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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8468
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I woke one day and my right eye hurt like crazy and I could

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I woke one day and my right eye hurt like crazy and I could not keep it open. Went to emergency room and they said I had conjuntivitis. I had no discoloration or discharge just lots of tears and could not keep my eye open. Took antibacterial ointment for 5 painful days and the pain just stopped as quickly as it came and I could open my eye again. Went to opthamologist to be certain and he gave me antibacterial drops to take. Saw him 3 times within 2 weeks. All seemed fine but a couple days later my eye started watering and has been doing so the past 5 days. Not alot but it keeps doing it. Any suggestions other than going back to the opthamologist?
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. Rick replied 4 years ago.

Dr. Rick :

Hi. I can help you today.

Dr. Rick :

Are you available to chat?

Customer:

Yes I am

Dr. Rick :

Ok. Do you wear contacts? Have you ever had any type of eye trauma, such as being poked in the eye, even with a fingernail etc?

Customer:

Never injured but I had bell's palsy 5 and 1/2 years ago.

Customer:

I don't wear contacts

Dr. Rick :

I don't think the bells palsy is an issue here.

Customer:

That's good ...I guess

Dr. Rick :

Since you were examined by an ophthalmologist, did she say that anything was abnormal on exam? Why the antibiotic drops?

Customer:

Guess I had conjuntivitis ... that's what they said...nothing abnormal ...

Dr. Rick :

ok. It sounds like you are suffering from recurrent corneal erosion syndrome (RCES). In this condition you can have the episodes of pain you are talking about and yet, even a hour later, a normal eye exam at the ophthalmologists. An ER doctor will almost always miss this one.....

Dr. Rick :

Recurrent corneal erosion is a condition where, usually after some type of trauma, the epithelial layer of the cornea ("skin") no longer attaches to the underlying tissue (bowman's layer) and keeps coming loose. Think it as a piece of Velcro, with the epithelium and bowman's layer as the two strips. In recurrent corneal erosion syndrome the little "hooks" in the Velcro are broken. RCES can also be seen as a secondary result of another disorder, such as map dot fingerprint disease.


 


Drops and ointment are the first line of treatment. The next step is the use of a bandage contact lens at night along with the natural tears. This helps to prevent the epithelium from sticking to the inside of the eyelid, although just taking out the contact can cause an erosion. The next step in treatment is anterior stromal puncture. This is where the ophthalmologist uses a bent 25 gage needle and makes little punctures in the cornea. This is thought to help by allowing the hemidesmosomes (Velcro hooks) to attach better. I would not recommend this is the erosion is in the center of the visual axis as it can leave a small scar.


The next step in treatment is phototherapeutic keratectomy with a laser (PTK). This is the same laser used in Lasik, but used in a different way. In PTK the epithelium is removed from the cornea and the laser is used to remove part of the cells in the corneal stroma. It is thought to work by stimulating the natural regrowth of cells such that these new cells can better attach to the epithelium and prevent RCES.

Customer:

Sounds serious Sometimes the outside corner of my eye feels ..I don't know .but dry or there is an eyelash or something in it

Dr. Rick :

That feeling would be very possible with RCES. Any foreign body, eyelash, etc present should have been picked up by the eye doc on exam. How does you right eye feel now?

Dr. Rick :

RCES is not really serious in that it almost never leads to corneal scaring or loss of vision. It's is serious because it hurts a whole lot.....

Dr. Rick :

and it can be hard to diagnose if you don't include the possibility of RCES in your differential diagnosis thought process.....

Customer:

Wouldn't the opthamologist have picked this up with the 3 exams he gave me? It doesen't water alot just has extra moisture I can feel no tears running just real wet ..little itchy on the outside corner of my eye

Dr. Rick :

is there pain involved now and in the majority of the episodes or do you just have a little extra bit of tears pooling inside your eyelid with no discomfort associated with them?

Customer:

No pain and yes just a little extra tears

Dr. Rick :

It is easy to miss this diagnosis during a very busy day in the clinic. "Normal exam, little bit of tears, little bit or red, I'm 5 patients behind, here try some sample antibiotic drops. See 'ya later"

Dr. Rick :

That does change things a bit. RCES is, in the vast majority of times, painful.

Customer:

Sounds familiar... lol

Dr. Rick :

You could have a number of things then.....dry eyes, punctal (tear drain) occlusion, allergies.....long list.

Customer:

Any suggestions on what to start with?

Dr. Rick :

Ya, I'm guilty of statements like that on some days :o)

Dr. Rick :

Dry eyes are actually "wet" because the irritation causes reflex tearing, not your normal soothing tears......for this I would try natural tears 4-6x/day, even if your eye feels OK, and, perhaps, some lacrilube ointment at bedtime. Give it a few days and see how things feel.

Customer:

I appreciate your help.. I won't take up anymore of your time.. I will try what you suggested..se ya later Thanks

Dr. Rick :

It not better, perhaps go back to the ophthalmologist and say. "Hi doc, I was just thinking, do I seem to have punctal occlusion or do my eyes look dry? What 'cha think about recurrent corneal erosion?" If he picks out any of these, as to split the cost of the office visit with him! lol

Dr. Rick :

ok

Dr. Rick :

I hope that this information was helpful for you. Please, allow me get credit for my time and effort in assisting you and press the ACCEPT button for this assist. I will be glad to answer additional questions until you are satisfied. Thank you very much.

Positive Feedback and/or Bonus is welcomed and appreciated.


 

Dr. Rick :

hope you feel better soon.

Customer:

I will do just that thanks again

Dr. Rick :

bye



Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8468
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Dr. Rick
Dr. Rick
Ophthalmologist & Retina Specialist
5435 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest