You are greatly remembered at this special season. May your life be continually filled by the love and joy of christmas. And may God continue to keep and bless you abundantly
Toxoplasmosis is an infection caused by a parasite known as Toxoplasma gondii (T. gondii). This single-celled organism is commonly found throughout the world and tends to infect birds and mammals. The parasite forms egg-like structures called oocysts. These must be ingested by mouth, which means the infection cannot be transferred from person to person.
Humans become infected with the toxoplasmosis parasite through contact with infected animal faeces (poo). Cats are the main hosts. They acquire T. gondii from eating infected rodents or birds and then may pass the infection to their human handlers.
Another way of catching this infection is touching or eating raw or undercooked lamb, pork or kangaroo meat. The parasites can be stored in small pockets (cysts) in the muscle tissue of these meats. Drinking contaminated unpasteurised milk can also cause infection with toxoplasmosis parasites.
Symptoms of toxoplasmosis
In most cases of animal and human infection, toxoplasmosis does not cause any symptoms. The only evidence of infection is detection of antibodies in the blood against the toxoplasmosis parasite.
Symptoms, if they do occur, include:
Swollen lymph glands, especially around the neck
Muscle aches and pains
Headache
Fever
Generally feeling unwell
Inflammation of the lungs
Inflammation of the heart muscle
Inflammation of the eye, for example, the retina (at the back of the eye).
Duration of infection with T. gondii
The toxoplasmosis parasite can cause a long-term infection. Following infection, a small number of parasites can remain locked inside cysts within certain parts of the body, such as the brain, lungs and muscle tissue.
Under normal circumstances, the immune system will easily destroy any parasites that escape these cysts, but a person with lowered immunity may not be able to fend off an attack. The parasites can greatly increase in number and cause a variety of serious illnesses, including infection of the brain.
Effects of toxoplasmosis on unborn babies
If newborn babies are infected, at worst, they will only suffer from mild illness. However, toxoplasmosis in pregnancy can expose babies in the womb to the parasite and this is potentially more serious. If a woman contracts toxoplasmosis for the first time while pregnant, the parasites may affect the baby through the placenta.
Most unborn babies aren’t affected at all, but a minority may be harmed by infection. Effects of toxoplasmosis on unborn babies can include:
Skin rashes
Nervous system damage
Mental retardation
Cerebral calcification (hardening of brain tissue)
Liver damage
Eye problems
Fetal death (in rare cases).
Precautions against toxoplasmosis
Pregnant women and people who have compromised immune systems should take precautions against toxoplasmosis. If a woman is infected before she becomes pregnant, then her immune system will attack the parasite and make it harmless. Problems only occur if a woman becomes infected for the first time while pregnant.
A pregnant woman and people with compromised immune systems can take simple precautions to reduce the risk of infection with the parasite. These include:
Wash hands after handling raw meat.
Cook meat (including kangaroo meat) thoroughly until the juices run clear.
Do not eat rare or medium-rare meat dishes.
Wash vegetables to remove any traces of soil.
Wash hands thoroughly before eating.
Immediately wash cutting boards, knives and any other implements that have come into contact with raw meat.
Wear gloves while gardening.
Avoid contact with cats.
Get someone else to handle litter trays.
Make sure litter trays are cleaned daily.
Toxoplasmosis in cats and sandpits
The infectious oocysts are robust and hardy. They can survive in water, soil or sand for around 12 months. Young children who play in sandpits and gardens may be at risk if they come into contact with infected cat faeces. Precautions include:
Make sure your child’s sandpit can be covered when not in use.
Discourage stray cats from your property.
Ask your child to always wash their hands thoroughly before eating.
Precautions against toxoplasmosis for your household cat
Cats are only infectious for a few weeks after ingesting the parasites and kittens are more likely to pass on the infection than older cats. Suggestions on reducing the risk of infection in your cat include:
Keep your cat indoors whenever possible.
Don’t allow the cat to hunt and eat birds or other wildlife.
Feed your cat canned or dry foods, instead of raw meat (including kangaroo meat).
Treatment for toxoplasmosis
Treatment of toxoplasmosis is often unnecessary. The infection is diagnosed with a simple blood test that checks for the presence of specific antibodies. A healthy person who is not pregnant and becomes infected does not require treatment. Symptoms, if any, are usually mild and disappear after a few weeks.
For pregnant women and those with compromised immune systems, such as those in the later stages of human immunodeficiency virus infection/acquired immunodeficiency syndrome(HIV/AIDS), medications including antibiotics may be prescribed.
Where to get help
Your doctor
Things to remember
People become infected with Toxoplasma gondii parasites through contact with infected animal faeces (usually cat faeces).
A healthy person does not require treatment for toxoplasmosis, as symptoms are mild and usually disappear within a few weeks.
Pregnant women and people who have compromised immune systems should take precautions against toxoplasmosis.
A pregnant woman is advised to avoid contact with cats, as her unborn child is at increased risk of birth defects if parasites cross the placenta.
Recurrence is your worst enemy. Here, a surgeon discusses ways to avoid it and what to do if the pterygium comes back.
It’s best to approach pterygium surgery with the goal of reducing the chances of recurrence at all costs. While most pterygia are asymptomatic and regarded as garden variety lesions, they become serious problems if they recur after removal. These cases most certainly warrant a subspecialist evaluation. In this article, I’ll discuss some surgical approaches to pterygium, with particular emphasis on recurrent pterygium.
At the Outset
When a patient presents with a pterygium, the first thing to decide is whether it’s necessary to do anything at all. Many patients have only mild complaints related to dryness or irritation, and are often best observed or managed medically. Lubrication or topical NSAIDs may help relieve ocular inflammation and reduce the pterygium’s appearance. Protecting the face and eyes from excessive UV exposure may also help, as pterygium is more prevalent in regions that receive strong ultraviolet radiation.
Only a small percentage of pterygium cases warrants surgical excision. Indications for surgery include obstruction of the visual axis, pterygium-induced irregular astigmatism, chronic eye irritation and cosmetic dissatisfaction.
If you do decide to surgically remove the pterygium, your next decision will be to determine how extensive a procedure is required. One day postoperatively, no matter which method you used to remove the pterygium, it’s going to be gone. The question is: Is it going to come back? You want to do everything you can to make sure the answer is “no.”
Surgical Strategy
There are many different ways to do a basic pterygium removal, and potentially hundreds of modifications of the surgical technique. The most common method of simple excision takes about five minutes but is associated with a much higher relative risk of the pterygium recurring. For this technique, you simply pry the scar tissue off the cornea and snip it off. It’s effective for about 90 percent of cases, but that means you can expect approximately 10 percent of cases to recur (often with a vengeance).
As a medical adjuvant to the simple snip excision, one might also consider the adjunctive use of antimetabolites such as mitomycin-C on the surgical site. This isn’t something that I usually do however, because mitomycin carries the risk of scleral melting. If you’re concerned enough to pour chemotherapy on the surface of the eye to prevent the pterygium from coming back, then, rather than using the mitomycin technique, the optimal thing to do would be to try the PERFECT technique (explained in detail below).
Pterygium Excision
We often use a nerve blocker for pterygium excision. Retrobulbar anesthesia is typically most comfortable for the patient because it provides good levels of pain control during the procedure. Take care not to damage the underlying corneal tissue or remove stroma when prying the pterygium off the surface of the eye.
First, make an incision at the limbus where the pterygium begins to encroach over the cornea. Cut it free and peel it from the corneal surface using blunt dissection. Once the pterygium’s been removed, we often polish the cornea with a diamond burr. When the cornea has been repaired, we turn our attention to the sclera and conjunctiva.
Dissect the conjunctiva free from Tenon’s capsule. Remove all of Tenon’s capsule where the pterygium was.
Once you remove the scar tissue from the nasal aspect of the cornea and globe, you must then decide what to put in the gap where the scar tissue used to be. You have a few options:
Option 1: Do nothing. You can just leave it bare and it’ll re-epithelialize on its own. This has the highest risk of recurrence and induces the most patient discomfort, but it can be done.
