eyestrain and IOL implants

[dcswanson]

I am having a devil of a time with eyestrain.  Using my eyes makes them ache horribly, especially in the area of the superior obliques.  I'm 61.  I used to read a ot.  I am also a writer who's avoiding the computer because of my eyes.  I am a retired MD.  I feel like I have been crying my eyes out most of the time.  They are swollen, red rimmed and very sensitive to light and irritants. I can still produce tears of irritation, but my eyes never feel soothed.

I have learemd to listen to books on tape, but find I am having to use my eyes as little as possible.  Accommodation hurts and after even a few minutes reading or typing with my eyes open, I am wanting to put cold compresses on my eyes. On a level of 1-10 my eyes are a 6 or 7.  This is bizarre.  The usualy do not hurt in the morning when I awakend and they get worse during the day. Obviously, not using them is the answer.  

I have a variety of things going on with my eyes. I had strabismus surgery at ages 3 (L) then at 5 (R). (esotropia) In my twenties, I had 20/20 vision.  Then I acquired a severe conjunctivitis that bloomed the day after a routine eye exam and was left with  dry eyes. It has gotten worse over the years.  

I use tears and gels during the day -- I am never without them.  I rotate brands..  At night. I add ointment and wear an eyeshade (in case I am opening my eyes during my sleep.) I've tried restatis several times to no avail. I've had my tear ducts plugged and years ago had them cauterized.  

At 45 I was diagnosed with SLE, though in retrospect, I was symptomatic in my teens.  That ended my medical career.  I also was noted to have a cataract on the right worse than left..  

I had cataract removal in 2001 (age 54) and IOL's.  I still must wear glasses -- progressive lenses.  I use non-glare lenses.. Around the same time, I had a retinal arterial infarct on the left that was fairly small.  It was treated with lasers (29 spot "welds) However, because it is near the macula, central portions images appear pleated.  I had macular edema treated for several years with Diamox. They're fine now. I call that eye my tag along.  It helps, but I can read only very slowly with it.  

In the past I have had multiple episodes of iritis, but don't now.  My pressures are normal.  I used topical steroids and have had a few courses of po steroids for flares, but far, far less than most people with sle.  I'm on methotrexate as my DMARD and am doing remarkably well.  After having felt 95 at 45, I now feel age appropriate.  I'm active, exercise, don't smoke, all the good things, though i do weight 16 pounds more than ideal. I do not have diabetes and am working to get the lard off.

I also have had for about twenty years a V-1 neuropathic pain on the right which was photically stimulated. Think tic doloreux without the electrical quality.  When I had a nerve block for the cataract surgery, the pain went away, so I use Botox for it with good results every few months..  

I've had primarily two eye doctors (one general, one retina), though have had several opinions. I check my prescription yearly and verify with my eye doctor that the lenses are correct.  I avoid the skinny rectanglular lenses as their "sweet spot" is too small.

Do people with IOL's complain that their eyeballs hurt from trying to accommodate?  Do you have any suggestions about how I can strain my eyes less?  My computer screen is non glare, I use non-glare lenses, I've lowered and tilted my monitor. I take breaks, fix on distant objects, yada yada yada.  

Surely I can't be the only person in the world who is having to use her eyes selectively?   I'd appreciate any tricks or tips that could hlep me.  

Thanks for any tips you might have.  

[light show]

I had bilateral cataract surgery 2-1/2 years ago. Although my vision had greatly improved I developed extreme sensitivity to various lighting conditions that exist to this day. I also have had headaches from the outer eye/brow to the temple and around my ear that seem to be triggered by light.  I had 2 nerve block injections (temple/orbit) at surgery and am convinced those injections triggered nerve sensitivity.

Last February I had one IOL replaced with a newer IOL that was developed to curb light/glare issues. This surgery removed some edge glare that was causing high order aberrations.  Some improvement but light intolerance remains. I now have eclipse like rings that glow  bright when I'm in contrast lighting.  

Since these surgeries I have always felt that my eyes have never accepted the IOLS.
I am always grateful for my vision even though life changes have proved more than challenging at times.  Always seeking new ways of 'looking at things' .. haha

My eyes also  feel strained all the time. Resting them is the only way to have some relief. Anti reflective coatings on my eyeglasses doesn't help. Dark sunglasses are helpful.  Liquid/Gel tears very temporary relief.... maybe a few minutes.

Opticians I've spoken to have heard very similar stories from their customers.

The Optician I dealt with recently had contact lens implanted in her eyes.  Since then she will not drive at night and is sensitive to everchanging lighting.  She told me anti-relective coating does nothing for her at all.

I sorry I cannot relay any tricks to avoid your vision difficulties.  We just learn to adapt around our new vision challenges. OUr bodies generally tell us what to do. I use sunglasses for TV watching and computer use...actually I wear polarized sunglasses with the brown tint a lot...I've  tried the blue/grey tint and it was of now help.

Right now my eyes are again burning and aching.  I have a glare-guard on my monitor and sunglasses on.  What can I say?

We are the people of the plastic eyes .... I can accept that our IOL's are not like our natural lenses but I'm sure thankful for the vision I do have ... even though I can't stand looking at it at times....haha...take care.

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

Well you have had enough eye pathology to train a dozen ophthalmologists. No IOL patients do NOT complain of the type of pain you have. One thought is that people getting botox injections around the eye have been reported to have accommodative weakness, ptosis, diplopia and Cranial nerve paresis.

I would suggest seeing a strabismus specialist. You might benefit from reading or computer glasses with prisms in them.

Given your list of problems it's one of those your're in pretty good shape for the shape you're in. Seriously do some research on botox complications and see a strabismus specialist.

JCH MD