The Hypochondriac's Guide to Life. and Death.

by Gene Weingarten

  OK, still with me? Now, take the grape and sit on it.

  My point is, don’t press your luck. The eye is not indestructible. Though a simple, small puncture won’t usually kill it, trauma with a blunt object will.

  Remember how your sainted mom always issued dire warnings about things that could take out an eye, such as BBs from Daisy air rifles, darts, rocks, and harpoons? Well, we mean no offense, but your sainted mom was an idiot. These things sometimes took out eyes, but less often than you might think, precisely because everyone expected them to take out eyes and approached them with a basic degree of caution. The things that actually take out eyes are far more interesting.

  Below is a list of actual things that have recently taken out an eye, compiled exclusively for this book by the Helen Keller Eye Research Foundation2 in Birmingham, Alabama:

  A chicken beak.

  A turnip, pulled from the ground in a reckless manner.

  A supermarket laser scanner. The customer apparently placed his eye on the glass for a look-see.

  A pine cone falling from a tree on a recumbent person.

  To this list, I would have to add hog slop and potato bazookas. I did not know about these things until recently, when I spoke with Dr. Lorenz Zimmerman, a famous eye pathologist in Washington, D.C., who has studied eye injuries and knows a million of them. He mentioned one tragic case in which a farmer got some hog slop in his eye. Hog slop is not produced with the fastidiousness one might associate with the production of, say, a vial of tetracycline. The eye got infected and the farmer went blind. The most lurid case Dr. Zimmerman knew of occurred in upstate New York a couple of years ago. It was a classic potato bazooka incident.

  A potato bazooka is a highly scientific homemade weapon that makes use of the volatility of hair spray and the structural integrity of PVC pipe to launch a potato the length of a football field. Potato bazookas are sometimes used by bucktoothed morons to hunt rabbit or squirrel. In this case, the individual apparently attempted to utilize this instrument in his living room. Alcohol was involved.

  To better understand the vast array of things that can go wrong with your vision, it might be instructive to review How the Eye Works.

  When we were in grade school, we learned the eye works by bringing an idea to a committee, which schedules public hearings in a timely fashion. Or possibly that is How a Bill Becomes a Law. Now that I think of it, we learned that the eye works like a camera. Recently I discovered that this is basically true. This came as a shock because most of what we were taught in grade school involved preposterous oversimplifications, due to the standard textbook requirement of reducing everything to simple numbered lists that can be memorized. (Reasons for World War II: 1. Hitler, 2. economy, 3. naval superiority, 4. Asia.) So you can imagine my surprise when I learned that, indeed, the eye works like a camera.

  The image comes in through the lens, and it is projected back through the vitreous humor3 onto the retina. You cannot see your retina any more than you can taste your tongue, but you can sort of see what your retina looks like when an ophthalmologist shines a bright light on it and you see a reflection. It is a tangle of capillaries against a sea of angry pink flesh. It is interesting that whatever you are looking at—a vista of breathtaking natural beauty, the face of a loved one beckoning to you in soft seduction—is processed through this screen that looks like highway raccoon viscera. Plus, the image is reflected upside down:

  The Eye

  The two most common eye problems are nearsightedness and farsightedness, which are caused by minor defects in the shape of the eyeball. The normal eyeball is 23.5 millimeters long. The nearsighted one is longer; the farsighted one is shorter. How can you tell if you are nearsighted or farsighted? One way would be to pop out your eyeball with a soup spoon and measure it. A better method would be to go to a mirror and look at your face, specifically that portion of your face visible behind your glasses. If it looks as though your head has been immersed in pickle brine for several years until it got as small as an egg, then you are nearsighted. If your eyes look huge, like one of those paintings by famed 1960s incompetent Walter Keane, then you are farsighted.

