,,FACT ,,& ,,FIC;N ,,( ,,H1L?Y ,,VI.N ,EYE ,C>E = ,ADULTS & ,*N ,,CLYDE ,K4 ,,KIT*51 ,M4,D4 ,PUBLI%$ 0,PRAEG] ,PUBLI%]S1 ,WE/PORT1 ,3NECTICUT ,COPY"R ^C #BJJG 0,CLYDE ,K4 ,KIT*5 ,FUR!R REPRODUC;N OR 4TRIBU;N 9 O!R ?AN A SPECIALIZ$ =MAT IS PROHIBIT$4 ,TRANSCRIP;N ( ,,ISBN-#AJ3 #J-BGE-IICDE-J ,,ISBN-#AC3 #IGH-J-BGE-IICDE-J ,TRANSCRIB$1 #BJJH1 BY ,C>OL ,/UD] ,"EGRE5 ,BRL ,S]VICE ,WA%+TON ,TALK+ ,BOOK @& ,BRL ,LIBR>Y ,S1TTLE1 ,WA%+TON ,9 #E ,VOLUMES ,VOLUME #B ,BRL ,PAGES P#A-P#F & #IC-AIF ,PR9T ,PAGES #CG-C#GI P#A ,,TRANSCRIB]'S ,,NOTES ,! ILLU/R,NS 9 ? BOOK >E ALL S*EMATIC CROSS-SEC;NS (! EYE OR "PS (! EYE4 ,!Y >E N NUMB]$ OR O!RWISE ID5TIFI$4 ,CAP;NS 6! ILLU/R,NS >E BRLD ": !Y APPE> 9 PR9T4 ,]RORS 9 SPELL+1 PUNCTU,N1 GRAMM>1 & SYNTAX H1 =! MO/ "P1 BE5 TRANSCRIB$ Z !Y APPE> 9 PR9T4 P#B ,,SPECIAL ,,SYMBOLS ,,US$ ,,9 ,,? ,,VOLUME @& 7#A1 #ABCDF7 AMP]S& SYMBOL ^C 7#DE1 #AD7 COPY"R SYMBOL _/ 7#DEF1 #CD7 SLA% ,' 7#F1 #C7 T]M9,N SIGN ,MA!MATICAL ,SYMBOL @+ 7#D1 #CDF7 PLUS SIGN P#C P#D ,,3T5TS ,PAGE ,"P ,,II4 ,-MON ,EYE ,PRO#MS """""" #CG #F4 ,"EY"D ,MALADIES """"""""""""""" #CI ,! ,R$ ,EYE """""""""""""""""""""" #CI ,=EIGN ,BODY ,S5S,N 78,"S?+ 9 ! ,EYE07 """""""""""""""""""""" B#DA ,H]PETIC ,OCUL> ,41SE """""""""""" #DD ,LACRIMAL ,4ORD]S """"""""""""""" A#DE ,SPOTS 9 ,VI.N """""""""""""""""" A#DG ,LUMPS & ,BUMPS (! ,EYES """""""" A#DI ,EYELID ,4ORD]S """"""""""""""""" B#EJ ,IT*Y ,EYES """"""""""""""""""""" A#EC #G4 ,/RABISMUS 7,CROSS-,EY$ & ,WALL-,EY$7 """""""""""""""""""" #EE ,"P ,,III4 ,AGE-RELAT$ ,EYE ,PRO#MS 7,GETT+ ,OLD ,A9'T = ,SISSIES7 #FA #H4 ,PRESBYOPIA """""""""""""""""""" #FC ,*OICES ( ,BIFOCALS1 ,TRIFOCALS1 ,ETC4 """"""""""""""""""""""" B#FI P#E ,3TACT ,L5SES Z AN ,ALT]NATIVE 9 ,PRESBYOPIA"""""""""""""""""" B#GA #I4 ,CAT>ACTS """""""""""""""""""""" #GD P#F ,,"P ,,II #CG-CI ,,-MON ,,EYE ,,PRO#MS #F ,"EY"D ,MALADIES ,"! >E _M R1SONS 6WANT 6SEE AN EYE DOC- TOR O!R ?AN R\T9E EYE EXAMS 6TE/ VI.N4 ,"S >E EM]G5CIES1 B1 IF "O "U/&S "S BA- SICS AB ! EYES1 ! NE$ 6SEEK C>E C 2 REC- OGNIZ$ Z URG5T OR N S URG5T4 ,"S "U/&+ ( EYE PRO#MS1 H["E1 _C REPLACE ACTU,Y SEE+ ! EYE DOCTOR4 ,! ,R$ ,EYE ,"! >E _M CAUSES ( R$ EYES1 & "H >E "S (! M -MON4 ,P9K ,EYE 7,3JUNCTIVITIS7 ,? IS A -MON 9FEC;N A6ECT+ "O OR BO? EYES1 &! 3JUNCTIVA1 ! ?9 \T]MO/ VASCUL> LAY] ( TISSUE COV]+ ! :ITE (! EYE4 ,X C O3UR AT ANY AGE1 B IS MO/ -MON 9 S*OOL- *N1 :O C !N 9FECT SIBL+S & P>5TS4 #IC ,"! >E BASIC,Y TWO K9DS1 VIRAL & A#CI BACT]IAL4 ,VIRAL 3JUNCTIVITIS DOES N RE- SPOND 6ANTIBIOTICS & MAY A3OMPANY AN UP- P] RESPIRATORY 9FEC;N 7A COLD74 ,CORN1L 9VOLVE;T MAY O3UR ) VIRAL 9FEC;NS1 CAUS+ =EIGN BODY S5S,N1 BLURR$ VI.N1 & PHOTO- PHOBIA4 ,! AV]AGE DUR,N IS TWO WEEKS1 &1 Z M5;N$1 ANTIBIOTICS D N CURE1 B1 9 "S SITU,NS1 ANTIBIOTIC-/]OID -B9,NS MAY LESS5 4COM=T4 ,BACT]IAL 3JUNCTIVITIS USU,Y HAS A M PURUL5T 4*>GE ?AN VIRAL 9FEC;NS & W RESPOND 6ANTIBIOTIC EYE DROPS1 "S"TS PROMPTLY4 ,AL? EXP]I;ED EYE DOCTORS C "S"TS TELL VIRAL F BACT]IAL 9FEC;NS1 !Y (T5 _C 2 SURE1 EI1 UNTIL FOLL[+ ! C\RSE (! 9FEC;N4 ,BO? TYPES >E 3TAGI\S1 & %>E ! FACT T ! SECOND EYE IS USU,Y LESS SEV]ELY A6ECT$4 ,VIRAL 3TA- GION MAY 2 ACTU,Y 8EPIDEMIC0 9 SPR1D1 S T S*OOL*N %D N RETURN 6S*OOL UNTIL RE- COV]$4 ,C>EGIV]S 7P>5TS7 %D 2 C>E;L 6WA% _! H&S AF APPLY+ EYE DROPS 6_! *N PA- TI5TS4 #ID ,SPONTANE\S ,3JUNCTIVAL ,HEM- #DJ ORRHAGE ,? IS ANO!R K9D ( R$ EYE1 : MAY APPE> Q S]I\S1 2C ! EYE IS S R$4 ,H["E1 ! R$;S IS LOCALIZ$1 USU,Y 6"P ( "O EYE1 & LOOKS WORSE ?AN X RE,Y IS4 ,SPONTANE\S BLE$+ F A 3JUNCTIVAL VESSEL C O3UR = UN"KN REA- SONS1 ! USUAL /ORY 2+ T A P]SON WAKES UP1 LOOKS 9 ! MIRROR1 & "! X IS4 ,"! IS NO PA91 NO 4*>GE1 & NO BLURR$ VI.N4 ,IF "O IS TAK+ ANTICOAGULANTS1 ! 9CID;E IS M -MON1 B USU,Y X IS A SPONTANE\S PRO#M )- \T ANY H1L? SIGNIFIC.E4 ,( C\RSE1 TRAUMA 6! EYE OR P]IORBITAL TISSUE C CAUSE ? =M ( BRUIS+1 : IS ASSOCIAT$ )A 8BLACK EYE40 ,! D[NSIDE IS T "! IS NO TR1T;T1 S9CE ! BLOOD HAS 6ABSORB L A BRUISE1 2COM+ YEL- L[I% Z X ABSORBS4 ,! BI7E/ -PLIC,N IS HAV+ 6REASSURE "EY"O :O SEES Y T X IS N Z BAD Z X SEEMS1 & T IF Y DID SEE ! DOC- TOR1 HE CD N D ANY?+ 6MAKE X G AWAY4 ,WE>+ SUNGLASSES C HELP AVOID UNWANT$ ATT5;N4 #IE ,EPISCL]ITIS A#DJ ,? IS USU,Y M (A LOCALIZ$ R$;S ( "O EYE1 )\T 4*>GE1 B AL USU,Y M UNCOM=TA# 9 T]MS ( PA94 ,X IS N AN 9FEC;N1 S X IS N 3TAGI\S1 & VI.N IS USU,Y N A6ECT$4 ,! TISSUE DEEP] ?AN ! SUP]FICIAL 3JUNCTIVA IS 9VOLV$1 B X IS "S"TS DI6ICULT 6TELL ! DI6];E F 3JUNCTIVITIS 0APPE>.E AL"O4 ,! CAUSE IS RELATIVELY UN"KN1 B X C 2 ASSO- CIAT$ ) 9FLAMMATORY 3DI;NS S* Z >?RITIS4 ,X IS USU,Y UNILAT]AL1 B C RECUR 9 ! SAME OR O!R EYE4 ,! TR1T;T IS 6USE TOPI- CAL /]OID DROPS1 R>ELY ORAL /]OIDS1 B N ANTIBIOTICS4 ,RESPONSE C 2 PROMPT OR DE- LAY$4 ,IRITIS 7,IRIDOCYCLITIS7 ,S* 9FLAMM,N MAY 2 9DICAT$ 0A LOCALIZ$ R$;S (! EYE1 ! R$;S 2+ A R+ >.D ! PUPIL TISSUE1 ! COLOR$ "P (! EYE4 ,H["E1 X MAY 2 G5]ALIZ$1 ESPECI,Y 9 M SEV]E CASES4 ,! PUPIL 2COMES SMALL]1 & S9CE USU,Y MONOC- UL>1 ! PUPIL (! R$ EYE IS SMALL] -P>$ ) T (! O!R EYE4 ,! DIAGNOSIS REQUIRES MI- CROSCOPIC OR 8SLIT LAMP0 3FIRM,N1 #IF ) : 8FL>E0 79CR1S$ PROTE9 9 ! B#DJ *AMB] 9 FRONT (! PUPIL7 & CELLS 7:ITE BLOOD CELLS VISI# 9 ! SAME >EA7 C 2 ID5- TIFI$4 ,S9CE ! PUPIL TISSUE 7IRIS7 IS 9FLAM$1 X 2COMES /ICKY1 & MAY /ICK 6! FRONT SURFACE (! L5S1 CAUS+ SC> TISSUE T C A6ECT ! R.D;S (! PUPIL4 ,AL1 2C ! PU- PIL TISSUE IS 9VOLV$1 S5SITIV;Y 6LIY1 IN- VOLV+ ONLY "O EYE1 B C -------------------------------------#DA 2 SECOND>Y1 Z RESULT+ F 9JURY OR IRRIT,N (! CORNEA4 ,H["E1 X AL C 2 RECURR5T & A6ECT ! SAME OR O!R EYE4 ,X IS R>ELY BI- LAT]AL1 &! CAUSE IS USU,Y UN"KN1 B ! T5- D5CY C A3OMPANY 9FLAMMATORY >?RITIC 3DI- ;NS1 S* Z ANKYLOS+ SPONDYLITIS4 ,! RELA- ;N%IP MAY 2 RECOGNIZ$1 B IRITIS IS N NECESS>ILY F.D P>ALLEL TO #IG SYMPTOMATIC RECURR;E ( >?RITIS4 A#DA ,?\< ! PUPIL MAY 2COME SC>R$1 VI.N IS R>ELY A6ECT$1 :5 ! IRITIS IS TR1T$ PROP- ]LY4 ,P>ADOXIC,Y1 DILAT+ ! A6ECT$ PUPIL1 9/1D ( MAK+ ! PHOTOPHOBIA WORSE 0LETT+ M LI 3DI;NS ( UN"KN CAUSE1 S* Z EPISCL]ITIS1 RECURR;ES 2COME LESS -MON ) AGE--"O (! R>E ADVANTAGES ( GETT+ OLD]4 ,SCL]ITIS ,X IS R UNCOMMON & IS A DEEP]-LAY] IN- FLAMM,N ?AN EPISCL]ITIS1 9FLAMM,N (! :ITE (! EYE XF4 ,! R$;S IS AL LOCALIZ$1 B ! PA9 IS Q 9T5SE1 5 6SU7E/ URG5T C>E4 ,! TR1T;T IS TOPICAL & ORAL CORTICO/]- OIDS1 & REQUIRES CLOSE FOLL[-UP 0AN OPH- ?ALMOLOGI/4 #IH ,ACUTE ,ANGLE ,CLOSURE B#DA ,GLAUCOMA ,X CAUSES A R$ EYE 7R>ELY BILAT]AL7 & IS A3OMPANI$ 0PA9 9 ! EYEBR[1 BLURR$ VI- .N1 PUPIL 5L>GE;T1 &A RAPID RISE 9 9TRA- OCUL> PRESSURE4 ,NAUSEA & VOMIT+ MAY OC- CUR1 ?US OBSCUR+ ! S\RCE (! PRO#M4 ,TR1T;T IS "O (! EYE EM]G5CIES1 & IS 4CUSS$ Z A =M ( GLAUCOMA 9 ,*APT] #AA4 ,=EIGN ,BODY ,S5S,N 78,"S?+ 9 ! ,EYE07 ,CORN1L ,=EIGN ,BODY ,X IS MO/ -MON1 Z OBJECTS C 5T] ! EYE ) S* =CE Z 6/ICK OR 2COME IMB$D$ 96! SU- P]FICIAL CORNEA4 ,A CORN1L =EIGN BODY CAUSES S5S,N ( "S?+ "U ! UPP] EYELID1 & PATI5TS (T5 NE$ REASSUR.E T REMOV+ ! CORN1L OBJECT IS ! CORRECT TR1T;T4 ,ME- TALLIC =EIGN BODIES >E -MON1 ESPECI,Y 9 ^? :O USE DRILL+ OR CUTT+ TOOLS4 ,F]R\S 7IRON7 =EIGN BODIES CAUSE A TELLTALE RU/ BUILDUP 9 A MATT] ( H\RS1 S T REMOVAL (! =EIGN BODY MAY 2 EASI] ?AN T (! #II RESULTANT 8RU/ R+40 ,IF C5TR,Y C#DA LOCAT$1 A L>GE RU/ R+ C L1VE A SC> T MAY A6ECT VI.N4 ,! REMOVAL IS USU,Y BE/ P]- =M$ )A 8SPUD10 OR A SIMIL> %>P-TIPP$ IN- /RU;T1 & IS BE/ A3OMPLI%$ ) AID (A SLIT -------------------------------------#DB LAMP 7MICROSCOPE74 ,! EYE C 2 ANES!TIZ$ EASILY1 Z TOPICAL ANES!SIA "WS V WELL ON ! CORNEA4 ,PATI5TS NE$ REASSUR.E AB ?4 ,3JUNCTIVAL ,=EIGN ,BODY ,? IS LESS PA9;L1 DEP5D+ ON ! SIZE & LOC,N (! "PICLE4 ,IF LOCAT$ 9SIDE ! L[] EYELID1 ! OBJECT MAY ACTU,Y "W \ SPONTA- NE\SLY OR RISE 6! CORN] (! EYE1 ": X C 2 SE5 & WIP$ AWAY )A COTTON SWAB4 ,IF LO- CAT$ "U ! UPP] EYELID1 X MAY CAUSE SIG- NIFICANT 4COM=T UNTIL REMOV$4 ,? MAY RE- QUIRE EV].N1 OR FLIPP+ (! UPP] EYELID1 S Z 6EXPOSE ! 9SIDE SURFACE ": S* =EIGN BODIES C 2 TRAPP$ & CAUSE SCRAT*+ (! CORNEA4 ,RELIEF IS PROMPT1 S T 3C]N = A4I;NAL =EIGN BODIES IS RELIEV$4 ,IF "! IS / ANY D\BT AB REMA9+ =EIGN BODIES1 X IS WISE 6IRRIGATE ! EYE ) WAT] IF #AJJ SPECIAL IRRIGAT+ FLUIDS >E N A#DB AVAILA#4 ,"! NE$ N 2 3C]N T A =EIGN BODY MAY "W XS WAY 2H ! EYE2 X C ONLY G A FEW MILLIMET]S "U ! EYELID4 ,IF ! =EIGN BODY SCRAT*ES ! CORNEA1 !N "! MAY 2 "S RESID- UAL =EIGN BODY S5S,N1 (A LESS] DEGREE1 AF REMOVAL (! =EIGN BODY1 UNTIL ! SCRAT* H1LS 9 A FEW H\RS4 ,>TIFICIAL LUBRICAT+ TE>S WD 2 SOO?+ UNTIL H1L+ IS -PLET$4 ,EV].N OR FLIPP+ ! UPP] EYELID IS "S?+ T IS D"O 0! EYE DOCTOR1 B IS AL "S?+ POSSIBLY 4COV]A# 0"Y P1 USU,Y Z A JOKE4 ,H["E1 :5 ! UPP] LID IS EV]T$1 OR FLIPP$1 "! >E "S BULGES T MAY MAKE A P]- SON 3C]N$ AB A MASS PRESS+ ON ! EYE4 ,I H SE5 M ?AN "O PATI5T = ? R1SON1 ?9K+ T "! IS "S SORT ( TUMOR (! EYELID2 "O 0 A SON (A LOCAL D5TI/4 ,! UPP] EYELID HAS A C>TILAGE-L TISSUE 9 ! C5T]1 ! T>SUS1 : 3=MS 6! R.D;S (! EYEBALL 9 ! USUAL POSI- ;N1 B IF FLIPP$1 X CAUSES A BULGE T[>D ! NOSE & T[>D ! E>4 ,TRI*IASIS ,TRI*IASIS1 OR ! IN-TURN+ ( AN #AJA EYELA%1 C CAUSE =EIGN BODY S5S,N4 B#DB ,! LA% MAY 2 S SMALL Z 6BE DI6ICULT 6SEE )! NAK$ EYE1 & C]TA9LY DI6ICULT 6REMOVE )\T PROFES.NAL HELP4 ,EPIL,N1 OR REMOVAL (! (F5D+ EYELA%1 GIVES IMM RELIEF4 ,UN=- TUNATELY1 EYELA%ES T GR[ 9 A CROOK$ DI- REC;N MAY REGR[1 AG 9 ! SAME DIREC;N & REQUIRE REP1T$ EPIL,N4 ,6PREV5T REGR[?1 CAUT]Y UNITS >E AVAILA# 6TRY 6DE/ROY ! G]M9AL ORIG9 (! LA%4 ,CORN1L ,ABRA.N1 OR ,SCRAT*$ ,CORNEA ,? 