Option 2:Cover the area with a biological material. Amniotic membrane, which can be placed and glued or sutured over the area of the defect, is a very effective method. We prefer to use glue, since it’s fast and simple. Amniotic membrane makes patients more comfortable and contributes to the healing of the tissue. However, it’s not quite as effective in discouraging recurrence as the third option.
Option 3:Rotational conjunctival autograft. This method might not be necessary in every case, but it’s the least likely to lead to recurrence. It’s also the technique I perform most often.
To perform a rotational conjunctival autograft, first measure the conjunctival epithelial defect and how much bare sclera you need to cover. Then, harvest the conjunctiva approximately 90 degrees or 3 to 4 clock hours away from the resected site, usually in the superior globe, with Wescott scissors. Dissect the conjunctiva free from the underlying Tenon’s capsule to an extent that matches the surface area of the pterygium. Create a pedicle flap and rotate it down to cover the area. Glue or suture the flap to the bed with 8-0 vicryl. If using glue, aim for as little glue as possible. Postoperatively, prescribe topical antibiotic drops such as fluoroquinolone q.i.d. for a week, and a steroid drop such as prednisolone acetate q.i.d., tapered over one to three months.
In terms of graft stability, gluing and suturing will give you the most peace of mind. A third technique, autologous in situ blood coagulum, will also work if you don’t have access to glue and you do have an extra 10 minutes to hold pressure on the site. The patient’s natural bleeding in the area will coagulate and anchor the amniotic membrane; however, you can’t be as sure as with glue or suture that the tissue will still be adherent after a day or a week. Besides, glue and suture are expensive, but the most expensive thing of all is time in the operating room—holding tissue down with your fingers for 10 minutes is quite expensive.
Recurrence (discussed below) is the most serious postop complication of pterygium excision. Additionally, you have to be concerned about scarring. When you’re cutting on the eye you’re generating scar tissue, so you need to be careful that you don’t end up with a tangled, fibrous mess. This is entirely possible, especially with multiple surgeries.
Other complications you may encounter include scleral melt due to the use of mitomycin-C; fibrosis, especially around the extraocular muscle in that location; infection, which is rare; and ocular surface discomfort, which can last for weeks or even months. Typically, the steroids help ease discomfort, but we also encourage the use of lubricant drops. Keep these complications in mind when forming your surgical strategy.
Recurrence
Young people are generally at increased risk for recurrence, as are African Americans and Hispanics of all ages, who tend to have more inflammatory phenotypes. Additionally, patients with double pterygia (on both the nasal and temporal aspects of the cornea) and bilateral double pterygia are at extremely high risk for recurrence. In these patients, you need to take every possible precaution and be very careful if you do any surgery on them.
It’s critical that these patients be watched carefully for recurrence. If you notice the area you’ve resected is starting to grow back, usually at a millimeter-by-millimeter pace, begin aggressive topical steroids immediately, since you want to do everything in your power to avoid a second surgery. If the eye is red and inflamed, that’s the time for drops, not surgery.
However, if you lose the battle—whether you’re inattentive, or the patient comes back years later, or was referred elsewhere and upon their return to you, the pterygium is growing over the visual axis—then it’s time to consider reoperating.
In the event that the pterygium recurs, I recommend trying the PERFECT technique. This technique, which stands for Pterygium Extended Removal Followed by Extended Conjunctival Transplant, was pioneered by Australian ophthalmologist Lawrence Hirst, MBBS, MD, MPH, who runs The Australian Pterygium Centre. It has by far the lowest risk of recurrence, at just 0.1 percent (Figure 1). This method involves extensive removal of Tenon’s capsule from the area of the pterygium and surrounding areas and is meant to be used on patients who have recurrent pterygium after previous surgical removal. This procedure has very good cosmetic outcomes, with most patients reporting being unable to tell which eye had surgery.
The PERFECT technique for pterygium consists of three components that each take about 15 to 20 minutes to perform. Following are the steps of the technique as described by Prof. Hirst in a video of the procedure.
First, mark and transect the pterygium. Strip it from the corneal surface. Try to avoid having any residual pterygium tissue. Next, separate Tenon’s layer from the overlying conjunctiva and sclera, almost to the superior and inferior rectus muscles, and over the medial rectus muscle back to the caruncle (Figure 2). Adequate removal will result in visible bare sclera above and below the medial rectus muscle.
For the extended conjunctival transplant, mark the donor graft starting at the superior bulbar conjunctiva (Figure 3). The mark should extend almost to the superior fornix, and about 1 to 2 mm short of the limbus, and nasally, almost to the pterygium excision site. Leave a 5- to 7-mm bridge of conjunctiva and Tenon’s layer. At the donor site, the conjunctiva to be grafted should be separated from Tenon’s. A successful autograft should be virtually transparent, without any Tenon’s layer carried over with the graft. This helps to ensure that the donor site will heal with minimal-to-no scarring. The conjunctival graft is then transferred to the site of the former pterygium and sutured into place (Figure 4). To view a video of this technique, visit youtu.be/ODpQ_RbgHn4.
While it has the best success rate for preventing recurrence, by a wide margin, PERFECT is a long procedure—taking an hour to two hours of operating time, depending on your experience and skill level. However, I believe that anyone who’s had a pterygium recurrence needs to undergo this technique, as opposed to the standard “rip and clip.”
Ultimately, a pterygium isn’t something you want to keep hacking off over and over again. If it recurs early on, and you don’t feel comfortable doing the very refined PERFECT surgery yourself, it’s a good idea to refer the patient to a specialist. REVIEW
A chalazion is a small, slow-growing lump or cyst that develops within the eyelid. They are not usually painful and rarely last longer than a few weeks.
A chalazion can develop when a meibomian gland at the edge of an eyelid becomes blocked or inflamed. These glands produce oil that lubricates the surface of the eye.
In this article, we look at the symptoms of a chalazion and the differences between a chalazion and a stye. We also describe causes, home treatment, when to see a doctor, surgery, and prevention.
In the early stages, a chalazion appears as a small, red or otherwise inflamed area of the eyelid.
Within a few days, this inflammation can develop into a painless and slow-growing lump.
A chalazion can appear on the upper or lower eyelid, but they are more common on the upper lid.
Although chalazia are generally painless, they can cause the eye to become watery and mildly irritated. A particularly large chalazion may press on the eyeball, which can lead to blurry vision.
People sometimes confuse a chalazion with a stye due to the similarities in appearance. A stye is also a small lump that can develop in the eye area.
Although people often use the two terms interchangeably, they refer to different types of lesion.
A chalazion results from a blocked oil gland, whereas a stye indicates an infected oil gland or hair follicle. However, a chalazion can sometimes develop into a stye.
There are two types of stye:
External hordeolum: These occur at the base of the eyelash and usually result from an infection in the hair follicle.
Internal hordeolum: These develop inside the eyelid and tend to result from an infection in an oil gland.
The most noticeable difference between a chalazion and a stye is that a chalazion tends to be painless. A stye is usually very painful and may cause the eye to feel sore and scratchy.
A chalazion usually requires very little medical treatment and tends to clear up on its own within a few weeks.
In the meantime, it is important to avoid squeezing or popping the chalazion, as this can increase the risk of an eye infection.
However, there are several safe ways to promote drainage and speed up the healing process. These include:
Warm compresses
Applying a warm compress to the affected eye can help soften any hardened oil blocking the gland ducts. This helps the ducts open and drain more effectively, which can relieve irritation.
To make and use a warm compress:
Soak a soft, clean cloth or cotton pad in a bowl of warm water.
Wring out any excess liquid.
Apply the damp cloth or pad to the eyelid for 10–15 minutes.
Continue wetting the compress often to keep it warm.
Repeat this several times a day until the swelling goes down.
Gentle massage
Gently massaging the eyelids for several minutes each day can help the oil ducts drain more effectively.
Before doing so, ensure that the hands are clean to reduce the risk of infection.
Once the chalazion begins to drain, keep the area clean and avoid touching it with bare hands.
Over-the-counter treatments
A number of over-the-counter products can help treat a chalazion or stye. These may reduce irritation, prevent infection, and speed up the healing process.
Some of these products include ointments, solutions, and medicated eye pads. A pharmacist can provide advice.
