Desperately Seeking Advice/Opinion

[sevensilly]

Hoping to make this as short as possible..

My problems began back in December of last year when I had the desire to begin wearing contact lenses again. I scheduled a visit with an optometrist who fitted me for a pair. The prescription I was prescribed seemed to be perfect for my right eye. However, I always had issues with the left lens. It seemed hit or miss at first, some days (maybe 1/5 times) I would be able to wear them all day. Other days, I end up taking them out after a couple of hours because of discomfort in my left eye.

So began a journey to trying many different brands and types of lenses for the left eye. Found them all to be equally as uncomfortable or even more so than the one originally prescribed.

I would notice that my eye would be irritated hours after removing the lens (usually not feeling normal again until the next morning). I was stubborn and continued to try to wear the lenses originally prescribed- eventually giving up after a couple of months off and on trying different things (drops and changing my diet mostly). The day I decided I would skip the contacts, I noticed my left eye was very irritated even though I hadn't worn a contact in the eye. My eye felt "gritty" and the foreign body sensation- and slight burning.

The condition seem to worsen so I went back to the optometrist who diagnosed me w/ ocular rosacea. After the diagnosis, I was thrilled to finally find a root cause and was confident that the doxy he prescribed me would fix my problems. Unfortunately after two months of antibiotics, I did not see any improvements.

I finally got a referral to an ophthalmologist who made the diagnosis of "blepharitis." He put me on a regimen of lid scrubs- morning and night time, using a new face cleanser, blephamide applied in the evening, lotemax drops three times a day, and doxy twice a day. After about a week, I stopped the blephamide and lotemax having not noticed any improvements. I went back to the ophthalmologist for a follow up who was unhappy with my deviating from his regimen. He told me to stick to his plan and come back in a month.

It has been a bout 1.5 wks since the last visit and can't say I have noticed a huge improvement. I am skeptical of the "belpharitis" diganosis because during the last visit, he said the severity of my blepharitis is about the same in both eyes. But- the symptoms I experience is only in my left eye. Logic would dictate that I would have some symptoms w/ my right eye if it is indeed blepharitis- but I have none. My right eye has never been a problem. Always just the left.

When I look at my eyelids in the mirror, I notice the left one "drooping" lower than the right. Visibly noticeable, even to others who I hadn't mention it to. I believe a lot of this is because I tend to sleep on my stomach, usually with my head to the side and the left side of my face into the pillow. I think that this is somehow contributing to the symptoms or may be entirely the root cause.

I have tried to break the habit of sleeping on my stomach, or at least on my left side but it's difficult. I've tried eye patches which don't really seem to help. I recently ordered a pair of protective eyewear (Onyix) which should arrive in the next few days.

Anyone have any advice? Or opinions on what they think the root cause is? Really desperate and open for suggestions. I hope these Onyix goggles do the trick.

TIA

[Tankie]

This might sound really silly, but you should get a friend to sit beside you and watch you close your eyes for 5 minutes straight.

Your friend will be looking to see if they remain closed for the full 5 minutes, or if they crack open a bit. If they crack open, you may suffer from something called lagophthalmos.

[sevensilly]

Thank you for the suggestion. I'll ask my wife to do this.

[sevensilly]

Without having my wife watch me, I observed that my left eye definitely has the tendency to open up much more than my right eye when simulating "sleep." Though I don't discount it, I'm quite sure this phenonemon isn't happening simply by power of suggestion.

I've, for the last three days, been taping my eye shut with medical tape as well as wearing the silicone night goggles. This seems to help- though I'm still struggling with some discomfort during the day and must continue use of the eye gel/ointment for any relief. Though I don't htink it's as severe as it was before. Giving it a week hopefully see vast improvements.

Any other suggestions? How do I fix the root cause? Did I kill some nerves/muscles in my eyelid by sleeping on it all this time?

[Rebecca Petris]

Welcome sevensilly.