9JURY C CAUSE =EIGN BODY S5S,N (A MILD 6SEV]E DEGREE1 DEP5D+ ON H[ M* (! EPI!LIUM1 OR SURFACE LAY]1 (! CORNEA IS DAMAG$4 ,! CORNEA1 ! W9D[ TRANSP>5T TIS- SUE OV] ! PUPIL1 IS ! MO/ -------------------------------------#DC S5SITIVE TISSUE 9 ! BODY4 ,A SCRAT* C O3UR F _M CAUSES1 9CLUD+ ! PROB+ F+] ( AN 9FANT4 ,X IS USU,Y S SMALL Z 6BE IN- VISI# 6! NAK$ EYE1 B ! FEEL+ Z IF "S?+ IS 9 ! EYE1 OR "U ! UPP] EYELID1 IS PRES5T UNTIL ! ABRA.N IS H1L$4 ,=TUNATE- LY1 H1L+ O3URS RAPIDLY B "S"TS #AJB NE$S 5C\RAGE;T4 ,PAT*+ (! EYE A#DC 3TROLS BL9K+ & ?US 5C\RAGES H1L+4 ,9 "S CASES A B&AGE 3TACT L5S MAY SPE$ RETURN 6USUAL ACTIV;Y4 ,PRESCRIP;N EYE DROPS MAY 2 NE$$1 & EV5 >TIFICIAL TE>S MAY SOO! ! CORNEA :ILE H1L+4 ,K]ATITIS ,K]ATITIS1 OR ANY 9FLAMM,N (! CORNEA1 C CAUSE =EIGN BODY S5S,N4 ,? C A3OMPANY 3JUNCTIVITIS (A VIRAL V>IETY1 2 ASSOCI- AT$ ) DRY EYE OR 3TACT L5S WE>1 9JURY S* Z 9 A SCRAT*$ CORNEA1 OR ANY?+ T 4TURBS ! H1L?Y SURFACE 3T\R (! CORNEA4 ,MICRO- SCOPIC EXAM 0AN EYE DOCTOR IS USU,Y RE- QUIR$ 6MAKE ! DIAGNOSIS 2F 9ITIAT+ TR1T- ;T4 ,H["E1 "S"TS S* AN ABRA.N C 2 SE5 )A FL\RESCE9 /A91 )\T MAGNIFIC,N4 ,SIGNIFI- CANT CORN1L IRRIT,N IS A3OMPANI$ 0PHOTO- PHOBIA1 : IS A SIGN ( AT L1/ MILD SEC- OND>Y IRITIS4 ,ACT9IC K]ATITIS IS DUE TO ULTRAVIOLET EXPOSURE & RESULTS 9 SWELL+ (! CORNEA 6! PO9T ": SEV]E PA9 RESULTS4 ,X W 2 4CUSS$ M 9 *APT] EITIFICIAL TE>S MAY GIVE RELIEF1 AT L1/ TEMPOR>ILY4 ,A M SEV]E EPISODE MAY REQUIRE PAT*+ OR B&AGE 3TACT L5S4 ,EXAM- 9,N %[S AN >EA (! CORN1L EPI!LIUM1 ! SU- P]FICIAL LAY]1 : DOES N H1L PROP]LY1 & MAY %[ EVID;E 2T ATTACKS ^U MICROSCOPIC EXAM9,N )A SLIT LAMP4 ,! PRO#M SEEMS 6BE A DEFECT 9 ! USUAL H1L+ ABIL;Y (! SUR- FACE CELLS1 ! EPI!LIUM (! CORNEA4 ,^! CELLS C 2 LIK5$ 6BRICKS 9 A BRICK WALL1 : >E HELD TGR 0MORT>4 ,! EPI!LIUM CELLS C NORM,Y REG5]ATE OR H1L Q RAPIDLY1 9 A MATT] ( H\RS4 ,H["E1 9 ! CASE ( RECURR5T CORN1L ERO.N1 X IS Z IF ! MAT]IAL T HOLDS ! CELLS TGR1 ! MORT>LIKE 9T]CELLU- L> SUB/.E1 IS DEFECTIVE4 ,?US1 ! SLI ,41SE ,H]PES ,SIMPLE ,VIRUS 7,COLD ,SORE ,VIRUS7 ,? VIRUS CAUSES K]ATOCONJUNCTIVITIS1 : C 2 -MONLY UNRECOGNIZ$ Z DUE 6H]PES SIM- PLEX TYPE ,I4 ,! BI7E/ PRO#M 9 RECOGNI;N ( ? SPECIFIC TYPE VIRUS IS T X C APPE> 6BE "S?+ ELSE1 S* Z A REGUL> P9K EYE4 ,X IS "S"TS CALL$ ! GRT MASQU]AD]1 2C EV5 = AN EYE DOCTOR X C 2 DI6ICULT 6DIAGNOSE4 ,IF TRADI;NAL1 X CAUSES A 8D5DRITIC FIG- URE0 TYPE ( CORN1L 9FILTRATE1 : IS TOO MICROSCOPIC 6DETECT )! NAK$ EYE4 #AJE ,! CORNEA AL T5DS 6BE RELATIVELY A#DD NUMB4 ,! DI6ICULTY 9 RECOGNIZ+ ? VIRAL 9FEC- ;N IS MA9LY RESPONSI# =! CAU;N = NONOPH- ?ALMIC DOCTORS 6N"E USE A TOPICAL /]OID EYE DROP 9 TR1T+ APP>5T EYE 9FLAMM,N4 ,? IS 2C USE ( TOPICAL /]OIDS MAY WORS5 OR PROL;G RECOV]Y F H]PES 9FEC;N4 ,P>ADOXI- C,Y1 TOPICAL /]OIDS MAY 2 9DICAT$ IF H]- PETIC 41SE 2COMES DEEP]1 9VOLV+ ! 8/RO- MA0 (! CORNEA4 ,N"E!.S1 ? IS A DECI.N LEFT 6! OPH?ALMOLOGI/4 ,=! ANTIVIRAL TR1T;T ( H]PES SIMPLEX VIRUS 7,,HSV71 TOPICAL EYE DROPS S* Z ,VIROPTIC1 OR A SIMIL> O9T;T1 >E US$1 & POSITIVE RESULTS C USU,Y 2 SE5 )9 A FEW "DS4 ,H["E1 ! M$IC,N IS IRRITAT+ 6! EYE & NE$S 6BE TITRAT$ S Z 6N PROL;G ILL;S4 ,! USUAL ANTIBIOTIC EYE DROPS D N "W1 B X IS BETT] =! NON-EYE DOCTOR 6/ICK 6S* M$IC,N :5 ! CAUSE IS UN"KN1 2F ! PATI5T IS SE5 0AN EYE DOCTOR4 ,AN ORAL ANTIVI- RAL S* Z ,ACYCLOVIR IS AL "S"TS US$1 :E!R RE,Y NEC OR N1 2C X HAS S* FEW SIDE E6ECTS & W AT L1/ D NO H>M4 #AJF ,O!R ?AN ! -MON MISDIAGNOSIS ( B#DD ,,HSV ,I1 ! MO/ IMPORTANT ?+ 6REMEMB] IS T X C RECUR1 )\T OBVI\S CAUSE O!R ?AN A M9OR OCUL> TRAUMA4 ,L A COLD SORE1 X RE- CURS 9 ! SAME PLACE1 S* Z ON ! LIP 7LA- BIAL ,,HSV74 ,! HI/ORY ( ,,HSV 9FEC;N %D ALW 2 MADE "KN 6ANY"O TR1T+ ? SAME EYE 9 ! FUTURE4 ,X IS R>E 69VOLVE ! O!R EYE PRIM>ILY OR SECOND>ILY4 ,,HSV ,,II IS ! SEXU,Y TRANSMITT$ =M ( ! 9FEC;N1 & 9VOLVES ! G5ITALIA4 ,XS SPR1D 6! EYE WD 2 R>E & 0ME*ANICAL TRANSF]4 ,X IS AL POSSI# 6TRANSF] ,,HSV ,I 09OCUL,N1 = EXAMPLE1 A "M )A LABIAL 9FEC;N KISS+ ! FACE ( H] 9FANT4 ,? WD ORD9>ILY RESULT 9 AN EYELID 9FEC;N1 N CORN1L 9FEC;N1 & 2 A3OMPANI$ 0A L>GE PRE-AURICUL> LYMPH NODE 7GL& 9 FRONT (! E>74 ,PRIM>Y H]PES BLEPH>ITIS IS AL POSSI# 2C ( ,,HSV ,I4 ,X CAUSES A BLI/]LIKE LE- .N LOCALIZ$ 6A POR;N (! EYELID & RE- SPONDS 6ANTIVIRAL O9T;T4 ,RECURR;E 9 ! SAME PLACE IS "S"TS A LAT] 3FIRM,N ( DI- AGNOSIS4 #AJG ,H]PES ,ZO/] ,VIRUS 7,,HZV7 #DE ,? 9FEC;N CAUSES %+LES1 : IS SUPPOS$LY ! SAME Z ! *ICK5 POX VIRUS1 & C 9VOLVE ! EYES4 ,AF RECOV]+ F *ICK5POX1 ! VIRUS REMA9S ALIVE 9 ! PATI5T B 9ACTIVE 9 C]- TA9 N]VE ROOTS = YE>S4 ,X -MONLY 9VOLVES ! N]VES >.D ! RIBS1 & >.D ! EYE X C IN- VOLVE BRAN*ES (! FACIAL N]VE4 ,MO/ -MON- LY 9VOLV$ IS ! OPH?ALMIC BRAN* (! TRI- GEM9AL N]VE1 )! F/ SYMPTOMS 2+ A VESICU- L> 7BLI/]LIKE7 ERUP;N 9 ! >EA S]V$ 0? N]VE BRAN*4 ,S* SK9 LE.NS C "!=E G F =E- H1D UP 96! HAIRL9E1 B J ON "O SIDE (! H1D1 & SPECIFIC,Y N CROSS+ ! MIDL9E4 ,! SK9 LE.NS H1L1 (T5 RAPIDLY 5 T ! SCALP NE$S 6BE EXAM9$ 6HELP MAKE ! DIAGNOSIS4 ,SK9 9VOLVE;T MAY V>Y2 &! SK9 MAY ONLY 9VOLVE ONLY SMALL >1S1 = EXAMPLE1 ONLY ! 9N] "P (! UPP] EYELID4 ,TYPIC,Y1 IF ! TIP (! NOSE IS 9VOLV$1 ! EYEBALL XF W LIKELY 2 AL4 ,H["E1 EYE 9VOLVE;T %D 2 SUSPECT$ ) ANY =M ( %+LES >.D ! EYE4 ,! EYE MAY DEVELOP ONLY A MILD 3JUNCTIVI- TIS1 B IF ! CORNEA IS 9VOLV$ "! C 2 LA/- +1 EV5 SEV]E1 -PLIC,NS4 ,"! C 2 #AJH V>I\S K9DS ( K]ATITIS1 EV5 APPE>+ A#DE L ,,HSV ,I1 B ! M SEV]E 9VOLVE;T IS IN- TRAOCUL>1 :5 X O3URS1 9 ! =M ( IRIDOCY- CLITIS ( V>Y+ DEGREE4 ,TR1T;T 9VOLVES TOPICAL /]OID DROPS1 DILAT+ DROPS IF "! IS IRITIS1 & ORAL ,ACYCLOVIR ANTIVIRAL M$IC,N IF 9DICAT$4 ,IRIS ATROPHY ) PUPIL 4TOR;N MAY RESULT1 B EV5TU,Y ! PROCESS CLE>S4 ,UN=TUNATELY1 "! >E RECURR;ES1 & L;G-T]M MA9T5.E M$I- C,N MAY 2 REQUIR$4 ,A NEW DEVELOP;T IS ! RECOMM5D,N = ^? OV] AGE SIXTY 6BE VA3I- NAT$ )A NEW DRUG CALL$ ,ZO/AVAX Z A M1NS ( PREV5;N1 S9CE ! OLD] "O GETS1 ! GRT] >E ! *.ES ( DEVELOP+ %+LES1 R1*+ #EJ P]- C5T OV] AGE EIIA# DEGREE4 ,TE>S >E NATURAL LUBRIC,N FLUIDS =M$ BY 3JUNCTIVAL GL&S &! LACRIMAL GL&4 ,3FU.N SURR.DS 4CUS.N (! TE> DUCT1 : #AJI ACTU,Y DRA9S FLUID F ! EYES1 D[N B#DE ! NOSE2 H;E ! NOSE 8RUNS0 :5 "O CRIES4 ,"S >E 3FUS$ 96?9K+ T ! TE> DUCT C>RIES TE>S F ! TE> GL&4 ,TE> =M,N IS RELATIVE- LY 3/ANT F 3JUNCTIVAL GL&S1 B C 2 A6ECT$ 041SES (! 3JUNCTIVA4 ,! LACRIMAL GL& IS RELATIVELY L>GE1 IS LOCAT$ LAT],Y & SU- P]IORLY 9 ! UPP] EYELID1 & FUNC;NS RE- FLEXIVELY 6IRRIT,N & EMO;N4 ,DRY EYE IS USU,Y DUE 69ADEQUATE TE> PRODUC;N 0! 3JUNCTIVAL GL&S4 ,:5 ASSOCIAT$ ) RHEUMA- TOID >?RITIS1 ! DRY EYE IS "P ( ,SJ@O- GR5'S SYNDROME4 ,IMPROP] TE> LUBRIC,N C 2 LIK5$ 6TRY+ 6SEE "? A C> W9D%IELD :5 ! W9D[ WIP] OR WA%] DOES N CLE> ! -------------------------------------#DF VIEW4 ,MUC\S %R$S MAKE ! TE> FILM /ICKY1 S T ! NORMAL BL9K C J SME> ?+S >.D1 L BUGS RESI/+ ! E6ECT (! W9D%IELD WIP]4 ,BL9K+ MAY AL 2 DEFECTIVE1 Z = EXAMPLE 9 ,BELL'S ,PALSY4 ,SYMPTOMS MAY 2 WORSE :5 R1D+ OR US+ A -PUT]1 2C ( DECR1S$ BL9K+4 ,AIR 3DI;N]S OR H1T]S C CAUSE DRY+ 2C (! 9CR1S$ EVAPOR,N ( TE>S1 S T P MAY 2 M UNCOM=TA# AF A TRIP 9 ! C>4 ,AIR #AAJ TRAVEL IS ESPECI,Y DRY+ 6! EYES4 A#DF ,MO/ DRY EYE PRO#MS >E SPONTANE\S & P]H M -MON 9 WOM54 ,9 A4I;N 6H1L? PRO#MS S* Z RHEUMATOID >?RITIS1 ! WE>+ ( 3TACT L5SES1 EV5 S(T "OS1 MAY CAUSE DRY EYES4 ,DRY EYES >E AL A -PLIC,N ( LASIK RE- FRACTIVE SURG]Y1 ON A TEMPOR>Y OR PRO- L;G$ BASIS4 ,TR1T;T 9VOLVES TE> SUPPLE;TS1 9 ! =M ( >TIFICIAL TE>S1 : >E AVAILA# )\T PRE- SCRIP;N4 ,PLU7+ ! TE> DUCT OP5+1 ! PUNC- TUM1 MAY 2 NEC 9 SEV]E CASES1 EI TEMPO- R>ILY OR P]MAN5TLY4 ,H["E1 ^? WANT+ A 8QK FIX10 OR ^? :O H HE>D ( S* A TR1T;T1 "S"TS -E 96! (FICE DEM&+ S* TR1T;T1 )\T R1LIZ+ T X C CAUSE UNWANT$ WAT]+ (! EYES4 ,"S NEW] EYE DROPS1 3TA9+ CYCLO- SPOR9 7,RE/ASIS71 (F] HOPE ( M P]MAN5T HELP1 ?\< TR1T;T RESULTS C 2 DELAY$ UN- TIL TR1T$ A L;G "T1 & MAY 2 M E6ECTIVE 9 FEMALES ?AN MALES4 ,2C ( 8DIRECT ADV]- TIS+10 Y W HE> A LOT AB ,RE/ASIS4 ,H["E1 IF Y R1D ! SMALL PR9T 9 ! PACKAGE 9S]T1 Y W F9D T ! IMPROVE;T RESULTS (A /UDY GR\P %[$ T AF #F MON?S ( USE 0A #AAA L>GE /UDY GR\P #AE P]C5T IMPROV$ B#DF TE> PRODUC;N1 AF HAV+ US$ ,RE/ASIS = SIX MON?S -P>$ ) #E P]C5T :O US$ O!R TR1T;T1 Z DEMON/RAT$ 0! 8,S*IRM]'S0 TE/1 A M1S- UR+ TE/ = TE> PRODUC;N4 ,SUPPORT]S PO9T \ T ? /UDY 0 P]=M$ ON SEV]E CASES ( DRY EYES1 & CLAIM T ^? ) LESS SEV]E PRO#MS MAY A*IEVE HI<] SU3ESS4 ,Z M5;N$1 LASIK SURG]Y C CAUSE DRY EYES4 ,"S LASIK SURGEONS R\T9ELY PLACE PUNCTUAL PLUGS AF ! LASIK1 Z IF X IS = SURE T "! W 2 A DRY EYE PRO#M4 ,TRUE1 ? MAY 2 HELP;L1 IF ! EYES >E DRY1 B MAYBE X IS 6%ORTCUT ANY -PLA9TS1 S9CE ! RE- FRACTIVE SURGEON DOES N WANT 6BE 9VOLV$ 9 PO/OP]ATIVE C>E4 ,:AT IF WAT]+ (! EYES O3URS EV5TU,Y4 ,GUESS !N ! PLUGS %D 2 REMOV$1 B DOES ! PATI5T "K AB ALL ?8 ,& :O IS SUPPOS$ 6D ?8 ,"! C 2 A LACK ( -MUNIC,N1 Z ,I H OBS]V$4 ,TE>+ 7,EPIPHORA7 ,TE>+ IS AL -MON & C 2 M -MON ) 9CR1S+ AGE4 ,H["E1 3G5ITAL TE>+ PRO#MS >E AL FREQU5T1 B ^! USU,Y SPONTANE\SLY #AAB IMPROVE4 ,PROB+ ! TE> DUCT MAY 2 C#DF NEC 9 9FANTS1 B IS LESS SU3ESS;L 9 ADULTS 9 CASES ( ACQUIR$ TE> DUCT OB- /RUC;N4 ,TR1T;T ( 3G5ITAL LACRIMAL OB- /RUC;N HAS V>I$ 9 9T5S;Y "? ! YE>S1 ! MA9 ATT5;N N[ 2+ T[>D TR1T+ ! LACRIMAL TRACT 9FEC;N UNTIL ! MATT]+ & TE>+ IM- PROVE4 -------------------------------------#DG ,9FLAMM,N MAY 2 A CAUSE ( SWELL+ (! TE> DUCT OR TE> SAC 7A RES]VOIR = TE> COLLEC;N71 9 *N OR ADULTS1 S T ANTIBIOT- IC EYE DROPS OR ORAL ANTIBIOTICS MAY 2 NE$$ 6CORRECT ! PRO#M4 ,! TE> SAC IS LO- CAT$ ": ! UPP] & L[] LIDS -E TGR1 9 ! 