Monday, October 8, 2007

Passing Out at the Optometrist's

Just a Routine Eye Exam

I went to the optometrist before work today to get a new prescription for my glasses, since it's beginning to get difficult to read fine print far away again. It's been one or two years since my last prescription, so this isn't all that unexpected.

My eyes have deteriorated just a bit — I seem to always go in for new prescriptions when my eyes have gotten -0.25 diopters worse. So now my right eye is -5.50 and my left is -5.75. My left eye also seems to be developing a slight astigmatism, which I hadn't known about before.

Glaucoma Testing Fun

Then it was time for the beloved glaucoma test. By which I mean, I hate the test where they blow a puff of air at your eyes. Always makes me nervous in anticipation, then I jump back when it happens. Sometimes we have to repeat the test in the same eye because I blink and jump back before they get the reading they needed.

I asked the doctor (assistant doctor?), Mauricio, if he was going to do the air-puff version of the glaucoma test, and he smiled and said no, they have another type of test for glaucoma that doesn't involve the puff of air. It involves eye drops instead — which I'm also not so thrilled about, but I'm just squeamish and overly protective of my eyes in general. (This is why I don't wear contacts; I can't even touch my eyes.)

So after a couple of tries, he gets the drops in my eyes. The drops stain my eyes (yellow, judging by the color of the drops themselves) and numb them. He brings one of the machine gizmos up to my face and says he needs to get very close to my eyes, hence the numbing agent. I ask Mauricio if "very close" means a chance of actually touching my eyes, to which he says yes. I sorta freak out calmly, by which I mean I hyperventilate and squeeze my knees with my hands while holding very, very still so as to reduce the risk of him bumping into my eyes and minimizing the time needed for the test.

It was over soon — maybe one minute, two? — and he sat back down at the computer to type up the results. He was busy saying something about the pressure in my eyes looking good when suddenly I noticed a headache coming on. Within a few seconds it grew much worse, so I closed my eyes and leaned back in the exam chair. I mentioned, "Um, I have a really bad headache all of a sudden."

And Not-So-Fun Adverse Reactions

The next thing I remember is waking up feeling very confused. My arms felt very heavy, like I'd had way too much to drink. My left hand was clutching the kleenex I'd used to dab the excess eye drops from my eyes, and it wasn't really feeling like unclenching. Someone was holding my right hand (in retrospect, I believe they were actually taking my pulse). I opened my eyes and looked around at the three doctors in the room with me.

The primary doctor, Dr. Kelly, said that this wasn't an unheard-of reaction (although not common, either, or they wouldn't still be using those eye drops!) to the fluorescein (the dye) and/or proparacaine (the anesthetic) in the eye drops. For most people, he said, they felt back to normal within 10–15 minutes. Very occasionally, people's nausea would lead to them throw up, so he showed me where the trash can was but told me not to worry about it too much. The woman doctor gave me a cup of water, which helped my very dry mouth and made me a little more alert. They helped me get out of my fleece zip-up, since I'd broken out in a cold sweat. I asked someone to fish my cell phone out of the fleece pocket and call Gaurav (my manager) to let him know I wouldn't be in on time. Some talking went on — I don't remember clearly — and then they turned down the lights for me and let me rest in peace.

(I heard Dr. Kelly out in the hall talking to Mauricio, who sounded understandably upset and concerned. [CYA? Heh.] He had apparently not known about this possible side effect. Dr. Kelly said something about not needing to give it to younger adults; my memory is, uh, a bit hazy and they were talking out in the hallway, but my impression was that he was saying younger people were more likely to have this reaction? I'm not sure... Anyhow.)

After the promised recovery time of 10–15 minutes had come and gone, the doctors asked how I was feeling. About the same level of abysmal, I told them. (Me: "Ugh, meh." Doctor: "What?" Me: "Um, not any better.") Soon, the nausea got the better of me and I threw up in the previously-pointed-out trash can. I felt a little better, but not much, so I climbed back in the exam chair and rested some more. When Dr. Kelly came in to check on me and I told him I'd thrown up, he said something along the lines of "Oh, geez," like I was reacting unusually badly, even for having this unusual bad reaction in the first place. He said that would be the low point of my feeling bad, and that I should feel better soon. He checked my pulse again, was satisfied, and let me rest some more.

I started feeling cold, so I draped my fleece over me and dozed off. The headache never really got any better, my limbs still felt heavy and difficult to use, and then the nausea came back and I threw up a second time. About two hours after the beginning of my eye drop reaction, I finally felt well enough to stand up and wander into the hallway, looking for Dr. Kelly, Mauricio, or the woman doctor (whose name I never caught).

I found Dr. Kelly and reported my status — still very crappy-feeling, but wanting to go home and lay down in my own bed. I asked if anyone would be able to give me a ride home, just two blocks down the street, since walking even that distance didn't sound like much fun at the time. He went off to ask around. But I'd forgotten that, insurance-ly speaking, the office couldn't let an employee drive me home in their personal car. They offered me a taxi, but the waiting for the taxi would take longer than just walking home, and it felt lame to take a taxi for two blocks even if I was feeling that bad.

