Signs do not match symptoms?

[jax8it]

I just got back from yet another eye doctor appointment. Again, my symptoms do not match my clinical signs. My eyes hurt, but I have a 10 second tbut and no corneal staining. Is this good or bad that signs and symptoms do not match? It makes me feel like a looney when the doctor says I can't see anything wrong. The docs just shrug their shoulders and say idk or nonobvious MGD.
Anyone else have this problem or could anyone shed some light on why this happens? I had LASIK almost 11 months ago.
Thanks

[Hemu]

Hey,

I visited Dr. Pflugfelder yesterday and garnered some info that might apply to you:

1. On looking at my eyes, the Schrimers test(he didn't use anasthesia which was... interesting...). he concluded that I don't necessarily have an aqueous tear deficiency.

2. My TBUT was around 4 seconds which is less, so there might be a possibility that my glands aren't producing much oil. My glands are most defintely not BLOCKED since I've had MGD probing.

3. He then prediced that I had Post Lasik Corneal Neuralgia. To confirm that, he had confocal microscopy be carried out to examine the nerve growth.

4. The results of the microscopy indicated that my left eye had less nerve growth than my right eye. He also pointed out cells that were causing inflammation in both of my eyes. He said that this is a very difficult problem to tackle.

5. He then suggested the following for possible treatments:
5.1 Plasma drops, 4 times a day(he claimed these are different from serum)
5.2 Neurontin by mouth, 3 times a day
5.3 Gamma Linoleic acid, 500 mg a day

While the visit was useful in garnering more information, a big part of me is worried whether anything will work for me going forward. However, I spoke with Rebecca and apparantely, Dr. Rosenthal is going to be heading some research specifically for this pain.

I hope this sheds some light for your case as well.

[Rebecca Petris]

Is this good or bad that signs and symptoms do not match?

Frankly it's good. I mean, it's better to have one problem (symptoms) than two problems (symptoms plus signs of disease which might or might not be fully treatable). It's frustrating to have no clear answers. I think of it as a sort of post LASIK syndrome. Almost impossible to quantify - other than by symptoms. Speaking of which, don't forget to use OSDI or some other questionnaire so you have hard and fast scientifically accepted numbers for those symptoms... it helps, esp. with doctors who don't speak the language of pain.

Sure wish there were some way to fast-forward all you post LASIK folks another year or so so you'd be much further down the healing road. Gritting one's teeth and waiting it out is not fun.

[Max]

http://www.ehealthme.com/ds/neurontin/xerophthalmia

[jax8it]

Hi Hemu,

Thank you for responding and the information you shared. I have been thinking about scheduling an appointment with Dr. Pflugfelder. I would really like to see how my nerves are regenerating. The doctor I saw yesterday mentioned corneal neuralgia. He also referred another doctor in Dallas who knows more than he did. Keep me updated with your treatment if you don't mind.

[jax8it]

Rebecca thank you for your response. I've forgotten about the OSDI. I will take it to my next appointment.

[patrick]

Hi,

Sorry,no answers for your problem here,but i experience almost exactly the same as you although my refraction surgery (lasek) was done much longer ago than yours. (2005). And another difference is that my problems didn't start right after surgery. I was fine for a couple of years when the dry eye pain gradually started and got worse over time.
My tbut varies between 10 and 15 seconds and i am told i am not overly aqueous water deficient.
Still my eyes hurt almost constantly and i mean not just a bit,but quite severe. Sometimes till the point it is really driving me crazy.
Next thing on my to do list is trying to get a confocal and find out if maybe something went wrong with my nerve regeneration.
If that would turn out to be the case i am afraid this is very difficult to treat or even more or less untreatable. Maybe sclerals could be of any use. If the corneas are protected with a scleral lens then maybe the nerve endings get a well deserved break and hopefully stop sending painsignals to the brain. But this is just my assumption. I am not an expert at all.

Patrick...

