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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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Eye irritation. Feels like sand inside.

Customer Question

My left eye feels like there is sand under the lid. I have used an eye wash and also a salve that is for dry eyes, but it is very irritated, and I am not sure what to do next. Should I see a doctor?

Submitted: 6 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 6 years ago.

There can be many reasons for an eye to feel like there is a foreign-body sensation. This can range from a viral conjunctivitis (usually follows an upper respiratory infection or exposure to someone with a cold or red eye) and can cause irritation, mattering, tearing, burning or sensitivity to light and these symptoms usually then spread to the other eye. Allergic conjunctivitis is usually distinguished by significant itching, but this can be associated with a foreign-body sensation.

If you have exposure to flying dust or debris or have had any incidental eye trauma, even something as innocent seeming as rubbing the eye, then an actual foreign body or scratch of the cornea may be at the root of all of these problems. Additionally, when a person complains of this foreign-body sensation first thing in the morning, this could be a sign that there is something wring with the epithelium of the cornea. This is the top, outermost later of the cornea similar to the outer layer of the skin that sloughs off routinely. In these persons, the epithelial cells don't anchor themselves as they should to the underlying stroma or substance of the cornea. This us called recurrent erosion or abrasion syndrome. It can feel like, to some people with this problem, that someone has ripped their eyeball off the first thing in the morning. The kicker with this us that the epithelium characteristically heals itself so quickly that by the time the patient makes it to the eye doctor's office, the eye looks normal.

I suspect that you have dry eyes with inflammation. If there is tearing associated with this, it is difficult to understand why the eyes may be dry when they tear: the tearing is a reflex in response to dry eyes that is not sufficient to hydrate the eyes as they need to.

When there is inflammation in the eyes and/or eyelids, this is usually from what's called blepharitis, which is inflammation of the eyelids and glands in the eyelids. The eyelids are key players in making a layer of tears that coats the surface of your eyes called a tear film. The inflammation that is blepharitis keeps the eyelids from making that tear film as healthy as it needs to be and so the eyes dry out. Also because there is inflammation in the tears because of the blepharitis, there are bacteria pooling in your tear film. Often times an antibiotic +/- steroid drop or ointment is used to help kill the bacteria. This therapy is usually only used in a pulse fashion, to start out the treatment and then only used when there are flare-ups, not on a regular basis for most people. However, treating this with a steroid drop for a few days is not enough to treat this entire problem, it is usually just an adjunctive measure combined with the baseline treatment as I state below.

The baseline treatment for blepharitis and what I think you should start doing, is every day in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations (Sterilid or Ocusoft) or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water): you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done.

It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working; often times combining this with the topical steroid helps to bring relief sooner. Also the eyes are still significantly dry during this 3-4 week so use artificial tears one drop in each eye, 4x/day. After 4 weeks you should be able to start tapering off of the tears to as you need them.

Just doing the artificial tears, hot compresses and eyelid scrubs alone would likely start to help you after three or 4 weeks--but remember it could take this long of doing it every day before you see a significant effect, so don't stop it thinking it's not working. Also you may need an antibiotic/steroid combination medicine to help augment the therapy. If after 3 weeks of diligent treatment you are better, but not completely normal, you may need to see your eye doctor to assess for other causes of dry eyes, as blepharitis is only one cause of dry eye. Many times dry eye patients have more than one cause of dry eyes (Restasis is an excellent treatment for those people with dry eyes because they don't make enough of their own tears). Each cause of dry eyes needs to be appropriately treated for your symptoms to resolve.

If, after 2-3 weeks of doing this you see no improvement in your symptoms or there is worsening prior to that time then I would suggest seeing your eye doctor as there may be inflammation that needs a steroid or antibiotic treatment to resolve.

Does this information help address your concerns? Does this make sense? Do you have any other concerns that I haven't addressed?

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Customer: replied 6 years ago.

Your answer is very comprehensive, but I get the feeling you are thinking the eye is dry, it is not. It is very irritated, with a tear or something under the lid. I will use the compresses tonight, and buy the scrub tomorrow. I cannot imagine having this last more than a day or two, it is VERY uncomfortable and at times difficult to focus or keep my eye open.

Expert:  Dr. Dan B. replied 6 years ago.

I see what you are saying. You should consider using cool compresses and also maybe an eye wash to flush the eye. If this is still severe tomorrow, then certainly a visit to the eye doctor may be in order. This can be a symptom of a chronic condition like dry eye and usually is, but it can certainly be due to an acute foreign-body or scratch which may be amenable to treatment by the ophthalmologist.