Tuesday, April 12, 2011

Pingueculitis a.k.a. "Inflamed Pinguecula"

Practicing in Texas (and the associated heat, dust, etc) we get a lot of these. I always joke that its one of the most common things no one has ever heard of. Every time I say the word "pingueculitis" the patient inevitably replies "PINK EYE!!??" No, not pink eye. :D

A pinguecula is an inflammatory degeneration or degradation of the bulbar conjunctiva & sclera on the surface of the eye. Brought on by "exposure" to high heat, wind, & UV rays, the collagen fibers of the sclera & conjunctiva degrade and deformed elastin fibers are produced. The result is a yellow or off-white bubbly-appearing "bump" or raised lesion on the surface of the eye, usually nasally & temporally only (b/c the superior & inferior conjunctiva is generally protected by the eyelids).



Many, many patients see a pingucula on the surface of their eye, Google "yellow eyes" and come up with "jaundice". I first blogged about this in 2007 (reposted in 2009):

http://myeyepod.blogspot.com/2009/06/visine-pingueculajaundice-dailies.html

Jaundiced eyes are EXCEEDINGLY rare. Pinguecula is not.

But today we're discussing "pingueculitis" or inflamed pinguecula. The pinguecula is the bump. When the bump becomes irritated, red, painful & bothersome, we call it "pingueculitis". Here's how it usually presents:

the patient has a red, painful eye. They go to their PCP and are occasionally prescribed antibiotic eye drops (or maybe they use some eye drops they already had in their medicine cabinet). After 3-4 days of the "pink eye not going away", they present to our office with "pink eye that won't go away". That's of course because antibiotics kill bacteria, but will not solve an inflammatory problem.

The treatment of the acute pain & redness of pingueculitis is steroid eye drops. I usually Rx Lotemax when its mild and Pred Forte when its more severe. Steroids do not make the pinguecula any smaller or make it go away, they only make it not inflamed and remove the pain, redness & swelling. The only way to get rid of a pinguecula is to have it surgically excised.

Pinguecula formation is usually a response to UV rays & exposure that you got a long time ago. "A lifetime of sunshine" I always say. In other words, you won't develop a pinguecula from a weekend at the beach w/o sunglasses. More like LIVING on the beach w/o sunglasses. A lay term for pinguecula is "farmer's eye" b/c many farmers who don't wear sunglasses or hats or adequate sun protection develop these.

You CAN, however, get pingueculitis from a weekend at the beach w/o sunglasses. In other words, if you have a pre-existing pinguecula it can become inflamed (red, painful) after a particularly high dose of UV (or wind, or heat, etc). Even though its called "farmer's eye", BIKERS are at high risk of both pinguecula & pingueculitis because frequently they're out on their motorcycle in the high heat, wind & UV.

Active pingueculitis (red, painful - this is a mild case):






Other various presentations of non-inflamed pingueculae:


370 comments:

  1. So glad I came across this blog. My 8yo presented with "blood shot" eyes a couple weeks ago. It would come and go. The teacher was concerned, but I knew it wasn't "pink eye" because it just didn't fit the bill. Tonight while sitting next to him I noticed a bump on the white of his eye, where the blood shot streaks lead up to. So I googled and came across this. I will take him to the eye doctor tomorrow to confirm, but this is exactly what it looks like. What I'm wondering is how would an 8yo boy develop this if it's caused by years of exposure? We live in SW Florida, but only for the past 3 years. I would say he's outside quite a bit, but no more than the average kid is. Should I be concerned about his age and the development of this?

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  2. if it does turn out to be a pinguecula...no thats not particularly "concerning". it would be unusual in an 8 yr old.

    in an 8 yr old I'd also be thinking maybe "episcleritis", especially if its not yellow at all

    http://www.nlm.nih.gov/medlineplus/ency/article/001019.htm

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  3. Hi Christian,
    thank you for this blog. I was diagnosed with a pingecula about 5 years ago . It does flare up and turn a nasty shade of blood red on occasion. The redness does not appear to be necessarily connected to wind , although it has flared up under those circumstances. Recently I have had a bad cold//virus and it's now been red for about 5 days.. What is the general duration of pingeculitis? I am sooo sick of the unsightly appearance this condition causes.

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  4. sorry...totally variable duration. depends on size & severity of the pinguecula as well as severity of the "exposure" or incident that caused the flare-up. difficult to predict how long this incident will last...

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  5. Dr Prince,
    Thank you very much for your prompt response.. and pardon me for the error regarding your name, lol.
    Is there anything I can do at home to expedite the process of recovery ?

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  6. no problem! things you can do at home: cold compresses, don't rub it, use a lot of artificial tears (like systane). even better would be chilled systane

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  7. THANK YOU Dr Prince ! :)).. One last question, is it possible for a pingeucula for flare up as the result of and upper respiratory virus or is it completely unrelated ?

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  8. Dr. Prince,
    I've had a pinguecula for several years now, and on a recent trip to Florida (very windy, warm conditions), I got pingueculitis. Got drops from my eye doc, it went away after a week...and then came back. I got more drops, different drops, stronger drops, etc. etc. And it still persists -- it's now been 2 months, and while it's not as red as it was at the beginning, it's still red. I'm starting a new job next week, and I've become extremely self-conscious about the appearance of my eye! Do you have any advice?

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  9. if you're already on steroids, no not really any great advice. chilled artificial tears, cold compresses, more frequent steroid use (depending on what your doc says, of course)

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  10. What is your opinion on surgical removal, is it a successful option for chronic pinguecula? Thank you.

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  11. Surgery is a mixed bag and causes some other problems but yes generally it's better than having a chronically inflamed pinguecula

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  12. I too am glad I found this! I am pretty sure I have it. I woke up Saturday with a little bump and super blood shot eye. I am a nervous wreck after googling eye diseases. That was some scary stuff, lol. The pinguecula is the closest thing I found that looks like what I have. I happen to have some Pred Forte drops- do you think it be ok to use them until I can get to the dr? I also have a link to a picture of it- do you agree that it looks like pinguecula? Thanks so much for your time! http://www.flickr.com/photos/39096938@N07/5805541260/

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  13. ok I have to be careful here. I really can't specifically advise you on the internet what to do for your red eye. you should be seeing an eye doc for that.

    that pic does look like either inflamed pinguecula or nodular episcleritis, both of which would, in theory, be treated with pred forte. i'd definitely go to the eye doc.

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  14. I know you can't really tell me- but even what you said is good enough. I plan on definitely making an appointment! Thank you so much!

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  15. I have 3 ping in one eye (and pingueculitis)- currently being treated with steroids. I've got the start/very small pings in the other eye. Is there anything i can do to stop them getting bigger/stop getting the red veins which accompany them?

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  16. limit sun exposure, cold compresses, artificial tears

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  17. Does the surgery to remove pingueculitis hurt. Im 26. I am going to be married soon and all the sudden I think i have pingueculitis. Im going to see the doctor but Im really scared! Help!

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  18. it depends on how big/deep the pinguecula is & how invasive the surgery has to be. yes, I have heard that its not awesomely comfortable.

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  19. Hello --

    I was hoping you could help me in providing clues/advice as to what I should do next in regards to my recent eye problems. I'm pretty sure I have pingueculas on both of my eyes near the corners by the nose, which have formed about 4 weeks ago, soon after using a new prescription in the contacts I have been using for over a year now (Freshlook Colorblends), which have never caused discomfort before except after wearing them over 12 hours or so. I don't know if this is a coincidence or not. Now I experience discomfort practically immediately after putting them in. And 8+ hours after they are out, I still feel like they are in. On the days I wear them, the effectiveness is not the same. I sometimes have trouble focusing. And by night my eyes have a section of red pretty much in the area of the exposed eyeball, but not above or below. I am getting massive migraines, which I don't know whether it is from the contacts or my increased use of eyeglasses or both. I went to my eye doctor and he did say that the yellow/whitish dots are due to being "exposed to the elements" and that they're common for people who live in my town, which is heavily polluted (Bakersfield). He did not specifically name pinguecula. I am 20 and am not one who goes into the sun excessively. Is such a development normal? He said I am probably having an allergic reaction to my contacts and that my eyes are getting irritated. He gave me a sample of ClearCare, which he said would be less abrasive than the no-rub solution I was using. He also prescribed Bereve to apply 10 minutes before putting my contacts in and before bed when I take them out. But I take them out immediately after coming home because by then my eyes are totally irritated. I am becoming increasingly frightened because my symptoms have expanded. And now, even with my newer eyeglasses -- with the new and somewhat stronger prescription -- it is hard for me to focus, and I feel like my eye is "lazy." Last night I was attempting to do important reading, but it became increasingly difficult, and I am nearsighted, not farsighted...Things were fuzzy, my head was pounding, and black spots kept appearing. Putting on my glasses (I had all corrective devices off while reading) made things worse. I don't know what to do; I have spent so much money on doctor visits lately. I'm afraid if I go back to my eye doc it will be to no avail. Do you have any recommendations?

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  20. "I'm pretty sure I have pingueculas on both of my eyes near the corners by the nose"

    thats usually where they are. nasally is the most common

    "which have formed about 4 weeks ago"

    no, they were there before that. they don't form that quickly. they take years to form. you just noticed them 4 weeks ago, maybe...but they didn't just form 4 weeks ago.

