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Medical Forum / General / Vision / August 2004A Puzzlement: Sudden Change in Refractive Error Following Conjunictivitis
One morning this week I noticed a large change in the focus of my left eye. My correction has always been symmetrical and small. Suddenly one eye was blurry both for closeup and distance vision, but the effect was much more pronounced close up. I could easily read standard size print with my good eye, but not with the bad one. My closeup vision in the bad eye was completely correctable with a reading lens. Since this happened suddenly, I was alarmed and went to an opthalmologist. I explained that I had had conjuctivitis several weeks ago in both eyes, but that it had subsided after a course of antibiotic and corticosteroid eye drops. He tested for glaucoma, did a refraction, and a retinal exam. His examination found nothing wrong with my eyes. He seemed surprised to find nothing and almost disappointed. He said matter-of-factly that it wasn't likely the result of a stroke since it was unilateral. He tested my visual field and it was normal. He acted somewhat mystified but then gave me a new eyeglass prescription and said I would see fine with new glasses! Needless to say, I would like to know why my prescription changed drastically in one night and I am not eager to get new glasses only to find my prescription changing again suddenly. I have to believe this is a sequela to the conjunctivitis. As a physicist, since my retina didn't move, I have to assume something changed either the shape of my eye, the curvature of my cornea, or the shape or position of my lens. The most obvious would be the shape of my cornea. Is there an opthalmologist out there who can suggest an explanation? As for his stroke comment, could a stroke make things blurry in a way that was correctable with a lens? The only way I could see that happening is if it affected the muscles that control the lens of the eye. Thanks in advance for your help, J.W.T. IT IS VERY STRANGE FOR ME TO SEE THESE VERY LEARNED PEOPLE REPORTING THESE CLEAR SYMPTOMS OF MENTAL STRAIN AND DO NOT RECOGNIZE THEM!!! THE EYE IS PERFECT, THE RETINA TOO, ETCETERA, AND STILL YOU HAVE IMPERFECT VISION. WHY DON'T YOU LOOK BEHIND THE EYE, INTO YOUR STRAINED MIND??? YOU WILL SEE THAT THE PROBLEM IS MENTAL STRAIN. GET RELIEF FROM THE STRAIN BY MEANS OF REST METHODS. Visit http://www.thecentralfixation.com if you want to know the truth about vision. > One morning this week I noticed a large change in the focus of my left eye. > My correction has always been symmetrical and small. Suddenly one eye was [quoted text clipped - 28 lines] > > J.W.T. Rishi, I disapprove of what you have to say, but I will defend to the death your right to say it. J. P.S.: You should get one of those newer computers with a SHIFT key. > IT IS VERY STRANGE FOR ME TO SEE THESE VERY LEARNED PEOPLE REPORTING > THESE CLEAR SYMPTOMS OF MENTAL STRAIN AND DO NOT RECOGNIZE THEM!!! [quoted text clipped - 10 lines] > Visit http://www.thecentralfixation.com if you want to know the truth > about vision. > Rishi, > [quoted text clipped - 4 lines] > > P.S.: You should get one of those newer computers with a SHIFT key. I really thank you, but I deliberately used the shift-lock because I wanted to convey that I was screaming out loud. Why don't you try to understand better my saying? Perhaps you won't disapprove it anymore. Feel free to ask help, I am available! > I have to believe this is a sequela to the conjunctivitis. It's pretty unlikely with simple conjunctivitis. I have to agree it's possible, but not common, and there are some other explanations. > As a physicist, since my retina didn't move, I have to assume something > changed either the shape of my eye, the curvature of my cornea, or the > shape or position of my lens. The most obvious would be the shape of my > cornea. Is there an Your reasoning is pretty sound, except one of the most common causes of sudden hyperopia in one eye, in male adult professionals, involves the retina. Look up "idiopathic central serous choroidopathy (ICSC). You'll find that this episodic swelling in the choroid _does_ lift the retina to a new, more hyperopic plane of focus. It usually _does_ diminish corrected acuity, but maybe not, and it usually resolves to near-normal in a matter of months, without treatment. It can be overlooked during examination, but it's the first rule-out in an adult male with sudden hyperopic blur in one eye. Your doc was probably "disappointed" because he couldn't find any. > opthalmologist out there who can suggest an explanation? As for his stroke > comment, could a stroke make things blurry in a way that was correctable > with a lens? The only way I could see that happening is if it affected the > muscles that control the lens of the eye. You're right again. So the parasympathetic fibers for accommodation ride along with other skeletal motor fibers, and a small "stroke" anywhere along their course would likely affect eye movements. Be sure you have no double vision in extremes of gaze. It's normal for some individuals to see double in extreme up gaze. Depending on your age, you may be poised for presbyopia anyway. "Overnight" blur is a pretty common complaint among these people, even though we imagine the loss of flexibility to be a slow, gradual change. If this is the problem, the refraction won't likely change back, and it will gradually get worse. Of course your corrected acuity remains sharp. If the refraction never comes back down from its present plus value, it's more likely a benign cause. If it improves at all, pathologies are more suspect. Some medications like scopolamine or stimulants can cause sudden changes in refraction, but not often. High blood sugar is perhaps the most common cause of sudden refractive changes. It usually affects both eyes, but your "bad" eye may have been more farsighted initially. Depending on your other diabetes risks you might want to follow up on that. Bottom line, if your _corrected_ acuity is equal in both eyes, and all those tests were negative, there's