RSD Puzzle #130

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #130

Eye Complications in CRPS

(Also read Puzzle #24)

Question:

Dear Dr. Hooshmand,

Over t he last year I have developed watering eyes and my left eye turns outwards with double vision. Can this problem be related to my CRPS/RSD?

Answer:

Dear S.J.,

Many thanks for your e-mail letter. You suffer from 2 well-known complications of CRPS.

1. Keratitis Sicca which is due to CRPS at early stage causing pain and irritation in the eye with secondary excessive secretion tears. As the condition becomes chronic, the tear glands become exhausted, causing "dry eye" ( Keratitis Sicca). You need to use artificial tears every 2-3 hours while you are awake. Also, halfway during the sleep hours(approximately 3 hours after you are asleep), you should set the alarm clock to treat the eyes with artificial tears in liquid or viscous form.

2. You described deviation of the left eye sideways as well as double vision, and poor equilibrium. These are typical signs of poor circulation to the brain stem causing disturbance of focusing, and partial paresis of the eyes, and poor balance and falling attacks.

Treatment for the above consists of cervical epidural blocks containing Depo-Medrol®, cervical paravertebral blocks followed by cervical massage to neutralize and to disseminate the irritative chemicals, e.g., substance P (pain substance which is identical to the chemical irritant Capsaicin), CGRP, and nitric oxide to peripheral blood circulation, and eventual excretion of these chemicals. Otherwise, you are at the risk of developing a major stroke.

With many thanks,

H. Hooshmand, M.D.

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