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- Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.
- A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
- Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
- There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
- The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
- Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
- The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
- Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).
Signs and symptoms
- Skin wounds: All bites and any cut or laceration greater than 1/2-inch long in which fat or deeper tissues (muscle or bone) can be seen will require medical attention.
- Any redness extending from the wound after two days or yellow drainage from the area should warrant medical attention. Infection may cause redness, swelling, heat, pus, or watery discharge from a puncture wound that is not noticed or not treated properly.
- Puncture wounds usually cause pain and mild bleeding at the site of the puncture. It is usually fairly obvious if cut. However, small pieces of glass may cause puncture wounds that the individual may not notice at first.
- Most doctors will not stitch a cut or laceration that is more than eight to 12 hours old. This is because there is a greater chance of infection after that time. In fact, after three hours, the incidence of infection begins to increase. Therefore, do not wait to have the injury repaired. If in doubt, call a doctor or go to the nearest hospital's emergency department. An open wound takes longer to heal and leaves a bigger scar.
- Healthcare providers recommend that 911 be called if: the wound is obviously life-threatening; any laceration is greater than 1/2-inch long and is through all layers of the skin exposing the underlying fat; the bleeding cannot be stopped; if the blood continues to spurt from the wound. Apply pressure and go to the hospital's emergency department: if there may be something in the wound such as glass, wood, or rust; if the individual cannot move their fingers or toes in the area of the laceration or if they have lost sensation in the area beyond the laceration; and for any bite wound (human or animal).
- Pressure sores: Bedsores fall into one of four stages based on their severity. Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst). The National Pressure Ulcer Advisory Panel, a professional organization dedicated to the prevention and treatment of pressure sores, has defined each stage as follows:
- Stage I: Initially, a pressure sore appears as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In African Americans, Hispanics, and people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage I wounds are superficial and go away shortly after the pressure is relieved.
- Stage II: In stage II, some skin loss has already occurred, either in the epidermis, the outermost layer of skin, in the dermis, the skin's deeper layer, or in both. The wound is now an open sore that looks like a blister or an abrasion, and the surrounding tissues may show red or purple discoloration. If treated promptly, stage II sores usually heal fairly quickly.
- Stage III: When a pressure ulcer reaches stage III, the damage has extended to the tissue below the skin, creating a deep, crater-like wound.
- Stage IV: Stage IV is the most serious and advanced stage. The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints. Stage IV wounds are extremely difficult to heal and can lead to lethal infections.
- If an individual uses a wheelchair, they are most likely to develop a pressure sore on: the tailbone or buttocks; the shoulder blades and spine; or the backs of the arms and legs where they rest against the chair. When an individual is bed-bound, pressure sores can occur on: the back or sides of the head; the rims of the ears; the shoulders or shoulder blades; the hipbones, lower back, or tailbone; or the backs or sides of the knees, heels, ankles, and toes.
- Anal fissure: The main signs and symptoms of an anal fissure include: pain or burning during bowel movements that eases until the next bowel movement; bright red blood on the outside of the stool or on toilet paper or wipes after a bowel movement; and itching or irritation around the anus.
- Extravasation: During extravasation, the individual will feel burning, stinging, or pain at the injection site. Redness or swelling may be observed at the site of injection. Also, there may be no blood return in the syringe when the healthcare worker tries to get blood.
- If a skin injury required medical attention, a doctor will want to know how the injury occurred, what home care was performed, if there is any pain, and when the last tetanus shot may have been.
- If a hand or finger is involved, the doctor will want to make sure the individual is able to move the extremity or finger through its full range of motion. Sensation and circulation to the area will be tested carefully as well. If there is some suspicion of a foreign body in the wound or an underlying bone break, an x-ray may be ordered.
- Pressure sores (bedsores) are usually unmistakable, even in the initial stages, but a doctor is likely to order blood tests to check the individual's nutritional status and overall health. Other tests may include: urine analysis and culture, stool culture, and a wound biopsy. A wound biopsy is a sample of tissue taken from wounds that do not heal or from chronic (long-term) pressure sores. The tissue may also be checked for cancer, which is a risk in individuals with chronic wounds.
- General Self-treatment:
- Minor cuts and scrapes usually do not require a trip to the emergency room, yet proper care is essential to avoid infection or other complications. Puncture wounds do not usually cause excessive bleeding. Puncture wounds resulting from human or animal bites, including those of domestic dogs and cats, may be especially prone to infection. Puncture wounds on the foot are also more vulnerable to infection.
- Guidelines developed by healthcare professionals can help individuals care for simple wounds at home. These guidelines include:
- Stopping the bleeding: Minor cuts and scrapes usually stop bleeding on their own. If they do not, apply gentle pressure with a clean cloth or bandage. Hold the pressure continuously for 20-30 minutes. Lifting the pressure to check on bleeding may damage or dislodge the fresh clot that has forming and cause bleeding to resume. If the blood spurts or continues to flow after continuous pressure, seek medical assistance.
- Cleaning the wound: Rinse out the wound with clear water in order to clean the wound. It is best to avoid getting soap into the wound itself, as soap can irritate the wound. If debris remains embedded in the wound after cleaning, see a doctor. Thorough wound cleaning reduces the risk of tetanus. Tetanus (also called lockjaw) is a preventable disease that affects the muscles and nerves, usually due to a contaminated puncture wound.
- To clean the area around the wound, use soap and a washcloth. Hydrogen peroxide, iodine, or an iodine-containing cleanser may irritate living cells. If they are used, do not apply them directly on the wound.
- Medicines: After cleaning the wound, apply a thin layer of an antibiotic cream or ointment such as Neosporin® or Polysporin® to help keep the surface moist. The products do not make the wound heal faster, but they can discourage infection and allow the body's healing process to close the wound more efficiently. Certain ingredients in some ointments can cause a mild rash in some individuals. If a rash appears, stop using the ointment.
- Over-the-counter (OTC) pain relievers such as acetaminophen (Tylenol®) or ibuprofen (Motrin®) are usually sufficient for any pain.
- Doctors recommend getting a tetanus shot every 10 years. If the wound is deep or dirty and the individual's last shot was more than five years ago, a doctor may recommend a tetanus shot booster within 48 hours of the injury.
- Bandaging the wound: Bandages can help keep the wound clean and keep harmful bacteria out. After the wound has healed (three to four days) enough to make infection unlikely, exposure to the air will speed wound healing.
- Dressing change: Change the dressing at least daily or whenever it becomes wet or dirty. If the individual is allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze held in place with paper tape, gauze roll, or a loosely applied elastic bandage. A local pharmacy will carry these supplies.