Things to avoid
To prevent further discomfort or irritation, it is best to avoid wearing eye makeup or contact lenses until the chalazion heals.
Consider seeing an eye doctor, an ophthalmologist or optometrist, if a chalazion does not drain and heal within 1 month.
The healthcare professional will ask about symptoms and examine the area to rule out other conditions. They may also prescribe anti-inflammatory eye drops or ointments to reduce discomfort and speed healing.
For some people, a doctor may give a steroid injection to reduce swelling. This will depend on the location, size, and number of chalazia present.
If there are signs of a bacterial infection, the doctor may recommend a course of oral antibiotics.
For a person with a severe or persistent chalazion, a doctor may recommend surgery to drain it. This typically takes place in the doctor’s office using local anesthesia.
Chalazia can sometimes recur. If this happens often, the doctor may need to take a biopsy of the lump.
A biopsy involves removing a small sample of tissue, which the doctor will examine for signs of a more serious condition.
Cleansing the eye area every day can help prevent a chalazion from developing or recurring.
Using eyelid scrubs or premoistened cleansing wipes to keep the oil glands from becoming blocked.
Other chalazion prevention tips include:
not rubbing the eyes
ensuring that the hands are clean before touching the eyes
protecting the eyes from dust and air pollution, for example by wearing sunglasses when outdoors or safety goggles when using machinery, such as power tools
replacing eye makeup every 6 months to prevent bacterial growth.
A chalazion is a painless lump that can develop on the eyelid.
Although chalazia can cause irritation and discomfort, they are usually harmless and clear up on their own within a few weeks. Occasionally, a chalazion may become infected and develop into a stye.
See an eye doctor, an optometrist or ophthalmologist, if the eye area becomes particularly swollen or painful, or if the chalazion does not respond to home treatment.
A daily eye-cleansing routine may help keep a chalazion from recurring.
Your eyes are an important part of your health. Most people rely on their eyes to see and make sense of the world around them. But some eye diseases can lead to vision loss, so it is important to identify and treat eye diseases as early as possible. You should get your eyes checked as often as your health care provider recommends it, or if you have any new vision problems. And just as it is important to keep your body healthy, you also need to keep your eyes healthy.
Eye Care Tips
There are things you can do to help keep your eyes healthy and make sure you are seeing your best:
Eat a healthy, balanced diet. Your diet should include plenty or fruits and vegetables, especially deep yellow and green leafy vegetables. Eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut can also help your eyes.
Maintain a healthy weight. Being overweight or having obesity increases your risk of developing diabetes. Having diabetes puts you at higher risk of getting diabetic retinopathy or glaucoma.
Get regular exercise. Exercise may help to prevent or control diabetes, high blood pressure, and high cholesterol. These diseases can lead to some eye or vision problems. So if you exercise regularly, you can lower your risk of getting these eye and vision problems.
Wear sunglasses.Sun exposure can damage your eyes and raise your risk of cataracts and age-related macular degeneration. Protect your eyes by using sunglasses that block out 99 to 100% of both UV-A and UV-B radiation.
Wear protective eye wear. To prevent eye injuries, you need eye protection when playing certain sports, working in jobs such as factory work and construction, and doing repairs or projects in your home.
Avoid smoking. Smoking increases the risk of developing age-related eye diseases such as macular degeneration and cataracts and can damage the optic nerve.
Know your family medical history. Some eye diseases are inherited, so it is important to find out whether anyone in your family has had them. This can help you determine if you are at higher risk of developing an eye disease.
Know your other risk factors. As you get older, you are at higher risk of developing age-related eye diseases and conditions. It is important to know you risk factors because you may be able to lower your risk by changing some behaviors.
If you wear contacts, take steps to prevent eye infections. Wash your hands well before you put in or take out your contact lenses. Also follow the instructions on how to properly clean them, and replace them when needed.
Give your eyes a rest. If you spend a lot of time using a computer, you can forget to blink your eyes and your eyes can get tired. To reduce eyestrain, try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds.
Eye Tests and Exams
Everyone needs to have their eyesight tested to check for vision and eye problems. Children usually have vision screening in school or at their health care provider’s office during a checkup. Adults may also get vision screenings during their checkups. But many adults need more than a vision screening. They need a comprehensive dilated eye exam.
Getting comprehensive dilated eye exams is especially important because some eye diseases may not have warning signs. The exams are the only way to detect these diseases in their early stages, when they are easier to treat.
The exam includes several tests:
A visual field test to measure your side (peripheral) vision. A loss of peripheral vision may be a sign of glaucoma.
A visual acuity test, where you read an eye chart about 20 feet away, to check on how well you see at various distances
Tonometry, which measures your eye’s interior pressure. It helps to detect glaucoma.
Dilation, which involves getting eye drops that dilate (widen) your pupils. This allows more light to enter the eye. Your eye care provider examines your eyes using a special magnifying lens. This provides a clear view of important tissues at the back of your eye, including the retina, macula, and optic nerve.
If you have a refractive error and are going to need glasses or contacts, then you will also have a refraction test. When you have this test, you look through a device that has lenses of different strengths to help your eye care professional figure out which lenses will give you the clearest vision.
At what age you should start getting these exams and how often you need them depends on many factors. They include your age, race, and overall health. For example, if you are African American, you are at higher risk of glaucoma and you need to start getting the exams earlier. If you have diabetes, you should get an exam every year. Check with your health care provider about if and when you need these exams
The term ocular hypertension usually refers to any situation in which the pressure inside the eye, called intraocular pressure, is higher than normal. Eye pressure is measured in millimeters of mercury (mm Hg). Normal eye pressure ranges from 10-21 mm Hg. Ocular hypertension is an eye pressure of greater than 21 mm Hg.
Although its definition has evolved through the years, ocular hypertension is commonly defined as a condition with the following criteria:
An intraocular pressure of greater than 21 mm Hg is measured in one or both eyes at two or more office visits. Pressure inside the eye is measured using an instrument called a tonometer.
The optic nerve appears normal.
No signs of glaucoma are evident on visual field testing, which is a test to assess your peripheral (or side) vision.
To determine other possible causes for your high eye pressure, an eye doctor (a medical doctor who specializes in eye care and surgery) assesses whether your drainage system (called the “angle”) is open or closed. The angle is seen using a technique called gonioscopy. This technique involves the use of a special contact lens to examine the drainage angles (or channels) in your eyes to see if they are open, narrowed, or closed.
No signs of any ocular disease are present. Some eye diseases can increase the pressure inside the eye.
Ocular hypertension should not be considered a disease by itself. Instead, ocular hypertension is a term that is used to describe individuals who should be observed more closely than the general population for the onset of glaucoma. For this reason, another term to refer to a person with ocular hypertension is “glaucoma suspect,” or someone whom the eye doctor is concerned may have or may develop glaucoma because of elevated pressure inside the eyes. An eye exam may show a glaucoma-damaged optic nerve.
As mentioned above, increased intraocular pressure can result from other eye conditions. However, within this article, ocular hypertension primarily refers to increased intraocular pressure without any optic nerve damage or vision loss. Glaucoma is diagnosed when characteristic optic nerve and vision changes occur; typically with elevated eye pressure but occasionally with normal pressure.
As of the year 2013, an estimated 2.2 million people in the United States had glaucoma and more than 120,000 are legally blind because of this disease. These statistics alone emphasize the need to identify and closely monitor people who are at risk of developing glaucoma, particularly those with ocular hypertension.
Studies estimate that 3-6 million people in the United States alone, including 4%-10% of the population older than 40 years, have intraocular pressures of 21 mm Hg or higher, without detectable signs of glaucomatous damage using current tests.
Studies over the last 20 years have helped to characterize those with ocular hypertension.
Recent data on people with ocular hypertension from the Ocular Hypertension Treatment Study have shown that they have an average estimated risk of 10% of developing glaucoma over 5 years. This risk may be decreased to 5% (a 50% decrease in risk) if eye pressure is lowered by medications or laser surgery. However, the risk may become even less than 1% per year because of significantly improved techniques for detecting glaucomatous damage. This could allow treatment to start much earlier, before vision loss occurs. Future studies will help to further assess this risk of glaucoma development.