    "soon after using a new prescription in the contacts I have been using for over a year now (Freshlook Colorblends), which have never caused discomfort before except after wearing them over 12 hours or so"

    the contacts didn't cause your pinguecula. they may be irritating/inflaming your pinguecula, tho

    "I don't know if this is a coincidence or not"

    probably not

    "And by night my eyes have a section of red pretty much in the area of the exposed eyeball, but not above or below"

    yes I agree that sounds like pingueculitis

    "I went to my eye doctor and he did say that the yellow/whitish dots are due to being "exposed to the elements, and that they're common for people who live in my town"

    yes thats what he's talking about: pinguecula. they're common everywhere, not just Bakersfield

    "Is such a development normal?"

    thats a question I get all the time about many, many eye conditions. in your case: NO it is probably not particularly "NORMAL" for a 20-year old who doesn't get excessive sun exposure to develop pingueculae. but you have. so whether or not its "normal" is kind of irrelevant

    "He gave me a sample of ClearCare, which he said would be less abrasive than the no-rub solution I was using"

    a good idea.

    "He also prescribed Bereve to apply 10 minutes before putting my contacts in and before bed when I take them out"

    also not a bad plan

    "I am becoming increasingly frightened because my symptoms have expanded"

    well, I'm sorry you're frightened but this is not dangerous. just annoying/irritating. so rest easy b/c its not alarming.

    "And now, even with my newer eyeglasses -- with the new and somewhat stronger prescription -- it is hard for me to focus, and I feel like my eye is "lazy.""

    ok this is a totally different complaint. not related to the contact lens irritation or pinguecula.

    "Last night I was attempting to do important reading, but it became increasingly difficult, and I am nearsighted, not farsighted...Things were fuzzy, my head was pounding, and black spots kept appearing. Putting on my glasses (I had all corrective devices off while reading) made things worse"

    again this is a separate problem from the pinguecula. this sounds like a refractive issue (need some other Rx)

    "I don't know what to do; I have spent so much money on doctor visits lately. I'm afraid if I go back to my eye doc it will be to no avail. Do you have any recommendations?"

    there is nothing else to do but go back to the eye doc & tell him/her all of these problems and see what they come up with to help you solve it. good luck!

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  21. Had ping removed. Scar healing well, but my plica semilunaris seems to have moved over the conjunctiva. It's not fixed where it should be in the corner of my eye. Have you come across this?Can it be fixed~?

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  22. yes that's normal. it doesn't need to be "fixed" IMO

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  23. wow interesting to come across this blog. Currently i have self-diagnosed with Pinguecula and spoken to one doctor who gave me artificial tears. The yellow raised bits of my eyes have wiggly blood vessels running into them, and i've only been aware of them for the past 4weeks. I have psoriasis and over the years have had UV treatment which perhaps has led to this condition. So, i was wondering with this condition does it take some time to build up until it shows it's self as these raised bumps? What are my chances of it going away without surgery? - my eyes feel constantly tingly and sore, i guess these are symptoms? - how i regret not wearing good sunglasses now! thanks for your help
    - Katie

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  24. Yes it takes time to build up & "show itself". They will not go away w/o surgery. Yes, soreness is a known symptom of pinguecula (although we don't know if your pingueculae are causing YOUR soreness or not).

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  25. Thanks for reply about the plica. At the moment, the plica semilunaris looks like a lumpy, vertical scar on my conjunctiva - between the iris and the nose side of my eye.
    How long does it take to go back? At the moment, if I look left (left eye) the plica moves and I have a large expanse of white conjunctiva between it and the caruncle. The other eye (not operated on) is not like this. The plica is kind of fixed next to the caruncle and gives me enough flexibility to move my eyeball. At no time is there a gap larger than a few mm between the caruncle and the plica on the unoperated eye.

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  26. Thanks for this... when people mention that they have 4 pings - does this mean 4 raised bumps?... now that i have the condition 'showing itself' is it more than likely that the condition will worsen? cheers - Katie

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  27. "Thanks for reply about the plica. At the moment, the plica semilunaris looks like a lumpy, vertical scar on my conjunctiva - between the iris and the nose side of my eye.
    How long does it take to go back?"

    It is probably never going to go back to what it was before. It is what it is. Whatever it looks like a few weeks after the procedure is probably what it will look like permanently.

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  28. "Thanks for this... when people mention that they have 4 pings - does this mean 4 raised bumps?"

    yes.

    "now that i have the condition 'showing itself' is it more than likely that the condition will worsen?"

    unfortunately, yes.

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  29. Amazing blog.. I was using a thrush cream recently and one night my eyes were a lillll irritated..the next morning I hav found this yellow patch in the inner corners of both eyes.. as if the cornea's fatty sheet is extending outwards..like it's continuation. both of them are a parallel concave to the iris..but still a lil away frm it. And they only show when I look towards the opposite side.. Does it sound normal or more like a pinguecula.. ? Or just an irritated cornea..incase the thrush cream went into my eyes frm hands while sleeping... :S

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  30. well, who knows what that is? haha. pingueculae do not pop up quickly. but its possible that you had them before & just didn't notice them. I doubt thrush cream (antifungal) made your eyes yellow, so its likely that you had them before & just didn't notice. the appearance you describe certainly sounds like pingueculea

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  31. I forgot to mention.the cream was in combination with clindamycin phosphate. Also..I'm just 22.. Cud this other ingredient be the cause..

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  32. Still probably not the cause. Go have it looked at by an eye doc

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  33. Hi, this site is incredible (THANK YOU) =). I have made peace with the fact that I have pingueculae ;). I just have two questions.
    1. I am taking Fluorometholone per Optometrists orders. If I am reading the above entries correctly, these drops will reduce the swelling, pain and redness, but will NOT reduce or remove the bump. The bump will be there as is forever. Unless, surgically removed. Is that correct?
    2. I understand that this is primarily caused by elements and I am sure that this was probably the case for me as well. I am wondering though if lasers used on skin and for hair treatments could also be a cause. I had a complimentary/introductory skin laser treatment around the eye about a good year or two ago. I recall feeling the “pulse” behind my eye and it made me a bit nervous and never had the procedure again. Could this be a cause?
    Thanks – Renee =)

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  34. 1) unfortunately, yes
    2) probably not related to your laser procedure

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  35. I am 25 and was just diagnosed with pinguecula yesterday...I have four different pings and I am severely depressed by them. My eyes are constantly pink, contacts (which I have worn for 12 years) are now impossible, and even with drops my eyes continue to feel like they have something in them. Will prescription eye drops help with the irritation? Will contacts cause these spots to grow? My doctor really did not give me much information...he just stated that they will never go away, and neither will the redness. Thank you in advance for your advice. Best.

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  36. "Will prescription eye drops help with the irritation?"

    in theory, yes. if you were to be Rx'd anti-inflammatory eye drops like Lotemax, the redness & irritation would lessen.

    "Will contacts cause these spots to grow?"

    possibly yes.

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  37. I have been diagnosed with a pinguecula recently. I am using eye drops 4-6x per day as per the optometrist's request. The redness and inflammation continues regardless. Of late my eyeball feels bruised, as if it has been hit. Can this symptom be related to the pinguecula as I don't see it listed as a typical symptom in medical websites related to pingueculitis. Thanks in advance.

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  38. what drops are you using? if it's just artificial tears or something, the redness & inflammation will "continue regardless". you need steroids. are you on steroid drops?

    yes inflamed pinguecula causes aching & pain.

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  39. I'm using 'Blink' intensive tears. They aren't steroids.

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  40. Just following up from April. It was in fact pinguecula my 8yo had. He was on steroid drops for 2 -3 weeks and it cleared up. However, we've noticed his eye gets very easily pink or blood shot looking when we're out in the sun. He has very very pale blue eyes to begin with, so I'm guessing that makes his eyes more sensitive. We're trying to get him used to remembering sunglasses when we're outside for any length of time.

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  41. well IMO there's the problem. often docs try & "treat" pingueculae with palliative care like artificial tears, which is fine. but when a pinguecula is actively inflamed & red & painful, "Blink" is not going to do anything. need to treat the active inflammation with anit-inflammatory drugs (ie steroids). just MO

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  42. Thank you for your opinion. As the pinguecula is with me for life (unless it is surgically removed), can I use eye steroids daily and indefinitely (or only when they get too inflamed), are there side effects, and are they available over the counter?

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  43. not OTC. Rx only. and they can have side effects & possible long-term implications, which the prescribing doc will have to monitor you for

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  44. Alright, many thanks for you opinion and page.

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  45. Thank you for blogging this information. I, too, think I may be developing Pinguecula in my left eye. I usually only get it in the morning after I wake up. I noticed that I would get it more often if I wore my eye mask and my theory was lack of oxygen to the eye. This morning I woke up with it again, but did not wear the eye mask. The white bump is near my nose (common) and was larger than normal. It usually goes away within a couple hours though. I was diagnosed with allergic conjunctivitis about 1.5 years ago. I was not in the U.S. at the time, so I wasn't sure if my condition would change once I moved to the desert. Well, it did not change. At that time, I was on steroids, allergy drops, and another eye drop to build the immune system back up. When I returned to the states I saw a specialist, they only put me on allergy drops and artificial tears. The allergic conjunctivitis returned. I went to another specialist and he said to continue using what I was using and added Restasis. Now I use artificial tears (5 times a day), Restasis (2 times a day), and allergy drops (once a day). This seemed to help with the allergic conjunctivitis. All of the doctors believe this condition is chronic because I have severe dry eyes. Now I am concerned about this new development with Pinguecula. I have sensitive eyes to light so I always wear sunglasses, but when I was a kid I never did. I did ask my eye doctor about this clear bubble like bump (it wasn't in my eye at the time) and he said he didn't know. He'd have to see it. I find that odd that he had no clue or guesses. Anyway, since the Pinguecula seems to be appearing more frequently, but still seems to go away after a few hours...is it likely it will not go away at some point and stay there permanently? Or is this something that will just get inflamed occasionally?

