extreme pain, red eye, blurriness:recurrent corneal erosion?

Post your questions and start your research in this forum if more than three months ago you had any type of surgery to reduce the need for glasses and contacts.

Postby ManiG » Mon Mar 16, 2009 7:44 pm

Another update!

The recurrent erosion of my epithelium is hopefully resolved. I've been off my Muro 128 ointment for several days now, with no recurrence of any epithelial defect. My personal hunch is that this has a lot to do with the resolution of my chronic dry eyes.

My bigger problem at this point is irregular astigmatism. As mentioned, my surgeon believes this has to do with microstriae with my lasik flap.

To resolve the striae, he lifted my flap last week, and sutured it back down with 7 very small stitches (they are invisible to the naked eye).

I had a checkup with him today, and the striae are gone!

However, my vision is a very blurry 20/40 (I can read the 20/40 line but the quality of vision is very poor). This is to be expected with the sutures and the unnatural way my corneal flap is being held down.

The sutures will come out next week, and a week or so after that, I will have an idea if the procedure resolved my vision problems. My surgeon is optimistic, so I guess I should be too!
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Postby LasikExpert » Tue Mar 17, 2009 2:11 am

It seems like a long road, but you are getting there!
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Postby Ryan D » Fri Mar 27, 2009 4:01 am

ManiG and Lasik Expert,

I would like to share my experience. Today was my 2nd week post op, and I am regretting this everyday.

I went thru surgery to correct +3.50 in both eyes. I come home from surgery and go to sleep. I awake some hours later, my right eye is clear and crisp, but my left eye is still blurry. SO, I go back to sleep.

A few hours later I am startled by the phone. It is the Doc calling to see if I am ok. I answer the phone and tell him that everything seems fine, but my left eye is blurry.He says it is normal for it to still be a bit blurry. I hang up and apply my eyedrops, and instant pain. And it didn't improve at all. So I tried to get some rest until my follow-up in the next morning.

I wake up with a swollen tear filled red eye. Once the Doc sees it, he notes that I formed a large Eithelial Defect dead center of my eye. Bit the Epithilium around the flap was still there. So he applies a bandage contact and prescribes another eye drop.

my vission sucked, I could only see the E on the chart. I went home and iced the eye, and the pain subsided.

Over the weekend my vision improved marginally, and as long as I kept the eye moist I could see ok up close. Come my appointment the following Monday, The defect had close to less than 2mm but had not closed, so they patched my eye.

Tuesday I go back and the defect is still not closed, and the Doc was concerned about the hazing that had occurred overnight, so they lifted my flap and flushed out the cells, and put another bandage contact in. Prescribed a oral steroid, Autologis drops, along with uping my pred forte.

Ok, the DLK responded to the steroinds and pred forte, and over the next week my defect closed.

ManiG I see you went thru the same scenario, except you healed faster?

My vision sucks in my left eye, I can't read crap, and everything is a blur. I can see colors and objects fine, but the contrast sucks. It seems like extreme astigmatism, because I can lay on my couch and see the stiches in the couch, but reading is out of the question.

Is this normal for what happened? It has been a day since the defect healed. The Doc said I would see a dip in vision as it closed, and man have I. My best vision out of the eye prior to the defect healing was 20/60 and that was a struggle. I can see every letter, but I can't make them out.

When you described a thick Blur in a earlier post, could you see anything at all?

What can I expect? I have worried myself sick over this. The doc say The blurriness will take weeks to clear. Is he right, or is this serious..

How long did it take your vision to improve?

Ryan

Any feedback helps.
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Postby LasikExpert » Fri Mar 27, 2009 4:27 pm

Ryan D wrote:Is this normal for what happened?


Your symptoms are consistent with what happened.

There clearly was some trauma to that eye. It may be that you rubbed or bumped it during your sleep. It may be that the eye was extremely dry and the inner eye lid became abrasive. Whatever the actual cause, the result was an epithelial defect and Diffuse Lamellar Keratitis (DLK). Your eye is very angry right now.

Although new epithelial cells have covered the area of the defect, your epithelium is far from healed. The cells must thicken and smooth. The center of your cornea will go through the same healing process as a patient who had PRK. Just search here and you will see that vision after PRK is very poor for a couple of days, functional fuzzy for a week or two, and it is not until about 3-5 weeks postop that you would get the most crisp vision possible.

Add to this that the defect is only in the center of the cornea and you are going to get a ring where the old epithelium meets the new epithelium and the edge of this ring will create some bizarre vision effects. These effects, such as halos, starbursts, distortions, ghosting, will likely be more pronounced in low light environments.

