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Just want to say hi to everyone and document my issues in hopes of helping someone.

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  • Just want to say hi to everyone and document my issues in hopes of helping someone.

    Background
    This information will be continually updated. I hope that this will be of use to someone. Good luck to everyone battling this problem.
    35 year old male. No alcohol or tobacco, healthy diet, drink only water. Constant eye pain, dryness, redness, inflammation, light and wind sensitivity, onset seemingly overnight. MGD, aqueous deficient, and partial blinker. 2 aunt + 1 uncle maternal side significant dry eye problems.
    Had lasik in the spring of 2008 and never had any problems until the fall of 2017, what contribution to this problem is unknown. Ophthalmologist says the three years spent in the middle east probably contributed. Roadside bomb incident ended with getting diesel fuel in both eyes. Heavy computer, TV, and video game use for many years. I believe the allergy eye drops are what set everything off.
    Component Assessment Normal Range Initial
    Measurement
    Initial
    Date
    Recent
    Measurement
    Recent
    Date
    Aqueous Schirmer's strip test >10 mm 2 mm 12/15/1017 7 mm 7/11/2018
    Lipid LipiView ; Lipid layer thickness (LLT) >100 nm 46 nm 2/28/2018 79.5 nm 7/11/2018
    Aggregate Tear breakup time (TBUT) >10 seconds 4 seconds 12/15/2017 10 seconds 8/22/2018
    Meibomian Glands Meibography 100% present
    Liquid oil
    80% present
    Solid oil
    2/28/2018 7/11/2018
    Sjorgens Sjorgens Negative
    Hormone Hormone Normal
    Allergic To: Trees Grasses Weeds Mold Mites
    Treatment History Improved
    Worsened
    Allergy Shots Summer 2015 until present
    Pain Management Efficay
    Tylenol Ineffective
    Ibuprofen Ineffective
    Diclofenac 0.1% Marginal: Pain 8 to 7
    Meloxicam 15 mg Marginal: Pain 8 to 7
    Ilevro 0.3% Worsened
    Gabapentin Ineffective
    Tramadol Marginal: Pain 8 to 7
    Treatment Date Duration Efficacy
    Allergy eye drop 6/1/2017 2 weeks Sgn Sym
    Lubricant eye ointment 7/1/1017 1 month Ineffective
    Steroid drop 8/1/2017 1 month Ineffective
    Fish + flax oil 10/1/2017 3000 mg / day Ongoing Unknown
    Multi vitamin 10/1/2017 Ongoing Unknown
    Doxycycline 10/1/2017 2 months Unknown
    Ocusoft lid scrub 10/1/2017 (On / off) 6 months Ineffective
    Baby shampoo 10/1/2017 (On / off) 3 months Ineffective
    Heat compress 10/1/2017 (On / off) 3 months Sgn Sym
    Manual expression 10/21/2017 Treatment X 1 Ineffective
    Refresh classic drop (preservative free) 12/1/2017 2 months 4 X day Ineffective
    Restasis (0.05% cyclosporine) 12/15/2017
    4/4/2018
    4 months 2 X day
    3 months 4 X day
    Unknown
    Eagle punctal plug (2 lower)
    (1 upper)
    12/15/2017
    4/11/2018
    6 months
    2 weeks
    Sgn Sym
    Sgn Sym
    Autologous serum drop (20%)
    (50%)
    2/15/2018
    4/19/2018
    2 months 4 X day
    5 weeks 6 X day
    Unknown
    Unknown
    LipiFlow 2/28/2018 Treatment X 1 Sgn
    Xiidra 4/21/2018 5 months 2 X day Unknown
    LipiFlow 6/14/2018 Treatment X 1 Sgn
    Prednisolone Acetate 1% 6/25/2018 1 week 2 X day Sgn Sym
    Klarity C (0.1% cyclosporine) 7/5/2018 2 months Unknown
    LipiFlow 7/26/2018 Treatment X 1 Unknown
    Bandage lens (L)
    (R)
    8/22/2018
    8/29/2018
    3 weeks Inefective
    Ineffective
    Europa scleral lens (16mm) 10/2/2018 Failure Failure
    (extreme blurriness)
    Tru Tear 11/14/2018
    Click image for larger versionName:	Capture.PNGViews:	1Size:	433.9 KBID:	212874
    Sjorgens And Hormone Test 7/5/2018