It's helpful to keep in mind, big-picture-wise, that ocular surface diseases are often multifactorial. So for example, there might be underlying conditions like bleph/rosacea, there might be some contact lens induced stuff, and maybe one or two thus far unidentified issues going on with you, plus there could be an eyelid issue (bearing in mind that eyelids are important not only for sealing your eyes shut at night but for pumping and spreading tears during the day) contributing to just one eye. So the challenge is to figure out what all is going on and what's important to treat, not simply identifying a root cause and treating it.

Another important little fact is that what you feel/experience often does not match the clinical signs they are seeing AND it is common to have a better eye/worse eye.

It has been a bout 1.5 wks since the last visit and can't say I have noticed a huge improvement. I am skeptical of the "belpharitis" diganosis because during the last visit, he said the severity of my blepharitis is about the same in both eyes. But- the symptoms I experience is only in my left eye. Logic would dictate that I would have some symptoms w/ my right eye if it is indeed blepharitis- but I have none. My right eye has never been a problem. Always just the left.

I wouldn't expect dramatic improvement anywhere near that quickly.

Your story reminds me of myself a bit, many many years ago. I had a chronic issue with my left eye that would interfere with my contact lens wear, which is a big part of my fateful decision to have LASIK. Based on everything I now know, I think I had GPC. Wish somebody had diagnosed it. But they always said that should happen to both eyes, and ditto allergies which is the thing they did sometimes diagnose and treat.

[Tankie]

Here's some pictures and a video of my problem: http://web.uvic.ca/~aswalker/eyes/index.html

Like Rebecca said, sometimes (perhaps even most of the time) people suffer from multiple problems. I personally suffer from 3 things:

1. Lagophthalmos (eyelids don't close properly, see the video and pictures)
2. Meibomian Gland Dysfunction
3. Blepharitis

I've never been able to find a cure for myself, but I'm going to be getting surgery soon in an attempt to fix my lagophthalmos. Having said that, don't rush off and get surgery, I've been dealing with my problems for 4 years and I've spent a lot of time reading and thinking about all the alternative options, and this is really my last resort. There's a lot of things you should try before surgery. I could suggest some things to you if you like; just let me know Rebecca is another good person to take advice from as she knows pretty much anything you would want to know about dry eyes minus "what is the one ultimate cure".

[NeedMyEyes]

I have this. I have the droopy lid on the side that I sleep on - I know I dig my head into the pillow. The treatment is supposed to be fox shields to sleep with. I haven't used them yet.

Also, you can use the medtronic adhesive eye patches that rebecca sells. It can't just be any eyepatch and I think Fox Shields are supposed to work the best. I read somewhere "dramatic improvement in 21 days" with a fox shield.

I use onyx for the same thing. One problem is that with people like us, we get pretty physical at night with out pillows and our heads and the onyx comes off alot. Also, you will find that your eyelids dig into the onyx plastic shields and may cause the same issues as with your pillow.

I ordered my Fox Shields and they should be in soon. Good luck!!

[sevensilly]

Wow. Thanks for the responses. Hadn't checked back in a little while.. will post a more substantial response this evening.. but I think I'm getting closer to the root cause.

[sevensilly]

Posting an update...

The last few days have been particularly intolerable which lead me to wonder what's different? Then I remembered a conversation I had with a colleague who mentioned it's the start of allergy season (I live in Ohio). I also noticed my wife and daughter's noses have been running- so I definitely think something environmental is contributing to my problems.

We've lived in this home only since about February so it could be something indoor that is causing our allergy symptoms although we had our ducts cleaned prior to moving in and all carpeting within the house is brand new.

One thing I am pretty certain of is that my eyelid condition is worsened by allergies because the discomfort seems to go away with taking Benadryl. Is it possible to develop allergies as you get older? I suppose it's possible that I've always suffered from allergies but not to a degree that bothered me much until I started having eye problems. I have tried Zyrtec and Claritin but neither seems to alleviate my symptoms although Benadryl works like a champ. Alaway doesn't seem to give any kind of relief. I'm thinking of giving Allegra a go since Benadryl causes a good bit of drowsiness.