nothing to treat. You'd get another clue to the cause by rechecking the refraction at three months. -MT, OD Mike, Thanks so much. Your answer is very helpful, much more so than my ophthalmologist. I should point out that I have had a mild myopia since early adulthood, that I am now 53, and that presbyopia has been a problem for the last 5 years or so. The reason I strongly suspected the conjunctivitis is that I have never had any acute eye problems before and now within the past few weeks I had a rather severe conjunctivitis, requiring three rounds of antibiotics and prednisone eye drops, and just after that seems to have healed, I suddenly developed this new problem. I caught the eye infection from my daughter who got it right after returning from Vietnam, where she spent three weeks providing medical care in an impoverished area (she is a pre-med). Who knows what strange tropical organism may have been responsible. Is it possible that some swelling of the cornea could be a result of a lingering infection? Would such a swelling be noticeable to the doctor? The doctor clearly said that my retina looked excellent, which is why I ruled out any kind of retinal detachment. I looked up ICSC as you suggested, but perhaps it was too subtle to be seen in the ophthalmoscope. Interesting comment about the double vision. I believe my doctor must have been testing for this. I remember him asking me to gaze in eight extreme directions. Was he watching my eyes to see if they both pointed the same way? I now have one additional symptom to report. I think it is new today, but it is possible I simply hadn't noticed it. If I look at a bright point source, I see a beautiful, almost circularly symmetric diffraction pattern, with a bright outer halo, and beautiful colored fringes inside. The angular diameter of the halo is about 1.5 degrees, or about twice the diameter of a quarter at arm's length. My physics training leads me to suspect a rather small (~30 micron) particle, bump, or imperfection in or on my eye, but I'm not an optics expert so this could be off-base. Thanks again for your excellent response to my message. I really appreciate it. J. >> I have to believe this is a sequela to the conjunctivitis. > [quoted text clipped - 50 lines] > > -MT, OD > for the last 5 years or so. The reason I strongly suspected the > conjunctivitis is that I have never had any acute eye problems before and > now within the past few weeks I had a rather severe conjunctivitis, > requiring three rounds of antibiotics and prednisone eye drops, and just > after that seems to have healed, I suddenly developed this new problem. Corneal causes sound more likely now, knowing your conjunctivitis was severe and "imported". Aggressive strains of virus (adenoviruses, "EKC") were once known to concentrate around seaports. Ordinary viral conjunctivitis (pinkeye) becomes "keratitis" when it produces white cell infiltration into the cornea. That usually clears without affecting the curvature or optics, just causing temporary haze. In "EKC," infiltrates can be profuse, distorting the cornea enough to change the surface contour. Usually the corrected vision is so hazy that the cause is obvious. In the microscope, one sees fluffy white clouds 0.1-1 mm scattered throughout the corneal stroma. Steroid drops quell the infiltration, but in EKC the viral particles remain longer, and white cells often come back after steroids are stopped. > cornea could be a result of a lingering infection? Would such a swelling > be noticeable to the doctor? Corneal infiltrates would be hard to miss. But a healing cornea might conceivably alter its curvature, and such a change wouldn't be detectable without specific measurements. > The doctor clearly said that my retina looked excellent, which is why I > ruled out any kind of retinal detachment. I looked up ICSC as you > suggested, but perhaps it was too subtle to be seen in the ophthalmoscope. The foveal pits produce a pinpoint reflection which disappears in ICSC. If your doc saw healthy "foveal reflexes" in each eye, that pretty conclusively rules out ICSC. > Interesting comment about the double vision. I believe my doctor must have > been testing for this. I remember him asking me to gaze in eight extreme > directions. Was he watching my eyes to see if they both pointed the same > way? Yes, certainly. > I now have one additional symptom to report. I think it is new today, but > it is possible I simply hadn't noticed it. If I look at a bright point [quoted text clipped - 4 lines] > suspect a rather small (~30 micron) particle, bump, or imperfection in or > on my eye, but I'm not an optics expert so this could be off-base. Rainbow diffraction is pretty specific for swelling in the corneal epithelium (like swimming too long in a chlorinated pool). Your infiltrates (keratitis) may be returning now that you're off steroids. Inflammation in the underlying stroma could be causing some epithelial edema. It isn't normally re-treated unless the haze gets severe. -MT Mike, Thanks again. I noticed today that my corrected visual acuity is declining in my bad eye. My doctor now wants to measure my corneal topography, scheduled for next week. I really appreciate your help. Regards, J. > quarter at arm's length. My physics training leads me to suspect a rather > small (~30 micron) particle, bump, or imperfection in or on my eye, but I'm > not an optics expert so this could be off-base. Your physics training is what is harming you the most. You believe that have studied some of quantum mechanics, and have the right to discuss the work of God in creating the eye and mind. Please, be a little bit more humble. Choose the simplest way: discard all the difficult explainations and go directly to the root problem, which is the mind under a strain. Demonstrate some useful rest method for yourself, for example, reading or gazing at microscopic type for ten minutes, and see how your presbyopia simply disappears, even for only few seconds. If you need help, please visit http://TheCentralFixation.com |
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