Hi Thinkt,
Hi thinkt,
Sublime1-ga, in his comment below is correct ? you do need to see
an ophthalmologist. This is not a condition you can resolve on your
own, and you may even aggravate your eye further. I understand that
you may not be pleased with your current ophthalmologist, but ask
around and find another. A doctor is the only one who can properly
diagnose your condition.
I can list for you things that MAY be contributing to your red eye,
but I can?t diagnose what the cause is. Something else to consider is
getting a complete physical exam, as the cause may not have anything
to do with your surgery. Some systemic disorders can cause your
symptoms, including, alas, allergies. There is also a connection
between the sinuses and the eye? pressure from the sinuses can affect
eye pressure. It may be possible that your strabismus surgery caused
some trauma, scar tissue, a small cyst, or some keratinization of some
eye muscle tissue (hardening of tissue). Without a complete exam of
your eye, it is not possible to know for sure.
You don?t state whether you drink or smoke, but if you do, they may be
aggravating your eye, as are the long hours at the PC. This is not
saying they are the cause of the disorder, only that they can
exacerbate symptoms.
?Allergic conjunctivitis
- the patient often has bilaterally itchy eyes following exposure to
an inciting allergen
- seasonal allergic conjunctivitis may be due to tree pollen (spring),
grass pollen (summer) or weed pollen (fall) and the patient may have
no symptoms during the winter months
- perennial allergic conjunctivitis is a year-round condition and may
be caused by animal dander, dust mites or cockroaches
- the conjunctiva is milky white or pink in color, +/- edematous (glassy chemosis)
- the discharge is clear and watery initially and may become white and
stringy later
I know for a fact that this can occur in one eye only, as it
frequently happens to me!
http://www.homestead.com/emguidemaps/files/redeye.html#Superior%20limbic%20conjunctivitis
?? causes of a red eye (cavernous sinus thrombosis, orbital
cellulitis, acute angle-closure glaucoma, necrotizing scleritis,
herpetic keratitis) from less serious causes (allergic or viral
conjunctivitis, corneal abrasion, episcleritis) => an emergency
physician should consult textbooks (eg. the many ophthalmology
textbook chapters at emedicine.com) for more details about the
different disease entities and their specific treatment after
determining the likely cause of the "red eye"?
http://www.homestead.com/emguidemaps/files/redeye.html#intro
Corneal Erosions and scleritis
==============================
?The corneal epithelium may repeatedly break down if the patient has
had a previous corneal abrasion, or if there is an
inherently weak adhesion between the epithelial cells and the corneal
basement membrane. The patient complains of a
watery, painful and injected red eye in the morning, or they may be
woken from sleep with a painful eye. This occurs as tear
secretion is reduced at night and abnormal adherences form between the
cornea and the eyelid resulting in the shearing off of
the corneal epithelium. Treatment is long term and entails lubricating
drops. Surgical debridement or corneal stromal puncture
may be carried out to enhance the adhesion between the epithelium and
the underlying basement membrane.
?Scleritis
Scleritis may be anterior or posterior. Anterior scleritis is usually
classified as nodular or diffuse. It may also be classified
as necrotising and non-necrotising. Scleritis may be unilateral,
simultaneously bilateral or alternate from eye to eye.
On presentation, the eye is red. However, because the active
inflammation is not superficial, when examined in
natural light, the involved area of the injected eye takes on a bluish
hue. There may be diffuse scleral injection or it may be
localised to one quadrant. Unlike episcleritis, the vessels do not
blanch with topical phenylephrine.
The patient complains of a deep boring pain which can wake them from
sleep and the eye is tender to palpation. Necrotising scleritis is
usually extremely painful. There are areas of necrotic sclera which
can slough off to leave scleral thinning. If the thinning is severe,
it may result in the formation of a staphyloma. An underlying systemic
disease is present in approximately 50% of patients who have
scleritis. Connective tissue disorders, of which rheumatoid arthritis
is the most common, are the most frequently associated conditions.