- Stitches: A wound that cuts deeply through the skin or is gaping or jagged-edged and has fat or muscle protruding usually requires stitches. A strip or two of surgical tape may hold a minor cut together, but if the individual cannot easily close the opening of the wound, see a doctor as soon as possible. Proper closure within a few hours minimizes the risk of infection.
- Signs of infection: It is recommended by healthcare professionals to see a doctor if the wound does not heal in a five to seven days or if there is redness, drainage, warmth, or swelling.
- Treatments for specific wounds:
- Animal bites:
- If an animal (especially a stray dog or a wild animal) inflicted the wound, the individual may have been exposed to rabies. A doctor may give antibiotics and suggest initiation of a rabies vaccination series. Report such incidents to county public health officials. If possible, the animal should be confined for ten days of observation by a veterinarian.
- Pressure sores:
- Once a pressure ulcer is identified, steps must be taken immediately to: relieve the pressure on that area. Use pillows, special foam cushions, and sheepskin to reduce the pressure; treat the sore based on the stage of the ulcer. A healthcare provider will give specific treatment and care instructions; avoid further trauma or friction. Powder the sheets lightly to decrease friction in bed; improve nutrition and other underlying problems that may affect the healing process; if the pressure ulcer is at Stage II or worse, a healthcare provider will give specific instructions on how to clean and care for open ulcers. It is very important to do this properly to prevent infection; keep the area clean and free of dead tissue. Generally, pressure ulcers are rinsed with a salt-water rinse to remove loose, dead tissue. The sore should be covered with special gauze dressing made for pressure ulcers. Do not massage the area of the ulcer, as massage can damage tissue under the skin. Donut-shaped or ring-shaped cushions are not recommended. They interfere with blood-flow to that area and cause complications, such as pressure sores.
- Non-surgical treatment: Treating pressure sores is challenging. Open wounds are slow to close, and because skin and other tissues have already been damaged or destroyed, healing is never perfect. Although it may take some time, most stage I and stage II sores will heal with conservative measures. But stage III and stage IV wounds, which are less likely to resolve on their own, may require surgery.
- The first step in treating a sore at any stage is relieving the pressure that caused it. Pressure can be reduced by changing positions often. Carefully follow a schedule for turning and repositioning - approximately every 15 minutes if in a wheelchair and at least once every two hours when in bed. If the individual is unable to change position on their own, a family member or other caregiver must be able to help. Using sheepskin or other padding over the wound can help prevent friction when moving.
- Using support surfaces is important.
These are special cushions, pads, mattresses, and beds that relieve pressure on an existing sore and help protect vulnerable areas from further breakdown. The most effective support depends on many factors, including the individual's level of mobility, their body build, and the severity of their wound. Healthcare professionals recommend avoiding using pillows and rubber rings, which actually cause compression.
- Mattresses should be low-air-loss beds or air-fluidized beds. Low-air-loss beds use inflatable pillows for support, whereas air-fluidized beds suspend the individual on an air-permeable mattress that contains millions of silicon-coated beads.
- Other non-surgical treatments of pressure sores include cleaning the wound to prevent infection. A stage I wound can be gently washed with water and mild soap, but open sores should be cleaned with a saltwater (saline) solution each time the dressing is changed. Saline solution is available at a pharmacy, or can be made at home by boiling 1 teaspoon of salt in 1 quart of water for five minutes. Store the solution in a sterile container and cool before using. It is best to avoid antiseptics such as hydrogen peroxide and iodine, which can damage sensitive tissue and delay healing.
- Controlling incontinence as far as possible is crucial to helping sores heal. If the individual is experiencing bladder or bowel problems, they may be helped by lifestyle changes, behavioral programs, incontinence pads, or medications.
- To heal properly, wounds need to be free of damaged, dead, or infected tissue. One approach to removing dead tissue is surgical debridement, a procedure that involves using a scalpel or other instrument to remove dead tissue. Surgical debridement is quick and effective, but it can be painful. A doctor may use one or more non-surgical approaches. These include removing devitalized tissue with a high-pressure irrigation device (mechanical debridement), allowing the body's own enzymes to break down dead tissue (autolytic debridement), or applying topical debriding enzymes, such as Granulex®.
- Dressings: A variety of dressings are used to help protect wounds and speed healing. The type of dressing used usually depends on the stage and severity of the wound. The basic approach, however, is to keep the wound moist and the skin surrounding it dry. Stage I sores may not need any covering, but stage II lesions are usually treated with hydrocolloids, or transparent semi-permeable dressings that retain moisture and encourage skin cell growth. Examples of hydrocolloid dressings include Tegasorb® and Relicare®. Other types of dressings may be more beneficial for weeping wounds or those with surface debris. Contaminated sores may also be treated with a topical antibiotic cream.
- Hydrotherapy: Whirlpool baths can aid healing by keeping skin clean and naturally removing dead or contaminated tissue. Whirlpool baths used for burn treatment are specialized, stainless steel baths used by trained healthcare professionals.
- Healthy diet: Eating a nutritionally rich diet with adequate calories and protein and a full range of vitamins and minerals, especially vitamins A, C, E, and zinc, has been reported to improve wound healing. A well nourished body can produce healthy skin, which guards against breakdown.
- Surgical repair: The goals of surgery include improving the hygiene and appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of future cancer. The type of reconstruction that's best in any particular case depends mainly on the location of the wound and whether there's scar tissue from a previous operation. In general, though, most pressure wounds are repaired using a pad of muscle, skin, or other tissue that covers the wound and cushions the affected bone (flap reconstruction). The tissue is usually harvested from the individual's own body. In spite of every precaution, flap reconstruction has one of the highest complication rates of any surgery, and the recovery period is long and arduous. Individuals must have a strong social support system, optimal nutritional status, state-of-the-art resources such as a pressure-release bed, and the ability and motivation to participate in their own recovery to be a candidate for this operation.
- Other treatment options: Hyperbaric oxygen, electrotherapy, and the topical use of human growth factors are methods of wound healing that are being researched. Growth factors, proteins that stimulate cell growth, have been approved for the treatment of diabetic ulcers but not, as yet, for pressure sores.
- Anal fissures:
- Anal fissures are fairly common and usually heal without treatment or with non-surgical treatments. Signs and symptoms may go away within two weeks, but it may take up to eight weeks for the tear to heal. If the tear doesn't heal within six to eight weeks, however, the individual may need surgery.
- For infants, the only intervention necessary may be changing the diaper regularly and keeping the anal area clean. A pediatrician can help provide ways to avoid constipation and ensure regular bowel movements to prevent the baby from straining.
