Vol. 41 No.
9 September 2023
Mayo Clinic
Health Letter
Reliable Information for a Healthier Life
Atrial fibrillation
Get the rhythm right again
Imagine a marching band without a
conductor — the band is still trying
to play the tune, but the music is not
very coordinated. What comes out
resembles noise more than music,
sounding unrhythmic and out of sync.
This is the situation for more than
3 million Americans and 33 million
people throughout the world who live
with atrial fibrillation. The heart has
no proper rhythm control. The action
goes on, but in a disorderly, inefficient
manner that may lead to serious
health problems, including stroke.
An irregular or racing heartbeat
(palpitations) or shortness of breath
can occur, but not everyone with atrial
fibrillation feels symptoms. Atrial
fibrillation can lead to blood clots in
the heart with or without causing other
symptoms. These clots can travel to
INSIDE: Supplement safety | Health Letter at 40 | Hair straighteners and cancer risk | Eye inflammation | Diverticulitis care
Brain tissue
40
ANN I V
ER S
th
A RY
death
Clot blocks
blood flow
Heart’s upper
chambers beat
irregularly
and block arteries that supply blood to
the brain. This blockage can result in
an ischemic stroke, the most common
type of stroke in which reduced blood
flow causes brain injury. Blood clots
related to atrial fibrillation cause about
15% of all strokes in the U.S. These
strokes tend to be more severe.
It’s important to be aware of the
risks and treatment options for this
quickly growing condition — atrial Blood clot
fibrillation is predicted to affect 12 forms and
million Americans by 2030. breaks loose
Missing the beat
Atrial fibrillation is the most common
type of irregular heart rhythm Atrial fibrillation occurs when altered
(arrhythmia), and it primarily affects electrical activity in the atria causes
the upper two heart chambers (atria). the heart’s upper chambers to beat
Atrial fibrillation occurs when altered irregularly and very fast. When this
electrical activity in the atria causes happens, the atria quiver and don’t
the heart’s upper two chambers to pump blood effectively. Blood clots
contract irregularly and very fast. As a can form in the heart, break loose, and
result, the muscles in the atria walls travel to and block arteries that supply
quiver (fibrillate) as they race at 400 to blood to the brain, resulting in a stroke.
600 beats a minute. A main risk of
fibrillating atria is that blood flow is
therefore sluggish, potentially
allowing clots to form.
Despite the lack of effective
contraction of the atria, the heart’s
lower chambers (ventricles) can often
still pump blood fairly effectively.
Between the atria and ventricles is
an electrical conduit, known as the
atrioventricular (AV) node, which acts
as a checkpoint. The AV node stops
many of the atria’s excess electrical
signals from reaching the ventricles.
The ventricles may beat faster than
usual, but not as fast as the atria.
A typical resting heart rate is between
60 and 100 beats a minute. People with
atrial fibrillation sometimes develop
an irregular heart rate in the range of
100 to 175 beats a minute. This faster
overall heart rate can cause the heart
to be overworked and stressed, leading
to new heart failure or worsening of
existing heart failure.
Common symptoms may include
lightheadedness, heart palpitations,
weakness or fatigue, shortness of
breath, chest discomfort, or confusion.
An irregular heart rhythm that occurs
sporadically is called intermittent
or paroxysmal atrial fibrillation.
You might have symptoms for a few
minutes or hours, then regain normal
rhythm. Intermittent atrial fibrillation
can be triggered by physical or
emotional stress, though it usually
develops in people with risk factors
listed in the next section.
Some people have intermittent atrial
fibrillation for years and may not know
it unless it’s discovered in a checkup
or after a stroke. See your health care
team if you experience chest pain,
shortness of breath or bothersome
palpitations. In addition, be sure to
keep up regular health checkups, which
can help identify problems early.
Age, other conditions put you at risk
The older you are, the higher your risk
of atrial fibrillation. As you age, the
electrical and structural properties of
the atria can change. This may lead to
the breakdown of your usual rhythm.
2 MCPress.MayoClinic.org/HealthLetter
Problems with the heart’s structure
are common causes of atrial fibrillation.
That includes diseases affecting the
heart valves or heart pumping system.
However, one-third of the people with
atrial fibrillation don’t have underlying
heart disease. For these people, the
cause is often related to preexisting risk
factors, including:
• Obesity.
• High cholesterol.
• Sleep apnea.
• High blood pressure.
• Diabetes.
• Smoking and alcohol overuse.
