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Jeruba's avatar

Problem with my eye: what kind of doctor?

Asked by Jeruba (51332points) October 19th, 2010

I’m not sure it’s actually an eye problem. I do know enough to go to a doctor, but I’m not keen on making two or three $25 copayments until I get to the right one. My primary care doctor is an internist. Fluther helped with this kind of question before, when the answer was podiatrist and not orthopedist or neurologist, so—here’s hoping.

Symptoms: About 2 weeks ago, maybe 3, I started noticing tenderness below my right eye. It seemed to be on the edge of the bone. So I couldn’t tell if it was actually at the bone, or in the soft tissue of the cheek on top of the bone, or in the eye socket behind it.

The tenderness has gradually increased so that by two days ago I started calling it “sore,” though not markedly so. The difference was that it was noticeable not just to the touch but even when I didn’t touch it. And there seemed to be excess crustiness in the morning.

This morning the area beneath the lower eyelid—again, meaning below, not within—is noticeably swollen, and there seems to be some redness on the rim of the lower eyelid.

I’ve never had anything like this before.

Complication: I’m out of town for the week, but still within driving distance of home and my usual medical services. Shall I make the trip back to see a doctor right away, and if so, which one?

Thanks for all knowledgeable advice.

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31 Answers

JilltheTooth's avatar

Does the redness look at all like a bug bite or the start of a rash? I had shingles last year near my eye (above, actually) that started out slightly resembling a bug bite, with some swelling and soreness. In a few days it got worse, redder, and started to resemble a rash. If there’s a chance it could be shingles, go in right away, it could permanently damage your eye if left untreated.

JLeslie's avatar

I don’t think it is shingles, because it has been going on for two weeks already, and it would most likely be full blown and a significant rash with blisters, etc.

This one is tough, at first I thought ear, nose and throat maybe? That it cold be sinus related? Do you have any pain in your teeth on the same side? Your upper teeth?

Jeruba's avatar

@JLeslie, I wondered about that. There is a sensitive area in the upper gum pretty much due south of this spot.

I don’t see signs of a bug bite, but then I can’t see very well without my glasses, and with them on they’re in the way. My husband says it looks like a couple of tiny blisters.

JilltheTooth's avatar

I’d get it checked out, anything that close to the eye is worrying. I don’t think you’d need an eye specialist, probably your regular GP can give you an idea. Good luck with this @Jeruba , please keep us updated. I’ll do your worrying for you, just be well.

Cupcake's avatar

I don’t think these symptoms are clear-cut enough to self-refer to a specialist. If it were me, I would go see my internist… and let them refer me out if needed. Hopefully the internist can take care of it. I’ll keep my fingers crossed that you don’t have to pay multiple co-pays.

janbb's avatar

I would go to your GP too; it sounds like maybe an infection of some kind that may be easily diagnosed.

MissA's avatar

If you were to go to a specialist, I would suggest an opthalmologist. However, if you have a well-rounded knowledgeable GP, start there. Don’t let it go.

BarnacleBill's avatar

Regardless of the cause, a dose of antibiotics seems to be in order to manage the infection. Determining if you need an ENT or an opthalmologist really does require an initial consult and referral in this case.

JLeslie's avatar

Hmmm. What I think is the difference between going to a GP and an ENT in this case will be the ENT will most likely ask you to do some xrays, which possibly are unnessary. If the sinus looks fantastically clear, then the xray will have ruled out that guess I guess, but if it shows something there it will just confirm what we already know. Either way I think they will give you an antibiotic. Tooth/gum pain is a classic symptom. Did you have a cold recently? The sinus could simply still be inflamed, and not infected, but since it is getting worse, I guess you have to assume your body is fighting something.

I almost never say GP first, because I find it to be an annoying step before finally seeing the specialist I needed in the first place, but in this case, I think both doctors will first try throwing an antibiotic at you, maybe augmentin, so I actually lean towards seeing a GP, which is surprising if you know me.

Disclaimer: I am not a doctor.

Dr_Lawrence's avatar

I agree with @BarnacleBill. Since it is unclear if the proximity to the eye means it is an eye problem, a good general practitioner will either treat it completely or get you started and refer you to the right specialist.

Damn this for profit health care and predatory for mega-profit health insurance!

JLeslie's avatar

Well, I am pretty sure @jeruba is not counting on a “good” referral, but at minimum advice on which speciatly to try next if she has to see someone else.

