Post LASIK dry eye disaster

[Hemu]

Hello everyone,

I'd first of all just like to thank Rebecca and everyone else for having a place for this specific suffering. It's really great that there exists a dedicated channel for this pain because to reiterate myself, this pain is very specific and those who suffer from it understand my statement the most.

I am a 28 year old well accomplished computer engineer/game programmer and before I had LASIK, I noticed something like dry eyes way back in high school when I found difficulty in wearing hard contact lenses. I decided to not wear them anymore and almost 6 months ago decided to have LASIK from a very reputed doctor in my area. I had an corneal abrasion on my left eye which healed in a week and for the first month or so did not notice any significant dryness. However, after that, hell broke loose and I was put on various drops that had preservatives and steroids and only kept making my condition worse.

For a while, I was on Restasis, Lacrisert, Refresh Optive Senstitive(preservative free), Refresh Celluvisc, Flaxseed oil and Doxycycline. I've been on this for approximately 2.5 months and haven't found much needed relief.

I read about Dr Steven ****** quite a bit on these forums and elsewhere and actually went to Tampa to do MGD probing(after reading about the procedure and talking to several doctors about it). The probing procedure was painful but I did feel tears and relief the next day. However, in less than a week, I'm back to being screwed and am really running out of options at this point. I still am following up with him and he is a very good doctor, very kind, compassionate and listens to what you have to say. He also did cauterize my punctums, both upper and lower. Before that, I had permanent silicone plugs in my lower ducts.

All I can think of are Serum tears since Boston Scleral Lenses have been advised against the use of the latter. I am writing this post from work since I'm really depressed and stressed about this.

My aqueous tears are very very low and all I know about this is that post lasik, your nerves are damaged and that is the cause of this mess. I keep getting told by my opthamologist

Here is my current regiment

Restasis(twice a day)
Flaxseed oil(twice a day)
Doxycycline 50 mg(once)
Lots of artificial tears(Systane and Blink at this point, preservative free)
Pataday(once in the morning)
Irrigation
Tranquil eyes at night
Moisture goggles when using computers

Please help me with any advice. I do not want to live like this forever.

[Rebecca Petris]

Whew. You're right in the thick of it aren't you - 6 months post LASIK. I'm so sorry. Welcome, by the way!

Question:

Are you getting recurrent erosions? I'm wondering about that initial abrasion you had and why. Any possibility you had ABMD - I've known folks with undiagnosed AMBD (doesn't necessarily mean an oversight... it's a very subtle diagnosis after all) who had really bad epithelial problems after LASIK because their epithelium was so fragile that cutting a flap in the epi/stroma sent it straight into that cycle. Anyway just wondering because that would make some difference to what path to take. You've shared a lot about treatments you've pursued but some more detail on symptoms, specficially what you've experienced in these months could be helpful too....

[Hemu]

Hey Rebecca,

Are you getting recurrent erosions? I'm wondering about that initial abrasion you had and why. Any possibility you had ABMD - I've known folks with undiagnosed AMBD (doesn't necessarily mean an oversight... it's a very subtle diagnosis after all) who had really bad epithelial problems after LASIK because their epithelium was so fragile that cutting a flap in the epi/stroma sent it straight into that cycle. Anyway just wondering because that would make some difference to what path to take.

I've not had any erosions other than the first. My Cornea has been fine for the most part, there was some inflammation and surface cell destruction that was suspected to be an issue in the beginning but that was mainly because the medications I was taking were hurting me more than helping me.

You've shared a lot about treatments you've pursued but some more detail on symptoms, specficially what you've experienced in these months could be helpful too....

Sure, here's a breakdown in a descending order:

Current condition(after probing):
Dry gritty eyes, require eyedrops every 1-2 hours. At times every 1/2 hour or more. Vision still fluctuates but when I use drops, it's good.

1-2 month ago(Refresh + Lacrisert + Restasis):
At times burning eyes, gritty and scratchy too from time to time. Required eyedrops for the same frequency. Vision started improving

3 months ago(Refresh + Alrex + other preservative drops like Blink):
Blurry vision, burning gritty and scratchy eyes. Right eye vision got worse, so did left.

4-5 months ago
Blurry vision, more in the left eye. Right eye had great vision.

The biggest issue I really have is the pain. I really want to get better and like I've said, I'm running out of options at this point

My thyroid glands are functioning just fine, I got a blood test to figure that out. I also got a blood test to check if I had Sjogrens and it looks like I don't. I might be lacking androgen and have gone to my general physician for that. She is on a vacation now and can only discuss the results with me in person on the 16'th. I'm holding my breath for that.

[Rebecca Petris]

K that helps thanks. What about vision. Do you know your refraction? Can you see clearly at least with lenses in the dr's office

[Hemu]

K that helps thanks. What about vision. Do you know your refraction? Can you see clearly at least with lenses in the dr's office

Right now, I'm almost 20/20 iN both eyes. My eyes do get blurry from time to time but for the most part, I'm 20/20.