9N] 8CAN?US40 ,:5 SWOLL51 X IS A PALPA# & "S"TS VISI# BULGE 9 ? >EA4 ,:5 9FECT$1 ? BULGE C 2 T5D]1 & PRESSURE MAY CAUSE REGURGIT,N ( MUCOPURUL5T MAT]IAL \ (! PUNCTUM4 ,"S"TS1 A NEW OP5+ NE$S 6BE MADE 96! NOSE SURGIC,Y1 CALL$ DACRYOCY/ORH9O/OMY1 B ? C USU,Y 2 AVOID$4 ,EYELID ABNORMALI- TIES C 3TRIBUTE 6! TE>+ PRO#M1 S* Z DROOP+ (! L[] LID \TW>D #AAC 7ECTROPIAN71 OR IMPROP] BL9K+ Z 9 A#DG ,BELL'S PALSY4 ,X IS ( "S -=T 6"U/& T TE>+ 6"S DEGREE IS -MONLY ACQUIR$ & IS C]TA9LY PREF]A# 6LACK ( TE>S1 Z 9 DRY EYES4 ,MY P]SONAL EXP]I;E IS T ,I H N"E SE5 AN ADULT PATI5T ) TE>+ DAT+ 6*ILD- HOOD1 : SU7E/S T SPONTANE\S IMPROVE;T IS C]TA9LY ! RULE4 7,"Q+ COLL1GUES HAS GIV5 ! SAME IMPRES.N47 ,SPOTS 9 ,VI.N ,FLOAT]S & ,FLA%ES ,SPOTS 9 VI.N1 : MOVE )! MOVE;T (! EYE 9 A FLOAT+ MANN]1 >E CALL$ FLOAT]S4 ,^! >E Q -MON1 ESPECI,Y NOT$ AG/ A LIGE FLOAT]1 ( V>I\S SIZE OR %APE1 IS FREQU5TLY A3OMPANI$ 0A S5S,N ( LIE SYMPTOMS ( :AT IS CALL$ A VITRE\S DETA*;T4 ,! VITRE\S IS A JELLY- LIKE FLUID T MA9LY 3SI/S (A WAT]LIKE FLUID1 B IS GEL-L 9 3SI/5CY1 & O3UPIES MO/ (! SPACE 2H ! L5S (! EYE4 ,X #AAD C 2COME M LIQUID & %IFT AB1 S Z B#DG 6EX]T TRAC;N ON ! RET9A4 ,A LOOSE ATTA*- ;T >.D ! OPTIC N]VE C PULL AWAY1 CAUS+ A R L>GE FLOAT]1 : C 2 NOT$ 6BE OVAL OR R.D1 B C APPE> ANY %APE4 ,! SLO%+ >.D (! VITRE\S GEL C CR1TE ! S5S,N ( LIGE FLOAT]S1 %D 9DICATE ! NE$ 6BE EXAM9$ 0AN EYE DOCTOR4 ,? IS 2C ^! SYMPTOMS MAY 2 ! F/ SIGN (A RET9AL DETA*;T1 A S]I\S 3DI;N T "S"TS NE$S EM]G5CY TR1T;T1 (T5 SURGI- CAL4 ,IF A C>E;L RET9AL EXAM %[S NO SIGN ( RET9AL HOLE OR DETA*;T1 !N "! IS NO NE$ = RE/RIC;N ( ACTIV;Y & G5],Y NO NE$ 6WORRY4 ,H["E1 A RECURR;E ( NEW FLOAT]S1 ESPECI,Y A 8%[]0 ( FLOAT]S1 : CD M1N BLE$+ 9SIDE ! VITRE\S1 OR A %AD[ -+ F ! SIDE VI.N T DOES N G AWAY1 %D /IMULATE PROMPT RETURN 6YR OPH?ALMOLOGI/ 6LOOK =A RET9AL DETA*;T4 #AAE ,! VITRE\S FLOAT] OR FLOAT]S1 #DH UN=TUNATELY1 MAY P]SI/ = AN 9DEF9ITE "T4 ,! "Q IS ASK$ :E!R !Y C 2 REMOV$4 ,TE*- NIC,Y1 !Y C1 0SURGICAL VITRECTOMY1 B ! CO/ & POT5TIAL -PLIC,NS MAKE ? AN UNREA- SONA# OP;N4 ,ACTU,Y1 9 ALM ALL CASES1 ! FLOAT]S C1SE 6BE A PRO#M1 EV5 IF "U C]- TA9 CIRCUM/.ES1 S* Z AG/ A BLUE SKY1 ! FLOAT]S MAY REAPPE> TRANSI5TLY4 ,"! SEEMS 6BE A -B9,N ( 8GETT+ US$ 6X0 &! MOVE;T (! SYMPTOM1 CAUS+ MAT]IALS \ (! L9E ( SIY ,SPOTS ,A SPOT 9 ! VI.N1 USU,Y C5TR,Y1 : DOES N FLOAT OR MOVE1 B SEEMS /,N>Y1 MAY 2 "S?+ M SIGNIFICANT1 ESPECI,Y IF ASSOCI- AT$ ) VI.N LOSS4 ,EYE EXAM MAY %[ A SWELL+ (! MACULA 7Z 9 C5TRAL S]\S RETI- NOPA?Y OR DIABETIC MACUL> $EMA71 OR HEM- ORRHAGE 9 ! MACULA 7Z 9 VASCUL> O3LU.N1 MACUL> DEG5],N1 OR DIABETIC RET9OPA?Y74 ,VI.N IS USU,Y REDUC$1 & AN ,AMSL] GRID OR VISUAL FIELD EXAM9,N MAY %[ #AAF SIGNS ( C5TRAL SCOTOMA 7BLACK\T ( A#DH VI.N C5TR,Y74 ,OCUL> ,MIGRA9E ,EPISODIC SPOTS 9 ! VI.N1 AL;G ) O!R ASSORT$ WEIRD VISUAL S5S,NS1 C 2 DUE 6A -MON PRO#M CALL$ OPH?ALMIC MIGRA9E4 ,S* EPISODES USU,Y LA/ #AE-CJ M9UTES1 ?\< DESCRIP;NS V>Y4 ,A TYPICAL EPISODE />TS )! S5S,N ( HAV+ LOOK$ AT "S?+ TOO B"R1 CAUS+ ! S5S,N ( SEE+ SPOTS SIMIL> 62+ DAZZL$ 0A BIG FLA% CAM]A4 ,2C ( ?1 _M W SWE> T LOOK+ AT A LID ! E>1 ! BI7] 8HALF0 ( SIDE VI.N4 #AAG ,:5 9=M$ (! 3NEC;N 6MIGRA9E1 _M B#DH REFUSE 62LIEVE ?1 S9CE !Y (T5 H NO H1D- A*E4 ,IF "! IS NO H1DA*E1 !N ! SYNDROME IS CALL$ OCUL> OR OPH?ALMIC MIGRA9E4 ,! ONSET MAY 2 LAT] 9 LIFE & IS M -MON 9 WOM51 ! TRI7] ME*ANISM 2+ HORM"O LEVEL FLUCTU,N1 & C O3UR EV5 IF HORM"OS >E 2+ TAK5 7,,HRT74 ,"! IS NO TR1T;T1 O!R ?AN TR1T+ HORMONAL IRREGUL>ITIES1 IF NE$$1 S9CE ! EPISODES >E V BRIEF1 & USU,Y IN- FREQU5T4 ,WELL1 2TA-BLOCK]S WD PROBABLY AVOID S* EPISODES1 B MO/ WD N L ! SIDE E6ECTS4 ,H["E1 ) W>N+ SIGNS ( AN ATTACK1 "O %D PULL OV] =A :ILE :5 DRIV+ A C>1 2C ! VI.N W 2 A6ECT$ =A FEW M9UTES4 ,! TRI7] ME*ANISM 9 M5 IS LESS CLE>1 B X MAY 2 DUE 6WOM5 7SMILE74 -------------------------------------#DI ,H["E1 X IS "KN T PRES]VATIVES 9 FOOD OR W9E >E ! CAUSE 9 "S 7E4G4 HOT DOGS74 ,IF A H1DA*E O3URS1 X FOLL[S ! VISUAL PRODROME1 & !N ! PRO#M IS CALL$ 8CLASSI- CAL MIGRA9E40 ,-P>$ ) MO/ MIGRA9E H1D- A*ES1 : >E (T5 SEV]E & ASSOCIAT$ ) NAU- SEA & VOMIT+1 ! H1DA*E MAY 2 MILD #AAH & USU,Y ON "O SIDE (! H1D4 A#DI ,LUMPS & ,BUMPS (! ,EYES ,T5D] ,BUMPS ON ! ,EYELIDS ,^! >E USU,Y DUE 6A /YE 7HORDEOLUM74 ,!Y >E SIMIL> 6PIMPLES OR BOILS ELSE": ON ! BODY1 & >E CAUS$ 09FEC;N ( AN EYE- LID GL& ) /APHYLOCO3US1 ! -MON SK9 PA?O- G5 BACT]IA4 ,TR1T;T C 9CLUDE HOT -PRESS- ES 6BR+ ! LE.N 6A 8H1D0 S T X C POP & DRA9 SPONTANE\SLY4 ,TOPICAL ANTIBIOTICS >E AL US$1 & R>ELY >E ORAL ANTIBIOTICS NEC4 ,SURGICAL DRA9AGE IS N USU,Y NEC1 OR EV5 PREF]R$1 S9CE PREMATURE ATTEMPT 6DRA9 ! /Y MAY CAUSE UNNEC SPR1D (! IN- FEC;N4 ,CY/S (! ,EYELID 7,*ALAZIA7 ,A *ALAZION MAY />T \ "S:AT T5D]1 L A /YE1 B ! T5D];S LESS5S &A CY/ 3TA9+ COT- TAGE *EESY /UFF DEVELOPS4 ,X DOES N DRA9 SPONTANE\SLY1 S9CE ! 3T5TS >E ?ICK] ?AN PUS1 & MAY 3T9UE 65L>GE4 ,IF SMALL1 X MAY SPONTANE\SLY G AWAY1 ABSORB+ #AAI GRADU,Y4 ,IF L>G]1 X MAY NE$ 6BE B#DI DRA9$1 9 ! DOCTOR'S (FICE USU,Y4 ,^? LO- CAT$ 9 ! UPP] EYELID MAY PRESS 9T]N,Y ON 6! EYE1 S Z 6RUB ON ! CORNEA OR BLUR VI- .N1 & "!=E NE$ DRA9AGE EV5 ?\< N L>GE4 ,IF ! O3URR;E ( *ALAZIA IS FREQU5T1 !N TETRACYCL9E ORAL M$IC,N MAY 2 NE$$1 M* L A P]SON ) ACNE "S"TS NE$S4 ,T9Y :ITE- H1D-L CY/S OR CLE>-FLUID-3TA9+ CY/S MAY O3UR ON ! EYELID M>G9S1 B NEI USU,Y ( SIGNIFICANT NE$ = TR1T;T4 ,PT]YGIUM ,? IS A SMALL GR[? ORIG9AT+ 9 ! 3JUNC- TIVA1 USU,Y T[>D ! NOSE1 : GR[S ONTO ! CORNEA4 ,MO/ PT]YGIA /OP GR[+ SPONTANE- \SLY1 B "S GR[ OV] 6BLOCK ! PUPIL1 UN.S SURGIC,Y REMOV$4 ,-PLICAT+ ! DECI.N AB TR1T;T IS ! FACT T ! EYE EASILY 2COMES V R$1 S T COSMETIC,Y X IS A PRO#M4 ,IF ! R$;S C 2 M9IMIZ$1 X 2COMES LESS (A PROB- LEM1 Z ! GR[? EV5TU,Y 2COMES 9ACTIVE4 ,USE ( DECONGE/ANTS TO 8TAKE ! R$ \0 NE$S 6BE LIMIT$1 2C ! REB.D E6ECT MAY MAKE ! R$;S WORSE4 ,ANO!R PRO#M #ABJ IS T SURGIC,Y REMOV+ ! PT]YGIUM C#DI MAY 2 FOLL[$ ) AB #EJ P]C5T RECURR;E RATE1 "S"TS EV5 6A WORSE DEGREE1 UN.S "S?+ L 2TA IRRADI,N IS US$ 6LESS5 ! -------------------------------------#EJ RECURR;E4 ,MO/ P >E REASSUR$ 6"K T ! GR[? IS LIKELY 6BE V SL[1 S T "O C TAKE "T 3SID]+ TR1T;T ALT]NATIVES4 ,! NUMB] ( SURGICAL APPROA*ES 6RECURR;ES HELPS PROVE T "! IS NO GU>ANTE$ TR1T;T4 ,! COSMETIC PRO#MS 2COME LESS 9 "T1 S T PA- TI;E 6ALL[ ! PT]YGIUM 62COME 9ACTIVE & /OP GR[+ SEEMS ADVISA# 9 MO/ CASES4 ,P+UECULUM ,? IS ANO!R SMALL GR[? ON ! 3JUNCTIVA1 USU,Y T[>D ! NOSE1 B MAY AL ORIG9ATE TO- W>D ! E>4 ,X IS USU,Y SLIC9OMAS & SQUAM\S C>C9OMAS MAY OC- CUR1 & C (T5 2 ID5TIFI$ Z 6TYPE )! SLIT LAMP MICROSCOPE4 ,! EYELID M>G9 IS FRE- QU5TLY ! SITE1 S T REMOVAL IS M -PLICAT- $4 ,! TUMOR _C J 2 SUP]FICI,Y CUT AWAY )\T L1V+ A NOT* OR DEFECT 9 ! LID M>G9 T WD N ALL[ PROTEC;N (! CORNEA4 ,AL1 USUAL TE*NIQUES ( WIDE EXCI.N M/ 2 M9IMIZ$1 & FROZ5 SEC;N PA?OLOGY TE*NIQUES MAY 2 UTILIZ$ 65SURE T ! TUMOR HAS BE5 -PLETE- LY REMOV$4 ,AF TUMOR REMOVAL1 ! DEFECT M/ 2 CLOS$ 0C>E;L REALIGN;T (! LID TIS- SUES1 S Z 6RE=M ! LID M>G9 & RETURN ! LID 6Z NORMAL A FUNC;N+ Z POSSI#4 ,USU,Y ? C 2 D"O IF ! TUMOR IS N ALL[$ 62COME TOO L>GE4 ,NEVUS (! EYELID IS AL -MON4 ,?\< BE- NIGN1 ^? : 9VOLVE ! LID M>G9 >E N S SIM- PLE 6REMOVE1 =! SAME R1SONS Z MALIGNANT TUMORS PRES5T4 ,%AV+ X (F L1VES #ABB DEEP] ROOTS T W CAUSE RECURR;E4 B#EJ ,! NEVUS M/ 2 W$G$ \1 & FULL ?ICK;S RE- PAIR IS 9VOLV$ 6AVOID NOT*+ (! EYELID4 ,) ? 9 M9D1 & 2C A NEVUS C 2 EXPECT$ TO 2COME M9IMAL 9 FULL SIZE1 X IS USU,Y AD- VISA# 6OBS]VE ! NEVUS & PLAN 6N REMOVE X UN.S X 2COMES SIGNIFICANTLY L>GE4 ,RE- MOVAL ( LID M>G9 TUMORS1 2NIGN OR MALIG- NANT1 >E BE/ MANAG$ 0AN OPH?ALMIC PLA/IC SURGEON R ?AN A D]MATOLOGI/ OR G5]AL PLA/IC SURGEON4 ,EYELID ,4ORD]S ,ECTROPION ,? IS A DROOP+ D[N (! L[] LID4 ,X C 2 AL;G ! 5TIRE L5G? (! L[] EYELID OR 3F9$ 6! "P NE> ! NOSE1 : M1NS T -------------------------------------#EA ! TE> DUCT IS 9VOLV$ & TE>+ IS A PRO#M4 ,! USUAL CAUSE IS ! UN=TUNATE -PLIC,N ( SA7+ ( FACIAL TISSUES ) AGE4 ,X C AL 2 A -PLIC,N FOLL[+ A FACE-LIFT1 ":BY EXTRA OR SA7+ SK9 IS REMOV$1 &! FACE 8TILY FOLL[+ SURG]Y1 X MAY GET A BIT BET- T] Z ! SK9 IS ALL[$ 6/RET* "S M4 ,:5 TE>+ IS 9VOLV$1 P T5D 6RUB _! EYES OR DAB AT !M 6BLOT ! TE>S AWAY4 ,UN=TUNATE- LY1 ? T5DS 6MAKE ECTROPION WORSE4 ,TR1T- ;T IS USU,Y SURGICAL1 9VOLV+ PULL+ ! LID LAT],Y 6SUSP5D X1 & "S"TS A SK9 GRAFT4 ,:5 ! ECTROPION IS MA9LY T[>D ! NOSE1 9VOLV+ ! TE> DUCT OP5+1 ! PUNCTUM1 X IS R DI6ICULT 6FIX1 & IF N A BIG COSMETIC PRO#M1 X MAY 2 BE/ LEFT UNTR1T$4 ,5TROPION ,? IS AN 9W>D TURN+ (! EYELID1 USU,Y ! L[] EYELID4 ,HAV+ 6D ) TISSUE LAX;Y1 X TOO O3URS M 9 ! ELD] POPUL,N4 ,= EXAM- PLE1 X MAY 2 ! CAUSE ( *RONIC MATT]+ 9 ! EYE (A NURS+ HOME PATI5T4 ,"S"TS ? PRO#M IS N OBVI\S1 2C ! EYELID APPE>S 6BE 9 POSI;N4 ,H["E1 CLOSE 9SPEC;N DEMON/RATES T ! EYELA%ES >E N VISI#4 ,G5TLE TRAC;N ON ! L[] LID ALL[S ! EYELA% R[ 6POP BACK 96VIEW1 (T5 ) RELIEF (! SCRAT*Y S5S,N CAUS$ 0! EYELA%ES RU2+ AG/ ! #ABD 3JUNCTIVA4 ,H["E1 ! RELIEF IS B#EA USU,Y TRANSI5T1 Z ! EYELID FLIPS BACK 9W>D1 (T5 ) J A BL9K4 ,ANO!R PRO#M IS T ! IRRIT,N CAUS$ 0! IN-TURN$ EYELA%ES CAUSES "O 6(T5 CLOSE ! EYES TID (! L[] LID4 ,TEMPOR>Y TR1T;T C 9VOLVE TAP+ 6HELP KEEP ! LID PULL$ \4 ,"S"TS A SPECIAL SUTUR+ TE*- NIQUE "WS1 B A M P]MAN5T RESULT MAY RE- QUIRE SPECIAL SURG]Y1 )! C>E;L %IFT+ ( LID /RUCTURES4 ,SURGICAL OV]CORREC;N CD CAUSE ! OPPOSITE PRO#M1 ECTROPION4 ,BLEPH>ITIS ,? IS PROBABLY ! MO/ -MON EYELID PRO#M & REPRES5TS A USU,Y *RONIC 3DI;N ( IN- FLAMM,N (! GL&S (! EYELID 7MEIBOMIAN GL&S7 & EYELA% FOLLICLES4 ,-MONLY1 X IS "P ( G5]ALIZ$ SK9 3DI;N S* Z SEBORRHEIC D]MATITIS1 B MAY AL 2 ASSOCIAT$ ) PSORI- ASIS OR ROSACEA4 ,HYP]S5SITIV;Y 6/APHY- LOCO3US1 ! -MON BACT]IUM 3TAM9ANT (! SK91 IS (T5 A FACTOR4 ,SIGNS (! PRO#M 9CLUDE R$;S AL;G ! EYELID M>G91 #ABE CRU/S ON ! EYELA%ES1 & FREQU5T C#EA /YES OR *ALAZIA4 ,TR1T;T IS USU,Y A L;G- T]M PROCESS1 9CLUD+ EYELID HYGI5E 9VOLV+ CL1N+ CRU/S F ! EYELA%ES1 & :5 SIGNIFI- CANT1 USE ( ANTIBIOTIC OR ANTIBIOTIC_/- /]OID1 O9T;T1 OR DROPS = 9T]VALS ( "T4 ,^? :O H SEBORRHEIC T5D5CIES %D TR1T _! SCALP SEBORRHEA1 & AVOID HAIR/YLES IN- VOLV+ 8BANGS0 HANG+ OV] ! EYEBR[S4 ,FRE- QU5T ASSOCIAT$ /YES OR *ALAZIA MAY SU7E/ 9T]VAL USE ( ORAL TETRACYCL9ES4 -------------------------------------#EB ,PTOSIS ,? IS A DROOP+ (! UPP] EYELID1 MAK+ ! EYE APPE> SMALL]1 & LIMIT+ ! AP]TURE1 OR SPACE1 2T ! EYELIDS4 ,? IS COSMETIC,Y A PRO#M1 ESPECI,Y IF "! IS A DI6];E 2T ! TWO EYES4 ,EV5 A #B- OR #C-;MM DI6];E IS NOTICEA#4 ,! NORMAL AP]TURE IS #AA OR #AB MM4 ,IF ! UPP] LID COV]S ! PUPIL1 OR Z M* Z HALF ! PUPIL1 !N VI.N MAY 2 AF- FECT$4 ,! PTOSIS MAY V>Y1 & 2COME WORSE :5 A P]SON IS TIR$4 ,X MAY 2 3G5ITAL1 H]$IT>Y1 OR ACQUIR$ SECOND>Y 69JURY OR A NEUROLOGICAL PRO#M4 ,TE/+ (! #ABF VISUAL FIELD MAY %[ LIMIT,N (! A#EB UPP] HALF ( VI.N1 & "!