  I am nearsighted. Once, for about forty-five minutes, I thought this was a blessing. At the time, I was lying on the floor of a small cabin in Vermont on a cold winter day. Inches before me was a glass of claret, nearly empty, its stem sunk deep into the russet pile of the carpet. The orange flush of a roaring fire was dancing on the belly of the glass. It was beautiful, and it was all I saw clearly. The rest of the room was a warm blur. I felt alone in an elegant old photograph, a tintype with softened borders.

  I had removed my eyeglasses and could not see anything to mar the elegance of that scene. I couldn’t see the toilet in the distance. I couldn’t see the unmade bed. I couldn’t see the pizza box with the ruins of dinner. At this moment, my world was a blissful distortion of closeness. Also, I was pitifully drunk.

  I contemplated my great good fortune. Only the nearsighted could truly understand the comforting intimacy of their affliction, I thought. Only the nearsighted can remove their glasses and he suddenly, profoundly alone with the hook they are reading or the person they are loving. As I lay there on the cabin floor, I felt inspired. I would write a book. It would be an ode to imperfect vision, a work of art, of poetry. A title leapt to mind: Myopia Utopia.

  The fire died out. I drifted off to sleep, flushed with wine and wisdom.

  In the morning I awoke and changed my mind. That is because once I got my glasses on I could see that while I had lain there, enraptured, planning my literary coup, a huge ember from the fire had leapt out and plopped onto the floor not ten feet away. Right before my eyes, it had slowly sizzled a four-inch hole through the carpet and into the floorboards. I had to pay the innkeeper extravagantly for the damage. I did not write the book.

  In the last twenty years, medical science has developed a surgical procedure called “radial keratotomy” to cure defects in vision. The procedure is relatively simple, if terrifying: The outer lining of the eye, called the cornea, is cut by knife or laser and re-shaped to compensate for a misshapen eyeball. The operation corrects bad vision, particularly myopia.

  My friend Karl recently went to a doctor to inquire about radial keratotomy. Karl has been myopic his whole life and is sick of it. He was concerned about the pros and cons of the procedure, possibly because places that do radial keratotomy make you sign elaborate waivers, thick forms that look like what you used to have to fill out to obtain airline flight insurance, where it listed potential damages with unnerving specificity, such as “$200,000 for the loss of one arm, both legs, and one ovary; $205,000 for the loss of one arm, both legs, and both ovaries,” etc.

  Karl wanted reassurance. He wanted to be convinced of the doctor’s professionalism. So he sat down with her and inquired about the risks of the procedure.

  The doctor told him that the only conceivable danger is that the operation cuts away about 10 percent of the cornea of the eye.

  “And …?” Karl asked.

  The doctor leaned forward. “Well, have you ever been in a bar?”

  “Yes,” Karl said.

  “Well, imagine that the guy next to you is drunk, and gets nasty, and he takes a beer bottle and smashes it against the bar, and then swings at your face with the broken bottle.”

  “OK,” Karl said.

  “Well, imagine that he strikes you in the eye.”

  “OK,” Karl said.

  “Well, you will have ten percent less protection against eye injury.”

  Karl waited. Just silence.

  “That’s it?” Karl said.

  “That’s it.”

  “So,” Karl asked, “what is your advice?”

  “My advice is to stay out of bars.”

  Karl got the surgery.5

  In the last few months, I have been reading extremely complicated medical books, and I must say that as a professional editor, I find them frustrating. These books were written by do
ctors, not writers, so they have no sense of pacing, character development, or drama. Here is a small example: Several sections on ophthalmological diseases point out that it is possible to contract gonococcal conjunctivitis—basically, gonorrhea of the eye—from contact between your eyeball and your partner’s infected genitalia. That’s it. That’s all the detail they supply! Then they go on to something else! This would be like ending Casablanca before Rick tells Louis whose names to put on the letters of transit. The credits would be rolling, Ilse and the weenie Victor Laszlo would be standing around in that phony fog, and everyone in the audience would be saying, “Huh? Wait a minute! Do some people have sex with their eyeballs?”

