Can a doctor "see" dry eyes?

Factual Questions
1

I’m on my third referral for ophthalmologists for a problem with my eyes. The doctors keep diagnosing me with something different than what I think I have.

I’m wondering what’s leading them to these diagnoses when I’m not reporting any symptoms of what they say I have. So, is it possible to “see” dry eyes in a patient?

Symptoms: Stinging, burning, scratchiness, stringy mucus, and excess irritation from smoke.

I have none of these problems. My problem is that the lashes in the corners of my eyes poke the opposite eyelid and it causes a great amount of discomfort. After almost 40 years of living with this issue, I started plucking the offending eyelashes and that provides relief. I’m trying to get them to use one of the treatments that permanently removes the eyelashes (laser, cryo, thermo, electric) but the doctor thinks that, instead of having a problem with my eyelashes, I have dry eye.

He tells me the symptoms and I tell him I have none of those, and repeat my symptoms to him. He says I need his treatment instead. He gives me eyedrops (Restasis) and then gives me punctal plugs.

I’ve had these plugs in for almost a week and they give me a sensation that makes it hard to look around. Every time I look left or right, it feels like the tip of a ballpoint pen is being shoved against my eyeball.

The eyedrops he gave me burn my eyes and make me feel uncomfortable pretty much all the time. Every swim in a heavily chlorinated pool, and your eyes burn for a short time after? Well, mine feel like that for about 10 hours after using the drops, and they are every 12-hour drops. And they make my eyes feel swollen like they want to pop out of my skull.

So why am I using painful and discomforting treatments that he’s giving me for a condition that I don’t think that I have? It’s not like he’s giving me a treatment that has no negative side effects at all. If that were the case, I would just take the treatment and report to him a lack of positive results later. But what’s happening now is horrible side effects that affect me every moment I’m awake, and I’ve so far seen no positive results from these treatments.
So - why is the doctor so convinced that I have dry eyes and not an eyelash problem? Can he “see” it when he looks in my eyes?

Let’s pretend I do have dry eyes, but the symptoms from my eyelash issues overwhelm the symptoms from dry eyes. I won’t even be able to tell if his treatment is effective, because another issue I’m suffering from is many times as bothersome.
I couldn’t convince the previous doctors that my eyelashes are a problem, either. They thought I had Blepharitis, and an optometrist thought I had an allergy. All of their treatments are massively unpleasant, and have so far yielded no relief from my symptoms. It seems that every doctor I visit gives me a treatment that is less pleasant than the previous treatment, but they have yet to treat the symptoms I’m reporting. They keep treating totally different conditions which are normally accompanied by symptoms which I do not have.
Any advice on how I can get them to discontinue treatment for conditions I don’t have and give me treatment for the condition I do have?

2

Well, yes. Dry eye leaves the surface of the eye vulnerable to abrasion, which is irritating in its own right. Abrasion leads to roughening of the surface, which is also irritating. This damaged surface can be seen, and can be revealed unequivocally by fluorescein, a dye which stains damaged areas, but not healthy eye surfaces. Dry eye is mainly diagnosed by a patient’s reported symptoms, though – here’s a questionnaire used for such diagnosis.

The thing is that almost any irritation can produce symptoms of dry eye; if, for example, you unconsciously avoid blinking because of your eyelash problem, your eyes probably are dry – but dry eye isn’t the problem.

Restasis is a suspension of cyclosporine in castor oil. Cyclosporine is an immunosuppressant, and Restasis is only useful in 15% of patients. My brother (an optometrist in a large ophthalmology practice) says flat out that it doesn’t work, but there aren’t any other treatments, so it gets prescribed out of desperation (or out of ignorance or greed). Many patients find it worse than the “disease.”

If your doctors aren’t listening to your history, especially the report of relief after plucking at home, you need to keep looking. Ciliary epilation (plucking) is a common procedure, as are electrolysis or laser treatment for trichiasis. These are usually done for more serious eyelash problems, like a lash curving straight back and contacting the eye itself, and doctors may be reluctant to diagnose trichiasis when they don’t see this. It’s possible that without some underlying irritation, the eyelashes wouldn’t bother you.

3

That was pretty much my read on it, too. Perhaps bleph and dry eye secondary symptoms are being noticed by the docs who look at my eyes, and therefore they assume the cause is either bleph or dry eye.

I know that trichiasis means the lash contacts the eyeball, and that does occasionally happen when I let the lashes grow out to their full length. After I pluck them, they start to contact the opposite eyelid which is very bothersome and distracting (especially while driving).

The doc did do the fluorescein test that you mention. The previous doc did a full round of eye tests (he wanted to rule out glaucoma as a cause of the eyelash symptoms I was reporting). I have the smallest blind spots he’s apparently seen in forever. I have great optic nerve strength. I have the appropriate thickness to my cornea, etc. So my eyes are amazingly health except for a pressure of 21-23.

So I wish they’d get off the eyeball and get on the eyelash and I’ll feel much better.

Since you’re in CA, maybe you’ve heard of this guy: Bruce B. Becker. He’s apparently a real whiz, top of his craft.

4

Not exactly, but the evidence of such a condition.

Quit going to these Drs. (Quacks?)

Schedule an appointment with a psychiatrist. Possibly he can give you some direction to find assistance.

5

Very classy answer for a question in the General Questions forum topic, thanks for your concern.

6

My suggestion is to tell the (next) doctor that you’ve been very frustrated in trying to deal with this condition because:

~ The treatments have been ineffective and actually seem to cause problems rather than solve any

~ The diagnoses seem to be very much at odds with the symptoms - i.e., you don’t have symptoms typically associated with the diagnosed condition(s), the symptoms you do have don’t appear to mesh with the diagnosed condition(s)

~ Your experience clearly indicates at least some, if not total, relationship to the eyelashes

AND tell him that you’re at a point where you really feel the eyelash issue needs to be addressed, at the very least with a satisfactory explanation of why it might not be as important as you perceive it to be; and that if he can’t provide that, you won’t have confidence that he can help you.

7

Thanks.

I just got back from an appointment with the doctor. I told him that the punctal plugs he put in on Wednesday last week are still bothering me. I told him it makes driving seem risky and dangerous, and it’s very bothersome every time I roll my eyes left or right.

I described the sensation as akin to a ball-point pen being shoved against my eyeball on both eyes.

He said he wants to wait a couple more days and see if it gets better.

I don’t understand why I need the plugs in the first place. All they seem to have done is irritate my eyes, but he feels they’re important. I almost wanted to yell at him to take them out right now, but I try to restrain those yelling impulses when I’m talking to a guy who might be doing more surgery on me.

8

When all else fails seek out an Opthomologist and get a second opinion/treatment plan.