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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3207
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Hi. 36 y/o male with eye issues since July. Been evaluated

Resolved Question:

Hi. 36 y/o male with eye issues since July. Been evaluated by three O.D's. Had pupils dilated and examined all three times. Everybody says my eyes look great and healthy. But they obviously aren't as I have burning eyes, severe glare, halos around lights and feel like a vampire in the daytime. One of them did the flureicin(spellling?) stain test and said my TBUT is not good. They think a "refractive error" due to dry eye is causing my symptoms. One of them also believes i have lid closure issues... That's the only explanation they give me and it sounds like baloney. I wake up in the morning and my left eye is so cloudy it takes 5 minutes to clear it by blinking and adding drops. I cant believe there is no erosion there or something not visible under the slit lamp.Could they be missing something so obvious?
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:

sure

Doctor DanB :

Do you wear contact lenses? Have you ever had any type of eye trauma before? Do you have any medical problems?

Customer:

no, and no. Just high bp that is controlled by atenolol

Doctor DanB :

Do you wake up in the morning with your eyes burning, itchy, irritated, and/or with mattering / caking of your eyelashes?

Customer:

This started in july with blurry vision in am. Not burning yet, that came months late. Doc suspects lagophatmolis(spelling) i wear tranquileyes now to help with the dryness and keep lids closed

Doctor DanB :

Let me be the first to say that when you are dealing with a medical problem of the eyes, an ophthalmologist is the doctor you should be seeing. While there are many knowledgeable and experienced optometrists, they don't have the training or experience by and large to deal with the medical problems of the eye as so many patients, like yourself need.

Doctor DanB :

So yes, they could be missing something. But I do suspect that they are right about your TBUT because your symptoms are classic and go hand in hand with a person who has tear-film problems, which the TBUT represents. The most common reason for the eyes to be causing these symptoms is due to a dysfunctional tear film syndrome. A dysfunctional tear film can be due to many different factors. Different medicines such as psychiatric medicines, antihistamines, cold medicines and others can contribute to a dysfunctional tear film Allergies in the eyes can also contribute (and or make worse). Some people have an innate deficiency in making their own tears (these people may also have other dry mucus membranes, such as their mouth, nasal passages, or genitalia). Many people have an inflammation in the eyelids called blepharitis which causes the tear film that is supposed to coat the front of the eye to not function as well, and then the eyes dry out. People with blepharitis can have morning tearing, burning, and often eyelash mattering. Their symptoms get better as the day progresses, but then they get intermittent blurring when they use their eyes heavily in activities such as reading, watching TV, computer use or driving.

I suspect you have blepharitis and because the treatment for it is relatively benign, you might consider starting this treatment, while concurrently using artificial tears. In order to treat blepharitis, 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 or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are called Ocusoft or Sterilid which 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. Also the eyes are still significantly dry during this 3-4 weeks so I would recommend using artificial tears 4x/day in both eyes (one drop per application). After 4 weeks you should be able to start tapering off of the tears to as you need them.

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.

If you are a person that doesn't make their own tears very well, then you may also benefit from a prescription drop called Restasis, which actually modulates a person's immune system to help them make more of their own tears. This drop actually requires constant usage on a daily basis for up to 10-12 weeks before its effect kicks in (takes awhile to change the immune response in the body).

Because there are numerous reasons for dry eye, if not all the reasons that exist in one patient are treated, it can seem as though the ones that are being treated are providing no benefit. If you've tried these recommendations and still don't feel better then you should consider seeing a corneal specialist for a dry eye evaluation.

Doctor DanB :

Does that make sense?

Customer:

Yes makes sense and I've already started the lid hygiene, even trying to figure out hwo to do expressions on my own. Is any opthamologist a corneal specialist or do they have a specifiic title? I'm a veteran who normally uses VA med service, but could not get past the O.D first to see a Opthomolgist because she said my eyes were fine, so I'm gonna be paying out of pocket for the corneal specialist. It's my eyes and you only get one pair, so I'll do what I have to do. I'm just wondering if it's possible for a person to have like corneal erosions and for O.D's to miss them on slit lamp? Several O.Ds?

Doctor DanB :

No, a corneal specialist is an ophthalmologist that has sub-specialty training in diseases of the cornea and external eye, exactly where your problems lie, I suspect. Corneal erosions can be a tricky thing because they can happen quickly (first thing in the morning) and if you're not in the doctor's microscope in an hour or so, they can heal quickly and not be seen. So yes, they could be missed, but it's not the first thing I suspect with you.

Doctor DanB :

Do you have any other concerns about this topic that I haven't addressed?

Customer:

No, I'll find a good corneal specialist and stop seeing the O.D.s as it seems to be a waste of time with them. thank you.

Doctor DanB :

You're welcome. I think that's a good plan. 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.

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3207
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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