[bakunin]

Hi,

Sorry,no answers for your problem here,but i experience almost exactly the same as you although my refraction surgery (lasek) was done much longer ago than yours. (2005). And another difference is that my problems didn't start right after surgery. I was fine for a couple of years when the dry eye pain gradually started and got worse over time.
My tbut varies between 10 and 15 seconds and i am told i am not overly aqueous water deficient.
Still my eyes hurt almost constantly and i mean not just a bit,but quite severe. Sometimes till the point it is really driving me crazy.
Next thing on my to do list is trying to get a confocal and find out if maybe something went wrong with my nerve regeneration.
If that would turn out to be the case i am afraid this is very difficult to treat or even more or less untreatable. Maybe sclerals could be of any use. If the corneas are protected with a scleral lens then maybe the nerve endings get a well deserved break and hopefully stop sending painsignals to the brain. But this is just my assumption. I am not an expert at all.

Patrick...

Almost the same with me.

I did Lasik in 2005. My problems started 6 years post-lasik. My symptoms are severe but my clinical signs are mild. In normal condictions my TBUT is lower then 10, my schirmer is lower then 10, but I have no stain in rose bengal test. A doctor says I have mild mgd.

Drops don't work, neither restasis.

I think I have some neuropathy: corneal evaporative hyperalgesia.

When symptoms don't match signs I think some kind of neuropathy may be the cause. I wish I could know Lasik doesnt have anything to do, in my case: frist for not beein angry bout doin Lasik, and secondly because if Lasik messed up my nerves probably it is something more difficuolt to cure or get better.

[Hemu]

jax8it, I will most definitely keep you updated on my progress, feel free to send me a PM.

I want doctors to pay more attention to this problem. From what Dr. Pflugfelder told me, this problem occurs for some patients Post LASIK. However, I did find a post here where there was someone who was diagnosed with corneal neuralgia and she hadn't mentioned anything about any surgery.

It's possible that one day, Stem Cell research will help in normal healthy growth of corneal nerves as well. Their focus right now is primarily the optic nerve though in Japan, they were able to generate a cornea from scratch.

In our present world, this problem is difficult to treat

[Rebecca Petris]

From what Dr. Pflugfelder told me, this problem occurs for some patients Post LASIK. However, I did find a post here where there was someone who was diagnosed with corneal neuralgia and she hadn't mentioned anything about any surgery.

I have known quite a few people who have been diagnosed with corneal neuralgia without any refractive surgery, including a few Sjogrens if memory serves. To some extent I think that term is starting to be used as a convenient catchall for anyone with unexplained symptoms, and whether it's strictly correct or not I don't know...

[Hemu]

I have known quite a few people who have been diagnosed with corneal neuralgia without any refractive surgery, including a few Sjogrens if memory serves. To some extent I think that term is starting to be used as a convenient catchall for anyone with unexplained symptoms, and whether it's strictly correct or not I don't know...

Out of curiosity, did those patients also have confocal microscopy done? Also, do you happen to know any specific regiment/therapy that helped them? I'd love to have more hope

[Hemu]

And I found this research being done that applies to corneal nerve regrowth post LASIK.

http://www.k-state.edu/media/newsrel...wend61311.html

[jax8it]

It is good to know that there is research in this area. Thank you for sharing.
Bianca

[LauraK]

Bianca:
Do you think you are doing better than you were? I have been on a roller coaster - was doing great for a couple of months and now my eyes are starting to ache more and feel dried out. Not sure if it's the increased dryness from heat being on and much more dryer outside. But, it is worse than it was. I have not been to an eye doctor for close to 4 to 5 months. I am afraid to go back and here what they have to say. I think sometimes mentally it would set me back even further, especially with the last doctor I went to.

I am still bitter about the surgery and my outcome. I know you and I are both coming up on our 1 year anniverary next month. I feel like mourning on that day as that moment triggered such a downward spiral for me emotionally and physically.

I hoping things will improve for us all next year. And, 2012 was just a bad dream.

[jax8it]

Hi Laura,

I think I was doing better in the summer. I really do not remember as that was my worst time mentally. In September, I was experiencing bad pain on the left side of my face along with my eyes. The face pain has gone away. The only thing I can attribute it to was an upper dissolvable plug (90 day)- maybe the plug was effecting my sinuses and causing the pain.

I hate to hear your eyes are hurting again. It most likely is the dry air.

A year is almost over and all I remember from 2012 are tears and pain. Sorry to be such a downer. I still struggle with coming to grips with this. But, I am not giving up. I am just always in a bad mood. Lol

Bianca