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Doctors' Answers to "Frequently Asked Questions" - Eye Problems

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Related Info: Eye Diseases

Tingling with eye movement [posted 1/13/99]
Question: I have been experiencing a "tingling" sensation down my arms and legs when I move my eyes left or right. Also a little in the face and chest. It varies in intensity from severe to mild. I've not been able to identify any aggravating factors except perhaps the one below. I have a pituitary adenoma, currently undergoing endocrine testing. I have the usual symptoms for that, I guess. No periods, galactorea, could only conceive my only child with a GNRH pump. I went through a major depression several years ago and have been on Zoloft pretty much on and off ever since. I quit taking it about 2 months ago, so I could take Zyban in an effort to quit smoking. It seems when I'm off of it, these symptoms with the tingling are worse. Could be a coincidence. Can these tingles be a symptom of some serotonin or other related problem? Or of the lack of Zoloft? Can they be allergy or congestion related? They only seem to occur with horizontal eye movement, not up and down. When they are severe, I can also detect a rushing sound in my ears. This whole thing happens in seconds, but goes on all day when I move the eyes around. I had an MRI, which showed sinusitis in the ethmoid sinuses. And I sound nasal when I talk anymore. It showed the adenoma, and everything else appeared normal. No cobwebs even! Also, I'm thin in the arms, legs, buttocks, but gain all my weight in my abdomen and upper hip in the back. Is this a hormonal thing? I don't gain weight where women usually seem to. I know this is a lot. My main concern is the tingling. I've been doing a lot of research that has come up short. The serotonin thing is the last thing I can think of. I even considered peripheral neuropathy, but I have no pain. I'm not an alcoholic, but do have a beer or two in the evening, and sometimes go out and have some drinks on the weekends. I have been taking a lot of tylenol and ibuprofen for bad headaches. The headaches are in the front, behind the right eye and at the back of the neck (left side). I'm sensitive to certain repetitive tones, they can really bug me, and I sometimes have problems with anxiety too. What a mess! Does any of this come together for you? I'm trying to think of every thing I can to help you help me, so I've probably overdone it. The neurologist said there is no connection between the eyes and the limbs, that could cause this, but it sure has been happening to me every day for about the last month.

Answer: Have your visual fields been tested? Since the optic nerve crosses right by the pituitary, there is a potential for involvement of the optic nerve with the adenoma. However, most likely an interaction with one of the medications. The tone issue suggests that something is amiss in your inner ear. This would probably have nothing to do with the pit adenoma, but is a normal dysfunction that's pretty common.

Eye Allergy [posted 1/8/99]
Question: I wear contact lenses (softperm type - rigid center with a hydrophilic outskirt). I have an eye allergy because after some hours of wear I get a lot of pus in both eyes. I cannot stop wearing the lenses because I have a fairly developed keratoconus in each eye and I don't regard the cornea transplant solution as the only way out. This is actually the only solution suggested by my doctor. Can you please advise me on some procedure, so I can avoid the constant pus and thus reduce the risk of developing an even more severe eye disease?

Answer: Sorry, too far out of my league.

Pain behind eye [posted 1/4/99]
Question: I have just recently been suffering from severe pain, localized behind my right eye. I have also noticed pupil changes. There is no N/V associated with this pain and nothing I have taken seems to alleviate it. I first noticed all of these symptoms after having been put to sleep for a Cystoscopy and Ureteroscopy, which immediately made me worry about an embolus. I went to see my physician, who agreed that it could have been a small clot but he didn't want to be too aggressive, instead he would just watch it. He gave me Imitrex for the headaches to see if it would help. The only thing it did was cause my heart rate to increase to 140. I have had two cardiac ablations for Inappropriate Sinus Tachycardia, and don't have much of an SA node left. Now I am on Norpace CR, and my EKGs reflect Sinus arrest with escape beats and my doctor is talking of a pacemaker. With all of this said, I would like to ask if there are any alternatives to treating this pain without causing other problems. I've been on Beta Blockers in the past, I take Aspirin daily and I still have pain.

Answer: Did you see an eye doctor? You're assuming a vascular cause, when I would want to ensure that you don't have glaucoma. A neurologist would follow, an optho-neurologist if one is available in your home town.

Horner's Syndrome [posted 12/08/98]
Question: I had cervical discectomy c6-c7 on Oct06/98 and now have horners syndrome in the left eye as explained by the neuro surgeon. Will this eye eventually return to normal or will it be something that is permanent .

Answer: Probably permanent, but, could improve over time.

