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Need your help with a diagnosis and some questions

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  • Need your help with a diagnosis and some questions

    Hello, I'm a (relatively) new dry eye sufferer, and I need your help with a diagnosis and preparation for a visit to the doctor. I apologize for the length of the post, but I have to mention everything to make sure you can help me get the right diagnosis.

    I don't really know how long I've had dry eyes because I've always used the computer a lot and my eyes were often sore, but I've had them for a long time. I can't say how long exactly, but I think it's safe to say over a year. Nine months ago I went to my doctor for a routine checkup and I mentioned dry eyes to him, only I said that I have this problem when I ride the bicycle or work on the computer. I was not conscious of the fact that my symptoms were there all day and not only when I do things that might cause them because I spend most of my time doing things that would cause dryness. My doctor concluded based on what I told him that I don't have a condition and that my eyes are dry all the time because of the activities I engage in. It would be later that I would figure out that I DO have dry eyes because I noticed that te symptoms were there even when I didn't engage in activities that might cause dryness.

    When I was at the clinic that time, nine moths ago, I had the Schirmer test performed with no anesthesia, but it was done without mopping away tears. I don't know how much tears I produced but the doctor said it was fine. The test was performed in a noncharlant manner because it was resonable to assume, given the info I gave him, that I didn't have dry eyes. I don't think much credibility should be given to this test.

    I went through the list of symptoms on this site, and here they are:

    -sensation of dryness

    -Aching or sore eyes (may be due to extensive computer use, but is hard to tell because, as you would expect, my eyes are dryer after extensive computer use, too), sometimes they tire easily

    -Watery eyes (only when my eyes get very dry - after I use the computer a lot or watch tv)

    -Eyes easily irritated by smoke (they get very red - the vessels become prominent)

    -a lot of the time I can hear my eyes moving (I think the sound is produced by the eyelids and the globe sort of moving against eachother), in particular when I look to the extreme corner (any corner - left, up, diagonaly...) of the eye and blink (does anyone else have this?)

    -Excessive mucus discharge

    This symptom, excessive mucus discharge, I am not sure is the kind of mucus other people get. It probably is but I'll describe it just to be sure. It most frequently seems to happen (I'm not 100% sure) when my eyes are the dryest, but it sometimes happens, to a lesser degree, when my eyes don't feel that dry. The mucus is white and in a kind of state that's between liquid and solid, much closer to the former (well I guess mucus is that way, by definition - sorry I'm not from an english speaking country). It appears in my eyes, floating on the surface, usually in very small pieces. It does not bother me, it's not even close to the mucus fishing syndrome (is that what it's called?) that I read about, I remember only one time that I could actually feel it in my eye and even then it didn't bother me at all, I could just barely feel it. Over time, this mucus will accumulate in the corner of my eye or both eyes (the one farther from the nose) and seems to be quite more fequent in my left eye. When it accumulates it creates a fine white film in the corner of the eye (the one farther from the nose). This does not happen every day, it seems to happen on days when I dry my eyes the most (like I said, I'm not sure it's triggered by the eyes getting dry, I've not been keeping track up till now) - I say when "I" dry them up because I'll usually take a break and close my eyes for half an hour or an hour when I feel my eyes are getting dryer, but sometimes I don't do this and the eyes get dry.

    -prominent blood vessels/redness

    I think I should describe the dynamic of how this happens. My eyes get red (blood vessels start showing) when I strain my eyes (usually computer work). I can't tell whether it's the strain that accounts for the vessels or dryness, because, as I mentioned earlier, the activity that strains my eyes dries them up as well. Then, when I rest the eyes this blood vessel (or vessels) that has appeared will go away. This dynamic repeats itself over a period of time. A blood vessel becomes visible, than invisible and visible again (as I strain and rest the eyes) until at some point it stops disappearing and I'm stuck with it. Then it will grow a bit more towards the iris, and the newly grown part will go through this dynamic of disapearing and appearing again until it, too, becomes permanent. Through this process, the blood vessels in my eyes, which I have quite a number of at this point, are growing in numbers and length, slowly converging on the iris.

    Some are single vessels, some branch. In one place two vessels seem to have met (it's hard to tell because they get very fine at the meeting point, they may not have actually met) and formed a loop, so now they look like one blood vessel that comes down from somewhere behind the visible part of the globe, enter the visible part, and go back.

    I can't tell whether the vessels are in the sclera or the conjuctiva, I never tried moving them, but if it's important I will.

    I've asked my doctor about this (at the time he didn't know about my dry eye, only prolonged computer use) and he said that the vessels were always there and that now they are just expanding because of increased demand on the eye due to computer use, and that they are becoming visible because they are expanding. That, to me doesn't sound quite right, because I can't believe that they could have ever been so fine and small as to not be visible. And, if they were, why didn't the thicken equally along the length instead of this way that creates the impression that they are growing from somewhere towards the iris. Looks to me like neovascularization, but what do I know?

    Now, here are my questions:

    1. I think I've read somewhere that if you have excessive tearing when the eyes get dry that it means that the glands producing watery tears are fine. Is this true?

    2. If the claim in #1 is true than I either have a problme with the first or the third tear layer. I've read a book on dry eye that says the main causes of evaporative dry eye are rosacea (which I'm 99% sure I don't have because I don't have any redness around the eyes), blepharitis and meibomian gland dysfunction. As I understand it, MGD can be either atrophic or inflamatory. I have two questions here:

    What is the cause and what are the treatment options for atrophic MGD?

    Does every variety of inflamatory MGD cause blockage? If so than in this case a lid scrub should do it, right?

    3. Is the mucus discharge that I have (described in symptoms under mucus discharge) the kind of mucus discharge that is common for dry eye? If not what could it be? Could it be that something is wrong with the mucin layer in my tear film? Perhaps that it's peeling off because of the absence of the first two layers. Could it be accumulation of solutes from the tears that are now in more solid state due to desiccation?

    4. This is related to what I wrote under symptoms in prominent blood vessels: What is going on here? Is the explanation my doctor gave me true or is it neovascularization or something third? Is it dangerous? Why does it happen? etc.

    5. I've noticed that when my eyes get tired and dry, like after a long stretch of working at the computer, my eyeballs seem to either get smaller or receed back deeper (can't tell which). Does anybody else get this or know what this could be? Is this normal?

    6. For a long time now I've been doing this thing where I sort of massage my eyes by pressing on them at a point just below the brow bone. I've been doing this for a very long time now and last week I stopped doing it for a few days and found that when I did it again after those few days it relieved considerable amounts of tension. Does anybody know why this would be so? Perhaps to do with muscles?

    This probably doesn't matter for dry eye diagnosis, but, I have -1.50 in both eyes and astigmatism in my right eye. Also I have a few floaters that have appeared a long time ago. At least six months and not older than five years.

    It's a long one and there are a lot of questions and if you can answer even one of them I'd be really greatful. I've had dry eyes for a long time now, and I'm really scared about what kind of damage my eyes may have taken by now.
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