Not sure what I have... dry eye, CVS?

[Someone24]

My experience with this affliction from hell started a few months ago, over the Summer. One day I just woke up and my eyes burned and hurt, especially in front of the computer. I'm only 32, never had lasik, don't wear contacts. Naturally I scheduled an eye appointment with an Optometrist, a supposed dry eye specialist, and she told me nothing I couldn't have learned from wikipedia. She was also strangely unconcerned, like I came in with a cold or something. Said eyes were healthy.

Over the next month or so I started getting into the supplements, first a good fish oil, then bilberry extract, and a few other things. I also bought a pair of Gunnar glasses. All of these made a huge difference, and I could work in front of a computer again for the majority of the day (I tried a 3-4 brands of eye drops before this, and they did nothing). For the most part it is in front of a screen where things flare up, not so much when I'm out and about... though I did have some of that at the very beginning.

Over the past week or so though, things have deteriorated again. Nothing in my daily regiment has changed, so I am hoping it's a passing virus or something. I've setup a humidifier to help with the drier winter air, but am not sure it's helping. At this point what I'm curious about is whether I have dry eye or simply computer vision syndrome (CVS). But the thing with CVS is, apparently everyone has it, it's synonymous with simply spending too much time in front of a screen. It's one of those things that's treated casually and not like a chronic illness, making it hard to research. Every google result gives you the same basic bullet points... 20/20 rule, take breaks, etc.

Anyway, any tips or insight would be most appreciated.

[pythonidler]

Welcome to the forum.

I was also young (25) when I had my first dry eye symptoms. It started off a general dry feeling, but progressed into grittiness, discomfort, and now pain. 2 years after my initial symptoms, my eyes felt so bad that I had to quit my office job. It's been five years now since my initial symptoms, and 3 years after quitting my job, and I haven't had a full time position since then.

A few facts about dry eye:

1. Excessive computer use causes dry eye.
Your kind (and my kind) of dry eye was most likely caused by excessive computer use. When you're at a computer, you don't blink as often as you should. When you blink infrequently, the oil producing glands in your eyelids (meibomian glands) don't squeeze out oil as often as they should. This leads to eventual clogging of the glands and a reduction in both the quantity and quality of oil you're able to produce, a condition known as meibomian gland dysfunction (MGD). It wouldn't surprise me if everyone in our generation had MGD by the time they were 40 or 50. MGD is also known as evaporative dry eye, since it is the oil that keeps the tear film from evaporating quickly.

2. Dry eye is a progressive disease.
If left untreated (or if given insufficient or inappropriate treatment), dry eye can get worse. At some point, you will do irreversible damage to your eye and tear-producing glands, and you will forever be left with discomfort, redness, pain, etc.

3. When it comes to dry eye, not all eye doctors are created equal.
The first few doctors I saw (optometrists) knew nothing about meibomian gland dysfunction. Slowly, doctors are getting more educated, but it's still very possible to see an eye doctor or be misdiagnosed. When you combine this fact with #2, it makes it SUPER IMPORTANT to find the right doctor ASAP. The longer it takes you to find a competent doctor, the better chance you have of doing irreversible damage to your eye. Don't feel like you have to see a doctor for a followup if you weren't impressed with your initial evaluation.

All of that being said, here's my advice to you right now.

1. Continue to visit dry eye doctors until you're comfortable with the doctor you're seeing.
Personally, the more tests a doctor does, the more comfortable I feel about a doctor. Ideally, a doctor should do tests that are both qualitative and quantitative. An example of a qualitative test would be meibography - images of your meibomian glands that detail their condition (e.g., how thick and long each gland is, how many there are, if there is any gland death, if there is scar tissue blocking your glands, etc). An example of a quantitative test would be something known as tear break-up time (TBUT), or how long it takes for your tears to begin to evaporate after you blink.

One other thing about tests - your doctor should do tests for both meibomian gland dysfunction as well as aqueous deficiency (not producing enough watery tears). One popular test for aqueous deficiency is the Schirmer Test, where a doctor will put a strip of paper under your eyelids, have you close your eyelids for a few minutes, then measure the amount of paper that's ben soaked by your tears. Anything greater than 10 mm is considered normal, while anything less than 10 mm is considered aqueous deficient. It is possible to have meibomian gland dysfunciton, as well as aqueous deficiency, as I do.

2. Buy a hot compress, such as Thermalon
A hot compress is a mask that you heat up in the microwave and put on your face for a few minutes. It will melt any thick oil in your glands and allow the oil to flow more easily. This is probably the cheapest way of managing MGD - there are much more expensive options such as Lipiflow, IPL, and probing that you may have to do if you have it bad enough.

3. To manage in the short-term, consider a humidifier or moisture goggles.
I personally bough a pair of 7eye moisture goggles this year. They do a good job at retaining moisture in your eyes. Another good brand is WileyX. Either brand you should be able to demo in an optometrists office, or in the case of WileyX, at a Harley Davidson.

4. Realize that your office career may be short lived
If you are aggressive at treating your dry eye and your condition continues to deteriorate, you should probably think about pursuing other careers that don't involve computer work. This is going to be difficult, no question, but consider my example. By working and allowing my condition to deteriorate, I've made it so that I have irreversibly bad dry eye. This does three things: Number one, it reduces my quality of life significantly; number two, it vastly increases my medical bills; and finally, it decreases my future earning potential. If you quit before your condition gets worse, at the least you won't have the first two things to worry about. So as a suggestion, I would consider other careers.

[farmgirl]

Excellent writeup pythonidler....to you Someone24, take her/his advice.

[Someone24]

thanks for the breakdown, pythonidler.

I am a digital artist and this of course has been on my mind, switching careers is not something I'd take lightly, so I do intend to fight this off as long as I can. There are some things that make me hopeful, E-Ink for instance is starting to make headway. There are "paper" monitors you can buy now that, if you don't require color, can probably suffice for office work and not aggravate the problem. I am a bit disillusioned by how little the medical community seems to have a grasp on this, but I guess it is a modern disease and will only increase in notoriety as more of our generation inevitably gets it.

I will buy one of those thermalons for the short term and see if that helps.

[pythonidler]

Someone24 One other thing you can do in the short-term is blinking exercises. Some people who've spent a lot of time on the computer are partial blinkers, meaning their lids don't touch completely when they blink. This is bad because you can't get oil out of your glands if you're not blinking correctly.

Here's a link for instructions:
https://www.youreyesite.com/eye-care...ing-exercises/

You don't have to do them as often as the instructions say, but maybe start out doing them 1-2x an hour while you're at a computer. If you use Chrome, you can install an extension called eyeCare: https://chrome.google.com/webstore/d...mnnijjhn?hl=en