Most Pain You've Ever Experienced

@Steel_Nation and @T3hPwnisher, both of you experienced corneal abrasions. The outer layer of the (5 or 6 layered, depending on who you ask) cornea is the epithelial layer. When the epithelium gets scraped or sheared off (by a stick, or an abnormal attachment to a contact lens, etc), it leaves underlying corneal pain fibers exposed. The cornea has one the densest distributions of pain fibers in the entire body, and the degree of pain is proportional to the size of the defect in the epithelium. The pain of a corneal abrasion can be utterly disabling.

As y’all note, topical anesthetics instantly resolve the pain, but only for 20 minutes or so. Unfortunately, topical anesthetics are quite toxic to the cornea, so we can’t simply give patients a bottle to use ad lib. However, this does not prevent the occasional pt from stealing a bottle and self-administering the drops at home. Such self-administration leads quickly to a vicious circle–the toxic anesthetic further damages the cornea, which leads to worsening of the pain, which leads to more frequent anesthetic administration, which leads to worsening of the corneal damage, etc. Every ophthalmologist has had a pt or two literally melt a hole in their cornea in this manner. On occasion, we have to admit such pts to the hospital and keep them under surveillance to prevent them from continuing to use drops. I had one such pt whose cornea continued to worsen in the hospital despite the fact that she had stopped (she swore) using the drops. Turned out she had a bottle of drops hidden under one of her breasts, which wasn’t found until we literally had her strip-searched by the nursing staff.

Fortunately, if not further abused, the cornea re-epithelializes very quickly, so even quite large defects will ‘fill in’ over the course of a few days. Unfortunately, in some individuals (I’m looking at you, Steel), the new epithelial cells fail to ‘put down roots’ properly, and thus are only loosely attached to the underlying basement membrane. When this occurs, trivial trauma will cause these loosely-attached cells to come off, thereby re-creating the original corneal abrasion. This situation is called recurrent epithelial erosion syndrome (REE). The classic REE presentation will sound very familiar to you. What happens is, while the pt is sleeping, a modest adhesion forms between the underside of the upper eyelid and the loose epithelium. Under normal circumstances, such an adhesion would not be strong enough to cause the corneal epithelium to shear away–the adhesion would simply break when the individual opened their eye. However, in an individual suffering with REE, the lid-epithelium adhesion is stronger than the epithelium-cornea attachment, and thus the act of opening their lids upon awakening literally tears away that section of epithelium. So it’s akin to waking up and having someone immediately rake their fingernail across your eye. Not a good way to start your day.

In some individuals (again, Steel) REE will eventually resolve with conservative treatment (moisturizing drops; etc), but others need more aggressive treatment to promote a firmer connection between the epithelium and the underlying tissue. Broadly, such treatment consists of mechanically stimulating the underlying tissue to promote better epithelial adhesion; this can be done by making multiple minute punctures through the epithelium into the main layer of the cornea (the anterior stromal micropuncture procedure), or by scraping off the epithelium and lasing the underlying tissue in a LASIK-like procedure called phototherapeutic keratectomy.

2 Likes

Thanks for that nice write up. Would have been awesome to have that explanation when this was all happening. I definitely considered stealing some of those drops too. They’re the best thing ever; you go from being blinded with pain to completely pain free almost instantly. They did tell me that they couldn’t prescribe them to me but didn’t say why (only “you can’t take them all the time”). So I just thought they were sadistic assholes. Makes a lot more sense now.

My doc offered to do that micropuncture procedure, and I actually had it scheduled a few times. But then we got close to the date of the procedure and the eye started feeling fine again. Then a month would go by, and I’d have a relapse, make an appointment, feel better before that date, cancel the appointment, rinse and repeat. I’m glad it finally resolved itself, but in hindsight I obviously should have had it done immediately.

Amazing write up. Like steel, I wish they would have told me WHY, I couldn’t have the drops. I can definitely see self administration to the point of putting a hole in your eye; those 20 pain free minutes were magical.

My favorite part was the series of eye tests I took while I was recovering.

“OK, cover your good eye and read to the lowest line you can.”

“Big letter K, and that’s really more of a guess”

The eye story reminded me of one in my youth. When I was 14 my older sister bought a sun lamp and told me I couldn’t use it. Naturally, the first thing I did when she went out was use it…for three hours on my face while I read a book.

During the evening my face was pink and it didn’t look like much more than a mild sunburn. However, I woke up in the middle of the night with my eyes in agony. Even moving them under my eyelids was painful. I ended up with second degree burns on the right side of my face and burnt my eyes. They went white for about three days and I couldn’t see. The ophthalmologist said it was similar to burns from snow blindness.