Serotonin Reuptake Inhibitor Discontinuation Syndrome [posted 12/04/98]
Question: I am an optometrist. I recently had a 26 y.o. w/f present to me complaining of a sudden, marked dizziness when she moves her eyes in an extreme gaze, particularly if the eye movement is rapid. She does not note the dizziness at any other time. She is on no other meds and systemic history is otherwise unremarkable.  Her dilated exam, pupils, visual fields and several ancillary tests were normal. She later reported to me that she had been successfully taking Paxil for depression for 2 years. She discontinued use on her own 4 months prior because she felt she no longer needed it. The dizziness symptoms began at approximately the same time. I completed a MedLine search and found numerous references to Serotonin Reuptake Inhibitor Discontinuation Syndrome. With the onset of the symptoms correlating with the cessation of the drug, it is my feeling that they are related. I am referring her back to the prescribing doctor. Please comment on this Syndrome. Do you have any other suggestions? Thank you. 

Answer: Possible, but, I would be reluctant to believe that it would last four months. There is some disagreement about whether the syndrome really exists;but, a lot of patients report similar symptoms, so it seems that it does in at least some patients. I have a few patients who have had symptoms for 2-3 weeks never as long as a month. I'd look for other reasons. Good luck.

Seeing Spots [posted 11/10/98]
Question: My son who is 6 yrs old, has been telling me he sees, colored spots, they are shaped like circles, that are blue, grey, purple, black and they float around. Would you have any information with these symtoms?

Answer: Proably floaters;but, seen a opthalmologist.

"Floaters" or Spot in Your Line of Vision [posted 10/21/98]
Question: How do I get rid of "floaters". This is limited to my left eye.

Answer: Usually permanent.

Eye Problems Post Scopolamine Use [posted 10/21/98]
Question:I am looking for information about scopolamine. I used a scopolamine transdermal patch during a Carribean cruise in early May. I was told that one of the side effects is anisocoria. I wore the patch for four days and had uneven pupils during that time. The problem is I still have anisocoria two months later . It's most notable when I wake up in the morning. My left eye is more dilated than the right. It lasts for a while and then corrects itself later in the day. Is it possible that the scopolamine is still in my system?

Answer: The uneven pupils should have gone away in a few days-see your physician for an evaluation.

Vision Problems & Glucose [posted 10/8/98]
Question:I have a problem with my right eye that appeared about 10 days ago after an infection (nose and tonsils) that was accompanied with high fever and headaches. A few days after the treatment with antibiotics, I noticed a blur in my right eye. I took all the prescribed blood tests (including toxoplasma and CMV but I do not yet have the results). All the blood tests where normal and the only problem was a raise in glucose. At the same time I started a diet to restrict glucose.The diagnosis was "choroiditis" but the doctors are still sure. A week after antibiotics and cortizone,the blur persists with slight vision improvement. I am a 46 year old male, without serious health problems previously (except hepatitis B when I was 14 years old). There is a small infection in the left eye but the doctor says it is in such a position that it does not affect my vision.

Answer: Well, the glucose can be contributing. When it is returned to normal after stopping the steroids or with treatment with insulin/other, see if the blurriness persists.

Eye Infection [posted 10/1/98]
Question:A friend's daughter is having vision problems. We are trying to rule out what caused it. Does the Hepatitus vaccine that you would get at a doctor's office have any side effects that might cause an internal vision problem? She has been to many specialists and is awaiting blood and x-ray results. The doctors have asked if she was sick anytime lately. The only thing we could think of was her getting her hepatitus vaccine, along with the MMR booster, and then a hepatitus booster shot in July. After the July booster shot her daughter developed problems with her vision. Could you let us know what the side effects of this vaccine are?

Answer: Wouldn't expect it to.

Eye Infection [posted 10/1/98]
Question: Only Right eye.....VERY watery....continuously tearing....second day. Not itchy, crusty, etc. Just running alot and headache on that side of forhead and cheek bone.... sinus infection???

Answer:Crusty eyes are usually an infection. Often it is not clear whether this is viral or bacterial-a culture can help. However, we usually treat with antibiotic eye drops awaiting the culture.

Blind In One Eye [posted 8/14/98]
Question: My mother had an infected tooth. At the same time she went blind in the eye nearest to the infection. She has seen numerous doctors and had a lot of tests done, but can't find what is wrong. She is also on numerous medications. The doctor thinks its a blocked blood vessel, but can't find it on any of the tests. What do we do?

Answer: I suspect one has little/nothing to do with the other. However, if there is a connection it is in the cavernous sinus underlying the brain. The optic nerves pass just above this and a mass or infection here could be a uniting factor. The mouth, nose etc., all drain through the cavernous sinus. A CT or MRI of the head will see the cavernous sinus.

Viral Eye Infection [posted 8/11/98]
Question: What is the best why to get rid of a viral eye infection?