Patients with thin corneas may be at a higher risk for glaucoma development; therefore, your eye doctor may use a measuring device, called a pachymeter, to determine your corneal thickness.
Ocular hypertension is 10-15 times more likely to occur than primary open-angle glaucoma, a common form of glaucoma. That means that out of every 100 people older than age 40, about 10 will have pressures higher than 21 mm Hg, but only one of those people will have glaucoma.
Over a 5-year period, several studies have shown the incidence of glaucomatous damage in people with ocular hypertension to be about 2.6-3% for intraocular pressures of 21-25 mm Hg, 12-26% for intraocular pressures of 26-30 mm Hg, and approximately 42% for those higher than 30 mm Hg.
In approximately 3% of people with ocular hypertension, the veins in the retina can become blocked (called a retinal vein occlusion), which could lead to vision loss. Because of this, keeping pressures below 25 mm Hg in people with ocular hypertension and who are older than age 65 is often suggested.
Some studies have found that the average intraocular pressure in African-Americans is higher than in whites, while other studies have found no difference.
A 4-year study showed that African-Americans with ocular hypertension were 5 times more likely to develop glaucoma than whites. Findings suggest that, on average, African-Americans have thinner corneas, which may account for this increased likelihood to develop glaucoma, as a thinner cornea may cause pressure measurements in the office to be falsely low.
In addition, African-Americans are considered to have a 3-4 times greater risk of developing primary open-angle glaucoma. They are also believed to be more likely to have optic nerve damage.
Although some studies have reported a significantly higher average intraocular pressure in women than in men, other studies have not shown any difference between men and women.
Some studies suggest that women could be at a higher risk for ocular hypertension, especially after menopause.
Studies also show that men with ocular hypertension may be at a higher risk for glaucomatous damage.
Intraocular pressure slowly rises with increasing age, just as glaucoma becomes more prevalent as you get older.
Being older than age 40 is considered to be a risk factor for the development of both ocular hypertension and primary open-angle glaucoma.
Elevated pressure in a young person is a cause for concern. A young person has a longer time to be exposed to high pressures over a lifetime and a greater likelihood of optic nerve damage.
Ocular Hypertension Causes
Elevated intraocular pressure is a concern in people with ocular hypertension because it is one of the main risk factors for glaucoma.
High pressure inside the eye is caused by an imbalance in the production and drainage of fluid in the eye (aqueous humor). The channels that normally drain the fluid from inside the eye do not function properly. More fluid is continually being produced but cannot be drained because of the improperly functioning drainage channels. This results in an increased amount of fluid inside the eye, thus raising the pressure.
Another way to think of high pressure inside the eye is to imagine a water balloon. The more water that is put into the balloon, the higher the pressure inside the balloon. The same situation exists with too much fluid inside the eye—the more fluid, the higher the pressure. Also, just like a water balloon can burst if too much water is put into it, the optic nerve in the eye can be damaged by too high of a pressure. See Images 1-2.
People with very thick but normal corneas often have eye pressure measuring at the high levels of normal or even a little bit higher. Their pressures may actually be lower and normal but the thick corneas cause a falsely high reading during measurements.
Ocular Hypertension Symptoms
Most people with ocular hypertension do not experience any symptoms. For this reason, regular eye examinations with an eye doctor are very important to rule out any damage to the optic nerve from the high pressure.
When to Seek Medical Care
Questions to Ask the Doctor
Is my eye pressure elevated?
Are there any signs of internal eye damage due to an injury?
Are there any optic nerve abnormalities on my examination?
How often should I undergo follow-up examinations?
Exams and Tests
An eye doctor performs tests to measure intraocular pressure as well as to rule out early primary open-angle glaucoma or secondary causes of glaucoma. These tests are explained below.
Your visual acuity, which refers to how well you can see an object, is initially assessed. Your eye doctor determines your visual acuity by having you read letters from across a room using an eye chart.
The front of your eyes, including your cornea, anterior chamber, iris, and lens, are examined using a special microscope called a slit lamp.
Tonometry is a method used to measure the pressure inside the eye. Measurements are taken for both eyes on at least 2-3 occasions. Because intraocular pressure varies from hour to hour in any individual, measurements may be taken at different times of day (e.g., morning and night). A difference in pressure between the 2 eyes of 3 mm Hg or more may suggest glaucoma. Early primary open-angle glaucoma is very likely if the intraocular pressure is steadily increasing.
Each optic nerve is examined for any damage or abnormalities; this may require dilation of the pupils to ensure an adequate examination of the optic nerves. Fundus photographs, which are pictures of your optic disk (the front surface of your optic nerve), are taken for future reference and comparison.
Gonioscopy is performed to check the drainage angle of your eye; to do so, a special contact lens is placed on the eye. This test is important to determine if the angles are open, narrowed, or closed and to rule out any other conditions that could cause elevated intraocular pressure.
Visual field testing checks your peripheral (or side) vision, typically by using an automated visual field machine. This test is done to rule out any visual field defects due to glaucoma. Visual field testing may need to be repeated. If there is a low risk of glaucomatous damage, then the test may be performed only once a year. If there is a high risk of glaucomatous damage, then the test may be performed as frequently as every 2 months.
Pachymetry (or corneal thickness) is checked by an ultrasound probe to determine the accuracy of your intraocular pressure readings. A thinner cornea can give falsely low pressure readings, whereas a thick cornea can give falsely high pressure readings.
Ocular Hypertension Treatment Self-Care at Home
If your eye doctor prescribes medicines (see Medical Treatment and Medications) to help lower the pressure inside your eye, properly applying the medication and complying with your doctor’s instructions are very important. Not doing so could result in a further increase in intraocular pressure that can lead to optic nerve damage and permanent vision loss (i.e, glaucoma).
Medical Treatment
The goal of medical treatment is to reduce the pressure before it causes glaucomatous loss of vision. Medical treatment is always initiated for those people who are believed to be at the greatest risk for developing glaucoma (see When To Seek Medical Care) and for those with signs of optic nerve damage.
How your eye doctor chooses to treat you is highly individualized. Depending on your particular situation, you may be treated with medications or just observed. Your doctor will discuss the pros and cons of medical treatment versus observation with you.
Some eye doctors treat all elevated intraocular pressures of higher than 21 mm Hg with topical medicines. Some do not medically treat unless there is evidence of optic nerve damage. Most eye doctors treat if pressures are consistently higher than 28-30 mm Hg because of the high risk of optic nerve damage.
If you are experiencing symptoms like halos, blurred vision, or pain, or if your intraocular pressure has recently increased and then continues to increase on subsequent visits, your eye doctor will most likely start medical treatment.
Your intraocular pressure is evaluated periodically using guidelines similar to these:
If your intraocular pressure is 28 mm Hg or higher, you are treated with medicines. After 1 month of taking the drug, you have a follow-up visit with your eye doctor to see if the medicine is lowering the pressure and there are no side effects. If the drug is working, then follow-up visits are scheduled every 3-4 months.
If your intraocular pressure is 26-27 mm Hg, the pressure is rechecked in 2-3 weeks after your initial visit. On your second visit, if the pressure is still within 3 mm Hg of the reading at the initial visit, then follow-up visits are scheduled every 3-4 months. If the pressure is lower on your second visit, then the length of time between follow-up visits is longer and is determined by your eye doctor. At least once a year, visual field testing is done and your optic nerve is examined.
If your intraocular pressure is 22-25 mm Hg, the pressure is rechecked in 2-3 months. At the second visit, if the pressure is still within 3 mm Hg of the reading at the initial visit, then your next visit is in 6 months and includes visual field testing and an optic nerve examination. Testing is repeated at least yearly.
Follow-up visits may also be scheduled for the following reasons:
If a visual field defect shows up during a visual field test, repeat (possibly multiple) examinations are performed during future office visits. An eye doctor closely monitors a visual field defect because it may be a sign of early primary open-angle glaucoma. That is why it is important for you to do your best when taking the visual field test, as it may determine whether or not you have to start on medications to lower your eye pressure. If you get tired during a visual field test, make sure to tell the technician to pause the test so you can rest. That way, a more accurate visual field test can be obtained.