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  46. Ok pingueculae do not come & go. If its a bump THAT GOES AWAY...that's not a pinguecula. That's something else like chemosis (swelling of conjunctiva) or a lymphatic cyst or something. A pinguecula is a yellowish PERMANENT bump.

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  47. Thank you for the other terms. I looked up chemosis conjunctiva and lymphatic cyst. They both sounded alike, but after I read about the lymphatic cyst again it said the cyst could move freely around the eye. So, I looked in the mirror a few minutes ago to see if I could gently move it with my lower eyelid (the size was smaller today too). I was able to move the sac, which makes me think it was a cyst, and it released the liquid from doing that. I appreciate your help on this matter.

    I don't mean to get off topic from your blog, but when I was reading up on the terms you gave me I also read about severe dry eyes. A treatment option is to use the drops I am using or to implant plugs. The eye doctors never recommended plugs, but told me I would be on these drops for life. I am wondering why they didn't mention this and if I might be a candidate for this procedure. What are your thoughts? Thanks again for your help.

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  48. I am personally not a big fan of punctual plugs, although they are a common & accepted therapy for tear deficiency

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  49. Ok, thanks! Just thought I would ask. I hate the thought of being on drops for life. : (

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  50. Thanks for the information. I wrote a response earlier, but it never showed up. Anyway, I was thinking about the plugs, since I don't want to be on eye drops for the rest of my life. I was just wondering if they would be successful in my situation. I am curious why you are not a fan of the punctual plugs.

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  51. I don't know if they'll work for you or not b/c I don't know which type of "dry eye" you have...there are multiple types. plugs only work if you have low tear production: that's not the only type of dry eye.

    IMO relatively few dry eye sufferers actually have low tear production...that's why I am not a "big fan" of plugs. also - IMO using a drug like Restasis that increases tear production probably works better than trying to prevent your own tears from escaping. just MO

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  52. I didn't know there were multiple types of dry eye. The doctors believe my dry eye and problems result from the Lasik I had 5 years ago. Ever since, I had a really bad eye infection and developed allergic conjunctivitis. Maybe the doctors didn't suggest plugs because of my situation, I don't know. I do appreciate your feedback, because I respect your opinion and it has given me more knowledge about what I can research and what is best for me. Thanks again!

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  53. Thank you for writing about this! I was diagnosed with a pinguecula 6 years ago. I'm recently having more pain/redness. I read that your home care recommendations for penguiculitis include using chilled systane drops. Would you recommend the preservative-free drops, or which type of systane do you think is best? It seems there are many different kinds under the systane brand. Thank you!

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  54. probably doesn't matter too much. I think the "preservative free" kick is probably a little overblown. just MO. *most* people are probably NOT having sensitivity issues with the preservatives in eye drops.

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  55. I've read every comment on this blog and I believe I have this pingceula u speak of. I live in Texas and am guilty of not wearing sunglasses all the time. The spots I have are on the outer corners of the eyes. One in each eye, buy it's not bumpy. It's just a yellowish pink spot with some veins running into it. Some days the veins are very light, and others days they are very thick and red. Very cosmetically bothersome. They become red after wearing contacts. My eyes are large and dark brown so the white of my eye is very contrasting. I don't mind the yellow spots so much as u can barely see them unless u are standing at my side and looking directly at my eye. However, the red veins are obvious and I can't stand them. Will steroid drops make them less visible? I've heard of a procedure in which drs can remove the veins. Can I do this along with LASIK or should I just keep contacts and use steroid drops? I'm seeing an opthamologist next week to see what he says about lightening the veins and possibly removing the spot. I attached two photos for u. Thanks!
     
    http://oi42.tinypic.com/rcn62g.jpg
     
     
    http://oi43.tinypic.com/15qygc0.jpg

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  56. those are pingueculae all right. not too bad, most ophthalmologists probably wouldn't opt for removal at that point, but see what they say next week.

    laser doesn't work, and steroids don't really make anything less visible

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  57. I should also add that I do not feel the pinguecula or have pain like others mention. Mine is more of a cosmetic concern. I can't stand them and would like to minimize the appearance.

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  58. i have a ping in my right eye, ugly little butthead. normal eye drops worked for years but now if i sneeze at it hard it gets super red. i use chilled eyedrops for right now and i was wondering if menthol eye drops like rhotos would help with the redness, burning, dry eyeball feeling?

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  59. rhoto menthol eye drops will make it worse. more inflamed/red/dry

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  60. I have really enjoyed reading this blog. I woke up one morning two months ago and my right eye was pink in the corner near my nose. After a month and clear eyes (occasionally) I went to an optomotrist. She said I had pinguecula however they were not "yellow" like they usually present instead they were pink. She gave me systane drops and I usued them faithfully for a month. My eye is still pink in the morning and gets redder throughout the night. This is EVERYDAY for 2 months. I just came from a different Dr. out of the same office and he perscribed steriods. Without the yellow presence and with the two month duration I am unsure if they have my diagnosis right. Have you ever heard of this lasting so long consistantly?

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  61. By the way I hate smoke, I do not work outside and I try to stay away from sunlight and I live in Chicago. If I do have ping I have no clue where it could have come from. Thanks in advance for your help!

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  62. " Without the yellow presence and with the two month duration I am unsure if they have my diagnosis right"

    pingueculae are frequently not yellow. and if 2 docs agree it's pinguecula...it probably is.

    "Have you ever heard of this lasting so long consistantly?"

    YES. unfortunately pinguecula and pingueculitis are VERY OFTEN "chronic" conditions that never resolve.

    smoke & sunshine are common causes of pinguecula...but so is WIND EXPOSURE (you live in "the windy city"). some of the worst cases of pinguecula/pingueculitis I have ever seen were in motorcycle riders and were caused by wind exposure

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  63. I went to the Eye doctor today, and he told me that I had pinguecula. I know I should have asked him, but what are the best glasses to block out all of the UV rays?

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  64. well, any glasses that say "block 100% of UVA & UVB"

    that's most commercially-available glasses sold in the U.S. even cheapo $5 convenience store glasses block UVA & UVB. you don't "need" Maui Jim's to be "better" as far as protecting your eyes & your pinguecula.

    now optical quality...(how you see thru the glasses) is a different story. generally cheaper glasses have poorer optical quality...

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  65. Thanks for all the info... I was diagnosed with Pingueculitis today after a month of redness. Two weeks ago, my optometrist prescribed me steroid drops for the inflammation, though she did not give me a specific diagnosis. After two weeks of the drops, the redness had not lessened, so I went to an ophthalmologist, who diagnosed the pingueculitis. He prescribed me Zylet drops and Erythromycin Opthalmic ointment. After reading your blog and others about pingueculitis, I'm gathering that steroids are the standard treatment, so I'm wondering why he prescribed the Erythromycin? Have you ever heard of that being a useful treatment?

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  66. if they really did Rx eryth ointment for the pingueculitis...that's useless. maybe the ophthalmologist thinks you also have blepharitis or something?

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  67. Yeah after reading a little bit I thought it seemed useless too... He did not mention any infection or differential diagnoses so I have no idea what else he might have been thinking. (And after looking up blepharitis I think I can pretty decisively say that I don't have that- I have no symptoms other than redness). I have a follow up appointment next week I will definitely ask about it.
    Is there any risk in continuing to use the ointment if it isn't indicated (I don't want to stop using it if he did have something else in mind).
    Also, I guess I'm now concerned that the 2 weeks of steroids was previously prescribed had no effect. Is is "normal" for them to take so long to work, or dangerous to use them for too long?
    Thank you for your quick response earlier!

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  68. No danger in continuing to use the eryth ointment. Not too concerning that the steroids didn't do much the 1st week. Not too dangerous to keep going for weeks or months on the steroid as long as you're being monitored.

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  69. I have it and so do a lot of people around me.(very sunny and dusty place-africa) but i was thinking,shouldnt it go away after a period of time without exposure to sun, dust, wind e.t.c., since cells degenerate, a new sclera (or is it conjunctiva :/ ) that is clear will form.and if it does form anew,how long does it take?

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  70. no, its permanent damage. sclera & conjunctival cells don't turn over like corneal cells do. a pingucula is a degenerative scar, and it's permanent. it can't ever "get better" & it won't ever "go away". it can only either stay the same, or get worse.

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  71. So based on the previous exchange... the pinguecula is permanent... that part I'm ok with, as mine is currently small and not noticeable. (Had actually never noticed it before it got inflamed.) The 'itis' part though... I'm now terrified that this redness will never go away. Is pingueculitis permanent? I'm actually not in any pain, but from a cosmetic standpoint, I'm freaking out. I've now had inflammation/redness for about 5 weeks (steroids don't seem to be having any effect). I'm gathering that it's going to be a chronic thing, but is it possible for it to go away entirely? Am I destined to have a permanently crazy looking red eye?

