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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11160
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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i have waked up with a terrible pain in my left eye for the

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i have waked up with a terrible pain in my left eye for the 4th time in 6 months. my optholmolgist said that it was iritis the first time and prescribed drops to dilate my eye and Durezol drops. He thought it was caused by congestion in my eye area. The second time, I was out of town and went to an optolmologist who said I had scratched my cornea and gave me ointment (Neomycin and Polymycin B sulfates and Dexamethasone ointment and had me wear a patch for a day---that cleared it up. I had the same exact symptoms a couple of months later and used the ointment and it cleared up quickly. I have waked up with it this a.m. and have tried both the Durezol and the ointment---my eye is watering profusely and i am very congested in my left nasal passage (it is always my left eye). I have a cataract on that eye that is to be removed in the next couple of weeks. Could that have anything to do with it and what do I do to stop the pain. I have taken aspirin, and my eye is pouring water and pain is not relieved. The eye is very red.

Dr. Rick :

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

Dr. Rick :

It sounds like you are suffering from recurrent corneal erosion syndrome (RCES). What's that you might ask?


 


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 :

I suggest you consult with a corneal/external disease specialist as they are the best trained doctors to deal with this condition.

Dr. Rick :

Does this make sense to you?

Customer:

What about the cataract surgery I am supposed to get in the next few weeks? Should this problem be solved first?

Dr. Rick :

No. It is safe to have cataract surgery with this condition although you might have epithelial defect after surgery, which will be a bit painful just like what you experienced when you were out of town, but it will not damage your eye in any way.

Dr. Rick :

The cataract is not the cause of this problem....


 

Dr. Rick :

Are you still there?


 

Dr. Rick :

I guess you have stepped away from your computer.

Dr. Rick :

Please remember the top 3 ratings are positives and Excellent service is my goal. Your positive feedback is how we are compensated. 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 :

I wish you the best in your upcoming surgery....Have a good day.

Customer:

I am still here---what specialist do I need to see?

Dr. Rick :

Oops....I see you are typing.

Dr. Rick :

I would consult with a cornea/external disease specialist.


 


Many times with RCES there are very few or no clinical findings where there is no pain. Given your history however I am 99% sure, even without examining your eye that this is what is going on.

Dr. Rick :

Does this make sense?

Dr. Rick :

There seems to be a delay in the chat system this morning......darn Gremlins at work again I guess :-)

Dr. Rick :

My screen showed that you were typing but nothing came through......does this answer your question?

Dr. Rick :

I guess you are no longer there......


 

Customer:

Can you recommend a specialist in this area in Dallas?

Dr. Rick :

Oops.....my screen shows you are typing again..... Darn them Gremlins!

Dr. Rick :

Ya, I sure can. I used to live near Dallas.....

Dr. Rick :

I have personally known Dr. Beebe for over two decades and would take my own family to him if needed. Here is his contact information:


 


http://www.corneatexas.com/html/about_beebe.html

Customer:

I go to Dr. Fagadeau on Preston Road----he has failed to diagnose this condition and said I had iritis. The next dr. was in L.A. where i was visiting and he said I had scratched my cornea. I have been wearing soft contact lens (throw away every night) for 20+ years.

Dr. Rick :

You may have to give up contacts.....but first, go see Walter

Customer:

I understand that after I have the cataract surgery, I will not be wearing contacts. I am having the crystal lens implant.

Dr. Rick :

sounds like a good plan. That is an excellent lens.

Dr. Rick :

I have surgery this morning and need to get ready to head out.....Is there anything else I can help you with?

Dr. Rick :


It's safe for you to press the 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 :-)


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