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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 10769
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have a crawling/twitchy/sometimes throbbing feeling in (or

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I have a crawling/twitchy/sometimes throbbing feeling in (or behind) my left eye. It is sometimes (by evening) slightly painful - but mostly just annoying. Often it seems to be localized in the outside corner of the eye. Other times more central. In the mirror, I cannot see anything I recognize as a problem. There does appear to be a blood vessel poking into the blue area of the eye.

When I close/open the eyelid, I feel more "resistance" in the left eye than in the right (as if it was dryer, or more "drag" was in effect). Also note that I do have "floaters" in that eye. They are annoying, but I would not have expected that you could *feel* them (??).

When "googled", I found this above description to be a known complaint, but there was no clear answer that I found. Some folks wondered if it was due to some kind of parasite (due to the crawly feeling). I have wondered the same thing, but that seems unlikely given my circumstance... modern American living in a fairly clean environment with no kids or mammalian pets, and using metropolitan city water.

I am a 58 year old (male) retired computer programmer. I still do a lot of programming, which means I often stare at a computer screen for hours a day.

Is this just a middle age man getting older? Or is it something I should get looked at?
Hi. I'm online and happy to answer your question today.

You are correct....floaters are not something you can feel.

The most likely cause of your symptoms, especially since it gets worse toward the end of the day is an anterior segment/dry eye problem.

Now you might say "But if the problem is near the front of my eye, why do I feel it behind that eye?" That is most likely because your eye and orbital area are very highly innervated and all of these nerves interconnect. In my experience, it is not uncommon for people to complain of feelings like yours and for their exam to show problems with the anterior segment. Can I give you a good reason why this is so? Nope :(

The good news? This is something you can fix with home treatment. Let me tell you a bit more about this:

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.

I understand that this treatment seems a bit "too low tech" to be of value, but after 2 decades of clinical practice, I can assure you (even from personal experience :) that it, does indeed, work.


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. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS
John,

One other thing may be going on at the same time as the above issues. You might also have mild myokymia, a benign condition of the muscles around the eye and eyelids.

. Myokymia is an involuntary, local twitching of a few muscle fibers in the body of a muscle. This twitching, if it occurs in a limb, is not strong enough to actually move a joint but can be felt and sometimes seen as an area of quivering.

Myokymia commonly involves the eyelids and muscles around the orbit. It often appears and resolves for no apparent reason and has not been linked to any underlying significant pathology. What causes myokymia? Studies have shown that it is associated with anxiety, stress, lack of good sleep, high caffeine intake and the use of some drugs.

The best way to treat myokymia is to get more sleep, decrease caffeine intake and decrease stress. The good news is that myokymia is not a sign of serious underlying pathology and often resolves on its own.
Here is an excellent article on this topic:
http://emedicine.medscape.com/article/1213160-overview
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