Manual for Eye Examination and Diagnosis. Mark W. Leitman

with hydroxychloroquine.

      Source: Courtesy of Neal A. Sher, MD, and Arch. Ophthalmol., Aug. 1979, Vol. 97, pp. 671–676. Copyright 1979. American Medical Association. All rights reserved.

      Allergies to medications

Inquire about drug allergies before eye drops are placed or medications prescribed. Neomycin, a popular antibiotic eye drop, may cause conjunctivitis and reddened skin (Fig. 15).

Family history of eye disease

Cataracts, refractive errors, retinal degeneration, and strabismus—to name a few—may all be inherited. In glaucoma, family members have a 10% chance of acquiring the disease. Eighty‐five percent of people with migraine have an immediate relative with the disease.

Fig 15 Neomycin allergy occurs in 5–10% of the population.

      A special question should be directed to a healthy lifestyle. It has been steadily worsening, causing a decrease in American lifespan to 78.6 years in 2017, compared with 82 years in Canada, Japan, and France. Fourteen percent of Americans still smoke cigarettes. It doubles the rate of cataracts, macular degeneration, and all types of uveitis. It also worsens exophthalmos due to thyroid disease, and was responsible for 480,000 deaths in America in 2018. Care must be taken in prescribing pain medications. In 2017, opioid use was the number one cause of death in America in those younger than age 50. At age 70, 80% of Americans have been diagnosed with high blood pressure. Over 50% of adults are diabetic or pre‐diabetic. One‐third of Americans are obese and another one‐third are overweight, contributing to cancer, hypertension, and diabetes. Patients should be reminded about minimizing the consumption of red and preserved meats, salt, sugar, and saturated fats. Recommend instead an antioxidant diet rich in fruits, vegetables, beans, nuts, fish, and whole‐grain cereals. Staying thin, minimizing stress, and following a routine daily exercise program should also be advocated, since even sitting at your job has been shown to shorten life span by 2 years. Mental disorders must be properly addressed since suicide, drug addiction, and alcoholism contribute significantly to morbidity. Remind patients that they must be proactive in taking responsibility for their health, and that they must become less dependent on pharmaceutical answers.