Optic Nerve Inflammation - Optic Neuritis

[digital]

SInce mid 2016 I have been having many different health problems, some reported here before. 45 Yrs  over the last 18m/2y my weight has gone from about 96kg to around 83/84 now.

Trying to keep it brief it started with Perinium pain. then abdominal pain was told kidney stones from xray but then cleared after a IVP. Bowel habits have been changed since this time. Have also had strong headaches in right hand side that last several days and recently lasting longer, sometimes with pain around right eye. Blocked right nose/sinus pains comes and goes. Anxiety and possibly some depression, sleep problems has been present a lot of this time. Often a nausea/ slightly dizzy unclear feeling in the head, this often follows after a few days of abdominal pain. A few times of severe vomiting in the night. Acid reflux presenting as sore throat. Other general aches and pains or random complaints that come and go.  Many symptoms have come and gone except the bowel changes, Anxiety and IBS has the the main diagnosis so far.

So my latest problem, I have recently changed my glasses, the new glasses did not seem quite as clear but would give my eyes a chance to settle. Last week when gardening I got poked in the right eye with a branch, watery, painful but not bloodshot eye. Then shortly after the headache was back and painful around the eye, but it did not go away, it was strong for 5 days and still present after a week. I notice now that if I cover my left my right eye is blurred, with both the old and new glasses but I cant be sure what it was like before I was poked in the eye as didnt chek vision with just one eye.
A visit to Ophthalmologist (Sunday) and they did not want to check my prescription but did a full eye check. I have a small scar on right eye which is not a worry, but I have swollen optic nerve on right eye Optic Neuritis, said not caused by the poke or stress etc caused by some infection or inflammation somewhere in the body. Her English is not good but she said if I wanted to find out where go to Bangkok hospital and it will cost >100k baht.  I was prescribed an eyedrop (anti inflammatory), diclofenac, what I think is an antacid and cortiosteroids 2000baht (they were a bit reluctant to write on the packet what they were prescribing). Come back after 3 days to check again.

 

After we paid and were about to leave she stuck her head around the door and said maybe you need an MRI! Of course this afterthought is the bit that worried me.

From my own research I guess they are most likely considering MS? I am anxious already and this has got me worried, especially with some of my other things over the last 18 months or so.
I have read up about the oral steroids and have concerns about them  (mood, sleep, dependency) although my dosage is 2 tabs twice a day of I think 5mg each. And also that they can speed recovery but not alter the longer outcome, possibly lead to a higher chance of repeat symptoms.

Went back to see my very good GP as he knows about my history and is a great supportive Dr, although he said dont worry to much he did seem more concerned than usual, asking me to come back to him after my next eye Dr visit. He has spent a lot of time with me with my problems, is supportive and has had very little money from me.
We are due to be away for almost 2 weeks from Sunday, just in Thailand but been planned for a long, next appointment is for Saturday. But was considering going to Vachira Govt Hosp instead for the follow up, because the hours are more convenient, and its maybe cheaper (cost is a concern), not sure if this is wise though to change the Dr before the follow up?

[Sheryl]

If I were you I would neither go to Vachira (definitely not recommended for something this specialized/complex) nor back to the same opthalmologist with whom you are unable to communicate adequately.

 

I would go, as soon as possible, to Rutnin Eye hospital in Bangkok and see a specialist in neuro-opthalmology which would be one of these, doctors  trained in the West and fluent in English
 

http://www.rutnin.com/en/doctor/detail.2.1_Search by name_18_0.html#thumb

  http://www.rutnin.com/en/doctor/detail.13.1_Pisit_0_0.html#thumb

http://www.rutnin.com/en/doctor/detail.15.1_Search by name_18_0.html#thumb

 

You could be placing your vision at permanent risk by doing otherwise.

 

It will cost a few thousand baht only unless scan is required, in which case more but still nothing like 100K

 

If the diagnosis of optic neuropathy is confirmed and you are concerned re possible MS, best doctors for this in Thailand are:

 

Prof. Naraporn Prayoonwiwat

Prof. Sasitorn Siritho

 

Both are available at Siriraj hospital which has a specialized MS clinic. Going through the public channel will be cheap but very slow, crowded, long waits. You can see them privately through Siriraj's  private wing http://www.siphhospital.com/en/home

 

Prof. Sasitorn Siritho ca also be seen at Bumrungrad but will cost more there

https://www.bumrungrad.com/doctors/Sasitorn-Siritho

 

There is no immediate rush on getting an MS workup (though I would not delay for months on end). But the eye problem you should deal with immediately.

 

 

 

[digital]

Thanks Sheryl (you helped me out before also over PM).