I was 20/40 in my right eye until 2 months ago and 20/40 in my left 4 months ago.

[Hemu]

I'd like to add that my eyes feel really sore for the most part. Sore is a better term to describe their condition than gritty.

[spmcc]

Some people notice they feel great when the wake, but then deteriorate in the afternoon. Others have eye pain when they wake, but feel better as the day progresses. Do you notice anything like that?

If nightime/sleep is a problem for you, a lot of people who get erosions find that Muro 128 OINTMENT (not the drops) helps them a lot. This ointment is kept *behind* the pharmacy counter even tho an Rx isn't required. You can search DEZ to read people's posts (e.g., http://www.dryeyezone.com/talk/showt...0111#post70111)

Have you been able to control your environment at all (e.g., blowing heat, a/c, fans, humidity)?

I noticed you mentioned moisture chamber glasses - have they helped?

Do you think perhaps your cauteries have opened?

Do you feel like your pain (soreness) is on the eye surface or in the lids? My experience with ****** is that he concentrates on relieving lid pain (via probing).

Also Scheffer Tseng has a paper published in Cornea Oct 2011 (http://www.ncbi.nlm.nih.gov/pubmed/21912234) that I found chock full of info. If you'd like, I can send you a pdf copy (just PM me with your email address).

Finally, Tseng and ****** are both proponents of amniotic membrane (AM) grafts. Tseng has a company that produces Prokera, an AM bandage (see http://www.biotissue.com/products/Overview.aspx). Perhaps, since your acute trauma (aka LASIK) was relatively recent, you're a candidate for this.

[Hemu]

I paid more attention to the nature of the soreness. I think the culprit was the steroid Pataday. I remember feeling like this when I had taken Alrex and Lotemax. Disregarding the soreness, my eyes definitely feel aqueous deficient. The best way to describe my condition would be my eyes are crying out loud: "Hey, lets have some more tears! We need lubrication!"

I'll break down my answers based on some time frame as well:

Some people notice they feel great when the wake, but then deteriorate in the afternoon. Others have eye pain when they wake, but feel better as the day progresses. Do you notice anything like that?

1 month ago: Waking up was difficult. My eyes would be glued shut. I used to use Refresh Celluvisc in the night(I can't take anything with preservatives) and Restasis. I had a humidifier blowing near my face as well.

1 week ago(since probing): Waking up isn't that big a deal any more. My eyes feel oily but not watery at all.

If nightime/sleep is a problem for you, a lot of people who get erosions find that Muro 128 OINTMENT (not the drops) helps them a lot. This ointment is kept *behind* the pharmacy counter even tho an Rx isn't required. You can search DEZ to read people's posts (e.g., http://www.dryeyezone.com/talk/showt...0111#post70111)

I looked at the definition of corneal erosions before answering this one. Here's what wiki has to say about it's symptoms: "Symptoms include recurring attacks of severe acute ocular pain, foreign-body sensation, photophobia (i.e. sensitivity to bright lights), and tearing often at the time of awakening or during sleep when the eyelids are rubbed or opened. Signs of the condition include corneal abrasion or localized roughening of the corneal epithelium, sometimes with map-like lines, epithelial dots or microcyts, or fingerprint patterns." The two I have experienced amongst these in particular are foreign body sensation and photophobia, the former being more severe.

1 month ago: Maybe 4-5 occurances of foreign body sensation every week, lack of tears making it feel like I'm rubbing against the cornea when blinking, grittiness.

1 week ago(since probing): Maybe one occurance of foreign body sensation, rare photophobia, lack of tears, particularly the water component

Have you been able to control your environment at all (e.g., blowing heat, a/c, fans, humidity)?

I'm wearing moisture goggles at work and have a humidifier at home. I also have a hygrometer which measures the humidity at my place. It fluctuates between 42% and 70% which is relatively good. I do live in a dry climate though(Austin).

I noticed you mentioned moisture chamber glasses - have they helped?

I've only started wearing them since last week. They've helped computer use, yes.

Do you think perhaps your cauteries have opened?

I'll be seeing my opthalmologist on Monday to find out more about that. I've had my eyes cauterized since one week only. Would they open up that soon?

Do you feel like your pain (soreness) is on the eye surface or in the lids? My experience with ****** is that he concentrates on relieving lid pain (via probing).

The soreness was felt on the surface but like I said, I think that's a reaction to the steroid. The dryness is felt on the surface too. My MGD's were severly blocked when I saw Dr. ****** and it's part of the reason why the probing process was that painful. I still find the lack of aqueous tears extremely frustrating.