Treatments vary, can be effective
Treatment for atrial fibrillation is
individualized depending on your
symptoms, lifestyle and underlying
conditions. A rundown of possibilities:
Lifestyle changes
Health improvements such as losing
excess weight, getting more exercise,
treating sleep apnea and high blood
pressure, and reducing alcohol intake
are effective tools for preventing and
controlling atrial fibrillation. These
actions also improve the long-term
success of other treatment strategies.
Reducing stroke risk
Most older adults who have atrial
fibrillation are prescribed medications
to reduce the risk of blood clots, and
thus the risk of stroke. For those with
high stroke risk, clot-preventing drugs
reduce the risk of stroke substantially.
These drugs are also known as
anticoagulants or blood thinners.
Reducing the risk of life-threatening
stroke is of utmost importance. But
the risk is often weighed against a
significant downside to clot-preventing
drugs: internal bleeding. People at
higher risk of internal bleeding may not
be able to take these drugs. Medication
options to prevent clots include
apixaban (Eliquis), dabigatran (Pradaxa),
edoxaban (Savaysa), rivaroxaban
(Xarelto) and warfarin (Jantoven).
Typically, clot-preventing drugs are
lifelong medications, whether or not
you feel symptoms. If you have atrial
fibrillation and feel OK, don’t stop
taking your clot-preventing medication
without taking to your health care team
first, especially if your risk of stroke is
high. If you’re having problems with a
specific drug — including cost — ask
your doctor or pharmacist for help.
You may be able to switch to a different
drug. Understanding the goals, risks,
and benefits of taking a clot-preventing
drug can help you and your care team
reach a shared decision.
If you can’t take these medications,
your care team may recommend a
left atrial appendage closure. With
this procedure, your care team seals a
small appendage called a sac, in the left
Mayo Clinic Health Letter
Senior Editor Medical Editor
Joey Keillor Daniel Roberts, M.D.
Managing Editor Associate Medical Editor
Jennifer Welch Amindra Arora, M.B., B.Chir.
Writers Medical Illustration
Daniel Simmons Catherine Delphia
Lisa Speckhard Pasque M. Alice McKinney
Editor in Chief,
Caitlin Vander Wert
Mayo Clinic Press
Nina Wiener
Copy Editing
Miranda Attlesey, Alison Baker,
Administrative Assistant
Julie Maas, Nancy Wright
Terri Zanto Strausbauch
Editorial Board Salvador Alvarez, M.D., Infectious Disease;
Shreyasee Amin, M.D., Rheumatology; Amindra Arora, M.B.,
B.Chir., Gastroenterology and Hepatology; Lisa Buss Preszler,
Pharm.D., Pharmacy; Clayton Cowl, M.D., Pulmonary and Criti-
cal Care Medicine; Mark Davis, M.D., Derma­tology; Christopher
DeSimone, M.D., Ph.D., Cardiovascular Medicine; Heather
Fields, M.D., Internal Medicine; Tina Hieken, M.D., Surgery;
Amir Khan, M.D., Ophthalmology; Kellen Lambeau, DNP, APRN,
CNP, Family Medicine; Denise Millstine, M.D., Women’s Health/
Internal Medicine; Timothy Moynihan, M.D., Oncology; Daniel
Roberts, M.D., Hospital Internal Medicine; Craig Sawchuk,
Ph.D., L.P., Psychiatry & Psychology; Phillip Sheridan, D.D.S.,
Perio­don­tics; Peter Southorn, M.D., Anes­thesiology; Paul
Takahashi, M.D., Internal Medicine; Matthew Tollefson, M.D.,
Urology; Rochelle Torgerson, M.D., Ph.D., Dermatology;
Gerald Volcheck, M.D., Allergic Diseases; Robert Wilfahrt, M.D.,
Family Medicine; Joey Keillor, Health Information.
All photographs and illustrations are copyright of MFMER,
except for the following: NAME: GettyImages-1048188358/
Page 1/ CREDIT ©Getty.
From time to time, Mayo Clinic or a Mayo Clinic physician may
have a financial interest in inventions, companies, products
or technologies mentioned in the Health Letter. For a full list
of financial disclosures related to a particular issue, submit a
request at MCPress.MayoClinic.org/contact-us
Mayo Clinic Health Letter (ISSN 0741-6245) is published
monthly by Mayo Clinic Press. Subscription price is $32 a
year, which includes a cumulative index published in January.
Periodicals postage paid at Rochester, Minn., and at additional
mailing offices. POSTMASTER: Send address changes to
Mayo Clinic Health Letter, Subscription Services, P.O. Box
9302, Big Sandy, TX 75755-9302.
upper heart chamber, where most of
these clots form. A closure device is
gently guided through a catheter to the
sac. The catheter is then removed, and
the device is left in place permanently.
