REFRACTIVE EWAP JUNE 2022 17 Contact information Baartman: brandon.baartman@ vancethompsonvision.com Greenwood: michael.greenwood@ vancethompsonvision.com T o patients, eye rubbing might seem innocuous, but to the ophthalmologist, it’s an action that can have sight- threatening consequences and is something that patients should be warned against. Eye rubbing has been associated with keratoconus most commonly 1 but also retinal detachments 2 and dislocated implants. 3 It½s also eÝperimentally been shown to significantly cause a rise in IOP. 4 Sometimes, when patients rub their eyes hard enough, they see lights, yashes, or dots. randon Baartman, MD, described this as not actually light but mechanical traction put on the retina by the vitreous. “The retina then communicates any stimulus, be it mechanical traction during a retinal tear or eye rubbing, as ‘light’ to the brain,” he said. Dr. Baartman said he’ll often ask patients to think about what structures they’re rubbing or pressing on. “Rubbing over the inner corner and pressing on bone is very different than the rubbing of the actual vulnerable structure of the eye itself,” he said. Michael Greenwood, MD, said he also tells people that rubbing the bridge of the nose or close to the temple is O . º ust don½t put your fingers on the soft part of the eye,” he said. Greater awareness needed about impact of eye rubbing by Liz Hillman Editorial Co-Director Dr. Greenwood added later that sometimes what the physician might think of as eye rubbing is not what the patient thinks of. Having the patient demonstrate how they rub their eyes can be helpful, as can having a family member in the room. Dr. Greenwood said when he asks a patient if they rub their eyes, they’ll say no, but the other person in the room with them is nodding their head yes. “People who rub their eyes aren’t always aware that they’re doing it,” he said. Dr. Baartman also said he asks a loved one, if present, if the patient says they don’t rub their eyes. ºI then usually describe the type of eye rubbing that can be harmful to an eye and eÝplain that it will lead to new or continued ‘warping’ of the ocular structures,” he said. “Particularly useful is the old basketball This article originally appeared in the April 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. analogy; nearly everyone in their school-aged days has been to a gym with that old basketball that has been bounced repeatedly and develops weakening in the wall of the ball, such that the wall then develops that ‘lump’ irregularity. Every time they rub their eye, it’s like bouncing that basketball, and their cornea may develop that same irregularity over time.” Patients to specifically counsel against eye rubbing include keratoconus patients, refractive surgery patients, patients with phakic IO s, dry eye and allergy patients, and patients with Down syndrome. For keratoconus patients, Dr. Greenwood said, it½s important to eÝplain to them that the goal of crosslinking is to halt progression. If they continue to rub their eyes, they might need another procedure. Refractive surgery patients
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