Answer: Few viral infections can be treated - the exception being herpes infections. However, we usually prescribe antibiotics to ensure that it is not a bacterial infection.

Eye Problem [posted 8/11/98]
Question: One day last September, I woke up and as I opened my eyes for the first time that day, I saw a light making an arc at the lower part of my left eye. It's like somebody's welding a door and I am looking on the other side. I see this almost every morning or when I get anxious or tensed up. Very rarely I see it when I am relaxed. I have consulted a few specialists and after thorough examinations, they said there is nothing serious they could detect or treat. I am worried as I have a history of retinal holes and have undergone laser treatment to seal up the holes. The last time I had treatment was two years ago.

Answer: Were your specialists retina specialists? If so, I don't know what to guess. If the problem does not persist, it would not be a permanent or disabling condition. I suspect your are stretching areas of your retina where you previously had surgery. This actually happens to most people (who haven't had surgery) as they age. They experience the "flashbulb" of stretching on the retina.

Pink Eye [posted 8/5/98]
Question: What exactly is Pink Eye, how contagious is it, and how is it treated? When treated, how long does it stay contagious?

Answer: Usually thought to be a viral infection. Treatment is symptomatic since antivirals for treating eye infections are basically limited to herpes infections. It is probably contagious for up to one week depending on circumstances.

Eye Problem
Question: I have seen my regular physician, an ear, nose and throat specialist and an ophthalmologist. Next, I will go to either the Mayo Clinic or Barrows Neurological Center. As one physician has continually referred me to another, because they have all been unable to diagnose my condition. The nearest anyone has come is my ophthalmologist. He suspected Horner’s Syndrome, but has many doubts. I woke one morning and my right eye was drooping. I have numbness above that eye from the eyebrow to the crown of my head, in a two inch strip. My headaches are severe. The eye closes more as the day wears on. (With rest, the eyelid droops less and the pain lessens) I have had an MRI, MRA, and a vision field test. No tumors, or aneurysms detected. The pain in my head (just on the right side, same as the droopy eye) is constant and excruciating. This is what is puzzling all the doctors that I have seen. Could you possibly suggest "words", or "conditions" that I may look for on the internet in order to research the symptoms that I am having?

Answer: Some possibilities: Myasthenia Gravis, Optic neuritis, Syphilis, Sarcoidosis. These are listed in order of most likely to least likely.

Blurry vision
Question: I have blurry vision that started three days ago. I have never had a problem with my eyes before. Besides the blurry vision, I have dry mouth. I'm thirsty all the time. After I have been up for a few hours I get a headache. I think my blurry vision gives me a headache, I can also see things better from a distance better than objects that are close to me. I had an infection in one of my eyes about 2 months ago, and eye drops cured the infection. After that, I didn't have any problems with my eyes, until three days ago.

Answer: There are two possibilities. First, that you have a systemic problem like Diabetes Mellitus. Second, that you have a return of your previous ocular problem. Call your eye doctor again to be examined.

"Choked Optic Nerve"
Question: Back in March, I began having a problem with the vision in my left eye. After seeing several doctors including Opthamologists, neurologists and hematologists, I have been diagnosed as having a "choked optic nerve" which is causing the blurred vision and blood tests have detected a low antithrombin III functional (I scored 92% where range should be 96%-112%). My antithrombin III (AT3) came back normal and so have all other blood tests and MRI. I was on the pill for seven years but I stopped taking it last September (of '96). My doctor (hemotologist) seems to think this is a genetic problem yet there is no history of blood clots or any type of blood problems in my family. I am otherwise a very healthy person and while my eyesight has not improved, it has not gotten any worse either. My concern is that I'm being told that I need to start on a lifetime treatment of coumadin. I have read a lot about this drug and its side effects and I'm concerned that I'm now going to begin a treatment that may or may not be the answer to my problem. I have been taking an aspirin a day (recommended by all doctors) since July. I'm going for another opinion, but I'd like to seve your opinion as to whether or not a woman of 32 years of age could possibly find another "blood thinning" solution that doesn't involve putting such a dangerous chemical into my body.

Answer: I assume that other tests than anti-thrombin III were ordered. This is a minimal variation from normal. Were lupus anticoagulants and Factor V leigands checked? Anyway, the only effective anticoagulants currently are aspirin and coumadin. There is Ticlid;but, it can be very toxic as well as expensive. I certainly would recommend aspirin. Some patients take a very small dose of coumadin. You must know that the side effects of coumadin are dose related. A small dose rarely causes side effects or excessive bleeding. Some patients take aspirin and one mg of coumadin. It would be hard to advocate systemic anticoagulation. However, I doubt you are interested in a stroke. Did you have an echocardiogram and an MRI angiogram?

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