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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3174
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Hello, I have had type 1 Diabetes for 43 years and have

Resolved Question:

Hello,

I have had type 1 Diabetes for 43 years and have had very few problems. Now in the last year, my vision is blurry and more importantly I have this acute sensitivity to light. It happens every day. It has been a year since I last saw my ophthalmologist, but was wondering if the light issue is diabetic related, or something else.

Thank you!
Lisa
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 3 years ago.
Hello and thanks for your question. Please allow me to ask you a few questions so I can get a better idea of the problem?

Is this light-sensitivity specific to one type or lighting environment such as oncoming headlights at night or fluorescent lighting or is it just a general light sensitivity?

Do your eyes get red and achy? How about foreign-body sensation, burning, itching, tearing, or nattering/crusting of your eyelashes in the morning?
Customer: replied 3 years ago.
Hello,

My eyes have always been a little red, but not achy and no burning or itching. I do have a lot of tearing - it is daily and mostly in the morning for a couple of hours. The light sensitivity is usually in the morning around 10 - noon, in bright light or even in bright fluorescent lights. I almost can't open my eyes, but no headache.
Expert:  Dr. Dan B. replied 3 years ago.

How is your vision? Any difficulty reading or seeing small objects up close or small things in the distance such as street signs or the ticker-tape on the bottom of the TV screen? Has the vision changed at all since you've become more light-sensitive?

 

Customer: replied 3 years ago.
Yes, I have been very fortunate for the last 42 years but now have vision problems. My ophthalmologist told me that it was just a result of getting older, so I have prescription glasses for minimal - 125 - reading, and minimal help in long distance. My blood sugar has always been controlled, so I keep hearing that the amount of years with no problems is fantastic, but isn't it almost inevitable that I will have retinopathy or something else related to diabetes? If not great, but...
Expert:  Dr. Dan B. replied 3 years ago.

Well, it is true that if you have diabetes long enough that you eventually will have some degree of retinopathy; however, for those who keep their diabetes under control (keeping their hemoglobin A1C under 7.0 consistently), the baseline level of retinopathy you may get after 30-40 years usually does not cause problems with the vision.

 

It sounds as though you have small glasses prescription for distance vision and that when you wear those and when you wear your near vision correction you see well? Is the blurry vision only when you're not wearing these glasses?

Customer: replied 3 years ago.
Correct.
Expert:  Dr. Dan B. replied 3 years ago.
As we age our eyes change shape and it is this change that necessitates a change or new prescription, at least as far as distance vision is concerned; so as long as you are able to see well in the distance with your glasses on, then this is normal. Also, your need for glasses to see well at near is also, unfortunately normal. The strength of glasses needed to keep your near vision sharp will increase about every 5 years until age 65.

As far as your light sensitivity I think it is related to inflammation on the surface of the eye that causes a dry eye syndrome. There can be many reasons for an eye to be red and irritated. This can range from a viral conjunctivitis (usually follows an upper respiratory infection or exposure to someone with a cold or red eye) and can cause irritation, mattering, tearing, burning or sensitivity to light and these symptoms usually then spread to the other eye. Allergic conjunctivitis is usually distinguished by significant itching, but this can be associated with redness and irritation. 
 
 I highly suspect that you have dry eyes with inflammation. If there is tearing associated with this, it is difficult to understand why the eyes may be dry when they tear: the tearing is a reflex in response to dry eyes that is not sufficient to hydrate the eyes as they need to.   
When there is inflammation in the eyes and/or eyelids, this is usually from what's called blepharitis, which is inflammation of the eyelids and glands in the eyelids. The eyelids are key players in making a layer of tears that coats the surface of your eyes called a tear film. The inflammation that is blepharitis keeps the eyelids from making that tear film as healthy as it needs to be and so the eyes dry out. Also because there is inflammation in the tears because of the blepharitis, there are bacteria pooling in your tear film. Often times an antibiotic +/- steroid drop or ointment is used to help kill the bacteria. This therapy is usually only used in a pulse fashion, to start out the treatment and then only used when there are flare-ups, not on a regular basis for most people. However, treating this with a steroid drop for a few days is not enough to treat this entire problem, it is usually just an adjunctive measure combined with the baseline treatment as I state below.
 
The baseline treatment for blepharitis and what I think you should start doing, is everyday in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations (Sterilid or Ocusoft) or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water): you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done.
 
It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working; often times combining this with the topical steroid helps to bring relief sooner. Also the eyes are still significantly dry during this 3-4 weeks so use artificial tears one drop in each eye, 4x/day. After 4 weeks you should be able to start tapering off of the tears to as you need them.

In addition, don't use tears that say get-the-red-out or redness reliever on the package. The use of these kinds of tears will actually worsen a red eye if used for more than 1-2 days and then the eyes can stat red from this for up to several weeks after they are stopped. 
 
Just doing the artificial tears, hot compresses and eyelid scrubs alone would likely start to help you after three or 4 weeks--but remember it could take this long of doing it everyday before you see a significant effect, so don't stop it thinking it's not working. Also you may need an antibiotic/steroid combination medicine to help augment the therapy. If after 3 weeks of diligent treatment you are better, but not completely normal, you may need to see your eye doctor to assess for other causes of dry eyes, as blepharitis is only one cause of dry eye. Many times dry eye patients have more than one cause of dry eyes (Restasis is an excellent treatment for those people with dry eyes because they don't make enough of their own tears). Each cause of dry eyes needs to be appropriately treated for your symptoms to resolve.

If, after 2-3 weeks of doing this you see no improvement in your symptoms then I would suggest seeing your eye doctor as there may be inflammation that needs a steroid or antibiotic treatment to resolve.

Does this information help address your concerns? Does this make sense? Do you have any other concerns that I haven't addressed?
 
I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need.
 
If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter; this allows part of the funds that you have deposited to the website to be released for my efforts to assist you. This does not end our conversation, however-we can continue to discuss any of your concerns without further charges until you are satisfied.
 
Any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. Thanks for your inquiry!

My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3174
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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