Resetting heart rhythm (cardioversion)
This process attempts to return the
atria to a stable rhythm and regulate
your overall heart rate. Cardioversion
can be tried by using anti-arrhythmia
drugs alone (chemical cardioversion) or
by using an electrical shock to reset the
heart’s electrical activity to restore its
usual rhythm (electric cardioversion).
Anti-arrhythmia drugs may be
prescribed to help maintain a regular
rhythm after electric cardioversion.
Restoring regular rhythm with
interventions or surgery
To restore a stable heart rhythm, a
catheter-based procedure to disrupt
electrical pathways inside the heart
may be considered. With this
procedure, one or more tubelike
catheters are inserted in a vessel near
the groin, then guided to the interior
of the heart. The catheter tip burns
(radiofrequency ablation) or freezes
(cryoablation) targeted areas of tissue,
causing small changes intended to
stop erratic electrical signals.
Permanent pacemaker leads
A heart doctor may implant a small medical device to maintain a heart rhythm
(pacemaker). The doctor then performs atrioventricular (AV) node ablation, applying
radiofrequency energy to the AV node — a small area of tissue between the upper
and lower heart chambers. This destroys the electrical signaling connection.
Open-heart surgery is another way
to access the atria and perform
targeted scarring. It’s more commonly
used during open-heart surgery for
another reason, such as a coronary
artery bypass or heart valve surgery.
Catheter ablation can be effective,
but the response varies depending
on multiple factors, including the
duration of atrial fibrillation and
whether it comes and goes or is always
present. Ablation can treat symptoms
of atrial fibrillation. However, in most
people, ablation doesn’t change stroke
risk or improve life span.
Controlling heart rate
This approach can be used in
conjunction with attempts at rhythm
control or as a stand-alone option when
a regular rhythm can’t be achieved.
The goal is to improve symptoms and
reduce the heart’s workload by slowing
the heart rate. This is most commonly
done with drugs. If the heart rate is
difficult to control and restoring
rhythm is not possible, a pacemaker
and a type of ablation that targets the
main conduction system of the heart
can be used to stabilize the heart rate.
This process — called atrioventricular
(AV) node ablation — is shown in the
image below.
Ablation catheter
HEALTH TIPS
SUPPLEMENT SAFETY
While it’s ideal to get vitamins and
nutrients from foods, sometimes
that’s not possible. An estimated
3 out of 4 older adults take at least
one supplement daily. However,
it’s very possible for those taking
supplements to exceed the
recommended amounts. Here’s
how to be supplement smart:
• Know the risks — Some vitamins
and minerals can be flushed out
of the body easily without serious
harm, even if you take too much.
But taking high-dose supplements
of certain nutrients that can’t
be easily eliminated can be
dangerous. Too much vitamin A
can lead to liver failure. Too much
vitamin D can affect levels of
calcium in the blood. Overdoing
iron can cause digestive system
issues and might interfere with
absorption of medications.
• Stay under the limit — A tolerable
upper intake level (UL) has been
established for many vitamins
and minerals. A UL is defined as
the highest level of daily intake
that is unlikely to cause adverse
health effects in most people.
This amount includes how much
of a nutrient you get from both
food and supplements. To be
safe, stay under each UL unless
specifically advised otherwise.
• Get a checkup — It’s best to get a
medical professional’s perspective
before starting any supplement.
Many supplements interfere with
medications and even with each
other. Bring your bottles so the
care team can see the ingredients.
• Check the labels — The marking
“USP Verified” ensures that the
product meets strength, quality
and purity standards set forth by
U.S. Pharmacopeial Convention,
which is an independent testing
organization. Watch the expiration
date. Vitamins and minerals can
become less effective over time.
September 2023 3
Health Letter at 40
Helping people stay healthy
An Aug. 17, 1983, headline in a
Rochester, Minnesota, newspaper
read: “Almost 6,000 sign up for new
Mayo Clinic newsletter.” With that,
the first issue of the Mayo Clinic
Health Letter launched.
The cover article on back pain
features two black-and-white drawings
of the spine and starts with the words:
“A-A-ACHOO! The pain can start with
a sneeze, but the disability is nothing
to sneeze about.” An article on the
dangers of children ingesting batteries
includes a black-and-white photo of
button battery sizes as compared to
a dime. Bothered by sniffles? That
was covered, too, as were varicose
veins and the health writing staple,
hemorrhoids — among other topics.
This month, Mayo Clinic Health
Letter celebrates its 40th year of
bringing helpful, actionable health
information — now with beautiful,
full-color medical art — to well over
400,000 subscribers. Now that’s
nothing to sneeze about! Below is a
conversation between Health Letter
Medical Editor Daniel Roberts, M.D.,
and Senior Editor Joey Keillor on
creating the best eight pages in health
for older adults.