A gonioscopy is performed at least once every 1-2 years if your intraocular pressure significantly increases or if you are being treated with miotics (a type of glaucoma medication).
More fundus photographs (which are pictures of the back of the eye) are taken if the optic nerve/optic disk changes in appearance.
Medications
The ideal drug for treatment of ocular hypertension should effectively lower intraocular pressure, have no side effects, and be inexpensive with once-a-day dosing; however, no medicine possesses all of the above. When choosing a medicine for you, your eye doctor prioritizes these qualities based on your specific needs.
Medications, usually in the form of medicated eyedrops, are prescribed to help lower increased intraocular pressure. Sometimes, more than one medicine is needed. See Understanding Glaucoma Medications.
Initially, your eye doctor might have you use the eyedrops in only one eye to see how effective the drug is in lowering the pressure inside your eye. If it is effective, then your doctor will most likely have you use the eyedrops in both eyes. See How to Instill Your Eyedrops.
Once a medicine is prescribed, you have regular follow-up visits with your eye doctor. The first follow-up visit is usually 3-4 weeks after beginning the medicine. Your pressures are checked to ensure the drug is helping to lower your intraocular pressure. If the drug is working and is not causing any side effects, then it is continued and you are reevaluated 2-4 months later. If the drug is not helping to lower your intraocular pressure, then you will stop taking that drug and a new drug will be prescribed.
Your eye doctor may schedule your follow-up visits in accordance with the particular drug you are taking, because some medicines (e.g., latanoprost [Xalatan], travoprost [Travatan], bimatoprost [Lumigan]) may take 6-8 weeks to be fully effective.
During these follow-up visits, your eye doctor also observes you for any allergic reactions to the drug. If you are experiencing any side effects or symptoms while on the drug, be sure to tell your eye doctor.
Generally, if the pressure inside the eye cannot be lowered with 1-2 medicines, you might have early primary open-angle glaucoma instead of ocular hypertension. In this case, your eye doctor will discuss the appropriate next steps in your treatment plan.
Surgery
Laser and surgical therapy are not generally used to treat ocular hypertension, because the risks associated with these therapies are higher than the actual risk of developing glaucomatous damage from ocular hypertension. However, if you cannot tolerate your eye medications, laser surgery could be an option, and you should discuss this therapy with your eye doctor.
Next Steps Follow-up
Depending on the amount of optic nerve damage and the level of intraocular pressure control, people with ocular hypertension may need to be seen from every 2 months to yearly, even sooner if the pressures are not being adequately controlled.
Glaucoma should still be a concern in people who have elevated intraocular pressure with normal-looking optic nerves and normal visual field testing results or in people who have normal intraocular pressure with suspicious-looking optic nerves and visual field testing results. These people should be observed closely because they are at an increased risk for glaucoma.
Prevention
Ocular hypertension cannot be prevented, but through regular eye examinations with an eye doctor, its progression to glaucoma can be prevented.
Outlook
The prognosis is very good for people with ocular hypertension.
With careful follow-up care and compliance with medical treatment, most people with ocular hypertension do not progress to primary open-angle glaucoma, and they retain good vision throughout their lifetime.
With poor control of elevated intraocular pressure, continuing changes to the optic nerve and visual field that could lead to glaucoma might occur.
Support Groups and Counseling
Educating people with glaucoma is essential for medical treatment to be successful. The person who understands the chronic (long-term), potentially progressive nature of glaucoma is more likely to comply with medical treatment.
Numerous handouts about glaucoma are available, two of which are listed below.
“Understanding and Living with Glaucoma: A Reference Guide for People with Glaucoma and Their Families,” Glaucoma Research Foundation, (800) 826-6693.
“Glaucoma Patient Resource: Living More Comfortably with Glaucoma,” Prevent Blindness America, (800) 331-2020.
Media file 2: Elevated eye pressure is caused by a build-up of fluid inside the eye because the drainage channels (trabecular meshwork) cannot drain it properly. Elevated eye pressure can cause optic nerve damage and vision loss.
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People often have “gender reveal” parties for their babies. You’ll see balloons in grocery stores that say, “It’s a boy!” or “It’s a girl!”
But what if it’s neither? Or both?
Most parents don’t consider their children being anything other than a boy or a girl, so you, the gender questioning individual, must figure that out for yourself.
In such a gendered society, it’s tough to figure out if you’re non-binary or transgender. But after this article, you’ll have a little more insight on how to know if you’re non-binary, not transgender.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=2712664100&pi=t.aa~a.799919054~i.11~rp.4&w=360&lmt=1624536242&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241364&bpp=73&bdt=10831&idt=-M&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&prev_fmts=0x0&nras=2&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=1597&biw=360&bih=512&scr_x=0&scr_y=537&eid=21066433%2C21065725%2C31061421&oid=3&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=2&uci=a!2&btvi=1&fsb=1&xpc=dkVkqCoUWn&p=https%3A//allaboutgender.com&dtd=814
(Conversely, if you think you might be transgender click here)
Let’s begin with some definitions, shall we?
What does it mean to be non-binary?
Let’s start with the word “non-binary” itself. A non-binary individual is someone who identifies outside of a binary.
A binary is a categorization with only two options. Salt and pepper are a binary. Black and white are a binary. Man and woman, too, are a binary.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=1124583932&pi=t.aa~a.799919054~i.21~rp.4&w=360&lmt=1624536242&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241364&bpp=33&bdt=10830&idt=-M&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&prev_fmts=0x0%2C360x300&nras=3&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=2500&biw=360&bih=512&scr_x=0&scr_y=537&eid=21066433%2C21065725%2C31061421&oid=3&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=3&uci=a!3&btvi=2&fsb=1&xpc=fVrlr3HalY&p=https%3A//allaboutgender.com&dtd=902
But there are more spices than just salt or pepper. There’s an infinite shade of gray between black and white. And, you guessed it, there are more ways to express yourself than just “man” or “woman.”
So a non-binary individual is simply someone who does not consider themself a man or a woman. They can feel most comfortable in between the two, switch from a man to woman and vice versa, or identify in multiple different ways.
At the end of the day, though, a non-binary individual does not feel solely like a man or solely like a woman, as cisgender people do. https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=1438455242&pi=t.aa~a.799919054~i.27~rp.4&w=360&lmt=1624536242&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241364&bpp=37&bdt=10830&idt=38&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&prev_fmts=0x0%2C360x300%2C360x300&nras=4&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=3446&biw=360&bih=512&scr_x=0&scr_y=537&eid=21066433%2C21065725%2C31061421&oid=3&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=4&uci=a!4&btvi=3&fsb=1&xpc=x1ztlru187&p=https%3A//allaboutgender.com&dtd=973
Now to clear up some points of confusion that may result from these definitions:
A non-binary individual is not to be confused with an intersex individual. An intersex individual is someone who was born with various male or female sex characteristics. For example, someone can have a vagina and a Y chromosome.
Intersex people are biologically between male and female. However, a person’s body parts or sex characteristics does not always dictate how this person will identify. So if you’re intersex, you can still identify as a man or a woman. Or neither.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=2496288911&pi=t.aa~a.799919054~i.33~rp.4&w=360&lmt=1624536243&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241441&bpp=34&bdt=10908&idt=35&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&prev_fmts=0x0%2C360x300%2C360x300%2C360x300%2C360x512%2C360x90&nras=7&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=4424&biw=360&bih=512&scr_x=0&scr_y=795&eid=21066433%2C21065725%2C31061421&oid=3&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=5&uci=a!5&btvi=5&fsb=1&xpc=IX3TR3yRTb&p=https%3A//allaboutgender.com&dtd=2165
Because it’s not the body that dictates gender identity, but simply how a person feels within their body.
And if you’re reading this, you’re probably feeling some type of way about the body you were born into. Let’s dig into that a little deeper.
Cis is shorthand for cisgender, or someone whose biological sexual characteristics matches up with the traditional gender identity for that body.
So when you see someone with boobs, wide hips, no Adam’s apple, long hair, etc, you’d think that person is woman.
And when you see someone with broad shoulders, short hair, muscles, body hair, etc, you’d think that person is man.