  The single most common complaint about the eye involves “floaters,” which I dealt with briefly in Chapter 6. Floaters move sluggishly across your field of vision, halfheartedly trailing the play, like the fat kid in the defensive backfield. They are almost always no cause for concern, unless you suddenly notice an increase in them. A sudden increase in floaters can mean your retina is detaching, or it could be the first sign of retinitis, an early complication of AIDS.

  Even though ophthalmology is one of the most sophisticated medical specialties, involving the use of high-tech futuristic equipment one would expect to find on the assembly line at Spacely Sprockets, there are a number of decidedly low-tech physical tests that can be used in basic diagnosis. To the practicing ophthalmologist, these would seem horribly primitive; asking him to perform them would be an insult, like asking the chief justice of the United States Supreme Court to represent you before Judge Judy.

  Even though these tests seem to work.

  Let’s say you have noticed a slight deterioration in your visual acuity. If you go to an ophthalmologist, he will perform various tests on you, some of which require him to dilate your pupils so you look like Little Orphan Annie. A far simpler test exists that can quickly indicate whether your vision problem is simple or potentially more troublesome.

  * * *

  Take a thin piece of cardboard. Make a pinhole in it. Now look through the pinhole without glasses or corrective lenses. If your vision problem is due to simple refractive error—nearsightedness or farsightedness—your eyesight will improve slightly when you look through the hole: You need glasses, or a change in your current prescription. This is because the pinhole blocks light waves coming in from the sides, which are the light waves that are most subject to distortion by a lens. But if your eye-sight does not get any better when you peep through the hole, this is a sign of more serious problems, like neurological impairment or, more likely, the beginning of macular degeneration, which is a slow deterioration of the center of the retina. Eventually, to see anything at all, you will have to try to look away and catch a glimpse of it at the periphery of your vision. This is not easy. A 1977 Chevy Nova, for example, might resemble a water buffalo.

  * * *

  One of the initial signs of problems with your thyroid gland, or a sign of a tumor in the nasal sinuses, is a condition called proptosis, which is a bulging of the eyeballs. This happens so gradually you may not recognize it. After a while you will just seem a little startled all the time, like Loni Anderson after a recent face-lift. There is a complex device called an exophthalmometer that doctors use to measure eye bulge, but a far simpler, ancient diagnostic test seems to work quite reliably. It is called Joffroy’s sign.

  * * *

  Tilt your head down, to look at the floor. Now, without moving your head, look up toward the ceiling. Your forehead should wrinkle. If it does not, you may have proptosis.

  * * *

  Have your eyes been hurting? Are they red? The good news would be conjunctivitis, which is a relatively minor infection treatable by pharmaceuticals. Worse news would be glaucoma, an increase in pressure within the eyeball that can ultimately lead to blindness. You might also have a serious condition called anterior uveitis, an inflammation of the iris and surrounding tissues. This also makes your eye hurt. If you suspect it, try this:

  * * *

  Close the eye that seems to be worse. Shine a flashlight into the open eye. If you feel pain in the closed eye, that is a positive sign for anterior uveitis. This is called the Au-Henkind test, and it is said to be nearly 100 percent reliable.

  * * *

  Anterior uveitis has many causes, but it can be an initial sign of awful diseases, including ankylosing spondylitis, which is, literally, a huge pain in the ass. Ankylosing spondylitis attacks in the buttocks, then spreads up the spine. It can create crippling deformities. Anterior uveitis can also signal Behcet’s syndrome, which leads to fiery ulcers of the mouth and genitals, and sometimes arthritis, phlebitis, encephalitis, arterial disease, and fatal pulmonary embolisms.

  That’s the alarming thing about the eyes: Eyes depend on the proper functioning of a delicate lattice of capillaries, and therefore various systemic illnesses that affect the blood can show up there first. Almost every symptom can mean either a minor problem or a major problem. Isn’t that exciting, hypochondriacs?

