Tweet
After seeing an NHS Ophthalmologist back in May who said I had no eye problems, diagnosed me with migraines and gave me an Rx for Viscotears (thanks), I finally got my new Doctor to refer me to another Ophthalmologist . I then waited the 7 weeks to actually get an appointment, which was last night.
I always think there is a tendency to slightly misrepresent the medical professional you see if you come away unhappy, perhaps taking what they said out of context or giving a biased report of what happened. So I'll try to be fair here.
Since last time, I've managed to see an optometrist who recognised my meibomian glands were blocked, and has taken pictures of this, and my tear film with and without meibum in it:
I've also taken pictures myself of my posterior eyelid, so I came prepared with these (much easier to show them evidence right rather than simply hope they find it).
In fairness to the guy, he did show interest in the pictures I'd brought, as well as what I had to say.
I told him my primarily problem was soreness and posterior lid inflammation which I'd had for 9 months, which was potentially job threatening. I was also quite dry in the night, when waking up my eyes I couldn't keep my eye's open for more than a second without blinking until I got some reflex tears etc. I indicated I felt this was due to MGD, possible aqueous deficiency and maybe a dermatalogical cause. I said I'd tried lots of different drops, including Viscotears (which he then said was what he normally prescribed).
He looked in my eyes with a scope thing, and said that I had lots of oil of my margins, and that my tear film instability was due to too much meibum (not too little). He said I did indeed have posterior blepharitis (seborrheic blepharitis in fact - can he tell this just by looking?) - this is the first time I've been told this. He then gave me an RX for Liquifilm, and said to do compresses, lid hygiene etc 4 times a day then a drop of Liquifilm for 3 months, at which point he'd see me again. I asked if the drop was preservative free, and he said it wasn't and one wasn't available, but they didn't worry about that unless the drop is used more frequently that every 2 hours. (3 months of this sounds worrying to me). He also said that I could try expresses my upper glands by pushing them against my brow bone???
I asked how I could have too much meibum given that 3 months ago my glands were blocked, and how the optomotrist was able to show a lack of lipid in my tear film (about 7 weeks ago that was), but that didn't seem to get an answer.
I asked if I might be aqueous deficient given I'm often very dry at night (I've even tried clingfilm etc although I didn't say that) - he said he'd look at that with a Schrimers in 3 months if this didn't work (so I have to wait 3 months to even find out).
I asked why I now saw halos around lights at night, and he mentioned a too much mucous idea (didn't seem to fit to me) but aside from that said he didn't know, but didn't seem to particularly care either.
I asked if I should see a dermatologist, and he said he wouldn't say yes or no to that. (surely if it's seborrheic blepharitis it is worth it?)
He told a story about a chef he'd seen that this treatment didn't work for, who had tried to use goggles but these fogged up in the kitchen so he couldn't use them. He casually said he then just discharged him (very strange almost happy emphasis about this poor guy who presumably can't work and is in daily pain!! - didn't really understand how this could be OK or why tell patients this).
In all in there were some positives, particular that the NHS now officially recongise I do have a tear film problem, but I didn't really feel confident in the diagnosis or treatment plan.
I always think there is a tendency to slightly misrepresent the medical professional you see if you come away unhappy, perhaps taking what they said out of context or giving a biased report of what happened. So I'll try to be fair here.
Since last time, I've managed to see an optometrist who recognised my meibomian glands were blocked, and has taken pictures of this, and my tear film with and without meibum in it:
I've also taken pictures myself of my posterior eyelid, so I came prepared with these (much easier to show them evidence right rather than simply hope they find it).
In fairness to the guy, he did show interest in the pictures I'd brought, as well as what I had to say.
I told him my primarily problem was soreness and posterior lid inflammation which I'd had for 9 months, which was potentially job threatening. I was also quite dry in the night, when waking up my eyes I couldn't keep my eye's open for more than a second without blinking until I got some reflex tears etc. I indicated I felt this was due to MGD, possible aqueous deficiency and maybe a dermatalogical cause. I said I'd tried lots of different drops, including Viscotears (which he then said was what he normally prescribed).
He looked in my eyes with a scope thing, and said that I had lots of oil of my margins, and that my tear film instability was due to too much meibum (not too little). He said I did indeed have posterior blepharitis (seborrheic blepharitis in fact - can he tell this just by looking?) - this is the first time I've been told this. He then gave me an RX for Liquifilm, and said to do compresses, lid hygiene etc 4 times a day then a drop of Liquifilm for 3 months, at which point he'd see me again. I asked if the drop was preservative free, and he said it wasn't and one wasn't available, but they didn't worry about that unless the drop is used more frequently that every 2 hours. (3 months of this sounds worrying to me). He also said that I could try expresses my upper glands by pushing them against my brow bone???
I asked how I could have too much meibum given that 3 months ago my glands were blocked, and how the optomotrist was able to show a lack of lipid in my tear film (about 7 weeks ago that was), but that didn't seem to get an answer.
I asked if I might be aqueous deficient given I'm often very dry at night (I've even tried clingfilm etc although I didn't say that) - he said he'd look at that with a Schrimers in 3 months if this didn't work (so I have to wait 3 months to even find out).
I asked why I now saw halos around lights at night, and he mentioned a too much mucous idea (didn't seem to fit to me) but aside from that said he didn't know, but didn't seem to particularly care either.
I asked if I should see a dermatologist, and he said he wouldn't say yes or no to that. (surely if it's seborrheic blepharitis it is worth it?)
He told a story about a chef he'd seen that this treatment didn't work for, who had tried to use goggles but these fogged up in the kitchen so he couldn't use them. He casually said he then just discharged him (very strange almost happy emphasis about this poor guy who presumably can't work and is in daily pain!! - didn't really understand how this could be OK or why tell patients this).
In all in there were some positives, particular that the NHS now officially recongise I do have a tear film problem, but I didn't really feel confident in the diagnosis or treatment plan.
Comment