Working with an optometrist

Marshall Protocol (MP) patients who have sarcoidosis or symptoms of eye inflammation should have an initial visit by an ophthalmologist (a medical doctor) to be sure that they do not have any conditions that need specific treatment. In general, people with sarcoidosis should have at least annual eye exams, with a photograph taken of the retina for future comparison. For MP patients who have any specific conditions that the doctor is following, more frequent exams may be necessary.

The eye exam should include a painless (numbing drops are used beforehand) procedure to measure ocular pressure. Inflammation or steroid use (even topical PredForte) can cause increased pressure in the eye, which could cause irreversible damage. An increase in eye pressure is often undetectable by the patient, so eye pressure should be measured with each eye exam. It is not necessary to dilate the eyes before ocular pressure is measured. If eye inflammation is present, monthly eye exams may be needed.

Before they put in dilating drops, ask to speak to the doctor. They can (and probably should) do part of the exam before the dilating drops. You can ask what they might miss if they don't use dilating drops. If they do use them, ask that they use as few as possible (as a lower dose is easier to tolerate). There are also some formulations that wear off more quickly, so you can see if they have that. (Our eye doctor uses a mixture they make up at the local eye hospital of 0.25% Phenylephrine hydrochloride and 5% Tropicamide. This makes the eyes dilate and then go back part-way to normal.

Margo, MarshallProtocol.com

As a veteran of many, many eye exams on the MP (and before), I can tell you that you'll just have to endure the light in the eyes for the exam, as there is no way around it. The doctors cannot tell what is happening in your eye without looking in with that bright light (the slit lamp). My experience has been that while uncomfortable when it's happening, it has not induced a flare of the uveitis or any IP symptoms.

My best advice is to look not directly at the light, but around it. They'll tell you to stare straight in, but I usually look off to the side, to a darker part of the room or the doctor's shoulder or something. All they really want is your eye to stay still and not move around. So focus on something beyond or beside the light itself. That makes it a little more bearable. Tell them beforehand that you are light sensitive due to some meds you are on and to please be as quick as possible. It doesn't last very long, and hopefully won't do you any real harm.

Joy, MarshallProtocol.com

Just so you know, the eye doc has an antidote drop for the dilation drug. It stings a bit and they won't offer it, you have to ask, but I never leave his office without it now.

John McDonald, MarshallProtocol.com

Let the doctor know how light sensitive you are, and hopefully he can make the exam as quick as possible. I would ask him/her to use the reversal drops after he dilates your pupils when he/she is finished. This will help you immensely the rest of the day so you won't be even more light-sensitive.

VEZ, MarshallProtocol.com

There is some risk of increased infection with contact lens use. Contact lens use is also associated with dry eye.

Anyone who has recently had uveitis should discuss the risks of contact lens use quite carefully with an ophthalmologist who has advanced training in treating uveitis.