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  72. the redness is usually not permanent. it will probably go away entirely. you are not destined to have a crazy looking red eye :D

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  73. Hi Dr P,
    I just noticed a clear bump on the nasal side of my left eye 2/3 days ago. it's been inflamed abt a week. Eyes are red/burning/itchy/feels like "something" is in my eye ALL the time. I self diagnosed after reading info on pinguecula.
    I have always worn sunglasses as I have very sensitive eyes (per an eye Dr's diag back in 1995). wearing sunglasses inside or until dusk, my eyes water just from yawning. Lately,I've had jobs with a lot of computer work, just started in a call center. I thought the pain and redness etc was from lack of sleep and staring at a computer screen all day. I am in so much pain and my eyes are killing me with all the computer work I must do. I don't have insurance and not much money for Dr appts. I am using Visine Total eye drops, warm cloths, tea bags, dark room on my break trying to find some relief. I've heard that something called Colloldal Silver will help. I am a recent transplant from WA state to AZ. but always wore sunglasses whenever I was exposed to the sun no matter where I lived. I also have been using reading glasses the last year. I am 46,healthy. Please help!

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  74. ok Colloldal Silver will not help. additionally: visine makes the irritation & redness WORSE, warm cloths make inflammation WORSE. Tea bags is a home remedy that I never believed in. I'd stop all of that immediately.

    i'd recommend to start using artificial tears like systane & refresh optive. I even like CHILLED artificial tears. and if you're going to do a compress, make it a cold one, not a hot one.

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  75. Thank you.. Where do I find artificial tears? Do I stand a chance of relief at all? I will stop using the things making it worse.

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  76. artificial tears: over-the-counter at any pharmacy

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  77. Love this blog, Ive read most of it. Ive had one Optometrist say I have a Pinguecula that wont ever go away its like a callous. Got another opinion had a Corneal Surgeon / Opthimologist say he wasnt sure it was a Ping. Both just prescribed eye drops like Systane. The Opthimologist did say I have Dry Eye that caused some irritation that had been untreated for awhile, hence the drops. He also said get a humidifier, and take some Omega 3 like Flaxseed and protect my eyes from air circulation. My question is do the red veins that seemingly grew into the corner of my eye because of irritation, once the irritation is removed, do they receed back or lessen, the tissue seems thicker to. Its these tiny excessive red veins that cause my right eye to look pink. Apparently my left eye isnt dry eye.

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  78. "My question is do the red veins that seemingly grew into the corner of my eye because of irritation, once the irritation is removed, do they receed back or lessen"

    could go either way, unfortunately. could retract or could be permanent. especially difficult to predict since your diagnosis is not confirmed, apparently.

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  79. I too have a ping. However, the ping is on the opposite side of the cornea (towards the ear). Is this common?

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  80. Super common. Almost as common as having them on the nose side.

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  81. Hello,
    I have my pings on both on my eyes for a long time,may be 10 years already,untill now my eyes were dry and tired but now they became really painfull,inflamed and soaring.I don't now if its because my pings are growing or may be because I have an allergy to smth.How can I figure out if its an allergy and pings or only growing pings which make my eyes so red and painfull? Especially after physical activities ( I am group fitness instrukter)it looks just very bad.Thank you.

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  82. ok if your eyes are red "especially after physical activities", that's not an "allergy" to anything. that is very, very likely to be inflamed pingueculae or chronic pingueculitis. you probably need to be using artificial tears before and after your fitness instruction, as well as Rx steroids

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  83. Hello Princedoc! Thank you very much for your answer.I use now artificial tears and my eyes are really not so badly inflamed as before.However,I think I can not go along with the drops all my life long.I ve found a specialist in Florida,Dr Gulani,who uses this new no-stitch methode to remove the pingueculae.But he is really very expensive,it costs like 7 000$ per eye if he operates.There are no such specialists in Europe,where I live,so maybe you know other eye specialists in USA,who are using this new methode as well but not so very expensive.Sincerely.J

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  84. I do not know of any surgeons who perform "no stitch" pingueculectomy, but a lot of those specialized eye surgeries run $7,000 - $10,000 so that's pretty average...

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  85. Do you have any idea if pregnancy could be causing the inflammation of my ping?

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  86. IMO it is improbable that pregnancy is causing inflammation of your pinguecula

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  87. Hi, so glad to find this blog. Very informative and helpful! I was recently diagnosed with pinguecula. They don't particularly hurt too bad, just look bad and cause a slight irritation at times - like dryness. I am curious if my career could be the cause. I am a metalsmith and use a torch to solder daily. I also have dust (metals, sandpaper, silicone, etc) in the studio when working with rotary tools, etc. I have been in the field for 13 years but am only 35. So, curious if this could be the cause as opposed to over exposure to sunlight? Doc suggested using Zaditor, but I don't really see a difference in the redness when I use it. Mornings and late night are worse. Thoughts?

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  88. well this initial blog post was about INFLAMED pinguecula. Sounds like yours are not INFLAMED that's why they're not hurting you right now. yes it could be your work environment: heat, wind & air particles can cause pinguecula, UV is not the only cause. Zaditor is an antihistamine, it will not reduce redness. It's not a bad idea tho...I agree with the basic premise. I'd try chilled artificial tears. If they're still red then you may need Rx steroids like Lotemax. Good luck!

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  89. Thank you for your thoughts, I truly appreciate it. Sorry I mistook the inflamed issue vs. simply having pinguecula. I was thinking that since I am experiencing the lovely (sarcasm intended) redness around them, that mine are in fact inflamed. They do often feel as if something is "in" my eye and dry, but I guess since I don't have pain, they are not actually inflamed - which is good to know. Just wish I could remedy the bloodshot look. Thanks again for your very informative blog post on this issue!! I know you are helping a lot of people.

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  90. Well if they're red they probably are a little inflamed...

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  91. I have pingueculitis. I put steroid drops in each eye and
    Can taste the drops, like
    its running down my throat. Is this normal?

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  92. yes. all eye drops end up at the back of the throat b/c your punctum drains into your canaliculus, which drains into your nose, which drains to the back of your throat. many, many eye drops have a funny "taste".

    the knee bone's connected to the...thigh bone :D

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  93. Hehe:) that's exactly what I was thinking! (Not really)
    Thanks so much! You make it seem so easy:)

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  94. Thank you for this post! I found out I had pinguecula at 21 years old; now I am 23.

    I think my pinguecula was caused by taking birth control pills. Apparently birth control pills make you more sensitive to UV rays, and I already am very sensitive to the sun (blond, fair skin, blue eyes, etc.). When I found this out, I stopped taking BC pills.

    Also, around this time, I became unable to wear contacts. They were irritating my pinguecula, and I'm not sure if it was because they were rubbing the pinguecula or if my contacts were just old (I had bought a package at Costco, and they lasted years longer than they should have!).

    I'm currently wearing glasses and not enjoying it. I want to try contacts again, but I don't want to spend the money if they are going to irritate my eyes again. So, I am considering LASIK.

    So my question is, does having pinguecula pose any more risks when getting LASIK? Do you think it's a good idea? Of course, I plan to get a consultation to see if I'm a candidate first, but I would like your opinion.

    One reason, besides the obvious cosmetic reason, that I want LASIK is so I can wear sunglasses more easily. Right now, I can't wear sunglasses because I have to wear glasses, unless I buy prescription sunglasses...but then there is the problem of having to constantly take them on and off whenever going inside/outside.

    Thank you for your help!

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  95. Hmm interesting about the birth control. I personally doubt that contributed a whole lot to the formation of your pinguecula, but I guess one never really knows.

    LASIK shouldn't be a problem with your pinguecula.

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    Replies
    1. I am a 26 year old female with what I believe are two pingueculas (one on each side) of my left eye. I alternate between wearing both glasses and contacts and don't suffer from any irritation. I will be having my yearly eye exam soon but until then I was hoping you could address a few questions:

      1. Can people still wear contacts with pingueculas?
      2. Is there anything else these yellow patches might be, or any major concerns I should consider?
      3. Is it likely these were actually there last year during my eye exam and my optometrist didn't mention it? I had a full exam including dilation.

      Delete
  96. 1) most of the time, yes
    2) probably not. people (even docs!) always mention "jaundice", but the people with jaundice are generally SICK and already have a host of other medical problems. the least of their worries is yellow eyes. if you're healthy & your eye has a yellow spot...its a 99.99% chance its a pinguecula
    3) possible, yes.

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  97. regarding #3 again...pingueculae are SO COMMON that I can see how a mild one might not be mentioned to the patient even if it was noted during the exam...

    ReplyDelete
    Replies
    1. Thank you so much for your reply. In regards to contacts and pingueculas, what circumstances prevent contact wear? And as a contact wearer what do I need to be concerned about or aware of?

      While I am as comfortable with my glasses as my contacts I prefer to be able to wear both because when I run hike etc. contacts are more desirable and work best with the sunglasses I use.

      Delete
  98. if they're BIG & very raised, they interfere with the way the lens fits. and obviously in some people (hard to predict who) the contact lens actually irritates the pinguecula

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    Replies
    1. Like the poster above I share common concerns about my contacts. While I am not having any irritation or pain I am terrified that when I go for my eye appointment my optometrist will tell me that I can't weA contacts anymore. Is this realistic or am I being a tad melodramatic? How do you usually help your patients with this problem?

      Delete
  99. that's a legitimate concern...but I've personally only had a handful of patients that I had to take totally out of contacts b/c of a pinguecula. we can work around them usually (small diameter lenses, dailies, low modulus lenses, etc)

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  100. How do you make sure this is not the early signs of ocular melanoma?

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  101. Ocular surface melanoma is really, really rare. That would be a "zebra" for sure. A doc would have to look, but melanomas don't look much like pingueculae. But really the answer is a doc would have to look.