=E SU7E/ T ! 9DI- C,N = SURG]Y IS M ?AN COSMETIC4 ,SURGI- CAL CORREC;N IS -PLICAT$ 0! NE$ ( N ONLY LIFT+ ! UPP] LID & TRY+ 6MAT* X 6! O!R EYELID1 B DO+ S 9 S* A WAY Z 6RESULT 9 3T9U$ ABIL;Y (! EYELID 6BL9K & CLOSE NORM,Y1 6PROTECT ! CORNEA4 ,? PROC$URE IS BE/ P]=M$ 0AN OPH?ALMIC PLA/IC SUR- GEON1 R ?AN A REGUL> PLA/IC SURGEON4 ,D]MATO*ALASIS ,D]MATO*ALASIS 7-MONLY CALL$1 ?\< IN- CORRECTLY1 BLEPH>O*ALASIS7 IS ! T]M =! BA7Y DROOP+ ( /RET*$ SK91 USU,Y (! UPP] EYELIDS4 ,X IS EXTREMELY -MON ) 9CR1S+ AGE1 & (T5 ASSOCIAT$ ) 2+ OV]WEIY4 ,! DEGREE V>IES F A MILD COSMETIC PRO#M1 6! PO9T ": ! SK9 (! UPP] LID DROOPS S M* T VI.N IS LIMIT$ 9 ! UPP] FIELD ( VI.N4 ,ONCE ! SK9 2G9S 6/RET*1 X IS ADVISA# TO AVOID ! TEMPT,N 6RUB ! EYES1 : C MAKE X WORSE4 ,REMOVAL (! EXCESS SK9 C 2 D"O1 ) GD COSMETIC & FUNC;NAL RESULT4 #ABG ,H["E1 9SUR.E & ,M$IC>E MAY N B#EB COV] ! EXP5SE ( SURG]Y IF X SEEMS 6BE ONLY = COSMETIC PURPOSES4 ,BLEPH>OSPASM ,? 3DI;N IS N -MON & AM.TS 6UNCONTROL- LA# T5D5CY =! EYELIDS 6CLOSE 9VOLUNT>I- LY1 TRANSI5TLY1 OR = 9CR1S+ P]IODS ( "T1 V>Y+ F 9CR1S$ BL9K+ 6CLOSURE (! LIDS1 ) PROL;G$ 9ABIL;Y 6OP5 !M 6ALL[ VI.N SAFE- LY =1 SAY1 DRIV+ A C>4 ,USU,Y ? IS AN IDIOPA?IC PRIM>Y 3DI;N1 B X C 2 A "P ( NEUROLOGIC 3DI;NS S* Z ,P>K9SONISM OR ,MEIGE'S ,SYNDROME4 ,9JEC;N ( BOTUL9UM TOX9 7,BOTOX71 96! FACIAL N]VE C %[ IM- PROVE;T = V>IA# L5G?S ( "T1 (T5 MON?S4 ,? 0 "O (! ORIG9AL USES ( ,BOTOX1 2F 8WR9KLES40 ,MYOKYMIA ,? IS A 3DI;N T 9VOLVES 9VOLUNT>Y TWIT*+ (! EYELIDS1 UPP] OR L[]1 OR BO?4 ,S5S,N C V>Y F A FEEL+ ( FULL;S1 6A TWIT*+ FEEL+1 62+ A# 6SEE ! LID TWIT* 9 ! MIRROR4 ,EPISODES >E TRANSI5T1 #ABH BRIEF1 & V>IA# 9 FREQU5CY4 ,! C#EB USUAL EXPECT,N IS = SPONTANE\S -------------------------------------#EC CESS,N1 ?\< "! MAY 2 O3A.NAL RECURR;E4 ,TWIT*+ IS FELT 6BE AK9 6N]V\S;S1 S A P]SON 2COMES SELF-3SCI\S & SEEKS WAYS TO CALM D[N4 ,H["E1 AVOID+ C(FEE1 SLEEP+ L;G]1 OR TAK+ TRANQUILIZ]S DOES N HELP4 ,A P]SON GETS BETT] ANYWAY1 & MAY Z WELL P]=M Z NORM,Y4 ,LID ,RETRAC;N ,? IS A SITU,N ":BY ! UPP] LID ACTU,Y PULLS UPW>D1 MAK+ ! EYE OR EYES APPE> L>G]4 ,A SMALL DEGREE ( ? MAY 2 )9 NOR- MAL LIMITS1 B A GRT] AM.T1 ESPECI,Y IF M 9 "O EYE ?AN ! O!R1 MAY 9DICATE ?YROID HYP]ACTIVE 41SE1 & AL ESPECI,Y IF NOT$ :ILE LOOK+ D[NW>D4 ,WORS5+ (! ?YROID 3DI;N MAY AL RESULT 9 D\# VI.N1 ESPECI,Y :ILE LOOK+ UPW>D1 & BULG+ =W>D (! EYE OR EYES1 CALL$ EXOPH?ALMOS4 #ABI ,IT*Y ,EYES A#EC ,IT*Y ,EYELIDS ,^! C 2 AN ACUTE OR *RONIC PRO#M4 ,ACUTE PRO#MS 9CLUDE ! HIVELIKE REAC;N 6"S?+ USU,Y ( =EIGN PROTE91 S* Z AN IN- SECT BITE4 ,LOCALIZ$ SWELL+ C 2 REM>KA#1 UNA3OMPANI$ 0R$;S OR 4*>GE1 B ( C\RSE ASSOCIAT$ ) IT*+4 ,? %D 2 %ORT-LIV$1 & WD 2 SPE$$ 9 RECOV]Y 0TOPICAL /]OIDS OR ORAL ANTIHI/AM9E4 ,*RONIC IT*+ & R$;S1 (T5 A3OMPANI$ 0DRY SCALY D]MATITIS ) WR9KL+1 IS USU,Y DUE 6A 3TACT D]MATITIS4 ,? M1NS ! PATI5T IS H&L+ "S?+ 6: !Y >E ALL]GIC1 & SPR1D+ ! ALL]GY-CAUS+ MAT]IAL 6! FACE 0! H&S4 ,X IS N NEC T ! ALL]G5 2 DIRECTLY APPLI$ 6! EYE >EA4 ,9 A "R-H&$ P]SON1 ! "R EYE >EA IS M LIKELY 6BE IN- VOLV$4 ,! SK9 >.D ! EYES W 2 ! F/ SIGN ( ? 3TACT D]MATITIS1 &A M G5]ALIZ$ =M EV5- TU,Y %[S 9VOLVE;T ( 9SIDE ! ELB[S OR "U- >MS4 ,TR1T;T 9VOLVES RECOGNIZ+ ! ALL]G51 : MAY 2 "S?+ Z -MON Z A DET]G5T OR CLO?+ DYE1 & AVOID+ 3TACT ) X4 ,TOPICAL /]OID LO;NS RELIEVE SYMPTOMS1 B D N #ACJ AVOID RECURR;E4 ,! MO/ -MON M$I- B#EC C,N CAUS+ S* SYMPTOMS ( ALL]GY IS ,NEO- MYC91 : IS 3TA9$ 9 ,NEOSPOR9 & O!R ANTI- BIOTIC TOPICAL M$IC,NS4 ,IT*Y ,EYEBALLS ,^! C 2 A SIGNIFICANT PRO#M & N S EASY 6DIAGNOSE Z 6! CAUSE1 B USU,Y DUE 6ALL]- GY4 ,SYMPTOMS C 2 A "P ( ALL]GIES S* Z HAY FEV]1 OR Z OBVI\S Z VISIT+ A H\SE )A CAT PRES5T4 ,! EYES 2COME R$ & TE>+4 ,RELIEF C 2 OBTA9$ )A NUMB] ( M$IC,NS1 B USU,Y TOPICAL EYE DROPS >E BETT] ?AN ORAL ANTI-ALL]GY M$IC,NS4 -------------------------------------#ED ,"! C 2 PAPILL>Y *ANGES 9 ! 3JUNCTIVA1 : >E RECOGNIZA# 0A SLIT LAMP 7MICROSCOPIC7 EXAM1 6HELP DI6]5TIATE ALL]GY F O!R CAUSES ( R$ EYE1 S* Z 3JUNCTIVITIS4 ,^! C 2 S SEV]E Z 6CAUSE 8GIANT PAPILLAE10 MO/ -MONLY SE5 ) ALL]GY 6PROTE9 BUILDUP ON S(T 3TACT L5SES4 ,2F ! 9TRODUC;N ( DAILY WE> 4POSA# L5SES1 S* ALL]GIC REAC- ;N (T5 DOOM$ A PATI5T 6N 2+ A# 6WE> S(T 3TACT L5SES2 B S9CE 4POSA# 3TACT #ACA L5SES1 ? GIANT PAPILL>Y 3JUNCTI- A#ED VITIS TYPE ( ALL]GY IS R>E4 ,EYE DROPS GIV+ RELIEF C 2 (! VASOCON- /RICTOR TYPE1 S* Z ,VIS9E OR ,VASOCON1 : >E AVAILA# )\T PRESCRIP;N4 ,^! M$IC,NS GIVE PROMPT1 B TEMPOR>Y1 RELIEF4 ,! UN=- TUNATE T5D5CY 6REP1T USE1 AT :AT C 2COME %ORT] & %ORT] 9T]VALS1 C RESULT 9 REB.D R$;S 2C ( REFLEX VASODILAT,N1 & ACTU,Y MAKE ! EYES WORSE4 ,S IF X IS DESIRA# TO TAKE ! R$ \ =A SPECIAL O3A.N1 S* Z GETT+ YR PICTURE TAK51 X IS ,,OK 6USE VASOCON- /RICTOR 8TAKE ! R$ \0 EYE DROPS4 ,H["E1 IF L;G-T]M RELIEF IS DESIR$1 PRESCRIP;N M$IC,NS >E AVAILA#4 ,PRESCRIP;N EYE DROPS C 2 ANTIHI/AM9E1 MA/ CELL /ABILIZ]1 OR ANTI-9FLAMMATORY 9 AC;N1 OR A -B9,N ( ^! AC;NS4 ,S* M$IC,NS MAY N 2 Q S RAPID 9 RELIEF E6ECT1 B C 2 3T9U$ = L;G-T]M E6ECT DUR+ ! ALL]GY SEA- SON4 ,/]OID EYE DROPS >E AM;G ! BE/ = PROMPT & LA/+ RELIEF1 B ( C\RSE C>RY ! POSSIBIL;Y ( L;G-T]M -PLIC,NS S* Z GLAU- -A 7IN A SIGNIFICANT P]C5TAGE ( P7 OR CAT>ACTS 7IF US$ =A L;G "T74 #ACB ,,NSAID 7NON /]OIDAL ANTI- B#ED 9FLAMMATORY DRUG7 EYE DROPS >E AL AVAIL- A#1 : H SIMIL>1 IF N Z RELIA#1 E6ECTS Z /]OID DROPS1 )\T ! POT5TIAL SIDE E6ECTS4 ,LESS POT5T /]OID DROPS H AL BE5 PROVID- $1 : MAY GIVE ! POSITIVE B5EFICIAL EF- FECTS ( /]OID DROPS1 ) GRTLY DIM9I%$ *.ES ( -PLIC,NS4 #ACC C#ED #ACD #G #EE ,/RABISMUS 7,CROSS-,EY$ & ,WALL-,EY$7 ,/RABISMUS 7STRAH-BIS-MUS7 IS A FANCY T]M =! FACT T ! EYES >E N /RAIE 8PRIM>Y10 M1N+ ORIG9 F *ILDHOOD DEVELOP;T4 ,SECOND>Y /RABISMUS MAY RESULT F 9JURY1 NEUROLOGIC1 OR M$I- CAL PRO#MS4 ,ESOTROPIA1 2+ CROSS-EY$1 MAY 2 F BIR? 73G5ITAL7 OR ACQUIR$4 ,2+ CROSS-EY$ M1NS T "O EYE IS N /RAID ! NOSE4 ,IF A * %[S T ! SAME EYE IS ALW CROSS$1 !N T EYE IS 9 DANG] ( 2+ AMBLYOPIC1 & N DEVELOP+ NORMAL VI.N4 ,"S CROSS-EY$ *N C ALT]NATE FREELY1 M1N+ T !Y C SWIT* EYES1 & USE EI EYE Q WELL4 ,^! *N >E N AT RISK ( AMBLYOPIA1 B ( C\RSE NE$ PROFES.NAL REASSUR.E AB ?4 ,? IS ! GOAL ( PAT*+ :5 TR1T+ AMBLYOPIA1 TO MAKE ! * SEE WELL ) EA* EYE4 ,B1 IF ! * C ALT]NATE FIX,N NATUR,Y1 !N PAT*+ MAY N 2 NEC 6IMPROVE VI.N4 ,H["E1 PAT*+ MAY 2 US$ 2F SURG]Y EV5 IF ! VI.N SEEMS #ACE EQU,Y GD 9 EA* EYE4 ,? WD 2 D"O A#EE 6BR1K UP HABITS ( SUPPRES.N 7IGNOR+ "O EYE 6AVOID D\# VI.N71 & GET1 P]H1 A B9- OCUL> RESULT F SURG]Y4 ,! /RAILY 9FANCY1 :5 ! EYES MAY SEEM 6DRIFT ONCE 9 A :ILE4 ,! VI.N & EYE COORD9,N TAKES "T 6DEVELOP4 ,H["E1 IF X IS APP>5T T A BABY'S EYES >E RE,Y CROSS$1 !N ! * %D 2 EXAM9$ EV5 9 E>LY 9FANCY4 ,S IF ! BABY'S EYES / LOOK CROSS$1 ONLY "S"TS AT AGE SIX MON?S1 ? * %D AL 2 EXAM9$4 ,A * AGE ?REE C USU,Y 2 TAUT4 ,! FREQU5CY ( PRE- S*OOL ATT5D.E ^! "DS HAS M1NT T M *N >E ADV.ED 9 2+ A# 6R1D ! ,,ABC *>TS4 ,? IS GD1 2C ! RESULTS ( R1D+ A R[ ( LRS Z 9 ! ,SNELL5 ,,ABC *>TS IS M A3URATE ?AN ! ILLIT]ATE ;,E *>T 9 REASSUR+ T BO? EYES SEE EQU,Y WELL4 -------------------------------------#EF ,! GOALS ( TR1T;T (! CROSS-EY$ * >E BASIC,Y ?REE4 ,! F/1 & MO/ #ACF IMPORTANT1 GOAL IS 6PROVIDE TWO A#EF EYES T SEE WELL1 ) OR )\T GLASSES1 EV5 IF !Y >E N /RAIE N P]- FECTLY /RAIE ! EYES LOOK+ /RAIE /RAIE "W+ TGR B9OCUL>LY 7) /]EOPSIS DEP? P]CEP;N74 ,TO A3OMPLI% ^! GOALS MAY REQUIRE PAT*+1 EYE DROPS1 GLASSES1 SURG]Y1 OR A -B9,N ( ALL ^! ?+S4 ,IF ! ULTIMATE GOAL ( B9OCUL> VI.N IS OBTA9$1 !N 3T9U$ GD RESULT IS EXPECT$4 ,H["E1 IF FU.N1 OR B9OCUL> RE- SULT1 IS N OBTA9$1 !N "! IS NO?+ 6HOLD ! EYES /RAILY GD COSMETIC SURGICAL RESULT MAY N LA/1 & FUR!R SUR- G]Y MAY 2 NE$$ LAT]4 ,! ONSET ( 2COM+ CROSS-EY$ >.D AGE ?REE IS Q -MON1 & IS USU,Y RELAT$ 6! NE$ = GLASSES 6CORRECT F>SIE P>ALLEL = 4T.E M/ MOVE 9W>D TGR S Z 6BE LOOK+ AT AN OBJECT CLOS]4 ,! EMMETROPIC EYE1 9 P]FECT FOCUS = 4T.E1 REQUIRES #C DIOPT]S ( FOCUS+ AT #A_/C MET]4 ,ASSUM+ BO? EYES >E AB ! SAME1 ? NORMAL REL,N%IP DEVELOPS4 ,AL;G ) ? FOCUS+ DEM&1 "! IS AL A 8DEM&0 = 3V]G;E (! EYES1 S T !Y BO? PO9T AT AN OBJECT #A_/C MET] AWAY4 ,! 