Forty years is a long time for a
publication to stay in business. What
keeps the Health Letter relevant?
Dr. Roberts: So much of it is our board
of expert reviewers, who not only read
every article for accuracy and clarity
but also help generate the story ideas.
But really it’s our readers who keep
us relevant: They send in questions,
suggestions and challenges.
Keillor: Our relevancy continues
because we work to connect with our
readers. In recent years, we enhanced
the reader connection by adding stories
of people working through health
problems and successes. People share
their often very personal stories with
us to educate, inspire and provide hope.
4 MCPress.MayoClinic.org/HealthLetter
Great examples include our February
2023 Special Report where Scott
Phillips recounts the moment of clarity
when he became a caregiver of his
wife, who was diagnosed with brain
cancer. Or our November 2022 Special
Report on lung disorders, where
Mary Preble dispenses advice and
shares how she keeps active despite a
history of lung cancer and ongoing
emphysema. We’ve also added expert
interviews when we feel that our
readers will benefit from a more direct
connection to Mayo Clinic experts.
Dr. Roberts, tell us about your medical
role at Mayo Clinic’s Arizona campus
and how that dovetails with your
editorial role with the Health Letter.
Dr. Roberts: I’m a hospitalist — a
generalist who practices in the hospital.
So I see a little bit of everything, and I
can hopefully bring some focus on
hospital medicine to the mix.
Editing the Health Letter has made
me appreciate how hard it is for any of
us to absorb health information in real
time. If a professional writer backed up
by a panel of medical experts needs
several pages to cover a new treatment
for bladder cancer, then my patient
and I are going to need to go over my
update on her heart failure, diabetes
and pneumonia more than once —
with time in between to process and
think of questions. She can’t listen to
me at her own pace like she can when
she’s reading the Health Letter!
The Health Letter has a 21-member
editorial board. It’s printed on page 2
of every issue, but it’s easy to overlook
since the type size is so tiny. Can you
talk about the role this board plays in
producing the Health Letter?
Dr. Roberts: They come from different
specialties, different Mayo campuses,
and include not just doctors but also a
pharmacist and a nurse practitioner.
In addition to serving as a valuable
check on the overall medical accuracy
of the Health Letter, the story ideas
they bring are invaluable. Some
come from their particular specialty,
of course, but many are just things
that their patients have asked about
at the end of visits, or things family
members have asked about.
Keillor: In addition to board review,
every article we write is reviewed by
Mayo Clinic experts in the topic. As a
writer, putting your work before a
world-leading expert is nerve-wracking.
This level of scrutiny is a key reason
that the quality never slips. Experts
are generally not shy about correcting
draft errors or making sure our readers
are getting the most accurate and up-to-
date information available.
As the title implies, the Health Letter
was designed as a letter to readers.
I know that they write a lot of letters
back to you, as well. Can you tell me
about a few that stand out?
Dr. Roberts: The letters are as diverse
as our readership, but the ones that
really stand out are in two groups:
1. The ones that share how
something one of our writers put
together changed their health or
the health of their loved ones. One
example is the woman who got
her husband tested for one of the
“Parkinson’s mimics” conditions
we wrote about in our June 2022
issue and was able to get him on
effective treatment.
2. The ones that suggest topics for
future articles based on their own
health issues. We get some of our
best stories out of those letters.
Keillor: As we work to connect to our
readers, we also appreciate when
readers reach out and connect with us.
Even complaints or letters pointing out
a rare flaw are appreciated, as we can
make corrections or clarification as
needed — and it keeps us on our toes.
We know that what we say matters to
many people, and we put forth a huge
effort to say it the best way, every time.
The Health Letter content differs
from competitors in that it’s written
by journalists who aren’t doctors or
medical professionals. What about
that model makes it effective?
Dr. Roberts: Our writers have a knack
for taking complicated molecular
mechanisms and statistical analyses
— to give two examples — and making
them clear but not simplistic. If we go
too simple with something, our board
of experts points out: “That’s not
exactly what these study results say.”
Keillor: Not being steeped in science
and medicine can be a big advantage
when writing for an audience that
typically isn’t steeped in these topics
either. Our writers know what it’s like
to not understand medical topics, and
NEWS AND OUR VIEWS
HAIR-STRAIGHTENING CHEMICALS
LINKED TO ENDOMETRIAL CANCER
Chemicals in products used to straighten,
relax or color hair have previously been
linked to an increased risk of breast and
ovarian cancers. A new study discovered
a similar association with endometrial
cancer, finding that women who used
chemical hair straighteners or relaxers
had more than double the risk compared
with those who didn’t use these products.
