Mamarati

I went to the doctor to have the contact removed again and have the healing cornea checked out. It’s been doing all right, though sticking a bit. Still, the contact seems to act as a buffer between my lid and the cornea… so the spot that’s getting stuck now seems to be either lower on my eyeball or where the two lids are touching. Good news, too, since my lids usually never touch. I have “incomplete closure” but I think the goggles are helping put some pressure on my lids to stay more closed. The bad news is now my other eye is getting stuck.

But back to the doctor.

I don’t know if I’ve mentioned the anxiety that’s built up surrounding this. See, I don’t do well with pain. I really really don’t. I’m the biggest wimp you could possibly imagine. If they’re offering up pain relief, I’m all for it. I don’t care if it’s a hangnail. That’s the kind of wuss I am.

So I have some anxiety about going to sleep now. The first night that I was without the contact lens (actually the only night) I was so freaked out that I was going to rip open my eyeball, I stayed up till 5am. I kept drifting off on the couch and I would bolt awake in a complete state of panic. Finally I gave in, knowing that my boyfriend would wake me up in 4 hours.

My anxiety was further bolstered when after those mere 4 hours I did indeed wake up to my eyelid peeling away from my eyeball… lifting away the newly healed area that was just days before scraped away with a friggin’ exacto knife, basically.

So, anxiety. Insomnia. Fear. Loathing. Not Las Vegas.

I feel like I’m going to have to stay up all night and then maybe set a quiet and gentle alarm to wake me up every hour or so to add more drops and check for sticking… No big deal. It will be like I’m a new mom all over again except without the crying. At least not from a baby, unless you count me.

Doctor… right, so with that said, I go into the doctor… the contact is removed, he checks the eye out and asks me how it’s going… I say fine. He says it looks good. This is not my regular eye doctor, either. This is a follow-up appointment because I saw him the last time it ripped open and my regular doctor wasn’t available.

So he is about to let me go and is telling me to follow up with my regular doctor… I tell him I already have an appointment for the 12th with my regular doctor. Then I tell him I’m scared to go to bed between now and then and I’m afraid it’s going to rip open again. He gets this agitated look on his face and I’m not sure why. Then he says, “Well, use ointment and if you have some of the Muro around, use that.” I say, “Yeah, that’s what I did last time, but the ointment doesn’t seem to work well enough to stop it from drying out and sticking. Is there something stronger I can use?”

Silence. He’s writing something in my chart. I suggest that maybe if I could keep the contact lens then I could wear that at night since it seems to prevent the sticking and ripping. He looks up at me with this completely nasty look on his face and says, “But that’s not a cure. You have to follow up with your regular doctor.”

Ummm…. OK? I’m not sure what one has to do with the other and since I just told you that I already have an appointment with him, I don’t know how wanting to wear the contact lens negates going to see him. I say OK.

He continues on about going to see my regular doctor. I say, “Yes, I get it. I’m going to follow up. I already said that. All I’m saying is I’d like to wear the contact between now and then so I don’t mess up what’s already been done to my eye.”

He goes on. He’s yelling at me now about it not being a cure and I might need to see a cornea specialists because I might need surgery and if I don’t follow up with my regular doctor then I might not know whether I do or not.

I start to get agitated at this point. I’m thinking, “NO SHIT?” I thought we already cleared this up about going to see him. Can you drop it? He doesn’t drop it. He goes on and he’s pointing at the contact lens and he says, “It’s right there, you can have it.” I say, “Look, you don’t have to get mad at me, I’m just saying that the contact offers me some security. I have to work. I don’t have insurance right now. I’m a writer so all my work is done on the computer. I have to be able to see. Every time that I rip my eyeball open or every time it has to be scraped… that’s pain and it’s time that I lose at work and it’s less money that I have to pay for all these appointments. I’ve been here 6 times in the last month. It adds up. I’m not looking to the contact as a cure, I’m looking at it as prevention.”

And then he says, “Well, it can be a cure. But it’s just one treatment. It’s called a therapeutic contact lens. But you need to follow up with your regular doctor. You could need surgery.”

Geez. OK broken record.

So, then I’m all pissed and I’m crying when I leave he’s been such an ass… I get home and I start to research this whole contact lens thing and it turns out that I am not the only FREAK to have some anxiety over this whole thing:

“Symptoms may gradually subside over the course of the day and then start all over again the next morning. The unpredictability of these episodes may lead to an associated anxiety.”

and from the Journal of the American Society of Ophthalmic Registered Nurses:

The patient history is pathognomonic with a description a foreign body sensation upon opening the eye after awakening in the morning. The symptoms can progress to extreme pain and photophobia with profuse tearing. During the night, pressure from the eyelid on the dry epithelium produces an adhesion to the epithelium which is stronger than the adhesion of the epithelium to the basement membrane. Hence, upon awakening, the eyelid separates away from the epithelium. The unpredictable nature of recurrent corneal erosions often amplifies patient anxiety. Since erosions occur during sleep or on awakening, some patients experience varying amounts of insomnia, which exacerbates the psychological stress related with this condition.

In the conclusion it stresses helping the patient cope. Hi. That’s me. The patient. I need help coping.

I do some more research, since he said it was an option.

Turns out, a therapeutic contact lens or bandage contact lens is considered a “conservative” treatment measure. It’s something to be considered even before things like what I had, which was debridement (the exacto knife / passing out incident) or before stronger measures like anterior stromal puncture or Phototherapeutic Keratectomy (PTK).

I found this case report and the patient here sounds incredibly similar to my own situation. Here is some of the treatment plan and the results:

The impression remained as recalcitrant recurrent corneal erosion OD and the plan was to continue with the bandage lens; however, the patient was instructed to wear the lens only at night and to remove the lens every morning…

At a four-month follow-up visit, the patient said he was “doing great” and that he hadn’t had another episode. He was wearing the high-Dk silicone hydrogel 8.6/-0.50 lens during the night, removing it each morning, and was using the hypertonic sodium chloride drop three times per day. Corrected visual acuities were 20/20 OU and the slit lamp examination revealed resolution of the recurrent corneal erosion. The plan was to discontinue the bandage contact lens and use a lubricant eye ointment (GenTeal® ) at night and lubricant drops OU as needed during the day. At one year, the patient was using the lubricant ointment at night and was still doing well.

Dude, that is good news to me. I like reading that. I realize that my doctor may want to do something different. I may need surgery. I get all that. But don’t act like I’m acting for crack or something when all I’m asking for is a contact lens. I’m not some crazed drug addict in here trying to con you into prescribing me narcotics (as nice as I think hydrocodone is, I don’t need any more of it!). It’s a friggin’ contact lens and I only want to wear it at night.

It amazes me that people wear these things all the time. I know people who don’t take them out for weeks at a time. And I’m not asking for that…

Whatever. It’s all very frustrating and I don’t appreciate being yelled at by this doctor. No one deserves that…

I’m so ready for all these eye shenanigans to be overwith and get back to some normalcy.