My husband has been having problems with his eyes and ears. His eyes have been crusty and he has been leaking clear fluid from his ear. He also has red blotches on his face. He went to see his doctor but was seen by the nurse. He was told this was all due to allergies. He was never given any medication and is still having this problem. He never had allergies before. Is this normal, and how long will it continue before it gets better?

N.R.

Allergies? Well, maybe. Crusty eyes can be a symptom of allergic conjunctivitis. This may even be the most common explanation for crusty eyes. But how, then, are we to explain the red blotches on his face or the clear fluid leaking from his ears?

Attempting to unify seemingly unrelated symptoms under a common diagnosis is a common, well-recognized pitfall in medicine. We all know that our patients may suffer from two or more illnesses simultaneously. Nevertheless, our first reaction is to "try to put it all together."

In your husband's case, the blotchy face/crusty eyes combination is reminiscent of acne rosacea. However, rosacea uncommonly affects the ears, so the "leaky ears" are still unexplained. Another possibility, psoriasis, often affects the ear canals and facial skin. Conjunctivitis (an inflammation of the conjunctiva -- the tissue that lines the eyelids and parts of the eyes) is fairly common with psoriasis, and chronic conjunctivitis can lead to scarring of the conjunctiva as well as dry eyes and trichiasis (turned-in eyelashes). Blepharitis (oil accumulation on the eyelids and lashes) is also sometimes associated with psoriasis.

But let's approach this riddle from a different direction. What can cause clear fluid to leak from the ears? I suspect that the most common explanation is external auditory canal eczema. This condition is often self-inflicted, the result of repeated trauma with cotton swabs, paper clips, fingernails, pencils and other nasty weapons. It itches, so we scratch, but unfortunately scratching perpetuates the itch. The result is chronically inflamed, weepy skin. If this traumatized skin becomes infected with bacteria or fungi, the resulting infection is called otitis externa, better known as swimmer's ear.

Clear fluid may also leak from the middle ears, if the patient has a perforated eardrum. In this scenario, the clear fluid reflects chronically inflamed middle ear mucosa. I doubt that this is your husband's problem, however, because you have not mentioned any other "ear symptoms" (ear pain, pressure, hearing loss, tinnitus or vertigo).

By now, your husband should know whether his problems are due to allergy; the nurse undoubtedly handed him several samples of the latest "non-sedating" antihistamine (an interesting class of drugs, inasmuch as the number-one side effect for all of them is SEDATION), so if his symptoms have improved, I suppose she may have been right. But ... if he is still suffering from these symptoms, why not see a specialist?

Specialists exist for a reason. There's too much medical information on this planet for it all to be stuffed into the head of one general practitioner (or nurse practitioner). But what sort of specialist should your husband see -- an ophthalmologist for his crusty eyes? An ear, nose and throat specialist for his leaky ears? Or a dermatologist for his blotchy skin? My hunch is that we are dealing with a skin condition. For the reasons I mentioned above, I suspect that the ear problem is a skin problem, not a middle ear problem. And while the conjunctiva is the domain of the ophthalmologist, dermatologists are usually pretty sharp when it comes to mucous membrane disorders.