Interlude: They Say the Third Time's a Charm

(photo credit: http://www.eyedoctom.com/eyedoctom/EyeInfo/CornealAbrasion.asp)



21 to 27 April 2008

So, as I was saying, I was good until Monday afternoon. I was at work, figuring that if I’d actually re-scratched my cornea there’s no way I could have labeled sixty tiny centrifuge tubes in preparation for tomorrow’s experiment. On the other hand, if I weren’t concerned that I might have scratched it, I wouldn’t have labeled them a day in advance, in anticipation of impending extreme light-sensitivity.

The light sensitivity started around 2 p.m. By the time I got to the gym to lift weights, I was into the extreme tears phase. Wednesday had me back at Scheie Eye Institute for my third recurrence of recurrent corneal abrasion. So much for dodging a bullet.

Let me back up a little bit and explain this whole thing. If you’re oogy about eyeballs or if foul language offends you, read no further. Corneal abrasion comes with lots of both.

What happens is that some lucky people like me sustain a corneal scratch some time in our lives. The scratch heals, but the layer of cells over the cornea (the epithelium) is never quite as good as new. An untold number of years later (twenty-one for me) the spot that healed comes unglued. Over and over again.

The typical situation goes like this: Everyone’s eyes dry out a little at night. Combine this with seasonal allergies – including swollen eyelids – and a reason to wake up in the middle of the night – to pee, to cough, to make way for a cat, whatever – and all hell breaks loose. The swollen eyelids stick to the epithelium over the cornea, get a hold of the old wound site, and rip the wound open again.

This hurts like a sonofabitch.

Like road rash in salt water. For days.

What happens next, besides a good case of denial, is a free pass of a few hours to a day or so, when the flap of epithelium that tore might lie down over the cut and start to heal, loosely. If you’re lucky, things heal and you never know anything is wrong. Looking back, I think his happened to me at least three times last spring before things got bad in June. If you’re not lucky, the free pass goes away.

You start to notice that things are too bright. You pull down the shades, cut the brightness on your computer screen, and pull out the sunglasses. You look in the mirror and things seem a little watery. Your eye sort of hurts, especially when you blink. Things are only going to get worse from here, so if you haven’t already seen an eye doctor, you need to go right now.

By the time your name gets called at the Scheie Eye Institute, you’re holding a bandana on your cheek to catch the waterfall coming out of your eye. You can’t read for more than thirty seconds, so you’re sitting with your head back and your eyes closed. When your name gets called you open your eyes too quickly and FUCK that hurts!

Then you get an hour of bliss when the doctors put the numbing drops in. You want to take the whole bottle home, but they won’t let you. It impedes the healing process. Rats. They put fluorescein dye in your eye. The world out of your bad eye turns orange-yellow. The doctors flip on a blue filter and look in your eye. Where the cut is, they see green.

The first few times that corneal abrasion recurs, the doctors will probably let the flap of loose epithelium sit back down over the cut and heal. But the risk of the flap coming loose is always there. The surface isn’t smooth like it should be. It’s sticking up there, waiting to be pulled open again. The third time around, the doctors go for a more extreme treatment.

More numbing drops, a cotton swab, and the flap gets peeled off completely. A fresh wound, bigger, and it’s going to hurt like hell when the drops wear off. But this will make things heal more quickly, and, more importantly and hopefully, more smoothly. A good doctor will show mercy at this point, close your eye, and put a patch over it for a day. This is instantly more comfortable, because when your eye is open hurts like hell each and every time you blink, as your swollen eyelid rubs against the cut.

Congratulations. You’re a pirate for a day.

You ride the pain-free wave for about an hour, at which point your good eye is getting tired putting in overtime for no extra pay. You sit down to close your eyes for a few minutes.

MOTHERFUCK FUCK FUCK FUCK FUCK!!!!!!!!!!!!!!!!!!!!!!!!!!

You’ve just learned the hard way that, since your eyes track together, and since they roll up a little when you close your eyes, the crater in your eye is rubbing against your eyelid as your eye ever so slightly moves. You learn to dig your fingernails into your palm whenever you do more than blink.

A few hours go by before you realize that your good eyelid is at half-mast. You can no longer keep it open any further, nor can you look anywhere but down. It’s time to go to bed, and if you can’t, you need to stand up and walk around, focusing on nothing in particular. You can take a short nap if you want to, and you’ll want to because you’ll be exhausted. Just remember to get your fingernails next to your palm before you close your eyes. Tylenol might help a little here. It’s tough to tell.

Climbing into bed for the night feels good. The next morning you’ll notice that closing your good eye doesn’t hurt the bad one so much anymore. You won’t have to punch out the doctor after all. But your good eye still won’t open all the way. All you can do is count the hours until the patch comes off.

When it does, you know that the worst two days of this episode are over. But you can’t see more than colored blobs out of your bad eye. Your now have corneal edema – swelling of the cornea – and it’s going to take more than a few days to come down. You’re put on a regimen of antibiotic ointment to keep infection away and hypertonicity ointment to bring the swelling down. You’re binocular again, but half your vision is through a thick piece of clear Jell-O.

Knowing the worst is over, you can now entertain yourself as the swelling gradually disappears and the Jell-O gets thinner. On the first day you see a blob on the wall where the clock is supposed to be. By that evening you might notice that the blob might read 7 p.m. The next morning you can definitely tell the time, but not to the minute. By the evening, the second hand comes back. I like doing the shampoo bottle test in the shower. The first day the bottle is a white blob. At the end of the second day, if I get right up to it, I can read the fine print on the label. A day later I can step halfway back in the tub before the words blur in the Jell-O.

Two days after the patch comes off you can ride your bike again, even if you have to follow the double white line on the side of the road. Cloudiness and dark sunglasses help, even though you haven’t been light sensitive since the evening after the patch came off. The shades just eliminate the glare that seems to bounce off the Jell-O.

You find it amusing that you see as well at a distance out of your bad eye as Jack sees with his glasses on. You get to feel smug for having good vision.

Around the same time you’ll find you’re not squinting at your computer screen. You haven’t had to enlarge the text for a couple of days now. You don’t even notice the Jell-O unless you close your good eye. Even then, you can read the words on your screen with your bad eye, if you get all up close to the screen and stuff. OK, so you’re not completely healed. Stop with the testing and just ignore it. By the time you go back for your final visit to the eye doctor your vision will be almost normal.

Now all you have to do is keep up with the hypertonicity ointment, wear eye protection when you do yard work, and hope your eyes don’t crust over again at night, ever.

Because the next time this happens, the doctors are going to perform what they like to call a “procedure:” stromal puncture. They’re going to make tiny cuts with a needle, through the epithelium, down into the cornea, to create scar tissue at the wound site. They’re going to want to do this while you’re suffering through your next abrasion. Scar tissue, they say, will form at the injury site, and the scar tissue will hold the epithelium down much better than the epithelium has been doing by itself.

But you’re not going to let this happen again, are you? Because the crater has healed over smoothly this time, right? (I’ll know on Wednesday.)

OK, time to go put more Muro128 in my eye. All hail the mighty hypertonicity goop!