Communicating with Doctors

Factual Questions
1

I know we aren’t allowed to give medical advice on this forum, but maybe someone can give me some advice on communicating with my doctors about a condition that I have.

For a few years, my eyes have very occasionally had mild problems on the inside corner (nasal side) and outer corners, feeling prickly. At first, I couldn’t describe the problem accurately - I could only articulate it as something in my eye. As time went on the the issue got worse, I was able to differentiate the sensation from “something in my eye” and can now tell that it’s a rubbing or prickly feeling on the eyelid between and around the eyelashes.

Upon closer examination in the mirror, I can see that some lashes (about 8 or 10) along the outside corners on the top lid poke into or point at the bottom lid, and a few from the bottom poke up against the top lid. This is pretty uncomfortable when my eyes are anything other than Wide Open (wider than you would normally have your eyes).

Somehow, the first ophthalmologist diagnosed this as Blepharitis and prescribed medicine. I spent money, it didn’t work, he gave me another prescription for the same medicine, which didn’t work, another prescription, didn’t work, another prescription, didn’t work. I asked for a new ophthalmologist. He suggested I re-try one of the old Bleph medicines and come back for a re-exam. I did, he referred me to an eye-reconstructive plastic surgeon, but he was obviously convinced it’s Blepharitis, and not my eyelashes.

I go to this plastic surgeon, who uses a cryo-freezing method to permanently remove eyelashes. He also does not agree that it’s my eyelashes that are causing my discomfort, and suggests it’s dry eye.
By now, I’m frustrated.

I explain that I look in the mirror and see eyelashes banging against the opposite lid, and this is what seems to cause the discomfort. When I pluck the lashes, the symptoms disappear immediately.

I tell him I have let the existing lashes grow for several days, if he looks he can see them in the corner of the eye, about 1/4 the length of normal lashes. He is looking with a microscope and says he doesn’t see them.

I told him I can drive home and look in the mirror and see them. That he doesn’t need a microscope, to just look in my eye. He said if you can see it by looking in my eye, you can see it with a microscope.

I said I have gone home and my girlfriend can see them with her unaided eye. She has taken a picture with my camera, which I uploaded to the Internet. I had about 10 friends look at the picture and all of them can see lashes that would be an issue.

I’ve had this issue bothering me seriously for several months now. I know the pattern:
[ul]
[li]If I have no symptoms, I can look in the mirror every day and the lashes are not poking out[/li][li]The moment I get symptoms, I look in the mirror, and I see lashes poking out[/li][li]If I leave the lashes, I continue to have symptoms[/li][li]If I treat Blepharitis with the expensive prescriptions, I only feel worse, not better[/li][li]If I wait 1 day or several days, I continue to have symptoms[/li][li]If I pluck the lashes, I get immediate relief[/li][li]I have relief until the lashes are growing back[/li][/ul]

Somehow, I can’t convince these doctors (the last one of which has the cure to stop the lashes from growing) that the eyelash is the problem.

They describe Blepharitis and dry-eye symptoms to me, and I don’t seem to have them, but I do seem to have something similar to what I can Google as Trichiasis. Technically, Trichiasis means the lash pokes into the eyeball, and my lashes are only poking the opposite lid.

So, this doctor wants to give me a procedure that may or may not permanently affect me: He wants to add Plugs to my eyes. This is an operation (I don’t know if it’s considered surgery) which will reduce the amount of tears that travel from my eye to my nasal passage, like stuffing a cork in the tear ducts. i.e., he’s treating dry-eye, not my lash issue.

It doesn’t matter how many times I explain that the symptoms are only ever relieved by removal of offending lashes.

He suggested I use Soothe XP (lubricating eyedrops). I said I have, and showed him my bottle. The bottle says the drops last 8 hours. He said I may have to use them more often if I have dry-eye. “How often?” I ask. Every 30 minutes during extreme symptoms. I said there are times when I use them every 5 minutes, every 30 minutes, every 60 minutes, and they don’t seem to help much if at all. However, when I get home and am able to remove the lashes, the symptoms disappear, no more drops are needed at all!
So - how do I convince the doctors to use the treatment which stops the eyelashes from growing, as opposed to continuing to prescribe medicine and treatments which are obviously not helping my issue?

2

Get a new doctor. Some doctors you just can’t be convinced of anything. They are trained to treat problem X, can only see problem X, they are not going to be convinced otherwise and some stupid patient trying to tell them their job isn’t anything other than annoying. Not all doctors are like this but far, far too many. They don’t know about your history, they can’t feel what you are feeling and ,frankly, they aren’t interested. To be (a little) fair, they probably see a lot of people with whacky claims and I think some just get jaded.

So your original doctor referred you to his old college buddy and sent along a note telling him what your “real” problem is. You need to start over with a doctor that listens.

3

Actually, my Primary Care Physician referred me to an Ophthalmologist who gave me 5 prescriptions for Bleph. Unsatisfied, I asked my PCP for another ref, who sent me to Ophth 2. Ophth 2 referred me to Ophth 3, whom I saw yesterday. So that’s 4 total doctors.

This third Ophth wants to put plugs in and prescribed a tear treatment called Restasis.

I’ll use it, because I won’t get any further with the doctors if I refuse to, but when I got home, I plucked the lashes and the symptoms disappeared. I’d let them grow for 5 days after symptoms started so that I could show them to the doctor.