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  102. I have read this entry and all the posts. This summer I noticed what looked like a whitish glow on the nasal side of my sclelera and a yellowish one on the opposite side of the same eye. I really panicked. However, when I looked with a magnified mirror and a flashlight I realized these where small yellowish patches. I think they are pinguecula, but I still have a lot of anxiety over this and it is getting worse as my annual eye appointment approaches. Here is wht I am confused about...

    1. They aren't raised to any notable degree.
    2. I wear contacts and glasses and I keep reading about people saying they can no longer wear contacts. I like my glasses but I don't want to be forced to wear them all the time. What can I do?
    3. Should I be as terrified as I am for my eye appointment.

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  103. hey thanks for the reply!

    1) they probably are pingueculae, even if they are not "raised".
    2) millions of people successfully wear contacts with pingueculae
    3) a pinguecula is nothing to be worried about. usually they're just a nuisance. not dangerous

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  104. Thanks for taking the time to respond. I am sure you deal with worried people all the time! In regards to my contacts they do not currently bother them so is that a good sign?

    As for if the patches are pingueculae or not. They are about the size of the very first photo in your post. But if they aren't pingueculae what other things might they be? What exactly should I expect from my optometrist? I've had corrective lenses since 4th grade and contacts since 6th. I am good about eye hygiene, alternating between lpglasses and contacts, not overwearing my contacts, changing cases etc. this is really the first time I have ever been nervous for an appointment.

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  105. Yes it's a good sign that they don't currently bother you. As for what else your yellow "patches" could be...they are almost certainly pingueculae. There is not much else they could be. As for your contact lens compliance - pingueculae are usually caused by UV, heat & wind exposure. Even über compliant contact lens wearers get them

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  106. This is a fantastic blog, and very informative. I noticed some other have asked questions about contacts. I was hoping you might be willing to explain what you do for your patients who have pings but want to keep wearing contacts? In my case I have two pings developing and currently wear acuvue oasis contacts...I am wondering if my doctor is going to make me switch contacts or try to get me to stop wearing them even though they aren't bothering me or causing any irritation?

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  107. if the pingueculae are not being repeatedly/constantly/chronically inflamed by the edge of the lens, then I usually do nothing. i.e. let the patient continue to wear the contact lenses they're accustomed to. so if they aren't bothering you or causing irritation, then don't do anything. keep wearing AV Oasys.

    in cases where I think the edge of the lens is inflaming the pinguecula, I have tried multiple things like:

    - lower modulus ("floppier") material. this usually equates to a switch from silicone to soft plastic
    - larger or smaller diameter to try & get the edge of the lens off of the peak of the pinguecula
    - switch to gas perm lenses, b/c they do not fit on the conjunctiva at all & therefore don't usually touch a pinguecula

    but there's no NEED to do any of those things if you're not chronically/repeatedly inflamed. I don't think it's known in the medical community whether contact lens wear makes pinueculae worse or bigger. that's generally attributed to UV, heat & wind exposure.

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    Replies
    1. Thanks! This was very helpful. Do you find much success with patients being able to manage a ping and continue wearing contacts?

      Delete
  108. yes. high success rate in continuation of contact lenses

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  109. Hello dr.I had a qustion.What are the tiny pin point blue dots at the end of blood vessels that are on your eyes.
    I have one tiny blue dot at the end of a blood veseel on one eye and three on another eye.
    I looked at my husbands eye balls and he has several too? I have a;lso seen them in eye pictures and in other people's eyes.I have a tiny blue dot at the end of a blood veseel in my pinguecula .

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  110. assumedly those are capillary beds

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  111. This is possibly the most informative article on the internet about pinguecula.
    I was diagnosed with pinguecula about a. year ago. After that I had to discontinue wearing contacts (which I had been wearing for 11 years) and got LASIK done. Somehow for some months after LASIK the pinguecula did not bother me much. Possibly because i didnt have to wear any lenses. The redness was less too. However, they have returned now. And are pretty big. The redness looks kind of ugly. People frequently suspect I turn up for work "drunk" :P
    I have nearly given up on a permanent treatment. Will using steroids more often have harmful side effects? What kind?

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  112. Traditionally long term steroid use was thought to be not-so-great because of the risk of cataract formation & steroid-induced glaucoma with prednisolone & dexamenthasone. However a newer drug called loteprednol ("Lotamax") has much less risk for those potential complications, and has changed the managent of many patients with chronic inflammatory conditions like pinguecula

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  113. Great Blog! Couple questions for you.

    1. Went to get an eye exam and Dr said slight pinguecula formation however i dont have any bumps and this diagnosis was before i had blood work done. One i got blood work done turns out i have Gilberts syndrome which causes raised bilirubin levels (however not dangerous at all) Could the yellow at the 3 and 9 positions be from that?

    2. I also have a veins at the 3 and 9 position that are non inflamed that close to the cornea is this normal?

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  114. While it is of course possible that your yellow spots are from your Gilbert's syndrome diagnosis, I personally think that yellow spots only at "3&9" are way more likely to ba standard old pingueculae from exposure. Especially if you don't have yellow skin or any other forms of jaundice.

    Veins at 3&9 are also probably from exposure (heat, wind, uv)

    ReplyDelete
    Replies
    1. Thanks for the quick response....What can be done about the veins?

      Delete
  115. Replies
    1. I was feeling around my sclera with my finger by the veins for lumps (dont ask me why)i didnt find any but its been 16 hrs and the veins seem more prominent than they were before. Will they subside? As you can tell I sort of obsess over things like this... Thanks again for the quick responses this is a great blog

      -Sam

      Delete
    2. haha "feeling around" the surface of your eye with your finger is not advisable. sounds like you irritated your eye & have engorged surface blood vasculature. YES that should go away in 1-2 days.

      leave them alone haha

      Delete
    3. haha yeah not that smart i figured after i did it cause it seemed other smaller veins popped up in the area which i assume are cause of the blood vasculature you mentioned...no more poking around for me haha

      -Sam

      Delete
  116. Hi, first off this is an amazing site. Thank you for taking time to do this. I also have a pinguecula and currently it is inflammed. I have worn contacts for probably twenty years, since I was thirteen. I also have dry eyes and have been put on restasis. It feels like a vicious cycle. Have drastically limited my use of contacts. Glasses give me migraines....I feel so bummed about this...what are some contacts that you recommend that may lessen the rubbing of the pinguecula? I am wearing air optic s oft lenses currently. I have scheduled a LASIK consultation as well cause I am fearful my dr will tell me I can not wear lenses which is problematic due to headaches. Any advise is much appreciated. Also, should I call my dr again to see about steroid drops? Could restasis irritate pinguecula? Is it best to not wear lenses during steroid use. I was prescribed Alex before. I will try chilled drops as well as cold compresses. Sorry for all the questions. So grateful for this site. Thank you in advance. Julie

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  117. "what are some contacts that you recommend that may lessen the rubbing of the pinguecula?"

    non-silicone DAILIES. like ciba dailies aqua comfort plus, acuvue 1-day moist, etc

    "I am wearing air optic s oft lenses currently"

    that's a silicone lens. if the pinguecula is being aggravated by the contact lens, probably need to consider getting out of high-modulus silicone.

    "I have scheduled a LASIK consultation"

    well, dry eyes is usually a contraindication to LASIK

    "Also, should I call my dr again to see about steroid drops?"

    that's a good idea. inflammatory conditions need anti-inflammatories.

    "Could restasis irritate pinguecula?"

    a little bit unlikely

    "Is it best to not wear lenses during steroid use"

    depends on the exact reason for the steroid use and the type of steroid. in the case of an inflamed pinguecula...it depends on HOW inflamed: GREATLY inflamed...I say no contact lens wear. MILDLY inflamed...I say its possible to keep wearing them in some cases

    "I was prescribed Alex before"

    I love that stuff. same drug as lotemax but 1/2 the concentration

    "Sorry for all the questions"

    no problem! good luck!

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  118. Thank u so so much! Got omnipred today. Go back in a week. Will ask about different contacts. As for LASIK what about ipk? Again thank u so much...love this site! Makes me feel not so alone....hoping the pinguecula clears up soon so I do not keep looking like I have been partying all the time lol. Thanks again! Julie

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  119. ipk? intrastromal pocket keratotomy? literally no one is doing that yet. some research is being done...this is very similar to (the same as?) as "corneal onlays" that I've been blogging about since 2007:

    http://myeyepod.blogspot.com/2011/11/corneal-onlays-in-news-again.html

    unfortunately you can't have that yet. not soon, anyway

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  120. Sorry I meant prk but very interesting about ipk, love your blog! Julie

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  121. thanks for the compliment!

    prk is functionally pretty much the same as lasik. its neither better nor worse for pingueculae. longer healing time but can do "higher" Rx's & thinner corneas...

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  122. Good to know cause I am a negative nine in both eyes...it would be amazing to see w/o contacts...fingers crossed. Hope you have great day!

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  123. Do pinguecula overlap onto any part of the caruncle? also when I look left and right slowly in the mirror i can see "folding" ,i guess you could say, of the sclera and it unfolds when i slowly look in the opposite direction. Is this just the composition of the sclera? or the is that the pinguecula?

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  124. well it's hard to say exactly what you're seeing on your own eye, and yes I guess it could be possible for a pinguecula to become so large that it covers other anatomical features...

    but it's also possible that you're seeing your own conjunctival semilunar fold:

    http://flylib.com/books/2/953/1/html/2/13%20-%20Normal%20Eye%20and%20Ocular%20Adnexa_files/DA5C13FF16.png

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  125. I am currently treating an inflamed ping with prednislone and it tastes really bad, it even makes me nauseous ....do other streoid treatments taste as bad?