Finally, Tseng and ****** are both proponents of amniotic membrane (AM) grafts. Tseng has a company that produces Prokera, an AM bandage (see http://www.biotissue.com/products/Overview.aspx). Perhaps, since your acute trauma (aka LASIK) was relatively recent, you're a candidate for this.

Can you please describe the need for one to have the AM grafts sugery? What is that procedure and what does it really help with?

[robster]

I know it's hard but I would give it a bit more time before you consider something such as Prokera. I'm 14 months post-LASIK and I didn't see any improvements in my eyes until after 8 months. My eyes are still far from perfect but they are far better now than they were during the first 6 months. I know you want to try and find a solution as quick as possible but in a lot of LASIK cases time really is the best healer.

In the first year in particular you will have a whole load of up's and downs and be told various reasons as to what is causing the dryness(I know I was). I know that now I'm in the second year of this thing that it does get better and I hope that's the case with you. Any questions feel free to PM me.

[spmcc]

I'll be seeing my opthalmologist on Monday to find out more about that. I've had my eyes cauterized since one week only. Would they open up that soon?

The soreness was felt on the surface but like I said, I think that's a reaction to the steroid. The dryness is felt on the surface too. My MGD's were severly blocked when I saw Dr. ****** and it's part of the reason why the probing process was that painful. I still find the lack of aqueous tears extremely frustrating.

Can you please describe the need for one to have the AM grafts sugery? What is that procedure and what does it really help with?

Yes, your cauteries can open up that soon. Sometimes the cautery is done very superficially (that's what ****** says he does). That can mean that when the slight swelling goes down (within 24 hours) the cauteries open. But they can also re-open a week later, a month later, a year later...

If you believe that a drop is causing your surface soreness, by all means, talk to your doctor ASAP to get permission to stop the drop! This is very important esp if it's an Rx drop... not so much if it's OTC. Personally stop anything that is hurting me.

As for Prokera... you can search DEZ. There has been a lot of chatter about this lately. Also since you've got ******'s email, give him a shout. He usually answers right away (even on the weekends, I've found). He should be able to tell you if you're a candidate for Prokera. Everything that I've read about it suggests that it's a treatment for acute trauma (to be used early on). So waiting for months/years would put you in the chronic category. Whatever ****** tells you, please let us know here.

[Rebecca Petris]

I know it's hard but I would give it a bit more time before you consider something such as Prokera. I'm 14 months post-LASIK and I didn't see any improvements in my eyes until after 8 months. My eyes are still far from perfect but they are far better now than they were during the first 6 months. I know you want to try and find a solution as quick as possible but in a lot of LASIK cases time really is the best healer.

That is really good advice. I have seen a lot of people rush through a lot of treatments in their first year (naturally enough... there's a lot driving it) but without substantial benefits at the time. I tend to think there's a certain "course" that lasik dry eye runs for a lot of people that simply has its own timeline. Taking things slow is good, so long as you can get the tools you need to stay reasonably comfortable in the meantime.

[Joseph]

My eyes were very dry after lasik for one year and then slowly started getting better. Time = healing so give it more time and try to pamper your eyes and stay positive. 6 months is not enough time to say that this is forever..

[Hemu]

My eyes were very dry after lasik for one year and then slowly started getting better. Time = healing so give it more time and try to pamper your eyes and stay positive. 6 months is not enough time to say that this is forever..

I appreciate the advice from the veterans who have been there and experienced what I am currently going through. I am holding off any new treatments/surgeries until my first anniversary which would be next April. It seems like a long time ahead since every day is a suffering but I HAVE to be patient and hope for the best.

I do intend to find a treatment that works best for me as I haven't got there yet. The next step is going to be serum tears but I'm only going to be taking those once an analysis of my hormone results is provided to me by my general physician(that should happen on the 16'th of this month). What are the success rates for serum tears? Are they worth trying?

The soreness has diminished by 50% today since I stopped Pataday which was on Friday. I am still very aqueous deficient and I'll be seeing my OD tomorrow to take a peek at my ducts.

Once again, this portal is heaven sent. I am even able to offer some advice to people in pain by experiences I've had these last 6 months.

[Hemu]

I spoke with my doctor and she prescribed Serum Tears for me. Before I start using them, I do want to ask a couple of questions here:

1. Do you think it's too early for me to start using them? If so, when should I ideally consider trying them?

2. What are the benefits of the serum tears? What exactly do they accomplish?

3. I've read on the forums here that it takes possibly 3-6 months to get a full effect of them. Is that true? If so, is it a good idea for me to consider using them now?

4. Are there any drawbacks to using serum tears?

5. Is there something like I'm going to depend on them for the rest of my life if I start using them?

[jjimings]

My sister had lasik about 15 months ago, and had a lot side effects and problems similar to what's being describing above. After a lot of searching around we finally found relief for her with a doctor in Maryland. I would like to let you and others know that there is help out there!