8NORMAL0 RE- FLEX WD M1N T = E DIOPT] ( FOCUS+1 ! EYES LE>N 63V]GE AN APPROPRIATE AM.T4 ,?US1 =A CLOSE UP 4T.E ( #A MET]1 !N #A DIOPT] ( FOCUS+ IS REQUIR$1 &! EYES M/ MOVE 9W>D 6BE 3V]G$ 6A 4T.E ( #A MET]4 ,ASSUM+ T A * MAY 2 #C DIOPT]S F>SI1 :ILE FOCUS+ EXTRA = 4T.E1 M/ IGNORE ! EXCESSIVE REFLEX DEM& 6AL 3V]GE AT 4T.E4 ,!N1 = CLOSE VI.N1 ? SAME * WD H 6REDUCE ! AM.T ( 3V]G;E 2+ RE- FLEXIVELY CALL$ = 0M ?AN ! NORMAL #ACH AM.T ( FOCUS+ = ? CLOSE 4T.E4 C#EF ,US+ S* AN EXAMPLE1 X IS EASY 6"U/& H[ A * MAY 2COME CROSS-EY$ IF V F>SI+ GLASSES = #C DIOPT]S ( F>SI VI.N )\T GLASSES IS DI6I- CULT "U ^! CIRCUM/.ES1 B *N SEEM 6D X 9 MO/ CASES1 S9CE ! 9CID;E ( 2+ CROSS-EY$ IS N EQUAL 6! AM.T ( *N :O >E F>SISIE -------------------------------------#EG USU,Y /RAI1 = CLOSE "W4 ,! * IS N EXPECT$ 6-PLA91 Z ! BRA9 IS / ADAPTA#4 ,! BRA9 AVOIDS 3FU- .N BY 8SUPPRESS+0 ! IMAGE 9 ! DEVIAT$ EYE4 ,! * DOES N EV5 "K :AT IS M1NT BY 8D\# VI.N40 ,IF N TR1T$1 AMBLYOPIA MAY RESULT1 J L 9 ! * BORN CROSS-EY$4 #ACI ,! TR1T;T1 & POSSI# CURE1 ( AC- A#EG -MODATIVE ESOTROPIA IS GLASSES1 ?\< X MAY 2COME M -PLICAT$4 ,Z "O MAY 2 A# TO "U/&1 PUTT+ GLASSES ON ! #C-DIOPT] F>- SI1 ALL[+ ! EYES 6"W TGR 9 M NORMAL REFLEX AC;N4 ,H["E1 ONCE ! EYES 2G9 6CROSS1 M ?AN ! BASIC GLASSES MAY 2 REQUIR$4 ,"! SEEMS 6BE AN EXTRA PRO#M ( OV]CONV]G;E 9 _M *N1 S T EV5 ) GLASSES T /RAI WAY1 :AT"E X TAKES4 ,SURG]Y MAY AL 2 REQUIR$4 ,IF B9OCUL> RESULT C 2 OBTA9$1 !N ! * MAY G "? LIFE RETA9+ ? B5EFIT4 ,S9CE ? EXTRA 8SPA/IC0 TYPE REFLEX 6OV]CONV]GE AT NE> REDUCES ) MATUR,N1 ! NE$ = GLASS- ES W *ANGE4 ,! BIFOCALS W PROBABLY N 2 REQUIR$ Z ! * MATURES1 & EV5 ! NE$ = GLASSES MAY 2 REDUC$ 6A "P-"T NE$4 ,CON- TACT L5SES MAY 2COME AN OP;N4 #ADJ ,REPORT$LY1 A ,HEISMAN TROPHY W9- B#EG N]1 ! QU>T]BACK ON ! ,,USC ,NO4 #A FOOT- BALL T1M 9 ! N,N1 HAS G"O "? ^! /EPS1 BIFOCAL GLASSES1 & SURG]Y1 & APP>5TLY HAS A*IEV$ B9OCUL> RESULTS4 ,? MAY 2 AM;G 8 GRTE/ A3OMPLI%;TS4 ,SURG]Y = ESOTROPIA 7CROSS-EYES7 C 2 Q SU3ESS;L1 B SU3ESS M/ 2 TEMP]$ 0OV]ALL RESULT4 ,! GOALS M/ 2 3SID]$ PREOP]A- TIVELY4 ,IF BO? EYES SEE WELL1 O!R TR1T- ;TS H BE5 UTILIZ$ 6A*IEVE ? /ATUS1 &A B9OCUL> RESULT IS ! GOAL1 !N X M/ 2 "U- /OOD T GLASSES & O!R TR1T;TS MAY 2 NEC 6MA9TA9 A GD RESULT PO/OP]ATIVELY4 ,^! MUSCLES >E NORM,Y Q /R;G1 A# 6D P]H #AJJ "TS ! P[] REQUIR$1 B EXPECT$ 6"W 9 A DELICATE COORD9,N ) O!R MUSCLES4 ,SURG]Y MAY !N 2 -P>$ 6DO+ AN OR?OP$IC TYPE PRO- C$URE =A NEUROLOGIC PRO#M1 OR M CRUDELY1 A C>P5TRY MANAGE;T = AN ELECTRONIC PROB- LEM4 ,TR1T;T (! NEUROLOGIC 7ELECTRONIC7 POR;N1 ( C\RSE1 REF]S 6NE$ = GLASSES1 PAT*+1 & S =?4 ,! AM.T ( SURG]Y IS DET]- M9$ 0! AM.T ( CROSS+ (! EYES1 .) .COR- RECTIVE .GLASSES1 N ! AM.T ( #ADA CROSS+ )\T GLASSES4 ,? IS DI6I- C#EG CULT = P>5TS 6"U/&4 ,Z M5;N$1 IF GLASSES >E NE$$ PO/OP]ATIVELY1 !Y EV5TU,Y MAY N 2 NE$$ ONCE A GD RESULT HAS BE5 MA9TA9$ NEUROLOGIC,Y1 A B9OCUL> RESULT4 ,IF ! AM.T ( SURG]Y IS P]=M$ 6MAKE ! EYES /RAISIE N Z E6ECTIVE Z GLASSES1 BIFOCALS1 EYE DROPS1 OR SURG]Y 9 CORRECT+ ESOTROPIA & AMBLYOPIA4 -------------------------------------#EH ,! EXAMPLE ( 2COM+ CROSS-EY$ >.D AGE ?REE Z 9DIC,N ( A3OMMODATIVE TYPE AC- QUIR$ ESOTROPIA IS ILLU/RATIVE1 & BASI- C,Y TRUE1 B "! SEEM 6BE O!R FACTORS1 (T5 H]$IT>Y4 ,= EXAMPLE1 PROBABLY ! MAJOR;Y ( F>SI;Y4 ,9 REG>D 6H]$IT>Y FACTORS1 ,I RECOLLECT A LOVELY "Y LADY :O BR"\ H] ?IRD SON1 H] ?IRD *1 9 = EXAM4 ,%E 0 FULLY EXPECT+ T ! FACT T S9CE %E H]F _H BE5 CROSS-EY$1 NE$+ GLASSES & #ADB EV5TU,Y 3TACT L5SES 6KEEP H] EYES A#EH /RAI+ _! GLASSES71 T ? "YE/ SON 0 AL DES- T9$ ! SAME FATE4 ,:5 ,I TOLD H] T ? SON 0 N CROSS-EY$ & 0 N EXPECT$ 6NE$ GLASS- ES1 A FA9T SMILE CROSS$ H] FACE4 ,I 9T]- PRET$ ? 6M1N T X MAY 2 WOR? ANO!R TRY =A GIRL1 & MAYBE "O :O WD N 2 CROSS-EY$4 ,PSEUDO/RABISMUS C RESULT F A 3DI;N CALL$ EPICAN?US1 A FOLD 9 ! SK9 T[>D ! NOSE T IS Q -MON 9 ,ASIANS1 B O3URS 9 ALL RACES4 ,*N ) ? 3DI;N C APPE> 6BE CROSS-EY$1 EV5 :5 ! EYES >E P]FECTLY /RAIS AGO4 ,8 "M _H REASSUR$ ME T H] * 0 CROSS-EY$1 B WD \TGR[ ! PRO#M L 8 OLD] SIBL+S4 ,S9CE !Y 7 NE>BY1 ,I 9VIT$ ! O!R SIBL+S ( ? L>GE FAMILY 96! ROOM4 #ADC ,!Y DEMON/RAT$ /AGES ( NOSE GR[? B#EH & DIM9I%+ DEGREE ( EPICAN?US1 3FIRM+ T N"O ( !M _H "E BE5 CROSS-EY$4 ,H["E1 S* A /ORY ( 8\TGR[+0 2+ CROSS-EY$ IS A BAD 9FLU;E ON P>5TS :O DELAY BR++ _! *N 9 = TR1T;T4 ,EXOTROPIA1 ! \TW>D TURN+ ( "O EYE IS A DI6]5T PRO#M 9 _M WAYS4 ,! ONSET IS USU,Y LAT]1 S T E>LY ONSET 9 9FANCY C SIGNAL O!R NEUROLOGICAL PRO#M4 ,"! >E O!R DI6];ES4 ,3TR>Y 6ESOTROPIC *N1 AM- BLYOPIA IS N EXPECT$ ) EXOTROPIA4 ,9 AD- DI;N1 A =M ( B9OCUL> VI.N IS USU,Y MA9- TA9$1 A3OMPANI$ 0A TYPE ( SITU,NAL SUP- PRES.N 6AVOID D\# VI.N4 ,9 O!R ^WS1 ! * MAY H NORMAL DEP? P]CEP;N M* (! "T1 B :5 "O EYE DRIFTS \TW>D1 ! VI.N IS SELEC- TIVELY SUPPRESS$ 9 T EYE S Z 6N 2 ANNOY$ 0DIPLOPIA 7D\# VI.N74 ,! APP>5T ONSET ( EXOTROPIA MAY N 2 EVID5T UNTIL ADULT LIFE1 B ! LACK ( DIPLOPIA IS A FACTOR1 M1N+ T ! ACTUAL ONSET 0 9 E>LY *ILDHOOD4 ,USU,Y "O EYE DRIFTS :5 LOOK+ AT A 4T.E1 9T]MITT5TLY AT F/1 B ! 3DI;N MAY PRO- GRESS 6! PO9T ": "O EYE IS TURN$ #ADD \TW>D ALL ! "T1 EV5 = CLOSE VI.N4 C#EH ,9 ! M1N"T1 ! EXOTROPIC PATI5T DOES N -PLA94 ,P>5TS & O!RS MAY NOTICE DRIFT+ \ ( "O EYE1 & S9CE X SEEMS 9T]MITT5T1 & 3TROLL$ 0BL9K+ OR P>5TS YELL+ 9/RUC;NS 6/RAI5TS "S"TS ?9K !Y >E RESPONSI# TO 3TROL ! *'S EYES1 03/ANT REM9D]4 ,"O SYMPTOM IS ! APP>5T LIE ( ?1 S9CE HE OR %E IS N UNAW>E ( D\# VI.N1 & UNAW>E T ! CLOSURE ( "O EYE \TDOORS IS ACTU,Y 6AVOID A =M ( D\# VI.N1 : APP>5T- LY _C 2 S EASILY IGNOR$ 9 SUNLIE N TRULY PHOTOS5SITIVE1 OR !Y WD H TO CLOSE OR SQU9T BO? EYES4 ,IF ! \TW>D TURN+ 2COMES WORSE1 ! PATI5TS FEEL T P >E N LOOK+ AT !M 9 3V]S,N1 2C (! NATURAL T5D5CY ( P 6LOOK AT ! WR;G EYE1 ! \TW>D- TURN$1 EYE4 ,? MAKES A PATI5T FEEL UN- -=TA#4 ,AL1 O!R P MAY ?9K T #ADE EXOTROPIC PATI5TS H A %IFTY OR A#EI UNTRU/WOR?Y APPE>.E1 S9CE !Y D N APPE> 6LOOK O!RS 9 ! EYE4 ,TR1T;T ( EXOTROPIA MAY 9VOLVE GLASS- ES1 IF ! PATI5T IS NE>SIANTE$ TO 2 P]MAN5T4 ,ACTU,Y1 X IS ALL "R 63SID] COSMETIC GOALS Z AN 9DICATOR4 ,9 O!R ^WS1 IF ! PRO#M IS B>ELY NOTICEA#1 !N "! IS LESS 9DIC,N = SURG]Y4 ,ANO!R FACTOR1 H["E1 IS T 9SUR.E IS M LIKELY 6COV] ! SURG]Y 9 *ILDHOOD ?AN ADULT LIFE1 :5 ! PROC$URE MAY 2 3SID]$ COSMETIC 0! 9SUR.E -PANY4 ,PO/OP]ATIVELY1 D\# VI.N C 2 TEM- POR>ILY EXPECT$1 & ? IS N ALL BAD1 S9CE A M P]MAN5T RESULT MAY !N 2 EXPECT$ :5 ! D\# VI.N GOES AWAY4 ,SECOND>Y /RABISMUS REF]S 6SITU,NS ": ! EYES T 7 ONCE B9OCUL>1 OR "W+ #ADF TGR1 LOSE B9OCUL>;Y4 ,?1 ( C\RSE1 B#EI RESULTS 9 D\# VI.N 7DIPLOPIA74 ,? IS AL 9 3TRA/ 6! P]SON 9 *ILDHOOD :O DEVELOPS MISALIGN;T (! EYES &1 IF "Y 5\<1 C IG- NORE "O EYE S Z 6AVOID D\# VI.N4 ,CAUSES ( SECOND>Y /RABISMUS C V>Y F 9JURY1 TO SURG]Y1 41SE S* Z ?YROID PRO#M1 NEURO- LOGIC 41SE S* Z /ROKE OR MULTIPLE SCL]O- SIS1 OR N UNCOMMONLY1 CAUSE UN"KN4 ,ONCE B9OCUL>;Y HAS BE5 A3OMPLI%$1 ! EYES H "S DEGREE ( ABIL;Y 6KEEP !MVS /RAI$ 6! F9E-TUN+ (A ,,TV SET4 ,! \TW>D-TURN+ T5D5CY C 2 OV]- -E 03V]G;E1 A V P[];L ABIL;Y ( MO/ P 9 ORD] 6AVOID D\# VI.N1 L A HORIZONTAL HOLD ADJU/;T (A ,,TV4 ,! ABIL;Y 6OV]COME ! CROSS+ T5D5CY IS LESS1 & REQUIRES DI- V]G;E1 ! \TW>D-TURN+ ABIL;Y (! EYES4 ,! V]TICAL SEP>,N ( IMAGES IS ! MO/ DI6I- CULT =! EYES 6OV]COME1 & USU,Y REQUIRES A PRISM 9 ! GLASSES 6AVOID D\# VI.N4 ,( ^! F9E-TUN+ ABILITIES1 ! ONLY "O PRACTI- C,Y TR1T$ 0EX]CISES IS 3V]G;E4 ,S ! PRI- M>Y 9DIC,N = EYE EX]CISES IS = 3V]G;E 9SU6ICI5CY1 ESPECI,Y DEMON/RAT$ 9 #ADG R1D+ PRO#MS4 ,? C#EI -------------------------------------#FJ IS EI PRIM>ILY A PRO#M1 S* Z 9 NE>SI _! GLASSES = R1D+1 OR A SECOND>Y "O1 S* Z 9 H1D 9JU- RIES4 ,( 9T]E/ IS ! FACT T ! GRTE/ DIS- ABIL;Y IS 9 CASES ": ! IMAGES >E CLOSE TGR1 B SEP>AT$4 ,? TYPE DIPLOPIA IS V ANNOY+ & 3FUS+4 ,:5 ! IMAGES >E F> A"P1 X IS EASI] 6IGNORE "O IMAGE1 & 3C5TRATE ON ! O!R4 ,9 CASES ": ! IMAGES >E CLOSE TGR1 A LL PRISM 9 ! GLASSES MAY HELP A LOT 0BR++ ! IMAGES TGR4 ,H["E1 IF ! D\# VI.N V>IES1 Z :5 LOOK+ "R OR LEFT1 !N PRISMS W N "W4 ,IF ! EYES 7 B9OCUL> 2F DIPLOPIA 7D\# VI.N7 O3URR$1 !N "! IS A GD *.E T ! TWO EYES W REGA9 FU.N1 ! USE (! EYES TGR1 ONCE "! IS IMPROVE;T 9 ! PRO#M T CAUS$ ! SECOND>Y /RABISMUS1 S* Z 9 /ROKE RECOV- ]Y4 ,9 ! M1N"T1 X IS IMPORTANT 65C\RAGE B9OCUL> USE (! EYES1 S* Z ALL[+ H1D TURN OR TILT 6AVOID DIPLOPIA1 R ?AN COV] "O EYE4 ,COV]+ "O EYE IS A TEMPOR>Y RELIEF ( DIPLOPIA1 B MAY DELAY #ADH SPONTANE\S RECOV]Y4 ,EX]CISES1 IF A#FJ UTILIZ$1 MAY 2 GIV5 FALSE CR$IT = SPON- TANE\S NEUROLOGICAL IMPROVE;T1 S9CE ! PRO#M IS USU,Y N W1K MUSCLES1 B TEMPOR>Y LACK ( NEUROLOGICAL 9PUT4 ,SECOND>Y /RABISMUS MAY AL RESULT F LOSS ( VI.N 9 "O EYE4 ,! S-CALL$ FU.N- FREE POSI;N (A BL EYE IS 6BE CROSS$ 9 *ILDHOOD1 & 6BE \TW>D TURN$ OR EXOTROPIC 9 ADULT LIFE4 ,S* MAY 2 ! EXPECT,NS =A BL EYE F 9JURY4 ,AN EYE CROSS$ 9 *ILD- HOOD = S* R1SON MAY H["E SEEM 6/RAID 9 ADULT LIFE4 ,S* C AL 2 ! CASE = AN AMBLYOPIC EYE1 GO+ F 2+ CROSS$ 9 *ILDHOOD 6EXOTROPIC LAT] 9 LIFE1 EV5 IF "! HAS BE5 NO SUR- G]Y4 #ADI B#FJ #AEJ ,,"P ,,III #FA-FC ,,AGE-RELAT$ ,,EYE ,,PRO#MS 7,,GETT+ ,,OLD ,,A9'T ,,= ,,SISSIES7 #H ,PRESBYOPIA ,! TR1T;T ( AGE-RELAT$ HE>+ 4ORD]1 CALL$ PRESBYCUSIS1 IS AMPLIFIC,N4 ,! TR1T;T ( AGE-RELAT$ VI.N LOSS1 CALL$ PRESBYOPIA1 IS MAGNIFIC,N4 ,PRESBYCUSIS IS Q LIKELY4 ,PRESBYOPIA IS PREDICTABLY 9EVITA#4 ,! EYE1 HAV+ G"O "? NORMAL DEVELOP;T1 R1*ES FULL SIZE1 & HAS GRT P[]S ( AC- -MOD,N1 OR FOCUS+4 ,EV5TU,Y AB #AJ DIOP- T]S OR UNITS ( FOCUS+ ABIL;Y DEVELOP1 & >E RETA9$ "? ! TW5TIES 9 AGE4 ,! A3OMMO- D,N GRADU,Y REDUCES 9 \R ?IRTIES1 UNTIL X 2G9S 6BE A NOTICEA# PRO#M 9 FOCUS+ UP CLOSE 0MID =TIES1 AT : "T X HAS DROPP$ 6#C DIOPT]S1 GIV+ A NE> PO9T ( AB TWELVE 9*ES4 ,S :5 "O HAS _H A FEW 8,JACK ,B5NY ,BIR?"DS0 7HE 0 ?IRTY-N9E :5 HE DI$71 R1D+ HELP IS NE$$1 EV5 IF VI.N 0 #AEA 8P]FECT0 2F4 ,! >MS GET 8TOO A#FC %ORT10 2C ! CLOS] SMALL OBJECTS >E BR"\ 6! EYES 7N J = R1D+1 B ANY SMALL OB- JECT71 ! M ! FOCUS+ LIMIT,N IS EVID5T4 ,GD LIILY4 ,PRESBYOPIA IS AN AGE-RELAT$ PRO#M1 B N 2LIEV$ 6BE DUE 6OLD OR W1K FOCUS+ MUS- CLES4 ,?"