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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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My 93 year old mother-in-law complains of an intermittent film

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My 93 year old mother-in-law complains of an intermittent film coming over her 'good' eye. Two years ago she was diagnosed with wet macular degeneration in her right eye and after numerous injections, she has lost the central vision in that eye. What do you think is the problem with the 'good' eye?

Dr. Rick :

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

Dr. Rick :

It sounds like your mother-in-law is suffering from an anterior segment/tear film issue. Many times, for all sorts of reasons, 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 her miserable. In order to solve her problem she needs to address all of these issues at the same time.


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 her natural tear production, if this doesn’t work then she 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. She 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 her issues. Remember, this is not an instant fix. While she is waiting for the lid scrubs to have affect she can use over the counter allergy pills such as Travist, dimetapp or Zyrtec.


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

Dr. Rick :

Of course, with her history to wet macular degeneration it is also important for her to have a dilated exam to rule this out, although from what you have posted about her symptoms, I do not think this is what is going on right now.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

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Customer: replied 4 years ago.

So you don't think that this could be macular degeneration in the good eye then?


My mother-in-law did not say that there's any 'gunk' in the eye, but just that it clouds over, then goes. And she has never suffered from allergies, but does suffer with catarrh and blocked noses. She already puts drops in her eyes twice a day as her opthalmologist was concerned about the pressure in her good eye.


Does this make you re-think your diagnosis?


P.S. Good info so far.....



From what you have posted it does not sound like macular degeneration is the cause of her symptoms. It really does sound like an anterior segment/tear film problem as I discussed above.

In many cases the "gunk" is not visible to the patient....but it is easily seen on slit lamp examination.

At this point I do not think it is an emergency that she be seen by the eye surgeon.

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