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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
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Experience:  Eye Physician and Surgeon
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eyes..Also, he has pains in his head..neurologists..dry-eye

Resolved Question:

My son, who is 25 has problems actually shutting his eyes! He has to physically hold them down....and sleeps with a mask and only manages to fall asleep when hes very tired. Also, he has pains in his head..........usually a fuzzy feeling with the occasional stabbing pain..........he's seen three neurologists who didnt know what the porblem was and lastly a neuroopthomoligist who diagnosed dry-eye. But the drops he's been taking now for a week or so, hasnt really helped. Can you???
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. James replied 4 years ago.
Chat Conversation Started
Dr. James :

Hello.

Dr. James :

Please Note:
JustAnswer is a public forum. Information provided is for educational purposes & does not establish a patient-physician relationship nor substitute for a personal consultation with a physician.

Dr. James :

When did this problem start?
What other diagnosis were given by the neuro-ophthalmologist other than the dry eyes?
Has he had any CTs or MRIs?

Customer :

He had it a year ago for a few months but it went away. It has returned a month or so ago

Customer :

Yes, he had an mri and eeg but all clear

Customer :

no other diagnosis has been given

Customer :

except MEWDS

Customer :

but his recent specialist says his eyelid problems and head pains are unrelated to this

Dr. James :

To clarify, he is not able to blink his eyes?
Is he able to rase his eyebrows?
Can he close his eyelids at all?

Customer :

i think he does blink. But when he is tired or simply resting i see him physically holding his eyelids down as they wont go down on their own

Customer :

he says he can shut them but its uncomfortable

Customer :

he can raise his eyebrows yes

Dr. James :

When he closes his eyes all the way, are you able to see any parts of the eyes at all?
What other medical problems does he have?
When you look at his face, does it appear he is "staring" at your or have a "scared" look?

Customer :

he has o.c.d

Customer :

no he never appears to be staring

Dr. James :

OCD as in obsessive compulsive disorder?

Customer :

yes

Customer :

no other illnesses

Customer :

apart from the head 'pains'

Customer :

fuzzyness and stabbing pains

Customer :

oh, and when they are shut they shut properly

Dr. James :

Thank you for the additional information.

Problems with blinking of the eyes is usually due to paralysis of the facial nerves. This usually affects one side only and causes drooping of the mouth and weakness of other facial muscles. This does not appear to be the cases since he is able to raise his eyebrow adequately.

Customer :

he has said the pain seems to go kind of from all over his head including his face

Customer :

he does blink

Dr. James :

Another problem which can cause inability to close the eyes fully is due to thyroid problems. Thyroid eye disease can cause the eyelid muscles to get "tight" from scarring. This can cause retraction of the eyelids, causing a "scared" look.

Customer :

he hs had his thyroid tested and its normal

Customer :

it was tested only recently

Dr. James :

Dry eyes can cause eye pains which can sometimes lead to headaches.

Customer :

ok

Dr. James :

In most patients with dry eyes, they feel better when their eyes are closed because it lubricates the eyes.

Customer :

the drops arent really helping so we're concerned that it isnt dry eye

Customer :

does dry eye cause the pain ive described?

Dr. James :

In your son's case, blinking of his eyes may cause irritation and he may be erroneously keeping his eyes open as a way to prevent that blink induce pain.

Dr. James :

Yes, dry eyes can cause a stabbing type of pain.

Customer :

ahar

Dr. James :

What drops is he using?
How frequently is he using them?

Customer :

ok

Customer :

clinitas

Customer :

three or four times a day ... sometimes more

Dr. James :

I'd recommend he continue to use the artificial tears. You may consider switching to a preservative free artificial tear in the tear away individual vials and increasing the frequency to every hour or so.

A neuro-ophthalmologist would be best person to diagnosis a neurologic problem causing a blinking problem. It is good that he did not see an abnormality of his eyelids.

Customer :

he says blinking doesnt hurt

Dr. James :

He should continue to followup with his neuro-ophthalmologist as scheduled.

Dr. James :

Aside from the thryoid and nerve weakness, there are not many causes of inability to blink.

Dr. James :

You might consider a second opinion, but there are no other obvious reasons for this blinking problem.

Customer :

ok

Customer :

would it be ok to increase the dosage of the drops he has at the moment?