    Click image for larger version  Name:	photo 1.JPG Views:	1 Size:	166.9 KB ID:	210905
    LipiView (Pre LipiFlow) 2/28/2018

    Click image for larger version  Name:	photo 4.JPG Views:	1 Size:	121.2 KB ID:	210906
    LipiView (1st LipiFlow results) 4/11/2018

    Click image for larger version  Name:	LipiFlow 2.PNG Views:	1 Size:	433.2 KB ID:	213115
    LipiView (2nd LipiFlow results) 7/11/2018

    Last edited by dano6533@gmail.com; 15-Nov-2018, 08:58.

  • #2
    Hi and welcome to the forum.

    Do you have any other symptoms besides redness? If not, I'd consider yourself lucky.

    When you were diagnosed with MGD, what sorts of tests did the doctor do? Do you have meibography of your lids? Getting meibography done is vital because only then will you know if your meibomian glands have atrophied, or if they are just blocked. Also, did your doctor say if you were aqueous deficient or not?

    You're off to a good start in terms of treatment. I'd continue with 2000 mg of omega-3 daily (I use Nordic Naturals Ultimate Omega), because omega-3's are great at reducing inflammation. Warm compresses are also good for MGD. As for the Restasis - I've heard this is generally used to treat aqueous deficiency, not MGD. Still, it may be worth it to try it for a few months.

    Just so you're aware, there are other treatments for MGD - but they are more expensive than what you've done so far. Read up on IPL, probing, and Lipiflow if you have the time. Personally, probing and IPL have helped me unblock my glands and get the oils flowing again.
    What you need to know about computer-induced dry eye
    Dry Eye Survey
    IPL Doctors
    Probing Doctors
    PRP Injections Warning

    Comment


    • #3
      You are right I should be grateful for only having redness.
      I am going to an appointment today and I will ask them about the glands and what can all be done. I was told that restasis will help reduce inflammation.
      Out of curiosity can you tell me your age and symptoms? Also how much has IPL helped you?

      Comment


      • #4
        I got my first symptoms 5 years ago, when I was 25. At first I just had the sensation of dryness. As continued to work in an office environment and my dry eye progressed, I also developed aqueous deficiency.

        In year 2, I started getting a gritty sensation in my eyes - the grittiness was from nerve degeneration. When you're aqueous deficient, the corneal nerves don't get the nutrition that they need from your tears, so they deteriorate. A year and a half later, I started taking eye drops called serum tears (eye drops made from your blood serum that contain nerve growth factors), and the grittiness went away.

        However this year, I've started getting pain in my eyes and have been more sensitive to light. I'm disappointed with myself because I had finally established a routine that made my eyes comfortable, and I screwed it up by being on the computer too much. The moral is that you can always develop new, worse symptoms at some point if you let dry eye progress without sufficient treatment.

        I first got IPL about a couple years ago. At the time I had scar tissue over my meibomian glands that prevented IPL from being successful (and neither myself nor my then-doctor knew about the scar tissue). When I was referred to my current doctor, he took images of my glands and told me that there was scar tissue over them, and that meibomian gland probing would help clear up the scar tissue. I had the probing done last December, and this year I've done 7 total IPL treatments. You're supposed to do one IPL treatment each month for the first four months, then every [x] number of months thereafter. My doctor has told me that [x] should be every 3 months, but I think it kind of depends on the person. Some people may need it more frequently, others less frequently.

        IPL has been a great treatment for me. After the probing, I noticed improvement after my second IPL treatment. IPL can be difficult to find, however, since there aren't a lot of eye doctors that do it. More eye doctors do Lipiflow, but IMO that is only because the company that manufactures the device markets heavily to them. I asked my doctor to rank MGD treatments from most effective to least effective, and he said the order was heated manual expression (think probing but with heated probes), then IPL, then Lipiflow. I'm almost positive there's only one doctor in the world that does heated manual expression, and I have doubts over whether he still does it.
        What you need to know about computer-induced dry eye
        Dry Eye Survey
        IPL Doctors
        Probing Doctors
        PRP Injections Warning

        Comment


        • #5
          I am sorry that you have to go through all of this. It sounds absolutely awful. Thanks for your response. Do you have punctal plugs?

