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Lotemax is making my dry eyes much worse!

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  • Lotemax is making my dry eyes much worse!

    Okay, short synopsis: Dry eye specialist wants me to to use Restasis after a terrible Schirmer test. After one week on it, my eyes were inflamed, swollen eyelids, blurry vision, crusting and all the things I am trying to cure. So I called and was told to stop the Restasis. She then told me to go back on Lotemax 2 x per day for 2 weeks and then restart the Restasis 2x per day and continue with the Lotemax.

    This last week, I have used the Lotemax 2 x per day as instructed and my eyes are so dry that I am using drops almost constantly. I even woke up last night from pain due to severe dryness which is not normal for me. I have gone though a whole box of Theratears vials just this past week.

    I am going to drop back to once a day (at night) on the Lotemax followed by a drop of Dwelle or the new preservative free thera tears gel, though I am leaning towards the Dwelle.

    I have spent $50.00 in the last 10 days trying to get comfortable. Soothe doesn't work and I have so few tears that the gels just make my vision cloudy and seems to aggravate the gland problem. I understand that there is no magic bullet but what do you do when the treatment is as bad or worse than the disease? I have been barely able to work an 8 hour day.

    Sorry, this post is just venting a lot of frustration. Nothing seems to help except for the 10 minutes of bliss I get after using a hot pack. That's the only time my eyes feel remotely comfortable.

    Lasik induced severe dry eye.

  • #2
    I know exactly where you are coming from. It was about 7-8 months ago for me when I had a Schirmer score of 1 (likely 0) and the MD put me on Lotemax. I was also using all kinds of drops every 5-10 minutes. Some burned a little, some didn't. All were temporary with TheraTears lasting only a few minutes. However, TheraTears also caused the least amount of irritation (it kind of felt like water going into my eyes).

    When I was on Lotemax, I asked a glaucoma MD that I had seen at one point what he thought. He said that Lotemax had the potential of delaying my healing since it had a type of preservative that could irritate/delay the progress with my dry eye.

    I did complete the Lotemax treatment for 4 weeks (my burning w/Lotemax was not too bad). However, after that was done, I went preservative free with my drops due in large part due to my lack of tears. I bathed my eyes with TheraTears 4x/day (see side of box) and then used them frequently as needed.

    Also, I had my 4 plugs pulled since they were doing nothing for me. In my opinion, when your Schirmer score is 0 or even 1 and you have evaporative dry eye, then plugging up nothing still gives you nothing.

    I will say that when I had the plugs pulled, I started by asking the MD to just pull the bottom plugs for a week or two. I also took it easy during the transition process (working part-time, frequently resting my eyes, and doing warm compresses about 3x/day). I felt a little more dryness during the transition, but it was minimal since I was also taking it slow.

    I also started using Nature's Tears frequently (a water mist). Again, the relief was very temporary so I used it often, but my theory was that at least I wasn't flooding my tear film every few minutes with drops and possibly further messing with my already compromised LASIK-nerve damage tear connections.

    Also, I got on a good omega supplement. Finally, and this is a key point in my opinion, I stopped using night-time gels in my eyes. It doesn't sound like your severe dry eye problem is as big of an issue at night. IMO, you need to give your eyes a break from all of the drops and gels if you want to give them a chance to work on their own. If your issue is not so much of a night issue, then the best time to do this is when you sleep.

    The progress I saw was not immediate. It is slowww. However, I think it may be worth trying some of the things above after talking to your MD and thinking about your own situation.

    I am not recommending that you change everything you are doing and do what I list above. I am not an MD. However, listed above is some food for thought from someone who's been there. Best. YGB


    • #3
      Natalie, when you are at your very worst, it is imperative to rest (close) your eyes every minute you can. This means on the weekend, try and "catch up" on some shut-eye time. Doesn't matter if you're sleeping, or just vegging with your eyes closed. I know it's almost impossible with people's busy schedules, but this will help you work through the toughest times. It may take a long time. I still do this and I'm 7 years post op. (Don't let that be your guide.) I'm wearing my Panoptx goggles today because I've been having fits with my left eye. So, it's on with the goggles no matter where I go.

      I'm retired now, but while I was working with my eyes on fire, I'd have a gelpack at work and keep it in the office frig and on every break and lunch hour, I'd be somewhere out of the way with the icepack on my eyes. YGB's plan is right on target. Good luck with this seemingly never ending stuff. It will get better......
      Don't trust any refractive surgeon with YOUR eyes.

