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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7924
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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dry eyes - or this is what my eye doc says

Customer Question

I have dry eyes - or this is what my eye doc says. I have plugs, I use lotemax 4x a day, a variety of drops as often as I can, but still I have no relief. I sleep with a cpap machine which may contribute. I have a history of lupus but as of now, it is supposedly not active. I have recently discontinued the use of plaquenil, which I was on for about 6 years. My ANA pattern is positive for anticentromere B if that means anything to you. No other subtests values are positive. The dry eyes have been what I consider to be severe for over a month. (I've had dry eyes for many years, but never to this point.) Recently, I saw a retina specialist as a follow up to PVD surgery about 3 months ago. The surgery was successful. At my follow up visit, he thought maybe a cornea specialist could help. The cornea specialist just said "dry eyes, use steroids, drops, and let's do plugs." I am no better with any of this treatment. In fact, some of the drops make my eyes burn. I try to stick to preservative free Systane.
QUESTION: I have blurry vision almost all of the time. Lately, I have alternating blurry vision. The right eye will be blurry for a several hours, then suddenly the right eye will clear up and the left eye will be blurry. I have to keep my right eye closed most all day because of the irritation, blurriness, etc. I cannot get any relief. The alternating blurry vision is the most curious thing. There are not many minutes in the day when my vision is not blurry, and my eyes are not severly bothering me. Is there any other thing that might be causing alternating blurriness?
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

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

Dr. Rick :

The plaquenil would not be expected to contribute to these problems but, I agree with you, the cpap machine could....

Customer :

are you typing a more detailed response?

Dr. Rick :

From what you second I really think that the alternating blurriness is constant with, and caused by, your dry eyes. Since you have already tried many possible interventions for you dry eyes and are still having a lot of problems you might need to try using "moisture chambers" aka small swimming goggles. I would assume you have already used restatsis.....

Dr. Rick :

I'm a slow reader ;)

Dr. Rick :

There is a home treatment you can try if you are already not doing it. I bet you have some blepharitis.....you could try some lid scrubs and warm soaks.

Dr. Rick :

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 your 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.

Dr. Rick :

A cornea specialist is, really, the best trained individual to address your issues. If this one isn't explaining things well enough for you, or taking as active an interest in your continuing problems, I would suggest finding another one...... You know, the vitrectomy you had for your floaters may have contributed to your dry eyes.

Customer :

I'd like to explore the "alternating blurriness" more. Could there be something else to blame?

Dr. Rick :

Dry eyes, unfortunately, is a very difficult problem to treat in many patients. This being said, in the vast majority of people, the symptoms can be controlled to a tolerable, if not perfect, level.

Dr. Rick :

I suppose so, but with your history, I really would put your current external disease/dry eyes as number 1 through 10 on my differential diagnosis list. Could you have some rare and exotic condition causing your symptoms? Yes. Could you win a million dollar lottery three times in a row? Sure. But it is not likely.

Customer :

I've done the "scrub" you describe, but will try again. I have not been told that I have blepharitis. The vitrectomy was for the left eye. The severe dryness is in the right eye.

Dr. Rick :

Also, if you had one of these rare conditions I would expect the corneal specialist to notice that your physical findings do not seem to mesh with your current diagnosis and do a more extensive work up.......

Customer :

Can you explain what you mean by your last statement

Customer :

I'm probing because even after extensive treatment for dry eyes, I have no relief.

Dr. Rick :

Ok. I'm glad that the vitrectomy went well. I can understand your frustration with your right eye and I wish I could tell you that you were going down the wrong path and that a simple change in therapy will make everything better. That, however, in my opinion, is not the case.

Dr. Rick :

It is common to have extensive treatment for dry eyes and get little relief. This disease can be a real problem at times.

Dr. Rick :

I ment that if you had a rare and exotic condition, instead of dry eyes, the corneal specialist would have been able to tell the difference since there would be clues that he was not dealing with a disease process that he treats every single day......

Dr. Rick :

Does this make sense to you?

Dr. Rick :

I guess you have stepped away from your computer.

Dr. Rick :

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Expert:  Dr. Rick replied 2 years ago.
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Expert:  Dr. Rick replied 2 years ago.
Let me know if there are there any other concerns or issues you would like to discuss on this topic. Best of luck to you. Take care.
Customer: replied 2 years ago.

You said..." the vast majority of people, the symptoms can be controlled to a tolerable, if not perfect, level." Based on this statement, I was assuming I might not be in the category of the "vast majority," since this problem has not resolved despite several treatments over the last few months.

 

I had not stepped away from the computer but was considering how to respond. This is an interesting process. Actually, Dr. Rick, I suppose I gained some insight from our chat, but I'm less than satisfied. Your attempt at humor was somewhat offensive to me, though you probably didn't intend it that way. My eye problems are serious to me and this problem negatively impacts every aspect of my life. I'm only trying to get some help and further understanding.

Unfortunately I've had several unusual conditions over the course of my life; conditions which have been initially misdiagnosed by doctors. The mistakes have cost me dearly. It is reasonable that I would ask for "other" causes of my problems. I'm sure you are usually a compassionate and respectful doctor.

Customer: replied 2 years ago.
Relist: Answer quality.
Expert:  Dr. Rick replied 2 years ago.
I am sorry that my efforts at helping you have not met your expectations. Since you have had multiple, extensive, in person evaluations by physicians who are certified experts in their fields as it pertains to your conditions and they, using advanced testing, equipment, history and physical examination without being able to adequately improve your eye issues I am sure that you understand the limitations I face when "chat" is the only diagnostic tool at my disposal.

I agree that your eye issues are serious. Perhaps you should seek the advice of a University based corneal specialist/Professor.

I wish you the best of luck.
Customer: replied 2 years ago.

Yes, I understand your limitations.

Expert:  Dr. Rick replied 2 years ago.
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