Treatment of scleritis is with systemic anti-inflammatories,
corticosteroids or immunosuppressants.?
http://www.optometry.co.uk/files/939adbd36df959a1c2af2853329a028d_otoole20041008.pdf
Orbital Cellulitis
==================
?Bloodshot eyes appear red because the vessels in the surface of the
white portion of the eye (sclera) become enlarged and irritated. This
may result from extremely dry air, sun exposure, dust, foreign body,
an allergic reaction, infection, trauma, or other conditions.
One common cause of a red eye is straining or coughing. This can lead
to a bright red, uniformly dense bloody area on the sclera. This is
called a subconjunctival hemorrhage. Although this bloody area may
appear alarming, it is a fairly common occurrence and of little
significance. If you notice a bloody blotch in one eye that doesn't
hurt, but just looks bad, don't worry. It generally clears up on its
own within a week or two.
Eye infections or inflammation can occur in different locations. They
cause redness as well as possible itching, discharge, pain, or vision
problems:
·Blepharitis -- inflammation of the eyelash follicles along the
eyelid. It is caused by skin bacteria. Itching is common and your
eyelids may appear greasy or crusty.
·Conjunctivitis -- inflammation or infection of the membrane that
lines the eyelids and coats the surface of the eye (the conjunctiva).
This condition is often referred to as "pink eye". It may be caused by
a virus, bacteria, allergy, or irritation. If caused by an organism,
this is highly contagious.
·Corneal ulcers -- often caused by a bacterial or viral infection.
(The cornea is the outer covering of the eye.)
·Uveitis -- inflammation of the uvea, which includes the iris, ciliary
body, and choroid. This is often related to an autoimmune disorder,
infection, or exposure to toxins. Often, only the iris is inflammed,
which is called iritis.
Other potential causes include:
·Cold or allergies.
·Foreign objects in the eye that cut or damage the eye. (See eye emergencies.)
·Acute glaucoma -- a sudden increase in eye pressure that is extremely
painful and causes serious visual disturbances. This is a medical
emergency. Most times, glaucoma is chronic and gradual.
·Corneal scratches caused by sand, dust, or overuse of contacts.
·Bleeding problems (for example, from excess use of blood thinning drugs).
http://www.nlm.nih.gov/medlineplus/ency/article/003031.htm#Common%20Causes
http://www.fleshandbones.com/readingroom/pdf/1053.pdf
Blocked tear ducts ? perhaps scarring is causing an obstructed tear duct.
Obstruction of the tear duct is caused by:
Inherited abnormality.
Bacterial infection of the duct.
Sinus or nasal infection, especially the long standing infections.
Eye infection.
Fracture of the nose or bones of the face.
http://www.medindia.net/Patients/PatientInfo/blockedtearduct.asp#symptoms
http://www.healthatoz.com/healthatoz/Atoz/ency/lacrimal_duct_obstruction.jsp
?Proving the link between the sinus disease and strabismus may be
impossible in this heterogeneous group of patients. Both disorders are
chronic and common. There are many individuals with recurrent
sinusitis who never develop strabismus and many strabismus patients
who have no sinusitis or unrelated sinusitis. The patients reported
here had atypical strabismus, which responded poorly to standard
treatment until sinusitis was controlled. Some cases resolved with
sinus treatment alone, and many had unusually severe sinus
inflammation by radiologic examination and at surgery. Although
incidence figures are not available in this study, it is the authors?
impressions that the incidence of positive CT scans exceeded 50%.?
http://aosonline.org/xactions/2004/1545-6110_v102_p159.pdf
The following article makes me believe that you may have developed a
bit of scar tissue from your surgery. During the day, it causes little
problem (even improves) ? at least you did not mention photophobia
(pain in your eyes from light) of eye pain during the day. At night,
with your eyes closed, the scar tissue may be pressed against veins or
capillaries of your eye, causing a blood shot appearance in the
morning. A good ophthalmologist can examine your eye for this, using
an MRI and other tools at her/his disposal. Untill you see a new
doctor, you could try using artificial tears, or the new saline mist,
to keep your cornea moist, particularly before going to bed.
?Strabismus surgery involves making a small incision in the tissue
covering the eye which allows the ophthalmologist access to the
underlying eye muscles. The eyeball is never removed from the socket
during this kind of eye surgery. Which eye muscles are repositioned
during the surgery depends upon the direction the eye is turning. It
may be necessary to perform eye muscle surgery on both eyes. When
strabismus surgery is performed on children, a general anesthetic is
required while a local anesthetic is an option for adults.
