10 months Post Lasik and seeking advise/treatment

[tealeaf]

Hi all,

I am new in this forum. Like many of you, I have severe eyes dryness and the cause of it is from lasik. About 10 months agao, I made the worst decision of my life to proceed with lasik. 3 months post lasik, I was administered with anti-depressant. I was so worried that I would become blind and unable to be there for my 3 young children. Alot of regrets and struggling with self reproached.

Life throws us unexpected stuff, we can choose to remain sad and depressed or move on in life to look for solution. Not easy for me to say that, as I am still learning.

I have decided to try not to look back but move on. Went to eye specialist yesterday. He said I have MGD (due to too much oil on upper lids), but thankfully no inflammation. Doctor recommended warm compress and lid scrub twice a day. Shirmer tests showed 0mm (R) and 2mm (L) for my eyes and TBUT was 7 seconds for both eyes. He mentioned that 7 seconds of TBUT is quite resonable. Is it? He put in collagen lower eye plugs for both of my eyes, said will last between 2 to 6 months, depending on indivdual bodies. I supposed they are not Smart Plugs since they are dissolvable? (I am fearful of smart plugs after hearing so many reported complications that come along with them.) I suppose they are synthetic dissolvable plugs and are such synthetic plugs safe?
I feel minor relief to my eyes. If temporary eye plugs are suitable for my eyes, should I proceed to use permanent silicon eye plugs with cap?

Seems like I am unable to take those longer eye drops like cellusivc PF, bion tears PF and refresh liquidgel. Eyes feel very gritty and uncomfortable after putting in. Am currently using Systane Ultra and Refresh plus but they are not so long lasting. Is it that I am sensitive to the ingredients in such long lasting drops?

Currently, am using restasis twice a day, lotemax (for a month), vidisc eye gel at bed time.

Thank you for reading and many thanks in advance for your advise.

[DryLondoner]

Hi tealeaf,

I'm sure someone else who is more knowledgeable than myself will come along and answer your questions.

Just to say - I too am 10 months post LASIK and experiencing very dry eyes. In fact, we have very similar schirmer test readings. I also cannot tolerate most drops and find they make more eyes worse.

Good to hear you are making progress in terms of treatment and that you have someone you trust to look after your eyes.

Finger crossed our nerves heal and they get better.

[Rebecca Petris]

Sorry you had to join this particular club (post lasik dry eye).

Doctor recommended warm compress and lid scrub twice a day.

What are you using (if anything) for lid scrubs? Make sure not to "scrub". Gentle massage is all it takes.

Shirmer tests showed 0mm (R) and 2mm (L) for my eyes

Was this with or without anaesthetic drops?

and TBUT was 7 seconds for both eyes. He mentioned that 7 seconds of TBUT is quite resonable. Is it?

Well, yes, it's not great but it is 'reasonable'. But even with a reasonable TBUT, schirmer that low is plenty of explanation for how uncomfortable you are.

He put in collagen lower eye plugs for both of my eyes, said will last between 2 to 6 months, depending on indivdual bodies. I supposed they are not Smart Plugs since they are dissolvable? (I am fearful of smart plugs after hearing so many reported complications that come along with them.) I suppose they are synthetic dissolvable plugs and are such synthetic plugs safe?

Well, if they're collagen then they're not synthetic (somebody correct me if I'm wrong here). Collagen ones don't usually last anywhere near that long. Polymer based dissolvable plugs last longer. Are synthetic plugs safe... Well, if you mean dissolvable intracanalicular plugs, they are 'relatively' safe, as in, safer than putting a durable material in there, but anytime you put something in the canaliculus (as with putting foreign matter in any part of our bodies), there is always going to be SOME risk (albeit relatively small) of reaction - specifically, canaliculitis. There's always the possibility of having issues with the material and having some kind of reaction.

Kudos for being aware of SmartPlug complications!!!! Every prevention is a victory.

I feel minor relief to my eyes. If temporary eye plugs are suitable for my eyes, should I proceed to use permanent silicon eye plugs with cap?

I absolutely would in your shoes... but the conservative approach would be to go for the silicone external ones (true "punctal" plugs) with the caps. They are the lowest risk type and the ONLY type that can be readily removed at any time. When they say "permanent" it just means it's a durable material that won't dissolve. And if they're not fitted properly they may fall out so make sure you ask what their policy is for replacements.

Seems like I am unable to take those longer eye drops like cellusivc PF, bion tears PF and refresh liquidgel. Eyes feel very gritty and uncomfortable after putting in. Am currently using Systane Ultra and Refresh plus but they are not so long lasting. Is it that I am sensitive to the ingredients in such long lasting drops?

Maybe. Personally what I'd do is stick with the type that is most comfortable AND seek other means of making your eyes comfortable so that you can reduce frequency of dropping if necessary (like moisture chamber glasses part time). Or, you could pursue autologous serum drops which are often a great solution for people who have issues with commercial polymer based drops.

[tealeaf]

Hi DryLondoner,

Thank you for your reply ... and sorry that you are also facing this post lasik problem.

Are you using any plugs currently?

Yes, I truly hope that both our nerves will heal and in time, we will share our triumph stories. For now, together with all other patients, let's brave on each day and continue to seek treatment and do anything that will help our eyes.

[tealeaf]

Hi Rebecca,

Many thanks for replying.

