The College of Optometrists

i had a patient the other day who came in for a routine test.

she was 32 years old, and 2 years ago she was given a first time myopic rx.

2 years ago the rx found was:

-1.00/-1.50x 30

-1.00/-1.25x 135

The previous optom gave her a partial correction to ease adaptation (i would have just given her the full correction)

anyway she returned recently saying that she now felt she needed the full rx as her vision was not as good. after refraction i found the same result as above and just prescribed it.

The strange thing was that this lady could only get to the 6/6 line and even with this she struggled.

when i did ophthalmoscopy her cornea looked 'dotty' (technical i know!) i then looked on slit lamp and her central cornea did look compromised, i examined with fluorescein and the central cornea had punctate superficial staining.

i asked if she had ever been a cl wearer...no.

she was on homeopathic medicine (since october) which had replaced about 15 painkiller tablets that she was on previously. 4 years ago she had a child and since then she has been getting disturbing muscle pains, she has been under investigation and arthritis and rhematoid arthritis has been ruled out, drs say they cant find out what the muscle pain is caused by. i dont know if there was staining in her last eye exam as it had not been noted, but the previous optom could not get her passed 6/6 either.

i referred her on GOS 18, but i am not sure if i will get a reply back as to the cause of staining... does anyone know what this could be??

Dry eyes

Not all pxs see more than 6/6

yeah, have advised artificial tears also, but just thought the staining was alot considering... i have seen a patient with sjogrens who didnt have as much staining, and this lady didnt complain of having dry eyes....

You will not always get pxs with symptoms.........look at all the pxs you have seen with pingueculae.Only the signs may be present. Also look at lid hygiene, assess the tear film for TBUT etc.