Nightime Severe Pain in Eye

[Namaste58]

Hello
8 years ago I had cataract lens replacement in right eye followed by lasik surgery.  Previously I was extremely myopic at -18D. I needed lasik as the replacement lens made me far sighted and I couldn't cope.  Following these ops I started to get severe pain in my eye at night (never during the day) It was like needles being inserted, it was agony.  The pain came with closed eyes and when I was in REM or just waking up, so related to eye movement. My consultant put it down to dry eye and the eyelid sticking to the cornea causing recurrent corneal erosion. I learnt overtime never to open my eyes without dribbling drops in first and always focussing (through closed lids) into the distance. This would also lessen the pain when I did get an episode.  Following the episode my near vision (lens is set for reading) is fragmented and blurry, whilst distance vision is improved. It can take several days for vision to come back to normal.  Over the years I have managed to reduce the episodes to twice nightly to one every few weeks. It has had a huge impact on my health as at its worst I was scared to go to sleep and even now I wake frequently to put various drops and ointments in. I cannot go more than 4 hours, usually its just one or two.  Recently, over the last two years whenever I have been to get my eyes seen after an episode there is no evidence of corneal erosion.  I have often thought over the years that it doesn't feel like the pain is coming from my cornea but deeper in the eye.  Originally I thought it might be the lens moving but I am assured it is not.  I am now wondering whether it is some sort of muscular spasm and my research has led me to Ciliary Spasm. However from what I've read so far it doesn't seem quite right.  I would be very interested in your opinion as to what may be going on.  I would love to get this sorted and consequently improve my health.

[JohnHaganMD]

Your symptoms do not at all suggest ciliary spasm. It is a classic type of recurrent corneal erosion syndrome. Often the RES is NOT visible to the ophthalmologist even with large magnification. Go to my home page and look at the posts and read my posting on RES. Or use the search feature and read my article.  You could also possible sleep with your eyes slighly open during sleep. My suggestion after your read my article and other postings is to see a Eye MD cornea specialist.  And of course  you should be using a lubricating GEL or OINTMENT at bedtime every night and not sleeping under a fan or with air moving across your face.

[JohnHaganMD]

Your description is classic for RCE but not for ciliary spasm.  Read this article I wrote:  http://www.medhelp.org/user_journals/show/1648138/General-Information-About-Recurrent-Corneal-Erosions

You may have RCE but not have evidence of it on slit lamp exam by OD or MD. You will need to use either a lubricating GEL at bedtime or a lubricating ointment or a hypertonic ointment like MURO 128. Be sure you don't sleep under a fan or have air blowing on your face.

See a cornea specialist. In the worst cases a superficial keratectomy is often done with the eximer laser and a bandage lens is worn while the corea heals hopefully without RCE.    You may also have an underlying cornea disease like basement membrane disorder or/and dry eyes  which will need treated. See a cornea Eye MD ophthalmologist to get started on healing.

[Namaste58]

Thank you so much for the reply.  I am doing all you suggest and my specialist has mentioned the next step may be surgery as you suggest.  I just needed a 2nd opinion as nothing I do seems to have any lasting effect.
I will keep plodding on.
Thanks