DLK is an inflammation. Inflammation of the cornea will change the refractive error. The inflammation is likely irregular, so you will have irregular refractive error. This too can contribute to halos, starbursts, distortions, and ghosting.

Add to this the agressive treatment plan that normally is prescribed for a patient with DLK and your vision is simply going to suck for a while, however after the DLK resolves; the inflammation subsides; the epithelium heals, thickens, and smooths; and you no longer need the steroids; your vision will undoubtedly improve and will likely achieve the same acuity as the unaffected eye.

Have faith, have patients, and take those meds exactly as the doctor prescribed.
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Postby Ryan D » Fri Mar 27, 2009 5:11 pm

Thanks for the Reply,

Yeah my vision sucks, I had a doc visit today, and they couldn't correct my vision at all. I read the 20/50 line, but it was a struggle. I had to wait until things come into focus. But florescent lighting really messes with my vision, so I had to really focus.

He said my eye was still inflamed, but not enough to cause panic. He just upped my steroid intake and Pred-forte drops. He said the epithelium is healed over, but very rough and irregular.

So it is normal for my vision to suck near and far. I can't read the comp screen at all with my left eye. I am just a nervous wreck. I am getting by though.

Is it normal for the newly healed epithelium to look different? My wife can actually see the spot in bright light.

Doc says my risk of scaring is low, but he can't promise.

I really appreciate the response, and this board has helped me greatly.

Ryan
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Postby LasikExpert » Fri Mar 27, 2009 7:30 pm

Ryan D wrote:So it is normal for my vision to suck near and far.


At this point, absolutely. Your cornea and corneal surface is likely so irregular that you would not be expected to see much more than finger count.

Ryan D wrote:Is it normal for the newly healed epithelium to look different? My wife can actually see the spot in bright light.


Yes. The new epithelium is thinner than the surrounding epithelium, is rougher, and will reflect and refract light differently. It is probably quite pronounced to those who observe closely and with the proper light.

Ryan D wrote:Doc says my risk of scaring is low, but he can't promise.


The doc should not promise anything, but it sounds like you have received proper treatment in a timely manner. You may have some trace corneal haze for a while, but it may not interfere with your vision quality. Only time will tell.

I know of one Lasik patient who had undiagnosed DLK that went all the way to flap melt before being treated. Significant scaring cleared after several years. You are no where near this person's difficulty, but it is an example how the cornea will heal itself.

Ryan D wrote:I really appreciate the response, and this board has helped me greatly.


That is why we are here!
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Postby Ryan D » Fri Mar 27, 2009 10:00 pm

Ryan D wrote:Doc says my risk of scaring is low, but he can't promise.


"The doc should not promise anything, but it sounds like you have received proper treatment in a timely manner. You may have some trace corneal haze for a while, but it may not interfere with your vision quality. Only time will tell."



When you say haze, do you mean the remaining DLK, or something similar?

I am seeing a little better today. But still a blur. I can read signs and other stuff, but it is a hassle.

What is a reasonable time expected to clear DLK?

It has been a week and 3 days since my flap was lifted. The doc says there is still a little inflamation around the flap, and it hasn't gotten any worse. He wasn't going to see me again until next Wednesday, but I asked to come earlier for piece of mind. So it looks to me he is not as concerned.

I hate that this happened, but am thankful that it was caught and that it isn't my Dominant eye.

Ryan
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Postby ManiG » Fri Mar 27, 2009 10:47 pm

Hi Ryan,

Sorry to hear you went through the same problem as me!

Glenn has done a better job than I could at responding, but if there's anything specific you'd like to know from a patient's perspective, just let me know.

It might make you feel better to know that 4-5 weeks after the horrible epithelial defect, the vision in my affected eye was 100% back to normal. I know how scary it is thinking that you might have permanent damage. I asked my doctors many times "will this affect my vision permanently?", and just like you, they did not promise anything, which is understandable but caused a lot of anxiety.

It is now a few months after the epi defect. I was on a nightly saline ointment called Muro 128 which keeps your eye lubricated all night and helps the epithelium bind to the lower membranes. Now, I am off the ointment, and I have not had any recurrences since.

ps. I did experience a lot of cloudiness, and it did go away. I'm not sure how long, maybe a week or two. It's hard for me to remember all the details, best to go with my previous posts, I basically used this board as a journal for my healing process. I've researched DLK and it is only "dangerous" when left untreated for 48-72 hours, starving your flap of nutrients and causing it to "melt" ... but since you are getting aggressive treatment, hopefully means you're all good.
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Postby Ryan D » Fri Mar 27, 2009 11:52 pm

ManiG,

Thanks for the reply. I do have a few questions since you experienced what I am going through.

