Neil, question for you about sclerals

[charon8]

Hey Neil,
What is hyperesthesia of the sclera ?? I have had my Boston Sclerals for a year now, and while they're in, no probs EXCEPT for this almost unrelenting terrible burning on the exposed white of the eye, (mostly the left)the triangle part facing the nose. I kind of live in a bubble and goggle world right now.

My sclerals are 18 mm, and I was kind of begging BSF for larger ones but they said that they probably wouldn't work because the burning is probably not from dryness but something else....and besides, they haven't seen peripheral burning improve with a larger lens.

The plot thickens when Dr. Tseng in Fla. said that the burning was due to meiboiman gland nonfunction due to changed stem cells and would always burn because of the dryness.

The plot thickens further when Dr. Johns totally disagreed with what Dr. Tseng said, and then said the scleral burning is impossible because the sclera is insensitive. Oh, really??

Sorry this is long, but you threw a new word in here that may be of help to me in my never-ending quest of the burning question.

I should add that I have severe Sjogren's dry eye. Maybe that throws a wrench into the works, I dunno.
Charon

[neil0502]

Hmmmm.

The best answer that I can give you is that I have no earthly idea.

When I left the States, in July, it was with a hypothetical diagnosis of "CORNEAL hyperesthesia--" something I had only just heard of. Dr. Baudouin, in France, cinched the diagnosis, providing confocal microscopy (think: really, really high magnification microscope) imagery of my corneas showing that there were an exceptionally high NUMBER of corneal nerve endings that were exceptionally ACTIVE. Thus, hyperesthesia.

I didn't talk with him specificlly about the presence of similar nerve proliferation in the rest of the ocular surface, BUT....from my trial of intra-limbal contacts (bigger than regular hard lenses, smaller than sclerals), it was "painfully obvious!" that my limbus (limbi?) were equally hypersensitive. Prior to the BAK, I had worn hard lenses for years with no major problems.

It's one of the open issues that I hope either some research or further conversations with Dr. Baudouin will help resolve: what exactly IS the distribution of nerve endings throughout the front surface of the eye? It's clear to me that the BAK went EVERYWHERE--especially since I had plugs and cautery done along the way. This increases the time that the drug is "resident" on the eye by slowing/stopping tear clearance.

My "fear" is that the Boston Lens will find an unhappy home trying to sit on MY sclera, but....I'd love to be wrong.

In your case, Charon, I don't know what to say. It's my decided impression that--if your eyes are really dry (Sjogren's, for example), then they'll be dry all the way across. Unless the sclera really DO have SIGNIFICANTLY fewer nerve endings than the cornea--something that I just don't know--than I'm not sure why a scleral would be more comfortable where it contacts the ocular surface than another kind of lens.

I wish you all the best. When my SS tests came back negative, I felt lucky to have, at least, dodged THAT bullet.....for now.

I'll be back at "home" in a few days, and--within the confines of my visual limitations--will see what I can dig up, of course, posting anything of interest here.

Neil

[Lucy]

I'd like to interject here and say that having a cut on your sclera is still a cut. If you're with perfectly healthy eyes, maybe your sclera does not bother if you have an incision there. With me: I can still feel it, probably because I have dry eyes and/or Sjogrens. The eye that I'm having trouble with on my Boston Sclerals is the left eye, which among other things has had a small incision for insertion of an iol. I tried to get my lasik/cataract surgeon Dr. Butcher, to tell me if the cut was on the sclera. I asked him if I had a limbal or scleral cut. He said it was both.

Not getting into the frey here, cause I don't know the answers. I do say that my cut in the sclera even though it's tiny, tiny, tiny did hurt and still has problems two years later. All I know about is my eyes, my cut, my lasik, my flaps, etc. etc.

My scleral cut was in the upper left quadrant of my eye (the only way I can describe it.) That's me looking out, left upper.

PS. Sorry Charon and Neil --Obviously I AIN'T Neil.

[kakinda]

The scleral part of the eye (with the conjonctival membrane on top of it) is less sensivitive than the cornea but not insensitive...
the doctor you mentioned lacks of common sense and never had anything inside is eye I suppose because it's obviously painful...

Scleral cause friction and particularly in the inner part all, plus allergies are usually more severe in that portion all the way to caruncula (is that how you write it in English? in the far inner corner of the eye), friction of the sclerals increase allergy and irritation from MGD so ... there are just a few leads you may want to discuss w/ your doc.
take care
K

[charon8]

Neil, Lucy, and Kakinda,

Thank you so much for your informative replies. Now I need to correct myself and say that Dr. Johns didn't say that the sclera was insensitive, as I had said, but relatively insensitive in relation to the cornea. I was kind of in a hurry and not thinking fully of what I was actually saying. Dr. Johns is actually an excellent doctor and I don't fault her for not being able to find the source of my pain. None of the top docs have been able to account for it.

That being said...Lucy I can fully understand why you're having pain, because you have suffered visible trauma to your eyes. I'm very sorry that you have to go thru all of that, and SS on top of everything else!! You poor thing! I would like to compare notes on our sclerals at some point.

For me, the "only" trauma is SS dry eyes, MGD, redundant conjunctiva, and a rare toxic reaction to a cancer therapy, but when all the docs look into my eyes, they can only come up with red herrings. Yet my pain is so debilitating that...well...it's really debilitating let's put it that way. My primary eye doc said that he has only four patients with eyes as dry as mine, but I'm the only one in this much pain, ...and I'm not a woose either. My ducts are all plugged, so I usually have tears. Forget adding supplementary tears, it makes them only hurt worse. Without my Boston Sclerals, the pain is so searing that I can not open my eyes. So I am so thankful for them, they literally saved my sight, for 13 hours a day, I am able to open my eyes.

So...that led me to Neil's post on corneal hyperesthesia, because I have been harboring a suspicion all along that for some odd reason my eye nerves are hyperreactive to any and all stimuli. Neil, if you're still reading this, PLEASE post what you find when you are able. I was told by my corneal specialist that the cornea has more nerves in it than any other part of the body...and they wrap all the way around the eyeball. Oh...like...really cool.

Thanks everybody.
Charon