    I have been using them for a week now, but there does not seem to be any inprovement; in fact, the drops seem to iritate my eyes even more. Should I try to change to Lotamax?

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  126. yes unfortunately they all taste bad. it is possible that a change to lotemax could help with the irritation, yes

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  127. Do pinguecula have their own veins? When I move my eyes up and down I feel only some veins move in the area of the pinguecula

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  128. usually not. they're not a "growth" that needs a blood supply. its a degradation.

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  129. Dear princeidoc,
    I have had a rather diificult time with my left eye getting inflamed and cosmetically, it drives me nuts. I was thinking about i-brite surgery to have it remove and actually see white again. Have you heard of this and I would value your opinion...FRUSTRATED!!!

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  130. Hi. I was wondering about my condition. I have a pinguecula in my right eye and it has had inflammation. I have used Alrex and now have been given omnipred. I have used it for several days and will be seen again by dr on Tuesday which will make it one week on steriod as well as one week out of contacts. It gets very clear and then redness comes back. I was wondering if allergies could cause inflammation? Or makeup? I am spinning my wheels and do not understand why the redness subsides and then returns. I also have dry eye and notice the redness more in morning. I know there are many variables that may be compounding the issue like the lack of sleep from taking care of my baby as well. I am nervous that my dr will say no more lenses which is problematic due to headaches from glasses. Any thoughts would be greatly appreciated. Also, could excessive use of artificial tears possibly cause inflammation? That may be silly question but again I am spinning my wheels....thanks in advance for your help!

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  131. I have not specifically heard of "I-Brite".

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  132. "I was wondering if allergies could cause inflammation?"

    yes that can be a factor

    "Or makeup?"

    no, that's unlikely IMO

    "I am spinning my wheels and do not understand why the redness subsides and then returns."

    many, many chronic conditions do this. it sucks but it's not out of the ordinary.

    "Also, could excessive use of artificial tears possibly cause inflammation?"

    no. highly improbable. the more the better, usually.

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  133. Thanks so much for your response....do you recommend an allergy drop if that is the cause? I also am going to use a humidifier for the dry eye issue....regarding steroids, is continuous use bad for eyes? Or intermittent using okay? Thanks....you are a life saver!

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  134. People on steroids already don't need an allergy drop. The steroid stops the inflammatory process better than an antihistamine does.

    Pred forte & dexamethazone are known to have long term problems: cataracts, glaucoma, etc. Lotemax & Alex are safer. Long term steroid use is considered to be unhealthy/undesirable...BUT if it's your only option...

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  135. I have seen on a couple websites that if you catch pinguecula in its early stages, then a lot of the time it can be eliminated or reversed....any truth to this?

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  136. How prevalent is pinguecula in the patients that you see, would say nearly every one or like 50%?

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  137. not even close to "everyone" or even 50%. more like say 15%. that's just a guess

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  138. If you have pinguecula, is it safe to tan in a tanning bed with sunnies on, or would that be a bad idea

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  139. Can Ping be caused by too much computer usage? (I am staring at a computer screen 10+hrs per day, every day for my job)

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  140. Hi I just went to eye dr to check my inflammation it is much better in right eft eye. She did a pressure check with the yellow drop and all is well. But now it seems like my other eye is inflammed ....could the drop have irritated it? I put a steroid drop in later in the day thinking that the pinguecula was also inflammed....later I put contact in briefly and notice now that they are out that there is slight redness around the colored part of eye...ugh....I just left dr today and there was nothing wrong with left eye....I wonder if contact irritated it after the pressure drop? Or steroid drop? No clue here....I am out of my conta5.ts again so who knows....any advice?

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  141. I think tanning is probably fine as long as you're wearing the eye protection ("sunnies"?).

    No, pinguecula are not caused by excessive computer use. They are almost exclusively caused by heat, wind exposure & UV.

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  142. Yes it's possible that the drops your doc used caused some mild inflammation of your pinguecula. Hard to prove, but possible. Not much you can do, tho. Have to check for glaucoma, etc. it's unavoidable sometimes

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  143. dr. price?

    so i have lupus and fibromylia and my eyes have been like this for a while...i just came across your answer but my question is doi got to my pcp or to the eye doctor? it hurts and i can see only colors... is this bad have i waited to long?

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  144. always go to the eye doctor for eye problems.

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  145. Okay, I have pinguecula in both my eyes, on the outer corners(ears). One on each side. Not terrible. Not bumpy. Light yellow. The pings are not very obvious unless yoo are really up close. And the don't really hurt or bother me, however, there are a cluster of blood vessels near the pings that lately,often become very inflamed. These vessels were not obvious before, but one early afternoon in October, I noticed I had very red eyes. I wear Acuvue Oasys and don't sleep in my contacts. I could not imagine what caused the redness. 30 minutes after taking the contact out, the redness calmed down. I figured I needed a new pair so went without contacts the rest of that day to let my eyes rest. The next morning, my eyes looked rather clear, so I put in a new pair of contacts. They burned a little, so I took them out and rinsed them with solution and then put them back in. 20 minutes later, both my eyes were red again. So I took the contacts out and they calmed down again, however now there are these blood vessels that weren't noticable before.
    I went to my eye dr, and she instucted I use Blink contacts because my eyes were dry. A week later, there was still no change, so I went back to doctor. This time she said I had a mild infection so put me on Tobradex for 7 days.
    I finished the 7 days and my eyes looked nice and clear so resumed wearing contacts. My eyes did not immediately become red, but by early eveing(7ish), the new cluster of blood vessels(near the pings) were engorged. Only the cluster near the ping was red, not the entire eye.
    I figured after years of wearing Oasys, they were starting to bother my eyes for reasons unknown so I switched to Acuvue Moist dailies.
    Now its pretty much 50/50 whether the blood vessels will become engorged. Even when they are not engorged, there is an area in the blood vessel that is thick, as if blood is trapped inside the vessel.
    So....my question is, how to do I get the blood to circulate through the vessels properly and not get so irritated so easily, or get clogged?
    I understand that the pings are permanent but what about the veins that are near them? I just want them to lighten and not be so obvious.
    Will the Tobradex help them? Or do I need something like Vita Plus for circulation? Ive used cold compress and while it makes my eye very white, the cluster of blood vessels remain.
    Here is a photo with my eyes not irritated. This is the best I an ever get them to look. I'm only 25. Please help!

    http://oi42.tinypic.com/213g7qt.jpg

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  146. FYI: I'm -6.00 presciption so my glasses are pretty thick. I don't want to have to give up contacts. I've been weraing them since I was 13 and have never had problems until 4 mos ago.

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  147. those are indeed pingueculae. you did the right thing by trying dailies. vita plus with not help at all. zylet helps b/c it has a steroid in it (lotemax).

    if wearing dailies still causes major redness, there's not going to be much else you can do. i frequently Rx longer-term steroid use for these patients, which is a lot safer with the advent of lotemax than it was before lotemax was available.

    maybe try some looser-fitting dailies? especially if you're wearing the 8.5 BC acuvue 1 day moists

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    Replies
    1. Ok thanks! I will try looser fitting dailies. Also, when you say Lotemax, is that the same as Tobradex? Or do I need to go back to eye Dr and request it? While online, I saw something about Anti vegF being used to clear eyes of unsightly blood vessels. I've been told more than once that the pressure in my eyes is high, but not glaucoma just yet. I'm really just not sure what to do. I saw the IBrite procedure on tv and it looks great, however way too expensive for me right now( I'm in law school).
      I hate to sound vain because but I work as a print model and it's costly for them to have to going Nd edit my eyes. The pings were barely noticeable before and did not show up in photos. But these blood vessels are showing up. I have looked back at photos from only 6 mos ago, and the blood vessels were not there. Is there any procedure that can just zap the veins away? And when you say Lotemax will help, will it help to lighten the veins?
      Thanks again!:)

      Delete
  148. no, lotemax is not the same as tobradex. lotemax is loteprednol (a steroid), tobradex is tobramycin & dexamethasone (an antibiotic & steroid combo). dexamethasone is not particularly safe IMO for long term therapy. lotemax probably is. yes if you wanted to try it you'd need a new Rx from your doc.

    anti-vegF is not currently being used to "clear" eyes of "unsightly" blood vessels. it may be being studied for that, but it is not currently being used for that. it's only being used for treatment of wet AMD (blood vessels in the RETINA).

    "I've been told more than once that the pressure in my eyes is high, but not glaucoma just yet"

    well you probably really need to limit the dexamethasone use. it's a known eye-pressure-raiser

    "Is there any procedure that can just zap the veins away?"

    that's what i-brite is. it's expensive.

    "And when you say Lotemax will help, will it help to lighten the veins?"

    no, it'll just make your eyes less red.

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  149. Got it! Thank you. And 2 last questions: I've never had a dry eye problem before. However, aftermy eye Dr initially advised I use Blink, I feel that they are often dry. Is it possible to become dependent on natural tear drops and cause dry eye when not used? I don't know if it's because I've become dependent to natural tear drops, or if the fact that I'm wearing glasses more often than before is making them dry. I used to wear my contacts all day, only taking them off to sleep and putting them back on 5 min after waking. I didn't even own a pair of glasses! And I remember that the feeling of naked eyes was uncomfortable because my eyes were unaccustomed to air. But now I only wear contacts for a few hours a day. So perhaps that's why they've begun to feel dry? The change happened in October 2011. This irritation with the dryness and blood vessels is very
    new to me which leads me to my second question: What caused the vessels?

