optician

[chatterbox54]

I go to an private optician. I have an existing eye condition called Drusen which is where lumps form on the eye and it makes things look slightly wonky. This may or may not lead to Macular Degeneration in years to come. I had my yearly eye check up and the usual optician had moved on so I saw the other optician who runs the practice. I had not seen this optician for a few years because she is part time and does not fit in with my schedule so I saw her colleague who suited me better, however I did see the owner when I first went there. This time the owner looked into my eyes and said I have very dry eyes and advised me to use eye drops and also said I have a tear duct layer lost and the existing layers could rub together and if I do not lubricate then it could get worse. She sold me some drops and asked me to return in 6 weeks to check the situation and see if the drops are working and if not then she will try some other ones. Then she said to me I think you have Graves Disease because your eyelids are puffy. She did not explain further or go into any details. I said do I not need to go to the eye hospital to have this checked out and she said if you do you will be there for hours so I will not recommend you go there so just stay here. I am a bit upset and confused about this. I am not looking for medical advice but just wondered if I should get a second opinion because medics should not mention things to patients unless they are sure and my optician is not sure yet. They say ignorance is bliss and how can I enjoy Christmas with this hanging over my head which may come to nothing in the end.

The optician also said she did not think I had blepharitis which is crusty eye lashes. Every single optician I have seen has said I have blepharitis.

I am so fed up

I'd guess that since you have an existing eye condition, wouldn't it be better to see a professional eye doctor about any and all "conditions" you might have, and make it clear to the opticians that however much you appreciate their medical advice, you already have an eye doctor keeping a close eye at you ;-) and that you're with the optician simply to get a prescription for glasses?

hi

thanks for reply. I have not got an eye doctor keeping a close eye on me. In 2009 I was sent to Moorfields eye hospital because an optician told me I had the start of Macular Degeneration. When I went to Moorfields to see the consultant, he said I had no such thing but what I do have is Drusen. I was there for four hours and was very satisfied with the examination with the dye to dilate the pupils. The consultant said there was no point in going back and he discharged me and said if your eysight changes then please return but until then there is no point coming here. From 2009 until now I have been to get my eyes checked each year and there has been no change in my eyes or my sight. However if it turns out after my dry eyes have got under control and they can clearly see I have Graves then I will insist on being referred to the hospital and will not be fobbed off with the lame story of hospital appointments taking hours. Yes they do but you only get one set of eyes and I want the best for them

Ophthalmic Graves’ disease otherwise known as thyroid eye disease is,an auto immune condition. Most people with ophthalmic graves will have previously been diagnosed with an overactive thyroid. There are lots of possible signs and symptoms of this puffy eyelids is one, eyes becoming more prominent, feeling gritty , painful eye movements, double vision are some of the most common ones. I’m an orthoptist and part of my job is to see patients with this condition. I would advise you to see your GP first and you can be referred to your local eye unit if needed , the advice from the optician is not sound

I agree with Corneliussnitch - you need to discuss this with your GP. Ask them to check your thyroid levels and refer you to an Ophthalmologist to check you properly with regards to the blepharitis/dry eye as well as your puffy lids.
Don't worry about it though and enjoy Christmas as even if you have these problems they are not serious and can be managed.

Hi

Thanks. I actually have an underactive thyroid not an overactive one. I am on Thyroxine for it and have been on the medication for 15 years and my thyroid is ok and I have yearly blood test which always come back as normal. I have actually got a GP appointment for Friday to discuss this. My eyes do not feel that sore to be honest and there are times when they feel fine. I have heard some people say their eyes are so sore it is unbearable which mine have never been.

After I have seen the GP I will decide what to do regards the optician. One good thing though is that she is doing her best to get to the bottom of my dry eyes by telling me to use eye drops three times a day and then telling me to go back and see her to check the situation again. To be honest that is more than any other optician has done. The other optician I saw at the same practice just said use eye drops and never even bothered to ask me to go back in a few weeks to double check on my dry eyes.

chatterbox - blepharitis can come and go, it can cause dry eyes, but then so can lots of other things. Yes, lubricating drops for dry eyes are the first stage of treatment, whilst they don't cure the underlying condition, they do make your eyes feel more comfortable.

They can also provide more lubrication between the eyelids and the eye, so that the eyelid doesn't rub on the eye when you blink.

