Persistent Foreign Body Sensation in Elderly: Seeking Solutions for Eye Discomfort

Q: Persistent Foreign Body Sensation in Elderly: Seeking Solutions for Eye Discomfort

Hello： Generally, the symptoms of a foreign body sensation are usually due to lesions on the surface of the eyeball or the inner surface of the eyelids. <br>Therefore, a slit lamp examination should be able to identify the issue, and there is no need for ultrasound or other imagi

Foreign body sensation in the eye?

Dear Dr.
Wang,
My mother is 76 years old and has been troubled by eye conditions in recent years.
She suffers from cataracts and mild glaucoma.
The doctor has recommended surgery for the cataract in her right eye after the New Year.
However, she is distressed by a persistent foreign body sensation in her left eye, which is very uncomfortable.
She often feels as if something is crawling inside, and her vision is also somewhat blurred.
She has visited several well-known ophthalmology clinics for examinations, and after basic assessments, the doctors have reported no abnormalities, diagnosing her with dry eye or inflammation.
However, using artificial tears and eye drops has not improved her condition.
Upon examining her eyes, I noticed that her left eye appears noticeably smaller—the eyeball is smaller, the eyelid is swollen (without redness), and there is slight eversion of the eyelid.
My mother says she is increasingly unable to open her eyes.
It seems that the doctors she consulted only performed basic examinations and may not have identified the underlying condition.
Are there any advanced diagnostic tools available, such as ultrasound imaging, that could provide further insights?
Could you please advise what additional tests and treatments my mother should undergo? A desperate daughter.

Shi Laoshi, 40~49 year old female. Ask Date: 2005/02/14

Dr. Wang Zhangji reply Ophthalmology

Hello: Generally, the symptoms of a foreign body sensation are usually due to lesions on the surface of the eyeball or the inner surface of the eyelids.
Therefore, a slit lamp examination should be able to identify the issue, and there is no need for ultrasound or other imaging studies.
Indeed, many patients experiencing foreign body sensations are suffering from dryness or inflammation, which requires regular and timely administration of medication.
Additionally, it is important to check for issues such as meibomian gland dysfunction or trichiasis, which also need to be treated.
Furthermore, if the left eye has incomplete blinking, it can also lead to a foreign body sensation.
Sincerely, Dr.
Wang Zhang-ji, Ophthalmology.

Reply Date: 2005/02/14

More Info

It sounds like your mother is experiencing significant discomfort in her left eye, which is causing her distress. Given her age and existing conditions such as cataracts and mild glaucoma, it's understandable that you're concerned about her eye health. The symptoms you describe, including the persistent sensation of a foreign body, blurred vision, and changes in the appearance of her left eye, warrant further investigation.

Firstly, the sensation of a foreign body in the eye can be attributed to several factors, especially in elderly patients. Dry eye syndrome is a common condition that can lead to discomfort and a feeling of grittiness or irritation. This condition can be exacerbated by environmental factors, medications, or underlying health issues. However, since your mother has already tried artificial tears and other eye drops without relief, it may be necessary to explore other potential causes.

The appearance of her left eye being smaller and the eyelid being slightly everted could indicate a few possibilities. One concern is the potential for a condition known as "lagophthalmos," where the eyelids do not close completely, leading to dryness and irritation. This could explain the foreign body sensation and discomfort. Additionally, the presence of inflammation or scarring on the surface of the eye could also contribute to these symptoms.

Given that multiple eye specialists have conducted basic examinations without identifying a specific issue, it may be beneficial to seek a more comprehensive evaluation. Advanced imaging techniques, such as ultrasound biomicroscopy or optical coherence tomography (OCT), can provide detailed views of the eye's structures, including the cornea, lens, and anterior chamber. These tests can help identify any subtle abnormalities that may not be visible during a standard eye exam.

Moreover, considering her history of cataracts and glaucoma, it is crucial to ensure that these conditions are being managed appropriately. If the cataract in her right eye is affecting her vision significantly, surgery may be necessary, as recommended by her doctor. However, it’s essential to address the discomfort in her left eye before proceeding with any surgical interventions.

In terms of immediate relief, if dry eye is indeed a contributing factor, your mother might benefit from more aggressive treatment options. This could include prescription eye drops, punctal plugs (which help retain moisture in the eyes), or other therapies aimed at increasing tear production. Additionally, lifestyle modifications, such as using a humidifier, taking regular breaks from screens, and wearing sunglasses outdoors, can help alleviate symptoms.

Lastly, I recommend that you advocate for your mother by seeking a second opinion from a specialist who focuses on ocular surface diseases or a corneal specialist. They may have additional insights or treatment options that could provide her with relief. It’s essential to ensure that her discomfort is taken seriously and that all potential underlying causes are thoroughly investigated.

In summary, while your mother’s symptoms may be attributed to dry eye or inflammation, further diagnostic testing is warranted to rule out other conditions. A comprehensive approach that includes advanced imaging and possibly a referral to a specialist could lead to a more definitive diagnosis and effective treatment plan. Your concern as a daughter is commendable, and ensuring your mother receives the appropriate care is crucial for her comfort and quality of life.

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