Rarebear's avatar

Opthalmologist.

cazzie's avatar

Have you taken your temperature? Sometimes our bodies run really mild fevers when we have infections. You can’t check yourself for elevated white blood cells, but, if they’re looking for an infection, they’ll probably take blood and do a CBC count. What does the opening to your tear duct look like? Have you tried warm compresses? Do you suffer from sinus problems? Have you been taking any antihistamines? Can you hack up and out any good bits of mucus to check the colour? Green indicates infection, but there doesn’t have to be coloured mucus to indicate an infection. Infections can be dry and crusty too.

Any double vision? (postorbital swelling can cause double vision and would indicate swelling behind the eye socket.)

If it’s around your cheek bone but making your eye weep it could be a sinus problem. Tear ducts are often (and usually) effected by sinus infections. If you have no double vision or bloodshot eyes.. I’d say you’re looking at a course of antibiotics for a maxillary sinus infection.

Let us know how you get on, and I wouldn’t leave it too long.

Lightlyseared's avatar

If you have any changes to your eysight then I’d make this your number one priority and get to a doc asap.

As to which doctor I (personally) would start with a general practioner.

janbb's avatar

I suspect @Rarebear is the one to listen to here.

Rarebear's avatar

Yup. It’s an infection of some kind. It may be something as simple as a stye, or something as complicated as a periorbital cellulitis. No way to tell. In any case, you should get it looked at.

JLeslie's avatar

@Rarebear Stye? Interesting. And she feels it in her cheek? When I get a stye, it is has been a long time since I has had one, the majority of my complaint was about my eye, I did not really get that from what @Jeruba wrote.

Rarebear's avatar

@JLeslie I don’t think it’s a stye either, but it’s part of the differential diagnosis. That’s why she needs to see a doctor.

Kayak8's avatar

I agree with @Rarebear on the ophthalmology specialty, particularly with the reported crustiness, red lower lid, and general proximity to the eye.

I also just want to put in a plug for folks (of the appropriate age) getting the shingles vaccine as deemed appropriate by their physicians.

JilltheTooth's avatar

@Kayak8 : You have to be over 60 for the vaccine… I just hope I don’t get it again before that!

Kayak8's avatar

@JilltheTooth I understand that. That’s why I put “of the appropriate age” in the comment. 60 is the recommended age based on the population on which the clinical trials were conducted.

MissA's avatar

Even though I suggested an opthalmologist, I wouldn’t think stye. It’s always been my understanding that you don’t get styes unless you pee in an alley!

Jeruba's avatar

Late-night update:

We’re on vacation this week, but I decided to drive back to town from the mountain cottage in order not to miss my weekly class, so I made a hasty appointment for right afterward with the doctor at the eye clinic where I have my regular vision checks.

By the time I got there and looked in the bathroom mirror, the little red spots had become one big red lump. This was a new experience for me.

The doctor diagnosed a hordeolum [ description in Merck ], which is another word for a stye, and said that it had to be lanced and drained. He proceeded to stab it with a needle and treat me to detailed descriptions of what came running out of it, which he delivered with considerable relish. Ah, I do admire a man who shows enthusiasm for his work; however, I let him understand that I did not require such a vivid description. The bloody wet tissues were enough.

If untreated, he said, it would probably have turned into a chalazion, which sounds even nastier. He told me to go home and put hot compresses on it several times a day, and come back if it didn’t get better.

I asked him if I ought to have done anything when I experienced the initial tenderness, and he said no, there was really nothing to be done until it was possible to drain it. He nodded when I showed him the spot on my cheek where I initially felt it, as though that were not an uncommon symptom.

I had a long drive back but started with the compresses as soon as possible.

I have not been peeing in alleys, but thanks for the warning, @MissA.

And thank you, all, for jumping in here with such concerned helpfulness and great recommendations. If class had not taken me back today, your advice would have sent me to town tomorrow. I’m glad I didn’t wait.

JilltheTooth's avatar

Oh, @Jeruba < I’m so glad it’s taken care of. Thanks for letting us know.

JLeslie's avatar

Seems @Rarebear was right! :) Thanks for the update @Jeruba.

Rarebear's avatar

@JLeslie Your doctor loves pus. A man after my own heart. Glad you’re better.

janbb's avatar

Well, @Rarebear is a doctor (and plays one on tv) so I assumed he had the right idea.

Glad it’s getting resolved, although pusily.

Rarebear's avatar

@janbb No, if I played one on TV I’d be making a lot more money.

janbb's avatar

@Rarebear You mean you’re not House?

Jeruba's avatar

The problem seems to have cleared up pretty well now, after 3½ days of compresses. All’s well, it seems.

janbb's avatar

@Jeruba Glad to hear it, my dear.

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