Sclera Health - Peripheral yellow tinge

[GTXDingo]

After inserting contact lenses nearly every day, I have began to notice a yellow tinge on the outer surface of the whites of my eye (near nose and peripheral). I have problems when I use computer screens swell - even brief use causes a red static tired eye look that resembles being poked in the eye.

Its not a specific yellow 'lump', but a 'C-shape' discoloration that is beginning to appear when you get closer to my nose and peripheral eye (I notice this as I initially place my contacts on the white part of my eyes and look around for it to sit properly). The immediate sclera near the iris is white (blotted red when dry).

I've had recent eye tests including glaucoma who have not noted any serious issues. I highlighted the yellow tinge, but the opt. dismissed it as Wind&Sun damage - telling me to wear sun glasses and noted I have very dry eyes, i need to use moisturizing eye drops and being fair skinned I shouldn't be in the sun a lot.

I've had several blood tests including liver function after my GP wanted a base check as I moved countries. These all came back clear, and i've never had any issues. I asked the Dr about the yellow discoloration, who passively dismissed it as UV damage after a glance - told again to wear sun glasses and use eye drops.

I've moved to a hot climate, Australia, and been traveling around hot countries near the equator for nearly 10 years years. Sadly, I must admit I have not always faithfully wore sunglasses until recently. Also, I do a lot of sea activities.

Question - for some re-assurance.

The infamous google search - horror stores of liver failure and jaundice, along with haunting pictures of harrowing glowing yellow eyes? I must admit, this causes the most distress as I never want to look in the mirror and see that in myself.

The other explanation, Pinguecula. The images, however, appear to show a growth that seeps into the iris or a itchy lump. Mine look to be in the extreme right or left, and appears to blend into the white sclera in a distinct C-shape.

Can someone confirm what this is, as ultimately its causing some distress which I hope is just over cautious worry!

[John C Hagan III, MD, FACS, FAAO]

I don't think your optom dismissed it. He/she told you what it was. Sun damage and I'm sure contact lens wear. With dry eyes and contacts and these bumps they will likely grow bigger in the future as not only sun damage, dry eyes but especially contact lens wear can cause them and make them bigger.  In some cases they turn into pterygiums which grown over the cornea. You need to rethink wearing contact lens and consider going back to glasses. Also if you will Google Images pinguecula you will note they come in all sizes and shapes.

[GTXDingo]

I use monthly contacts.

In general, I wear them around 11 hours per day, 8am - 7pm, Monday-Friday. On the weekend, it depends on my activities but could be around half the day.

I'm 29 years old. I saw three 3 eye doctors actually at two separate independent clinics.

At the first clinic
There were two people whom may or may not have been a Ophthalmologist. I don't now as it does not clarify this anywhere for me to check. The first person said I had Pigmentary Dispersion Syndrome, followed by a field vision test which I failed. The further visit was a follow up Field Vision with his colleague at the same clinic, I passed 2nd time. I questioned the Eye Doctor about her colleagues notes about the Pigmentary Dispersion Syndrome. She said there was no notes apart from a 'Spindle' observed and using my own words, he was probably just using 'big words'...

At the second clinic
The second separate independent eye clinic did a further eye test including Glaucoma pressure and confirmed no issues found (This was to check up on the pigmentary dispersion syndrome as I did not trust him).The 2nd separate clinic eye Dr who said my eyes were fine was a B. Optom as I can see it on the business card.

I put the initial quick diagnosis down to someone/clinic who just wanted medicare money... as no other eye dr has told me this and his colleague couldn't even see it in the notes. Therefore I did not mention it in this post.

All 3 Drs I asked about the discoloration who all said wind and sun damage (the first actually told me to not wear contacts for while as my eyes are so dry, the others said my eyes were fine and I can wear contacts... one even said I can sleep in my type of contacts - albeit, I personally wouldn't dare)

As you can see, the different opinions received lead me to mistrust them, ask my GP about it then subsequently ask on here for advice. I originally left this out as I did not want to confuse my initial question with all this.

[John C Hagan III, MD, FACS, FAAO]

I really don't see the problem.  You have dry eyes, you wear contacts too long and you are getting irritated  symptoms on the outside part of the eye. Most everyone is going to suggest you stop contacts or reduce drastically the time you wear them every day and maybe go to daily wear disposable.

The second is a totally new problem you did not discuss. If you have a collection of brown pigment on the back of your cornea (especially if brown eyes, young male and myopic) that is called a Krukenberg Spindle or K spindle. It raises the risk of getting an especially severe form of glaucoma called pigmentary glacuoma. You cannot make diagnosis of glaucoma from single measurement of intra ocular pressure (IOP). If I saw a patient like yourself I would explain K spindle, explain pigmentary glaucoma and do a complete baseline glaucoma work up. This would include complete medical eye exam by Eye MD ophthalmologist, measurement of cornea thickness (pachymetry), Visual Fields, gonioscopy and optic nerve OCT. If all normal I would recomend an annual eye exam by an Eye MD with at least one extra glaucoma test usually a optic nerve OCT or visual field.   I fail to see a reason for your mistrust of the people who have checked your eyes.

[GTXDingo]

Thanks for the response, much helpful.

My own mistrust was a result of the perceived the mannerism in which I was told about this PDS. It was quick and abrasive, and the follow-up after a failed vision test contradicted him with mentioning it’s a spindle in the notes, no PDS noted.  

No test other than a Vision field were conducted as that clinic, which left open questions.

[John C Hagan III, MD, FACS, FAAO]

Well never an excuse for bad manners and brusque behavior.  Most people with K spindles do not develop glaucoma especially if no family hx and IOPs normal.  I'm less optomistic about your ability to continue to wear contact lens. About 20% of the refractive surgery our clinic does is due to people happy with contacts who become unable to wear them or wearing them damages the eye. Of these by far the most common underlying problem is dry eyes.

[GTXDingo]

Thank you John, very helpful input and greatly appreciated.

[GTXDingo]

My vision is sph -1.0 and sph -1.25.
Perhaps in the future, if it progresses, I'll look into refractive surgery.
Also, I'm in to the progress of requesting the original optician to make a referral to a qualified Ophthalmologist to verify the reported findings.

[John C Hagan III, MD, FACS, FAAO]

That is mild myopia. Know that if you had refractive surgery you would likely be happy camper till about age 43-45 then your reading vision will fail (presbyopia) and get worse as you get older. so you would be in reading glasses for a while then in your 50's some time likely progressive bifocals to see and different distances closer than 20 feet. If you do no have surgery you near vision without glasses will probably be quite good till about age 50-55.  That is why I have never had lasik. I'm -2.50 myopia and can do all my near work, reading and computer without glasses.

[GTXDingo]

You have been very helpful, thank you John. I will stay with the blessing of my current vision, keeping it simple.

[John C Hagan III, MD, FACS, FAAO]

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