Hello and thanks for your question. Are you available to chat?
Can you describe the pain? Is it sharp, dull, achy, burny, pressure, stabbing, foreign-body or gritty sensation?
Is it associated with a red eye, light-sensitivity, tearing, itching, burning, discharge, or decreased vision?
How old are you and do you have any medical problems like diabetes, high blood pressure, lupus or rheumatoid arthritis?
Pain feels like a toothache. right eyelid is swollen sometimes. I am 58 years old.
But the eye isn't red or light sensitive?
And the vision is the same?
Yes, you can get pain behind the eye and in the temple from a significantly dry eye. The reason for this is because the same nerves that supply this area of the head with sensation also supply sensation to the front of the eye.
How often did you do the Refresh tears when you did them for two weeks?
Like 4 times a day.
Did you see an optometrist or an ophthalmologist who gave you the Lotemax? Did they diagnose you with something different besides dry eye when they gave you the Lotemax?
He is an ophthalmologist and eye surgeon. No just dry eye.
Okay, thanks for the additional information. Just a couple of more questions. Is the pain intermittent (coming and going)? When you have the pain are you experiencing nausea and/or seeing halos or starbursts around lights? On a scale of 1-10, if 10 is the worst pain you've ever experienced in your life, how bad is this pain you're having now?
Pain come and goes, but right now is pretty painful, I would say about an 8. Is the pressure of 25 considered high?
Normal eye pressure, in the absence of other signs of glaucoma, is 21 or lower, so yes, 25 is considered high, though certainly not acutely dangerous. I think it's possible that a few different things are causing this. First...
it's possible that this is a dry eye, but usually they have to be pretty significant for someone to have 8/10 pain and also that using artificial tears 4x/day for two weeks doesn't even touch. Second, this could represent...
intermittent pressure rises from glaucoma (though the pressure if this were the case would be rising to upwards of 40 or above for you to feel significant pain). When the pressure is very high (like above 50, for example), many people see halos around lights and/or are nauseous with possible blurry vision. While it doesn't sound like this is the case with you (very high pressures), it's possible that your elevated pressure is causing this. Lastly, it's also possible that you have...
Some intraocular eye inflammation called iritis. Usually someone is light-sensitive and has a red eye when they have this, but not always. However, the mainstay treatment of iritis is steroids, like Lotemax. So with significant pain that resolved pretty well with Lotemax, I have to think this is possible as well. I don't think, however, that you need to see your internist or have a CT scan. Your ophthalmologist needs to evaluate you again in the context of this return of your symptoms as this is very highly likely an eye problem exclusively. Does this make sense?
Yes, How do I get the pressure down?
The only way is to use glaucoma drops that would need to come from your ophthalmologist. It's quite possible that the pain is not being caused by your pressure at all (a good chance) and that this is one of the other entities I discussed. Many people walk around with pressures of 25 and don't need it lowered until/unless glaucoma starts to set in.
So if it's not a good chance that the pain is from the pressure, what could it be? Iritis? So I should call the ophthamolist back?
Yes, I think (in order of likelihood) it's probably dry eye or iritis, but a high eye pressure is a close third. Ultimately, though, I would recommend that you call the ophthalmologist back and get in to see him/her. That's where your answer is going to come from.
Do you have any other concerns or questions about this topic?
Thank you so much Dr. Dan for your knowledge and expertise.
My pleasure. Good luck to you.
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