- Non-surgical treatments: Lifestyle and dietary changes include adding more fiber to the diet, drinking more water, getting regular exercise, and taking a stool softener, such as docusate sodium (Colace®). A doctor may recommend non-surgical treatments including medicated creams or suppositories. A doctor may prescribe a rectal corticosteroid (Anusol® or Anusol HC®) or recommend an over-the-counter (OTC) cream or ointment containing hydrocortisone (Preparation H®) to help reduce inflammation and ease discomfort.
- Some doctors recommend applying nitroglycerine ointment (Nitrol® ointment) to the anus, which widens blood vessels and increases blood flow to the tear, promoting healing. This fairly new therapy also helps reduce pressure in the anal sphincter, which eases the spasm and decreases pain, thereby promoting healing. The dose of nitroglycerine is small to avoid dangerous side effects. However, it may cause side effects such as headaches, low blood pressure, and dizziness. Men shouldn't use nitroglycerine within 24 hours of taking erectile dysfunction medications such as sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®) because of the possibility of significantly lowered blood pressure.
- Another fairly new treatment involves injecting a small dose of botulinum toxin type A (Botox®) into the internal anal sphincter. Botox paralyzes the muscle for up to three months, causing the spasm to relax. A possible side effect is temporary, mild leakage of gas or stool (anal incontinence).
- Both topical nitroglycerine and Botox® have shown promise in relieving anal fissures in most studies. Researchers are testing these treatments alone and in combination with other drugs. Blood pressure medications nifedipine (Adalat®) and diltiazem (Cardizem®), taken orally or ground into a gel and applied to the tear, also have shown some promise.
- Surgery: If an individual has a chronic anal fissure that will not heal on its own, a doctor may recommend surgery. Surgery usually involves cutting a portion of the anal sphincter muscle to reduce spasm and pain and promote healing. Surgery may also include removal of the fissure and any scar tissue resulting from it.
- Adults usually have outpatient surgery. Children who have surgery may need to stay overnight in the hospital. Rarely, cutting the anal sphincter results in loss of ability to control bowel movements.
- Unclear or conflicting scientific evidence:
- Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
- Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
- Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
- Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
- Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
- Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
- Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
- Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
- Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
- Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
- Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
- Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
- Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
- Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
- Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
- Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
- Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
- Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
- Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
- Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
- Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
- There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
- Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
- Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
- Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
- Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
- Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
- Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
- Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
- Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
- Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
- Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
- TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
- Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
- Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
- Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
- Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
- Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
- Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
- Fair negative scientific evidence:
- Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Family Physicians. .
- American Academy of Pediatrics. .
- Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
- Centers for Disease Control and Prevention. .
- Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
- Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
- de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
- Natural Standard: The Authority on Integrative Medicine. .
- National Institute of Allergy and Infectious Diseases. .
- Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
- Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.
Prevention and self-management
- Self-management of physical symptoms:
- Many health problems that occur during pregnancy can be managed at home using methods recommended by healthcare professionals.
- Constipation and hemorrhoids: One of the reasons for constipation may be changes produced in the digestive tract due to hormones slowing down the movement of food. Additionally, during the last trimester of pregnancy there is more pressure on the rectum from the uterus. To avoid these problems, healthcare professionals recommend drinking plenty of water and eating fruit and vegetables with a high fiber content, such as green, leafy vegetables. Some pregnant women experience relief drinking a glass of room temperature water before breakfast. Over-the-counter (OTC) stool softeners may be used, such as docusate sodium (Colace®). It is recommended to tell the doctor of any OCT medication or dietary supplement taken during pregnancy.
- Nausea: Nausea occurs due to metabolic changes. In the morning before getting up, eating crackers and standing up very slowly is recommended to decrease feelings of nausea. It is best to try to eat in small quantities every three hours (fractionated diet). During pregnancy, it is good to eat proteins (meat, eggs, beans) before going to bed at night.
- Heartburn: Heartburn can occur when stomach acid from digesting food is pushed into the esophagus. During pregnancy, all digestive processes are slowed down and the engrossed uterus presses up on the stomach. To avoid heartburn, eat in small quantities, several times a day. Avoiding spicy and greasy foods and not eating at least one hour before going bed is important. Some pregnant women experience relief resting at night by elevating their heads with two or three pillows.
- Fatigue: Pregnancy may stress a woman's body. It is important to try to sleep eight hours daily and if possible, take a nap during the day. Avoiding hard work and eating a balanced diet throughout pregnancy is recommended by healthcare professionals.
- Headaches: Headaches may develop during pregnancy. This may be in part due to stress or in some cases it is cased by the higher level of blood in the body during pregnancy. Relaxing in a dark room may help decrease the pain and length of a headache. It is recommended by healthcare professionals to not take medications for headaches while pregnant unless directed by a doctor.
- Frequent urination: During pregnancy, the uterus is pressing down on the bladder. Even if the bladder is almost empty, this pressure produces the same sensation as if it were full. Do not avoid the urge to urinate.
- Cramps: Cramps are due to circulatory problems associated with the weight gain as the individual progresses in pregnancy. Exercises can be recommended by a healthcare professional to alleviate these discomforts.
- Chloasma: Chloasmas are obscure marks in the skin caused by the hormones secreted during pregnancy. They tend to disappear after delivery. Common areas of chloasmas include the forehead, temples, cheeks, or upper lip. Avoiding sunlight on sensitive areas can help prevent chloasma.
- Stretch marks: Skin tissue that has to support extra weight causes these marks. They appear on the abdomen and breasts and in most cases slowly disappear after delivery. Creams that contain cocoa butter may be useful in preventing stretch marks.
- Varicose veins: Varicose veins are produced by the pressure of the uterus on the lower part of the abdomen that causes difficulty in circulation during the nine months of pregnancy. Varicose veins usually appear in the legs especially if the mother must stand or sit for long periods of time. Moving frequently helps improve circulation. Elevate the legs when possible or lie in bed with a pillow under the feet. While sitting, try to keep the feet up. Do not wear tight clothing. A doctor may recommend support stockings.
- Breathing difficulties: Breathing difficulties may happen during the third trimester of pregnancy because the fetus is occupying more space in the abdomen; breathe deeply several times a day but avoid hyperventilation. Sleep propped up and avoid crowded places and smoggy environments.
- Backaches: Backaches are a consequence of the growing of the abdomen and weight increase associated with pregnancy. If an individual is suffering from backaches, healthcare professionals recommend: to avoid wearing high-heeled shoes; try to keep the back straight; and avoid lifting heavy weights. It is good to practice some relaxation exercises that will help to lower the tension in the muscles.
