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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 10553
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

can you tell me a little bit more about the pain and the swelling? Does it affect your vision? What part of your eye swells? The lids, around the orbit etc? What medical problems do you have and what medicines do you take? What makes the swelling go away?

Customer :

The pain feels like i have glass in my eye. I cannot open my eye it is too painful. The swelling is on the top lid and under the eye. Not on medication.I just have to lie still and rest. Next day its gone but eye still abit puffy.

Dr. Rick :

It sounds like you have a couple of things going on. First is allergies, second dry eyes and third blepharitis.


When it comes to allergies it is almost impossible to pin down the offending agent(s) and, therefore, treatment needs to focus on controlling the symptoms. Dry eyes is very common and can be improved by a stepwise series of therapies. First, the use of natural tears 4-6+ times/day to augment your natural tear production, then temporary punctal occlusion of the lower puncta, then temporary occlusion of all 4 puncta then surgical ( non-reversible) closure of the puncta.


Blepharitis is a condition where glands in the eyelids are not functioning normally. They become plugged and instead of putting out their normal clear, oily secretions, they put out thick, toothpaste like gunk.


The best treatment for this condition daily lid scrubs combined with warm compresses. I like to use baby shampoo for lid scrubs. In the shower, place the shampoo on your index fingers, close your eyes, raise your eyebrows (to stretch the skin on you eyelids) and scrub back and forth along your eyelashes for 3 to 5 minutes. The hot water in the shower helps to soften the plugged oils in the glands while the mechanical scrubbing with your soapy fingers removes the oils.


Baby shampoo lid scrubs will also help to wash away allergens and stimulate tear production, thereby addressing all three of your issues. Remember, this is not an instant fix. While you are waiting for the lid scrubs to have affect you can use over the counter allergy pills such as Travist, dimetapp or Zyrtec.


Should your symptoms get worse, your vision become significantly affected or things just not get better in 3 weeks or so you should have a complete eye examination by your local ophthalmologist to look for other, less common, causes of your symptoms.

Dr. Rick :

these things, of course, can be made worse with drinking......

Dr. Rick :

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Customer: replied 5 years ago.
Yes i gave you an answer. I stated that i had tried what you said in the past but to no avail. It does not happen all the time when i have had a drink but somehow it seems related. The pain is excruciating and cannot touch my eye. It waters alot and also my nose runs the side to which eye is affected. 24 hours later it is gone.
Thanks for the additional information. What you are describing now sounds like recurrent corneal erosions.

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.

I know you already paid me for my last answer but don't worry about paying again as this is sorta along the same issue we discussed before.

You might want to have another complete eye exam by an ophthalmologist in the near future.

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