  Symptom Most Likely Diagnosis Most Terrifying Diagnosis

  Red, scratchy eyes You have conjunctivitis, a minor infection, treatable with antibiotics. You are showing one of the first symptoms of Reiter’s syndrome, a rare and mysterious condition problems and recurrent and sometimes permanent crippling arthritis.

  Indistinct sight, particularly in the center of your field of vision You have floaters. You have macular degeneration. You will slowly go blind.

  Eye discharge You have conjunctivitis. You have onchocerciasis, which is river blindness, caused by the bite of black flies that deposit worms in you.6

  Drooping eyelid, called “ptosis” You have a minor eyelid infection. You have myasthenia gravis, it can turn you into flaccid goop.

  Lump on eyelid You have a chalazion, a papilloma, or a xanthelasma, none of which is as serious as it sounds. You have a basal cell carcinoma or a blepharoatheroma. These are as serious as they sound. If they are caught early enough, you will survive with surgery, but your eyelid may get a little gnarly looking, like genitalia.

  Pupils of unequal size You have benign mydriasis, a harmless condition. You have tabes dorsalis, usually linked to syphilis. It causes an inexorable deterioration of the spinal column. You start walking stupidly, like a drunken drum major. Then you lose control of your bladder and sexual function.

  Double vision, with light sensitivity You have chorioretinitis, which usually clears up. You have botulism, which sometimes doesn’t.

  Double vision You have a minor imbalance in the strength of the muscles around the eye. You have an inoperable brain tumor, or a cerebral hemorrhage, or meningitis, or encephalitis, or diphtheria.

  Cloudy vision You have a cataract. You have interstitial keratitis. It is a sign of many diseases, including leprosy.

  Here are some commonly asked questions about the eye:

  Why do some women paint their eyelids the color of eggplants? Do they think this looks good?

  This is not strictly a medical question, though the overuse of eye shadow, mascara, and other eye makeup can create corneal ulcers and exacerbate allergic reactions; this is why makeup companies must test their products by rubbing them on rabbit eyeballs until the eyeballs explode. Some men find purple eye shadow attractive. These men tend to have their first names (“Wayne”) stitched over their shirt pockets at work.

  What happens to the eyes when you get to be middle aged? What is that all about?

  Here is an interesting diagnostic test anyone can perform. Go to some public place, like a park or playground. Find someone who is attempting to read a book but holding it at arm’s length. This person will be experimenting with different distances and squinting. He will look as though he were attempting to play a slide trombone. Then walk up to this person and say, “I bet you are exactly forty-two years old.”7 Chances are you will be correct. This is because at almost exactly forty-two, the eye loses a certain amount of elasticity. This condition is called “presbyopia.” W
hen my friend John Pancake was forty-eight he actually purchased trifocals, which leads to the obvious follow-up question:

  What kind of a name is John Pancake?

  This book may be tasteless, but I draw the line at making fun of someone’s name. I “flatly” refuse to do so.

  Remember “X-ray Specs” those $2 glasses for sale in the back of 1950s comic books that supposedly let you see through ladies’ clothing? Has anyone actually invented such a product?

  No one has invented such a product, nor will anyone.

  Is that because no one would buy a product that would violate people’s privacy in such a shameful way?

  Don’t be ridiculous. It won’t be invented because it won’t work well enough. I talked to experts in the field of sonar and infrared technology, who agreed it would be possible, and not terribly difficult, to create a visual scanner that could penetrate clothing, survey the contours of the skin below, and transmit it back to a computer, which would use an algorithm to create a realistic, skin-toned image that could be projected on a mini-computer contained within a pair of glasses. Henry E. Bass, distinguished professor of physics at Mississippi State University and director of the National Center for Physical Acoustics, estimates such a product, if it were available commercially, would cost about $1,500. No problem, for the motivated pervert. The problem is a built-in design flaw. “Pubic hair is not that much different from clothing,” Dr. Bass says. “If you are able to eliminate one, it would be hard to see the other. That’s gonna be tough.”