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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My eyes have always been sensitive and tend toward wetness

Customer Question

My eyes have always been sensitive and tend toward wetness but today upon awakening I noticed that my eyes were bloodshot and when I pulled back the skin at the outer corner of my eye I saw a bulging white area. It is less but there on the other eye.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Dan B. replied 1 year ago.

Doctor DanB : Hello and thanks for your question. Are you available to chat?
Doctor DanB : Is there any itching, burning, caking or mattering of your lashes, foreign body sensation, intermittent vision changes?
Doctor DanB : The most common reason for the eyes to be causing these symptoms is due to a dysfunctional tear film syndrome. The front of your eyes has a layer of tears coating it called the tear film (this layer of tears is different from the tears you produce when you cry or have an irritation in your eye). The tear film normally provides a healthy environment for the front of the eye (the cornea and conjunctiva) and also contributes significantly to clear vision. When the tear film is unstable or unhealthy (there are many reasons why this can be so, which I will get to) it becomes dysfunctional and can produce uncomfortable symptoms and blurry vision. This is called a dysfunctional tear film.People with a dysfunctional tear film can have multiple different symptoms ranging from redness, dull aching or pressure, sharp or stabbing pain, morning tearing, burning, and often eyelash mattering to tearing, stinging, itching, burning, a gritty/foreign-body senstation or just intermittent vision fluctuations. Their symptoms sometimes get better as the day progresses or they can often times worsen throughout the day, but they can get intermittent blurring when they use their eyes heavily in activities such as reading, watching TV, computer use or driving. A dysfunctional tear film can be due to many different factors. Different medicines such as psychiatric medicines, antihistamines, cold medicines and others can contribute to a dysfunctional tear film. Allergies in the eyes can also contribute (and or make worse). Some people have an innate deficiency in making their own tears (these people may also have other dry mucus membranes, such as their mouth, nasal passages, or genitalia). Any kind of eye surgery can actually cause and/or worsen this Many people have an inflammation in the eyelids called blepharitis which causes the tear film that is supposed to coat the front of the eye to not function as well, and then the eyes dry out. Your symptoms sound consistent with blepharitis; I would recommend starting this treatment, while concurrently using artificial tears. In order to treat blepharitis, everyday in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are called Ocusoft or Sterilid which are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water), you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done. It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working. Also the eyes are still significantly dry during this 3-4 weeks so I would recommend using artificial tears 4x/day in both eyes (one drop per application). After 4 weeks you should be able to start tapering off of the tears to as you need them. Just doing the artificial tears, hot compresses and eyelid scrubs alone would likely start to help you after three or 4 weeks--but remember it could take this long of doing it everyday before you see a significant effect, so don't stop it thinking it's not working. If you are a person that doesn't make their own tears very well, then you may also benefit from taking that Restasis, which actually modulates a person's immune system to help them make more of their own tears. This drop actually requires constant usage on a daily basis for at least 10-12 weeks before its effect kicks in (takes awhile to change the immune response in the body). If you are a person that doesn't make their own tears very well, then you may also benefit from a prescription drop called Restasis, which actually modulates a person's immune system to help them make more of their own tears. This drop actually requires constant usage on a daily basis for at least 10-12 weeks before its effect kicks in (takes awhile to change the immune response in the body).Because there are numerous reasons for dry eye, if not all the reasons that exist in one patient are treated, it can seem as though the ones that are being treated are providing no benefit. If you've tried these recommendations and still don't feel better then you should consider seeing a corneal specialist for a dry eye evaluation.
Doctor DanB : Does this make sense? Does this information help address your concerns? Do you have any other questions about this? It appears as though you are not in the chat room currently. I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need. If you would like to ask further questions or clarification regarding anything I've said, please let me know and I will be happy to address your concerns when I return to see if you've responded. If your concerns have been resolved... Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!
Customer:

I am here

Customer:

My eyes are not dry

Customer:

The bulge appears to come from the back of my eye, under the lid, in the outer corners

Customer:

No itching now but sometimes in the evening they get itchy and watery.

Customer:

I don´t think you understood my symtom.

Customer:

The eye with the largest bulge is starting to feel sorenow.

Customer:

I do sometimes get blurry vision.

Customer:

Are you there?

Expert:  Dr. Rick replied 1 year ago.
Hi. My name isXXXXX and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

I see that your expert has opted out and is no longer available.

How can I be of assistance?
Customer: replied 1 year ago.

Are you on this chat now?


 

Expert:  Dr. Rick replied 1 year ago.
yes.
Customer: replied 1 year ago.

Thank you. I continue to be concerned about my eyes. I have no insurance and don't even know what type of doc I should go to. I started wondering if the white "bulge" could be puss. When I move my eyes the mass stays put so it's not on the eye but next to.


I can only see it if I pull back the outer corner of skin. I looked at my son's eyes and h doesn't have that.


 

Expert:  Dr. Rick replied 1 year ago.
Can you photograph this white bulge?

Here is a good way to upload it to me for review:

Save your picture on your computer, someplace easy to find it such as your desktop.
Go to www.tinypic.com
Upload your picture to the site tinypic.com by browsing for it as directed.
This opens up files on your computer. Double click on the picture you want to upload then hit open (bottom right of the screen). This will take you back to the tinypic page. Hit "upload now" then do the secret code thing and your picture will upload into the system.
Once you do that it gives you a bunch of links you can use, one of which says "direct link for layouts" It is important to use this box. It is the forth one down from the top of the page.
Copy the link from inside this box and then paste it into your justanswer dialog box and send it to your expert.

Customer: replied 1 year ago.

I will do that but it could take me some time since I am not Camera/computer savvy. I would like for you to see it. How much longer will you be available so I get it to you in time to continue this conversation today?

Expert:  Dr. Rick replied 1 year ago.
I'll be on and offline all day today as I have a light clinic schedule this afternoon. I usually go offline for the day around 10 pm CDT
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and 2 other Eye Specialists are ready to help you
Customer: replied 1 year ago.

http://i42.tinypic.com/6ylkk9.jpg


 


 


 


 


I hope the image is good enough. The other eye has the same bulge but smaller.

Expert:  Dr. Rick replied 1 year ago.
Let me go look at the picture. I will be back after a see get ahead in the clinic again...won't be long :)
Expert:  Dr. Rick replied 1 year ago.
Hi. Wow! The clinic got crazy...


Got your picture and it shows exactly what is going on.

That bulge is not puss. It is the normal orbital fat that surrounds and protects your eyeball.

What has happened is that tenons capsule, a very thin and tough membrane, has got a small hole in it and allowed this fat to "pooch" forward under the "skin" of your eyeball (conjunctiva).

This is nothing to be concerned about and no treatment is necessary.

If you really wanted, the fat can be surgically removed but in my opinion you should leave well enough alone.

Here is a good article on this topic:

http://www.nejm.org/doi/full/10.1056/NEJMicm054986

http://www.sarawakeyecare.com/Atlasofophthalmology/anteriorsegment/anteriorsegment15orbitalfatprolapse.htm

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

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


Also, thank you for you patience while I dealt with a very busy afternoon in the office :)

Customer: replied 1 year ago.

Thank you so much. Could this good news be the reason that my eyes water frequently and sometimes itch at night? Is it okay to rub that area when they itch?


I am relieved and grateful to hear it is not serious. I was worried.


 

Expert:  Dr. Rick replied 1 year ago.
This should not cause itching but it might contribute to your eyes watering some.....

You can rub that area safely when your eyes itch.

I'm glad I could help you to stop worrying :)

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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