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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7761
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Since your last comment, collected some more detailed notes

Resolved Question:

Since your last comment, collected some more detailed notes as things progressed over the winter.


A few visits to the eye specialists early on pointed towards some sort of conjunctivitis or Blepharitis. The treatment was Azasite at first, with an Erythromycin mixed in petrolatum later on.

The nature of the discomfort at the time was more in the eye, feeling like a dry eye sensation, with at times outright pain. The sensation was not completely symmetrical, seeming a bit worse in the left than the right. No particulate irritant was ever found. The Azasite seemed to resolve that irritation.

We had begun a significant interior renovation project at about the time when I began to experience difficulties, so I was not too surprised that I might suffer some adverse effects from all of the construction dust and chemicals.

However, since that early original discomfort subsided, I have continued experiencing a different eye-related irritation. This irritation is almost 100% bilateral. It generally subsides to some degree overnight and feels pretty good in the morning for about and hour or so. Then, throughout the day it gets worse until about 10 pm, when the irritation often requires my closing the eyes and giving up on anything requiring visual activity.

For a time I attributed this irritation to cold dry air I felt when I was outside, so I tried wearing closed-in downhill ski masks when I was outdoors to see if this helped, and, to a limited degree, it seemed to help.

The strongest part of the sensation is at the medial tear duct area and it FEELS like the irritation is more focused on the canaliculus (I hope I am using the term correctly – the roundish thingy at the medial vertex of the eyelid.).

I also experience some significant sensitivity to bright light, sensitivity that often requires that I wear a second pair of sunglasses over my prescription sunglasses.

I have one treatment that offers a little relief. Several times a day, I wash my eyelids with OCuSoft. Then I apply GenTeal to only the outer surface of the eyelids. While I am doing this, the skin of the eyelid feels sensitive, almost like a mild sunburn would feel. The positive impact is sometimes very good, lasting several hours. Other times, like this past weekend, the positive effect is almost imperceptible.

I always wash my hands before I touch any part of my eyes. I no longer use anything to wipe my eyes after they have been wet except for clean dry paper towels or Kleenex. I do not dry my eyes with anything that has previously been wet.

I am not able to dispense eye drops into my eyes without touching the eyes occasionally with the dispenser, as explained below. Thus there is always the chance that I may subject myself to the possibility of infections when I infuse eye medications by the dropper method.

There does not appear to be any correlation with my location, such as being at work, at home etc. Even over the weekend, when I was at my mother’s home in Iowa, the feeling was the same. Thus I have more or less ruled out any localized chemical sensitivity issues.

I seem to see well enough. Some days all feels fairly good, though never “normal”.

I have tried Claritin with absolutely zero impact, positive or negative. This is not unexpected since I have no history of allergies. However, a friend suggested that I might try it since people can develop allergies later in life. It would seem that an allergic response is not my issue.

The only thing I have found in my recent history that may indicate any trigger of this irritation is that I probably did not apply the Azasite properly. I was not instructed that there was any particular method of application until I looked on line to see why the first prescription did not seem to work out very well (I ran out of it in two days or so rather than the 2 weeks it was supposed to last). Among other things, I found that caution must be taken to avoid getting the medication into the tear ducts, a precaution I did NOT take at first. I do not know the possible adverse impact of this but that is what took place. I am quite certain that a LOT of it went down the tear ducts as I am no longer stable enough in my hands to apply this properly even after I learned the proper method. My hands simply shake too much. This shake is not a cause for concern for me as this has been present for a long time with only a very slow progression. The shaking only requires that I use two-point support of my hands when I solder parts or perform similar intricate tasks. It is not a source of worry or concern for me – I simply attribute that to normal aging. However, the eye irritation is becoming very much a concern.

Then I began to read what I could find about the impact of this mis-application of the medication on my part and found an infection called Periorbital Cellulitis. The symptoms of this malady seem to fit s
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.

Dr. Rick :

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

Customer:

I sent a description of the way I am feeling. I am to the point of going to Rochester Mayo. I thought I'd give this portal another try with the added information I provided in my introduction letter.

Dr. Rick :

I see you ran out of room when you got to preseptal cellulitis. I'd not worry about that condition if I were you.

Dr. Rick :

I'd give baby shampoo lid scrubs a try.

Dr. Rick :

The treatment for this condition, however, is not antibiotics but rather cleaning the eyelids with baby shampoo. Buy some unscented baby shampoo and, in the shower, put the shampoo on your index fingers. Close your eyes, and raise your eyelids (to get skin out of the way) and scrub back and forth along your EYELASH margin. This is where the gland openings are located. The warm water will soften the gunk in the plugged glands, the friction and pressure of your fingers will massage the glands, forcing the gunk out and the shampoo will wash it away. You can also use warm compress to the affected lids during the day as your schedule allows.


 

Dr. Rick :

Do this in addition to what Dr. James has you doing. If things are not improved in 3 to 4 weeks I agree -- a trip to Rochester Mn could very well be fruitful.

Dr. Rick :

Are you there? My board shows you are in the chat room.....

Dr. Rick :

Does this make sense to you?

Dr. Rick :

I guess you have stepped away from your computer.

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)


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Expert:  Dr. Rick replied 3 years ago.
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Expert:  Dr. Rick replied 3 years ago.
Let me know if there is anything else you would like to discuss pertaining to this issue.
Customer: replied 3 years ago.

I did need to step away. I am at work.

 

DO I then substitute the baby shampoo for the OcuSoft?

 

Now that I have thought about the instructions you gave for the eyelid cleaning, I think I have it. At first, "closing my eyes, then lifting my eyelid" seemed both contradictory and painful. However, I assume you mean that I hold my eye closed while tugging at the eyelash to peel the margin into position for cleaning.

Expert:  Dr. Rick replied 3 years ago.
yes, I believe that you do a much better job with the baby shampoo on your fingers in the shower then you do with the ocusoft.

It still would be good to use the ocusoft at work etc for extra cleaning.....

Then, if you are still having problems I fully agree -- head to Minnesota this June to see if the team at Mayo can help to solve your suffering.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7761
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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