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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7853
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Im a 39 year old female. My left eye hurts on the side close

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I'm a 39 year old female. My left eye hurts on the side close to my nose. It has been red in that area for over 2 months. I stopped using eye makeup for ahwile, that didn't help. I take Zyrtec everyday in case it's an allergy, but it's not improving. Optometrist says the sclera is inflamed, and thinks I have 'allergic eyes.' Opthamologist says it's blepharitis. Only have symptoms in one eye. I'm starting to have more pain in my eye and sinus pain too, and can't breathe good out of my left nostril. Any idea what's causing this? I can send a picture of my eye if you need it. Thanks!
Submitted: 11 months ago.
Category: Eye
Expert:  Dr. Rick replied 11 months ago.

Dr. Rick :

Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

Although it doesn't make sense, it is common to have symptoms in one eye even though you probably have evidence of blepharitis etc in both eyes on slit lamp exam.

Dr. Rick :

I would bet that you have more than just blepharitis going on from what you have posted....

Dr. Rick :

Well It sounds like you have a couple of things going on. First is allergies, second dry eyes and third blepharitis.


 


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 and the use of a medication called restasis to improve your 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 is 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 :

If things don't get better in a few weeks with the above treatment and OTC meds I would consult with an ENT to see if the issues with your breathing and sinus pain have to do with a chronic sinus infection/inflammation.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

You can also continue with the tobradex 3 to 4x/day as that should help some while the above home therapy "kicks in"

Customer:

Full Size Image

Dr. Rick :

got the picture.

Dr. Rick :

That patch of redness in your left eye looks like an area of episcleritis. In order to be sure I'd need to look at you at the slit lamp....

Customer:

I used Tobradex for 7 days. Would it be safe (after being off it for a week) to start using it again for awhile until I can see the opthamologist again? Since it's a steroid, I'm nervous about it. I am 'legally' blind in my other eye, so I don't want to cause damage to my good eye. Also, could I possibly have a sinus infection that spread to my eye? I also have ear pain on the same side that comes and goes. Wondering if the ear, eye, and nose problem are connected somehow. Thanks.

Dr. Rick :

For that I would take motrin 800 mg 3x/day for about two weeks (with food), in addition to the home therapy above, and see how things go. It should improve.

Dr. Rick :

Don't worry about the steroid as long as you are being followed by your ophthalmologist. You can safely start it back up.

Dr. Rick :

Sinus infections don't really spread to the eye, so no worries there...

Dr. Rick :

The ear, sinus and orbit pain could all be related, but not to that patch on your eyeball.

Customer:

Episcleritis? That's strange. I have been trying to get in to see a rheumatologist. I have had joint pains really bad for years and am starting to think it's an autoimmune disease, maybe Rheumatoid Arthritis. I read that episcleritis is related to RA. That's just great. :-(

Dr. Rick :

Why are your eyes so white? Have you had surgery on them?

Customer:

Never had surgery on them. They don't look very white to me. Left one looks awful today.

Dr. Rick :

It must just be the way the flash caught your eyes....

Dr. Rick :

Anyway, does this make sense to you?

Customer:

I will make another apointment with the Opthamologist tomorrow, if you think I should. If it's blepharitis though, I guess it would be a waste of money since theres nothing he can do. So if it's episcleritis, should I go to the doctor? Is there any cure? My eyes has looked this way since mid July!

Customer:

*eye has looked this way

Dr. Rick :

You managed to catch me up....the dogs needed to go out...... Tomorrow is my surgery day; got a full schedule :)

Customer:

thank you so much for being online. I am so scared about this eye. I will be blind completely if something was to happen to my left eye

Dr. Rick :

There is no need to go to a regular doctor for episcleritis and the only reason to see you eye MD tomorrow is to confirm or deny the diagnosis of episcleritis.....which really needs a slit lamp exam to diagnose properly

Dr. Rick :

From your picture and what you have posted I do not think you have anything to worry about concerning loss of vision, or blindness, in that eye at this point.

Dr. Rick :

Is there anything else you would like to ask me this evening?

Customer:

ok, thanks for your help! I will get out the Tobradex again and use it tonight. It seems to clear it up pretty fast. Thanks for your time!! Have good night!

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

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7853
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 11 months ago.
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