Tweet
My wife (unicorn) has finally got to see the specialist we have been trying to track down for about a year... here's a quick summary of the outcome.
The consultant was far superior in terms of level of interest and thought than previous docs. He has done research around dry eye-related topics (which is why we wanted to see him in the first place).
Based on examination his feeling was that my wife's eyes are not very dry, tear film is 'adequate' if not good, but meibomium glands are clearly not functioning normally and there is clear inflammation. Interestingly he wanted to check for retained contact lens fragments and talked of previous cases he had dealt with--hence some rather painful lifting of lids and examination, but it turned out negative. Viral swabs had also come back negative from previous visit.
The doc felt ultimately that the problem is one of sensitization to what he called 'multiple trauma', essentially long years of contact lens wear, allergic reaction and a year or more of using various drops which he feels have increased the problem rather than led to improvement (which is my wife's own opinion too). Problems leading on from contact lens wear have been exacerbated in his opinion because my wife has quite 'tight' eyelids and because at the time of stopping wearing the lenses there was an allergic reaction to one of the lens solutions. He mentioned 'corneal neuralgia' as a possibility, ie excess sensation of pain despite not necessarily very extreme physical symptoms.
An important aspect was that he was definitely not trying to say 'the pain's in your head'--he understood that the pain, which has been growing so much over the past 18 months, is real and is having very significant effects on quality of life.
Hence the doc's advice is to cease all use of eyedrops and also any 'disturbing' cleaning such as rubbing with cotton buds. This again agrees with my wife's own previous worry that the cleaning regime was tending to make her eyes more sensitive to problems. He emphasised that this will be difficult to begin with. He suggested warm and cold compresses to combat pain and gentle washing with warm water.
He also prescribed azithromycin. This was interesting because we had been reading about this and were going to ask about it, but he came up with it himself anyway. He did not feel topical az was a good idea due to the sensitization and the difficulty of the drug reaching the glands (typically it is administered in a gel, which while it can effectively maintain a high concentration by reducing 'washing away' by tears also massively slows down diffusion of the drug toward the important places--my research specialism happens to be in molecular transport and gels!). For this reason he prescribed oral az. We'll have to see if it works out.
He felt that pain relief using something like gabapentin (?) could be useful in future but it was better at this stage to try the az to see if it could help with the inflammation and physical symptoms.
We're quite encouraged by this visit (fifth or sixth or seventh time lucky!) Although no doubt there is a strong possibility that none of the above will help, it was good to have the problems taken rather more seriously and by someone who has clearly got a strong background in the field. Hope this might encourage other strugglers that perseverance can perhaps start to pay off...
The consultant was far superior in terms of level of interest and thought than previous docs. He has done research around dry eye-related topics (which is why we wanted to see him in the first place).
Based on examination his feeling was that my wife's eyes are not very dry, tear film is 'adequate' if not good, but meibomium glands are clearly not functioning normally and there is clear inflammation. Interestingly he wanted to check for retained contact lens fragments and talked of previous cases he had dealt with--hence some rather painful lifting of lids and examination, but it turned out negative. Viral swabs had also come back negative from previous visit.
The doc felt ultimately that the problem is one of sensitization to what he called 'multiple trauma', essentially long years of contact lens wear, allergic reaction and a year or more of using various drops which he feels have increased the problem rather than led to improvement (which is my wife's own opinion too). Problems leading on from contact lens wear have been exacerbated in his opinion because my wife has quite 'tight' eyelids and because at the time of stopping wearing the lenses there was an allergic reaction to one of the lens solutions. He mentioned 'corneal neuralgia' as a possibility, ie excess sensation of pain despite not necessarily very extreme physical symptoms.
An important aspect was that he was definitely not trying to say 'the pain's in your head'--he understood that the pain, which has been growing so much over the past 18 months, is real and is having very significant effects on quality of life.
Hence the doc's advice is to cease all use of eyedrops and also any 'disturbing' cleaning such as rubbing with cotton buds. This again agrees with my wife's own previous worry that the cleaning regime was tending to make her eyes more sensitive to problems. He emphasised that this will be difficult to begin with. He suggested warm and cold compresses to combat pain and gentle washing with warm water.
He also prescribed azithromycin. This was interesting because we had been reading about this and were going to ask about it, but he came up with it himself anyway. He did not feel topical az was a good idea due to the sensitization and the difficulty of the drug reaching the glands (typically it is administered in a gel, which while it can effectively maintain a high concentration by reducing 'washing away' by tears also massively slows down diffusion of the drug toward the important places--my research specialism happens to be in molecular transport and gels!). For this reason he prescribed oral az. We'll have to see if it works out.
He felt that pain relief using something like gabapentin (?) could be useful in future but it was better at this stage to try the az to see if it could help with the inflammation and physical symptoms.
We're quite encouraged by this visit (fifth or sixth or seventh time lucky!) Although no doubt there is a strong possibility that none of the above will help, it was good to have the problems taken rather more seriously and by someone who has clearly got a strong background in the field. Hope this might encourage other strugglers that perseverance can perhaps start to pay off...
Comment