I took my defect a little longer to heal, (I don't know if it was because the flap was lifted before it healed) ,it healed rapidly and then slowed. But it closed Yesterday, and that was my worse vision day thus far. It was so so blurry it made my head swim. However I still have some DLK inflammation that has persisted around the edge of my flap and he has increased my steroid drops and oral steroids a little. But other that that my vision isn't as bad today. But it is still a blurry mess overall.

I can read close and far, but only if the light is right, it is a big strain though, and it is not clear at all.
Using the Computer at this point is only because I have a 20/15 right eye. The glare from the screen just makes all the words look like a streak.
Did you experience what I describe?

Could you read at all during the first few weeks?

Also how long did it take you to be clear of the DLK, and how long did your doctor keep you on the drops?

Was this mentally hard on you? As this is the lowest I have ever felt in my life. My wife has been my savior, without her I would have probably just given up.

Did you experience halo's, glare, ghosting and so on during this? Glen said it was to be expected, as I am experiencing all the above.

I wasn't able ot find the Muro ointment, but I did get preservative free Systane ointment to help. I have slept three nights with out a contact and no problems. I haven't been experiencing dry eyes until late at night.

Sorry to ask a lot of questions, but you are the only person that has experienced what I am going through on here.

The sad thing is, I never got to see out of my eye as this happened the day of surgery, so I can only imagine what it will be like when it clears.

Glen, and you have been a big help thus far and have really re assured me a lot.

By the way, how are you doing after with your stretched flap?

Thanks,

Ryan
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Postby ManiG » Sat Mar 28, 2009 5:11 pm

I'll do my best to answer, but *please* remember that I don't remember a lot of the specifics. My whole memory of the experience is a "blur" (pardon the pun). I think it was all so scary and traumatic that I've tried to shut it out. :)

Ryan D wrote:ManiG,

Thanks for the reply. I do have a few questions since you experienced what I am going through.

I took my defect a little longer to heal, (I don't know if it was because the flap was lifted before it healed) ,it healed rapidly and then slowed. But it closed Yesterday, and that was my worse vision day thus far. It was so so blurry it made my head swim. However I still have some DLK inflammation that has persisted around the edge of my flap and he has increased my steroid drops and oral steroids a little. But other that that my vision isn't as bad today. But it is still a blurry mess overall.

I can read close and far, but only if the light is right, it is a big strain though, and it is not clear at all.
Using the Computer at this point is only because I have a 20/15 right eye. The glare from the screen just makes all the words look like a streak.
Did you experience what I describe?


Yes. I'd say my vision was a combination of the following:

- a general haze that covered everything, kind of like looking through a window that's been fogged up.
- strong astigmatism, things would be "smeared" pretty badly on a computer monitor like you describe.
- extreme light sensitivity. i could barely open my damaged eye for a few days.

the above symptoms translate to very poor vision, halos, starbursts, you name it.

Could you read at all during the first few weeks?


I could, but because like you my dominant eye was not affected. It is amazing how your brain can ignore poor vision coming from your non-dominant eye.

Also how long did it take you to be clear of the DLK, and how long did your doctor keep you on the drops?


I believe the DLK fully cleared up 3 days or so after it was discovered. My treatment was first to flush the flap of DLK cells, pred forte steroid drops, and some anti inflammation pills.

Was this mentally hard on you? As this is the lowest I have ever felt in my life. My wife has been my savior, without her I would have probably just given up.


To give you an idea how hard it was on me, even though I've fully recovered, it is actually stressing me out to type this and relive the memory. I remember the day when they said I had DLK, and flushed the flap, was when I hit rock bottom. It was very, very tough mentally. Talk to your friends, your wife, your family - you'll get through it.

Did you experience halo's, glare, ghosting and so on during this? Glen said it was to be expected, as I am experiencing all the above.


Yes.

I wasn't able ot find the Muro ointment, but I did get preservative free Systane ointment to help. I have slept three nights with out a contact and no problems. I haven't been experiencing dry eyes until late at night.


Muro 128 ointment was prescribed by my surgeon, but I do believe it is available over the counter. I am not a doctor - it's a much better idea to stick to what your doctor recommends. If you want peace of mind, you can always get a second opinion from another opthalmologist.

Sorry to ask a lot of questions, but you are the only person that has experienced what I am going through on here.


Glad to help .. the whole reason I posted my experience here was so that someone going through the same thing could get some information. Not glad you had the problem, but I am glad that this thread has helped someone.