- Swelling: Swelling can occur due to the retention of water in the tissues. Swelling has a high occurrence in the feet. Try to elevate the legs whenever possible and avoid tight clothes that bind the legs. It is important to notify a doctor if swelling is taking place in uncommon areas, such as the face, or if weight increases suddenly.
- Pregnancy prevention, family planning:
- Abstinence: Abstinence is a lack of sexual relations. There are many ways to prevent pregnancy, but only abstinence is 100% effective.
- Natural family planning (NFP): Researchers have found that a method of natural family planning that uses two indicators to identify the fertile phase in a woman's menstrual cycle is as effective as the contraceptive pill for avoiding unplanned pregnancies if used correctly. The study specifically investigated the efficacy and the acceptability of the symptothermal method (STM), a method that uses two indicators of fertility, temperature and cervical secretions observation. In the largest study of STM, the researchers found that if the couples either abstained from sex = during the fertile period, the rate of unplanned pregnancies per year was 0.4%. The study authors suggested that the effectiveness of STM is comparable to the effectiveness of modern contraceptive methods such as oral contraceptives, and is an effective and acceptable method of family planning.
- A number of fertility awareness based methods of family planning have been advocated over the years, but comparisons between different methods and studies of their effectiveness have been limited and hampered by problems such as differences in cultural backgrounds, different ways to measure the effectiveness of a FAB method, different ways of classifying unintended pregnancies and other study design problems. Researchers recommend that women or couples who want to learn the method should buy a book, attend an NFP course, or get some teaching by a qualified NFP teacher.
- Early studies have also suggested that couples who practice NFP: have a dramatically low (0.2%) divorce rate; experience happier marriages; are happier and more satisfied in their everyday lives; have considerably more marital relations; share a deeper intimacy with their spouse; and realize a deeper level of communication with their spouse. Further, more well-designed studies are needed.
- Sterilization: Sterilization in the male is termed vasectomy and in the female tubal ligation, or tubal sterilization.
- Tubal sterilization, or tubal ligation, is surgery to block a woman's fallopian tubes. Tubal sterilization is a permanent form of birth control. After this procedure, eggs cannot move from the ovary through the tubes (a woman has two fallopian tubes), and eventually to the uterus. Also, sperm cannot reach the egg in the fallopian tube after it is released by the ovary. Thus, pregnancy is prevented.
- Vasectomy is a procedure in which the two tubes that carry sperm from the testicles to the urinary tract are surgically altered so sperm cannot pass through and be released to fertilize a woman's egg during sexual intercourse. For couples who have made the decision not to have any further children, vasectomy is the safest and easiest form of surgical sterilization. While reversible in many cases, vasectomy should be considered a permanent form of birth control.
- Hormonal contraception: Hormonal contraception to prevent pregnancy includes birth control pills, birth control patches, and birth control vaginal rings.
- Birth control pills, also known as oral contraceptives, have been marketed in the United States since 1962. Over the past 40 years, the type of estrogen and progestin (hormones) used in the pills has changed and the amounts of those hormones has been lowered. Birth control pills today are designed to improve safety and reduce side effects. Lower doses of estrogen are associated with a decrease in side effects, such as weight gain, breast tenderness, and nausea.
- Over 30 different combinations of birth control pills are available in the United States. Most of the combinations of these pills have 21 hormonally active pills followed by seven pills containing no hormones. A woman begins taking a pill on the first day of her period or the first Sunday after her period has begun.
- If a dose of oral contraceptive is missed, the individual may not be protected from pregnancy. A backup method of birth control, such as condoms, may be used for seven days or until the end of the cycle. Every brand of oral contraceptives comes with specific directions to follow if one or more doses have been missed. It is recommended to call a doctor or pharmacist with questions regarding missed oral contraceptive dosages. It is recommended by healthcare professionals to continue to take the tablets as scheduled and use a backup method of birth control until the questions are answered. Advantages of using birth control pills include their use to treat irregular menstrual periods. Women can manipulate the cycle to avoid a period during certain events, such as vacations or weekends by extending the number of intake days of hormonally active pills or by skipping the non-active pill week. Birth control pills may help prevent certain conditions, such as benign breast disease, pelvic inflammatory disease (PID), and functional cysts. Functional cysts are reduced by the suppression of stimulation of the ovaries. Ectopic pregnancies are prevented by the cessation of ovulation. The relationship between birth control pills and certain types of cancer is still being studied.
- Disadvantages of birth control pills include nausea, breast tenderness, breakthrough bleeding, no periods, headaches, depression, anxiety, and lower sexual desire. Birth control pills do not provide protection from sexually transmitted diseases (STDs). Taking the pills daily and consistently (same time every day) is important. If a woman stops taking birth control pills, she may need a few months to get her normal ovulatory cycle back. After six months, her healthcare provider may need to examine her.
- Additional risks include blood clots (venous thrombosis). At particular risk are heavy smokers (especially those older than 35 years), women with high or abnormal blood lipids (cholesterol levels), and women with severe diabetes, high blood pressure, and obesity. The association of birth control pill use and breast cancer in women remains controversial.
- The relationship between birth control pill use and cervical cancer is also quite controversial. Important risk factors include early sexual intercourse and exposure to the human papillomavirus (HPV). Women who use birth control pills should have a periodic Pap test.
- Intra-uterine device (IUD): An intrauterine device (IUD) is a small T-shaped plastic device that is placed in the uterus to prevent pregnancy. A plastic string is attached to the end to ensure correct placement and for removal. IUDs are an easily reversible form of birth control, and they can be easily removed. However, an IUD should only be removed by a medical professional.
- Birth control barriers: Birth control barriers such as diaphragms, cervical caps, and condoms may also be used.
- Spermicides: Spermicides are chemical barriers to conception. They are a reversible method of birth control, meaning that when a woman stops using them, full fertility returns. Vaginal spermicides are available in forms such as foam, cream, jelly, film, suppository, or tablet. Spermicides are not as effective as many other forms of birth control when used alone. They are often used with barrier methods of birth control and are much more effective when used in this context.
- Emergency contraception: Plan B is the only emergency contraceptive pill ("morning after pill" or "day after pill") being sold in the United States today, although women can also use many kinds of daily birth control pills to prevent pregnancy after sex.
- Plan B contains the hormone progestin. Other options for emergency contraception include taking a different dose of daily birth control pills (most of which contain both progestin and estrogen, so they are called "combined" pills) or having a healthcare provider insert an IUD within five days after the birth control failed and having had sex without using contraception, or if the individual was forced to have sex. Preven®, the brand name of a combined emergency contraceptive pill that was approved for use in the United States, is no longer being sold here. Plan B is more effective and has fewer side effects than other emergency contraceptive pills.
