Future Colleague Needs Help

[ophtho wannabe]

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I'm graduating from med school in 2 weeks, and I've matched for ophtho. Of course, I know next to nothing about eyes, and wouldn't you know it, my wife is having eye problems. Please help my feelings of inadequacy with any advice you can offer.

Around New Year's she started having pain in her left eye when wearing her contacts. She had never experienced anything like this before, and she has worn contacts for over 10 years. She went to her optometrist a few weeks later for an eye exam thinking it may have been the brand of contact causing her problems. She was given a new prescription and a different brand. These felt fine for a few days so she ordered a year's supply. However, within a week she started to have the same pain in her left eye. She returned to the optometrist who gave her another brand to try. He thought the discomfort was due to a change in the shape of her cornea, but this brand didn't work either. So at her last visit he said her contacts and cornea were normal and has attributed the pain to presumed recurrent cornea erosion. He prescribed hypertonic saline solution OS BID for 1-2 months. She has used the drops for about 1 1/2 months now, and she recently put in her left contact and immediately felt the same discomfort as before. Before we schedule an appointment with a cornea specialist, does anyone have any thoughts on what could be causing her problem?

 

[Andrew_Doan]

I'm graduating from med school in 2 weeks, and I've matched for ophtho. Of course, I know next to nothing about eyes, and wouldn't you know it, my wife is having eye problems. Please help my feelings of inadequacy with any advice you can offer.

Around New Year's she started having pain in her left eye when wearing her contacts. She had never experienced anything like this before, and she has worn contacts for over 10 years. She went to her optometrist a few weeks later for an eye exam thinking it may have been the brand of contact causing her problems. She was given a new prescription and a different brand. These felt fine for a few days so she ordered a year's supply. However, within a week she started to have the same pain in her left eye. She returned to the optometrist who gave her another brand to try. He thought the discomfort was due to a change in the shape of her cornea, but this brand didn't work either. So at her last visit he said her contacts and cornea were normal and has attributed the pain to presumed recurrent cornea erosion. He prescribed hypertonic saline solution OS BID for 1-2 months. She has used the drops for about 1 1/2 months now, and she recently put in her left contact and immediately felt the same discomfort as before. Before we schedule an appointment with a cornea specialist, does anyone have any thoughts on what could be causing her problem?

We need more info, thus an exam is needed. We need to know the keratometry (curvature of the cornea) measurements. Contacts have different fits depending on the basecurve; thus, not all contacts will fit a flatter or steeper cornea. Improper fit could cause tightness resulting in pain and corneal problems.

Recurrent corneal erosions usually occur when patients awake in the morning, and there are corneal signs, such as sub-epithelial lines, maps, dots, and epithelial defects. Therefore, an examination is needed in order to rule-out or rule-in recurrent erosions syndrome (epithelial basement membrane dystrophy, aka map-dot-fingerprint dystrophy: http://www.emedicine.com/oph/topic95.htm).