Rebecca - I haven't worn any contact lenses in quite some time, do you still think GPC is a possibility? If so, how is it generally treated? What is your take on my allergy theory?

I also think how I sleep exacerbates my condition. NeedMyEyes - I bought the Fox Eye shield immediately when I saw your post. I don't thnk the medtronic eye patches would be of much help for my situation- but I shall give them a shot if the shields don't work. I have a pair of Onyix goggles which I've been wearing- it indeed does seem to help however, as you mentioned, I tend to find them off when I awake in the morning. One optician suggested floppy eyelid however every other "eye doctor" has dismissed this possibility (because of age). If you dont mind me asking, how old are you? Also, how do you actually wear these Fox Eye Shields?

[MaryVa61]

Hi. Sorry your are having multiple eye issues. That makes improvement really complicated, and I know that first hand. Some things to think about:

I was suspected, by an opth, of having floppy eyelid syndrome at age 49, so I don't see how age matters. Turned out not to be though. My lids are a little extra-stretchy or loose, maybe because I may have a heritable disorder of connective tissue like Ehlers-Danlos (to be evaluated soon), so on top of the dry eyes the lid kind of gets draggy and looks droopy. Treating the dry eyes appropriately is what helps.

Allergies can develop at any age. But some (or all?) antihistamines cause eye dryness. I'm not sure that's true of Benadryl. Most eye drops for allergy contain BAK which can eventually increase dryness and a lot of people are sensitive/allergic to BAK so don't notice improvement with those even if they had allergies affecting the eyes. Similasin allergy drops may not contain BAK, probably don't since it's a "natural" product. If you have any type IV allergies (like allergic to the fomaldehyde off-gassed by new carpets, other chemicals in the house), those aren't helped by antihistamines. Only avoidance works for those. Patch tests by derm can tell you if you're allergic to formaldehyde.

Superior Limbic Keratoconjunctivitis (SLK) can be caused by or triggered by contact lens wear. Your opth probably would have checked for that though. There would be a lot of redness on the white part of the eye that is normally covered by the upper lid. You could pull up the lid and check in a mirror. If not redness, it's definitely not SLK.

I have several different disorders that affect my eyes, and my right eye is dramatically worse than the left 95% of the time, though all of these disorders affect both. The opth claims that's not unusual. I couldn't even tell that the SLK was in my left eye at all, but the doc could tell. My SLK wasn't contact lens related. It had to do with my eyelid drag problem apparantly or subclinical hypertyroidism (before becoming officially hyperthyroid).

I'm not sure you have the rx the opth prescibed enough time. Some disorders take several weeks or even months to respond to treatment, unfortunately.

I hope you find answers and get some relief. It's challenging, but this site has been a huge help for me.

[sevensilly]

Thank you all for the encouragement and suggestions.

I've suspected from the beginning that the root of my eye troubles has been my habit of sleeping on my face. Opthalmologist dismissed me when I brought this up. To me it made sense, considering the eye that I've been having issues with is the side on which I sleep. But what do I know right...?

A few days ago I received set of aluminum eye shields that NeedMyEyes recommended. I've worn them for a mere 3 evenings (beginning Saturday)- I went from having to use over the counter nighttime ointment just to make it tolerable to WEARING CONTACT LENSES TODAY (which I've not done in months) with very little discomfort (just from dryness and having to get used to them again).

Thank you very much NeedMyEyes- the eye shields are awesome. Thanks to all others for words of encouragement and the ideas. I will continue with the lid hygiene and supplements to encourage good tear and oil production.

I actually bought the post-surgery goggles from Rebecca's store that likely would work fairly well for others though I find they are just wide enough for me.

[shanku]

Are these eye shields good alternative to eye(PM) ointment for night time protection? Do these cut out the airflow & how to use these? Can you use these along with Tranquil Eye Goggle? Can you please post me the link to the product you ordered? Do regular pharmacies like CVS, Walgreens carry these?

Thanks