Next step - attempting to treat pain

[Súil Eile]

I have an appointment with my opthmologist on Monday and we're going to start tackling the issue of my eye pain.

I have an ache in my eyeball that feels similar to toothache and is there approx 60-70% of the time.

I have MGD, whereby I have very little oil production but my glands are not inflammed. I also have severe DES.

I'm currently on Artelac SDU, Vidisic, Minims, and Pred Mild. I'm taking Eltroxin for hypothyroidism. I noticed a distinct lessening in the occurence of pain once I started on the Eltroxin.

I want to go in on Monday armed with as much knowledge as I can, to make the most of my appt. Gabapentin and Lyrica seem to be the most commonly prescribed drugs for eye pain. I've been described Lyrica (150mg) in the past for a back injury. I felt completely out of it so had to stop using it. Has anyone here had success on low doses of Lyrica?

I know the issue of pain management has been covered a lot in this forum, but any input would be hugely appreciated. I'm a little excited, quite a bit nervous, and very hesitant to get my hopes up that the pain can be easily treated!

[Cabut]

Yes indeed...

Hi,

I am at the same point you are. Thinking of a asking for a trial of gabapentin to see if
it provides any relief. I have plugs top and bottom which have helped, and a 6 week course of tobradex drops which have my bleph under control, but still, underlying is the
pain. My latest diagnoses is migraine (neurologist), but after a trial of Topamax (headaches worse) and a course of indomethacin for inflammation with limited success, I've lined up a neuro-opthamologist in August.
Will see my current opth tomorrow (a corneal specialist) to start serum tears, but I think gabapentin may be in my future too. Don't know about low doses of Lyrica. Please keep of apprised of your progress and I will mine. The eye indeed alters all...

[Dog2012]

Do you have a normal tear production ..just no oil ?

[Cabut]

Do you have a normal tear production ..just no oil ?

I am a three on the Schirmer scale low tear and oil.

[Súil Eile]

Ok, so I have to admit I was very disappointed with my appointment today. My opth said he was happy with the progress of my eye surfaces, that the bleph and cists were under control, and the plugs looked good. I asked him about eye pain and he drew a blank expression. He said he couldn't see anything that would cause eye pain and seemed satisfied with that. After I pushed (quite firmly...this is not something I can just shrug my shoulders and live with!) he suggested it may be something to do with sinuses and offered to make an appointment with a neurologist. To be honest, he seemed completely disinterested in it. I asked about painkillers and he used the metaphor of using a sledgehammer to sort the problem.

So, looks like I'm on a new search for a specialist. I need to deal with this eye pain. I'm going to search for neuro-opthomologists in Ireland. I'm willing to go to the UK at this stage, so if anyone has any recommendations I'd be very grateful.

He did mention a new gel - Artelac Nighttime - which contains lipids and might be of interest to some on here. I haven't checked availability yet.

I've taken a bit of a bashing today; I had managed to get myself into a positive space with this doc but the fact that he sees this as the end of the road is hugely disappointing. But it has also made me realise that I'm not ready to give up on this fight just yet!

Cabut, let me know how your appt goes!

[Cabut]

Mine was a bit disappointing too, but only a bit.. She didn't blow me off, but I was expecting a treatise on every dry eye sufferers burning question: Is it nerve pain or surface pain. I mentioned Perry Rosenthal, who developed the Prose scleral lens and his theories regarding dry eye along with his pet condition corneal neuralgia. although she thought Dr. Rosenthal might be some kind of marketing genius, she could not buy his theories on corneal neuralgia because she said there wasn't enough science yet to back it up.
What I did get from her was that my eyes didn't look THAT dry to cause the kind of pain I was describing, however there was one more thing we could try-serum tears. She said that 90% of the people who use them do get some relief, even those with some form of trigeminal neuralgia. So of course I said sure, I'd try them, even though they weren't covered by my insurance (180.00US for a three month supply)
Still I pressed her about the nature of the pain. If it isn't coming from my eyeballs what could it be? Well she said it could be a sinus issue or some kind of a migraine but that is an issue to be discussed with your neurologist. She did say that many patients of hers who've tried everything she had to offer, finally found relief with gabapentin. She also said dry eye can provoke a migraine and there are many migraines that masquerade as eye pain. So I left with two avenues of attack. Serum tears and gabapentin. She gave me a script and I went to the local hospital when they drew 5 vials of blood which would be separated by a compounding pharmacy into 3 months worth, or 90 vials of serum tears. While there, the tech who took my blood echoed what my doc said. About 90% of the people using this method were thrilled with their results. So , I should have the tears thursday and I'll let you know how it goes!

[kanon]

Hi, I am interested to find out more about what serum tears do and how they work. I haven't heard of them...I have had my top puncta cauterized for about 12 years and just last week got my bottom cauterized because a bout with conjunctivitis last February made my severe dry eye symptoms come back after all these years. Now, with the 4 puncta cauterized, my left eye still hurts a lot. And I can tell that it doesn't produce as many tears as the right one does. I don't know why this is going on. When I went back for an appointment with the dr. he didn't know why I was still having this pain in my left eye. Burning pain, I have to close my left eye when I walk across the room because it hurts so bad. He mentioned trigeminal neuralgia or migranes, but I've had headaches, and I know this is different- a burning pain on the surface of the eye that just won't EVER go away!! It can't be sinus problems...I'm not prone to that, and I know what that feels like. Need help! Ashley

[Cabut]

Hi,
They have been around for awhile. The Japanese have been using them for 7 years or more I was told by a tech at the hospital.. As to how they work, I couldn't say but I am slated to start using them at the end of the week'
Here is a good article on eye pain and migraine which includes trigeminal neuralgia:
http://www.revophth.com/content/d/fe.../1200/c/22648/

Have you seen a neurologist?

[Súil Eile]

Ooooh, new treatment! Very exciting, do let me know how it goes Cabut.

Looks like we're in a similar boat so. I'm thinking of going for a neurologist in the public system. It means there may be a few months wait, but I can't face spending €150 to be told it isn't a neurology problem! I've found 4 neuro-opths in Dublin so I'm going to email them all my symptoms and see if they think they could help.


I'm also going to try a holistic approach as an experiment. I'm going to start Pilates next week, as well as meditation. I'm also going to try psychotherapy as i've read a good bit about 'phantom' pain and how sometimes our brain can't recognise when the source of pain is gone so keeps sending out pains signals. I'm also going to the dentist to get a full checkup just to make sure there's nothing wrong there that could be contributing to pain in my eyes. Feels a little like starting from the beginning again! But my eyes are in a better place than they were three years ago so I'm trying to stay positive

[Cabut]

I will.
Good to come at this thing from another viewpoint.
I notice if I'm doing something physical my eyes aren't such a bother. Its only afterwards...
My guess is the neurologist will be of some help. The first thing he might prescribe a trial of is gabapentin.
See to be the drug that works for this kind of a problem.
Anyway, good luck!