By the way, how are you doing after with your stretched flap?


It helped only a bit, but will give it some more time. I will be seeing my surgeon next week. To give some perspective, however, my daytime vision is just great, and my night time problems are a nuisance that I would like to have corrected. Nothing debilitating like the healing process of a major epi defect.
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Postby Ryan D » Sat Mar 28, 2009 6:50 pm

Were you able to work during the first few weeks of recovery. I own a business with my dad, and I have maybe worked 4 days in the past two weeks. I am keeping the faith though, I know I will make it thru this.

I can't wait to get off the steroid pills and drops, I feel like I can't sleep. I wake up every hour and look at the clock. I can actually reed the clock, but only in a dark room. Lights really distort stuff. I am not that light sensitive anymore, but light really puts a glare on everything.

I am able to read the TV some, and see some minor detail, but it still blurry. I don't think that the DLK has cleared yet, but my Doc doesn't seem overly concerned as the steroid seem to be working. He will see me again on Monday.

I know you said talk to people and I have, but is there any other tips you can pass on to help in the mental healing process. I know you are not a Doc, but you had a first hand account of my situation.

Thanks again,

Ryan
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Postby ManiG » Sat Mar 28, 2009 9:47 pm

i was back to work maybe 10 days after it happened. vision was still far from perfect, but i was able to work and it helped take my mind off it.

as for the mental strain ... just focus on the recovery i guess, and don't beat yourself up on making the decision to do LASIK. bad things happen to people all the time for different reasons. in your case, you'll probably make a full recovery and will be laughing about this a few months down the line.

other than that ... distract yourself. eat some good food, get some light exercise, do any kind of fun activity that doesn't require perfect vision. ;)

kind of ironic for me to be saying this, but stay off the internet. online forums are filled with horror stories and worst case scenario results from LASIK. reading that stuff will just freak you out and make you second-guess your surgeon who is treating you.

communicate with your surgeon, be polite and respectful and help them help you. you might be angry or upset, but don't take it out on your opthalmologist. they are only human and the last thing you want to do is get on the bad side of the one person who can help you the most right now!

good luck,
mani
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Postby Ryan D » Sat Mar 28, 2009 10:38 pm

Mani,

I really appreciate the advise, and yeah I need to stay away from google and researching my problem.

It has only been three days since my defect has healed, so I am sure this is the worse my vision will be. I assume that you wont start your recovery until the defect is closed, so I guess I am three days in psot closing and the recovery has just began.

I hope things get better, I am able to drive as I can see really well with my right eye. But working is out for now, I need my eye to recover for now.

When you did return to work, were you able to read with the injured eye, or was it still to early.

Thanks,

Ryan
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Postby ManiG » Mon Mar 30, 2009 2:36 pm

once the hole closes, the surface of the eye is still very rough. it has to continue healing and smooth over. for me, this part took longer than the hole closing (i had a 9mm diameter defect, considered huge, which closed in i think 3 days total).

ever skinned your knee? i guess it's the same sort of thing. the "hole" closes quickly, but it takes weeks before there's no more sign of the injury.

also, i experienced swelling of the eye as a result of the injury, which exacerbated my astigmatism. the astigmatism for me was initially measured at 1.25, and verrrrry slowly settled at 0.5 (same as pre-injury) after 3-4 weeks.

as for my return to work, it was still too early to read with the eye. but like i said my brain is really good at ignoring the image coming from my non dominant eye. your brain might work differently than mine. my good eye really did all the work.
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Postby Ryan D » Mon Mar 30, 2009 3:19 pm

Well I had a check up today, and it was a good one. It has been less than a week since the whole closed. And Light really distorts stuff, but in low light I can see okay.

I was able to read the 20/30 line, but it was not clear. I did manage one letter on the 20/25 line. But they had the lights dimmed in the room, so that helped a bunch.

The doctor reduced my drops and oral steroids, ad the inflammation is pretty much gone. Which is a good thing. I have a few micro striae, which he thinks will heal with time.

And when I put eye drops in, it fills the unevenness of the epithelium and everything is clear crisp and in focus, but that goes as soon as I blink.

My eye feels 100% normal, except for the foggy window vision.

I will be starting a nighttime gel as well to help with the smoothing process.

As far as reading a comp screen with the eye, it is still a struggle, I can, but I have to be super close. I figure as the epithelium heals, it will get better. As I am seeing small but steady improvement everyday.

This has really lifted my spirits, and I am back to work. Hopefully in a month or so I will be much better.

Ryan
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