\S AL;G ^! L9ES H SU7E/$ EYE EX]CISES OR SPECIAL DIETS1 B S* EXP]I;TS >E N FRUIT;L1 O!R ?AN PSY*OLOGIC,Y4 ,! A3EPTA# !ORY IS T DECR1SE ( A3OMMOD,N DUE 6AGE IS DUE 6SCL]OSIS1 OR H>D5+ (! L5S (! EYE1 S* T FOCUS+ MUSCUL> EF=T GETS LESS RESULT4 ,"O (! PRO#MS 9 EVALU- AT+ AGE-RELAT$ FOCUS+ PRO#MS1 IS T MO/ E/IMATES >E BAS$ ON SUBJECTIVE FACTORS1 : 9VOLVE TOO _M V>IA#S1 S* Z LISI+ -------------------------------------#FD _! GLASSES1 EXP]I;ES TR\# R1D+ AL1 & NE$S "S?+ DI6]5T = R1D+ ?AN !Y D = 4T.E4 ,SAME =! F>SIE EMMETROPIC1 "! 0 NO PRE- VI\S PRO#M1 &! EYES MAY 3T9UE 6SEE Q WELL = 4T.E )\T GLASSES4 ,? MAKES ! NE$ = GLASSES1 =! F/ "T1 P]H EV5 M SURPRIS+4 ,! EMMETROPIC SITU,N EXI/S 9 AB =TY P] C5T (! POPUL,N1 & "!=E ! L>GE/ GR\P4 ,"! >E .?REE K9DS ( R1D+ GLASSES4 ,:AT MO/ P ?9K ( Z R1D+ GLASSES >E :AT >E CALL$ S+LE-VI.N R1D+ GLASSES4 ,? M1NS T ! :OLE FULL SIZ$ L5S IS ! R1D+ CORREC;N1 9 A FULL SIZ$ FRAME4 ,ACTU,Y1 EV5TU,Y1 ? 2COMES ! WOR/ (! ?REE *OICES = R1D+ GLASSES DUE 6LACK ( V]SATIL;Y4 ,A P]SON HAS 6SLIDE ! GLASSES D[N1 & LOOK OV] !M 6SEE ,,TV OR 4T.E OBJECTS4 ,^? :O *OOSE S* R1D+ GLASSES MAY D S = DI6]5T #AEC R1SONS1 S* Z EMPHASIZ+ T !Y >E A#FD ALM P]FECT1 B "S"TS NE$ R1D+ GLASSES4 ,^? :O WI% 6WE> GLASSES AT A M9IMUM C A3OMPLI% ? GOAL ) S+LE-VI.N R1D+ GLASS- ES1 2C X IS TOO 9CONV5I5T 6WE> !M M*4 ,Z "T GOES ON1 /R;G] R1D+ GLASSES W 2 RE- QUIR$ 6SEE SMALL OBJECTS1 CAUS+ M & M (A %UT-IN FEEL+ :5 LOOK+ ACR ! ROOM4 ,9 PRACTICE1 ,I H EXP]I;ED R>E R1SONS ":BY S+LE-VI.N R1D+ GLASSES >E JU/IFIABLY BE/4 ,9 "O 9/.E1 A /EEL "W] "W+ ON SKY- SCRAP]S SD T X 0 REQUIR$ Z A WELD]1 T HE H S+LE-VI.N CLOSE-UP GLASSES1 S T HE WD N EV5 3SID] TAK+ A /EP AWAY F 8 "W ) 8 R1D+ GLASSES ON4 ,ANO!R MAN1 A ,UNION NEGOTIATOR1 DESCRIB$ H[ HE SU3ESS;LLY 3TROLL$ NEGOTI,NS 0PUTT+ ON 8 GLASSES TO R1D 3TRACTS1 !N REMOV+ !M 6RESPOND1 !N SL[LY REP1T+ ? PROCESS1 6GIVE HM "T 6?9K & /ALL ! OPPOSI;N4 ,PROBABLY ! MO/ -MON R1SON = GETT+ S+LE-VI.N R1D+ GLASSES IS T A P]SON C TRY !M ON 9 ! DRUG /ORE1 & IF !Y SEEM 6HELP1 ?9K T !Y C AVOID AN EYE EXAM9,N4 ,ANO!R /AT$ & PRACTICAL R1SON IS T !Y >E *1P1 &A P]SON #AED KEEPS LOS+ !M1 2C !Y H 6TAKE !M B#FD (F 6D "S?+ ELSE4 ,A SECOND TYPE ( R1D+ GLASSES >E CALL$ ,HALF ,EYES4 ,^! >E SMALL] GLASSES T FIT L[]1 -MONLY CALL$ ,B5 ,FRANKL9S 7:O /RANGELY 5 ACTU,Y IS CR$IT$ ) 9V5T+ ! BIFOCAL74 ,) HALF-EYES1 "S"O ) GD 4T.E VI.N C LOOK OV] ! GLASSES EASILY 6SEE AT A 4T.E4 ,ANO!R ADVANTAGE IS T S* GLASSES MAY 2 WORN HI<] = -PUT] USE4 ,9 MY EXPE- RI;E1 P EI LOVE HALF EYES OR HATE !M1 ) LL ATTITUDE 9 2T4 ,AM;G ! 4ADVANTAGES 9CLUDE T !Y USU,Y D N FIT WELL1 & T5D TO SLIDE D[N4 ,:5 ,I SEE P WALK+ >.D WE>+ _! HALF-EYES1 TOO BUSY 6TAKE !M (F1 !N ,I 3CLUDE T !Y >E R1DY =! ?IRD K9D ( R1D+ GLASSES1 ! BIFOCAL4 ,! MA9 -PLIC,NS ( />T+ \ ) OV]-!-C.T] R1D+ GLASSES >E3 7#A7 ,P ?9K !Y H SOLV$ _! EYE PRO#M & D N NE$ AN EYE EXAM1 EV5 ?\< ! AGE ( 4COV- ]Y ( R1D+ PRO#MS IS AL ! AGE :5 AGE- RELAT$ EYE 41SES MAY APPE>4 7#B7 ,/>T+ ) S* GLASSES FREQU5TLY MAKES X DI6ICULT -------------------------------------#FE 6ADJU/ 6MULTIFOCALS1 ESPECI,Y 6! #AEE NO L9E BIFOCAL CALL$ ! PROGRES- A#FE SIVE L5S4 ,! M5;N (! ^W BIFOCAL C RESULT 9 SIG- NIFICANT REAC;N 9 P1 & -MONLY NEGATIVE4 ,_M 2LIEVE T ! ^W BIFOCAL M1NS NE$ 6WE> GLASSES 3/ANTLY1 & MO/ FEEL !Y NEI NE$ OR DESIRE 6WE> GLASSES FULL "T4 ,ACTU,Y1 A BIFOCAL IS J "O ( ?REE *OICES ( R1D+ GLASSES1 & FULL "T WE> IS N REQUIR$4 ,X J PROVIDES M V]SATIL;Y 9 ! L;G RUN1 & AL;G ) HALF-EYES >E ! BETT] *OICES =! EMMETROPIC P]SON1 "O :O 3T9UES 6H GD 4T.E VI.N1 Z 69ITIAL R1D+ GLASSES4 ,IF A P]SON LIKES 6WE> SUNGLASSES1 !Y NE$ 6"U- /& T EV5TU,Y ! BIFOCAL W 2 NE$$ 9 ! SUN- GLASSES4 ,H["E1 AF GO+ "? ! :OLE 4CUS.N Z 6! PROS & CONS (! .?REE TYPES ( R1D+ GLASSES )! PRESBYOPE GETT+ _! F/ R1D+ GLASSES1 ! USUAL RESPONSE IS1 8,I J WANT ! R1D+ GLASSES40 ,? M1NS1 ( C\RSE1 T !Y H N LI/5$ OR PREF]R$ N 6LI/5 6MY PRES5- T,N4 ,HEY1 ,I AM US$ 6X4 ,:AT !Y WANT1 ( C\RSE1 IS S+LE-VI.N R1D+ GLASSES4 ,WANT & NE$1 ( C\RSE1 >E "S"TS DI6]5T4 ,IF "! IS ANY 4T.E PRO#M ( #AEF POT5TIAL SIGNIFIC.E1 !N ! BIFOCAL B#FE %D 2 ! EASY *OICE1 AT L1/ LOGIC,Y4 ,H[- "E1 LOGIC DOES N ALW W9 \4 ,R1SONS (F]$ AG/ A BIFOCAL 9CLUDE3 ,"Q3 ,:Y D ,I NE$ A BIFOCAL IF ,I ONLY NE$ R1D+ GLASSES8 ,ANSW]S3 #A4 ,EV5 IF 4T.E VI.N IS P]FECT1 X W BE- -E 3V5I5T 6BE A# 6L1VE ! GLASSES ON :5 BUSY1 & REQUIR+ VI.N AT ALL 4T.ES4 #B4 ,IF SAFETY GLASSES >E REQUIR$ AT "W1 !Y NE$ 6BE A BIFOCAL 6ALL[ VI.N SAFELY AT ALL 4T.ES1 & YET COV] ! EYE = PRO- TEC;N4 #C4 ,IF Y L 6WE> SUNGLASSES1 Y W EV5TU,Y NE$ A BIFOCAL SUN GLASS 6BE A# 6SEE SMALL ?+S UP CLOSE1 USU,Y 0AGE #EJ-FJ4 ,IF A GOLF]1 ! SPORTS BIFOCAL MAY IN- VOLVE A SMALL BIFOCAL SEG;T PLAC$ L[ 5 Z 6N GET 9 ! WAY = PUTT+1 B YET 5 HELP 9 CASE Y GET A 8SMALL SCORE40 #D4 ,IF Y "W ) -PUT]S1 & NE$ 6SEE AT ALL 4T.ES1 !N Y W 2 EV5TU,Y A #AEG C&IDATE =A TRIFOCAL4 ,H["E1 "O C#FE F/ M/ 2COME A3U/OM$ 6A BIFOCAL1 & !N NOTE T "! IS A PRO#M = 9T]M$IATE DIS- T.ES1 Z EV5TU,Y NOT$ "S": 9 ! #EJ-FJ AGE RANGE4 ,J Z "O NE$S 6BE A# 6WALK 2F LE>N+ 6RUN1 "O NE$S 62COME A3U/OM$ 6A BIFOCAL 2F LE>N+ 6USE TRIFOCALS4 ,:5 ? PROP] SEQU;E IS TAK51 MO/ P SAY T ! TRIFOCALS 7 EASI] 6ADJU/ 6?AN _! F/ BIFOCAL1 ESPECI,Y IF WELL MOTIVAT$1 Z 9 -PUT] USE4 ,ACTU,Y1 ( C\RSE1 TRI- FOCALS >E SUP]IOR 6BIFOCALS1 EV5TU,Y Z AN UPGRADE4 ,!Y >E AL J AN ALT]NATIVE = "S"O :O WANTS 6SEE "EY?+ AT ! APPRO- PRIATE AGE4 ,A P]SON DOES N H 6G 6A TRIFOCAL H["E1 IF SATISFI$ ) _! BIFO- CAL4 ,M W 2 SD AB TRIFOCALS LAT]4 ,"Q3 ,IF ,I AM NE>SISISIE4 ,H["E1 0US+ A BI- A#FF FOCAL Y H ! *OICE ( L1V+ ! GLASSES ON TO SEE UP CLOSE1 OR TAK+ !M (F1 IF 3V5I5T4 ,"H >E "S -MON SITU,NS3 #A4 ,"S H N"E WORN _! GLASSES 6R1D1 DAT+ BACK 6F/ GLASSES = NE>SIE NO H1L? OR PRACTICAL R1SONS 6REMOVE ! GLASSES = R1D+1 ES- PECI,Y 9 ! CLASSROOM SITU,N4 ,S* MY- OPES 2COME PREMATURELY PRESBYOPIC1 M1N+ T !Y _C R1D ) _! GLASSES ON AT AN E>LI] AGE1 MAYBE 9 _! ?IRTIES4 ,_! EYES 2COME 8LAZY0 :5 X -ES 6FOCUS+1 S9CE !Y C SEE )\T GLASSES ) LL OR NO FOCUS+ EF=T AT NE>1 & >E N US$ 6! NOR- MAL AM.T ( FOCUS+ REQUIR$ = CLOSE "W ) GLASSES ON4 #B4 ,?\< !Y ONCE WORE _! GLASSES MO/ (! "T1 & N[ T !Y >E =C$ 6REMOVE !M = CLOSE "W1 !Y 5D UP N WE>+ _! GLASSES S M*1 UN.S =C$ TO1 L = DRIV+ A C>4 ,S* P H TRAD$ R\T9ELY GD 4T.E VI.N1 =A -PRO- MISE BAS$ ON NE$ = CLOSE-UP #AEI VI.N4 B#FF #C4 ,^? MILDLY OR MOD]ATELY NE>SI VI.N IS PRETTY GD1 6A DEGREE1 B X IS EV5TU,Y NO L;G] Z GD Z X %D BE4 ,S* P MAY 2 DI6ICULT 63V9CE 6GET A BIFOCAL1 & :5 GIV5 A *OICE MAY WANT TWO PAIR ( GLASSES1 "O = 4T.E1 & "O = NE>4 ,? M1NS ?REE ALT]NATIVES3 ,NO GLASSES1 R1D+ GLASSES1 & 4T.E GLASSES4 ,NO GLASSES W 2 ! USUAL *OICE4 ,H["E1 IF HAV+ A BIFOCAL1 "! >E N[ ONLY TWO *OICES3 ,NO GLASSES OR GLASSES T ALL[ IMPROVE;T ( VI.N = BO? 4T.E & NE> 7& "P-"T WE> IS F9E74 #D4 ,AL;G ) DESIRE 6AVOID BIFOCALS1 "S WOND] AB ! *OICE ( GO+ 63TACT L5SES4 ,G5],Y 3TACT L5SES >E WORN 0NE>SISIT+ 3TACT L5SES = NE>SIE BETT] (F 6G 63TACT L5SES PRIOR 6! PRESBYOPIC AGE4 ,ON ! O!R H&1 "S F>- SIE Q HAPPY 6G 963TACT L5SES 9 ! PRESBYOPIC AGE4 ,_M ( ^! P H N AC- CEPT$ ! FACT T !Y H A 4T.E PRO#M1 & REMEMB] WELL :5 !Y CD SEE AT ALL 4T.ES )\T GLASSES4 ,S* P (T5 ADAPT WELL TO MONOVI.N 3TACT L5SES1 M1N+ "O EYE SEES BETT] = 4T.E1 &! O!R = NE>4 ,MONOVI.N IS AL (T5 Q SU3ESS;L Z AN ALT]NATIVE 6! NE>SI+ 3TACT L5SES :5 !Y 2COME PRESBYOPIC4 ,! EMMETROPE1 "O :O / SEES WELL AT 4T.E ) BO? EYES1 C WE> "O 3TACT L5S = CLOSE "W1 ANO!R TYPE -------------------------------------#FG ( MONOVI.N4 ,H["E1 MO/ P H TR\# ADJU/+ 6J "O 3TACT L5S1 EV5 IF A S(T 3TACT L5S4 #E4 ,3TACT L5SES WE>]S1 ( C\RSE 2COME PRESBYOPIC TOO1 MAK+ ! WE> ( 3TACT L5SES LESS MOTIVAT+1 IF ! MA9 #AFA R1SON IS 6AVOID GLASSES4 ,! A#FG 3TACT L5S WE>] IS ADVIS$ T X IS ,,OK 6USE OV]-!-C.T] OR DRUG /ORE R1D+ GLASSES1 S9CE ! 3TACT L5SES USU,Y MAKE BO? EYES BAL.ED 9 GD 4T.E VI.N1 & S* 8DRUG /ORE0 GLASSES >E = P ^: EYES >E EQU,Y 9 NE$ = R1D+1 & H NO SIGNIFICANT UNCORRECT$ A/IGMATISM4 ,(T51 ! NE>- SI]1 :5 2COM+ PRESBY- OPIC1 MAY 2 LESS MOTIVAT$ & SWIT*ES BACK 6WE>+ GLASSES4 ,H["E1 3TACT L5S WE>]S H OP;NS1 9CLUD+ ! SAME Z ! EMME- TROPIC P]SON1 T IS "P-"T R1D+ HELP1 9CLUD+ BIFOCALS4 ,AL1 Z M5;N$1 MONOVI- .N FITT+ C 2 SU3ESS;L4 ,BIFOCAL 3TACT L5SES H BE5 AVAILA# = YE>S ) LIMIT$ SU3ESS1 & >E 2+ ADV]TIS$ LATELY Z IF A NEW ALT]NATIVE4 ,^! MUL- TI FOCAL L5SES H "S PRO#MS DUE 6HALOES & 4TOR;NS1 S* T ! AV]AGE 3TACT L5S WE>] WD PREF] ! %>P] VI.N OBTA9$ ) _! ORIG9AL 3TACT L5SES1 & USU,Y PREF] 6G 6MONOVI.N Z A PREF]A# APPROA* 6SOLV+ R1D+ PRO#MS4 #F4 ,^? :O H WORN GLASSES FULL "T #AFB = MO/ ( _! LIFE1 USU,Y ADJU/ B#FG RAPIDLY 6BIFOCALS & TRIFOCALS4 ,"S >E S NE>SIE (A PRO#M UNTIL !Y H PRESBYOPIA A4$ 6_! BASIC PRO#M ) A/IG- MATISM4 ,NATUR,Y1 A BIFOCAL IS ! BE/ *OICE ( R1D+ GLASSES1 S T !Y C AL SEE :AT !Y H BE5 MISS+ = 4T.E4 ,H["E1 AD- JU/;T MAY 2 DI6ICULT IF !Y H N 2COME US$ 6WE>+ GLASSES1 & M* PATI;E IS RE- QUIR$ 6GET US$ 6SEE+ ?