      The Dry Eye Queen


      • #4
        Thanks for the encouragement!

        I have no plugs. I have no doubt they tipped me over into full blown blepharitis after the Lasik due to acne rosacea, hormones or both as I was at high risk due to both. I tried just lower plugs back in December, hoping they could get me through the winter but they did not help and made my eyes feel worse. And this specialist does not believe in plugs for just that reason.

        I am not using any gels at all. I only tried them again because she suggested it and I guess I had to "prove" to myself that my instincts were right and gels are BAD news for me.

        Lucy, I am taking this week off and hope the break from the work environment and the computer will help. I do nap a lot these days since that's what happens when I close my eyes. It's just hard to keep up with my house and animals since I live alone. Housework has definitely suffered. No one who hates pet fur wants to come to my house these days.

        I only used the Lotemax once yesterday and today my eyes feel better. I also got some Occusoft lid cleaner to try since my eyelashes were a mess. It's also cool and rainy. Tomorrow? Who knows.

        Thanks for listening. Most of the time I am okay but every once in a while it just gets to me. I am sorry for sounding like a whiner. I have to go to Utah in August and possibly Las Vegas for work and the thought of dealing with severe dry eye on those trips is making me very depressed so I am praying for some fast improvement.



        • #5
          Natalie - one more thing I would suggest is searching this site for "demodex" and then talking to your MD. I apparently developed a big demodex problem after LASIK and this can really aggravate MGD. You need to get the demodex under control in order to improve the MGD.

          Having said this, I don't know if you have demodex (an MD would have to pull some eyelashes and look at them under the microscope). However, you have several signs ... LASIK (decreases immune system allowing demodex to multiply), lipid layer issues (demodex feed on the oils from the lipid glands), eyelid flaking and possibly losing eyelashes (I don't know if you have this), and pets (many people with pets have demodex althought this is usually not an issue unless the immune system is compromised ... see LASIK).

          Dr. Tseng in Miami is big on testing and treating for demodex. Many Ophthalmologists have either not heard of this being an issue or don't bother with it. Based on my personal experience, eradicating the demodex problem seemed to really help. I know this isn't what you may want to hear ,but it's worth looking into since if it is an issue, it likely needs to be addressed in order to improve your lipid layer.


          • #6

            I acually have thought about the demodex thing. I do lose eyelashes but I have no idea how much of that is "normal". The itching eyelids were around long before Lasik so obviously Lasik just made it worse. One of my dogs did have Sarcoptic mange a few years ago as did the neighbor's. I will research and bring this with me to my appointment with the Dry Eye specialist. Both dogs "itch" despite using flea control and the vet can see nothing so there may be something there. But they have to take skin scrapings to diagnose a dog with mange.

            Using the Lotemax just 1x per day is helping. Can't speak to the lid scrub though it doesn't hurt or burn and my lid margins look pretty good. Not inflamed like they were.

            Thanks again for the tip!



            • #7
              Natalie - while getting the dogs checked out is a good thing, I'll say that I had demodex and my dogs had no signs of scratching. Many people have demodex who do not have pets. It is just speculated that those with pets increase their chance of having demodex. Therefore, regardless of what happens with the dog check-up, I would recommend that your MD pull a few of your eyelashes (Dr. Tseng's group pulls about 10-12) and examine them under the microscope.


              • #8
                Demodfex treatment?

                What is the treatment for demodex? Is it a metro cream or drops?


                • #9
                  I know this post is old - I am having the exact same issues as the original poster! I was on Lotemax for 10 days and my eyes are as bad as they've ever been - extremely dry, working is miserable, and I even woke up last night from the pain. Has anyone (including Natalie) had this and then gotten better? It's been 5 days since I stopped using the Lotemax and no improvement...


                  • #10
                    Using twice a day or more is a little rough, but once a day is tolerable. I notice when I go hard on the lotemax (or whatever steroid drop is prescribed), as in 2 or 3 times a day, for about three days or so, it does seem to make my eyes dry. So I put up with the misery about 3 days and then about day 4 I drop to once a day in the morning. Usually fine after that. Hope that helps.

                    Also, Lotemax has a different preservative (BAC? can't remember). My cornea specialist prescribed Durezol (brand name), which is a similar steroid drop but with a different preservative (sodium somethingorother, sorry, I don't have my bottle with me right now). My eyes seemed to tolerate that a little better. The price is around the same as for lotemax.


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