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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8342
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My wife, after having a nasty flu recurring twice at the beginning

Customer Question

My wife, after having a nasty flu recurring twice at the beginning of this year, noticed the onset of a droopy left eyelid(up to 1/2 of the height of her left eye) a month ago.

In contrast, her right eye appears bulging a little and larger than normal. The right eyelid even appears to tilt a little upwards.

She also feels pain on her forehead above the brows as well as on the sides of her forehead when pressure is applied, as I massaged her head.

Appreciate your diagnosis if possible, or which medical specialty to seek further advice, thank you.
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.
Hi. I'm online and happy to answer your question today.
Customer: replied 2 years ago.
I don't see your answer anywhere! Please advice.
Expert:  Dr. Rick replied 2 years ago.
Sorry :-)

My computer froze up and I had to reboot.

Does your wife have any vision problems? Double vision etc?
Customer: replied 2 years ago.
No, my wife doesn;t have any vision problem.
Expert:  Dr. Rick replied 2 years ago.


Ok. I'm glad that she doesn't have any vision problems.

I see from your posting that your wife has seen an eye doctor. The ophthalmologist should have measured your wife's eyelid, looked closely for any abnormal lid function, position or swelling and checked her eye movement and used a special instrument, called a hertel exophthalmometer, to check the position of her globes relative to her orbital rim.

Do you know what he found during his exam?
Expert:  Dr. Rick replied 2 years ago.
Are you still there?
Customer: replied 2 years ago.
The ophthalmologist used a special instrument, I don't know whether it is the Hertel exophthalmometer you described, but found my wife right eyelid tilted somewhat upwards, with the right eye globe bulging a little. Subsequently, she sent us checking for thyroidal activity blood test in which 2 items T3 & T4 turned out to be normal .
Expert:  Dr. Rick replied 2 years ago.
Was this doctor on ophthalmologist (MD; does eye surgery) or an optometrist?

The next step being to check only thyroid levels seems a bit out of character for an MD...
Customer: replied 2 years ago.
Yes, she's an ophthalmologist MD according to my wife!

She probably checked for thyroid levels becos my wife told her she had small lumps in her thyroid glands in previous physical checks.

We are particularly worried that my wife is experiencing a pressure pain on her forehead, the symptoms of which seem to indicate something wrong with blood vessels, the eyelid muscles and the nervous systems of the head.

Are there any diagnostic means we can thoroughly check for the integrity of these systems?
Expert:  Dr. Rick replied 2 years ago.
I can understand you worry. Any issues with the eyelid muscle function would have been picked up by an ophthalmologist; same with nerve function to the face and orbit.

There is an inflammatory condition, called Giant Cell Arteritis that can cause head pain, jaw pain, weight loss and other symptoms but, once again, I just don't see an ophthalmologist missing that one.

I think that you have already done the correct thing by consulting with an eye surgeon. If the pressure pain persists it might be useful to have her primary care MD have a look at her.

From what you have posted and the examination your wife has had so far I do not believe that anything serious is going on.

Does this make sense to you?


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Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8342
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.
Thank you for the Giant Cell Arteritis diagnosis.

My wife temporal pain symptoms certainly appears to be related to the disease on initial browsing of the literature.

We certainly will follow up further with local hospital diagnosis to ascertain its existence. Just a final question: which of the following non-invasive technique would u recommend to test for Giant Cell Arteritis:
1. Duplex Ultrasound,
2. MRI
3. PET Scan?

Appreciate v. much your time & advice.
Expert:  Dr. Rick replied 2 years ago.
I would do a temporal artery biopsy. Ultrasound, MRI and PET scan really wouldn't give information helpful in making this diagnosis and justifying the long course of steroid therapy with it's attendant risks and complications.

I cases where no point tenderness can be found overlying a specific area of the temple artery I normally choose to obtain long segments from arteries on both sides of the head to give the pathologist the maximum chance of obtaining a diagnostic section. TA biopsy in experienced hands has a very low risk of complications and provides the best chance of making a correct diagnosis with this disease.

