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Ask Dr. Dan B. Your Own Question

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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quick pain and quick spasm in outer corner of right eye and

Resolved Question:

quick pain and quick spasm in outer corner of right eye and eye aches. No vision problems.
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 3 years ago.

Doctor DanB :

Hello and thanks for your question. Are you available to chat?

Customer:

Yes

Doctor DanB :

Has that eye been red, light sensitive, have a foreign-body sensation, burning, itchy, or teary?

Customer:

no

Doctor DanB :

What was the CAT scan of the sinuses for?

Customer:

see if the pain was a sinus condition

Doctor DanB :

Can you describe the type of quick pain / spasm you are having, in addition to the eye ache? Is it sharp, stabbing, electrical, burning, pressure or foreign-body sensation type of pain?

Customer:

sharp/stabbing---then later light pressure---the pain comes every few months since last October

Doctor DanB :

In that CT of the sinus did they include a CT of the brain?

Customer:

there was no mention of the brain

Doctor DanB :

You're not having any other neurological symptoms such as dizziness, weakness/numbness, difficulty walking, talking or hearing are you?

Customer:

none

Doctor DanB :

Any headaches besides the pain you're having?

Customer:

yes-mild,but not often- like a wreath around my head and my head feels sort of tired.

Doctor DanB :

Just one more question; please tell me about the regimen of tear drops you used/using. How many times per day, how many days consistently did you use the tears and what kind of tears?

Customer:

Restasia[ twice a day-no help] then Soothe xp,not regularly because I experienced no help and then GenTeal, 2 times a day-no help with the ache from any of these. The ache is dull but tiring at times

Doctor DanB :

For how long (how many days) did you do the Restasis and then how long (how many days) did you do the GenTeal?

Customer:

Restasis one month, Feb/March-- GenTeal on and of since April.

Doctor DanB :

The most common causes for this intermittent, sharp, stabbing pain is a dry, irritated eye. Because it’s the most common, please let me elaborate just a bit on this before I touch on the other suspect I have for your symptoms, which may be more likely causing your problems than dry eye. Dry eyes can also produce symptoms of burning, tearing, foreign-body sensations and general dry sensations, but don’t have to cause any other symptoms besides the intermittent, sharp, stabbing pain you’re having. Patients who have had surgery on their eyes can have dry eyes because of that. Women who are post-menopausal are more likely to get dry eyes. Some people have dry eyes because they don't make enough tears. Some have dry eyes because of inflammation in their eyelids and some because of allergies. There can be many causes of dry eye, just in one person alone, and if all the causes are not treated appropriately, then it can seem as though what you have been doing is not working and therefore it’s easy to give up on.


 


The first thing to dry with dry eyes is to use artificial tears, as you’ve done. However, your regimen may not have been what I would recommend for the strongest efficacy. I recommend to my patients that they start by using them 4 times per day in each eye. The important thing is to use them consistently, in a scheduled fashion for 3-4 weeks before cutting down on them. If artificial tears are used for dry eyes only when you feel like you need them, then they usually only work for thirty seconds or so and don't help the overall hydration of the eyes.


 


It sounds like, though, that you have already done a few of the things I would recommend for dry eyes and not had much success; while there may be other causes of dry eye that aren’t being treated, I can’t examine you so it’s difficult to consider those here. To that end, there are other things to consider that maybe causing these symptoms.


 


An entity called Trigeminal Neuralgia (TN) is a disorder where the trigeminal nerve, the nerve that supplies sensation to the face and to the eyes, becomes irritated, usually from where the nerve exits the brain. This is happening inside the head, but affects your face and eyes. It can happen for no apparent reason, or due to brain stem lesions. It can produce this sharp, electrical stabbing pain that you speak of, but usually causes more facial pain than eye pain. Unfortunately there is not always a cure for trigeminal neuralgia, but sometimes a reason for having it can be found and eliminated by surgery or medical therapy. Sometimes amitriptyline is prescribed for trigeminal neuralgia. Another medicine that can be taken for this include Neurontin.

Customer:

Then am I hearing to use the tears 4times a day regularly and not to worry unless the pain worsens or travels to the face?

Doctor DanB :

I think that is a good start. Because dry eye is so common I highly suspect it, but I'm not ready to rule out something like Trigeminal Neuralgia yet. If you are using artificial tears 4x/day consistently every day for a month and have no change in your symptoms, then I would suggest seeking out a corneal specialist (an ophthalmologist like I am except they have sub-specialty training in the cornea which is where dry eye affects mostly) to have a thorough dry eye evaluation. If this turns up negative or not to be the problem after having seen a corneal specialist, then I think it would be good to see the neurologist to see if you have this trigeminal neuralgia. Does that make sense?

Customer:

yes- any special type of neurologist?

Doctor DanB :

No, I think a general neurologist is fine to see.

Customer:

Thank you, XXXXX XXXXX feel more secure about the use of tears since you gave me further vital information. Sometimes old people are dismissed too readily, as if we are all mentally incompacitated.

Doctor DanB :

You're welcome. It's a sad statement, but unfortunately, I think your observation is correct way too many times. I hope this has been useful and I hope you end up feeling better.


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 regarding this topic 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 trusting me to help you with your concerns!


 


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.

Customer:

I will. God blesses you.

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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