Went to see a Dry Eye Specialist Yesterday... :(

[patientpatrick]

Hey everyone. I just went to see a Dry Eye specialist yesterday for a dry eye exam. I was told I have an aqueous deficiency I scored a 9mm on a Zone Quick test normal is 20mm+, I was told that the Schirmers test isn't very accurate. This is very depressing. I inquired about punctal plugs and he stated that plugs may not be a good idea because i also have MGD/Posterior Blepharitis. Seems like plugs may help the aqueous deficiency but would make the MGD/Posterior Blepharitis worse.

I do the Eye Spa by Dr Latkany daily, do eyelid scrubs with ocusoft, take 6000mg of omega3, wear moister chambers, use preservative free tears. I was really hoping that plugs would be of help to me and now I'm even more depressed that it may not be an option.

Thanks Patrick

[jax8it]

Patrick,

It will be a year for me in Jan. So sorry you had a discouraging appointment. I recently saw a new doc last week- my fourth outside my LASIK clinic. He prescribed me serum drops. Have you looked into that option yet? I have been on them for a week. I am hoping this will help.

[Guest]

I inquired about punctal plugs and he stated that plugs may not be a good idea because i also have MGD/Posterior Blepharitis. Seems like plugs may help the aqueous deficiency but would make the MGD/Posterior Blepharitis worse.

Here's the thing about plugs and MGD though... based on Dr. L's book, can't one of the possible causes of MGD be inflammation that results from aqueous deficiency? Obviously there is no way to know FOR SURE if this is the case for you, but what if your MGD is caused by inflammation from aqueous deficiency? If so, then plugs would help alleviate some of the aqueous deficiency, which would lower inflammation, and the lowered inflammation could lead to an improvement in your MGD.

As far as I'm concerned, there's no way to tell unless you try the plugs. Temp plugs are temporary, so nothing to lose in trying those. If temp plugs help, then umbrella plugs could be tried and worst case if they made your overall ocular symptoms worse, then they can be removed.

Lastly, for what it's worth, I had MGD back in 2009 before I got plugged and cauterized. Mind you, my MGD wasn't horrific and out of control or anything, but still. Despite that, it is now 2012 and my MGD is much much better than it was in 2009... even though I've been plugged and cauterized all that time (all 4 puncta blocked). So, being plugged/cauterized didn't prevent my MGD from mostly resolving. (Not saying everyone will end up with that result... just saying it's a possibility worth considering)

IF this dr. seemed to have a heart and seemed knowledgeable, then maybe stick with whatever treatments he suggested for a month, if you're not in a satisfactory state after that, go back to see him again and re-suggest the plugs option with him.

So keep your chin up... don't get more depressed... try to be patient (I know, it's so hard sometimes since this all totally sucks)... but you'll see... things will come around... it just takes time, and if this dr. is a good one, stick with them a while (ie several months) and see what happens... it can take time for them to figure you out and get to a point where they will consider your opinions more. Key to this is try what they suggest for a month or whatever they suggest, and if not working well enough, call back and make another appointment to report back on the results (or lack of results) of the treatment... keep doing this every time until you start to get somewhere in terms of eye improvement.

Also, if you haven't already, familiarize yourself with the "DEWS report" (google it and it comes up).

[littlemermaid]

Seems like plugs may help the aqueous deficiency but would make the MGD/Posterior Blepharitis worse.

Patrick,

We managed without plugs for 3y because the eye doc was worried about 'toxic tear' on the eye surface and was trying to clear the meibomian glands and reduce inflammation first. Toxic tear means inflammatory mediators held on the eye surface. LM was using tear substitute eyedrops 6/8/day, and minimum steroids to control inflammation. He put lower plugs in for 10m, then they infected so we removed them and treated infection. But meanwhile the tear film was lovely and comfort much better, especially eg on computer and in airconditioning, which otherwise used to become unbearable sometimes.

Dry Eye Disease by Dr Baudouin This video link by Professor Baudouin is great on this.

These are some of the pros/cons. Most docs clear blepharitis causes and reduce inflammation before they plug for this 'toxic tear' reason. But you are a post-Lasik rather than an MGD patient, with a good MGD regime for 1y. Maybe the blepharitis is from sensitivity to eyedrops even. So maybe this needs another conversation at the next visit. Maybe he'll want to use plugs when he feels he's given the blepharitis regime a try. We had good improvement on the tear film just with lower plugs.

I think SAAG is right as usual on her doc-handling and consultation advice, and this is our experience too. It's about having someone you're comfortable to work with, then the regime-tweaks and judgement calls that go on are not so worrying. To be fair, it's about them getting used to our different eyes and working out how to heal and support them. As long as they're interested and that's happening, I'm good with them changing their minds about what might help.

[patientpatrick]

Thank you all for the replies you all have such good advice and are so wise. I wish we met on different circumstances sigh... How have you all been fairing these days?

