Dr. Glenn N. Pomerance

As the questioner has correctly stated, cephalexin is an antibiotic, not used for treatment of glaucoma. Nor would pain medication be a treatment. I note, however, that the patient is 33 years old. Unless the patient has had an injury to the eye at some point and has scarring sufficient to cause pressure elevation, it is unlikely that he has glaucoma. May the questioner is mistaken about the diagnosis. Sounds more like an eyelid or orbital infection. If the patient has not been seen by a qualified eyecare provider, I would seek another opinion.

G. N. Pomerance, M.D.

Timely question as this is being considered currently! The reason probably lies in several planes. Unfortunately lengthy answer.

First, separating the surgeries insures that unlikely contamination and infection won’t afflict both eyes. Theoretically, same day surgery makes such an event more likely! Second, occasionally, the vision doesn’t recover for a day or so after surgery, leaving a patient at risk of reduced function in the operative eye. If both eyes are done sequentially in the same day and similarly affected, there is a risk of overall poor function for a finite period! This is basically risk averse behavior. Historically, it was thought best to allow one eye to recover completely before doing the other and this became a “standard of practice”. Physicians, like everyone else, are often resistant to change! Fourth, the surgeon may learn from the first surgery and thereby have an opportunity to adapt the second surgery to refine the outcome!

And last, you knew I get to this, is the fact that insurance companies like Medicare will only pay 50% of the standard fee for a second or subsequent surgery performed at the same surgical setting! Margins are tight these days and neither surgeons nor surgery facilities can really afford that hit! Cataract surgery depends on expensive technology, and regulatory compliance is adding to costs while payments are being reduced.

The push to bilateral same day cataract surgery is being motivated by trends in other countries where it is more commonly done!

Hope this answers your question!

Glenn N. Pomerance, M.D.
Chattanooga, TN

If your little guy’s strabismus is caused by an uncorrected optical error (farsightedness), a pair of glasses may control it. Otherwise, it may take muscle surgery to fix the strabismus. The muscles controlling the alignment of the eyes may be effectively lengthened or shortened to bring the eyes into proper alignment. Often, it is necessary to operate on both eyes, even though only one appears to be misaligned. It is important to fix the misalignment, one way or the other as soon as possible to prevent amblyopia or “lazy” eye as this may cause permanently reduced vision. Although surgery may seem drastic for such a little person, it is safe and effective when done by a qualified Pediatric Ophthalmologist.

G. N. Pomerance, M.D.

A study done four years ago linked the propensity to have dry eye after LASIK vision correction surgery to carriers of a specific gene. Although the association is not confirmed in the general population, it is certainly interesting and there is increasing interest in detecting if this is also true of dry eye patients who have not had refractive surgery. So, the verdict is still out, but evidence may, indeed, support a hereditary basis for dry eye. Stay tuned!!!

G. N. Pomerance, MD

Most likely allergy but could be infection. Seek medical advice if it doesn’t clear up in a day or so with OTC allergy medication (drops and/or oral).

G. Pomerance, M.D.

The American Academy of Ophthalmology knows of no report to substantiate this fear.

G. Pomerance, MD