- Emergency contraceptive pills are available without prescription to women and men 18 and older in the United States, though women 17 and under will still need a prescription from a healthcare provider to buy them. In some states, women of all ages can get emergency contraceptive pills directly from a pharmacist, without having to see a doctor first.
Structure and function of the eye
- The eye:
- The eye is a hollow, fluid-filled, three-layered ball. The outer layer is the sclera, the innermost is the retina (the thin light-gathering layer), and the middle layer is the uvea. The uvea is made up of the iris, the ciliary body, and the choroid.
- The eyeball is divided into two sections, each of which is filled with fluid. The front section (anterior segment) extends from the inside of the cornea to the front surface of the lens. It is filled with a fluid called the aqueous humor, which nourishes the internal structures. The back section (posterior segment) extends from the back surface of the lens to the retina. It contains a jellylike fluid called the vitreous humor. The pressure generated by these fluids fills out the eyeball and helps maintain its shape.
- The anterior segment itself is divided into two chambers. The front (anterior) chamber extends from the cornea to the iris; the back (posterior) chamber extends from the iris to the lens. Normally, the aqueous humor is produced in the posterior chamber, flows slowly through the pupil into the anterior chamber, and then drains out of the eyeball through outflow channels located where the iris meets the cornea.
- Light and image transmission:
- Light enters the eye through the cornea, a transparent dome on the front surface of the eye. The cornea serves as a protective covering for the front of the eye and also helps focus light on the retina at the back of the eye. After passing through the cornea, light travels through the pupil (the black dot in the middle of the iris), which is actually a hole through the iris. The iris is the circular, colored area of the eye and controls the amount of light that enters the pupil. The size of the pupil is controlled by the action of the pupillary sphincter muscle and dilator muscle. These muscles contract to either dilate (enlarge) or constrict (shrink) the size of the pupil. The iris allows more light into the eye when the environment is dark and allows less light into the eye when the environment is bright.
- Behind the iris sits the lens. Through the action of small muscles (called the ciliary muscles), the lens becomes thicker to focus on nearby objects and thinner to focus on distant objects. By changing its shape, the lens focuses light onto the retina.
- The retina contains the photoreceptors, which are nerve cells, and the blood vessels that nourish them. The most sensitive part of the retina is a small area called the macula, which has millions of tightly packed photoreceptors. The density of photoreceptors in the macula allows for highly detailed visual images. All photoreceptors are connected to individual nerves, which bundle together to form the optic nerve. The optic nerve begins at the optic disk, a small round structure at the back of the eye. The photoreceptors in the retina convert the image into electrical impulses, which are carried to the brain by the optic nerve.
- There are two main types of photoreceptors, cones and rods. Cones are clustered mainly in the macula and are responsible for color vision as well as sharp, detailed central vision. The rods are responsible for night and peripheral (side) vision. Rods are more numerous than cones and much more sensitive to light, but they do not register color. Rods are grouped mainly in the peripheral areas of the retina and do not contribute to detailed central vision as do the cones.
- Protective structures:
- The bony structures of the orbit protrude beyond the surface of the eye. They protect the eye while allowing it to move freely in a wide arc.
- The eye has a relatively tough white outer layer (sclera or white of the eye). Near the front of the eye, the sclera is covered by a thin mucous membrane (conjunctiva), which runs to the edge of the cornea and also covers the moist back surface of the eyelids.
- The eyelashes are short, tough hairs that grow from the edge of the eyelid. The upper lashes are longer than the lower lashes and turn upward. The lower lashes turn downward. Eyelashes keep insects and foreign particles away from the eye by acting as a physical barrier and by causing the person to blink reflexively at the slightest disturbance.
- The upper and lower eyelids are thin flaps of skin that can cover the eye. They reflexively close quickly (blink) to form a mechanical barrier that protects the eye from foreign objects, wind, dust, insects, and very bright light. The reflex is triggered by the sight of an approaching object, the touch of an object on the surface of the eye, or the eyelashes being exposed to wind or small particles such as dust or insects. On the moist back surface of the eyelid, the conjunctiva loops around to cover the front surface of the eyeball, right up to the edge of the cornea. The conjunctiva protects the sensitive tissues underneath it.
- When an individual blinks, the eyelids help spread tears over the surface of the eye. Tears consist of a salty fluid that continuously bathes the surface of the eye to keep it moist and transfers oxygen and nutrients to the cornea, which lacks blood vessels that normally supply these substances to other tissues. When closed, the eyelids help trap the moisture against the surface of the eye. Small glands at the edge of the upper and lower eyelids secrete an oily substance that contributes to the tear film and keeps tears from evaporating. Tears also trap and sweep away small particles that enter the eye. Moreover, tears are rich in antibodies that help prevent infection. The eyelids and tears protect the eye while allowing clear access to light rays entering the eye. If allowed to dry, the transparent cornea may become injured, infected, or opaque.
- The lacrimal glands, located at the top outer edge of each eye, produce the watery portion of tears. Mucous glands in the conjunctiva produce mucus, which mixes with the watery portion of the tears to create a more protective tear film. Tears drain from each eye into the nose through one of the two nasolacrimal ducts; each of these ducts has openings at the edge of the upper and lower eyelids near the nose, called the punctum.
Common eye disorders
- Age-related eye disorders:
- Scleral changes:
Years of exposure to ultraviolet light, wind, and dust may cause changes to the sclera (the white of the eyes) late in life. These changes may include yellowing or browning, random splotches of pigment (more common in people with a dark complexion), or a bluish hue due to increased transparency of the sclera.
- Dry eye: The number of mucous cells in the conjunctiva may decrease with age. Tear production may also decrease with age, so that fewer tears are available to keep the surface of the eye moist. Both of these changes explain why older people are more likely to have dry eyes.
- Arcus senilis: Arcus senilis (a deposit of calcium and cholesterol salts) appears as a gray-white ring at the edge of the cornea. It is common in people older than 60. Arcus senilis does not affect vision.
- Retinal disorders: Some diseases of the retina are more likely to occur in old age, including macular degeneration, diabetic retinopathy, and retinopathy. Other eye diseases, such as cataracts, also become common. Please see individual condition monographs for more information on these eye disorders.
- Ectropion: The muscles that squeeze the eyelids shut decrease in strength with age; this, combined with gravity and age-related looseness of the eyelids, sometimes results in the lower eyelid falling away from the eyeball, a condition called ectropion. In rare cases, ectropion may be present at birth. In such instances, ectropion is usually associated with genetic disorders such as Down syndrome.
