Please Help - Pain, Vision Trouble for 6 Months, Doctors Unsure of Cause

Discussion in 'Eye-Care' started by Jesse, Jan 12, 2005.

  1. Jesse

    Jesse Guest

    Hi all. Since August 2004, I have been suffering with pain and vision
    troubles in my left eye, and at this point, no one has a good
    explanation as to why. Long story short, I've got pain around the left
    eye and in the cheek bone area, along with some focus troubles
    (blurred/double-vision). Also, every doctor visit I've had a low grade
    fever (99 to 100; typically I'm around 98.1). I've had a CT that
    indicated some fluid in the left maxillary sinus, but an ENT ruled this
    out as a possible cause. I've had an MRI of the ocular area and brain,
    which didn't indicate anything out of the ordinary. I've had multiple
    rounds of antibiotics (for possible sinusitis). Each round seemed to
    help for a few days or more, but the problem always came back. I've
    been to the dentist, who found some cavities (working on getting them
    all filled), but he didn't believe that would cause the eye problem
    either. Now, I'm again on the antibiotics, which helped for a couple
    of days, but the pain and blurred vision is back again. The severity
    varies from very bothersome (it's interfering with my computer job) to
    barely noticeable, but it's always there. I'm really getting
    stressed/frustrated and I'm about at the end of my rope. I'm hoping
    someone out there can help. That said, now for the long story....

    My vision history is this... I have a slight misalignment or eye drift
    in one eye (I believe the left eye is actually the good one, but I'm
    not sure). It's not really noticeable to look at me, but when I was
    around 15, the optometrist told me that I might have to do something
    about it when I was older (i.e. glasses, and he didn't mention
    surgery). At that point my vision was around 20/30 I think. In my
    early twenties, a new optometrist basically told me the same thing, and
    he also diagnosed a diagonal astygmatism for which I received glasses
    (but I didn't have to wear them all of the time).

    Along with the vision troubles, I've always had problems with ear and
    sinus infections. At age 25, I had sinus surgery for chronic
    sinusitis. A couple weeks after the surgery, I had some trouble in one
    eye (don't remember which). As I recall, it was like I had looked at a
    bright light and still had that bit of afterglow (sorry, that's the
    best description I have). The opthamologist (bad spelling, sorry)
    chalked it up to being a floater and said that it would go away on its
    own, which it did in a few days. He also noticed my misalignment and
    said that if I had lived with it that long, I should probably just
    continue to live with it. He did mention surgery as an option, but he
    kinda steered me away from that.

    After that, I was fine (well, except for the less than perfect vision)
    until August 2004 (I'm now 28). At first, I just noticed that I was
    having blurred and/or double vision from time to time when I was
    driving home after work. At the time, I figured my eyes were just a
    bit tired/strained. Then, after a couple of weeks, I got that light in
    the eye problem again. This progressed until I was feeling dull pain
    in my cheek bone, the jaw, above and around the problem eye. I got to
    the optometrist and he said I needed a new prescription (I hadn't worn
    my glasses for awhile) and that the pain was probably just eye strain.
    Somewhat unsatisfied, I went to a new opthamologist and he said that my
    eyes weren't working together and added a prism to my new prescription.
    A follow up visit three months later showed no improvement (I couldn't
    wear the new glasses much, because they made things worse). He then
    set me up with a 6 mo. followup (later this year) and mentioned that
    surgery might be necessary if I still don't show any improvement.

    In the meantime, my family doctor, knowing my history, suspected a
    possible return of the sinusitis and put me on antibiotics. This
    actually seemed to help, but only until I was off the antibiotics.
    After two months of off and on the antibiotics and prednisone (again
    for the sinuses), we went into a wait and see mode. The problem did
    subside a bit, but not enough to where I could wear and get used to my
    new glasses. Again, whenever I did wear them, the problem seemed to
    get worse.

    Now, my questions... Could all of this really be attributed to the eye
    drift/misalignment? Could sinusitis or tooth cavities play any role in
    this (i.e. could either cause or make it worse)? Why did the
    antibiotics seem to help for awhile (again, perhaps sinusitis made the
    eye problem worse)? Would surgery be a good next step (even if I have
    multiple problems, I could at least fix one thing at a time)? Should I
    go see a neuro/opth (the ENT recommended this)? Is there any hope?

    I'm just getting really tired of this and the stress is getting to me.
    On top of that, about 4 weeks ago I became a first-time Dad. That's
    been tough, because I come home from work and I just want to close my
    eyes and rest.

    If you've read through all of this, thank you for your patience and
    time. I'd be open to any advice that you have to offer. I'm starting
    to get desparate for help.

