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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Hi, I have a problem with my left eye, symptoms include pain

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Hi, I have a problem with my left eye, symptoms include pain in my left eye particularly when reading, I have had my eyes tested and have prescription reading glasses. I get double vision regularly particularly when tired and again it seems to be from a weakness in the muscle in my left eye. I have chronic rhinitis on the left only and feel my problems are all related to this however all I ever get from the doctors is steroid nose drops that I use everyday. If I don't use them I soon get severe sinus symptoms and my eye gets worse. This has been going on for years, I have recently started studying for a degree but the pain in my eye is getting me down and hindering my studies, can anyone give any advise I would be most grateful. Thanks Jennie
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.
Hi. I'm online and happy to answer your question today.

Have you been examined by an ophthalmologist? What have you been able to do to make things better over the years?

Do you have any medical problem or take any medication?
Customer: replied 1 year ago.

hi, I've had my eyes tested I asume by an opthamologist, I usually mention the double vision, when I mention the eye paid when reading they think I have strained my eyes, but it's always the left eye and is much worse when my sinuses are playing up. I don't know how to make it better other than doing steam inhallation. No medical problems or medication.

Expert:  Dr. Rick replied 1 year ago.
Jennie,

Let me give you some advice about treating a common cause of your eye problems. Now, I know you have been dealing with this for years, so I am going to also add some advice on where you should go for an evaluation next if you don't get some improvement in about 3 weeks or so. This home therapy may seem to "low tech" after all you have been through but you would be surprised how well I've seen it function in patients with problems like yours :)

Here is the information:

It sounds like you are 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 you miserable. In order to solve your problem you need 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 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.

And. If you are not better in a month, I think it is time for you to seek help from the Mega Experts:

At this point I think the best thing you can do would be to gather up copies of all your medical records and travel to a large University Teaching hospital. At an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.

The Mayo Clinic in Rochester, Minnesota is an excellent example of just such a place as this. That being said there are many excellent teaching hospitals all across the country and I am sure that there is one near you.

If you could tell me what large city you live near and how far it would be possible for you to travel in seeking treatment I would be happy to give you some names. Of course, you could also ask friends and associates or check the internet yourself. Let me know what you would like to do.

Expert:  Dr. Rick replied 1 year ago.
Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick
Customer: replied 1 year ago.

thanks for this, are you saying the dry eyes are causing the pain? my mother has blephritis and she has drops and has to do hot flanels every evening, but moms eyes are very red and sore looking most of the time. mine don't look that bad just pain. how about the double vision can that have the same cause? I live in UK so not sure if the same applies. thanks

Expert:  Dr. Rick replied 1 year ago.
Yes. Dry eyes can cause pain and it common for the pain to be worse when reading as you don't blink as much.

Some doctors use antibiotic drops for blepharitis but this really doesn't solve the problem like the lid scrubs do. And, as far as the redness is concerned, you can have pretty advanced blepharitis and your eyes many not be that red. Everyone is different...

Dryness of the eyes can cause intermittent double vision but in your case, from what you have posted, I would think you have an underlying phoria that breaks down to a tropia when you are tired.

What does that mean in regular talk? That when you are tired etc you eyes tend to cross just because of the way your eyes are wired from birth. Normally there is nothing that needs to be, or can be, done for this issue.

Even in the UK they have teaching hospitals. Moorfields Eye Hospital is one of the best ones in the entire World.

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, but, as I do work for tips, I want to make sure you are happy before rating me.
Customer: replied 1 year ago.

just one more question, my sinuses have flared up this week following a cold and my eyes are worse than ever, can this be related to the blephritis or is it somethi g else?

Expert:  Dr. Rick replied 1 year ago.
Blepharitis does not impact the sinus' although, on the fipside, sinus issues can make your eye symptoms from blepharitis worse....

I think you sinus problems are from something else.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year ago.
Hi Jennie,

It has been about three weeks since we chatted and I was wondering how your eyes are feeling. You should have seen improvement by now -- have you?

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