- Puffy eyelids: In some older people, the fat around the orbit shrinks, causing the eyeball to sink into the orbit. Because of lax tissues in the eyelids, the orbital fat can also bulge forward into the eyelids making them appear constantly puffy.
- The muscles that work to regulate the size of the pupils weaken with age. The pupils become smaller, react more sluggishly to light, and dilate more slowly in the dark. Therefore, people older than 60 may find that objects are not as bright, that they are dazzled initially when going outdoors (or when facing oncoming cars during night driving), and that they have difficulty going from a brightly lit environment to a darker one. These changes may be particularly bothersome when combined with the effects of a cataract.
- Other changes in eye function also occur as people age. The sharpness of vision (acuity) is reduced despite use of the best glasses, especially in people who have a cataract, macular degeneration, or advanced glaucoma. The amount of light that reaches the back of the retina is reduced, increasing the need for brighter illumination and for greater contrast between objects and the background.
- Vision problems:
- 20/20 vision is a term used to express normal visual acuity (the clarity or sharpness of vision) measured at a distance of 20 feet. If an individual has 20/20 vision, they can see clearly at 20 feet what should normally be seen at that distance. If the individual has 20/100 vision, it means that they must be as close as 20 feet to see what a person with normal vision can see at 100 feet.
- 20/20 does not necessarily mean perfect vision. 20/20 vision only indicates the sharpness or clarity of vision at a distance. There are other important vision skills, including peripheral awareness or side vision, eye coordination, depth perception, focusing ability, and color vision that contribute to the individual's overall visual ability.
- Some people can see well at a distance, but are unable to bring nearer objects into focus. This condition can be caused by hyperopia (farsightedness) or presbyopia (loss of focusing ability). Others can see items that are close, but cannot see those far away. This condition may be caused by myopia (nearsightedness).
- There are many types of visual disturbances. These include blurred vision, halos, blind spots, floaters, and other symptoms. Blurred vision is the loss of sharpness of vision and the inability to see small details. Blind spots (scotomas) are dark "holes" in the visual field in which nothing can be seen.
- Changes in vision, blurriness, blind spots, halos around lights, or dimness of vision should always be evaluated by a healthcare professional. Such changes may represent an eye disease, aging, eye or brain injury, or a condition like diabetes that affects many organs in the body. Whatever the cause, vision changes should never be ignored. Vision problems can get worse and significantly impact the quality of the individual's life.
- Astigmatism: Astigmatism simply refers to a very common eye condition in which the eye curves more steeply on one side than the other, so that the cornea is oval or "football" shaped. Astigmatism causes light rays to focus at two different points in the eye which causes distant and near images to be blurred. Most cases of astigmatism are inherited and present at birth or early childhood. Other cases may develop secondary to other eye conditions or as a result of a traumatic injury to the cornea.
- Myopia: Myopia, or nearsightedness, is probably the most common type of vision disturbance, affecting about one in four people in the United States. Individuals with myopia can see things up close (this may be as little as a few inches), but anything further away appears blurry or even indistinguishable. With myopia, the eyeball is too long, or the cornea is too steep, so images are focused in the vitreous inside the eye rather than on the retina at the back of the eye. This causes blurred vision. Having a family history of myopia is one of the most well-known risk factors for myopia. It has been estimated that as few as 6-15% of people with myopia have no family history of the disorder. Some experts suspect that people may inherit a tendency to develop myopia, but a combination of genetic and environmental factors determine whether or not a person actually develops the condition. Genetic markers on chromosomes 1, 2, 12, and 18 have been linked to myopia, although specific genes have not been identified.
Hyperopia, or farsightedness, results from an eye that is too short, meaning that light rays reach the retina before they have the opportunity to converge into a focused image. Individuals with this condition are able to see, with varying degrees of success, objects further away, but close-up items are blurry.
- Presbyopia: Presbyopia, or double vision, is difficulty focusing on objects that are close. In middle age (usually starting in the middle 40s), the lens of the eye becomes less flexible and less able to thicken. The eyes become less able to focus on nearby objects, a condition called presbyopia. Reading glasses, or bifocal lenses, can help compensate for this problem.
- Currently, an estimated 90 million people in the United States either have presbyopia or will develop it by 2014.
- Floaters: Floaters are tiny particles drifting across the eye. Eye floaters look like black or gray specks, strings, or cobwebs that drift about when the individual moves their eyes. Most eye floaters are caused by age-related changes that occur as the jelly-like substance (vitreous) inside the eyes becomes more liquid. When this happens, microscopic fibers within the vitreous tend to clump together. These clumps of debris float around within the vitreous cavity, and they can cast tiny shadows on the retina, which the individual may see as floaters. Eye floaters are most noticeable when the individual looks at a plain bright background such as a blue sky or a plain white wall. Although often brief and harmless, they may be a sign of retinal detachment. Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Eye floaters tend to affect those over age 40. Other risk factors for eye floaters include nearsightedness, eye trauma, complications from cataract surgery, diabetic retinopathy, and eye inflammation.
- Other vision problems: Other potential causes of vision problems include fatigue, overexposure to the outdoors (temporary and reversible blurring of vision), and many medications. Medications that can affect vision, including causing blurry vision and dry, irritated eyes, include: antihistamines (such as diphenhydramine or Benadryl®), anticholinergics (such as dicyclomine or Bentyl®), digitalis derivatives (such as digoxin or Lanoxin®), some high blood pressure pills (guanethidine, reserpine, and thiazide diuretics), indomethacin (Indocin®), phenothiazines (such as prochlorperazine or Compazine®), and medications for malaria (such as chloroquine or Aralen®) and tuberculosis (including ethambutol or Myambutol®).
- Conjunctivitis, or pink eye, is an inflammation or infection of the transparent membrane (conjunctiva) that lines the eyelid and part of the eyeball. The cause of pink eye is usually a bacterial or viral infection, and it is often associated with colds. Both viral and bacterial types are very contagious. Conjunctivitis can also be caused by an allergic reaction. In newborns, an incompletely opened tear duct may lead to conjunctivitis. Blocked tear ducts may also lead to conjunctivitis.
- Bacterial conjunctivitis: The most common types of bacteria that cause bacterial conjunctivitis include Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, and Pseudomonas aeruginosa. Bacterial conjunctivitis is usually associated with a thick discharge or pus and can affect one or both eyes. Bacterial conjunctivitis often produces a thick, yellow-green discharge and may be associated with a respiratory infection or with a sore throat. Adults and children alike can develop both of these types of pink eye. However, bacterial conjunctivitis is more common in children than it is in adults.