    Jesse, Jan 12, 2005
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  2. Jesse

    ycdbsoya Guest

    Get to a neuro/opth. It sounds similar to symptoms of early trigeminal
    neuralgia (5th nerve) or ATFP (atypical facial pain). The latter is
    more likely due to the recurring sinus infections and tooth problems.
    Low grade fever could be anything, even anxiety from seeing dr. No
    history of head trauma?
    Treatment is usually anti-convulsants such as neurontin, elavil, etc.
    ycdbsoya, Jan 12, 2005
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  3. Jesse

    Jesse Guest

    No head trauma that I can think of. Another thing that I should
    mention (regarding my head) is that when I was born, my mom had an
    exceptionally difficult labor (48 hours) during. The end result was
    that I was pulled out with forceps (by the head). I believe that they
    also had trouble getting me to start breathing (my parents tell me that
    I almost died). This is all probably completely unrelated, but I'm an
    engineer and my nature is lay out all the facts - even if they're
    seemingly unrelated - until the puzzle starts to come together (my poor
    wife; I must drive her crazy ;-).

    Thank you for taking the time to listen and answer my cry for help. I
    will start looking into the ATFP (ok, so I actually started searching
    while I was writing this reply), and I just got the name of a good
    neuro/opt today. I think I'll make the call. At this point, I'll try
    just about anything.

    On a side note, I am by no means a sue-happy guy, but considering that
    my mom's OB at the time was later convicted of drug possesion, I am
    supposing that my care at birth was less than ideal. Still,
    considering what my mom and I went through, I am just thankful to be
    Jesse, Jan 12, 2005
  4. Jesse

    Dr. Leukoma Guest

    Sounds like you have a "complicated" diagnosis.

    The combination of an eye misalignment and the prediction of "future
    problems in your 30's suggests an accommodative esotropia, or esotropia
    associated with farsightedness in one or both eyes. Excess
    accommodation can cause headaches.

    Also, eye misalignment, where the eyes are struggling to align but
    cannot quite, can produce headaches.

    As well, sinusitis can cause headaches, as can dental caries, hence the
    improvement with antibiotics.

    However, you also suffer from "doctoritis," which means that too many
    cooks can spoil the broth, or too many chiefs and not enought indians.
    Perhaps you need someone who can take an overview....maybe a good
    optometrist or a visit to a good general ophthalmologist. I think that
    getting a referral for a neuro-ophthalmologist could be difficult and,
    in any event, quite possibly unnecessary. It would not have occurred
    to me based upon your symptoms.

    Dr. Leukoma, Jan 13, 2005
  5. Jesse

    Jesse Guest

    Thanks for that as well. If I had my choice, I would hope that this
    really is a result of the eye misalignment. Sinus surgery is truly
    horrible, so if my sinusitis isn't directly causing this (as you said,
    it could contribute to it), that's ok with me.

    While my insurance doesn't require me to get a referral (I can go to
    any specialist I choose, if they'll see me), I'd rather not make things
    more complicated than necessary. I'm not a proponent of unnecessary
    tests and the like... I just want to get better.

    That said, does anyone out there know of a good opth in the Pittsburgh,
    PA area?


    Jesse, Jan 13, 2005
  6. Jesse

    Neil Brooks Guest

    Just had Functional Endoscopic Sinus Surgery on December 8th. It was
    absolutely /not/ "truly horrible." It was uncomfortable, and damned
    inconvenient, but--just a month later--I'm very glad I had the procedure
    done. I also had the more "traditional" surgery done over a dozen years
    ago. The FESS was far less dramatic and promises far better results.

    I've also had three alignment surgeries for eye alignment issues, and have
    issues with my accommodative mechanism. I would agree (as a patient) that
    any or all of these issues could contribute to the issues you describe.

    Best of luck,

    Neil Brooks, Jan 13, 2005
  7. Jesse

    Jesse Guest

    Thanks. The weird part is that my normal congestion and allergies that
    I've dealt with forever hasn't been much of a problem over the 6 months
    that this has been going on. In fact, I usually get a cold every fall
    and winter, which usually leads to either a sinus or ear infection.
    This year, I didn't even get a cold.
    Jesse, Jan 13, 2005
  8. Jesse

    nipidoc Guest

    As another poster suggested, my thoughts were along the lines of
    trigeminal neuralgia. I would consider an appointment with a neuro oph
    or just a neurologist. The distrobution of the pain is what caused me
    to think this. It seems to follow the path of the trigeminal nerve.

    I have seen two patients with similar conditions who were ultimately
    diagnosed with Lyme Disease. You should have your doctor give you the
    simple blood test for that.

    let us know how it turns out. a very tough case.

    nipidoc, Jan 13, 2005
  9. Jesse

    Jesse Guest

    Thanks. I will.

    One other comment about the pain (after looking at some sites on the
    neuro stuff)... My pain is never severe or sharp or anything like
    that. It's more like a dull ache that comes and goes. I could
    actually deal with that ok, but it's the changes to my vision that's
    becoming very difficult to live with. It's hard to deal with this
    blurring problem when you work with computers.

    Thanks again. I'm taking all of your suggestions into consideration.
    Jesse, Jan 13, 2005
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