 

She does speak English but not that great and I will have my wife with me which is why we delayed going back until she could come with me on  Saturday (my wife would need to come for language and I cant see well after the appointment also), we were going to see if she could get some time off work and go on Friday.

 

As I said we do have a trip planned starting on Sunday and the first part of that is a flight to Bangkok on route to a wedding in Udon so I could maybe go straight from DonMuang (land 9.45AM) and hope to get to the hospital, the second Rutnin Dr shows 8.30-12.30.

 

My sight is blurred but not enough to be a huge problem, I still have some aching around the eye. But I will follow your advice if you really think Rutnin is the best thing to do. I am probably jumping the gun a bit with MS but its reading that that got me worried. 

[Sheryl]

Don't take any chances. Go to Rutnin being sure to bring records from the doctor who has treated you so far esp. the meds given.

 

Be warned that appointments at Rutnin are just approximates and long waits are common so don't plan on making an afternoon flight after that. Evening or next day.

 

[digital]

Thanks for your advice.

 

Have appointment with Dr Pisit Preechawat for Sunday, they know my flight arrival time and basic history. They said upto around 2,000 baht not include any scan, they said don't know price of that because don't do here. They did also say I could see him at RamaThibodi Hospital.

 

No wont make any onward connection until the next day.

 

I can take the meds, not sure if they will let me take a copy of the records from 1st visit, will try. I'm a bit cautious about taking the steroids but it will only be a week. Should I buy any further meds given at Rutnin or buy elsewhere.

[Sheryl]

Depends what they are. If steroids buy at the hospital, not sold over the counter.

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[digital]

went to rutnin yesterday, i arrived early and was in to see dr before my appointment time but it was very rushed, he didnt really want to hear my history, did not dilate eyes but said from reaction he agree maybe optic neuritis, did not look my medicines.

sent for mri hrain +orbit, which i did yesterday and today going back to rutnin for ctvf and follow up

[soalbundy]

In Germany I had an iris inflammation ( very painful ) which came every year on the same day!! my vision was so blurred I couldn't read the biggest letters on the chart. This was treated successfully with heavy doses of cortisone tablets however one year it was so bad that my optic nerve was badly inflamed and my optician thought it even possible that I could lose my sight in one eye. He sent me to the university hospital in Munich where a massive dose of cortisone was injected into the eyeball (the only pain was from the local anaesthetic to the eyeball, burnt like hot coal ) this cured me and the inflammation to the iris never returned.

[digital]

To follow up from my Rutnin Appointments.

 

I was a bit annoyed that the Dr did not have much time for my appointment on the first day, but I went for the Mri of brain and orbits as he ordered. Prachacheun MRI which I have seen recommended on here a few times wanted 15K baht inc contrast but were not available for a few days, So I went to where Rutnin recommended RMC Rachvipa MRI which I was told 15K baht but for foreigners 18K baht. Very professional place seen same day.

 

An anxious wait until my Dr appointment next day. First had CTVF a computerised visual field test, then in to see the Dr. It was a much better appointment this time, first thing he said was don't worry I have time today. Everything on my MRI he said was good, he did say sorry for sending me for the MRI but said there was some anomaly that made him agree with the Phuket diagnosis of nerve inflammation without dilating and looking himself. He repeated the slit lamp test and some other test in a dark room. He said no inflammation is present, I asked if it was there but gone away and he said no never had it.

 

Send for refraction eye test (which is what I requested on my very first appointment) and they found my prescription to be wrong (done by Phuket Opthalmologist last year 6-10months ago)

 

RIGHT -3.50 -0.50 AXIS 50
LEFT - 4.00 -0.50 AXIS 180
ADD +1.25

 

New from Rutnin:

RIGHT -4.25 +1.00 AXIS 95

LEFT -5.00 +1.00 AXIS 85
ADD +1.50

 

So I have now ordered new glasses and also some reading glasses which I don't currently use and am really hoping that this fixes the problem. The pain did go away for a few days but its back again now, around the eye most prominent under and also right sided headaches. Also I have some swelling under the one eye (eye bag). Taking Diclofenac and Paracetamol but not making much difference. I have been having a blocked right nose on waking nearly every morning again. (And my ibs symptoms have been worse the last week but probably unrelated).

[digital]

New glasses arrived yesterday early afternoon (From Zenni, must say I was impressed with their service and they even gave me credit on the first pair even though it was a prescription error).

 

Vision overall seems bit better, but still not as good in right eye as the left it is still a little blurred using the distance glasses, but does seem to vary. Its just still doesnt feel exactly right somehow, still have bag just under the right eye only. Some pain, tiredness etc around the right eye still and still feel blocked in right nose with discomfort at top right next to nose.