- Viral conjunctivitis: Viral conjunctivitis is a common type of conjunctivitis caused by a viral infection, such as the common cold or influenza viruses. Viral conjunctivitis is highly contagious, because airborne viruses can be spread through sneezing and coughing. Viral conjunctivitis also can accompany common viral upper respiratory infections such as measles, the flu, or the common cold. Viral conjunctivitis is usually associated with a watery discharge, and may affect both eyes. However, the infection typically starts in one eye and quickly spreads to the other eye.
- Gonococcal and chlamydial conjunctivitis: Gonococcal or chlamydial conjunctivitis are caused by bacteria commonly associated with sexually transmitted diseases, including gonorrhea and chlamydia. Newborn babies may be exposed when they pass through the birth canal of an infected mother. Chlamydial conjunctivitis typically affects sexually active teens and young adults and is the most frequent infectious cause of neonatal conjunctivitis in the United States. The Centers for Disease Control (CDC) recognizes chlamydia as one of the major sexually transmitted pathogens, estimating approximately three million new cases per year. Women seem to be more susceptible than men, possibly due to differences in reproductive anatomy. The incidence of infection seems to be directly related to sexual activity and geography, with urban populations having higher incidences. The incidence in pregnant women overall is 4-10%. Trachoma is a form of chlamydial infection that causes the eye's surface to become scarred. Trachoma is the world's leading cause of preventable blindness.
- Neonatal conjunctivitis: Most cases of neonatal conjunctivitis are caused by viruses. In newborns, conjunctivitis may also result from an incompletely opened tear duct. Neonatal conjunctivitis in newborn babies can cause blindness when left untreated.
- Neonatal conjunctivitis can also be caused by herpes viruses, which are also associated with sexually transmitted diseases. Herpes simplex virus type 2 is most often found in the genital area and can infect the eyes of infants during birth. Herpes simplex virus type 1, more commonly associated with cold sores on the mouth, also can cause genital herpes and may thus also result in neonatal conjunctivitis.
- Allergic conjunctivitis: Allergies can cause lead to a very common form of conjunctivitis, called allergic conjunctivitis. Allergens that can trigger allergic conjunctivitis (as well as other types of allergies) include pollen, animal dander, and dust mites. The most common symptom of allergic conjunctivitis is itching of the eyes. Itchy eyes may be relieved with special eye drops containing antihistamines, which block the histamines that cause allergic reactions. These eye drops are available by prescription or over-the-counter.
- Non-infectious conjunctivitis: Conjunctivitis may be caused by non-infectious sources, smoke, diesel exhaust, perfumes, and chemical splashes. Discharge tends to be mucus rather than pus. Sometimes, flushing and cleaning the eye to rid it of the chemical or object causes redness and irritation. Signs and symptoms usually clear up on their own within about a day.
- Certain forms of non-infectious conjunctivitis, including giant papillary conjunctivitis (GPC), can be caused by the eye's immune responses to foreign objects such as contact lenses or ocular prosthetics (artificial eyes). Toxic conjunctivitis can be caused by allergic reactions to certain ingredients in eye drops or ointments, such as preservatives or other chemicals.
- The eyes of newborns are susceptible to bacteria normally present in the mother's birth canal. These bacteria cause no symptoms in the mother, but in rare cases, these bacteria can cause infants to develop a serious form of conjunctivitis known as ophthalmia neonatorum. This condition requires immediate treatment in order to preserve sight. For this reason, doctors or healthcare workers apply antibiotics to every newborn's eyes as a preventative measure.
- When any part of the uvea becomes inflamed, then it is called uveitis. The most common type of uveitis is an iritis (anterior uveitis, or inflammation of the iris). Uveitis can be quite serious and may lead to permanent vision loss. Early diagnosis and treatment are important. Uveitis is most common in people ages 20-50. However, in some people, uveitis is associated with autoimmune disorders, such as rheumatoid arthritis or ankylosing spondylitis; inflammatory disorders, such as Crohn's disease or ulcerative colitis; infections, such as syphilis, toxoplasmosis, or tuberculosis; eye injury, and certain cancers, such as lymphoma.
- Xerophthalmia (dry eye):
- Xerophthalmia,also known as keratoconjunctivitis sicca or commonly as dry eye, is a medical condition in which the eye fails to produce a sufficient amount of tears for lubrication. The more modern term is dysfunctional tear syndrome, as that covers the many causes of this very complex problem. Anything that disturbs either the production of tears and/or the quality of the tears leads to dry eye syndrome or dysfunctional tear syndrome.
- Dry eye problems are extremely common with increasing age, although they are more common in women than men. About 10-14 million Americans have some form of this problem. With age, tear production and quality may decrease. There are several conditions and medications that can lead to dry eye syndrome or make it worse. These include autoimmune conditions such as rheumatoid arthritis; diabetes; thyroid disease; some genetic conditions such as Sjögren syndrome and Bell's palsy; some ocular surgical procedures including cataract surgery, refractive surgery for vision correction, and glaucoma surgery; ocular allergies and allergies in general; certain oral medications such as diuretics, anti-allergy medications, beta blockers, sleeping pills, pain relievers, and anti-anxiety medications; wearing contact lenses, especially excessive wear, low-water contact lenses, and ill-fitting contact lenses; preservatives in many eye drops, such as thimerosal (mercury); high-wind and low-humidity conditions, not only outside but wind drafts from heaters, fans, or air conditioners aimed toward the eyes; prolonged reading, computer use, or viewing of television or movies; use of a CPAP (Continuous Positive Airway Pressure) device for treatment of sleep apnea; diseases that affect the ability of the eyelids to close fully such as Bell palsy or facial paralysis; a deficiency in vitamin A; surgery of the eyelids that causes greater exposure of the eye; bone marrow transplant; inflammatory diseases; and degenerations of the cornea (outer covering of the eye).
- Keratitis is an inflammation of the cornea, the transparent membrane that covers the colored part of the eye (iris) and pupil of the eye. Keratitis is generally the result of a corneal infection injury or severe dryness. Risk factors that increase the likelihood of developing this condition include: poor contact lens care; overuse of contact lenses; illnesses or other factors that reduce the body's ability to overcome infection; cold sores, genital herpes, and other viral infections; crowded, dirty living conditions; poor hygiene; and poor nutrition (especially a deficiency of vitamin A, which is essential for normal vision).
