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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
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Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Last night In the middle of the night I eperienced pain in

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Last night In the middle of the night I eperienced pain in my left eye and brow which was painful to touch and lasted about 5 minutes. Today there was no pain until about 8 PM when the same thing occurred and lasted a short time but is still tender to the touch on the left corner. The eye does not appear to be red and the vision seems normal. I have used ipratropium bromide nasal spray only about 5 times in the last 3 days which I have never used before. There is a residual aching now.
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 :

It sounds like you may be having a recurrent corneal erosion.

Dr. Rick :

Recurrent corneal erosion is a condition where, usually after some type of trauma, the epithelial layer of the cornea ("skin") no longer attaches to the underlying tissue (bowman's layer) and keeps coming loose. Think it as a piece of Velcro, with the epithelium and bowman's layer as the two strips. In recurrent corneal erosion syndrome the little "hooks" in the Velcro are broken. RCES can also be seen as a secondary result of another disorder, such as map dot fingerprint disease.


 


Drops and ointment are the first line of treatment. The next step is the use of a bandage contact lens at night along with the natural tears. This helps to prevent the epithelium from sticking to the inside of the eyelid, although just taking out the contact can cause an erosion. The next step in treatment is anterior stromal puncture. This is where the ophthalmologist uses a bent 25 gage needle and makes little punctures in the cornea. This is thought to help by allowing the hemidesmosomes (Velcro hooks) to attach better. I would not recommend this is the erosion is in the center of the visual axis as it can leave a small scar.


The next step in treatment is phototherapeutic keratectomy with a laser (PTK). This is the same laser used in Lasik, but used in a different way. In PTK the epithelium is removed from the cornea and the laser is used to remove part of the cells in the corneal stroma. It is thought to work by stimulating the natural regrowth of cells such that these new cells can better attach to the epithelium and prevent RCES.


 

Dr. Rick :

You should get some bland eye ointment such as refresh PM or lacrilibe ointment and, just before going to be tonight, goop up your left eye. During the day you should use artificial tears at least every 2 hours ( and more if you can) to keep your eye very moist. I suggest that you continue this therapy for at least 4 weeks.

Dr. Rick :

If you have another event with the above treatment, if things should get worse or your vision become affected you should be seen by an ophthalmologist.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

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


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Dr. Rick :

I see that you are offline. I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)


 

Expert:  Dr. Rick replied 2 years ago.
Let me know if there is anything else you would like to discuss pertaining to this issue.
Customer: replied 2 years ago.
I do not believe it is a corneal abrasion. It is more internal
Expert:  Dr. Rick replied 2 years ago.
Can you tell me more about what the pain in your eye feels like? Does it change if you blink, move your eye, read, be exposed to bright light (like sunlight) etc? Any nausea?
Customer: replied 2 years ago.
Not bothered by light, doesn't hurt to read, no nausea. If I squeeze the eye shut during and after the initial pain, it feels like there is an ache in and around the eyeball.
Expert:  Dr. Rick replied 2 years ago.
Since it lasts for such as short period of time and your eye otherwise looks normal to you and there is no change in your vision I think I would have to put recurrent corneal erosion close to the top of my differential diagnosis list. It is entirely possible for it to feel like an ache-like pain.

That being said it could also be some inflammation inside your eye, maybe some foreign body up under your lid, like a piece of lint etc, or even a sinus issue.

Since the list of possible causes is so large and branching it might be best if you get a complete eye exam by an ophthalmologist, although I do not think it is an emergency at this point.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and 2 other Eye Specialists are ready to help you
Customer: replied 2 years ago.
I will make an appointment with my ophthalmologoist tomorrow. Thanks
Expert:  Dr. Rick replied 2 years ago.
my pleasure. Have a good evening.

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Dr. Rick
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Ophthalmology since 1994 with Retina sub-specialty interest