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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7963
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My right eye seems to have a film over it and it waters alot.

Customer Question

My right eye seems to have a film over it and it waters alot. I'm 65 and in very good health and have never had any eye issues before..
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 :

Do they itch, burn or seem to have any mattering?

Customer:

no

Dr. Rick :

Have you ever been told you might have something called ocular rosacea?

Dr. Rick :

Hi. Are you still there?

Dr. Rick :

I guess you have stepped away from your computer.

Dr. Rick :

It sounds like you are suffering from an anterior segment/tear film issue. Many times, as we get older, and especially after eye surgery, the anterior surface of the eye starts to have difficulties. What can cause this? Well, there are a number of conditions but the most common are dry eyes, allergies and blepharitis....many times all three conditions act together to make you miserable. In order to solve your problem you need to address all of these issues at the same time.


 


 

Dr. Rick :

When it comes to allergies it is almost impossible to pin down the offending agent(s) and, therefore, treatment needs to focus on controlling the symptoms. Dry eyes are very common and can be improved by a stepwise series of therapies. First, the use of natural tears 4-6+ times/day to augment your natural tear production, if this doesn’t work then you can try temporary punctal occlusion of the lower puncta, then, if needed, temporary occlusion of all 4 puncta then, if indicated, surgical ( non-reversible) closure of the puncta. The openings to your tear drainage system are called puncta and you have one opening on each lid, near your nose.


 


Blepharitis is a condition where glands in the eyelids are not functioning normally. They become plugged and instead of putting out their normal clear, oily secretions, they put out thick, toothpaste like gunk. You may not be able to see this “gunk” yourself, unless it is really bad, but it shows up clearly on slit lamp examination.


 


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, thereby addressing all three of your issues. Remember, this is not an instant fix. While you are waiting for the lid scrubs to have affect you can use over the counter allergy pills such as Travist, dimetapp or Zyrtec.


 


Should your symptoms get worse, your vision become significantly affected or things just not get better in 3 weeks or so you should have a complete eye examination by your local ophthalmologist to look for other, less common, causes of your symptoms.


 

Customer:

I have not heard that. I have tried steroid dropps and warm compresses and now restatius and doxacycline (low doses)

Dr. Rick :

It seems that you are already getting some treatment for dry eyes (restatis), ocular inflammation/allergies (steroid drops) and blepharitis/rosacea (doxy). I think that the above may go along way toward making you symptom free, especially when combined with your current thearapy.

Dr. Rick :

I think you are kinda hitting one thing at a time....let's try to hit them all at once and see if you can start to feel better....

Customer:

the flim over the right eye has been there for at least 2 yrs. The left eye is fine... The light bothers me and the watering is a problem. It is hard to read.

Dr. Rick :

Has your ophthalmologist mentioned anything about problems with your eyelid function or position in the right eye or any problem with the tear drainage system?

Dr. Rick :

It is important to closely evaluate your eye for any problems in this area before starting on medicine or topical therapy.....

Dr. Rick :

Also, I suggest using 100 mg of doxycycline/day for at least 30 days and then, if things improve, trying to go to a low dose, such as 40 mg/day.

Customer:

she thinks they are swollen or inlarged. I don't see it or feel it. She put me on 20mg. of the doxycycline 2x's a day for 30days and said she read about the low does working just as well and a high dose.

Dr. Rick :

Is she an ophthalmologist (MD/Surgeon) or an optometrist?

Customer:

optometrist, but i have been to 3 ophtalmologist and gotten different answers

Dr. Rick :

I know that in many States Optometrists are allowed to prescribe oral medication, treat glaucoma and many other things. In my opinion, I do not believe that they have the training to safely do this......that being said, I don't have a problem with using low dose doxycycline to try and treat rosacea. I would, however, give it as one 40 mg dose in the morning on an empty stomach.

Dr. Rick :

While I can understand your frustration at being evaluated by 3 different ophthalmologists and now an optometrist....all giving separate and different advise that is not working I think you should try the home therapy I've discussed (OH NO!! A fourth, and different opinion lol!)

Dr. Rick :

and if it doesn't work, then go see a cornea/external disease specialist. They are the super-experts on your issues.

Dr. Rick :

Does that make sense?

Dr. Rick :

Actually, Dr Susan, on this JustAnswer site, is a Fellowship trained Cornea expert.....you might try requesting her in 3 weeks or so if thing don't work out....that is if you would rather chat with her then see a cornea expert in person.

Customer:

yes. I saw a cornea specialist and he wanted to operate and replace the cornea . He thinks it is Fuch's dystrophy. He scared me to death...The next dr. said he saw the fuch, but did not think it was bad and would probably be that way for a few yrs before it got worse..

Dr. Rick :

Ok. that is an entirely different beast. Your tearing may be due to corneal decompensation/bullous keratopathy.

Dr. Rick :

The medical management of that condition is completely different from what you are doing.....and is way beyond the ability/training of an optometrist to deal with.

Dr. Rick :

Fuchs will, in time, get worse. Decompensation can be sped up with eye surgery (cataract removal etc) and other ocular issues. It does tend to respond very well to surgery, either a full thickness corneal transplant (PK) or replacement of the endothelial cells (DSEK). If you are unable to do the things you like to do --such as read-- then it may be time for you to meet again with a cornea specialist you like and trust and see what options are available for you.

Dr. Rick :

It would be very unlikely that a general ophthalmologist, and unheard of that a cornea specialist, would make a mistake in diagnosing a condition suchs as Fuchs corneal dystrophy.

Customer:

But 2 drs. have said he is premature in his ideas

Dr. Rick :

Well then, you should try some sodium chloride eyedrops, 4 to 6x/day, and maybe gently "drying" your eye with a hair drier on very low held about 18 inches from your eye in the mornings....sounds crazy, but it works sometimes :)

Customer:

Thanks.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7963
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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