Endometrial cancer begins in the
endometrium, the layer of cells that
form the lining of the uterus. The study,
published in October 2022 in the Journal
of the National Cancer Institute, looked at
medical records and outcomes of about
34,000 women ages 35 to 74. Over 11
years, those who reported regularly using
hair straighteners or relaxers had about a
4% risk of developing endometrial cancer
by age 70. Those who didn’t use these
products had a substantially smaller risk
of about 1.6%. Researchers found no
similar heightened risk of cancer in
women who used other common hair
products, including dyes, bleaches and
solutions used for perms.
The risk didn’t appear to be any higher
for Black women than for other groups.
But the authors note that their findings
may be especially important for Black
women because previous studies have
found that these women tend to use
relaxers at a higher rate — and begin
using them at an earlier age.
part of the success of our writing is our
empathy. I remember a Mayo expert
saying to me, “Entire textbooks are
written on this topic, and you got it
down to a page and a half that my
grandparents could understand!”
The Health Letter has undergone a lot
of improvement in the recent past.
What will the future bring?
Dr. Roberts: I love the printed word, of
course, or I wouldn’t be doing this job.
But I can’t wait for our digital offering
to be as accessible and easy to read and
share as an article you clip out of a
Mayo Clinic experts say that the
study provides an important piece in
understanding the risk factors for
endometrial cancer. While the study isn’t
evidence that the straightening products
cause cancer, it supports the need for
further investigation. The study came in
the wake of a large study that found a
significantly increased number of deaths
from some types of uterine cancer
between 2010 and 2017. These increases
were disproportionately high among
Hispanic, Black and Asian women.
Although there’s no standard screening
test for uterine cancer, some experts
recommend an annual pelvic exam. See
your health care team if you experience
unusual vaginal bleeding, such as
bleeding after menopause. This can be a
symptom of some gynecologic cancers.
MENTAL HEALTH CARE IN A
SINGLE SESSION
Mental health challenges tend to be
complex and can require professional
care that goes on for weeks, months or
even years. But getting that level of care
isn’t always possible, often due to the
shortage of mental health professionals.
To combat this issue, psychologists are
studying care models for some people
that dramatically scale back the length
of care — even to just one visit.
A single-session intervention is a fairly
new approach. But interest in it has
grown, in part due to the mental health
paper copy and give to a friend or post
on the fridge. Coming soon!
Keillor: It’s a joy to get away from
screens and read a printed publication.
Still, we are creating a better website
experience to improve what we can
offer. Imagine reading a great Health
Letter article on back pain — and then
being able to enhance that article by
watching a video of back exercises or
listening to an expert interview online.
The goal is to continually earn the
loyalty of our readers with a better and
more helpful product.
crisis brought about by the COVID-19
pandemic. The approach has shown
promise in limited trials treating people
with a number of serious conditions,
including alcohol use disorder, anxiety
and chronic pain. It takes a “less is
more” approach to the time you spend
with a professional and focuses on
teaching effective strategies to help you
navigate your mental health challenges.
Mayo Clinic experts say the approach
holds promise as a way for more people
to get mental health care. Single-session
interventions may be particularly helpful
for those on a waitlist for mental health
services. The model also improves
convenience, with visits happening in-
person, online or via a smartphone app
— sometimes with a guided process with
or without a professional directly
involved. However, more testing and
development are needed to assess
effectiveness. So far, most trials have only
involved younger people, in part because
that group faced a serious mental health
crisis due to missed school and isolation
during the pandemic shutdowns.
The single-session approach is seen as
a complement to more-involved mental
health care rather than a substitute,
especially in people with serious,
ongoing mental health conditions such
as depression and post-traumatic stress
disorder (PTSD). Talk with your health
care team to see if this approach may
be an option for you or a loved one.
September 2023 5
Eye inflammation
Seeing red
Looking in the mirror and realizing
that one of your eyes is red may lead
to an exasperated sigh. That’s often an
appropriate response, as pink eye is
an annoying — but not particularly
harmful — condition.
Several types of eye inflammation
can cause your eyes to look red or pink.
Some require urgent medical care due
to the risk of complications such as
vision loss. Luckily, your symptoms can
help distinguish between less serious
and more-serious problems. If you’re
in doubt, call your health care team.
Inflammation of the eye
Several parts of the eye can become
inflamed, including the:
• Conjunctiva — The clear membrane
that covers the white part of the
eyeball and the inside of the eyelids.
• Sclera — The white area of the eye.
It is a tough wall that protects the
eye’s delicate internal structures.
• Episclera — The region between
the conjunctiva and the sclera.