I know its not been long and sometimes there needs to be a settling in period with a new prescription so I hope things will improve over the next few days, if not what to do next.

 

I also ordered some reading glasses, these seem clear in both eyes but actually I would have been better to order for computer distance rather than reading. Can't decide which glasses to wear when looking at computer screen which is about 60 cm away.

[Sheryl]

Good news that there is no optic nerve inflammation.

 

Your stuffed nose etc have nothing ot do with your vision. Likely an upper repsioratory infection or allergy.

[digital]

52 minutes ago, Sheryl said:

Good news that there is no optic nerve inflammation.

 

Your stuffed nose etc have nothing ot do with your vision. Likely an upper repsioratory infection or allergy.

Thanks Sheryl, yes was good news. After my first appointment and he said there was some anomaly in my pupil reaction I was expecting him to find something, probably should have asked more about this anomaly but was just relieved about the optic nerve, I guess if there was anything worrisome he would have said.

 

Hopefully the right eye vision will settle in a few days, or perhaps its as good as it gets in that eye, the Rutnin eye exam seemed thorough so don't expect there to be any error there. Pain is better a bit today but still does not feel exactly right. Bought 3 pairs of glasses in last month so don't want to be buying anymore.

 

It does seem strange that my nose, pains etc are only in the right side, is that possible with respiratory infection or allergy, the nose/sinus problem has been present for quite a while.

[Sheryl]

Yes. You can have a blocked/partially blocked sinus on only one side.

[digital]

I'm still having problems but not sure what to do next?

 

I stopped taking any pain medications for a couple of days, but this morning I woke with strong pain so took 50mg diclofenac but has made little difference.

 

Mostly I get dull pain around the right eye, hard to pin point exactly but can be prominent near to cheek bone and headache pain in right temple mostly (sometimes one or the other, sometimes both at same time), slight swelling under right eye (like an eye bag but not present under left eye). Pain is there pretty much all the time but sometimes its mild and other times like today its quite strong and been there for around a month. Have been having a stuffy congested right nose for many months.

 

I thought about eye strain, but after eye exams and new glasses this should be ruled out, and pain can be there on waking after eyes have been rested.

Migraine? some symptoms seems to fit, have had occasional nausea feelings and sensitive to smells. But has lasted too long for migraine?

Sinusitis/sinus infection/sinus headache etc? possibly fits the symptoms for pain/congested right nose, but not really any discharge, have had sore throats but thought this was acid reflux. (Mri showed a mucus retention cyst in left maxillary sinus, was told this is a common finding no problem. Its the wrong side anyway)

 

Tempted to try a course of antibiotics myself (amoxy??). I have tried iliadin nose spray for the last 2 days (oxymetazoline hydrochloride) helps the stuffiness but not the pain and I know should not take it for more than a few days. Temporarily a cold gel eye mask helps.

[Sheryl]

Although mucous retention cyts in the maxillary sinus are not serious, and are usually asymptomatic, they do cause headaches and peri-orbital pain in some people and might be the cause of yours.

 

Antibiotics will have no effect, this is nto an infection.

 

Suggest you see an ENT.  Prof. SONGKLOT AEUMJATURAPAT  is good, can be seen at Bangkok Hospital and  St Louis Hospital (the latter is less expensive)

 

https://www.bangkokhospital.com/index.php/en/find-a-doctor/doctor-profile/?id=189&doctor=Dr._SONGKLOT_AEUMJATURAPAT

 

At St Louis the website is only in Thai. He used to be there on Thursdays and Sundays, call to confirm. 

 

When you see him, do yourself a favor and do nto start in with your entire unrelated medical history  (IBS, perineal pain etc). Stick to what is related to this complaint i.e. the pain and nasal stuffiness and that you have ruled out opthalmic cause.

 

 

[digital]

Thanks again Sheryl.

 

I was rather hoping to avoid seeing yet another Dr. costs are adding up.

 

The cyst was in the left side but my problems are with right side. Do you have any Phuket Ent recommendations?

 

I might just wait and see for a while if its not an infection.

Edited May 26, 2018 by digital

[Sheryl]

If the cyst is on oppodite side from the pain then not likely the cause.

Is the stuffiness on same sude as the psin?

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[digital]

22 minutes ago, Sheryl said:

If the cyst is on oppodite side from the pain then not likely the cause.

Is the stuffiness on same sude as the psin?

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Thanks, Yes cyst opposite side to the pain according to the report.

 

Stuffiness, pain (probably unrelated slightly blurred vision) all on right side.

 

Report also says "Included nasopharynx, all other air sinuses and mastoids are unremarkable"

Edited May 26, 2018 by digital