+S PROP]LY4 ,TILT+ & 4TOR;N ( IMAGES C 2 EXPECT$ 0^? ^: A/IGMATISM HAS BE5 UNCORRECT$1 B S* P NE$ 6BE ASSUR$ T ? ALL W G AWAY Z !Y ADJU/ 6_! GLASSES4 ,WE>+ A BIFO- CAL1 9 ? SITU,N1 MAY 2 MA9LY = R1D+4 ,"! !N IS ! EXPECT,N T EV5TU,Y ! 4T.E POR;N W 2 APPRECIAT$ AT "S PO9T1 & ? W 2 A GD SIGN4 ,= EXAMPLE1 _M S* P CD N PASS A DRIV]S TE/ )\T GLASSES1 & IF !Y H X PUT ON _! DRIV]'S LIC5SE T #AFC GLASSES >E REQUIR$1 !Y >E 9 C#FG DANG] ( 2+ CIT$ = N WE>+ _! GLASSES IF !Y H N ALL[$ !MVS 62COME ADJU/$4 ,"Q3 ,:Y %D ,I GET A BIFOCAL1 :5 ,I FEEL ,I C / SEE GD = 4T.E1 & ,I AM F>- SIATE PAIR ( 4T.E GLASSES4 ,!Y -------------------------------------#FH WD N GET WORN1 & Y WD N"E "K ": Y LEFT !M4 ,B IF Y GET A BIFOCAL1 Y C SEE :AT Y >E MISS+ = 4T.E1 & !N DECIDE IF Y W WE> !M M ?AN J = R1D+4 ,! R1D+ NE$ WD / 2 PRIM>Y1 &! 4T.E NE$ 2 SECOND>Y4 ,X IS EXPECT$ T ANY 4T.E IMPROVE;T W 2 ESPE- CI,Y APPRECIAT$ AT NI4 ,IF Y DECIDE Y NE$ 6WE> ! BIFOCAL #AFD MA9LY = R1D+1 T IS ALL "R4 ,!N A#FH LAT]1 IF Y RECOGNIZE "S NE$ OR HELP = 4T.E1 Y C WE> !M M1 Z Y WI%4 ,IF Y H TR\# WE>+ !M = WALK+1 !N DON'T WE> !M = WALK+ >.D4 ,B AL REMEMB] T ! O!R *OICES ( R1D+ GLASSES >E EV5 WORSE = WALK+ >.D1 & T )A BIFOCAL Y H ! POT5TIAL ( 2+ A# TO 6L1VE !M ON M (! "T4 ,"S P1 S9CE !Y >E S C]TA9 !Y NE$ NO?+ = 4T.E1 OR 2C !Y ?9K WE>+ A 4T.E CORREC- ;N MAY MAKE _! EYES 8W1K10 WANT NO?+ 9 ! TOP ( _! BIFOCAL4 ,S* A P]SON1 IF1 #A DIOPT] F>SI "W4 ,! JUMP F @+#A DIOPT] 9 ! TOP1 OR 4T.E POR;N1 6AN- O!R @+#B DIOPT]S 9 ! BOTTOM (! BIFOCAL1 IS EASI] 6TOL]ATE4 ,ANO!R EXAMPLE1 US+ NUMB]S1 IS A FEMALE PATI5T ( M9E :O _H A BIFOCAL PREVI\SLY PRESCRIB$1 ) NO?+ 9 ! TOP1 & @+#A.JJ 9 ! BOTTOM4 ,\R EXAM DEM- ON/RAT$ T %E 0 #A DIOPT] F>SIY1 DEP5D+ ON :E!R A P]SON IS 9 NE$ = GLASSES = F>SISISI- SI+ GLASSES1 SEES ! #BJ_/BJ L9E BI7] ?AN ! EMMETROPE4 ,! P]SON WE>+ 3TACT L5SES HAS ! MAGNIFIC,N FACTOR 8NORMALIZ$10 S* T ! NE>SISISI$ 6H[ SE5 ) _! GLASSES4 ,! #AFF F>SILY1 & (T5 N UNTIL !Y 2COME PRESBYOPIC4 ,= !M1 ) _! F/ GLASSES1 !Y N ONLY H 6GET US$ 6! IMPRES- .N T ?+S SEEM A BIT BLURR$ = 4T.E 7?\< RE,Y N71 B T ?+S LOOK BI7]1 & -------------------------------------#FI "!=E CLOS]4 ,) 3TACT L5SES1 ! OBJECT SIZE IS M NORMALIZ$1 N Z BIG Z ) SPECTA- CLES4 ,"Q3 ,:Y H MY EYES 2COME 8W1K]0 S9CE ,I />T$ 6WE> GLASSES8 ,I US$ 6H EXCELL5T VI.N1 & 0 A PILOT 9 ! AIR =CE4 ,S9CE ,I />T$ 6WE> GLASSES1 9 MY =TIES1 ,I N[ NE$ BIFOCALS ALL ! "T4 ,MY 4T.E VI.N IS BAD AL4 ,I "S"TS ?9K T IF ,I N"E />T$ WE>+ GLASSES1 ,I WD N 2 S BAD Z ,I AM N[4 ,ANSW]3 ,YR "Q & DESCRIP;N ( YR DILEM- MA >E Q "U/&A#4 ,H["E1 X IS N ! FAULT ( YR GLASSES T Y N[ NE$ 6WE> YR BIFOCAL FULL "T4 ,Y >E PROBABLY F>SISIE ( ANY PRO#M4 ,H["E1 :5 PRES- A#FI BYOPIA A4S NE$ = ANO!R "O OR TWO DIOPT]S = R1D+1 ! LAT5T F>SISISIE WE>+ !M4 ,? IS 2C A P]SON T5DS 6SELECT GD VI- .N1 ) GLASSES1 -P>$ 6POOR VI.N1 & N 2C ! GLASSES H MADE _! EYES 8W1K]40 ,? IS AC- TU,Y A BETT] RESULT ?AN =! P]SON :O N"E TRIES ! BIFOCAL1 ?R[S ! GLASSES ASIDE & SAYS T !Y N"E W 2 A# 6WE> A BIFOCAL4 ,"O ( MY S5IOR PATI5TS1 :5 ASK$ :Y HE #AFH DID N WE> A BIFOCAL1 /AT$ T HE 0 B#FI GIV5 A BIFOCAL1 W5T \ & PLAY$ GOLF ) !M1 & N"E %OT S* A BAD GAME ( GOLF 9 8 LIFE1 S HE ?REW !M AWAY & V[$ 6N"E TRY AG4 ,S* A P]SON'S IMPATI;E MAY RESULT F A LIFE"T ( N SEE+ WELL1 & FUSS+ ) MULTIPLE PAIRS ( GLASSES1 : N"E SEEM "R4 ,C]TA9LY1 PO/- PON+ ! ADJU/;T1 L WAIT+ 8UNTIL ,I RE,Y NE$ !M0 MAKES X EV5 M DI6ICULT 6ADJU/ TO :AT IS RE,Y NE$$4 ,& IF Y WAIT TOO L;G1 !N "! MAY 2 NO USE 8BU7+0 Y1 = Z 9 ! CASE ( MY PATI5T ) BAD GOLF EXP]I;E1 X MAY 2COME TOO LATE 6TRY NEW ?+S4 ,*OICES ( ,BIFOCALS1 ,TRIFOCALS1 ,ETC4 ,! OLD FA%ION$ BIFOCAL _H A R.D TOP & 0 COSMETIC,Y N BAD1 B ! USE;L;S 0 LIMIT$ 0DESIGN1 & IS N[ PRESCRIB$ MA9LY 6ELD]LY P :O >E A3U/OM$ 6ONLY ? /YLE ( BIFOCAL4 -------------------------------------#GJ ,! /&>D BIFOCAL HAS A /RAIATE 4T.E VI.N F NE> VI.N1 ) APPRO- PRIATE HELP4 ,! L9E MAY G "P WAY #AFI OR -PLETELY ACR ! L5S1 Z 9 AN A#GJ 8EXECUTIVE0 BIFOCAL4 ,! EXECUTIVE BIFO- CAL IS GD1 B ! TOP L9E IS Q PROM95T1 & LOOK+ SIDE 6SIDE DOES N REQUIRE A BIFO- CAL SEG;T ALL ACR ! L5S = NE> "W4 ,"O NE$S 6GET US$ 6! 8L9E0 AT F/1 B AW>E;S ( ! 8L9E0 J SEEMS 6G AWAY ) "T4 ,&1 IF -P>$ 6HALF-EYE R1D+ GLASSES1 ? L9E IS NO DI6]5T ?AN ! TOP FRAME (! HALF-EYES4 ,! NO-L9E BIFOCAL1 CALL$ ! PROGRESSIVE BIFOCAL1 COSMETIC,Y LOOKS J L S+LE-VI.N GLASSES1 NO DI6]5T F GLASSES WORN PRIOR 6PRESBYOPIA1 OR F S+LE-VI.N R1D+ GLASS- ES4 ,"! IS A GRADUAT$ *ANGE F 4T.E COR- REC;N 6FULL NE> CORREC;N1 S* T F1TURES ( A 8TRIFOCAL0 >E PRES5T1 F ! 2G9N+4 ,? TYPE R1D+ GLASSES HAS COSMETIC APP1L1 & IS Q USE;L1 B HAS A SMALL R1D+ >EA -P>$ 6O!R *OICES1 BIG 5\<1 B SMALL] ?AN :AT "O MAY H 2COME US$ TO1 S* Z HALF-EYES OR S+LE-VI.N R1D]S4 ,"! >E EXPECT$ PRO#MS ( ADJU/;T 6F/ BIFOCALS1 ) OR )\T ! L9E4 ,IF "O HAS BE- -E US$ 6O!R K9DS ( R1D+ GLASSES1 L HALF- EYES1 OR S+LE-VI.N R1D+ GLASSES1 #AGJ !N C]TA9 PRO#MS MAY 2 PREDICTA#1 B#GJ S9CE ! R1D+ >EA ( ^! ORIG9AL GLASSES IS Q L>G]4 ,S* P PROBABLY WD ADJU/ EASI] 6! /&>D BIFOCAL1 )A L9E1 S9CE ! R1D+ >EA IS L>G] ?AN ! R1D+ >EA 9 ! PROGRESSIVE R1D+ ADD4 ,"! >E AL "S 4TOR;NS )! PROGRESSIVE ADD 9ITI,Y1 : >E TEMPOR>Y4 ,IF1 H["E1 ! PROGRESSIVE ADD IS YR F/ PAIR ( R1D+ GLASSES1 OR IF Y >E A P]SON A3U/OM$ TO WE>+ GLASSES FULL "T = 4T.E1 & N[ NE$S A4I;NAL HELP = R1D+1 ! PROGRESSIVE ADD MAY 2 Z EASY 6ADJU/ 6Z ! BIFOCAL )! L9E1 OR EASI]4 ,ANO!R ADVANTAGE ( PROGRESSIVE ADD MULTIFOCALS1 IS T ONCE "O IS A3U/OM$ 6!M1 !N GETT+ US$ 6/R;G] GLASSES IS EAS- I] ?AN )A /&>D BIFOCAL1 & "! IS NO NE$ 6G 6A 8TRIFOCAL40 ,!N :AT IS A TRIFOCAL1 & :Y WD T 2 NE$$8 ,:5 A P]SON HAS R1*$ ! FIFTIES 9 AGE1 !Y USU,Y NE$ #B DIOPT]S R1D+ A4I;N4 ,:5 ? HAPP5S1 IF N 2F1 S* P NOTE T "! IS AN >EA1 9 2T1 T IS N COV]$ 0! BIFOCAL-- TYPIC,Y >M'S L5G? AWAY4 ,? IS ESPECI,Y NOT$ N[ T S _M P >E US+ -PUT]S1 : >E FUR!R AWAY 9 "W+ 4T.E ?AN USUAL #AGA R1D+ 4T.E4 ,! P]SON )A BIFOCAL C#GJ NOTES T !Y H 6TIP _! *9 UP 6LOOK "? ! BIFOCAL1 & MOVE =W>D 6GET 96FOCUS4 ,? IS AWKW>D1 9CONV5I5T1 & "S"TS UNCOM=TA#4 ,) A TRIFOCAL1 A P]SON DOES N NE$ 6RAISE ! *9 S HI<1 & "O DOES N NE$ 6MOVE =W>D1 2C ?+S >E 9 FOCUS AT >MS L5G? 4T.E4 ,P ) TRIFOCALS AL MAY 2 NOTIC$ 6BE LOOK+ "? ! TRIFOCAL 9T]M$IATE SEG;T 9 ! 3V]S,N DIS- T.E4 ,"O POT5TIAL 4ADVANTAGE IS ! NOT,N T YR FRS MAY H WR9KLES4 -------------------------------------#GA ,X IS NATURAL 6ASSUME T TRIFOCALS WD 2 DI6ICULT = ADJU/;T1 B IF A P]SON />TS )A /&>D BIFOCAL1 & WANTS 6SEE "EY?+1 & IS Z WELL MOTIVAT$ Z -PUT] US]S1 ! USUAL RE- SPONSE IS T ! TRIFOCAL 0 N Z DI6ICULT Z ! F/ BIFOCAL4 ,L ! BIFOCAL1 ! HI<] L9E 2COMES N NOTICEA# EV5TU,Y1 Z "O GETS US$ 6! GLASSES4 ,"S TRIFOCAL WE>]S WE> J BI- FOCALS 9 _! SUNGLASSES1 B O!RS WANT ! TRIFOCAL 9 ALL GLASSES4 ,0! WAY1 ,I H _H PATI5TS :O CAME BACK )A PROGRESSIVE L5S1 ?9K+ T ? IS A 8TRIFOCAL40 ,ACTU,Y1 ! PROGRESSIVE L5S HAS 8F1TURES0 (A #AGB TRIFOCAL1 B IS N A TRUE TRIFOCAL4 A#GA ,! P]SON :O HAS _H A /&>D BIFOCAL WD 2 EXPECT$ 6ADJU/ BETT] 6! /&>D TRIFOCAL1 ) TWO L9ES1 R ?AN ! PROGRESSIVE ADD4 ,^? :O H _H AN EXECUTIVE BIFOCAL1 "O T HAS A L9E GO+ ALL ! WAY ACR ! L5S1 MAY AL WANT AN EXECUTIVE TRIFOCAL4 ,? C 2 D"O1 B A M PRACTICAL TRIFOCAL IS :AT IS CALL$ AN ,,ED TRIFOCAL4 ,? TRIFOCAL HAS AN 9T]M$IATE SEG;T L9E T GOES ALL ! WAY ACR ! L5S1 B ! BIFOCAL SEG;T IS M (A REGUL> SEG;T BIFOCAL1 )A L9E T DOES N G ALL ! WAY ACR4 ,! R1SON = ?1 IS T X IS M -MON 6SCAN SIDE 6SIDE :ILE DO+ -PUT] OR O!R 9T]M$IATE 4T.E "W ?AN X IS 9 R1D+4 ,AL1 TWO L9ES GO+ ALL ! WAY ACR C 2 M 3FUS+ :5 LOOK+ >.D 9 A SCANN+ SITU,N1 L RAILROAD TRACKS4 ,ONCE1 AF 4CUSS+ TRIFOCALS )A LADY "W+ 9 AN (FICE ) -PUT]S1 ,I 0 GIV5 AN IMPOR- TANT R1SON = D5IAL4 ,%E SD1 8,I AGREE1 F :AT Y H SD1 T ,I NE$ A TRIFOCAL1 B ,I AM N GO+ 6GET TRIFOCALS4 ,Y SEE "! >E A LOT ( GIRLS 9 ! (FICE1 ALL AB ! SAME AGE1 & ,I AM N GO+ 6BE ! F/ "O 9 #AGC TRIFOCALS40 B#GA ,3TACT ,L5SES Z AN ,ALT]NATIVE 9 ,PRESBYOPIA ,3TACT L5SES >E N ! BE/ ALT]NATIVE = MANAGE;T ( PRESBYOPIA4 ,"! >E S* ?+S Z BIFOCAL 3TACT L5SES & MULTI FOCAL L5SES1 B !Y >E N V SU3ESS;L4 ,PRO#MS 9CLUDE SEE+ HALOS >.D LI+ 3TACT L5SES1 0GO+ 6:AT IS CALL$ MONOVI.N4 ,T M1NS KEEP+ "O EYE1 USU,Y ! "R EYE 9 A "R H&$ P]SON1 SEE+ WELL = 4T.E1 & US+ ! O!R EYE = SEE+ AT NE>4 ,IF "! IS N TOO GRT A DI6];E 2T ! TWO EYES1 ? C "W Q WELL1 AT L1/ =A :ILE4 ,MO/ 3TACT L5S WE>]S >E NE>SI+ 3TACT L5SES1 USU,Y AT A "Y AGE1 & !Y !N 2COME L AN EMMETROPIC P]SON1 "O :O SEES WELL AT ANY 4T.E )\T GLASSES1 UNTIL !Y 2COME PRESBYOPIC1 0AGE =TY TO =TY-FIVE4 ,AT ? AGE1 !N ! 3TACT L5S WE>] C 2G9 WE>+ R1D+ GLASSES1 "P "T1 & #AGD H ! *OICE ( ANY (! ?REE K9DS ( C#GA R1D+ GLASSES AVAILA#4 ,AL1 S9CE ! 3TACT L5SES BAL.E ! EYES = 4T.E1 ANY (! R1D+ GLASSES AVAILA# 8OV] ! -------------------------------------#GB C.T]0 W "W1 OR :AT ,I CALL 8DRUG /ORE GLASSES10 AT L1/ AT F/1 :5 !Y >E 3V9C+ !MVS T !Y RE,Y NE$ !M4 ,& ?\< ^! P ONCE WORE PRESCRIP;N GLASSES ( QUAL;Y1 X IS 9T]E/+ T !Y MAY 3T9UE WE>+ UNATTRACTIVE ILL-FITT+ DRUG /ORE GLASSES1 Z IF 6EM- PHASIZE T !Y RE,Y DON'T NE$ GLASSES1 OR AT L1/1 N M*4 ,?\< MO/ 3TACT L5S WE>]S >E NE>SISI]S >E (T5 AM;G ! HAPPIE/ ) MONOVI.N4 ,! HYP]OPIC1 OR F>- SI+ ONLY "O S(T 3TACT L5S1 =! R1D+ #AGE EYE4 ,X C 2 D"O1 B ACTU,Y "! >E A#GB FEW :O H ! MOTIV,N 6MA/] ? APPROA* 6MAN- AGE;T ( PRESBYOPIA4 ,0! WAY1 MONOVI.N 3TACT L5S WE> REQUIRES T BO? EYES SEE WELL4 ,IF "O DROPS D[N 9 VI.N1 = EXAMPLE DUE 6A CAT>ACT1 !N X 2COMES A PRO#M Z 6: WAY 6USE ! SECOND BE/ EYE1 = 4T.E OR = CLOSE "W4 ,MONOVI.N IS ACTU,Y A -PROMISE4 ,TWO EYES >E BETT] ?AN "O4 ,"!