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  150. "Is it possible to become dependent on natural tear drops and cause dry eye when not used?"

    not really, no. you're either dry & the drops help, or you're not & they don't.

    "What caused the vessels?"

    well, long term UV, wind & heat exposure. same things that caused the pinguecula

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  151. Good evening all! Wonderful and informative blog. I'd like to share my story regarding veiny eyes and pinguecula. I'm female, 37 years old. To the girl above(law student), in my opinion, your eyes don't look bad. And if that is a photo of your eyes without make up, I bet they look very white with eyeliner on. Don't obssess over it.
    Moving on... Have you ever noticed how clear and white the eyes are on actors/actresses in movies? I live in L.A. and I will tell you that Teri Hatcher admired to me that their white eyes are due to blue eye drops 5 minutes before shooting a scene. Just an FYI.;)
    Anyway, I began noticing some discouraging in my eyes in my late 20's. I went to an esteemed opthamologist in my area who told me it was pinguecula. He also told me that it's believed they are a result of sun and wind but it's not exactly certain. My 70 yr old father who grew up on a ranch and to this day lives on a ranch in sunny CA. He has never been a subclass wearer and he certainly has had his share of the elements. You'd be amazed how white his sclera are!
    About 2 years ago, my eyes in the area of the pinguecula started to become veiny. I tried Visine, artificial tears, cold compress... Nothing seemed to work.
    6 months ago I started taking slow fe iron pills due to low hemoglobin counts. 2 weeks into taken one iron pill every morning with breakfast, I noticed a significant clearing in my eyes. Not perfect white, but at least 30% improvement. This gave me hope! So I began a routine: in the morning I give myself one drop of artificial tears in each eye. I take my iron pill with breakfast. I wait until I've parked at work before putting my contacts in. I keep them moist with systane contact drops througout the day. If I notice even a slight redness, I take my contacts off immediately and switch to glasses for the remainder of the day. Once home and am ready for bed,contacts off, I begin my using a hot compress on my eyelids for 3 minutes. Either in the shower, or with cotton balls soaked in hot water. This will make your eyes a little red but it helps loosen things up. After the hot conpress, I switch to a cold compress. I've discovered that sliced potatoes work the best. I refrigerate the potato first, then slice a thin piece like you would a cucumber. Put them on your eyes for 10-15 minutes. After taking them off, your eyes should look white and rested.
    Also drink alot of water throughout the day. Like 4 water bottles.
    It seems like alot to do but once you get in the routine, it's really easy.
    You need to discover what vitamin you're deficient in and be sure to take a daily supplement. In my case it was iron. I've also decreased my caffeine, cholesterol, and fried food intake.
    After 6 mos of this routine, my eyes look amazing! I've had no surgery, and do not use vessel constrincting drops like Visine . The veins I had are almost invisible. You can still see them but they are hardly visible. The pinguecula are still there, but they have lightened in color.
    I've actually received compliments on how white my sclera is. If only they know how ugly and discolored my eyes were 6 mos ago! On evenings before going out, I use the blue eyedrops I mentioned above.
    I'm telling you that it IS possible to naturally improve the whites of your eyes.
    I'm able to wear my contacts practically throughout the entire day until bedtime. There ate a couple days each month when they act up, but I think it's due to allergies and cold air-condition.
    Before considering surgery which could ruin your eyes, try taking control of the situation first and see if you can get results! You might be surprised!:-)

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  152. Ok I'll publish this comment, but I'm going to have to make some rebuttals...

    "Teri Hatcher admired to me that their white eyes are due to blue eye drops 5 minutes before shooting a scene"

    I doubt this. and even if they were "blue", it wasn't the color that made them white...more like a vasoconstrictor

    "6 months ago I started taking slow fe iron pills due to low hemoglobin counts. 2 weeks into taken one iron pill every morning with breakfast, I noticed a significant clearing in my eyes"

    no. iron pills do NOT make your eyes whiter. sorry.

    " I refrigerate the potato first, then slice a thin piece like you would a cucumber. Put them on your eyes for 10-15 minutes. After taking them off, your eyes should look white and rested"

    yes, anything cold (doesn't have to be a tuber) will constrict your blood vasculature and temporarily (a few minutes is all you get) make your eyes "whiter". it doesn't really solve the problem long term, however.

    "Also drink alot of water throughout the day. Like 4 water bottles"

    drinking a lot of water will NOT make your eyes whiter.

    "You need to discover what vitamin you're deficient in and be sure to take a daily supplement. In my case it was iron. I've also decreased my caffeine, cholesterol, and fried food intake"

    ok those are all decent ideas as far as your overall health is concerned, but none of those will make your eyes whiter or help a pinguecula.

    "After 6 mos of this routine, my eyes look amazing! I've had no surgery, and do not use vessel constrincting drops like Visine . The veins I had are almost invisible. You can still see them but they are hardly visible. The pinguecula are still there, but they have lightened in color"

    sorry - this is anecdotal "evidence".

    "I've actually received compliments on how white my sclera is. If only they know how ugly and discolored my eyes were 6 mos ago! On evenings before going out, I use the blue eyedrops I mentioned above"

    what "blue eye drops"? if it whitens your eyes, this has to be a vasoconstrictor...which isn't really helping much (and could actually hurt you if over-used). it just "hides" the problem by constricting your surface vasculature

    "I'm telling you that it IS possible to naturally improve the whites of your eyes."

    no, not really. not long term, anyway, & not with any of the methods you just listed. sorry.

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  153. Hi I was just wondering if u could help me regarding an eye issue. You have been so helpful with the pinguecula info and I am in process of getting icl because my pinguecula gets inflammed every time I wear contacts and my glasses cause migraines. I just received yag laser iridotomy today which was a little uncomfortable. My eyes feel very tired today is that normal? I tried to put my contacts in which they said would be okay but my eyes felt like they were on fire. Is this common after the procedure? I called dr and they said to try to stay out of them for rest of day and try again in morning. I will follow direction and use the drops as prescribed for four days. I just was wondering if it was common to experience some burning and a foreign body sensation from the laser puncturing holes in the eye? Any help is greatly appReciated. Thanks

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  154. you needed an iridotomy before your icl? to deepen your anterior chamber, I guess?

    anyway yes its average to be a little uncomfortable after an iridotomy

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  155. Perhaps you're right and it's coincidence, but my eyes have certainly improved. Even my opthamologist commented on them. When I told him what I was doing, he also discredited my methods but said that what I was doing wasn't hurting so to continue if that's what works for me.
    The blue eyedrops I mentioned are a blue tinted drop. No constricters are in it. Just google blue eye drops to whiten eyes and you'll find it. It gives the eye a slight blue tint which actually causes the sclera to appear white and brightens the color the eye.
    I just wanted to share my experience.

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  156. well, thank you for sharing! and I have to admit I learned something new (about the blue eye drops - I didn't even know those were available)

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  157. Hi I was just wondering if you could tell me if Gas Permeable lenses would be easier on my eyes than silicone hydrogel soft lenses? I have slight pingueculae in the outer corners of both my eyes, that recently become irritated after a few hours with soft lenses on. My eyes also feel dry and I feel like my contacts "peel" off at the end of the day. Since the gas permeable are much smaller, would there be less chance of them irritating the pingueculae?

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  158. yes I frequently do this (switch the patient to GP's) when I think the edge of the lens is rubbing/irritating the pingueculae. I think there's mention if this above but since there's 175 comments now, maybe it got lost haha

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  159. I posted on Feb 18 with concerns about red veins due to pinguecula in my eyes. I went to another optician, and she switched to a whole new brand of contacts because the Acuvue Moist dailies were drying out my eyes. She switched me to Biofinity lenses. It's only been 3 days, but so far I love them. I don't sleep in them, but sometimes I wear them until 2 or 3 in the morning. They don't bother the pinguecula (at least not yet), and the veins have not become engorged at all which makes them less noticeable.
    When this issue first began, it was in October of 2011. Here in Texas, that's pretty much the end of summer. My apartment complex has a pool and I was out there pretty much every weekend. I'm beginning to wonder if the constant exposure to sun , caused pingueculitis( which is when I first noticed the inflamed red veins).
    I finally got the pingueculitis under control, and that's when I switched to the Acuvue Moist. The dryness they caused, made the veins bloodshot.
    So I hope these Biofinity contacts will continue to be comfortable for me. And I am now wearing sunglasses anytime I'm outside, even if it's cloudy!
    Dr., have you noticed more satisfied customers with the Biofinity contacts or no? I hear Purevision allows the most oxygen in but I'm afraid the thickness with rub against the pinguecula.
    Oh! And I just read that there are these special contacts that are to be worn at night that change the shape of the cornea so you can see the following day without glasses or contacts. What are your thoughts on those for people whose pinguecula become irritated from contacts? I believe it's called Corneal Refractive Therapy.

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  160. IMO there is nothing special about Biofinity. I'm glad they work for you, but its just another silicone lens to try. no better or worse than a number of other silicones

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  161. I am 23 and have been dx with pinguecula. One temporal on my left eye, and beginning stages of pings on my right eye. My doc told me to use systane and wear my contacts less often. I have done this for a few months and have noticed slight improvement, but my eyes are still red, especially in that left corner of my left eye. I went to him again and he noticed blepharitis and gave me Zylet to use for a week then to come back. Overall, i am worried about the pings becoming larger and possibly turning to pterygium over the cornea. Am i doing all there is to help control the pings I have, or should i be doing more?
    Thanks

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  162. maximize your UV/eye protection by wearing sunglasses, try to avoid hot/windy conditions like riding a motorcycle in Texas in August. other those that you're doing as well as you probably can...