Grave's Disease or thyroid eye disease (TED) is less common in those who have an underachieve thyroid, but around 10% of people who have an underactive thyroid also have thyroid eye disease.

Eye puffiness and dryness are two of the signs, but they are signs of a lot of other things as well. They can actually also be a sign that your medication dosage needs adjusting.

Optometrists only refer eye conditions if they are unable to manage them in practice. Our profession is also becoming a lot more specialised and many of us have higher qualifications in particular areas. For example, my areas of specialisation are the front of the eye and binocular vision. So, I would not refer someone who had an eye infection, but I would someone who had high eye pressure as glaucoma is not one of my areas of speciality and I wouldn't feel comfortable monitoring them myself.

If you do have mild thyroid eye disease therefore (I can't say for sure if you have or not as I haven't seen you personally) and you don't have any double vision/severe lid problems and the Optician is confident that they can manage your condition with dry eye drops, then they are right, there is no point you being referred. You'll most likely sit in the clinic for ages and then come out with a bottle of dry eye drops that will be less effective than the ones that your purchased from the optometrist.

Having said that though, if you would like to be referred then the Optician/Optometrist will do so. You just need them to write to your GP and they will refer you to the hospital eye service. You can either call them to write the referral or wait until they see you in a few weeks to look at how the dryness is progressing.

Either way, please, please don't worry. If it was serious the Optician would have referred you without hesitation.

Cornelius - can I remind you, you need to be aware of your legal professional duty with regards to inter-profession relations.

My optician recommended flaxseed oil capsules for dry eyes in addition to drops - might be worth a try?

Op if you have thyroid eye disease this cannot be managed by an optometrist , dry eye conditions can . People with hypothyroidism can occasionally develop thyroid eye disease but it is nowhere near 10% of them. Underneaththeash I will pm you rather than get into a more public spat.

Op to give you the correct figures 10% of people who develop thyroid eye disease have normal thyroid function or an under active thyroid at the time of diagnosis. Which is very different from saying that 10% of people who are hypothyroid develop thyroid eye disease. Hopefully you will turn out to have a dry eye/ blepharitis condition hope you get things sorted soon

I went to the GP today. She said all my thyroid tests in the past have been normal and my underactive thyroid is on the correct dose of medication (125mg of Thyroxine). She also said that if I did indeed have Graves disease my eyes would be protruding and they are not. I did not say anything to her but I did wonder whether protruding eyes only occur if you have Graves and have done nothing about it and if your Graves disease is in the very early stages, your eyes do not protrude and look like you have seen a ghost. Anyway the GP said put it out of your mind for the time being and she gave me some forms to get blood tests done for thyroid. The tests she said are the same as the yearly test I have to check my medication levels against my thyroid but one of the tests she has asked for is for auto imune because Graves can give you auto imune problems. Also I have done a bit of research online and found that when people have Graves it can also make the whites of your eyes look red and blotchy and the only time my eyes have ever looked like that is when I accidentally got some shampoo in my eye and it was irritated but when I bathed it, it went away. The GP did however agree with me that the optician should not have said to me that she thinks I have Graves disease without something concrete to back it up with because saying something like that can scare people and cause unnecessary alarm. Both the GP and I agreed that nothing should have been said until she was more sure about it. I am a strong person and being told by a medic that you may have this or that could cause a weaker person serious harm. Yes I am a bit concerned about it which is natural but another kind of person could lapse into a dreadful state of depression. I am not brushing this under the carpet because I am seeking advice. I have never had high blood pressure, and my cholesterol levels are fine. I relayed this to someone today and she said I should go to the eye hospital for a second opinion and I do not need a referral as I can go there the same as you would to any hospital A and E. I really think if I was in any danger then the GP would have said go to the eye hospital but she did not think there was any cause for immediate concern.

Glad you have been reassured by your visit to the GP. What happens in ophthalmic Graves is that all the soft tissues in the eye socket and eyelids swell. Inside your eye socket you have muscles and orbital fat when this swells it pushes the eye forward. For most people the symptoms are mild so that they notice some swelling , redness of the eyes and a gritty sensation with eyes feeling dry but often watering a lot which sounds a bit of a contradiction. In a few people this can become more severe. If you have always had an underactive thyroid it is very unlikely you will get Graves , but not impossible. The key thing is to go back and see your doctor if you ever notice your eyes becoming more prominent.

yeah thanks. Merry Xmas