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Dr. JP
Dr. JP, Ophthalmology, Oculoplastic Surgery
Category: Eye
Satisfied Customers: 28
Experience:  Harvard Medical School, Massachussetts Eye and Ear
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i have a herniated c5-6 disc and bulges at c3-4 and c4-5.

Customer Question

i have a herniated c5-6 disc and bulges at c3-4 and c4-5. i have also been suffering from bilateral eye pain which sometimes feels like aching but at other times feels like burning. my pupils sometimes bilaterally dilate in ambient light. i have also had wavy vision on and off for a year. i was examined by a neuro-ophthalmologist who noted my abnormal pupil responses but did not see any problems with my optic nerve, etc. he said my eyes and vision looked perfect. i have also had a clear brain MRI w/ & w/o contrast. no one can seem to figure out what's going on.

any ideas???
Submitted: 5 years ago.
Category: Eye
Expert:  Dr. JP replied 5 years ago.
Are the pupils equal in size or is one smaller and one bigger?
Customer: replied 5 years ago.
the pupils are equal in size.
Expert:  Dr. JP replied 5 years ago.

When you mentioned that the pupils act funny, could you describe this a bit more?

Customer: replied 5 years ago.
very often they kind of subtly dilate and contract which my neurologist referred to as "pronounced hippus." he said a lot of people have this, but it's not usually as visible to the naked eye.
Expert:  Dr. JP replied 5 years ago.

Thank you for your answer. Hippus is a physiologically normal response to healty well innervated pupils. This is a good thing. Now lets talk about the disc bulging. The neural input to the pupils come from two places, the sympathetic (which dilate the pupil in response to fear, dim light, excitement) and the parasympathetic (which constrict the pupil in bright light, reading, distance vision etc..). The pathway for the parasympathtic start high up in the brainstem many levels above the disc bulging. The pathway for the sympathic originate in the thalmic region and then descend down the spinal cord and exit in the thoracic (chest) region, then travel in the tissues of the neck to eventually travel with the internal carotid to opthamic artery and on to the eye. I haven't seen a correlation of disc bulging affecting pupils or causing eye pain. So I think this is trully unrelated.

 

The eye pain is something I'd like to focus on next if you'd like?

Dr. JP, Ophthalmology, Oculoplastic Surgery
Category: Eye
Satisfied Customers: 28
Experience: Harvard Medical School, Massachussetts Eye and Ear
Dr. JP and other Eye Specialists are ready to help you
Customer: replied 5 years ago.
the fact that the herniations are unrelated to the vision problem seems to be the general consensus. it's just so bizarre how this happened all at once.

FYI--i have also been screened for MS through brain & c-spine MRIs, and had a normal visual evoked potentials test just last week. my neuro said it's now off his radar. do you concur?
Expert:  Dr. JP replied 5 years ago.

Absolutely. MS typically causes acute vision field loss and decrease vision that can improve over several months and typically will return close to baseline by a year. But this initial onset is visual field defects, with dimished vision and serve eye pain with eye movement. This almost alway occurs in one eye. In your case you mention that the you see distorted images, is this correct?

Let me ask you does the wavy images persist or do they last a few seconds and then go away.

Also if you don't mind have you had any ocular surgery, recent eye infections?

Do they symptoms seem to occur in both eyes or in just on eye?

Do you note seeing more than two images at times?

Dr. JP, Ophthalmology, Oculoplastic Surgery
Category: Eye
Satisfied Customers: 28
Experience: Harvard Medical School, Massachussetts Eye and Ear
Dr. JP and other Eye Specialists are ready to help you
Expert:  Dr. JP replied 5 years ago.

Do you happen to have any skin conditions like seborreic dermatitis of the face?

How old are you? (you don't have to answer this if you don't wish, but it will help me narrow down the cause of you symptoms.)

The eye pain and burning. Is it all the time? Is it better in the morning and gets worse at night or when you are doing activities like reading, watching tv or driving?

