Through repeated painful experience, Shannon Bream had learned to keep her eyedrops close at hand wherever she went — even in the shower.
Although they did little to quell the near-constant thrum of pain, the lubricating drops were better than nothing. She clutched the bottle while working out at the gym and kept extras in her purse, car and desk. At night, she set her alarm clock to ring every few hours so she could use them; failing to do so, she had discovered, meant waking up in pain that felt “like someone was stabbing me in the eye,” she said.
“Daytime was okay, I could function, but nights had become an absolute nightmare,” said Bream, who covers the Supreme Court for Fox News.
But a doctor’s suggestion that she was exaggerating her worsening misery, coupled with the bleak future presented on the Internet message boards she trolled night after night searching for help, plunged her into despair.
“I didn’t think I could live like this for another 40 years,” she recalled thinking during her 18-month ordeal.
Ironically, it was those same message boards that helped steer Bream to the doctor who provided a correct diagnosis and a satisfactory resolution.
In the middle of one night in February 2010, Bream, then 39, awoke suddenly with pain in her left eye “so searing it sat me straight up in bed.” She stumbled to the bathroom, where she frantically rummaged through the medicine cabinet and grabbed various eyedrops, hoping to dull the pain. Her eye was tearing profusely; after about three hours, both the pain and tearing subsided.
Ten years earlier, Bream, who wears soft contact lenses, had accidentally scraped the surface of her left eye with a brush, scratching her cornea, the eye’s exquisitely sensitive protective outer layer. “That time, I knew instantly what had caused it; this time, I couldn’t remember doing anything and thought, ‘Well, I must have done something in my sleep.’ ”
After the same thing happened again a few weeks later, Bream made an appointment with the optometrist who fits her for contact lenses.
He told her that because she was nearly 40 years old, her problem might be dry eye, a common condition among women entering middle age. He prescribed rewetting drops, but the nighttime episodes continued. After a second visit, the optometrist told her he didn’t know what was wrong and suggested she see an ophthalmologist.
Bream turned to a respected corneal specialist in Northern Virginia; he agreed that dryness was the most likely cause and added Restasis, a prescription medicine that treats chronic dry eye.
At first, the Restasis seemed to help ease the pain, but the incidents became more frequent; both eyes were now affected, and she was having episodes several times per week. After about six weeks, she went back to the ophthalmologist, who spotted a myriad of tiny scratches on her corneas.
He urged Bream to be patient; Restasis, he noted, takes time to work, and its effect is cumulative.
Bream tried to heed his advice and hoped he was right; her eyes were red and painful much of the time, and she worried about her ability to work. Several months later, she returned for a third visit. By this time, she was waking up every two or three hours at night to put drops in her eyes, the only thing that seemed to help. On nights when Bream slept through the alarm, she experienced searing pain when she awoke.
“I would sit there and pray for the pain to pass and just ride it out the best I could,” she recalled. “I would try to calm myself.”
Although her vision was sometimes affected, she managed to compensate at work because both eyes were rarely impaired simultaneously.
The ophthalmologist, she said, was unmoved by her account. He told her he thought she was being “emotional” and made it clear he believed she was exaggerating. Keep using the drops, he advised.
Bream, devastated that the doctor thought she was being a drama queen, vowed never to return.
For much of the next year, she used the drops every few hours round the clock — she was terrified to be without them — and pondered her next move. Many nights she spent hours online, trolling patient message boards for clues.
A corporate lawyer before she became a reporter, Bream said she didn’t seek another opinion because she worried that another eye doctor might tell her the same thing. “I just felt sort of crushed,” she said. “I thought maybe it was me.”
The patient postings terrified her: People talked about going to an emergency room in searing pain, which the staff didn’t know how to treat. Some said they had become so despondent they were considering suicide.
For Bream, that option had started to make sense.
“I couldn’t imagine living another 40 years like this,” she remembered thinking. Perpetually exhausted — it had been nearly a year since she had slept through the night — and in constant pain, she tearfully confided to her husband one night in September 2011 that she couldn’t imagine continuing. He urged her to find another doctor.
“The fact that suicide didn’t sound crazy and irrational to me was a wake-up call,” she said. She remembered seeing favorable mentions of Washington corneal specialist Thomas Clinch on several postings and decided to call him.
During her initial visit, Clinch recalls that he was struck by Bream’s description of her pain — particularly that it was worst when she awoke. She had been taking Restasis for months, long enough to achieve the maximum response, which indicated that dry eye was not her chief problem.
“Her symptoms were fairly classic,” said Clinch, adding that what he saw when he examined her eyes made him certain he knew what her problem was.
Bream’s cornea was blanketed by tiny, superficial scratches and signs of a disorder called map-dot-fingerprint dystrophy. It features clusters of dots and areas that look like fingerprints that form on the layers of the cornea. The condition, which usually arises between ages 40 and 70, results in cellular abnormalities that cause the epithelium, the outermost layer of the cornea, to weakly adhere to the underlying membrane.
As a consequence, the epithelium is easily sloughed off, often during REM sleep, a stage in which the eyelids repeatedly come into contact with the moving corneas. That exposes the underlying nerves, which can be excruciatingly painful. Patients with the disorder are predisposed to developing recurrent corneal erosion syndrome, which causes painful scratches on the surface of the cornea.
“Think of the epithelial cells as grass that has to grow on a field. If you lay sod and then play soccer on the field, you’ll immediately tear it up,” Clinch said. In Bream’s case, her corneas never healed because “she kept re-traumatizing the surface.” Restasis and the rewetting eyedrops, while helpful, were not sufficient to repair the damage.
Clinch said he isn’t sure why the previous ophthalmologist missed the corneal erosion, a condition that is both common — he sees it weekly — and “pretty clinically apparent. . . . I think the focus [got stuck] on dry eye.”
Bream said that when Clinch made the diagnosis during that first visit, she was hugely relieved. “It was the first time I felt a glimmer of hope,” she said.
But that hope was quickly tempered when Clinch told her that there was no cure for her condition and that if it did not improve with treatment, she might have to stop wearing contact lenses, which can injure the cornea.
Clinch advised her to use a thick, nonprescription ointment called Muro 128 at bedtime; the ointment reduces the chance of corneal abrasion. He also prescribed different eyedrops, along with the Restasis.
Several weeks later, as her eyes began to heal, Bream slept eight consecutive hours — the first time she had done so in more than a year. “It felt like I’d won the $300 million lottery,” she recalled.
Clinch also implanted tear duct plugs; a fairly common procedure performed in the office, the plugs help eyes retain moisture by reducing drainage.
Bream now stockpiles Muro 128, which she calls “my desert island item.” She occasionally experiences a recurrence, but her condition is far more manageable and she is still able to wear contact lenses.
Looking back, Bream said she is not sure why she waited so long to find a new ophthalmologist — and why she told almost no one, including her parents, about the problem while she was going through it.
“Now I would have immediately started searching for another doctor,” she said. “I think a lot of it was that I was so exhausted and operating in such a diminished capacity.”
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