[Guest]

How have you all been fairing these days?

Well, I'll start this off with how I'm fairing...

I am currently the humidifier queen - have 3 of them running on my kitchen countertops as I type - so, it's cost me a huge chunk of my beloved counter space, but the indoor humidity in the kitchen is a lovely, soothing 40%, so it's all worth it haha I now cook and prepare food squeezed in between the humidifiers... must admit it's very soothing to the eyes despite the inconvenience of cooking this way

After the weekend, the furnace/humidifier guy will be back from holidays and hopefully my furnace humidifier will be fixed and I can reclaim my countertops!

Other than that, I'm still scheming for the best, fastest way to escape our horrid winters (well, horrid to me because I'm a total wimp when it comes to cold weather ... plus my eyes detest the dry winter air of course)

Eyes are still easily irritated when at work due to the cold snap and resulting dry air we've had, so my handy dandy Wiley X's are my new look for eyewear at work... I've been told I resemble the terminator

Not. exactly. the look. I was going for.

...but took a good look in the mirror and had to admit that it's kind of true (and, well, the comment wasn't meant maliciously or anything like that, so no worries) So there you have it... SAAG is the new terminator... look out...

Ok next... how are the rest of you doing?

[jax8it]

Well, I recently started 20% serum drops 4x/day. I do not know if this will be very effective since I have read other posts that say 50% 8x/day is the better way to go...? I went to a new corneal specialist last week. Yes, I have become the typical dry eye patient moving from doc to doc. He performed schirmers and I measured a 4 on my left and 14 on my right and my tbut was a 4 on left and 10 on right. I have to say my left eye is always worse than my right. I also started doxy and restasis again. I am keeping my fingers crossed!

I really want to look into cautery of my upper left puncta. I still have a lower left plug. It does not bother me at all, but upper plugs bugged the heck out of me.

Anyway, I am taking it day by day with my onion goggles on!

[Guest]

Anyway, I am taking it day by day with my onion goggles on!

That's the way to do it!

[patientpatrick]

I've been taking it day by day as well. Perhaps one of the most interesting things I've done is ordered a pair of non prescription glasses similar to my old pair i used to wear. They help block out direct air currents and I wear them pretty much everywhere I go. It's ironic really, I had Lasik because I didn't want to be dependent on glasses and now I'm dependent on them again. My eyes still hurt and I'm still dependent on drops but I must admit, at least when i look in the mirror I half smile a bit. I remember the old me and how much I like the old me. The sad part about it is I'm no longer the old me. I'm the guy to screwed up my eyes with this stupid elective surgery when I should have just accepted who I was and been proud of the fact that I wore glasses. Perhaps that's one of the hardest things I have to deal with on a daily basis. I feel like I betrayed who I am. Everyday I ask myself why i felt I needed to changed myself. Glasses were a big part of my identity, and now that I have to wear non prescription ones, I'm just wearing a lie.

[sazy123]

I've been taking it day by day as well. Perhaps one of the most interesting things I've done is ordered a pair of non prescription glasses similar to my old pair i used to wear. They help block out direct air currents and I wear them pretty much everywhere I go. It's ironic really, I had Lasik because I didn't want to be dependent on glasses and now I'm dependent on them again. My eyes still hurt and I'm still dependent on drops but I must admit, at least when i look in the mirror I half smile a bit. I remember the old me and how much I like the old me. The sad part about it is I'm no longer the old me. I'm the guy to screwed up my eyes with this stupid elective surgery when I should have just accepted who I was and been proud of the fact that I wore glasses. Perhaps that's one of the hardest things I have to deal with on a daily basis. I feel like I betrayed who I am. Everyday I ask myself why i felt I needed to changed myself. Glasses were a big part of my identity, and now that I have to wear non prescription ones, I'm just wearing a lie.

Patrick, im sorry you are going through this dry eye hell. Dont blame your self for having this surgery, millions of people have it and so many shout about how amazing it was and the best thing they had ever done. Some then find out years later than its not that great, when they start experiencing dry eye or thier vission deteriates. My point is you werent to know that you would suffer from dry eye, you trusted the doctors and thought that they had your best interests at heart. I too have bad guilt, not from lasik- but from wearing contacts and going on anti depressants (two things that millions of people do without issues) I ovbiously had a vulnrability to dry eye/ocular rosacea and i wasnt aware if it. How could i have known? I warned my friend about wearing her contacts to long and she didnt listen to me, she suffered abrasions (which took ages to heal) has some scaring and now suffers from mild/transient dry eye. It can happen to anyone! I cant wear makeup anymore can i feel that effects my identity and i look washed out.

You are fairly new to dry eye im not sure what you have tried, but keep at it, the majoiry of people do get to a managable state with the right treatment. Best wishres to you in the new year!