Chronic eye pain in just one eye

[julieanne444]

Since 2004 I have had chronic pain in my right eye, and it has progressively worsened.  At first this was attributed to age-appropriate dry eye.  I tried Restasis without positive results.  A variety of over-the-counter eye drops and gels were tried with only temporary relief.  Since the pain was so pronounced in the right eye, I was referred to a neurologist.  He performed blood tests, diagnostic scans and, finally, an MRI.  There was no sign of tumor, but a bony deviation in the right septum was revealed as well as "chronic small vessel ischemic changes of white matter, slightly more prominent in the right than left cerebral hemisphere."  

Following the MRI I had surgery to repair the deviated sinus.  I was also prescribed an 81 mg. aspirin daily.  I was also evaluated for Sjogren's Syndrom,with negative results there.

Temporary plugs were placed in the right lower punctum without success, and the pain persisted.  Finally the right lower punctum was cauterized to see if the presence of additional tearing would be helpful.  But the pain did not abate.  Because the excess tears caused blurring of vision, I recently had a Jonbes tube placed in the right eye.  I am two weeks out at this time from surgery.  That has healed well, but the pain is ever present.  As the day goes on pain worsens, and I finally just have to lie down and close my eyes.  At this point that seems to be the only relief I get from pain.  NSAIDS do not relieve the pain.

Is there any suggestion for further treatment or medication?  I would appreciate your advice.

[Houman Vosoghi, MD]

Consider going to a glaucoma specialist to have gonioscopy done.  Narrow angle glaucoma may lead to blurry vision and aching eye pain/headache but is usually intermittent and comes and goes.  Other than that, making sure you have the correct reading glasses perscription is the only other thing I can think of.  Inadequate blood flow could cause eye ache but I would want the other two things checked to make sure it's not something that needs treatment.  Let us know what happens.

HV

[Houman Vosoghi, MD]

Is it a stinging quality pain or aching?  are there any visual changes that go along with it?  I would go to a well known ophthalmologist, have him/her do a full eye exam and see if there is anything others may have missed.

HV

[BigDannyV]

A related discussion, Deviated septum, chronic sinusitis = vision loss was started.

[julieanne444]

Thank you for your quick reply.  This is in answer to your two questions:

(1)  The pain is a strong dull pain, nothing sharp or stabbing.  It feels like the occasional bad headache I would have in years past, but the pain is located in the right eye.

(2)  I do have some moderate blurring of vision in the right eye.  There is also eye strain and fatigue.  I do very little reading anymore because of this.  

I am seeing a respected ophthalmologist who was recommended to me by my family physician and a family friend who is an optometrist.  They refer to him as the "regional specialist" in our area.  I have been satisfied with his treatment and attention to detail.

I have had fluoroseine injections and associated scans with my current opthalmologist.  That testing has revealed circulation problems in both eyes.  

In mid 2010 I experienced a vein occulsion in the left eye.  That cleared up with Avastin injection therapy.  However, in December a macular hole developed in the left eye.  A vitrectomy was performed, with the expected difficult (face down) recovery period.  Although the macular hole is now closed, my vision has made very modest improvement.  Fine focus has not returned.  You can imagine the degree of concern I continue to have in wanting to maintain healthy function of the right eye.  My quality of life has been curtailed, and I want to avoid any further deterioration.  I am 63 years old and have overall excellent health, with an active lifestyle.

Thank you for your consideration of this matter.  I do appreciate it.