But you can have those biological characteristics and not be a man, because, again, a body does not dictate gender identity.
How we express ourselves can be in different ways in the gender spectrum. Short hair and painted fingernails can no longer be assigned to just one gender or the other. Both genders are taking it up, or no gender at all.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=46347350&pi=t.aa~a.799919054~i.53~rp.4&w=360&lmt=1624536285&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241513&bpp=34&bdt=10980&idt=45&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&cookie=ID%3Df9a156dba5ba4796-229463c7b67a00ca%3AT%3D1624536240%3ART%3D1624536240%3AS%3DALNI_MY5oTEv9924UoE2zMnqUuc3iT2_6Q&prev_fmts=0x0%2C360x300%2C360x300%2C360x300%2C360x512%2C360x90%2C360x300&nras=8&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=6628&biw=360&bih=512&scr_x=0&scr_y=2683&eid=21066433%2C21065725%2C31061421&oid=3&psts=AGkb-H8j1td-CXV2SpfHIyALNISMLnoHz32d6KzFDJh_yweLs0p3W5ZzlfrLuF_RTn9fehRSIiDJ0QMbiPZnXFfnkCCGN8oJU-SRzShC%2CAGkb-H8m_OwEXV_lurVwh7w-hvejwwRVf1BVRGBwduZWFlElS78t3KORWTnnmC1vf-suudvTSRCk5MPLlUnQBA%2CAGkb-H9ObkuvoJ3ZaakHEfUO99sJHe-9YeOLlSwaI7WeWdyj01g8Wjdw9eT3PQQT6QFVdRgJNJRDm9gIYksnng%2CAGkb-H8Uo06nd22MDTWyTbwJN3EDzwB1w6kMQWw7YIrT69MHUCIRuLdfF4ArBkv8f1HJhGv8lP6cEc7l8syqzQ%2CAGkb-H-6zbNfJtj8ikgVlZUJA5Hqrzum4GdJX1v7bEE5kNndG0GQtahUj6mG0RQQhChGXJuwqt32VHFLzdkLnw&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=6&uci=a!6&btvi=6&fsb=1&xpc=RybFYeG4Ps&p=https%3A//allaboutgender.com&dtd=44438
So with that let’s talk about practical ways you can know if you’re non-binary:
You don’t feel comfortable on either gender binary. You don’t want to be seen as a man, you don’t want to be seen as woman. You don’t like she/her or he/him pronouns. All in all, you feel someplace in the middle of male and female.
You feel as if you have to be reminded that you’re a man or woman.
You feel weird when someone calls you he/him or she/her. Something about they/them pronouns honor you, or you feel the best knowing that you’re not being seen as a male or female.
You’ve changed your appearance to be more androgynous.
Things you’re already doing that might indicate you’re non-binary:
Shortening or changing your name so that it’s gender neutral.
Using “They/them” when describing the gender of people you don’t know. This might be because you wish someone called you by those neutral pronouns.
Wishing there were more gender-neutral bathrooms in this world.
Wishing parts of your body were different (less pronounced, fuller — especially in an androgynous way).
Wearing baggy, ill-fitting clothing that hides your body and secondary sex characteristics (breasts, hips, thighs, neck, etc).
Speaking less because of voice dysphoria. (I get misgendered the SECOND I open my mouth.)
Eating less. It’s sad to say, but some causes of eating disorders is latent gender dysphoria. Transgender and genderqueer individuals are about 5 times more likely to develop eating disorders than cisgender LGBTQ or heterosexual individuals.
Wishing you had a different name or pronouns.
Wanting the masculinization/feminization of hormone treatment. While you don’t have to completely masculinize/feminize yourself, some people do hormone treats to make their body more androgynous.
Things to help figure out if you’re non-binary:
Change your hairstyle. Cut it, grow it, shave it, dye it.
Experiment with makeup. Or don’t. Buy some eyeliner and lipstick. Throw the ones you do have away. Or, hey, if you want to, give yourself a beard with some mascara. Whatever works!
Try on different clothing. Raid a sibling’s closet, a parent’s wardrobe, or try stuff on at goodwill. Do you like what you see?
Ask people to call you different pronouns or names. Sometimes that’s all you need to reaffirm your gender. If you’re not in a place where you can ask people that, websites like Pronoun Changing Room can help you out.
Specifically, start asking people to use “they/them” pronouns with you.
The absolute best way to figure out if you’re non-binary: navigate your euphoria and dysphoria.
Euphoria is when something feels good. Dysphoria is when something feels bad (especially in relation to your gender).
Try to notice each time you feel good when gendered one way and feel bad gendered another way.
If you find non-gendered traits make you feel better than gendered traits, you’re most likely non-binary.
For example: You don’t like being called “sir/ma’am,” (or maybe neither elicits a response from you). You do feel good, though, when someone uses they/them pronouns with you. You feel uncomfortable in male or female bathrooms but are always relieved to find a gender-neutral bathroom.
Give yourself some time. It’s hard to understand euphoria and dysphoria in the moment (as other environmental/contextual factors can influence those feelings in the moment), but looking back and perhaps writing down a few key experiences may give insight to your gender identity.
A lot of this sounds like how to know if you’re trans (as a lot of these behaviors are also found on the transgender article).
At the end of the day, a lot of the same feelings of dysphoria for transgender and non-binary individuals stem from the same body issues. A lot of people who think they’re trans eventually realize that they’re non-binary and vice versa.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=276673348&pi=t.aa~a.799919054~i.77~rp.4&w=360&lmt=1624536451&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241594&bpp=30&bdt=11061&idt=31&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&cookie=ID%3Df9a156dba5ba4796-229463c7b67a00ca%3AT%3D1624536240%3ART%3D1624536240%3AS%3DALNI_MY5oTEv9924UoE2zMnqUuc3iT2_6Q&prev_fmts=0x0%2C360x300%2C360x300%2C360x300%2C360x512%2C360x90%2C360x300%2C360x300&nras=9&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=11249&biw=360&bih=512&scr_x=0&scr_y=7277&eid=21066433%2C21065725%2C31061421&oid=3&psts=AGkb-H8j1td-CXV2SpfHIyALNISMLnoHz32d6KzFDJh_yweLs0p3W5ZzlfrLuF_RTn9fehRSIiDJ0QMbiPZnXFfnkCCGN8oJU-SRzShC%2CAGkb-H8m_OwEXV_lurVwh7w-hvejwwRVf1BVRGBwduZWFlElS78t3KORWTnnmC1vf-suudvTSRCk5MPLlUnQBA%2CAGkb-H9ObkuvoJ3ZaakHEfUO99sJHe-9YeOLlSwaI7WeWdyj01g8Wjdw9eT3PQQT6QFVdRgJNJRDm9gIYksnng%2CAGkb-H8Uo06nd22MDTWyTbwJN3EDzwB1w6kMQWw7YIrT69MHUCIRuLdfF4ArBkv8f1HJhGv8lP6cEc7l8syqzQ%2CAGkb-H-6zbNfJtj8ikgVlZUJA5Hqrzum4GdJX1v7bEE5kNndG0GQtahUj6mG0RQQhChGXJuwqt32VHFLzdkLnw%2CAGkb-H8SnqIXJEyV_0GPYo0fvtZdNyqIDxgsu2NRAzyMSqJi6VF0kk9feoi7Yk-s-caiFr4wekxvxrfieAVPAck4&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=7&uci=a!7&btvi=7&fsb=1&xpc=fXYqE5Mm5C&p=https%3A//allaboutgender.com&dtd=M
But I’d say the biggest indication that you’re non-binary rather than trans is that you don’t want to be seen as either male/female or man/woman. Your pronouns and gender presentation may reflect that. Or they might not.
Thing To Remember:
You can feel non-binary and look like a traditional man or woman.
You don’t have to use they/them pronouns to be non-binary. You can use any pronoun you want.
Pretty much, the only criterion to being non-binary is feeling like you’re not a man or woman. (E.g., “I’m not a man or woman, I’m a human” or “I’m just me.”)
At the end of the day, you decide how you feel. But hearing other people’s stories helps validate things you’re feeling or help you realize that you’ve been feeling some type of way this whole time.
