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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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Hello, I have been experiencing eye pain for about a month

Customer Question

Hello,

I have been experiencing eye pain for about a month now. It is very noticeably worse in the left eye than the right. It is somewhat intermittent in that it is worse at different periods of the day generally being worse at night. In fact, last night I had to close my left eye and put a warm washcloth on it to reduce the irritation. It is a throbbing pain, not a burning pain and hurts most when I look up. I am also somewhat light sensitive.

I have seen an optometrist and an ophthalmologist for this. The optomotrist has said I am farsighted and need glasses so those have been ordered and both the optometrist and ophthalmologist said I have dry eye. The thing is, it does not just hurt when I read or use the computer which I must do for 8 or more hours a day. It hurts on weekends too when I am not doing these things.

I have been tested and evaluated for most of the catastrophic stuff. But can dry eye and farsightedness cause moderate to high degrees of eye pain that occurs even when I am not trying to focus on small print or objects?
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 :

That is a very good question and, the answer is yes.....

Dr. Rick :

Severe dry eye can cause all the symptoms that you are experiencing. I am glad that you have been evaluated by both an optometrist and an ophthalmologist recently....This makes me feel safe in believing that any and all other, possibly more serious, reasons for your discomfort have been ruled out.

Dr. Rick :

Now, that being said, with you symptoms I feel you are going to need more then new glasses and artificial tears to get relief.

Dr. Rick :

One drop that my help is called restasis. It is only available by Rx and takes a few weeks to "kick in" but I've had patients like yourself get excellent results with using this medication.

Dr. Rick :

In addition you should start some home therapy to address the possible causes of your dry eyes. Let me tell you a little bit about some simple, but very effective, thing you can do on your own:

Dr. Rick :

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.

Dr. Rick :

Does this make sense to you?

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

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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Customer: replied 1 year ago.
So dry eye can be that painful? I had no idea. Some days the throbbing pain is intense. Also , is there a pain reliver that helps?
Expert:  Dr. Rick replied 1 year ago.
Byron,

Yes, unfortunately, dry eyes can be that painful.

As far as pain relievers, you can try tylenol but,in reality, even strong narcotics only knock you out.....the best "pain relief" is to aggressively treat the dryness and any underlying causes.

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.
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
Customer: replied 1 year ago.

Well, I have been using artificial tears now for a few weeks. I think the ones that come in the individual little plastic containers that have no preservatives appear to work the best. I think the others eventually begin to irritate my eyes as I have used those before.


 


The last ophthalmologist I have seen said to wait a couple months or so and see if persistent use of artificial tears and the glasses helps. He said my eyes look like someone who has been wearing contacts for ten years (from the dryness) even though I have never worn them. They said the new glasses would help too. I guess the glasses are supposed to reduce my eye strain and promote more blinking?


 


They also said that the Rx eye drops you mentioned (they were mentioned last week before you said it) are a last resort of medication for dry eye because they are permanent.

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

The preservative free ones are good. The packages says to throw out any extra after use but you don't need to do that. Just keep the tip clean and put it carefully down and you can use them for a day or so, until empty....no need to waste $.

The glasses may help with decreasing evaporation and help with eye strain but they probably won't impact your blinking :)

I do not agree that restasis is a last resort.....I would call them a first line therapy....Give 'em a try.
Customer: replied 1 year ago.
One last thing. I had been working on my dissertation and drinking 60 oz of soda and 40 oz of coffee a day and no water. Would this make things worse for dry eye. I was drinking no water.
Expert:  Dr. Rick replied 1 year ago.
Byron,

No. That should have no significant effect on your dry eyes.

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.

Hello Dr. Rick


 


Since your last message, I have been taking the following steps:


1. I do a warm compress for 30 min twice a day


2. I do eye lid scrubs twice a day with baby shampoo


3. I take 3000 mg of fish oil per day


4. I am back taking zyrtec for my eye allergies


5. I use Systane gel at night when I go to bed


 


I know it has only been a week but my eyes seem to feel better? There is still some very mild soreness sometimes in the evening but I have had no more "complete meltdowns" where they get so inflamed that I cannot open them easily. Also, I have been using fewer drops of preservative free tears during the day.


Does this mean it is working and restasis may not be necessary?

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