Customer :

I repeat he doesnt have a problem blinking

Dr. James :

Yes, using the artificial tears more frequently would be helpful.

Dr. James :

What exactly is the problem?

Dr. James :

You say he has a problem "shutting his eyes".

Customer :

when he is tired and wants to shut his eyes he cant

Customer :

he has to hold them down

Customer :

when he shuts his eyes or is just resting them open it is uncomfortable

Dr. James :

So, keeping his eyes closed causes pain?

Dr. James :

Hello? Are you still there?

Customer :

hello

Customer :

sorry

Dr. James :

Yes.

Customer :

ws on phone to him sorry.

Customer :

im here

Customer :

he says he hold them shut when theyre hurting

Dr. James :

Not a problem. What was his reply?

Customer :

hes not sure

Customer :

hang on ill ask him again............hes in leeds im in london

Dr. James :

When is he scheduled to see his ophthalmologist again?

Customer :

no it doesnt hurt when theyre shut

Customer :

seems they get uncomfortable when theyre open

Customer :

as if straining

Dr. James :

Yes, all those symptoms are consistent with dry eyes.

Customer :

oh

Customer :

so perhaps its just a question of finding the right drops?

Customer :

and doseage

Dr. James :

The right drops and time to allow the eyes to lubricate. Depending on the severity, it may take some time for the eyes to get comfortable. More than a week and sometimes months in severe cases.

Customer :

ok

Customer :

thanks very miuch

Customer :

much

Dr. James :

With your son's moderate symptoms, there should be findings on his exam.

Customer :

i was sooooooooooooo worried it was something else and noone seemed to know

Dr. James :

So, you may want to double check with is ophthalmologist or get a second opinion if the diagnosis is in doubt.

Customer :

yes he had a test with a yellow substance in his eyes and dry eye was diagnosed but was concerned he was wrong as the drops werent helping

Dr. James :

The drops definitely take time to work.

Customer :

oh what a relief

Customer :

thank you

Dr. James :

You're welcome.

Please remember to press the accept button so I can receive credit for assisting you.

Customer :

one more question..........i gather the drops alleviate the symptoms........is there a cure?

Dr. James :

Well, he's young to have dry eyes. There is usually an underlying cause such as medication induced dry eyes, ocular allergies, or an autoimmune disease -- such as thryoid or rheumatoid.

Dr. James :

Chronic contact lens use can do it as well.

Dr. James :

So, the "cure" would be to figure why he has dry eyes at such a young age.

Customer :

i see

Customer :

hes not on any medication......how would i find out about ocular allergies

Customer :

he gets alot of mouth ulcers

Dr. James :

Usually ocular allergies has itching type symptoms.

Customer :

he doesnt itch

Dr. James :

Mouth ulcers may or may not be related.

Customer :

should he see a rheumatoid specialist

Dr. James :

A condition called Behcets disease can have ulcers with eye symptoms.

Customer :

wow really?

Customer :

thats interesting........specifically mouth ulcers?

Dr. James :

Not necessarily a rheumatologist. A good complete exam from an internist would be sufficient.

Dr. James :

If there are abnormal findings on exam or blood work, then a referral may be helpful.

Customer :

an internist.......do you mean a GP

Dr. James :

Yes, a GP.

Dr. James :

In Behcets disease, there are characteristic mouth ulcers called aphthous ulcers.

Customer :

ok.........ill note 'behcets' and mention it to a gp

Dr. James :

http://vasculitis.med.jhu.edu/typesof/behcets.html?

Customer :

is this serious

Dr. James :

It may not be what he has, but something to consider.

Customer :

ill look it up. Again thankyou.....you'r very good!!!

Customer :

i will of course press accrept

Dr. James :

Thank you. Best wishes to your son.

Customer :

thankyou

Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience: Eye Physician and Surgeon
Dr. James and other Eye Specialists are ready to help you
Customer: replied 4 years ago.

can dtry eye be caused by inflamation of the eye? As is with symptoms of behcets

 

Expert:  Dr. James replied 4 years ago.
Usually the inflammation from Behcets is inside the eyes rather than on the ocular surface common in dry eyes. The ophthalmologist would have noted the difference. It's unlikely he has iritis or anterior uveitis commonly associated with Behcets.

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