Below are some insightful YouTube videos I found.
“How I Knew I Was Non-Binary” Personal Stories
I really like Charlie’s video describing what it feels like to be non-binary.
“I don’t go walking around thinking about how gosh darn neutral I am. It’s…a thing I get reminded of. When I see something for men or women it reminds me I’m neither of those.”
I think Charlie hits the nail. You can be androgynous and feel an affinity to male or female. But if you feel like neither you’re probably non-binary.
Jeff Miller’s video being transmasculine: being assigned female at birth but identifying more with masculine presentation and things, while not feeling like a “man.” As he says, gendered language like “man,” “dude,” “bro” makes them uncomfortable.
A video compilation by Ryan Cassata which includes a buuuunch of non-binary individuals saying what it is that makes them non-binary. Most of the responses describe feeling neutral to gender or simply not feeling male or female.
A popular non-binary bean, Ashley Wylde, describes how it feels to be non-binary. They say that being non-binary feels like having blonde hair or brown eyes. Their gender, or lack of gender, feels pretty normal.
(Please check out more great content from these YouTubers on their channels! Give ’em all the love and views they deserve).
In conclusion…
You can resonate with someone else’s coming out story or you can totally feel like your experience is unique. That’s okay.
You don’t have to rush to any conclusions. Just take your time, read up on other coming out stories and experiment with your gender until you find something you’re the most comfortable with.
Although Coronavirus (COVID-19) is a new disease and experts are still learning how it spreads, touching a surface or object that has any virus or germs on it and then touching your mouth, nose, or possibly eyes can lead to infection.
We’ve teamed up with Dr. Jennifer Tsai, OD to answer a few questions about ways to protect your eyes during this outbreak.
Is it safe to wear contacts?
Yes, as of now and the most sanitary option is daily contacts.
The cardinal rule for staying healthy is to wash your hands often. The eyes are an entry point for germs, including viruses which makes washing your hands immediately before handling contacts especially important. This will also help keep the silicone hydrogel clean and free of unwelcome particles, like skin oils, dust, and harmful bacteria. The American Optometric Association recommends that you scrub your hands carefully and thoroughly with soap and water for at least 20 seconds, followed by hand drying with unused paper towels. This should occur before every contact lens insertion and removal. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.
How do you clean your glasses?
COVID-19 can live on hard surfaces for 1-3 days. To sanitize glasses, fill a spray bottle with 3/4 alcohol (70% ethyl alcohol or rubbing alcohol), 1/4 water, and 2-3 drops of dish soap. Apply the solution and wipe any part of the frames that touch your face. This solution is only recommended for glasses without anti-reflective coating and not plastic lenses, as the alcohol can strip off the coating.
For most frames, adding a drop of soap to the surface and rubbing with your fingers will do a substantial job of removing any bacteria. Be sure to wash your hands first (to remove any oil) and don’t forget the nose pads!
To dry, shake off excess water and wipe with a microfiber cloth. Be mindful that using your shirt or paper could scratch the lenses. Microfibers can sometimes leave particles so if you don’t have a cloth, use a compressed air duster instead (like the one for your keyboard).
Is it safe to wear eyelash extensions?
It’s currently unclear but why risk it? Bacteria can live on hair and lashes for short amounts of time. Stick to mascara for now and be sure to sanitize your brushes and applicators regularly.
How do you clean makeup applicators?
Easy! Fill a spray bottle with 3/4 rubbing alcohol and 1/4 water, then apply to any brushes before every application. You can also use gentle shampoo periodically. Simply squirt a bit into a cup of warm water, then soak your sponges in the bubbly solution. Squeeze and rinse until the water runs clear. For brushes, swirl the tips in the water and shampoo, then in the palm of your hand to work up a lather. Next, run the bristles under warm water until there is no more product. Finally, lay all your brushes and sponges flat on a clean cloth to dry. Voila!
This article was reviewed by Dr. Jennifer Tsai, OD. Dr. Tsai practices optometry in New York City.
Information received through VSP Vision Care channels is for informational purposes only and does not constitute medical advice, medical recommendations, diagnosis or treatment. Always seek the advice of your eye doctor, physician or other qualified health provider with any questions you may have regarding a medical condition.
People who have diabetes are unable to produce enough insulin or use the insulin their body does produce in an efficient manner. This can affect your blood sugar levels. It’s important to monitor what you eat to keep your blood sugar levels as steady as possible.
One way to do this is by checking the glycemic index (GI) score of each food. The GI shows how much a certain food can increase your blood sugar levels. GI helps with the planning of daily meals and avoiding high-carbohydrate combinations. A low GI is between 1 and 55 and high is 70 and above.
It’s important to know that natural foods, such as garlic, though not rich in carbohydrates, can influence blood sugar levels.
Most adults can safely consume garlic. For some people, taste, odor, or spiciness can be an issue.
Traditionally, garlic has been recommendedTrusted Source to help reduce high cholesterol levels and high blood pressure. Garlic consumption may also reduce the incidence of heart disease, a condition that affects approximately 80 percent of people with diabetes.
A 2006 study found that raw garlic might help reduce blood sugar levels, as well as reduce the risk of atherosclerosis. This is particular interest, as diabetes increases a person’s risk of atherosclerosis-related inflammation.
Though this is still under investigation, a 2014 review of studiesTrusted Source also supported the idea that regular garlic consumption may help lower blood sugar levels.
Garlic is also a good source of vitamins B-6 and C. Vitamin B-6 is involved in carbohydrate metabolism. Vitamin C may also play a role in maintaining blood sugar levels.
If you don’t mind the taste, add a couple of finely chopped garlic cloves to your salads or potato salad. There isn’t a standard dosage for eating garlic, so feel free to add garlic whenever a recipe or snack allows.
If you prefer a less strong odor and taste, look for garlic greens, which are young plants, and garlic scapes, which are curly shoots that appear as the plant matures. They’re available at farmers markets and local produce stores during the spring season. Both have a milder flavor. You can chop them and mix them in salads, dips, and savory spreads.
It’s recommended that you let chopped garlic sit for at least 5 minutes to allow allicin, one of the herb’s main components, to be at its highest concentration. This may enhance the herb’s potential health benefits.
If you find the taste of raw garlic too offensive or are unable to have it as often as you’d like, you may want to try supplements. Look for aged garlic extract or other garlic extracts that contain allicin.
Here are a few things to keep in mind when purchasing supplements:
Consult with your doctor before adding supplements to your regimen. They can help you determine whether this is the best option for you.
Always buy from a reputable manufacturer that doesn’t use heat processing. This can destroy the active compounds in the garlic, which provide the most health benefits.
Avoid completely odorless products. They’re likely stripped of the sulfur compounds that give the characteristic smell and are responsible for some of its possible health benefits.
You can use garlic to improve the taste and quality of meals. Consuming it may also help you maintain better levels of health. For best results, consume garlic regularly in moderate amounts. Cooking garlic lowers its potential therapeutic qualities, so be sure to use fresh and raw garlic in your dishes. Supplements are also an option, but you should consult with your doctor before using them.
23 Top-Notch Lunch Ideas for People with Diabetes
Figuring out what to eat for lunch every day can be challenging, especially for people with diabetes.
Fortunately, there are plenty of delicious, healthy, and easy-to-prepare options that can help round out your diet and keep blood sugar levels steady.
Here are 23 healthy and delicious lunch ideas for people with diabetes.
Burrito bowls are delicious and easy to tailor to your taste buds by adding your favorite ingredients.
To keep the carb content low, try using mixed greens as your base instead of rice, and top with beans, salsa, and grilled veggies.
You can also throw in some chicken, ground beef, or tofu to boost the protein content, which may support better blood sugar control (1Trusted Source).
2. Turkey veggie wrap
Wraps are convenient, customizable, and portable, making them a great choice for lunch.
Turkey veggie wraps, in particular, are high in protein and feature a variety of fiber-rich vegetables, which can slow the absorption of carbohydrates to stabilize blood sugar levels (1Trusted Source, 2Trusted Source).
