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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7908
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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6 months ago I had what appeared to be an eye infection, I

Customer Question

6 months ago I had what appeared to be an eye infection, I visited my own GP who confirmed this. A few weeks later when I was still having problems I visited another GP within the surgery who said it was hay fever. The 'infection' cleared up but I was still experiencing a lot of eye pain which feels like someone tearing my skin around the eyes. These last two weeks I have had a couple of attacks where I can only describe it as someone gorging my eyes out of their sockets one of those being today. I visited my doctor this morning on an emergency appointment only to be told that he doesn't know what it could be and I have been prescribed amitriptyline which may help the nervous system. On arriving home and reading the packet it says that these pills are for depression. The only thing that is making me depressed is this constant pain not the depression causing pain. I enjoy my work and my family I have two dogs that I like to take out every day. I explained to him that I am losing focus on life that even going for a walk I have to work hard to connect to the outside environment that I love. I am 57 years old and have a lot to gain out of society I don't want to go down the road as a depressive patient. Please can you help I am now beside myself and don't know who to turn to? Just a footnote I have had a CAT scan and allergy test and they have come back clear.
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 :

Are both eyes equally affected?

Dr. Rick :

Also, how is your vision each eye?

Customer:

Yes both eys and like at the moment I am extrememely hot like as though I have a temperature

Customer:

my vision sometimes gets blurry during an attack but I have visited the optician and they say there is nothing. It's just crazy

Dr. Rick :

If you look at your eyes in the mirror, how do they look to you?

Customer:

Nothing visual no red eye no no large pupils.

Dr. Rick :

how long do these attacks seem to last when they occur?

Customer:

At the height of pain around 20 minutes then it gradually calms over a period of two hours till it is like now when I feel like something is in my eyes. If I rub them It is still like a small tear. If I push slightly on the ball of my eye obviously when they closed over the lid I can still feel pain. Today has been the longest to date. I slept for three hours this afternoon to aliviate the pain.

Dr. Rick :

Ok. I believe I know what is going on......but, first,let me answer your question about the amitriptyline. Yes, it is used for depression, but one of the other uses is in pain due to nerve dysfunction, do don't worry that your doctor thinks you are depressed....that is not what she is using it for.

Dr. Rick :

That being said, nervous dysfunction in not your problem :)

Dr. Rick :

As an eye surgeon I see issues like yours fairly often. You are suffering from recurrent corneal erosion syndrome. Many times (but not always) this follows being poked or scratched in the eye. In your case I think it can be traced back to your infection.

Dr. Rick :

Have you scratched your eyes in the past?

Customer:

Not that I am aware of, no It just began with my left eye blood shot and an infection which we thought was conjuntivitous

Dr. Rick :

Ok. Well, this can happen after eye issues like infections, although it is less common. The good news? We can make things better? The bad news? It might come back sometime in the next six months or so.

Dr. Rick :

Here is information on this condition and what can be done for it:

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 if 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 :

Does this make sense to you?

Dr. Rick :

I would suggest that, just to be complete, that you have a complete eye examination by an ophthalmologist (eye MD) to rule out any of the systemic issues, such as map/dot/fingerprint dystrophy that you might have that are contributing to your problem. Not that there is anything else that can be done if you do have these issues, but rather just for completeness sake.

Dr. Rick :

I'm not sure if you are still there......what do you think about what I have told you?

Dr. Rick :

I guess you have stepped away from your computer.

Customer:

No sorry I am trying to digest what you have said

Dr. Rick :

OK. What do you think? Do you have any questions or concerns?

Customer:

How do I get to see an ophthalmologist? I thought that you had to get a referal from your GP and I am not convinced he thinks that I have a problem.

Dr. Rick :

I'm in Wisconsin, USA and here you just give the eye doc a call. I do believe in the UK you have to have a referral from your GP.

Customer:

You say that if I do have any of these issues map/dot/fingerprint that anything can be done maybe does this mean that there is no cure if that is what it turned out to be?

Dr. Rick :

You could show her this conversation and point out that a US eye surgeon with 20+ years of clinical experience feels it would be best if you saw an ophthalmologist....

Dr. Rick :

As you can see by my posts above if simple measures don't work then, after a good exam, there are other things that can be done to fix it, up to and including laser surgery.

Dr. Rick :

But, in the vast majority of patients the use of drops, bedtime ointments and bandage contact lens will solve the issues.

Customer:

Can you possibly e-mail me with the information then I can take a print to my surgery?

Dr. Rick :

You could also tell your GP that I don't do heart attacks, and she shouldn't do eyes! lol!

Customer:

Ha ha thank you yes I do like humour at least to date I haven't lost mine.

Dr. Rick :

I am unable to access email with this system, but you can copy/paste it to any word processor and then email it to yourself or print it.

Customer:

Oh ok I will try that thank you for the information

Dr. Rick :

That is a good thing! Without humor the World is a very pointy and prickly place ;-)

Dr. Rick :

My pleasure. I hope you feel better soon.

Dr. Rick :

Please remember the top 3 ratings are positives [Excellent service is my goal] and this is how we are compensated. Please don't click "bad" or "poor" service as this leaves me negative feedback. If you aren't 100% satisfied, just click "reply." I will be happy to discuss your issue in more depth and do everything I can to provide you with the information you require.


Otherwise, a high positive rating is very much appreciated, bonuses are great, and find me anytime for follow up.



Let me know if you have further questions.


 

Dr. Rick :

Have a good day.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7908
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 2 years ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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Customer: replied 2 years ago.

Your quote 'But, in the vast majority of patients the use of drops, bedtime ointments and bandage contact lens will solve the issues.'


Help what are bandage contact lens. I don't wear contacts just glasses for reading and haven't a clue what you mean?


 

Expert:  Dr. Rick replied 2 years ago.
See your other post.....
Customer: replied 2 years ago.

Sorry the quote was taken from your post but I don't know what you mean by Bandage contact lens. Please could you explain what this is please.

Expert:  Dr. Rick replied 2 years ago.
Ok.

A bandage contact lens is, in most cases, just a normal extended wear soft contact lens that is place on your eye and left in place to protect your cornea. Nothing special about the lens itself :-)

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