• Uvea — An area that includes the
colored portion around the pupil
(iris), the muscle fibers around the
lens (ciliary body) and the layer of
blood vessels and connective tissue
that lines the back of the eye
(choroid).
• Cornea — The clear, rounded tissue
on the front of the eye.
Episclera
Conjunctiva
Sclera
Cornea
Iris
Ciliary body
Choroid
6 MCPress.MayoClinic.org/HealthLetter
Inflammation in some of these parts
of the eye is quite serious, requiring
urgent medical care from an eye
specialist such as an ophthalmologist.
Generally, you should contact your
health care team if:
• Your vision significantly changes.
• Your eyes are sensitive to light.
• You experience eye pain with other
symptoms such as vomiting or
headache. For severe eye pain,
emergency care may be necessary.
• It feels like something is stuck in
your eye — to the point that you
can’t open your eye or keep it open.
Conjunctivitis
Conjunctivitis is known as pink eye
because of the reddish appearance that
results when the small blood vessels
in the conjunctiva become swollen.
Another telltale sign is eye discharge.
The discharge may form a crust
overnight, making it difficult to open
the eye upon waking. The eye can feel
gritty or mildly sensitive to light.
In adults, conjunctivitis is usually
caused by a virus. It will usually get
better without medication eye drops.
Self-care measures for symptoms
include cleaning your eyelids with a
wet cloth to clear discharge, using cold
or warm compresses for discomfort,
and using artificial tears if your eyes
feel dry and irritated. However, if
the conjunctivitis is chronic or isn’t
improving with self-care treatments,
it may require antiviral medication.
Conjunctivitis caused by a bacterial
infection is less common than viral
conjunctivitis. While viral conjunctivitis
produces watery or stringy discharge,
bacterial conjunctivitis tends to
produce pus-like discharge all day.
Antibiotic eye drops may be prescribed
if symptoms last more than a few days.
Viral and bacterial forms of
conjunctivitis are contagious and can
spread to your other eye or another
person. Avoid touching your eyes. If you
do touch your eye, wash your hands
promptly. Don’t share towels, and
change your pillowcases frequently.
If you wear contact lenses, it’s best to
see an ophthalmologist or optomitrist
right away if you suspect conjunctivitis.
Remove your contact lenses until you’re
told you can use them again. You may
be advised to throw out soft contact
lenses or disinfect hard contact lenses.
Alternatively, conjunctivitis may be
from an allergy, such as to pollen. This
type typically affects both eyes. Along
with inflammation, your eyes may itch
and produce watery discharge. This
may be accompanied by other allergy
symptoms. Allergic conjunctivitis is not
contagious and may be managed with
nonprescription eye drops.
Conjunctivitis may be caused by
irritation from a substance such as dust
or chlorine. The substance may need
to be flushed out with water or saline
solution. But this can lead to discharge
and eye redness. These symptoms often
improve quickly, but if not, see your
care team. If a caustic material such as
bleach, paint or cement enters the eye,
immediately flush with clean water,
then seek emergency medical care.
Scleritis
Scleritis is hard to miss because it
causes deep, piercing pain and redness.
The pain usually gets worse with eye
movement and when the eyelids are
touched. Pain may be so intense that
it’s difficult to sleep. And pain may
radiate to the temple or face. Eyes may
tear and be sensitive to light. A section
or the entire white part of the eye may
look reddish-purple, and there may be
one or more raised bumps on the eye.
Less commonly, scleritis may appear
as a white area surrounded by red,
signifying damage to the scleral tissue.
This is called necrotizing scleritis and
may cause a gray-blue spot on the eye.
Scleritis can result in vision loss and
requires prompt treatment. If you
develop eye redness with intense pain,
contact your care team immediately.
People who develop scleritis may have
an underlying autoimmune condition,
such as rheumatoid arthritis. Though
less common, infections such as
shingles, Lyme disease or tuberculosis
may cause scleritis. An infection also
may occur with trauma to the eye or
as a complication of eye surgery.
 Condition
Conditions that
Conjunctivitis
are not serious and
typically resolve
on their own Episcleritis
Scleritis
Conditions that
require urgent care Uveitis
because they can
cause vision loss
Keratitis
Noninfectious scleritis may be treated
with nonsteroidal anti-inflammatory
drugs (NSAIDs), corticosteroids and
immunosuppressants. Scleritis caused
by infection is treated with medication
such as an antibiotic.
Episcleritis
Though it affects an adjacent part of
the eye, episcleritis is much less serious
than scleritis. There is no concern for
vision loss. Episcleritis is usually mildly
painful at most. Part of the eye or the
whole eye may be red, and sometimes
a raised bump appears. It doesn’t cause
discharge other than tearing.
