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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7808
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Dear dr. Over the past 15 years, treatment of iritis with

Resolved Question:

Dear dr.
Over the past 15 years, treatment of iritis with prednisolon or dexamethason has resulted in head aches, first behind my eye and later on also in my head (back, front and behind the eye). First it all happened on the left side (1998), secondly on the right side (2008, the head ache on the left completely disappeared) and recently on the left again. Now (2013) I have head aches on both sides. Recently, an anaesthesiologist discovered that I had developed a severe occipital neuralgia. Amitryptiline and Lyrica somewhat ease the pain, but still I have constant pain now with attack of jabbing pain on top. PRF nerve blocks do not really help.
Have you ever seen in your practice cases of occipital neuralgia that were triggered by eye medication against iritis ?
Thanks in advance, Peter Quaedflieg, The Netherlands
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

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

Customer:

Hi, I'm online as well. Do you need more information ?

Dr. Rick :

I have to admit that in over 20 years of clinical practice I have never come across a case of occipital neuralgia that has as its trigger point ophthalmic drops.

Customer:

Could it also be the type of conservating agent in the drops or that my eye is allergic to any of the components ?

Dr. Rick :

It is also interesting that you are using steroid drops for iritis, which would be expected to act in such as way as to decrease inflammation and, therefore, any occipital neuralgia.

Customer:

Could I give more detailed info on the history of my case ?

Dr. Rick :

That is a possibility. All steroid compound have a preservative in them but, perhaps, doing a trial with specially made drops by a compounding pharmacist wouldn't be such a bad idea to see if this helps.

Dr. Rick :

Have you thought about seeking help at a large University Teaching hospital?

Dr. Rick :

Sure.

Dr. Rick :

 


It sounds like you have been receiving good care from very qualified physicians without any significant lasting improvement in your condition. At this point I think the best thing for you to 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.


 

Dr. Rick :

I do not know were the large medical centers are in the Netherlands, but it might be worth giving them a try if you have not done so already......

Customer:

I have been to Acad. hospitals in the Netherlands, mostly in Maastricht.

Customer:

I was treated there with a multidisplinary team of opthalmologists, neurologist, anaesthesiologists, etc.

Customer:

Just recently, a pain specialist in another hospital discovered that I reacted on palpation on nerv. occ. major and I reacted positively on temp nerve blocks

Dr. Rick :

It sounds like you have done everything that is humanly possible over the last 15 years. If the Professors at the University can not come up with a new therapy for you, then you might have to do the best that you can until some new technology comes along.....

Dr. Rick :

That is the problem with medicine...we can't fix everything :(

Customer:

The diagnosis Occipital neuralgia is still tentative. Have you seen other kinds of neuralgia's causes by eye medicines against iritis or for pupil dilatation ?

Dr. Rick :

Occipital neuralgia can be very difficult to treat...as you, unfortunately, know.

Dr. Rick :

But it does sound like you are on the right track and have done everything modern medicine has to offer.

Dr. Rick :

Peter, I wish I some new and wonderful insight for you.....but you've done it all already....

Customer:

Have you seen other side effects or neuralgia's / neuropathic pain causes by eye medication in general ?

Dr. Rick :

Nothing even close to the severity you are reporting......

Dr. Rick :

I realize that this was not the answer you were hoping to hear but it would be unfair to you and unprofessional of me were I provide you with anything less than truthful and honest information.


Surely, you prefer that I tell the truth rather than what you wish to hear. Because it reflects very poorly on me unless you press one of the top three feedback choices, keep this in mind when rating my answer and please do not punish me for being honest. I understand that this may not be easy to hear, and I empathize.

Dr. Rick :

With all that you have been through over the years, you could write a book!

Customer:

Thanks a lot for your answers and honesty.

Dr. Rick :

My pleasure. Have a good day.

Dr. Rick :


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

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7808
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and 2 other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year 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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If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Rick replied 1 year ago.
Peter,

Our system briefly went down just at the end of our conversation.

Let me know if you have any further questions. Have a good day.


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.

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