          Comment


          • #6
            Originally posted by dano6533@gmail.com View Post
            I am sorry that you have to go through all of this. It sounds absolutely awful. Thanks for your response. Do you have punctal plugs?
            Yes, my doctor put some silicone (permanent) punctal plugs in a couple weeks ago.
            What you need to know about computer-induced dry eye
            Dry Eye Survey
            IPL Doctors
            Probing Doctors
            PRP Injections Warning

            Comment


            • #7
              What do you think of the plugs? Are they the just the lower ones? Are they helping you at all?

              Comment


              • #8
                Originally posted by dano6533@gmail.com View Post
                What do you think of the plugs? Are they the just the lower ones? Are they helping you at all?
                Correct, they're just in my lower ducts right now. To be honest, I don't know if they really helped or not.
                What you need to know about computer-induced dry eye
                Dry Eye Survey
                IPL Doctors
                Probing Doctors
                PRP Injections Warning

                Comment


                • #9
                  FYI, often 2 plugs are not enough, if they are not helping, and the difference should be very noticeable if they are, then I would suggest that you plug the uppers as well.

                  Comment


                  • #10
                    Update:
                    Situation continues to decline. I will continue to update and track how things are going.

                    Comment


                    • #11
                      Update and added image.
                      Last edited by dano6533@gmail.com; 08-Apr-2018, 10:31.

                      Comment


                      • #12
                        Where's the image

                        Comment


                        • #13
                          Sorry to hear you're not doing well. The good news is your meibography doesn't look bad at all. There are certainly a lot of people on this board who have worse glands than you do. Has a doctor described the quality (e.g., toothpaste or olive oil) and quantity of oil coming out recently?

                          Two suggestions:
                          1. My doctor believes that anyone who needs serum tears should take them 8x/day. Try increasing the amount of drops for a couple weeks and see if it makes a difference. If it helps, it's possible you could eventually decrease the amount of drops after a few months.
                          2. Most artificial tears I've taken have been extremely ineffective - regardless of how severe my symptoms were at the time. This includes drops like Retaine MGD and Soothe XP which are designed for MGD patients. However, recently I discovered an OTC eye drop that actually WORKS for me. It's called Refresh Optive Mega-3. The oils seem to stay in my eye for a long time. Though they won't work for everybody, I'd suggest giving them a try. If they don't work, just don't use them.
                          What you need to know about computer-induced dry eye
                          Dry Eye Survey
                          IPL Doctors
                          Probing Doctors
                          PRP Injections Warning

                          Comment


                          • #14
                            It appears that the lipiflow helped one eye as the lipid layer increased.

                            They said oil was on thick side. I will be switching to 50% serum drop and I'll do like you say and try the 8 times per day. I am at the desperation stage now and will try anything. If that does not work I'll try the Optive one.

                            How are your symptoms doing lately? I hope your making some improvements.

                            Thanks for the tips and good luck with the dry eye battle.

                            Comment


                            • #15
                              Have you felt any relief in the eye that Lipiflow helped? And do you know how significantly the lipid layer increased in that eye?

                              It's great that you have a "will try anything" attitude, but you shouldn't feel so hopeless - there's still a lot left to be tried (including potentially Intense Pulsed Light for your MGD).

                              Regarding the serum tears - I don't think my doctor believes that 50% serum tears are necessary. The 8x/day directive is based on a 20% solution of serum tears. Still, it wouldn't hurt to try 50% serum tears for 8x/day.

                              Thanks for asking about my dry eye. I'm feeling much better recently due to scleral lenses as well as the Mega-3 eye drops.
                              What you need to know about computer-induced dry eye
                              Dry Eye Survey
                              IPL Doctors
                              Probing Doctors
                              PRP Injections Warning

                              Comment

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