confused by discrepancy between symptoms and diagnosis

[wishforchange]

I attended the emergency department at my local eye hospital with over two weeks of deep eye pain.  Like a headache behind my eye.

They examined me and said I had severe dryness of the eyes and blocked oil glands, especially under the lids - Blepharitis.  They gave me a leaflet and ian ntensive treatment regime of drops, compresses and massages for a month.  They also said I had evidence of follicle inflammation from a recent viral infection.

On the leaflet, and on their own website, I had none of the symptoms of this condition.  The symptoms included gritty feeling in the eye, crusting in the mornitng, photosensitivity, pain on blinking etc.  I had NONE of these.  I had only pain deep within the eye, not made worse by light, no grittiness or corneal problems, and was wearing my contact lenses comfortably.  I have had no reddening, conjunctivitus or anything recently.

I was told how the pain could be referred back through the corneal nerves.  But I still can't 'buy' this as a diagnosis, as there are no surface symptoms.  I argued it was a finding, but surely it could not be the cause of my deep pain.

I have followed the regime for several days now.  The pain has subsided, but has not gone.  This makes no sense.

Please explain how dry eyes can cause no surface symptoms but deep pain.  I am still in pain though, just not so bad.  This is a very respected hospital so they generally know their stuff.  I'm very confused.

[Michael J Kutryb, MD]

Honestly - you really wouldn't be able to see if unless you could look at your own eyes with a slit lamp microscope. Since I really don't  know your true findings,  you should just take this conversation up with your own ophthalmologist. Ocular pain and discomfort can be a "surface' complaint - and by the way I've never actually used that term before.

MJK MD

[wishforchange]

Thanks for answer, but I am still unclear as to why there would be NO surface symptoms, really, nothing.  My eyes are clear, non gritty, able to tolerate lenses (although off them for a month on advice).  No photosensitivity, no 'dandruff' etc.I have absolutely no corneal surface symptoms.  Just the deep pain. They found severe dryness of the lids and blocked ducts.  This still makes no sense.  Can you explain this at all???  Even with the regime the amount of crusting on my eye was minimal for one day and is now all gone.  I am putting on hot compresses day and night, massaging, drops every hour.  It's like the invisible problem!  Surely something should show.  Also on waking there is no pain.  It comes on as the day progresses.  I cannot get my head around this.  Makes no sense to me.  There should be some surface symptoms, surely?

[Michael J Kutryb, MD]

I'm glad the current regimen is working.  That is great! I would continue to keep close follow up with the doctors and continue current regimen. Dry eyes and lid margin disease, among its symptoms,  can cause a deep, aching pain of the eyes sometimes, that's for sure.  There are other causes of such pain but I am sure that your doctors have considered that as well.  The bottom line is that the doctors will treat what they think it is from the exam and history.  It sounds like they might be on the right track - how else would you explain your improvement.  Remember, it is a chronic disease and will  never totally resolve.  It's also possible you have another problem too like sinusitis?   In other words, it is entirely  possible you have more than one  condition.

MJK MD