Customer: replied 5 years ago.
no, i don't have any skin conditions. i am a 42-year-old female. the eye pain and burning do not seem to correlate to any particular activities. it seems to be sporadic.
Expert:  Dr. JP replied 5 years ago.
have you tried any eye drop medications? do you have any allergies?
Customer: replied 5 years ago.
i haven't tried any eyedrop meds. i do not have allergies either.
Expert:  Dr. JP replied 5 years ago.

any medical conditions like hypothyroid, diabetes?

 

Expert:  Dr. JP replied 5 years ago.
any family history of diabetes or thyroid disease....mom, dad, siblings?
Expert:  Dr. JP replied 5 years ago.

when you have the symptoms are the occuring on and off all day?

how many images do you see? two, three, or more?

Expert:  Dr. JP replied 5 years ago.

Are you still there?

 

Customer: replied 5 years ago.
yes, i am still here. my computer just didn't tell me you had asked another question.

sorry about that.

yes, my symptoms occur pretty much on and off all day, with some days being worse than others.
Expert:  Dr. JP replied 5 years ago.

Okay I'm going to render my opinion?

 

Customer: replied 5 years ago.
okay.
Expert:  Dr. JP replied 5 years ago.

Is sounds to me like you have Dry Eye Syndrome. It is known to cause intermintent visual distortion, sometime blurring, eye discomfort, burning, itching and occasionally tearing. It often goes undiagnosed by specialist because is seems so benign. However I beg to differ, it is the most common eye syndrome on the planet. It's just not diagnosed. It can be diagnosed by an eye doctor by doing the following test:

 

1. TBUT (tear break up time with flourscein)

2. Shirmers Test

3. Dye disappearance test

4. Lid apposition evaluation

5. Punctal position on the lid

 

Dry eye syndrome can be associated with:

1. thyroid dysfunction

2. sarcoidosis

3. meibomian gland dysfunction

4. diabetes

5. previous lasik surgery or other corneal surgery

 

Treatment is step-wise:

First Start with this:

1. start with warm compresses twice a day for a week then as needed there after

2. go to walgreens, CVS or other drug store and get one of the following:

-Systane Drops

-PM Refresh

-Genteal Drops

-Bion Drops

3. when you shower wash the lashes with Johnson and Johnson Baby shampoo.

 

If that doesn't help then go back to your eye doctor and they can evaluate to see if you are a candidate for a medication called: Restasis.

 

There are other treatments such as punctal plugs. But this is typically not first line.

 

Also I'd recommend finding a local eye doctor who can evaluate your eyes again and test you for Dry Eye Syndrome. They will likely start you on what I've described above. In addition they can evaluate if deemed necessary for hypothyroidism, diabetes, or other systemic causes of this syndrome.

 

It's been a pleasure chatting with you. If there anything else I can assist you with today.

 

Regards,

 

Dr. JP

 

 

Customer: replied 5 years ago.
just one more question and i'll stop bugging you Smile

any chance dry eye syndrome can go along with perimenopause??
Expert:  Dr. JP replied 5 years ago.

Absolutely, thanks for mentioning this. I'm always being educated by my patients and on this website by subscribers like yourself.

 

There is an association.

 

Please let me know in feedback later if this helps you. I wish you all the best and hope I've been helpful.

 

Regards,

 

Dr. JP

 

Dr. JP, Ophthalmology, Oculoplastic Surgery
Category: Eye
Satisfied Customers: 28
Experience: Harvard Medical School, Massachussetts Eye and Ear
Dr. JP and other Eye Specialists are ready to help you
Expert:  Dr. JP replied 5 years ago.

check out this website for information on menopause and dry eye:

 

http://www.womentowomen.com/womenshealth/dryeyes.aspx?id=1&campaignno=dryeye&adgroup=ag3menopause&keywords=menopause+dry+eye

Customer: replied 5 years ago.
thanks, XXXXX XXXXX i have bookmarked the link you posted.

hopefully i'll have good news to report back to you at some point.

sincerely
wonkus
Expert:  Dr. JP replied 5 years ago.
okay, sounds great

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Dr. JP
Dr. JP
Staff Ophthal, Fellow Oculoplastics Surg
28 Satisfied Customers
Harvard Medical School, Massachussetts Eye and Ear