The cause of episcleritis is usually
unknown. Autoimmune conditions are
less common in episcleritis. Infections
such as shingles can cause episcleritis,
but this is rare.
Episcleritis may resolve on its own.
When it’s persistent, eye drops, NSAIDs
and compresses may relieve symptoms.
Uveitis
Uveitis can affect several different
parts of the uvea. Anterior uveitis,
which affects the inside of the front of
the eye, commonly causes eye redness.
Anterior uveitis also is called iritis since
the iris is in the front (anterior) portion
of the uvea. Posterior uveitis involves
the back of the eye, and intermediate
uveitis occurs in the central portion.
All forms of uveitis can affect your
vision. Vision changes may include
In addition to red eye …
Pus or watery discharge, itchy eyes,
gritty feeling in the eye
May be mildly painful, may produce
a raised bump on the eyeball
Tearing, light sensitivity, raised red
bump, white spot, intense pain
Eye pain, light sensitivity, vision changes
Tearing, discharge, eye pain, light
sensitivity, vision changes, eyelid swelling,
feeling like something is in the eye
central blurring, floaters and blind
spots. Uveitis can lead to serious
complications such as retinal swelling
or scarring, glaucoma or cataracts,
especially if untreated. Uveitis also
can lead to permanent vision loss.
Uveitis may be caused by an
inflammatory condition such as
ankylosing spondylitis, sarcoidosis,
psoriatic arthritis, Crohn’s disease and
ulcerative colitis. Infections that can
cause uveitis include tuberculosis,
herpes and syphilis.
Corticosteroid eye drops are used
to reduce inflammation. Dilating eye
drops can minimize the formation of
scar tissue between the iris and the lens.
More severe inflammation requires
corticosteroid injections in or around
the eye, oral corticosteroids, or systemic
immunosuppressive drugs. Infectious
forms of uveitis can be treated with an
antibiotic or antiviral medication.
Keratitis
Keratitis is inflammation of the cornea.
It may be caused by an autoimmune
condition or an infection that may lead
to an ulcer on the cornea. Symptoms
include eye redness, tearing, discharge,
pain, sensitivity to light, blurry vision,
eyelid swelling, feeling like something
is in the eye, and difficulty keeping the
eye open due to pain or irritation. In
some cases, the area of inflammation
on the cornea may be visible as a white
or cloudy spot.
Key characteristics
Eye discharge that may crust overnight
Mild eye pain
Intense, piercing pain that may get
worse with movement or with touch
Vision changes, pain
More likely in those who wear contacts
You’re more likely to get keratitis if
you use contact lenses — especially if
you sleep in your contacts, wear them
while swimming, don’t clean them
properly or wear them longer than
recommended. These behaviors can
break down the corneal surface and
make it prone to infection, which
causes severe inflammation. Keratitis
also can be caused by viruses such as
the herpes simplex virus or herpes
zoster (shingles) virus.
Although milder keratitis can often
be treated successfully, severe or
untreated cases can result in loss of
vision. If you suspect keratitis, contact
your care team and immediately stop
wearing contact lenses. For a persistent
white spot, seek emergency care if an
eye care professional isn’t available.
If the cornea is inflamed and not
infected, keratitis may be managed
with eye drop medications such as
steroid drops to manage pain or
discomfort. Infectious keratitis might
require a culture to identify the
appropriate treatment — such as
antibacterial or antifungal eye drops
or oral medication. If keratitis has
damaged your vision, a corneal
transplant is sometimes an option.
Keratitis also can be caused by
autoimmune conditions such as
rheumatoid arthritis. This type of
keratitis may require medications
to treat the underlying disease and
reduce bodywide inflammation.
September 2023 7
Second opinion
Q I recently visited urgent care
for a bout of diverticulitis. I
was given special diet instructions
and a prescription for pain. When
my brother had the same problem
years ago, he was in the hospital for
days and was given antibiotics
through an IV. Why the difference?
A Recent research has changed
how diverticulitis is managed.
With age, it’s common for people to
develop diverticula — small, bulging
pouches in the lining of the large
intestine. Diverticula themselves don’t
often cause problems. But about 1 in 4
people with diverticula experience at
least one episode of inflammation and
sometimes infection of the diverticula.
This condition, marked by abdominal
pain, fever, nausea and a change in
bowel habits, is diverticulitis.
The standard treatment of mild
diverticulitis has long been antibiotics,
along with a temporary clear liquid diet
to allow the intestine to rest and heal.
Historically, this involved a hospital stay
to give the antibiotics through a vein.