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    Replies
    1. Thanks! I was reading earlier posts about the steroid drops and wasn't sure if it was something I should be also taking to help with the pings..?

      Delete
  163. Thank you for a very informative blog. I have had pinguiculae for over twenty years but only just now at 51 found out what they are. One doctor i consulted said they were cholesterol deposits. Another said they were cause by allergies. I do notice that i have flare ups with inflammation when i take allergy meds like Allegra or Claritin. Thanks for the advice on chilled eyedrops. Will give that a try.

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  164. Thank you for posting about this. I'm 31 and was diagnosed with pingueculae two years ago--at the end of a year of living on an equatorial, tropical island, preceeded by several years of semi-regular work with UV light (and many beach vacations). I had no idea this was coming, but now it's like--OF COURSE I have pingueculae. Lately the one on the nasal side of my left eye has become so inflamed and irritated I'm using Systane every day, and sometimes twice a day. (I still live on a tropical island, but I'm much more careful now, and I'm leaving soon.) Also, it's kind of heartbreaking for cosmetic and basic comfort reasons--I can't wear my contacts anymore (and I have horrible vision and heavy, thick eyeglasses--even with the low index lenses, they're really uncomfortable to wear) and I of course have all the redness to deal with. I've (almost) resigned myself to having the pingueculae--I've read that the removal surgery not only has a low long-term success rate, but that regrowth following removal is often worse than the original pinguecula. Is this true--is this why surgery isn't recommended unless vision is impaired by the pingueculae? Also, I notice my eyes are always more irritated at the end of a work day--I sit in front of a computer all day and I'm worried that I'm speeding up the growth of the pingueculae--am I? And is there anything I can do to mitigate it (switching careers isn't an option!)? And finally, my eye doctor two years ago told me that the only thing she could do for the flare-ups was to prescribe steroid drops, but that she didn't want to because of the risk of glaucoma. How much of a risk do you think that is? In the end, she told me to use preservative-free eye drops that have since proven to be ineffective; I discovered Systane for moderate-to-severe dry eye on my own, and it helps with the pain (which lately has been kind of intense). Oh, actually, and one other thing, if you don't mind: I really want to get LASIK, but I'm afraid of the resulting dry eye exacerbating this condition. Should I be worried about that?

    Thank you!

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  165. "I've read that the removal surgery not only has a low long-term success rate, but that regrowth following removal is often worse than the original pinguecula. Is this true--is this why surgery isn't recommended unless vision is impaired by the pingueculae?"

    it used to be. better nowadays

    "I sit in front of a computer all day and I'm worried that I'm speeding up the growth of the pingueculae--am I?"

    computer use has no effect on "speeding up" the growth/progression of a pinguecula

    "And is there anything I can do to mitigate it"

    steroids!

    "my eye doctor two years ago told me that the only thing she could do for the flare-ups was to prescribe steroid drops, but that she didn't want to because of the risk of glaucoma. How much of a risk do you think that is?"

    if you're rx'd LOTEMAX, the risk is small. if you're rx'd any other steroid, the risk is greater.

    " I really want to get LASIK, but I'm afraid of the resulting dry eye exacerbating this condition. Should I be worried about that?"

    yes. you are not a great lasik candidate b/c of these problems

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  166. HI,

    I woke up on 3/16 with a normal eye. By 5 pm, I had an engorged vein, a small hemorrhage below, and the previously diagnosed lymphatic cyst mass was full of blood. I saw my optometrist today, and while he said not to rub it as that might cause the engorged vein to rupture, the only thing else he did was take a photo. He said he would use the photo to "ask around". I'm not feeling comfortable with this answer. When I asked if I should see an ophthalmologist, he said to save my money, as he would be "asking around", and that I should keep an eye on it (pun?) for a couple of weeks. Am I wrong to be concerned about this?

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  167. surface eye conditions like this are usually not very "scary". the chances that its a tumor or something bad are slim slim slim. a second opinion is never a bad idea, but this does not sound emergent to me. a lymphatic cyst is not dangerous, nor is a subconjunctival hemorrhage.

    but if you're "not comfortable", then like I said a second opinion is never a bad idea.

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  168. Hi there. First of all, thanks for your time to answer all these questions...it's a great resource to those that have found your site. I am a 38yr male Canadian that's been aware of these slightly raised, slightly yellow spots on the nasal side of my cornea for at least 10 years. My vision is fine, but it wasnt until recently I went to the optometrist as the yellow spot on my right eye has changed. For the last 4 months it has formed into what looks like a yellow cyst, raised about 1 mm off the sclera. From reading here, it sounds like it could be pingueculitis, but I also noticed that it now has connected and ever so slightly grown into the cornea (about .5mm). The actual area going into the cornea looks clear, almost like a clear fluid filled blister. The optometrist diagnosed me with pinguecula in both eyes, and thinks a Ptyregium is forming under the pinguelcula in the right eye. There are pronounced blood vessels heading from the right side pinguecula towards the nose. I was given a very mild steroid over 2 weeks which did absolutely nothing. I am wondering if these characterisctics are normal, especially to progress only in the one eye? Do you think I need to see an opthamologist? I am considering surgery as I am trying to progress my career and this condition (red, inflamed yellow sac) is very embarrasing.

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  169. yes it sounds like you're developing a pterygium. yes, that's really common. also common to "only" happen in 1 eye (at 1st).

    yes if you want it excised, you need to see an ophthalmologist. that's what an ophthalmologist is...an eye surgeon.

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    Replies
    1. Thanks for your quick response/advice. I noticed you haven't commented too much on the available surgical options. Doing some website browsing (haven't scrubbed Pubmed) it seems the most "advanced" option is conjuntivital autograft with glue. To your knowledge has this procedure become generally accepted by the opthamologist community? Have there been many published clinical studies to support this procedure?

      Delete
  170. haha yeah I don't read up on the surgical procedures too much b/c I'm not a surgeon. the surgeon we refer to in the Houston area does use the conjunctival glue autograft. I assume it's becoming the standard, but I haven't read peer-reviewed articles about it or anything, sorry.

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  171. Hi there. I have been diagnosed with pinguecula on December, when I went to the eye doctor because I had a very red and painful eye after taking a flight back from Europe.
    I have been on different treatments like anti inflamatories drops (which didnt work) and now I am on steroid drops. The inflamation its getting smaller but I have notice that every time that I get inside a building with air- conditioning my pinguecula becomes swollen and red again.
    I have been using drops and oinments to help the swelling (plus the steroid drops). However as soon as I spend 30 minutes inside a shopping mall, airport, anything with air conditioning my eye gets swollen. I am flying back to Europe in a month time and I am very worried that my eye is going to back to the beggining (with a very very swollen pinguecula).
    I dont know what to do to avoid it. Please help!!

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  172. there's not much one can do to "avoid" problems like these. Use artificial tears like crazy & probably more of the steroid eye drops as well.

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    Replies
    1. Thanks fro your reply. Do you think that maybe something like this would help??

      Moisture chambers

      http://www.dryeyeglasses.co.uk/

      I dont mind to look funny during the flight and the airport, as long as it helps my eyes.

      What do you think?

      Delete
  173. maybe. as a "protection" from the elements that cause your ping to be inflamed...not a bad idea

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  174. I have pingueculitis and am 3 months pregnant. Is it safe for me to take steroid eye drops while pregnant, or something else I can do? I am already using Systane drops with some temporary relief. My ping seems to be swollen and pink with all the blood vessels now. It is like it got larger when my eye got irritated. Is that normal for pingueculitis?

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  175. these are tougher. ideally pregnant women wouldn't take steroids. but eye drops are usually pretty safe, especially if you practice punctal occlusion (squeeze the "top" of your nose/corners of your eyes to prevent them from being drained into the nose). so I guess the person to ask would be your OBGYN. I doubt they're going to freak but who knows?

    yes, inflamed pingueculae are "swollen" and larger

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  176. Hi great information on this site. I was diagnosed with pingueculas and was given Rapitil eye drops which cleared the redness in the eye. However I still feel at times like there is a foreign body in my eye (irritation). Is this because the pingueculae is still imflamed? Is this irritation feeling due to the imflammation and as such will go when the imflammation is treated?

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  177. well Rapitil is on older mast cell stabilizer - and "allergy" drug. In theory it won't help much with redness, irritation nor inflammation.

    If you're red, inflamed, and have a foreign body sensation...you probably need steroids. IMO, anywyay.

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  178. Thank you for your quick response. My redness has seemed to cleared but I am just irritated by the foreign body sensation. Should this clear with steroids ? Obviously I assume that this feeling will likely to come back when it gets inflamed again ?

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  179. the foreign body sensation could "clear" with steroid use. it depends on how big of a pinguecula we're talking about here. a large one will still cause FB sens even when it's not actively inflamed...

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  180. Hi Thank you again for your response. I have posted a link to a picture which hopefully will show you the size of the pinguecula - http://www.vpreston-builders.co.uk/photo1.jpg. Could you let me know your opinion on whether this should cause a foreign body sensation when the imflamation has subsided.

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  181. yes that looks raised enough to cause FB sensation even when not actively inflamed. I'd use a lot of artificial tears as a lubricant...maybe even consider excision if it bothers you enough

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