My eye is unwell again.  Two nights ago I woke up feeling like something was in my eye, usually a first indication of impending pain.  I got up, put ointment in it, and went back to sleep.  Last night I was jolted awake with pain and my eye was watering.  I put some ointment in it, and lucky for me, the pain was not horrible and it was short-lived.  Today I feel very upset and depressed about what appears to be a relapse of a condition that is seemingly resistant to treatment and is significantly interfering with my sleep.

When I first saw the ophthamalogist, I suggested to him the possibility that the changing hormones of pregnancy and postpartum were partially responsible for the eye trouble that cropped up 12 years after the initial injury.  He did some hand-waving and basically said “who knows, there are only a few things we can do, and they may or may not work…” (some digging today revealed a 50-80% success rate with the interventions I’ve already had).  I decided to hop on MedLine and check out some articles.  I couldn’t find too many things about the interplay between hormones and recurrent corneal erosions, but did find some information about menstrual cycle, pregnancy, and menopause-induced changes in corneal thickness and curvature.  Estrogen levels fluctuate during the menstrual cycle, and also rise during pregnancy followed by a rapid drop postpartum (particularly in the breastfeeding mother).  I thought that perhaps this could account for what I’m experiencing, at least in part.  I did searches on luteinizing hormone, follicle-stimulating hormone, and progesterone, and couldn’t find too much information.  Finally, I found an article detailing the growth factors and proteins responsible for maintaining the integrity between the corneal epithelium, the basement membrane, and the acellular Bowman’s membrane.  One of these matrix molecules, collagen, seems to be responsible for anchoring the basement membrane to the stroma, and changes in collagen expression seem to be at the heart of traumatic recurrent corneal erosions.  Guess what low estrogen levels do to collagen expression?  Yup, if you guessed that low estrogen leads to low collagen, you win.  And guess where my estrogen levels are right now?  Lower than the Dow.  

So where do I go from here?  I don’t want to stop breastfeeding.  I considered for a brief second the strategy of taking oral contraceptives to boost my estrogen, but that is also problematic as estrogen can interfere with milk supply and has poorly understood effects on the breastfeeding infant.  Most healthcare providers recommend low-estrogen or progestin only pills for breastfeeding mothers, which of course, won’t really tackle the problem I’m having.  So I’ve decided to wait this one out.  I’m in for a few months of continued sleep deprivation and excruciating pain.  I may be able to see the eye doctor to get periodic contact lens bandages for temporary relief when I go on my job talk, for example (assuming that a job talk is even still in the cards at this point).  Once I’m done breastfeeding, if I’m still having problems, I’ll go back to the eye doctor and have the debridement procedure repeated.  It won’t do me any good to have it done again right now, as the success of the procedure depends on the body’s own ability to heal.  And my healing seems to be impeded at this point by those pesky hormones.  

If I thought it would do any good, I would sue the shit out of Wal-Mart (who is responsible for my injury in the first place), and then use the money to fund research on the relationship between estrogens and eye disease/pathology.  (I just learned that macular degeneration is more common in women and coincides with the menopausal period).  I couldn’t believe how much digging I had to do to get even a hint of an answer to all of this.  Of course, all of this underscores the larger issue of a lack of basic research into women’s health issues.  I’m not even talking reproductive health here….I’m talking health in general, which just happens to be heavily influenced by female reproductive hormones.