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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Three weeks ago my contact folded in my eye and i attempted

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Three weeks ago my contact folded in my eye and i attempted to get it out (without washing my hands first). I never found the contact. I have a chronic feeling (a foreign body or else scratch kind of feeling) in the corner of that eye (the inside corner, is that the caruncle?), which grows worse throughout the day, and my eye sometimes feels dry. I have seen five doctors, all say nothing is there (though some have seen inflammation and one said he saw papillaries inside the eyelid) and i've tried both antibiotic drops and steroid drops. Nothing has worked (in fact, it's worse than it was three weeks ago). What can it be??


Dr. Dan B. : Hello and thanks for your question. Are you available to chat?
Customer:

Yes

Customer:

Thank you for any assistance you may provide.

Dr. Dan B. : Knowing that you have seen five different doctors, and that nothing abnormal can be found on the exam, this is very likely most attributable to a dysfunctional tear film. . The tear film as a layer of tears that coats the front of the eyes and when it is dysfunctional, a foreign body sensation is one of the most common symptoms. A dysfunctional tear film can often appear to be a normal appearing eye to the casual observer or to the experience physician who is not paying attention to subtle signs of it. Let me elaborate...
Dr. Dan B. : 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.
Dr. Dan B. : I would recommend using artificial tears 4x/day in both eyes (one drop per application). After 4 weeks you may be able to start tapering off of the tears to as you need them. 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).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.
Dr. Dan B. : 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:

Thank you for your response, I wonder though would this explain the foreign sensation in that specific corner of my eye? Also, my vision is fine, no problems with my vision but my eye still hurts. Is it at all possible that a fragment of contact could be in the corner of the eye, even though all of my doctors say they can't see anything? And will it heal on its own?

Customer:

It's frustrating because, besides the papillaries that the one doctor saw under fluroscope, and the slight inflamation, the rest "looks normal". How could it look normal? I know that something is causing this...

Dr. Dan B. : Yes, it could still explain a foreign body sensation in that particular portion of your eyes. It is virtually impossible for a fragment of your contact lens to be there and causing this if five doctors have not seen it. The papillary conjunctival reaction can contribute to a foreign body sensation like this, I would've expected any significant papillary reaction to have been quelled by the drops you have already taken. Have you seen a corneal specialist?
Customer:

I've seen regular optomotrists/opthomologists, would you recommend a corneal specialist? Would they possibly recommend something my previous doctors had not?

Customer:

And i'm glad to hear that the contact could not be there, I must admit i've been very worried that it was perhaps far back where they could not see.

Customer:

Also would a corneal specialist be the person to see? Is the corner the cornea area?

Dr. Dan B. : Yes, a corneal specialist would be the person to see. While the corner of the eye is not the cornea, the corneal specialist is the expert in the diseases of the cornea, conjunctiva, and anterior surface of the eye which would include where your problem is.
Dr. Dan B. : Do you have any other questions about this?
Customer:

Thank you. Three last questions. Should I continue using the lotemax drops/eye cream? I started using them yesterday, or would that not help? And could this possibly heal on it's own? And would the corneal specialist be possibly more helpful than previous doctors?

Dr. Dan B. : If you just started the Lotemax yesterday, there is no harm, and possibly you would benefit from, continuing this for the next several days. It is certainly a possibility that this goes away on its own. Especially if you haven't been consistent about lubricating the eyes every day, using artificial tears 3 to 4 times per day consistently, every day for three to four weeks--this may help it go away. And, absolutely, I think the corneal specialist is very likely to offer you more information and help than the other eye doctors you seen.
Dr. Dan B. : I sure hope this has been helpful. If you have no further questions...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.
Dr. Dan B. : Are you there? Do you have any other questions or concerns?
Customer:

You've been very helpful, thank you. My last question: is it normal for these sort of conditions to last this long (three weeks now)? And I will schedule an appointment with the specialist.

Customer:

And it's not likely this is a caruncle lesion correct?

Customer:

I read about that online

Dr. Dan B. : Caruncular lesions are quite easy to spot. They are kind of like hiding a Humvee on a road full of hatchbacks. It's hard to miss a carbuncular lesion, especially 5 doctors.
Customer:

Ok, and it's not abnormal for a condition like mine to last three weeks?

Dr. Dan B. : Oh certainly not at all.
Customer:

Excellent, thank you for all the help!

Dr. Dan B. : My pleasure. Good luck! 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.
Customer:

Of course, if I ever wanted to ask you questions after this encounter how would that work?

Dr. Dan B. : You could just request me by name.
Customer:

Ok great, thank you!

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