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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7906
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have a pain in my eye that gets worst when I am exposed to

Resolved Question:

I have a pain in my eye that gets worst when I am exposed to sunlight. The pain seems to indicate that the eye is photosensitive. That pain is also accompanied by slight blurry vision where all light sources have a spider wed halo affect. So what can I do to resolve this problem?
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. My name isXXXXX and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

How long has this been going on for?

Dr. Rick :

Do you wear contact lenses?

Customer:

Glasses and it has been going on for almost a decade

Dr. Rick :

Well, in that case I would expect that you have already had an extensive work up and all the normal things that would cause photophobia and a slight decrease in vision have been ruled out.....is this correct?

Dr. Rick :

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 cannot see anything that you are typing. Our chat system may not be working well at the moment. I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)

Customer:

No, I haven't been to a doctor about it. Here is what I I found out about this problem. I observed that when I go to sleep that some mornings I wake up with this severe eye pain. Like someone stuck a needle in my eye. My eyes become very watery and my vision is blurry for several hours. Then I take some aspirin and relax my eyes for a bit. Then I go to bed later that night and the following morning my eyes seem fine. But sometimes I get the repeat eye pain again and well I have been feeling this slight eye pain for a couple of days now.

Dr. Rick :

Ok. Got it.....

Dr. Rick :

I believe I know what is going on. No need to run to the University Experts just yet :)

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.


Here is an excellent article on this condition that you might find helpful:


http://emedicine.medscape.com/article/1195183-overview

Dr. Rick :

Does this make sense to you?

Customer:

I think it has something to do with my septum because I am told that it might be deviated. Is there some relation to that and my recurring problem?

Dr. Rick :

No. A deviated septum would not be expected to cause the ocular symptoms you are having. In addition I, personally, have a very deviated septum (which to the dismay of my ENT colleagues I have not let her operate on!) and I have no eye problems..

Dr. Rick :

I think that the next time you are experiencing the pain you should try to be examined -- while in pain -- by an ophthalmologist. She will probably be able to see an area of staining on your cornea.

Dr. Rick :

No need to continue to suffer with this for another decade.

Customer:

Thanks for the information. The hardest part was not knowing what this is about and how to deal with it.

Dr. Rick :

My pleasure. I hope you feel better soon.

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

Customer:

Thanks

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7906
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.
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