same. Background noise may be harder to filter. My grandma complained of not being able to hear if there were a bunch of people in the room or if the television was on. People with a higher pitched voice were hard for her to understand. This type of hearing loss is known as nerve deafness.

Another problem is constant ringing in the ears, known as tinnitus. It may also manifest as a clicking, buzzing, or hissing sound and it can be much more than annoying. It can make hearing almost impossible. There are many causes such as some medications, illness, allergies and of course listening to loud music. Well, any loud noise over time, such as running machinery or gun fire. Talk with an audiologist about options to reduce the annoyance. It usually involves using white noise in some manner to mask the constant sound.

When talking with a parent who is hard of hearing, do not yell. Stand or sit in front of them and face them. We all do a certain amount of lip-reading anyway, but those who are hard of hearing often depend on seeing the movement of your mouth and facial expressions for understanding. Keep your hands away from your face. Turn off the television, radio, running water or any other background noise if possible.

Enunciate clearly but without exaggerating the mouth movement. Speak up, but do not shout or raise the pitch of your voice. If anything, lower it slightly. Do not talk with gum or food in your mouth or while trying to smoke. Use simple and direct sentences. If you are asked to repeat something, rephrase it. Using different words may be easier to understand. Use body language and facial expression appropriately, smiling, touching, pointing, nodding. When eating out, go at an off hour or pick the quietest part of the restaurant to reduce background noise.

In addition to an audiologist, you might want to consult with a speech therapist. They have all kinds of tips that may be useful.

Besides gadgets that amplify sounds on things such as the phone, alarms, etc., consider also using instruments that provide visual clues such as flashing lights. At the very least, make sure your parent one can hear smoke alarms and carbon monoxide detector alarms. Televisions usually have the ability to print text along the bottom of the screen and most stations provide closed captioning.

Hearing aids can be quite expensive and you will not know how well they will work until you try them for a while. There will be a period of adjustment. Few insurance companies will pay for more than the cost of testing. There are civic organizations that will help. Contact the Alexander Graham Bell Association for the Deaf and Hard of Hearing for a list of organizations that offer financial assistance. You can also call Self Help for the Hard of Hearing @ 301-657-2248 and they can give you a list of organizations in your area that offer help. You might also want to contact the Council on Aging, Senior Citizens Organization and other community, civic and spiritual organizations in your area.

Sometimes the simplest devices are the best. I knew a lady, whom everyone called Granny G, who had tried several hearing aids with limited success. One day she saw an ad for a device you wear around your neck that amplified sound and you put ear buds in your ear. It was similar to a Walkman (for those of us old enough to remember those). She loved it and swore it was better than all her hearing aids. She showed it to everyone and several of her friends ended up getting one.

While eating at an out-of-town restaurant one evening, a man approached her table and asked her about the device hanging around her neck. It seems his wife was hard of hearing and they had tried everything with limited success. Granny G immediately took it off went over to his wife and had her try it. The wife’s face lit up! She could hear! Her husband was amazed and very grateful. This little box that cost about twenty dollars worked better than some very expensive equipment he had tried. It turns out he was an ENT (ear, nose and throat specialist). That really tickled Granny G. She didn’t get too many opportunities to teach a doctor something!

Besides approaching strangers when out in public, there are other resources available to you. These include American Speech-Language-Hearing Association; Self Help for Hard of Hearing, American Tinnitus Association; National Institute on Deafness and Other Communication Disorders; American Academy of Audiology; American Academy of Otolaryngolgy-Head and Neck Surgery

Apr 192012

Ah, the cliche of the hard of hearing senior citizen.While our ear canals normally clean themselves, various things can cause a build up leading to difficulty hearing and discomfort. One of the most common methods people use to clean their ears is to use a cotton swab or hair pin. This is not a good idea however, because these can push the ear wax further down into the ear canal or even puncture an ear drum. Ouch!

Warmth and oil are usually enough to relieve the problem.  Use mineral oil or over the counter ear drops after warming the bottle to room temperature by rolling it in your hands for a moment. If you place the bottle in warm water test a drop or two on your wrist before using. Holding a warm cloth over the ear will help relieve discomfort and facilitate drainage.

Hydrogen peroxide may be used if the wax is really stubborn but gently rinse out the ear with warm water afterwards and insert a couple of drops of alcohol to dry out the ear canal to avoid complications. Avoid using cold solutions in the ear as this can lead to dizziness and vomiting.

Proper cleaning of hearing aids is also important. The best time to clean hearing aids is at night after you take them out. Look for and remove any wax buildup using the brush or pick that came with the hearing aid. Alternatively, you may use a soft toothbrush to gently clean away the wax. If your parent has an ear mold or behind the ear hearing aid, disconnect the tubing from the hearing aid and gently clean with warm soapy water and rinse well. Ensure no water is trapped in the tube by gently blowing on the tube and allow it to dry overnight before reconnecting.

Remove the battery and gently clean the hearing aid with a dry brush. Leave open to air to decrease moisture build up and prolong the life of the battery and hearing aide. Make sure everything is completely dry before reassembling the next morning. If you need to dry your hearing aid quickly, use a blow dryer on low, warm setting and hold it 18-24 inches away from the equipment.

Heat can quickly damage a hearing aid, keep this in mind when you store it and avoid sunlight and heat sources. Do not leave them in your vehicle where heat can build up quickly. Also avoid water from showers, pools, or saunas.