That being said there are many cases of biopsy negative (yet clinically proven) cases of giant cell arteritis. In cases where I feel that the clinical evidence is strong --even if the biopsy is negative -- I proceed with treatment as the consequences of leaving GCA untreated are severe.

What do you think?

It's safe for you to press the accept/positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you at no additional charge :-)


Customer: replied 2 years ago.

Dear Dr Rick,

 

I certainly will take note of your high regard for temperal artery biopsy as better method for determining GCA. However, my wife is rather apprehensive of the pain & the higher risk involved with any biopsy. She has had breast biopsy before which had left her unpleasant memories.

 

My wife also does not have enough confidence in local medical profession in performing TA biopsy. The temperal parts of the head is a rather sensitive area for performing TA biopsy!

 

The botXXXXX XXXXXne is my wife cares much about the appearance of her right eyelid being tilted upwards and her eye globe being slightly bulging, ie. how she looks! It now appears that her right eye possess a somewhat 'angry stare' although she is at a normal stance! She'll be v. happy if I could get to the bottom of what caused her eyelid tilt & slightly bulging globe, and hopefully arrive at a cure for them.

What causes these 2 sypmtoms?

Could GCA have caused this 'angry stare' look of the right eye?

Or, optic neuralitis, for that matter?

 

Could we hazard a guess that both these ailments are caused by earlier infection by 2 bouts of flu, or by the consumption of certain antibiotics during flu? Or, caused by severe fatique during this period?

 

Would these 3 causes lead to GCA or some form of eye muscle weakness, or optical neuralitis, leading to my wife's tilted eyelid and bulging eye conditions?

 

During previous bouts of flu, my wife was taking a broad spectrum antibiotic called 'levofloxacin' manufactured by Daiichi Sankyo Pharmaceutical (Beijing) Ltd.

Although this antibiotic professes to be v. effective for flu administered by local medical profession, its manufacturer stated it had up to 5% patients with various undesired side-effects. How likely would GCA & other inflammation caused by side-effects of this antibiotic?

 

Hope you will be patient with me, and with my wife for that matter, thank you.

 

Look forward to your thoughts, best regards.

 

 

Expert:  Dr. Rick replied 2 years ago.
.
Expert:  Dr. Rick replied 2 years ago.
GCA and optic neuritis do not cause the globe to protrude forward and cause an "angry stare" appearance. I also do not believe that previous episodes of the flu, the use of antibiotics or fatigue would have anything to do with your wife's current condition. Also, none of these issues would "lead" to GCA, optic neuritis (which she has no symptoms of at all) or any changes in her eyelids or eye appearance.

Levofloxacin is an antibiotic and,as such, only affects bacteria. The flu, as you I'm sure know, is caused by a virus. Levofloxacin would have no effect whatsoever on the flu. It would also not cause GCA or any type of inflammation.

It might be best for your wife to consult with oculo-plastic surgeon to see if he has a better idea of what is causing the changes in your wife's eyelid and the appearance of her globes in her orbit. I do not believe that any of the things we have discussed here would cause these changes she is experiencing.

I'm happy to continue to discuss this with you until you and your wife are satisfied. There is no need to worry that you are taxing my patience :-)

I am happy to be able to help you today. 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. I would also be happy to continue to answer any more questions you have until we have resolved your concern.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8342
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.
I thought I have already pressed the accept button before my last question!

I have just pressed it the 2nd time. Hope the rating of 'Informative & helpful' has gone through.

Appreciate your final advice to consult a oculo-plastic surgeon.
Expert:  Dr. Rick replied 2 years ago.
Ya....my mistake. Sorry about that :(

You did press the accept button before. My memory is good, just short ;-)

Now, you've pressed the accept button again. Not that I'm complaining, mind you, but another payment -- which you have now been charged for -- was not necessary.

If you would like, you can contact customer service and they will cheerfully refund your second payment. Here is a link:

http://www.justanswer.com/help/contact.aspx

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Dr. Rick
Dr. Rick
Eye Doctor
8342 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest