Need advice on how to deal with my GP!

[britgirl]

Hello, I have been suffering with dry eye for the past 7-8 months. Symptoms of severe burning pain came about suddenly one day last summer and haven't gone away since. I have been out of work for the past 6 months and barely been out of the house. I am fed up of this, quite frankly, and eager to leave this behind me and get on with my life.

My optician has been the most helpful so far, she said I had severe dry eye and the glands looked blocked/infected. She said over the counter remedies probably wouldn't be enough, and referred me to my GP for treatment.

My GP didn't agree. He simply prescribed me different OTC eye drops and lubricants. Unfortunately, anything oil/lubricant-based makes my eye more watery & irritated. Hot compresses provide short term relief. As do goggles.

My GP is pretty clueless. He didn't know the difference between posterior/anterior blepharitis. He keeps on saying there's nothing more he can do ... and is acting like I am making a big fuss out of nothing. This frustrates me, because I have NEVER been to a doctor in my life! This is the one time I ask for help and he treats me like I am some sort of hypochondriac!

I've read online about treatments such as punctal plugs, but when I mentioned them he looked at me like I was mad. I am in the UK so maybe the treatments aren't so well known over here? He also prescribed chloramphenicol and fucidin (sp?) but these just seemed to irritate more than anything. In fact, the fucidin had 'DO NOT PUT NEAR EYES' written all over the box & tube yet my GP insisted it was fine. This gave me terrible bloodshot eyes for 3 weeks, which still hasn't completely gone away.

When I told my GP I'd been unable to work due to the pain, he offered me antidepressants. I refused, but am now considering trying them -- will they really take away 100% of the pain? The pain is quite severe at times so I am wondering how one tablet a day can numb it.

It is ridiculous that the internet is more helpful than my GP. Everyone I've spoken to for advice is telling me to change GP, but I'm thinking if I bug him enough he might try other treatments. I'd hate to have to start again with another doctor.

Any advice?

[Rebecca Petris]

Welcome!

My optician has been the most helpful so far, she said I had severe dry eye and the glands looked blocked/infected. She said over the counter remedies probably wouldn't be enough, and referred me to my GP for treatment.

She sounds good.

My GP didn't agree. He simply prescribed me different OTC eye drops and lubricants.

Why didn't your optician refer you to a consultant ophthalmologist? Even THEY are often inadequate in dry eye but there is absolutely no way a GP is equipped to help you in the situation described by your optician. This specific one sounds really useless. You CAN get decent care though in the UK - look for other UK members here who have found more helpful doctors.

Hot compresses provide short term relief. As do goggles.

Be careful with the hot compresses - overdoing them can give you more inflammation. You might also include some COLD compresses which are great for pain.

When I told my GP I'd been unable to work due to the pain, he offered me antidepressants. I refused, but am now considering trying them -- will they really take away 100% of the pain?

No, they won't.

Everyone I've spoken to for advice is telling me to change GP, but I'm thinking if I bug him enough he might try other treatments. I'd hate to have to start again with another doctor.

I sympathize with the frustration of trying to find someone else but... bugging him is getting you nowhere and that's VERY unlikely to change. He obviously does not have the knowledge or experience to help you. But don't move on to another GP, find a dispensing optician or consultant ophthalmologist who actually understands blepharitis.

[Súil Eile]

Hi Britgirl,

To be blunt - going to a GP for dry eye is a complete waste of time and money (both yours), and it can prolong you actually getting proper help. The best thing you could possibly do right now is ask your gp for a referral to an opthamologist. Maybe do a bit of research, or ask people from the UK on this forum for ideas on who to go to. Don't be afraid to ask your gp to refer you to someone specific.


The fact that your optician is concerned about your eyes would indicate that there is something wrong that needs to be treated.

I've had several courses of anti-depressants over the years...they help with the anxiety and depression associated with the social exclusion, emotional upset and pain caused by dry eye. But they won't take away the actual physical pain. That requires treatment by a specialist. I hope you find someone soon that can help you

[irish eyes]

Britgirl

I agree, the GP is not the person to help you. You need a referral to someone with appropriate expertise.

