I had an appointment this morning at Dean McGee Eye Institute in Oklahoma City with Dr. Farris to get more information about my vision problems. My parents drove down from Tulsa to go to the appointment with me. Overall this evening I am relieved with the results. To best explain the outcome I want to start with what the problem isn't. It isn't a tumor, that was evident in my MRI. It isn't a neurological disease or disorder, my brain is healthy. It isn't a problem with my optic nerve, there is no indication of inflammation or disease. It isn't an eye disease that will cause me to lose my eyesight, I will not become blind because of this.
So if all of those things are true, then what is it you ask? I have an ocular surface disease. There are a few things at play here. First, there is a mucous membrane on the surface of your eye, the function of which (among other things) is to provide clarity of vision. My membrane is 1/3 the thickness that it should be, so if a normal membrane is 100% mine is 30% in thickness. Second, there are goblet cells in the eye, the function of which is to secrete an oil that combines with the water created by your tear ducts that lubricates and supports that mucous membrane. I have a low count of those cells which means that my eyes routinely do not get the kind of lubrication necessary for clear vision. I am creating enough tears, but the goblet cells are required for sustained lubrication and that is something I am missing.
In addition to those two things specific to my eye, I also have some rosatia around my eyes and some veining on the sides of my nose (where my glasses rest) that the doctor said is typically seen in 50-60 year old patients, rather than in someone my age. This time last year, I had a a very bad case of eczema also around my eyes. If you saw me at all during that time I literally looked like a raccoon. Steroids corrected the problem over a couple of weeks and it has not returned since. All three of these things...rosatia, eczema and ocular surface disease...indicate the presence of an autoimmune condition.
There is no cure for my eye condition. I cannot regrow a mucous membrane or increase my goblet cell production. What I can do is learn to manage my symptoms so that my vision improves and that includes a three part treatment plan. First, I have an oral prescription that I will take daily for the next six months for sure, probably longer. Second, today the doctor placed punctal plugs in my tear ducts. Using a mirror, if you pull down your bottom eyelid and look toward your nose, you should see a small hole that looks like a pin prick. You have one in each eye on the bottom and one in each eye on the top, for a total of four. One way to treat my lubrication problem is to plug those holes so that the lubrication that my eyes can make naturally doesn't drain out. Today, Dr. Farris placed silicon plugs in my lower ducts. They feel a little funny right now, I know eventually I'll get to where I don't feel them, but for now it's kind of like a contact lens or a grain of sand I can't get rid of. They can be removed or I could accidentally rub them out if I rub my eyes too hard, so I have to get used to not rubbing my eyes. (Tough to do by the way when it's a foreign object around your eye!) If I do accidentally rub them out they can easily be replaced. The third part of my treatment plan is regular use of eye drops, up to ten times daily. There is a specific drop that I can buy over the counter that is specifically for someone with the goblet cell condition that I have. Not all drops do the same things, but luckily at this point I do not need prescription drops, there is an over the counter option.
As the doctor pointed out today, my career choice and hobby of reading create a visual challenge that other people might not face. Because I spend a lot of time focusing on text or a computer screen, diminished clarity impacts me in a significant way. That being the case it is important for me to follow this treatment plan to restore clarity to my vision. I'm currently in a chronic stage with this problem but by following the treatment plan I should get to a more manageable place. Unless I have a major setback or emergency, I will not have to go back to Dean McGee, my local doctor will be able to handle future treatment. I've been told to give the treatment plan three months before making any changes to it, such as adding plugs in my upper ducts if I haven't made sufficient improvement.
When I went to bed last night I was trying to mentally prepare myself for the worst case scenario of permanently losing my vision, a tumor or disease that would require surgery or some other equally serious diagnosis. I am relieved tonight that it is a manageable condition. It is something I will deal with it for the rest of my life and the investigation into an autoimmune condition is just beginning. Additional testing with an internist may be necessary to determine the extent of my condition and any additional systems or organs that may be effected. I thank you, and my parents thank you, from the bottom of our hearts for all of your prayers and support throughout these times of living with the unknown. I still have hurdles...I will continue to limit how much I read and I will not be able to drive at night until I get my clarity back, but I have a plan that will hopefully get me there.
At the end of my appointment today Dr. Farris asked if he could pray with me and very eloquently asked the Lord to heal me and bless me on my road to recovery. His prayer collectively with your prayers have allowed me to feel safe, loved and supported. Thank you.
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