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Dr. Stevens
Dr. Stevens, Ophthalmologist
Category: Eye
Satisfied Customers: 1404
Experience:  Board Certified Ophthalmologist
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Dear Dr. Stevens, In a recent answer you said that patients

Resolved Question:

Dear Dr. Stevens,
In a recent answer you said that patients rarely have a mucous deficiency, short of a chemical burn to the eye. I currently have all four puntal plugs, take doxycline and flaxseed, shampoo my eyelids, and use hot compresses. I still have eyes that hurt constantly. The problem is my occupation, where this all began with chemical burns to my eyes. I have been tested for goblet cells and was found to have none. I know that goblet cells produce mucin, and I believe my mucin deficiency is caused by the chemical burns. My goal is to prove this to my employer(of 25 years.) They have no clue as to how much my eyes hurt even when I am not exposed to the wind, dust, and chemical fumes, all of which I am exposed to daily. Do you know of any tests, Doctors, or lawyers that could help me get my point across?
Submitted: 6 years ago.
Category: Eye
Expert:  Dr. Stevens replied 6 years ago.
When you initially had a chemical injury years ago was it documented? Did the problems begin n shortlyafter? Are any old records available?
Customer: replied 6 years ago.

Dear Dr. Stevens,

I guess my main question is - What else causes goblet cell depletion? If not chemical burns, could it be the RK surgery? I do have documentation of the accident and all of the following information:

1991 First Report of injury: With chemicals in both eyes, eyes were keep closed for over a minute until reaching an eye was station. Removed contacts while flushing eyes. Recieved additional care at hospital within a half hour.

Chemicals involved:

- Polyurea Cure Agent "Isocyanate"

- Polyurea Component One "Urethane" Primer

- MIBK Solvent

1992 Started seeing doctors for headaches and fatigue.

1993 After trying two different pairs of contacts, thinking they were the cause of irritaion, I had RK surgery done with complete success.

1993 While working night, I went to school during the day, the headaches and fatigue continued so I dropped out of college later that year to see if stress was the cause.

1994-1996 Continued seeing doctors for headaches and fatigue.

1996 Diagnoised with dry eye.

1997 Left my job on the Paint Line beause of headaches.

1997-2006 worked around these chemicals "Waterborne Milltreat Preservative and a hot glue melt.

1997-2001 Continued seeing doctors for headaches and fatigue.

2001 Diagnoised with K-sicca, considered plugs.

2002 Occupational & Environmental Medicine

2003-2004 tried Allegra, Rhinocort Aqua, Patanol drops, Naphcon A, and Clarinex.

2004 Plugged lower right eye.

2005 Plugged lower left eye too. Tried Depo Medro 80.

2005 Seen by allergy and asthma doctor- no known allergies.

2006 More doctors.

2007 Tried Restasis, stared on doxycycline and thera tears.

2008 Tried puncta occlsion on upper, he also thought I might have rosacea- went to the dermatologist and she said "possibly early rosacea if any."

2008 tried Scleral contact lens but were to irritating.

2009 more upper puncta occlusion of both eyes

2009 tried catarizing uppers

2010 just plugged both uppers so that all for are plugged.

With all for plugged now, the headaches are very minamal unless over exposed to TV, brightness, chemicals, dust, wind, to much reading and driving. That is everthing. Thank you for your time and understanding.

Expert:  Dr. Stevens replied 6 years ago.

Hello there

I apologize for the long interval for your reply. I appreciate the effort you put in trying with the timeline above. There are several issues that bother me in trying to prove a direct link between your chemical injury and the final result. I have a difficult time arguing in favor of your early symptoms (headaches and fatigue) being related to the injury. I am not saying it is not possible, it may well be, but a stronger argument may be made that those symptoms are not related. Furthermore, severe chemical injuries tend to cause significant problems early on including severe dry eye, poor lubrication, chronic redness etc. I would tend to think that the RK surgeon would have noted these issues and advised against surgery. Furthermore, arguments could be made that you had surgery and wore contact lenses and they are known to contribute to both dry eye and mucin deficiency due to goblet cell dysfunction. I wish I could say that the link can be proven but I think it would be tough to make that argument. I have found a recent article for you that discusses some of the latest thoughts in dry eye treatment. This article focuses on treatments that are on the horizon for those patients like yourself who have tried many conventional treatments. I also think you should retry restasis as it is one of the main treatments that actually help majority of my patients. I hope you found my answer helpful, I put lots of thought into it before arguing one way or the other. I wish you well, Dr. Stevens

Customer: replied 6 years ago.
to be clear, you are saying that contact use and RK surgery can cause goblet cell depletion?
Customer: replied 6 years ago.
to be clear, wearing contact lens and having RK surgery can cause goblet cell depletion? -------- My eyes were always blood shot after the accident, but I just contributed that to the contacts and working on a paint line where the cemical exposure continued. I also believe I was sensitized to the chemicals. This will be all, then I will accept your answer. Thank you.
Expert:  Dr. Stevens replied 6 years ago.

hello there

I apologize, for some reason, I did not get the last reply from over a week ago. I would like to confirm, indeed contact lens wear and any ocular surgery can cause goblet cell depletion. You can simply search on google ocular surgery goblet and you will come up with different articles that site that particular phenomenon. I apologize your reply was not answered before, I wish you well, Dr. Stevens

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