My GP is really good but she knows that she is not the person to help me. I don't think any less of her because of that - and her knowledge of dry eye and blepharitis has certainly increased over the years because of me!

[jads]

Totally understand the frustration you are feeling. There was a time I was where you are with my GP also. At least I was referred to a specialist, so he at least had the professionalism to to that for me. A competent GP will put aside his ego and refer you. Simple as that.

I would highly recommend you have your hormones checked, particularly, progesterone, testosterone and estrogen. Again, your GP may or may not be very helpful in this regard but you have to insist on it. It is your health after all !!

You may find this helpful http://www.dryeyezone.com/talk/entry...out-of-balance

Though everyone's body is a little different, in general if your progesterone and testosterone are on the low side, and estrogen (E2) is in the high side of the range or higher you have a problem that needs addressing.

Best
Jamie

[irish eyes]

That's a good point.

When I initially tried to get some of my problems addressed by the local GPs, it was really frustrating. One of the GPs is a nice chap BUT could not think beyond the very few occasions he treated people with dry eye in the past. One of these patients happened to be his elderly dad - ! I'm female, I was decades younger and I was not his dad - yet he wrote prescriptions for the same tubes of this and that!!

Doctors (not all) can lump all people together who have similar symptoms and of course it's not like that. I know it's hard when you don't feel well but you need to be a bit assertive on occasion.

[britgirl]

Thank you to all of you for the advice! So helpful.

Why didn't your optician refer you to a consultant ophthalmologist? Even THEY are often inadequate in dry eye but there is absolutely no way a GP is equipped to help you in the situation described by your optician. This specific one sounds really useless. You CAN get decent care though in the UK - look for other UK members here who have found more helpful doctors.

Here in the UK you have to be referred by your GP. I have requested a referral but my GP has said that 'blepharitis is normally treated in the GPs office.' However, he agreed he will refer me eventually, if all other treatment options fail. I am currently using chloramphenicol ointment (instead of drops), he said to give it another week. If he doesn't refer me after this I will change GP.

I've had several courses of anti-depressants over the years...they help with the anxiety and depression associated with the social exclusion, emotional upset and pain caused by dry eye. But they won't take away the actual physical pain. That requires treatment by a specialist. I hope you find someone soon that can help you

This disappoints me. My GP said it would help with the pain ... I thought he meant the physical pain. Depression/anxiety isn't an issue for me. I can sleep fine and I am generally in a good mood. During the day the pain distracts me. My job involves a LOT of mental work and I cannot concentrate at all when I am in pain. Working with this condition is simply impossible for me.

Britgirl

I agree, the GP is not the person to help you. You need a referral to someone with appropriate expertise.

I see you are in the UK, is it normal not to be referred for this? My GP has said on many occasions that blepharitis is normally treated by GPs.

I would highly recommend you have your hormones checked, particularly, progesterone, testosterone and estrogen. Again, your GP may or may not be very helpful in this regard but you have to insist on it. It is your health after all !!

I was also considering hormones might be a factor, I find my skin has been more dry also. I will ask about this. Thank you.

[Súil Eile]

I have requested a referral but my GP has said that 'blepharitis is normally treated in the GPs office.' However, he agreed he will refer me eventually, if all other treatment options fail.

I find this bizarre! We have the same referral system here in Ireland, but my GP gave me a referrral on my first visit. Just insist that you want a referral letter or you are going to go to another GP. A GP can't treat effectively for blepharitis and ocular disease...he is sworn to see you are provided with the best appropriate care and by a doctor best suited to your needs.

I think you may need to change your GP, at least go to another to get a letter. There is no way you should have another GP appointment without coming out with a referral letter.

If you can afford to go private, I don't believe you need a referral letter. In Ireland I don't need a referral to make an appointment with a private consultant. I'd be so annoyed if I were you!

[magoo]

Some antidepressants are used to treat neuropathic pain. I think an ophthalmologist would need to determine that your eye pain is of a neuropathic origin before trying an antidepressant for it. They can have a bit of a drying affect and so the benefit would need to be weighed against that possibility.

I take an antidepressant for peripheral neuropathy in my feet and it helps a great deal. I am sure it does dry my eyes some, but the pain relief is worth it for me.

