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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11303
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My aunt is having eye persistent pain, and we don't know

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My aunt is having eye persistent pain, and we don't know what is causing it or what to do! The pain seems to be on one side. I looked; there is no redness or "pinkeye." The O.D. took a look and saw no corneal irritation or other sign of infection. She is an occasional contact lens wearer, is not a smoker, is non-diabetic, and does not work around dust or debris. If it's not an infection, then what might be causing her pain?  What can either of us do to help eliminate the pain?
Submitted: 5 years ago.
Category: Eye
Expert:  Dr. Rick replied 5 years ago.
Hi. I'm online and happy to answer your question today.
Expert:  Dr. Rick replied 5 years ago.
The first thing we need to do is try to figure out what is causing her pain. I see that you are offline and in order to assist you in any meaningful way I will need more information on what is, and what has been, going on.
Hopefully you will be online soon and we can "chat" back and forth....
Customer: replied 5 years ago.

Hi, Dr. Rick. I am sorry that I missed you earlier. It appears that you are online now, so I am here to chat.

I do not know what is causing my aunt's pain. Not exactly.

Apparently, the symptoms seem to fluctuate and have been around for at least two weeks. She had dryness in both eyes which was thought to be fixed a few months ago, before wearing contacts again. (She had quit wearing them for about 8 months, but not because of dry eye.)

Added information: She also complained of warmth on the same side of her face that comes and goes days at a time.

Expert:  Dr. Rick replied 5 years ago.
Your Aunt is suffering from one of the most difficult issues to diagnose: Intermittent eye/orbit pain. One thing I can say for sure...this issue is way beyond the training and ability of an optometrist to deal with. She should limit her care and workup of this issue to an ophthalmologist or ophthalmology sub-specialist.
That being said the warmness that she is experiencing makes me think that there may be some type of neuralgia going on, perhaps from a virus, such as varicella zoster, messing with the nerve. The most important thing to do, and she may have already done this, is to have a complete eye exam by an ophthalmologist to make sure that nothing is going on with her eyes or orbits to account for her pain. One possibility that comes to mind is intermittent angle closure glaucoma, although this is usually associated with nausea.
The differential diagnosis list for your Aunt's symptoms is long and branching. In many cases the actual cause of the pain is never found and treatment consists of addressing the pain itself. This sometimes requires the assistance of an anesthesiologist trained in the amelioration of discomfort (pain specialist).
Does this make sense to you?
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Customer: replied 5 years ago.

Thanks for the update, Dr. Rick. I think she will visit an opthalmologist in the morning, or sometime before Friday.

What I know is that she went to her O.D. (but not an ophthalmologist) earlier this year, before her pain started. I asked my aunt a few specific questions about this:

- (5 weeks ago) The O.D. found normal pressure; Aunt denies nausea.

- (maybe 2 weeks ago) My aunt denies trauma, but has difficulty with contacts. She said she switched lens types. She also swimming without the contacts, I think.

- (almost 2 weeks ago) The O.D. looked for evidence microbial corneal infection - no ulceration or cloudiness present.

I heard my aunt has an eye spasm. How would a muscle spasm cause pain in the front of her eyes?

Also, would sinus allergies cause surface pain on the eyes? Could she even be allergic to her lenses?


Expert:  Dr. Rick replied 5 years ago.
Thanks for the information.
I agree with you....muscle spasms would not be expected to cause the type of pain you are describing.
Sinus allergies and sinus issues can cause eye pain and it is possible that it could feel like it is coming from the front of her eyes....although this would not be my first thought.
Allergies to contacts are common. There would, however, be specific findings that your Aunt's optometrist would not have missed.
I think figuring out this one is going to take a personal visit to an ophthalmologist.
If you have a chance let me know how things turn out.
Customer: replied 5 years ago.

My aunt eventually saw an opthalmologist during the week. The opthalmologist did a quick exam and apparently said nothing about spasms or contact lens allergy. There was no sign of ulceration with the slit lamp test, but no culture was done. The slit lamp test indicated dry eye syndrome. Her current corrected vision is still 20/20. The diagnosis was allergic conjunctivitis.

Since the appointment, my aunt said she still experienced pain. She was diagnosed with dry eye (and I think RA - but she hasn't told me) some time ago, so I think these might also have something to do with her pain.

With this in mind, I have more questions:

-- Are there certain prescription anti-inflammatory drops that would be recommended or avoided in my aunt's case?

-- Should my aunt ask for a culture or smear to rule out possible infection?

-- A general question: Can disposable contact lenses cause chronic eye pain (without infection) even after discontinuing wear?

Expert:  Dr. Rick replied 5 years ago.
I would avoid drops that say they are for "getting the red out" these drops just make things worse in the long run.
No culture is necessary or indicated.
No. I don't think so.
It has been a pleasure to help you and I'm glad your Aunt managed to get a good eye exam by an ophthalmologist. I hope she feels better soon.
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