chronic right eye pain for 4 months now.

[Markz999]

I had this chronic eye pain (aching, burning) for 4 months, seen as much as 5 eye doctors (3 ophthalmologists, 2 optometrist) none of them could explain my right eye pain.. my TBUT is normal, all tests shows healthy eye (tried one steroid and many preservative free eye drops with no relief)
since i have sinus, my right side is most of the time blocked (when I sneeze, my right side of my nose sometimes comes with small drops of blood).. went to see an ENT doctor, and he says everything is normal.


Note: I had PRK on both eyes in Jan 2016, left is 20/20, right is 20/25. Pain started 2017 July.

[JohnHaganMD]

Sinus problems is a common cause of pain around or behind the eye with a normal eye exam but it doesn't cause burning sensation. Moreover your sinus xrays or CT should have shown problems and the ENT should have been able to identify it. Assuming the 3 ophthalmologists did not find anything inside your eye causing pain by far the most common thing would be 1. dry eye caused by PRK  2. neurotropic post PRK/Lasik eye pain.  This is described in these links:  http://eyewiki.aao.org/Pain_Reduction_After_Photoablation    and  https://www.aao.org/eyenet/article/diagnosing-treating-neurotrophic-keratopathy?julyaugust-2008    

Normally you would work through this with the cornea surgeon who did the PRK.  If that isn't working out you might try a cornea specialist at a university eye program or a cornea/refractive ophthalmologist that specializes in post-refractive surgery complications.

[Markz999]

Thanks doctor Hagan,

1: for the neuropathic pain, I will a confocal microscopic next month with my doctor, can this be a final determination if its a neuropathy or not?. (the burning feeling sometimes goes away, but its there almost all the time)

2: Also, I noticed when I use anti histamine like Bendryal or any kind of anti histamine and using the Neti pot saline, it helps the pain for about half an hour

3: (I did a CT scan for my sinus and next week I will see my ENT doctor, CT scan should be enough? or an MRI is also an option).

Kind regards,

[Markz999]

1: I will do*

[JohnHaganMD]

1. No the diagnosis of neuropathic pain is not made from a single test but from the history and ruling out other causes.
2. antihistamines dry the eye and mouth and usually make dry eyes worse. So this suggests the problem is not primarily dry eyes.
3. CT scan is enough to rule out sinus disease.

[Markz999]

Thank you doctor.

[JohnHaganMD]

Best of luck Mark