- Herpes simplex keratitis: Herpes simplex keratitis is caused by an infection by the herpes simplex virus types 1 and 2 and is a major cause of adult eye disease. Herpes simplex keratitis may lead to chronic inflammation of the cornea; development of tiny blood vessels in the eye; scarring; loss of vision; and glaucoma. Herpes simplex keratitis generally begins with infection and inflammation of the membrane lining the eyelid (conjunctiva) and the portion of the eyeball that comes into contact with it. It usually occurs in one eye. Subsequent infections are characterized by a pattern of lesions that resemble the veins of a leaf. These infections are called dendritic keratitis and aid in the diagnosis.
- Recurrences may be brought on by stress, fatigue, or ultraviolet light (UV) exposure (such as outdoor activities especially on water, which reflects UV rays off of the surface). Repeated episodes of dendritic keratitis can cause sores, permanent scarring, and numbness of the cornea. Recurrent dendritic keratitis is often followed by disciform keratitis. This condition is characterized by clouding and deep, disc-shaped swelling of the cornea and by inflammation of the iris. It is very important not to use topical corticosteroids with herpes simplex keratitis as it can make it much worse, possibly leading to blindness.
- Bacterial keratitis: Bacterial keratitis is keratitis caused by bacteria including Streptococcus, Pseudomonas, Enterobacteriaceae (including Klebsiella, Enterobacter, Serratia, and Proteus), and Staphylococcus species. In bacterial keratitis, individuals
wake up with their eyelids stuck together. There may be pain, sensitivity to light, redness, tearing, and a decrease in vision. This condition, which is usually aggressive, can result from improper use of contact lenses. Overnight wear of contact lenses can increase the risk of bacterial keratitis by 10-15 times more than if wearing daily wear contact lenses. Improper lens care, such as not cleaning and storing properly, is also a factor. Contaminated makeup can also contain bacteria. Bacterial keratitis makes the cornea cloudy due to infection and inflammation. It may also cause abscesses to develop in the stroma, which is located beneath the outer layer of the cornea.
- Fungal keratitis:
Fungal keratitis is a serious and painful corneal disease that is caused by fungal infection.
Fungal keratitis is usually a consequence of injuring the cornea in a farm-like setting or in a place where plant material contaminated with fungi is present. Fungal keratitis often develops slowly. This condition usually affects people with weakened immune systems and often results in infection within the eyeball.
- Peripheral ulcerative keratitis:
Peripheral ulcerative keratitis is also called marginal keratolysis or peripheral rheumatoid ulceration. This condition is often associated with active or chronic rheumatoid arthritis, relapsing polychondritis (connective-tissue inflammation), and Wegener's granulomatosis (a rare condition characterized by kidney disease and development of nodules in the respiratory tract).
- Superficial punctate keratitis: Superficial punctuate keratitis is often associated with the type of viruses that cause upper respiratory infection (adenoviruses). It is characterized by destruction of pinpoint areas in the outer layer of the cornea (epithelium). One or both eyes may be affected.
- Acanthamoeba keratitis:
Acanthamoeba keratitis is an eye infection caused by Acanthamoeba. Acanthamoeba keratitis is a pus-producing condition that is very painful. It is a common source of infection in people who wear soft or rigid contact lenses. It can be found in tap water, soil, and swimming pools.
Photokeratitis or snowblindness is caused by excess exposure to UV light and a resulting burn of the cornea. This can occur with sunlight, sun tanning lamps, or a welding arc. It is called snow blindness because the sunlight is reflected off of the snow. It therefore can occur in water sports as well, because of the reflection of light off of the water. It is very painful and may occur several hours after exposure. It may last one to two days.
- Interstitial keratitis:
Also called parenchymatous keratitis, interstitial keratitis is a chronic inflammation of tissue deep within the cornea. Interstitial keratitis is rare in the United States. Interstitial keratitis affects both eyes and usually occurs as a complication of congenital or acquired syphilis. In congenital syphilis, it can occur between age two and puberty. It may also occur in people with tuberculosis, leprosy, or other diseases.
- Other eye disorders:
- Corneal abrasion: A corneal abrasion is a painful scrape or scratch of the surface of the clear part of the eye known as the cornea. This transparent window covers the iris, the circular colored portion of the eye. The cornea has many nerve endings just under the surface, so that any disruption of the surface may be painful. A corneal abrasion may occur when an object, such as a piece of dirt, hits the eye. In addition to causing corneal injury, high-speed particles may penetrate the eye and injure deeper structures. Examples include pieces of metal fragments thrown by a grinding wheel or ashes from a hot cigarette. Corneal abrasions may also occur when the eyes are irritated or rubbed excessively. Wearing contact lenses longer than recommended may injure the corneal surface and cause a corneal abrasion.
- Retinitis pigmentosa: Retinitis pigmentosa is actually the name given to a group of hereditary eye disorders, all of which involve the retina, the light-sensitive nerve layer that lines the back of the eye. All diseases classified as retinitis pigmentosa cause a progressive vision loss. The retinal defect may be found in the rod cells, which are found outside of the central retina. Rods help to transmit dim light and allow for peripheral vision. The retina's cone cells may also be affected and/or the connection between the cells that compose the retina. Cone cells are a type of retinal cell found inside the center of the retina that help to transmit the color and detail of images.
- Several different inherited retinal problems can cause retinitis pigmentosa. In most cases, the disorder is caused by a recessive gene. This means that one abnormal gene must be inherited from both parents. Some cases have also been linked to genetic mutations on the X chromosome. Other cases are caused by a dominant gene, which means that people develop the disorder if they inherit the mutated gene from just one parent. For example, an estimated 30% of autosomal dominant cases occur when there is a mutation in the gene that codes for rhodopsin, a pigment in the retina that is needed for vision. When the gene is mutated, rhodopsin does not form properly and photoreceptor cells die in the eyes.
- Some patients have no family history of the disease. In such cases, the genetic mutation may occur randomly during the development of the egg, sperm, or embryo.
- Other cases may occur as part of other genetic disorders, such as Bassen-Kornzweig disease, or Kearns-Sayre syndrome, Waardenburg syndrome, Alport syndrome, or Refsum disease.
- Blepharitis: Blepharitis is an eye disorder whereby the margins of the eyelid, the parts of the eye where the eyelashes grow, are inflamed, causing itching, redness, swelling, and irritation. This disorder may be caused by oil gland malfunctioning (posterior blepharitis), seborrheic dermatitis or excess growth of bacteria such as Staphylococcus bacteria (anterior blepharitis, staphlycoccal blepharitis), or allergies. Blepharitis may result in flaking of the skin around the eyes, crusted eyelashes, closed eyelids during sleep or upon wakening, sensitivity to light, or abnormal growth or loss of eyelashes. Blepharitis is usually treated, controlled, and prevented through proper ocular hygiene.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.