Recovery time is rapid and the patient is usually able to resume their
normal activities within a few days. Following surgery, glasses or
prisms may be needed. Over-or-under correction can occur and further
surgery may be needed. As with any surgery, eye muscle surgery has
certain risks which include infection, bleeding, excessive scarring,
and other rare complications that can lead to loss of vision.?
http://www.kellogg.umich.edu/patientcare/conditions/strabismus.html
?After strabismus surgery on the horizontal recti, there are some
alterations in the retrobulbar blood flow with a significant
difference between pre- and postoperative blood flow velocities after
single and double rectus surgery. The clinical significance of these
results needs to be determined because CDI may be a useful tool in the
investigation of hemodynamic alterations after anterior segment
interventions that may cause anterior segment ischemia.
http://taylorandfrancis.metapress.com/app/home/contribution.asp?wasp=b11f23ee51e5427aa7b1edcdd58c97dc&referrer=parent&backto=issue,4,9;journal,22,30;linkingpublicationresults,1:103119,1
?Question: Are there any risks with strabismus surgery?
Answer: All surgery carries risks. The main risks with strabismus
surgery include under- and over-correction. There is a very small risk
of infection, bleeding, and excessive scarring. Fortunately,
complications that may lead to vision loss are extremely rare.?
http://www.eyemdlink.com/EyeProcedure.asp?EyeProcedureID=63
?PURPOSE: Patients with overcorrected strabismus (and several patients
with undercorrection after extraocular muscle resection) underwent
exploration of previously operated muscles, with the intention of
advancing their tendons to prevent the need for surgery on additional
muscles. Unexpectedly, it was found that, in many cases, an elongated
scar segment of variable length was interposed between the muscle and
its insertion site on the sclera.?
?The scars consisted of amorphous connective tissue interposed between
the globe and normal tendon. Repair was accomplished by excision of
the scar and reattachment of the muscle to sclera, using absorbable
sutures in 64 cases and nonabsorbable sutures in 70 cases.?
?CONCLUSIONS: A lengthened or stretched, remodeled scar between an
operated muscle tendon and sclera is a common occurrence and is a
factor contributing to the variability of outcome after strabismus
repair, even years later. This abnormality may be revealed by careful
exploration of previously operated muscles. Definitive repair requires
firm reattachment of tendon to sclera with nonabsorbable suture
support.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10703142&dopt=Abstract
?Strabismus surgery is generally regarded as a relatively safe
procedure, with the greatest risk to the patient often being that
associated with anesthesia. However, as with all surgical procedures,
postoperative complications do occur in a minority of patients.
Both acute and chronic inflammatory reactions are reported, most
commonly to topical antibiotics or absorbable suture material. These
events cause pain and conjunctival hyperemia but do not often threaten
visual function except in the very rare case of necrotizing scleritis.
Most cases of inflammation resolve spontaneously or with the use of
topical steroid or non-steroidal medication. It is very important to
consider the possibility of infection when managing these patients.
Postoperative infection is less common but more serious, carrying the
threat of permanent visual impairment from endophthalmitis. Although
most often associated with intraoperative scleral perforation, other
sources of infection have been cited, including localized suture
abscess formation. Orbital cellulitis also occurs infrequently, but
can progress to cavernous sinus thrombosis and even death in young
children. Suspected infection following strabismus surgery should
prompt urgent evaluation and aggressive treatment.?
http://www.ingentaconnect.com/search/expand?pub=infobike://wisc/aoj/2003/00000053/00000001/art00009&unc=
Remember, these are only suggestions, not diagnosis. I urge you to
find a trusted eye doctor as soon as possible. You would not want to
risk losing your vision! I wish you the best!
Please do not rate this question without asking for an Answer
Clarification, if any part of this answer is unclear. This will allow
me to assist your further, if possible.
Regards, Crabcakes
Search Terms
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Chronic unilateral red eye + post surgical
Chronic unilateral bloodshot eye
Unilateral red eye + post strabismus
Strabismus surgical risks |