Sweat can also damage hearing aids. When engaged in strenuous activity, consider using an old hearing aid, wearing a sweat band or bandanna to catch the sweat.

When going to the hair salon, take their hearing aid out before the beautician starts and keep it out until you are ready to leave. Avoid using hair spray and other hair products while wearing a hearing aid and allow a minute or two for drying after using products before applying hearing aids.

Concerning hygiene. The ear canal is warm, moist and dark, the perfect medium for growing all kinds of nasty things especially if you are inserting something like a hearing aid every day. Use only approved disinfectants and avoid alcohol based products as alcohol can damage a hearing aid. Use a proper storage container for storing your hearing aids to not only protect them from damage but to also keep them clean.

What to do when someone will not wear a hearing aid:

It is frustrating yelling at someone who has poor hearing and will not wear a hearing aid. Try to understand that not only do hearing aids amplify what you are saying they also amplify all the other noises in the surrounding area. Those who are new to hearing aids and may be hearing things they have not heard in a while and have trouble ignoring the excess noise.

Talk with thier audiologist about what can be done to minimize background noise such as digital hearing aids, wearing two and directional microphones. There is also auditory training that can help such as Seeing Speech. Dr. Patricia B. Kricos, Ph.D. has a great article that explains this much better than I can.

With my own granny, it is because those batteries are, “just too expensive.” I wonder if I stock her up, will she wear them?

Source: Better Hearing

Hearing Aid Cleaner

Apr 132012

Among the Elderly, dry eyes are a common problem. Untreated they can lead to infection and even permanent damage including blindness.

Our eyes normally produce a flow of tears that provide moisture to lubricate and clean the eyes for comfort and vision. Our tears also contain proteins and antibodies that help prevent infection. When our eyes do not produce enough tears we may experience pain, grittiness or feeling like something is in your eye, light sensitivity, itching, and blurring of vision.

Medications, dry air and other environmental factors, declining tear production and some medical conditions can all cause dryness. ¬†Sometimes the eyes will try to compensate by producing more tears until they are running down the face. Unfortunately these tears are mostly water and do not lubricate the eye. Not only is this annoying, your parent’s skin can become raw and painful from the constant moisture and wiping.

Artificial tears and lubricants are available over the counter and Restasis for chronic problems is available with a prescription. It may be necessary for the eye doctor to insert a plug (called punctal plugs) into the ducts that drain the eye to see if this will keep tears in the eye longer. Try a temporary one first to see if it works before having permanent ones placed. Usually this can be done in the office with little to no local anesthetic. See Punctal Plugs for more information.

There are times when your parent may have to use artificial tears episodically. When taking medications that dry out the mouth, such as antihistamines or diuretics, the eyes will become dry as well. If using more than one kind of eye medication, such as antibiotic drops or glaucoma drops, ask your health care professional (eye doctor, pharmacist, nurse) for the correct order of use and wait 5 -10 minutes between medication application. Wait at least 15 minutes after administration before putting in contacts. Many eye medications may cause blurred vision for a few minutes after application. Instruct your parent to avoid walking until their vision clears.

Extra care needs to be taken with eye medications to avoid infections. Only use medications that are manufactured and labeled for use in the eyes. Double check your bottle as many ear and nasal medications may have similar packaging. Store these medications separately.

Remove contacts and any makeup from the eyes. Wash your hands. To maintain sterility and avoid cross contamination do not let the tip of the dropper, bottle or tube touch the eye. If the dropper touches the eye, discard and get a new one. If the bottle tip touches the eye call your pharmacist about getting a replacement. (This is the recommendation. In reality, most people will just wipe the tip with alcohol. However, if the eye is infected, I would not use the medication in the unaffected eye.) Use a separate tissue to wipe each eye. Replace cap immediately. Never share eye medications! Ever!

Administering eye drops can be quiet challenging for caregivers and their parent’s alike. First, try having them rest their head against the back of a recliner or chair, tilting the head back slightly. Instruct them to roll their eyes upward as if trying to see the top of their head while you gently pull down on the lower lid and instill the drops. You may find it helpful to rest the hand holding the bottle on the bridge of their nose, their forehead or the finger holding down the eyelid.

It may also help to have them look upwards and to the side of the head opposite the eye being medicated. If your parent cannot keep their eyes open to put drops in, try this trick: have them lay down on their back and with their eyes closed, place a drop on the inside corner of your eye. Have them open their eye and the drops will flow into the eye. Blink to distribute the medication. When administering eye medication to someone who shuts their eyes so tight that you can not open them, have the person open their mouth wide. You can’t close your eyes as tight when your mouth is open. (I’ll wait why you try). There are also c

For best results, after applying eye drops, your parent should squeeze their eyes shut or squeeze the bridge of the nose near the inner corner of their eyes to prevent the medication from draining down the tear ducts. This also helps to keep the medication from entering the bloodstream which can cause changes in your blood pressure among other things, depending on the medication. (I had this happen to a patient and we could not figure out what was going on until his wife mentioned that he had seen the eye doctor recently and been started on a new medication for his glaucoma. Tell your doctor everything you take).

Another thing to note is the expiration date. Once they are open, eye medications should be discarded after a week, though if they have a preservative they can be kept up to four weeks, if stored properly. Ask your pharmacist. Many people use recently expired medications but I would never use expired eye medications. It’s really not worth the risk to your vision.

Caring for you elderly parent’s eyes isn’t difficult and a little extra care can prevent problems.