Be sure to opt for whole wheat or low carb wraps and fill up on nutrient-dense ingredients, such as hummus, tomatoes, lettuce, and bell peppers.
3. Tuna salad
Tuna salad is a healthy, high protein meal typically made with ingredients like tuna, celery, onions, and mayonnaise (3Trusted Source).
You can make it at home and boost the protein content by trading mayonnaise for Greek yogurt. Or, add more fiber with veggies like carrots, radishes, or tomatoes.
Pair your tuna salad with some whole wheat crackers for a simple lunch to enjoy at home, work, or school.
4. Stuffed bell peppers
Stuffed bell peppers are often filled with meat or beans, mixed veggies, and whole grains like brown rice, couscous, or quinoa.
By choosing high protein and fiber-rich ingredients for your filling, you can easily make it a healthy, diabetes-friendly meal.
Lean sources of protein like ground beef or ground turkey are great choices, along with nutritious veggies like tomatoes, zucchini, garlic, and onions.
5. Chicken fajita bowl
A chicken fajita bowl can be a healthy, flavorful lunch for people with diabetes.
They’re easy to prepare in advance and typically feature several foods high in protein and fiber that help keep your blood sugar levels in check, including chicken, brown rice, and veggies.
Be sure to pack on the vegetables to maximize the potential health benefits and top it off with a bit of salsa, avocado, or cilantro.
6. Buddha bowl
Buddha bowls are popular meals consisting of small portions of several different foods, typically plant-based proteins, veggies, and whole grains.
Not only can you mix and match the ingredients to add more protein and fiber to your diet, but you can also make it ahead for a simple and convenient meal to enjoy during the workweek.
Edamame, sliced avocado, quinoa, broccoli, red cabbage, cucumber, sweet potato, tofu, and carrots can all be great additions to your Buddha bowl.
Brown rice is considered a whole grain, meaning that it contains all three parts of the wheat kernel.
Some studies show that eating more whole grains could be linked to improved blood sugar control (4Trusted Source).
Brown rice is also rich in fiber, which can slow the absorption of sugar into the bloodstream to prevent spikes and crashes in your blood sugar levels (2Trusted Source, 5Trusted Source).
Try pairing brown rice with stir-fried veggies and a lean protein source for a healthy and delicious lunch.
8. Quinoa
In addition to its high fiber content, quinoa is one of only a few available plant-based complete proteins. That means it contains all nine of the essential amino acids your body needs to obtain from food sources (6Trusted Source, 7Trusted Source).
It also has a low glycemic index, which is a measure of how much certain foods affect your blood sugar levels (8Trusted Source).
Quinoa salad can be a simple and nutritious lunch option for people with diabetes. It’s easy to customize using whichever ingredients you have on hand, such as chickpeas, feta, cucumber, tomato, beans, avocado, onion, or bell pepper.
9. Whole grain tortillas
Not only are whole grain tortillas versatile and delicious, but they can also be a great addition to your lunch if you have diabetes.
In fact, one large whole grain tortilla contains nearly 7 grams of fiber to help keep blood sugar levels steady (9Trusted Source).
For an easy lunch, add your favorite spread, like hummus or tzatziki, to a whole grain tortilla with some fresh veggies and your choice of protein.
10. Whole grain pasta
Whole grain pasta can be a healthy alternative to refined flour pasta, especially if you have diabetes.
In one small study, whole grain pasta was also more effective at reducing hunger and promoting feelings of fullness than refined pasta (12Trusted Source).
For the best results, load up on the veggies and include a good source of protein with your pasta, such as chicken, salmon, ground beef, or legumes.
11. Chicken
Chicken is jam-packed with protein, providing nearly 24 grams per 3-ounce (85-gram) serving (13Trusted Source).
One review of 13 studies reported that following a high protein diet could reduce insulin resistance in people with type 2 diabetes, which could potentially improve blood sugar control (14Trusted Source).
Chicken is also easy to add to a variety of recipes and can be grilled, baked, roasted, or stir-fried.
12. Tuna
Often found in convenient cans, packets, and pouches, tuna can be a healthy lunch option, high in protein and omega-3 fatty acids.
In one study, consuming a high protein, low glycemic index diet supplemented with omega-3 fatty acids improved blood sugar control and decreased belly fat in 30 people with type 2 diabetes (15Trusted Source).
You can easily add tuna to pasta, salad dishes, wraps, sandwiches, and casseroles for a healthy weekday lunch.
13. Turkey
Turkey boasts a good amount of protein in each serving, with almost 25 grams in just 3 ounces (85 grams) (16Trusted Source).
It’s also low in fat and calories, making it a great option for those who are looking to lose weight.
Sliced turkey is perfect for wraps, pitas, and sandwiches. You can also try adding ground turkey to pasta dishes, taco salads, rice bowls, or homemade burger patties.
14. Tofu
With 14 grams of protein in each 1/4-block (81-gram) serving, tofu is an excellent plant-based protein source for people with type 2 diabetes (17Trusted Source).
Additionally, because it easily absorbs the flavor of the foods you pair it with, tofu is an incredibly versatile ingredient. Try adding it to veggie bowls, curries, soups, salads, or sandwiches for an easy make-ahead lunch.
15. Eggs
Although eggs are a beloved breakfast staple, they can also be a great addition to your midday meal.
Though research has turned up conflicting results, several studies have found that regularly eating eggs could improve blood sugar levels and insulin sensitivity for people with type 2 diabetes (20Trusted Source, 21Trusted Source).
Eggs are also versatile. For instance, hard-boiled eggs can bump up the protein content of salads and sandwiches, while scrambled eggs work well in wraps, veggie skillets, or rice dishes.
Rich in fiber, iron, vitamin A, and vitamin C, spinach is one of the most nutrient-dense foods on the planet (22Trusted Source).
It also contains beneficial compounds like thylakoids, which have been shown to enhance insulin sensitivity, improve blood sugar control, and support feelings of fullness in human and animal studies (23Trusted Source, 24Trusted Source, 25Trusted Source).
Plus, there are plenty of creative ways to enjoy spinach for lunch that go beyond salads. For example, try adding it to curries, soups, pasta dishes, or wraps. You can also sauté spinach and sprinkle it with some salt, pepper, and garlic for a simple side dish.
17. Apples
Apples are high in fiber and have a low glycemic index, making them a great dietary addition for people with diabetes (26Trusted Source, 27).
In fact, one small study found that eating an apple before a rice meal reduced the subsequent increase in blood sugar levels by 50%, compared with a control (28Trusted Source).
Apples can be enjoyed in place of dessert to help satisfy your sweet tooth. For example, try pairing them with a sprinkle of cinnamon or some nut butter. Alternatively, add sliced apples to chicken salads, grilled sandwiches, or even quesadillas for extra flavor.
18. Broccoli
Broccoli is highly nutritious, boasting nearly 3 grams of fiber in each cup (91 grams) (29Trusted Source).
It may also help stabilize blood sugar levels. For instance, one small study in 13 adults found that eating cooked broccoli alongside mashed potatoes reduced blood sugar and insulin levels more than eating mashed potatoes alone (30Trusted Source).
For a healthy lunch, try pairing roasted broccoli with brown rice, grilled chicken, and other veggies like zucchini, Brussels sprouts, or carrots.
19. Grapefruit
Grapefruit has a unique tart, tangy flavor, perfect for bringing a refreshing zing to your lunch.
It also has a low glycemic index and has been shown to support healthy blood sugar and insulin levels in some animal studies (31Trusted Source, 32Trusted Source).
Try making a tasty side salad for lunch by pairing fresh grapefruit with arugula, sliced avocado, cucumber, and a drizzle of olive oil.
Note that if you’re taking statins such as simvastatin (Zocor), lovastatin (Altoprev), or atorvastatin (Lipitor), it’s advised to avoid eating grapefruit or drinking grapefruit juice.
20. Cauliflower
Cauliflower is a nutritious vegetable packed with essential vitamins and minerals, including vitamin C, folate, and vitamin K (33Trusted Source).
It’s also low in carbs and can be easily added to recipes in place of high carb ingredients like rice, flour, or potatoes.
Additionally, cauliflower makes a great side dish and can be roasted, boiled, or steamed.