With regard to warm compress, I am using rice baggy. After using, my vision is blurred for a few seconds and at times, eyelids a little painful, does it mean is too hot for my eyelids? (though I feel rather comfortable with the heat)

Thanks for the advise on gentle massage. At times, I think I scrubbed too hard. I am using Lidcare wipes. Roughly, can you tell me how many times to wipe each eyelid?

The Shirmer test is with anaesthetic drops. What's difference with or without anaesthetic drops?

I will feel more settled with a permanent silicon plugs to my eyes than to keep going to eye specialist for temporary plugs. Yes, I would want to use only those permanent silicon plugs with cap. I don't think I can take more stress with regard to eyes.
I read from this forum that some patients have problems finding the right fit of permanent silicon plugs with cap. Any advise on the brand of permanent silicon plugs with cap which has good review?

Is it normal to be able to feel the plugs even when they are temporary?

My eye specialist put in plugs on 30th June. Since then (2 days already), I noticed a little bit of muscus coming out my left eye thrice and a little itch near the puncta areas of both eyes. My eyes are still white. Wondering is there infection or my eyes are adjusting to the plugs?

What is autologous serum drops?

Thank you

[Rebecca Petris]

The Shirmer test is with anaesthetic drops. What's difference with or without anaesthetic drops?

With anaesthetic measures your basal tear production. Without measures your reflex tear production.

I read from this forum that some patients have problems finding the right fit of permanent silicon plugs with cap. Any advise on the brand of permanent silicon plugs with cap which has good review?

It's really less about the brand than about the experience of the doctor in correctly gauging size and choosing the appropriate plug.

My eye specialist put in plugs on 30th June. Since then (2 days already), I noticed a little bit of muscus coming out my left eye thrice and a little itch near the puncta areas of both eyes. My eyes are still white. Wondering is there infection or my eyes are adjusting to the plugs?

Early days yet - if there's no obvious problem (redness, lots of discharge, pain) then I would wait a week to let things settle down then if you still have concerns have them take a look. It's normally to have some irritation from the dilation/insertion process.

What is autologous serum drops?

Eyedrops made from your blood. There are quite a few people on the forum who use them.

[LaDiva]

Hi Tealeaf,
A TBUT of 7 hurts. That is where I was at one point, and it is very uncomfortable. It took awhile for my eyes to feel better after plugs were inserted. The added moisture makes a difference, but it takes some time for the eye surface to heal and benefit from the extra tears. Also, being diligent with compresses and scrubs made a big difference for me. Best wishes to you.

[tealeaf]

Many thanks Rebecca for answering my many questions.

LaDiva,
Do you have plugs for the lower ducts or all four? After 2 days of temporary plugs, my eyes do feel better. How do I know if I need to plug the uppers as well? Read from this forum that plugging upper ducts may make the eyes very uncomfortable due to abrasion.

[LaDiva]

Hi Tealeaf,
I am quadra plugged. The doctor started out plugging the bottoms first. It wasn't enough and I was still uncomfortable so I asked him to plug the tops as well. The left eye is a little too wet sometimes, and the right is still too dry. I think it is an oil problem now. Tankie posted about having plugs with small holes in them, so that the ducts were not completely closed, but almost. I think this worked well for him, and it was a way to balance the tear over-kill. Uncomfortable plugs are generally a sign that they are not fitted correctly. I waited forever to get the plugs I am now wearing, because the first two sets were quite uncomfortable, and in the long run, fell out. I changed eye doctors and suddenly I had plugs that were comfortable and worked well. I've had them awhile now, and no problem with them falling out. I waited about a month before deciding to get upper plugs. It takes awhile for the plugs to settle, and I remember that they initially rubbed a little, but rarely bother me now. Happy to hear your eyes are feeling better!

[tealeaf]

Hi LaDiva,
I am glad to hear that you are happy with the plugs Are your plugs permanent with caps? Being quadra plugged, do you still need to use any eye drops, do warm compress, take fish oil etc?

My eye specialist puts me on lotemax for a month, I am not sure the imporved comfort is due to the steroid drops or plug.

[LaDiva]

Hi T,
Yes, permanent plugs. The plugs in the bottom are Herrick plugs, and I don't know what kind are in the top. My oil is bad, so I still use drops and compresses and take fish oil. You are only 10 months out, so hopefully your situation will greatly improve. I have not enough tears, MGD, and ocular rosacea, so a little bit of everything!

[tealeaf]

Hi LaDiva,
Are your eyes comfortable most of the time now?
Yes, I am also doing a bit of everything to improve the current condition. Hope your dry eyes are under control

[LaDiva]

Hi T,
My eyes feel best if I don't spend too much time on the computer, and I need to be careful about what I eat. No, my eyes are not great, but much better than they were four years ago. I think there is good reason to be hopeful for your situation. Wishing you all the best.

[tealeaf]

LaDiva,
I may request for plugging my upper tear ducts too; will decide after some time.
Can I check being quadra plugged, will there be any issues with no tears being drained?

[LaDiva]

My eye doctor said it is very difficult to take out the top plugs, but not hard to remove the bottom, so that is a consideration. He said if the top needed to be removed it might need to be done surgically. If you have an eye infection, plugs might be an issue, but there are meds for that. I think others might have more to say about tear quality and plugs than I. It is possible that four plugs might retain too many tears and you might have overflow. Best wishes.