These are gory closeups of my eye, but you can see the small lashes here:
http://picasaweb.google.com/cheeop/20090122Eye#5294261702040177650

and I highlighted them here:
http://picasaweb.google.com/cheeop/20090123Eye#5294704683907106178

I took more last night before plucking them, I haven’t posted them yet.

Just imagine as I close my eye slowly, those lashes touch the opposite eyelid.

4

Oh one more fact … the first Ophth I saw is this medical group’s lead ophth - he authorizes all referrals for the medical group.

So when Ophth 2 put in the referral request to go to Ophth 3 to treat the symptoms I claim I have, it had to go to Ophth 1 who might feel burned that I went to a 2nd and now 3rd doctor. Who knows what he put on the referral authorization? What did he communicate to Ophth 3 before my appointment yesterday?

5

One way to start fresh is find another primary care doctor and ask him to refer you to another opthamologist that you have not seen yet. Thay way everyone gets to start over and not have any previous info about your eye.

6

Well, eyes are funny things. I’ve had a bunch of eye problems and sometimes what it feels like isn’t what the actual problem is. For example, I thought I had something in my eye, like sand, and it turned out to be pink-eye - a viral infection. So I certainly won’t try to give you medical advice. Being irritated by your own eyelashes does sound a little odd though. I can look at my lashes and they touch when my eyes close and I’m not irritated by them. Maybe the problem is that your eyelids are overly sensitive for some reason?

In my case, my doc diagnosed blepharitis too although I had very different symptoms from yours. That’s pretty general and doesn’t really tell you anything about the why. It’s like, if you came to me and told me your eyes are irritated and, after careful study, I said “your eyes are irritated, that will be $100.” If you goggle blepharitis it quickly becomes clear that there are a lot of opinions on what it is and what to do about it. So you’ve tried the one solution the one doctor offered and it didn’t work. Either he tries something else or you need to see someone else. It tried the general eye hygiene suggestions and that has solved my problems so far.

You prictures … ugh. I could only look once. If you’re plucking your eyelashes, isn’t that painful?

7

Only for a moment, and then there’s some lingering discomfort for 30 minutes or so, but it’s less than the discomfort I normally get.

The discomfort I get from the eyelashes isn’t that they touch eyelashes on the opposite eye, but that they touch the opposite eyeLID. So 10 or so lashes from my upper eyelid will actually come in contact with my lower eyelid, not the lower eyelashes. It’s this contact with the eyelid that causes me distress - it’s so distracting it makes it hard to drive.

8

I work in ophthalmology but not really in this area, IANAD/N, etc., etc.

Stupid question: Have you tried an eyelash curler to bend them into a better shape, rather than actually plucking the possibly-offending lashes out? Or just trimming those lashes short?

From what little I know (in a layman’s sense) about plucking - if you don’t actually kill off that hair follicle, you might just get them to grow back even more “crooked”* and potentially have them poking you in the actual eyeball.

  • I wrote “cockeyed” at first here… :smack:
9

The base of the eyelash is what rubs against the opposite eyelid. There’s no way to curl it “enough” so that the base of it doesn’t hit it.

Picture a row of tall, thin trees. Now picture a wall being placed on top of the trees. If you were to curl or bend those trees, the wall would still come to rest on the trunk of the trees.

In this case, the wall is the opposite eyelid, and the row of trees is a row of offending lashes. Even if I trim it, the smallest bit of it that pokes out of the skin is going to poke the opposite eyelid.

10

I have similar problems (with my eyes, not my doctor!).

I am constantly plagued by eyelashes - both by them coming loose and falling into my eye, and by them “meshing together” and causing irritation.

It’s never occurred to me to go and see a doctor about it though - I guess it’s just the way my eyes are built.

11

Sometimes you just have to break down and go to a doctor outside your group. If you live in a big city, try a research hospital. If you have one, they usually have doctor referrals, call them up and explain say “I need a referal for a TOUGH CASE, I’ve been getting no satisfaction.”

Sometimes you just gotta break down and spend the cash, because a good doctor is a RARE thing.

12

Not to be snarky, but I tend to find that when a patient tells me they’ve gotten no satisfaction from their previous half-dozen doctors, they’re not going to be satisfied with me either.

Sean, have any of the doctors explained to you why they think you get relief from plucking if the problem is not coming from your lashes?

13

When I was a technical support rep on the phones, and a customer tells me that they did not get satisfaction from the previous 6 support reps, I find that what helps is for me to just listen to their problem with an open mind. Often I’ll find that the previous 6 reps pigeon-holed the customer’s problem incorrectly, because the customer didn’t explain it right, or the support rep wasn’t listening carefully.

Sure, sometimes the customer is the boneheaded one in this exchange, but far more often, the previous 6 reps just weren’t listening right or there was some other miscommunication. I’d like to think that’s what is happening here.

As far as why they think I get relief from plucking? I can’t get a straight answer from them. The Ophth I saw yesterday (Dr. Bruce Becker) is apparently a leader in his field and a serious expert. When I tell him my tale of “symptoms are only present when eyelashes are present, as soon as I pluck them, the symptoms disappear,” he says that I should try his eyedrops. I can’t seem to get them to give me a straight answer to that question. I tried several times during yesterday’s appointments. He would say that when I come back in to have the plugs added to my tear ducts, he will look at my lashes again then.

I don’t even know that I need plugs.