I declined the taxi and said I'd walk after all, which they okayed so long as I wasn't feeling dizzy. Which I wasn't... But just walking from the exam room to the reception desk brought on the headache much worse, so I slunk off to a back room with a gurney, pillow, and thin blanket to rest some more. A while later, I wasn't feeling any better, and was actually shivering. All I could think about was getting back to my warm apartment and my own comfy bed. (My apartment's gotten warm since the cold weather has set in, because the steam pipes deliver warmth to the apartments above me even when my own heater is turned off.)

I tracked down the woman doctor and told her I'd take her up on that taxi after all. But when I went downstairs to meet the taxi, it wasn't there. I could see my apartment building from where I was standing. My legs were shaking and my head hurt. I just wanted to get home, dammit, so I gave up on the taxi and walked the two blocks home. (I did call the optometrist office when I got home, to let them know I hadn't disappeared on them.) I crawled into bed, where I dozed off and on for the next many hours.

Researching the Reaction

While I was still at the doctor's office, Forrest called several times on my cell phone to check up on me. He was also googling about what information I had passed along to him. He was concerned that he couldn't find much online about this supposedly "not unheard-of" reaction to the eye drops. At his suggestion, I called my primary physician's office at Virginia Mason for a second opinion. The nurse there taking patients' calls said that, so long as my pulse was okay and the headache had abated in 24–48 hours, I should be medically okay. Not at all a happy camper, but okay.

It wasn't until 12 hours after the eye drops that I could finally sit or stand for more than a minute before the headache forced me to lay down again. (The headache isn't responding to ibuprofen, but laying down makes it much more manageable.) Once I could sit at the computer, I googled fluorescein and proparacaine for myself. Like Forrest said, there wasn't much talk about such bad reaction to eyes drops.

What I experienced (with all durations of symptoms being estimates):

  • losing consciousness (lasted a few minutes? I'm not sure; I wasn't quite there at the time ;))
  • nausea (lasted 1-2 hours)
  • vomiting (twice, about an hour into it)
  • bad headache (lasted 14 hours and counting :()
  • sweating (lasted 1 hour)
  • chills and shivering (started 1 hour into it, lasted 1 hour)
  • muscle rigidity (lasted 1-2 hours; like when I had too much caffeine, back in high school)
  • light sensitivity (lasted 1 hour)
  • dry mouth (lasted 2 hours)
  • tiredness (sleeping on and off for the past 12 hours; however, this was partially to escape the nasty headache)
  • paleness (lasted 2? hours; the doctors commented that I looked pale)

On three different medical websites, I did find some mention of some of these reactions. WebMD talks about the following "severe" rare side effects:

  • low energy
  • excessive sweating
  • abnormal nervous system function affecting mental alertness

Medscape warns about these rare adverse effects:

  • CNS depression
  • fatigue
  • hyperhidrosis (aka excessive sweating)
  • pallor (heh, original name) lists these adverse reactions also lists "CNS: stimulation followed by depression" among the adverse reactions.

Decent overlap with my actual reactions, eh?

And Still Without New Glasses!

So yeah, that was what I did today instead of going in to work. :( Thankfully, Gaurav is not a slave-driver; he was concerned about me and told me to take the day off, or work from home if I felt better by mid-day. Dr. Kelly said he was glad to hear I wasn't going to lose my job or anything. (I hope he was just kidding around; it would suck to have a job where you got fired for such things happening to you!)

And after all that, I still need to go back in and actually pick out my new frames and get the prescription for new lenses filled. Ah well, such is life sometimes. At least everything but the headache has cleared up.

And how was your case of the Mondays? ;)


smanoli said...

I'm sorry, I too dislike the puffs of air, but not nearly so much as you. And unlike you I'm ok touching my eye, but not other people touching it. When I first got contacts the doctor took forever to get the contacts in as i kept blinking and warned me that I might not be a candidate since I seemed to be having so much difficulty. He then told me to see how I did taking them out and putting them back in. Out took a few tries, but I got them in on my first try. Hope you're feeling better today

Rene said...

You should write the Pharmaceutical company a nasty letter starting with "Yooooou bastards!"

Rene said...

All that happened and you didn't even get a visit from House!

Wilson would have been better, but it wasn't cancer, so you wouldn't get transfered to him.

Sad panda!

The White Rabbit said...

I just stumbled onto this post of yours after googling this bad reaction because a similiar thing happened to me today! While at the eye doctor's for a routine eye exam, I was given eye drops to dialate my pupils (something I'd never had done before). I had no nausea or headache like you did, but less than a minute after being given them (and after the doctor left the room), I started feeling very tired, as if my body was getting heavy. I then proceeded to sweat profusely and pass out for around 10 minutes. I woke up a minute before the doctor got back in the room. He explained to me that this is a very rare reaction to hitting a nerve that runs through the eye, and that hitting it causes an immediate drop in blood pressure. He said it's most common in young males from the age of 18 to 26, although I'm a 25-year old woman, so who knows...
Anyway, glad to hear someone else had this same sort of thing happen. Maybe it's not so rare after all.

Anonymous said...

happened to me last week... they now think i might have diabeties?