However, antibiotics are no longer
routinely recommended for people
without other major health conditions
who have uncomplicated diverticulitis.
This refers to diverticulitis that’s not
causing problems related to infection,
such as an abscess, blockage or bowel
perforation. Studies have shown that
healthy people with uncomplicated
diverticulitis have similar outcomes
whether or not they take antibiotics.
Diverticula
COMING NEXT MONTH: Transient ischemic attack | Sex after cancer | Belly breathing | Couples counseling | RSV vaccine
These people have comparable pain
levels and recovery times. They also
have similar rates of requiring further
care and having the condition recur.
Also, mild diverticulitis is now often
treated at home. Along with a brief,
clear liquid diet, you might take oral
pain relievers, such as acetaminophen
(Tylenol, others) or a drug to reduce
muscle spasms. If an antibiotic is
recommended, it could be given orally.
For people with more-severe
diverticulitis attacks or a high risk
of complications, treatment in the
hospital is typically still recommended.
This may include intravenous (IV)
antibiotics and other possible
treatments over a course of days. For
some, surgery to remove the areas of
damage in the intestine is necessary.
Your health care team will recommend
a treatment approach that best fits
your health situation.
Q
I’m about to have knee surgery.
One of my friends said I should
tell my anesthesiologist that I used
to have naturally red hair (I’ve since
gone gray) because redheads need
more anesthetic. Is this true?
A
Many anecdotal stories warn that
redheads need more anesthetic,
but only a few studies back up this idea.
For example, a small study of 20 white
women — 10 with red hair and 10 with
dark hair — found that the redheads
needed 19% more of an inhaled general
anesthetic to reach full sedation.
But a larger study including over
300 male and female redheads found
that redheads undergoing surgery
did not receive more anesthetic and
pain-relieving medications. The
redheads also were not more likely to
be partially awake during surgery.
Looking at local anesthetic, a study
with 60 women found that injections of
lidocaine didn’t work as well for women
with red hair compared with women
with dark hair — but topical lidocaine
worked roughly as well for both groups.
Studies exploring red hair and pain
tend to focus on the melanocortin-1
receptor (MC1R) gene, which plays a
role in both hair color and pain
pathways. But there are plenty of
other genes that affect hair color and
the way people react to medication.
While these studies point to possible
differences in anesthetic requirements
for redheads, Mayo Clinic experts say
there’s not enough evidence to affect
how a doctor should treat you. Instead
of making medication rules for all
redheads, medical professionals
try to personalize care. Work with
your health care team to create an
individualized treatment plan based
on what medications have or have not
worked for you in the past, no matter
what your natural hair color is.
Have a question or comment? We appreciate every letter
sent to Second Opinion but cannot publish an answer to each
question or respond to requests for consultation on individual
medical conditions. Editorial comments can be directed to:
Senior Editor, Mayo Clinic Health Letter, 200 First St. SW,
Rochester, MN 55905, or send email to
HealthLetter@service.MayoClinic.com
For information about Mayo Clinic services, you may
telephone any of our three facilities: Rochester, Minnesota,
507-284-2511; Jacksonville, Florida, 904-953-2000; Scottsdale,
Arizona, 480-301-8000; or visit www.MayoClinic.org
Copyright © 2023 Mayo Foundation for Medical Education
and Research. All rights reserved. MAYO, MAYO CLINIC, the
triple-shield Mayo logo, and RELIABLE INFORMATION FOR
A HEALTHIER LIFE are marks of Mayo Foundation for
Medi­cal Education and Research.
Purpose To help our subscribers achieve healthier lives by
providing useful, reliable, easy-to-understand health informa-
tion that’s timely and of broad interest. Mayo Clinic Health
Letter supplements the advice of your personal physician,
whom you should consult for personal health problems.
Mailing lists We make our Mayo Clinic Health Letter
mailing list available to carefully selected companies and
organizations. If you do not wish to receive such mailings,
please contact us using the information below.
Correspondence
Mayo Clinic Health Letter
Subscription Services
P.O. Box 9302
Big Sandy, TX 75755-9302
Phone: 800-333-9037 Fax: 903-636-9009
Email: customerservice@mayopublications.com
Customer Services Print subscriptions
are $32 in the U.S. and $45 in Canada.
Call Customer Services at 800-333-
9037. A digital e-magazine is available
for $10 with worldwide email delivery.
Visit MCPress.MayoClinic.org for more
information. Single copies are available
within the U.S. and Canada for $4 plus
shipping, handling and taxes. For bulk
orders of 25 issues or more, email
Corporate Sales at SpecialSales@
Mayo.edu
Printed in the USA
MC2019-0923 • 100923