And, remember, if you try an antidepressant you can always stop taking it if it causes problems, but I would get a more expert opinion first, myself.

Best wishes to you in your search for help, Britgirl.

Lynda

[britgirl]

I find this bizarre! We have the same referral system here in Ireland, but my GP gave me a referrral on my first visit. Just insist that you want a referral letter or you are going to go to another GP. A GP can't treat effectively for blepharitis and ocular disease...he is sworn to see you are provided with the best appropriate care and by a doctor best suited to your needs.

I think you may need to change your GP, at least go to another to get a letter. There is no way you should have another GP appointment without coming out with a referral letter.

If you can afford to go private, I don't believe you need a referral letter. In Ireland I don't need a referral to make an appointment with a private consultant. I'd be so annoyed if I were you!

How bad did it look when your GP referred you? Did he diagnose blepharitis straight away? Or was he referring you for a diagnosis?

[Súil Eile]

He diagnosed the blepharitis straight away, but didn't really seem to understand how my eyes could be so dry and sore. I didn't know what was causing my eye probelems - I'd never even heard of 'dry eye' before! So I was both worried and relieved when he referred me to a specialist.

From looking on this forum, it seems rare for blepharitis to occur on its own and a GP wouldn't be able to spot or treat any other underlying occular diseases

[Shell]

Hi there

My SO uses Fucidin cream for eczema in his ear... Don't know why your doc would give you that for your eyes! Insist (yes, INSIST!!) to your GP that he sends you to an ophthalmologist for a proper diagnosis/ treatment. You don't say where you are in Britain? I am in the north west of England and I had punctal plugs fitted at my local hospital. It's not a painful procedure. They can put in temporary plugs to see if they help (they dissolve after several days..or, at least, mine did) and then put in silicone ones if the temporary ones helped. You can have upto four plugs (one top, one bottom in each eye... I got bottom ones only) Mine kept falling out (the silicone ones) and in the end, to save going back and forth to the hospital to have new ones put in, I had my lower punctums cauterised...not nice, very painful ime and I wouldn't go there again tbh. I'm not sure the plugs/ cauterisation helped but it may really help you.
I haven't tried it but you could try Blephasol to cleanse and Theratears single vial preservative-free drops (there is a lighter drop and a nighttime, thicker drop which I actually prefer even for day)... I think they can all be bought at Andrew Matheson optometrists in Alresford, UK - do a google search. I get my Theratears from them and they have been very reliable!
Can't recall if you mentioned hot compresses but if you are doing them just try lukewarm instead for a while... Hot compresses irritate my eyes but I do have ocular rosacea (you could google this in case it fits you, especially if you have facial redness/ sensitivity!)
HTH a little. Shell

[irish eyes]

Britgirl

Blepharitis can clear up with over the counter treatments or prescription drugs - that is why some people are so dismissive when they hear someone has it. I know several people who have had episodes of it and it's been a nuisance and nothing more. The problem is when it doesn't respond to treatments, or it is seriously affecting the ability to function with day to day activities. That should be a 'red flag' to a GP.

[spmcc]

RE: referral from GP

I'm in Canada and we have universal health coverage too. When I go to my GP to get a referral to my cornea specialist/ophthalmologist all I have to do is throw around words like "Schirmer's scores of zeros", "meibomian gland dysfunction", etc.

I suggest you ask your GP to tell you what your Schirmer's scores are, or your TBUTs, or if the oil coming out of your meibomian glands resembles toothpaste. He doesn't even have the tools to properly answer those questions.

Please press him to refer you to someone trained in this field.

[Súil Eile]

Britgirl

Blepharitis can clear up with over the counter treatments or prescription drugs - that is why some people are so dismissive when they hear someone has it. I know several people who have had episodes of it and it's been a nuisance and nothing more. The problem is when it doesn't respond to treatments, or it is seriously affecting the ability to function with day to day activities. That should be a 'red flag' to a GP.

This is very important! I know a few people who have blepharitis and were completely unaware of it until they were examined prior to laser surgery. If the majority of people have mild, short-term blepharitis then GPs tend to dismiss it. It's essential that your GP understand how badly this is effecting you.

I like what Spmcc said...confuse him with jargon so he realises he's out of his depth