Dear Doctors: Several months ago, my right eye began to be bothered by “little critters” flying through the air; when I tried to brush them away, nothing existed. I mentioned this to several people and was informed it is a case of floaters. Please explain this condition and what can be done.

Dear Reader: The term “floaters” refers to the bits of cellular debris that can accumulate in a certain part of the eye. They are common enough that we suspect a significant percentage of readers are nodding their heads in recognition. Eye floaters can develop at any age. However, they typically begin around age 40 and become more common as we grow older.

The eyeball is a fluid-filled orb. In front are the cornea, lens and iris, the “hardware” of sight. Lining the interior of the back of the eye is the “software,” which includes the photoreceptor cells of the retina, the light-sensitive tissues of the macula and the ocular nerve. Between the two is a gelatinous fluid called the vitreous humor. It makes up about 80% of the volume of the eye. It supports the eyeball’s spherical shape and helps stabilize the retina.

The vitreous humor is primarily made of water, with a small amount of dissolved salts and sugars. It also contains a matrix of collagen fibers. These add structure and stability and help anchor the vitreous humor to the retina. As we age, the vitreous humor gradually softens and starts to shrink. When this happens, portions of the collagen matrix can break free and travel through the gel. Cellular debris, small blood clots and clumps of collagen and other proteins can also become floaters.

As debris drifts through the vitreous humor, light entering the front of the eye causes the floaters to cast a shadow on the retina. The photoreceptor cells deliver this information to the optic nerve, which converts it to electrical impulses and sends them to the brain. The brain then creates a visual image of the changes taking place within the eye.

Unfortunately, there is no cure for floaters at this time. Many people rely on the ability of the brain to learn to ignore their presence, a process known as neural adaptation. But for some people, whether due to heightened sensitivity or the quantity or obstructive placement of the floating debris, this can be a challenge.

Some eye care professionals offer laser treatment to vaporize debris and render floaters less visible. However, this approach is applicable only to a certain subset of floaters, has limited success rates and carries the risk of damage to the retina. In extreme cases, a surgical procedure to replace the vitreous fluid with saline may be considered. This is known as a vitrectomy. Possible complications include retinal tears, retinal detachment and cataracts.

For many of us, floaters are a normal part of aging. If you are worried, a visit to your eye doctor can help ease your concerns. It can also provide a baseline assessment to measure against for any changes to your vision in future.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: My nose has been plugged up for a few weeks from a sinus infection. Now my left ear is feeling full, and sounds are muffled. Can that be related? My dad says yes. (He has GERD, and he says it has affected his hearing.) GERD is so different from a sinus infection that I don’t see the connection.

Dear Reader: You are correct that GERD and a sinus infection are different conditions. Gastroesophageal reflux disease, commonly called GERD, is a digestive disorder. When the acidic contents of the stomach come back up into the esophagus and beyond, it can irritate the delicate tissues. A sinus infection is an upper respiratory condition. The hollow, air-filled spaces in the bones above and around the nose become inflamed. This can be due to a viral or bacterial infection, or in response to allergens or other airborne irritants.

However, your father is also correct. Both GERD and a sinus infection can have an adverse effect on hearing. The upper respiratory and upper digestive tracts cross paths anatomically with the middle ear in the nasopharynx, an area in the upper part of the throat. The structures of the middle ear connect to the nasopharynx by the eustachian tubes. These are narrow, hollow canals that help regulate air pressure in the middle ear. As you swallow, chew or yawn, a pair of muscles located in the soft palate contract. This briefly opens a valve within the eustachian tubes. This allows air to flow in or out, depending on the atmospheric pressure.

The acid reflux of GERD can surge beyond the esophagus and reach the throat. When this occurs, the corrosive liquids can cause inflammation and swelling at the opening to the eustachian tubes. In addition to equalizing pressure, the eustachian tubes allow mucus and fluids that collect in the ear to drain into the throat. The narrowing of the tubes associated with GERD can cause the tubes to become blocked, muffling sound and setting the stage for infection.

The same principles apply to a sinus infection. The inflammation and buildup of mucus that occurs in a sinus infection can block the tubes. This type of blockage is known as obstructive eustachian tube dysfunction. Symptoms include the sensation of fullness and diminished hearing that you describe. Some people hear popping or clicking sounds, develop tinnitus, have problems with balance, or experience discomfort or even pain. A prolonged blockage increases the risk of middle ear infections.

Clogged eustachian tubes can respond to home remedies. These include chewing gum, yawning, the use of a saline spray or rinse, or decongestants or antihistamines. If symptoms continue for more than two weeks, it would be a good idea to seek medical care. Clinical evaluation may include tests to assess whether the tubes are functioning properly. If a sinus infection is causing the obstruction, medications may be prescribed to treat the infection.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: We have three kids in school, and they’re not always happy with the lunches I’ve been packing. Our 7-year-old is the easiest -- he loves his PB&J. But his 9- and 13-year-old brothers are a lot harder. You have mentioned you are parents. How do you deal with school lunch?

Dear Reader: As moms who plan and pack school lunches, your question resonates with both of us. Making sure that kids eat a nutritious and well-balanced lunch is important. A good midday meal supports physical growth, provides energy, improves mood and focus, and bolsters cognitive development. It can also be a pleasurable bright spot in an otherwise long and regimented school day. Yet cracking the code of a healthful lunch that kids will actually enjoy can be a challenge.

The school lunch dilemma is not surprising. Children’s food preferences typically expand and change as they grow older. Don’t be surprised if one day your 7-year-old suddenly rejects the peanut butter and jelly sandwiches keeping him happy right now. The environment of the lunchroom, which can be noisy, chaotic and sometimes rushed, can also make mealtime less than appetizing. Add in the dictates of peer pressure, social media food fads and the siren call of ultra-processed foods, and getting your kids to eat a good lunch can feel like an uphill battle.

We have found it can be helpful to give kids a say in planning their own menus. When they have skin in the game, they are more likely to consume their lunches. Try taking them shopping so they can choose their preferred foods. Then get them involved in the prep and assembly side of things, as well. It can be as simple as washing fruit, portioning out veggies or assembling sandwiches. When packing the lunch, make sure portion sizes are reasonable and that the foods themselves are easy to eat. It’s also important to remember that each element of a packed lunch must be able to survive the bumpy and unrefrigerated journey from home kitchen to school cafeteria without wilting, melting, breaking, leaking or falling apart.

When you’re making a family favorite for dinner, consider doubling the portions. That way, everyone can pack up the extras for a special midday meal the next day. And don’t discount the school’s own lunch programs. If it’s affordable for your family, this is a great way to slip a few days of variety into the lunchtime routine. You and your kids can peruse the menus together and choose the days they will buy their lunches. Whether homemade or purchased, talking over the components of lunch can be a stealth lesson in the basics of nutrition.

Finally, we know we’re talking about lunch here. However, don’t forget about the power of breakfast. Kids who start the day with something balanced and filling are more likely to reach the lunch hour without the kind of hunger that makes you brush aside the healthy options and rip into a bag of chips.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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