=E1 VI.N ) BI- FOCAL GLASSES IS BETT]1 B1 Z M5;N$1 ? IS N (T5 SU3ESS;L ) 3TACT L5S BIFOCALS4 ,MONOVI.N IS Q SU3ESS;L UNTIL AB ! MID- FIFTIES 9 AGE4 ,:5 ! NE$$ R1D+ P[] (! 8R1D+ EYE0 IS GRT] ?AN @+#A.EJ OR @+#A.GE1 B9OCUL> VI.N IS ?R1T5$4 ,! R1D+ REQUIRE;TS ( "S"O AGE #EJ OR GRT]1 IN- CR1SES F @+#A.GE 6@+#B.JJ1 & GRADU,Y UP 6@+#B.EJ 7FULL /R5G?74 ,IF AN ATTEMPT IS MADE 6MAKE ! R1D+ EYE 8KEEP UP0 ) ^! NE$S1 ! PATI5T 2G9S 6FEEL UNCOM=TA#1 & IF !Y C EXPRESS ! PRO#M1 L US+ "O EYE AT A "T4 ,!Y H LO/ B9OCUL>;Y1 ?\< !Y MAY ACTU,Y 2 A# 6R1D BETT] )! /R;G] R1D+ 3TACT L5S4 ,I H SE5 "S P1 H["E1 #AGF :O ?\< !Y H LO/ _! B9OCUL>;Y1 SEE B#GB WELL = R1D+1 & >E N -PLA9+1 S >E ALL[$ 63T9UE WE>+ ! /R;G] L5S = R1D+4 ,! MOTOR VEHICLE DE"P;T DOES N L1 OR "U/& MONOVI- .N1 B USU,Y IS UNAW>E (! SITU,N4 ,X IS PROBABLY BETT] 6A3EPT ! 8-PRO- MISE0 SITU,N ) MONOVI.N1 0L1V+ ! 8R1D+ EYE0 AT ONLY @+#A.EJ OR @+#A.GE4 ,) ?1 P >E USU,Y SATISFI$ 9 MO/ SITU,NS1 EV5 96M S5IOR AGE4 ,ONLY "S"TS IS "! A NE$ 6SEE BETT]4 ,P MAY SAY T1 "S"TS !Y FEEL L A NE$ 6REMOVE ! 3TACT L5SES & PUT ON ! 4T.E GLASSES :5 DRIV+1 ESPECI,Y AT NI GLASSES1 OR R1D )- \T GLASSES1 IF SUITABLY NE>SI]S1 R ?AN REMOV+ _! 3TACT L5SES1 MAY REV]T 6! DRUG /ORE R1D+ GLASSES4 ,S* GLASSES >E OBVI\SLY WR;G1 S9CE !Y TR1T BO? EYES ! SAME1 &) MONOVI.N1 -------------------------------------#GC "O EYE NE$S LESS HELP ?AN ! O!R4 ,! BE/ SOLU;N IS1 GUESS :AT1 A BIFOCAL #AGG 6WE> OV] ! 3TACT L5SES4 A#GC ,A NATURAL RESPONSE 6? SU7ES;N1 IS T ! R1SON A P]SON IS WE>+ 3TACT L5SES IS TO AVOID GLASSES1 L BIFOCALS4 ,A LOT (! RE- SI/.E IS AG BAS$ ON ! IDEA T BIFOCALS >E = FULL "T GLASSES WE>4 ,ON ! 3TR>Y1 9 ? CIRCUM/.E ESPECI,Y1 ! BIFOCAL IS M1NT TO 2 ONLY "P "T1 & Z A WAY 6ASSURE M FULL "T 3TACT L5S WE>4 ,! BIFOCAL WD 2 PUT ON :5 DRIV+ AT NIRIV$1 ! GLASS- ES >E REMOV$ & USUAL VI.N ) 3TACT L5SES 5JOY$4 ,!N1 :5 NE$+ 6R1D BETT]1 ! BIFO- CALS AL CD 2 POPP$ ON TEMPOR>ILY1 UNTIL N NE$+ 6SEE S P]FECTLY1 : WD 2 EXPECT$ 6BE MO/ (! "T4 ,! BIFOCALS WD 2 A BETT] *OICE ?AN DRUG /ORE GLASSES = R1D+1 & NO GLASSES = 4T.E1 OR A SEP>ATE PAIR ( 4T.E GLASSES : WD N 2 WORN1 2C !N "O _C SEE WELL UP CLOSE4 ,MO/ (! "T1 #AGH PROBABLY #IE P]C5T (! "T1 ! BIFO- B#GC CALS WD N 2 NE$$1 &! MONOVI.N 3TACT L5S WE>] WD 3T9UE 6FUNC;N WELL )\T GLASSES4 #AGI C#GC #AHJ #I #GD ,CAT>ACTS ,O!R ?AN PRESBYOPIA1 ! MO/ -MON AGE- RELAT$ EYE PRO#M IS CAT>ACT4 ,CAT>ACTS >E AL 9EVITA#4 ,Y W HE> ?+S SU7E/+ WE>+ SUNGLASSES OR TAK+ NUTRI5TS 6AVOID CAT>ACT1 B1 IF WE LIVE L;G 5\<1 WE ALL GET CAT>ACTS4 ,X C 2 SD T ! SAME PROCESS T MAKES ! L5S M RIGID ) AGE RE- SULTS F/ 9 PRESBYOPIA1 & !N1 9 ADV.ED =M1 CAUSES 9 CAT>ACTS4 ,SIXTY P]C5T ( \R POPUL,N OV] ! AGE ( SIXTY H CAT>ACTS1 & #GJ P]C5T ( ^? OV] AGE SEV5TY-FIVE H CAT>ACTS4 ,CAT>ACT M1NS CL\D+ (! L5S (! EYE4 ,"! >E DI6]5T K9DS1 B ALL PROGRES- SIVELY BLOCK \ LIISON IS T ! PICTURES TURN \ DIMM]1 & LESS COLOR;L4 ,MO/ CAT>ACTS >E V SL[ 9 DEVELOP;T1 ESPECI,Y ! MO/ -MON1 ^? AGE-RELAT$4 ,SECOND>Y CAT>ACTS MAY O3UR F USE ( /]OIDS1 TRAUMA1 OR DIABE- TES1 & ^! MAY 2 M RAPID 9 DEVELOP;T4 ,3G5ITAL CAT>ACTS >E R>E1 #AHA =TUNATELY1 S9CE VISUAL RESULTS >E A#GD (T5 N S GD AF TR1T;T4 ,9 MO/ CASES1 IF VI.N HAS _H A *.E 6DEVELOP NORM,Y1 & "! IS NO?+ ELSE WR;G )! EYE1 !N ! VI.N IS USU,Y WELL RE/OR$ AF CAT>ACT REMOVAL4 ,H]$IT>Y CAT>ACTS O3UR1 B >E N -MON4 ,IF FAMILY HI/ORY DESCRIBES CAT>ACTS 9 RELATIVES 9 _! SEV5TIES OR EIACTS4 ,CATA- RACTS O3URR+ 9 "Y] P1 9 _! =TIES OR FIF- TIES1 MAY SU7E/ A H]$IT>Y T5D5CY4 ,S A CAT>ACT IS ANY OPAC;Y (! L5S (! EYE4 ,DEP5D+ ON H[ M* ? OPAC;Y BLOCKS ! PUPIL1 ! VI.N IS PROGRESSIVELY BLURR$4 ,:5 ! VI.N IS BAD 5\<1 !N CAT>ACT SURG]Y MAY 2 P]=M$4 ,?1 ( C\RSE1 DEP5DS ON ! SUBJECTIVE DESIRE 6SEE BETT]4 ,_M P >E N EV5 AW>E ( _! VI.N *ANGE UNTIL X IS PO9T$ \ 6!M 9 ! C\RSE ( AN EYE EXAM9,N4 ,"S >E S WORRI$ AB _! CAT>ACTS T !Y H TO 2 REASSUR$ T WE >E N D1L+ ) "S?+ L A C.ER T HAS 6BE TR1T$ E>LY4 ,AGE IS ANO!R 3C]N1 B WE C ASSURE T "! IS #AHB NO S* ?+ Z 2+ TOO OLD1 OR ALM TOO #GE SICK1 6H CAT>ACT SURG]Y4 ,X IS D"O "U LOCAL ANES!SIA1 & Z AN \TPATI5T PROCE- DURE4 ,X IS AL TRUE T _M P N"E GET 5 EF- FECT ON _! VI.N T !Y NE$ 6H _! CAT>ACTS REMOV$ 2F !Y >E DEC1S$4 ,! *ANGE 9 VI.N F CAT>ACTS IS USU,Y Q SL[1 ESPECI,Y 9 :AT IS CALL$ 8CORTICAL CAT>ACTS40 ,CORTICAL CAT>ACTS >E L SPOKES ( CL\D$ >1S />T+ 9 ! P]IPH]Y (! L5S1 & "W+ C5TR,Y4 ,ANO!R K9D ( CAT>ACT1 PO/]IOR SUBCAPSUL> CAT>ACT1 IS AN OPAC;Y Z IF PA9T$ C5TR,Y ON ! BACK SURFACE (! L5S4 ,? K9D ( CAT>ACT MAY PROGRESS M RAPIDLY1 & C 2 H]$IT>Y1 DUE 6DIABETES1 OR RESULT F USE ( ORAL /]OIDS1 S* Z PR$- NIS"O4 ,A ?IRD TYPE ( CAT>ACT1 NUCLE> SCL]OSIS1 IS AL USU,Y SL[ 9 DEVELOP;T4 ,H["E1 X C CAUSE NUIS.E BY 8MYOPIC %IFT40 ,? M1NS T ! EYE MAY 2COME M NE>- SISI- SIACTS >E RESPONSI# =! 8TALE ( SECOND SIMS GOT TOO %ORT1 & ,I NE$$ R1D+ GLASSES4 ,! O!R "D1 ,I NOTIC$ T ,I C R1D )\T GLASSES AG2 ,I H GOT ,8,SECOND ,SIACT1 )\T NE$ = EXAM9,N4 ,! USUAL CRIT]ION Z 6:E!R A CAT>ACT IS R1DY = SURG]Y HAS 6D ) 2+ A# 6PASS A ,,DMV OR DRIV]'S LIC5SE VISUAL TE/1 USU- ,Y REQUIR+ #BJ_/DJ VI.N 7IN ,CALI=NIA74 ,ACTU,Y1 ONLY "O EYE IS REQUIR$ 6PASS A DRIV]'S TE/1 B X IS AL LOGICAL T "S SORT ( EXPLAN,N 2 PROVID$ Z 6:Y ! O!R EYE DOES N SEE WELL 5 6PASS ! VI.N TE/4 ,(- T51 ! R1SON IS T A P]SON %D 2 WE>+ COR- RECTIVE GLASSES1 S FAILURE 6PASS A DRIV- ]'S TE/ MAY TRI7] A NE$ = YR EYE DOCTOR 6-PLETE A VI.N EVALU,N =M 9 ORD] 6GET A DRIV]'S LIC5SE4 ,ANYWAY1 IF VI.N HAS FAIL$ 9 ! CAT>ACT PATI5T 6! PO9T T "O EYE DOES N SEE WELL 5 6PASS ! #AHD DRIV]'S VI.N TE/1 !N ? P]SON HAS B#GE WAIT$ L;G 5\<1 & N[ G5],Y QUALIFIES = CAT>ACT SURG]Y1 EV5 IF "O DOES N DRIVE A C>4 ,( C\RSE1 ? IS N A RIGID CRIT]ION1 & C]TA9LY A P]SON DOES N H 6"UGO SURG]Y IF HE OR %E DOES N WANT 6SEE BETT]4 ,H["E1 X IS AL TRUE1 T 6PO/P"O SURG]Y 2C ( FE> (! PROC$URE IS N JU/IFI$1 IF "O C 2COME FAMILI> )! DETAILS ( SURG]Y1 LOCAL ANES- !SIA1 &! M9IMAL PO/OP]ATIVE LIMIT,NS4 ,! #BJ_/DJ GUIDEL9E = E/ABLI%+ ! NE$ = CAT>ACT SURG]Y IS A /&>D 3S]VATIVE AP- PROA* 6RECOMM5D+ CAT>ACT SURG]Y4 ,ACTU- ,Y1 ! PATI5T DET]M9ES :5 X IS "T1 2C (! NE$ 6SEE BETT]4 ,"S PATI5TS NE$ A PEP TALK 6GET !M R1DY 6DECIDE 6H SURG]Y1 & O!RS >E ALM TOO EAG]4 ,Z M5;N$1 "S PA- TI5TS ?9K ! CAT>ACT NE$S 6BE GOTT5 \ ( "!1 L "S SORT ( C.ER4 ,X IS AL TRUE T "S P MAY 2 A# 6SEE Z WELL Z #BJ_/BE OR #BJ_/CJ1 B 2 BO!R$ -------------------------------------#GF 0GL>E AT NI1 _! VI.N C 2 %[N 6DROP 6M DANG]\S LEVELS = #AHE DRIV+4 ,! PATI5T & SURGEON MAY !N A#GF AGREE "S?+ NE$S 6BE D"O4 ,AMAZ+LY Y MAY HE> ADS = EYE DROPS1 SPECIFIC,Y ,SIMILI- SAN1 Z USE;L TO 8RELIEVE SYMPTOMS ( CAT- >ACTS10 & EMPHASIZ+ T "! >E NO H>M;L SIDE E6ECTS4 ,S9CE ! SYMPTOMS ( CAT>ACT 9VOLVE BLURR$ VI.N 6A V>IA# DEGREE1 ANY SU3ESS ( S* DROPS WD 2 EXPECT$ 6BE PSY- *OLOGICAL &! LACK ( SIDE E6ECTS DUE 6! 9ACTIV;Y (! 9GR$I5TS4 ,R1D]S1 HAV+ LE>N$ AB CAT>ACTS1 %D N 2 3FUS$ 0S* CLAIMS4 ,:AT AB WAIT+ =A CAT>ACT 6GET 8RIPE10 A T]M Y MAY H HE>D4 ,WELL1 ? IS A R 8OLD-FA%ION$0 3CEPT T NE$S EXPLA9+4 ,9 ! 8OLD5 "DS10 & ,I REMEMB] !M WELL1 WE RE- MOV$ ! CAT>ACT & ?US R5D]$ ! EYE 6AN 8APHAKIC0 3DI;N 7,LAT9 = 2+ )\T A L5S74 ,T RESULT$ 9 ELIM9,N (! CL\D$ L5S1 B 0 2F ! USE ( AN >TIFICIAL L5S 6REPLACE ! NATURAL L5S4 ,! EYE ?US 2CAME Q F>SIACT SURG]Y4 ,! GLASS- ES 7 S /R;G T A P]SON CD N WE> ! #AHF APHAKIC CORREC;N ON "O EYE & REG- B#GF UL> GLASSES ON ! O!R EYE4 ,! APHAKIC SPECTACLES CAUS$ MAGNIFIC,N S T D\# VI.N WD RESULT4 ,6AVOID ?1 A 3TACT L5S CD 2 FIT ON ! 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FACTORS1 :5 PATI5TS CD N SEE1 !Y 7 Q HAPPY = VISUAL RE/OR,N1 9 SPITE ( PRO#MS ) APHAKIA4 ,(T51 ) APPRO- PRIATE APHAKIC SPECTACLES1 OR 3TACT L5S- ES1 ! VISUAL RESULT 0 #BJ_/BJ4 ,"O ( MY GRTE/ P]SONAL SATISFAC;NS 9 ! 8OLD "DS0 0 A PATI5T ,I OP]AT$ ON 9 A M5TAL HOSPI- TAL4 ,HE 0 DESCRIB$ Z VIOL5T & UNMANAGE- A#4 ,HE CD N SEE1 N HE>1 & N SP1K4 ,HE (T5 *>G$ \ ( 8 :EEL *AIR PUN*+ 8BLLY0 AT ANY?+ )9 R1*4 ,:5 ,I REMOV$ 8 CAT>ACT1 ,I WORRI$ 2C HE _H 6BE RE/RA9$ PO/OP]A- TIVELY & _H PUS RUNN+ \ ( 8 E>S4 ,ON 8 F/ PO/OP]ATIVE VISIT 6! CL9IC A FEW "DS LAT]1 ,I PUT A PAIR ( TEMPOR>Y APHAKIC GLASSES ON HM & WROTE -------------------------------------#GG A NOTE 9 L>GE LRS1 SAY+1 8,C Y SEE80 ,HE SMIL$ WIDELY & NO4$ YES6 ,! POOR GUY _H N BE5 A# 6-MUNICATE1 B ) VI.N RE/OR$ HE 2CAME A MODEL PATI5T &A REGUL> AT ! C>D TA#4 ,HE CD AL GET >.D )\T A :EEL *AIR1 EV5 )\T 8 GLASSES4 ,? AL REM9DS ME (A MIS.N>Y DOCTOR ,I MET :5 HE #AHH RETURN$ = M TRA9+ & SD HE DID A#GG CAT>ACT SURG]Y 9 ,AFRICA1 ) C]TA9 CRITE- RIA4 ,IF NATIVES 7 FALL+ 96! RIV] OR 96! FIRE1 !N HE WD REMOVE _! CAT>ACTS4 ,B1 IF !Y WANT$ 6WE> GLASSES AF _! SURG]Y1 !N !Y _H 6G 6! MIS.N>Y HOSPITAL = SUR- G]Y4 ,WELL1 =TUNATELY1 ?+S H *ANG$4 ,=A L;G "T N[1 WE H US$ 9TRAOCUL> L5S IMPLANTS1 >TIFICIAL L5SES 6REPLACE ! EXTRACT$ NOR- MAL L5S (! EYE4 ,!N PO/OP]ATIVELY1 A PA- TI5T WE>S M REGUL> GLASSES1 S* Z ^? HE OR %E NE$$ 2F CAT>ACT DEVELOP;T1 & (T5 M* LESS /R;G ?AN NE$$ :5 "Y]1 A =M ( RE- FRACTIVE SURG]Y4 ,2C ( ?1 ! OP]AT$ EYE C "W WELL )! UNOP]AT$ EYE1 Z 2F CAT>ACT DEVELOP;T4 ,Z A RESULT1 WE NO L;G] H TO WAIT =A PATI5T 6G S BL 2F (F]+ CAT>ACT SURG]Y4 ,T IS GD1 2C "S"TS X TAKES YE>S 2F ! O!R EYE NE$S SURG]Y4 ,)! >TIFICIAL L5S 9 PLACE1 ! EYE IS SD 6BE 8PSEUDO- PHAKIC10 & N APHAKIC1 Z WD H BE5 )\T ! >TIFICIAL L5S4 ,H[ ! 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