I spent the summer with a scabby burned face for the move to a new high school. The bright side was that I didn’t have to write my final exams which was sweet because I’d done fuck all to prepare. Also, when the burn finally healed, my skin was beautiful; like home dermabrasion. 37 years later I’m wondering if skin cancer will result from that adventure.

Speaking of the sun, one interesting fact is that my sister is actually allergic to sunlight. If she is out on a summer day not only will she burn very quickly but she will also develop hives. She basically always goes out wearing a large sun hat and sunglasses. She is not albino, fwiw.

I use to be friends with a girl like that, shit is crazy.

Yeah, there’s a reason people wear those goofy little goggles while using a tanning bed. Excessive UV light exposure causes photokeratitis, which you had a hella bad case of, apparently.

Flashburn! Worst I ever had it was when arc gouging in a hurry. Someone got my attention and distracted me, so I lifted my hood and talked for a minute then went right back to gouging- without putting the hood back down. Looked directly at an approximately 15kw arc. After the floating orb went away it felt like red ants were eating my eyes.

ED, a few local places were handing out vials of that stuff like it was candy to people at a place I worked. Once word got out that they were doing the same thing with oxycontin it was like an epidemic of flash burn. Guys were literally burning their eyes out once a week to get a script.

If it was a thing in '79 it wasn’t well observed among the 14 year olds :slight_smile: It certainly was painful but pain was superseded by a worry that I would have burn scars on my face; much more of a priority for a teen girl.

Before reading this thread, I was sure the kidney stone was a really bad thing.
I stand corrected. There are some horrible experiences in here.

Not the thread you want to win, but I’ve wondered who the WINNER is. I can’t decide, but I know I never want to experience the debridement thing, or the accidental ingestion of drain cleaner, or the thing Maximus went through, or the sharp stick in the eye.

KInda funny. When my husband was driving me to the ER with the kidney stone, I started telling him, “My chest hurts! Honey, my hands are tingling. Now I think my arms are going numb. I can’t feel my hands! If I pass out before we get there, tell them I might be having a heart attack.” He had to help me out of the car because I couldn’t walk. Then we get checked in and the nurse says, “Your hyperventilating. Here’s a paper bag.” Ha!! It wasn’t funny at the time. Everyone at the ER seemed to be moving in slow motion, like they weren’t at all concerned that I was about to DIE. It would have made me feel a lot better just to see them walk a little bit faster. I wanted to see someone yelling STAT and hustling around.

2 Likes

drain cleaner takes it for me, with the debridement a close second

1 Like

It’s hard for non-welders to appreciate the tremendous amount of energy those devices put out. They can cause devastating eye injuries–to both the cornea and the retina–with even very short exposure times.

Yeah, I’ve had more than a few welders tell me that their boss/job kept anesthetic drops on site in order to keep the welders working (and the project on schedule).

I agree with your assessment but I’d say debridement first and drain cleaner second.

1 Like

Me too. That debridement can go on for months and it’s as painful the last time as the first.

My friend that got blown up/burned has had so many 1 square inch skin grafts that when he goes out in the sun he (admittedly) looks like a stamp collection.

Yell out “code blue” in the ER, that will get some people moving.

1 Like

Which is ironic, because I am sitting here thinking the drain cleaner was worse. Burns, in general, chemical or fire, are the chicken-dinner-winner.

Although I know several guys who had limbs blown off that had screaming phantom pain for months. I think they resolve this now by finding the correct nerve and somehow disconnecting the wire to the spinal cord. Some sort of spinal surgery, regardless.

I managed to dodge the patchwork look; not a lot of grafts except on a loop right where the kevlar vest meet around the shoulder opening. (The plastic edge melted into my skin.) It actually looks pretty badass, or so I am told.

I think I dodged a lot of visible scarring by having dark/red skin. I have a few lighter spots and darker spots, but it just looks like I’ve done something with my life.

I saw Pres. George Bush on TV, at the Invictus Games. It was reassurring to know that he really did spend time with injured Soldiers.

Debridement wins, hands down. Sharp stick in the eye was not fun, but if your pain can be instantly taken away by some eye drops, then it ain’t that bad. Dislocated hip was pretty bad, but a little Dilaudid had me floating on a cloud and not giving a single fuck.

Drain cleaner sounds really bad, but it’s too hard to visualize.

I’ve heard cluster headaches are worse than anything, but again, hard to visualize.

If TTR starts to get cluster headaches and drinks a tumbler of Drano, then we can settle this conclusively.

good point. We need TTR to drink drano and SkyzykS to get blown up. Only way to know for sure.

And get a good kick in the balls while youre at it.