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  • Struggling..

    Me: male, 30's

    Been lurking on the boards now for several months following PRK that I had done roughly 10 months ago to correct minor nearsightedness (L 1.25, R 1.50). I was hoping that my DE would be a temporary condition as I've learned that roughly 60% of laser vision patients experience some degree of dry eye during healing and only a very small percentage experience DE beyond 6 months. At the 3 month post-PRK check-up I was still putting in eye drops about once every hour and occasionally waking up with a stuck eye lid (hurts like hell). I was told by my optometrist to increase my omega-3, use warm compress, and switch from regular eye drops to Refresh Advanced. By following this advice, I was eventually able to improve my dry eye from putting in drops once an hour to about 6 times a day.

    At the 6 month check-up I was still having dry eye discomfort and putting in drops about 6 times a day, so I was put on Restasis. At first, the Restasis really seemed to be improving my DE. I was eventually able to go most of the day without needing any eye drops at all, though my eyes never felt the way they did pre-PRK. The eye sticking mostly stopped except for a couple of times, though my eyes always felt off (almost like they were numb) when I would wake up. After a couple of months on the Restasis I decided to stop taking it because I noticed that it would make my eyes burn in the morning after putting in the drops and the burning would sometimes last into the afternoon. I also decided to quit the omega 3 around this time because the 3,000 mg dose was upsetting my stomach.

    One thing I had discovered over the past few months is that the surface of my eyes would feel numb in the evening - almost like they would just shut down and decide to stop producing tears. I wouldn't get any burning sensation or redness, it was just a weird numbness. I found that if I lightly pressed on my eyes and rolled the eyes in the sockets up, down, left, and right I would get a very painful surface sensation and then a flood of tears, which would lubricate the eye and kick-start them again. I would do this eye rubbing exercise nightly and found that I could avoid having to use the drops if I did this.

    Flash forward to about 3 weeks ago (no more Restasis, no omega-3, no warm compress) and I had spent the last 2 days working day and night staring at my computer screen with few breaks. Sunday afternoon I finish up my work and I notice my eyes are incredibly dried out. I try the rubbing eye trick I had been using and that isn't working anymore. That night, for the first time in months, my eyes are red and burning like crazy. I wake up the next morning with a stuck eye lid. As I'm working on the computer, I keep noticing what looks like a piece of hair or dust on my right eye lid. After trying to rub the piece of dust or hair several times I realize that it's in my vision. I've come to find out that the excessive eye rubbing likely caused a PVD in my right eye.

    I've since started the Restasis and omega-3 again. Unfortunately, both of these take time to work so the last couple weeks have been absolute hell for me. I am back to where I was at the beginning of the PRK healing - only now I also have a floater in my otherwise perfect vision. I've become very depressed by this as I believed I was on the road to recovery only to find out that the DE is still very much an issue and at this point I believe it will be a chronic life-long condition for me.

    I went to an ophthalmologist this week who diagnosed my floater as a PVD and told me that I have evaporative dry eye (left eye: 5 sec, right eye: 8) coupled with low tear production in my left eye (Schirmer: 7 in left, 13 in right). I had punctal plugs inserted in the lower ducts of both eyes. Fortunately, I've been getting some relief from the plugs; I just wish I had them done sooner and didn't resort to rubbing my eyes like an idiot

    I'm doing my best to try to stay positive and hope that starting the Restasis again, taking omega-3, punctal plugs, and also starting warm compress at night will get me back to where I was or even better. I'm also hoping, though I know it's highly unlikely at this point, that there will still be some residual healing from the procedure that might improve my DE condition naturally. It took me nearly 4 months for my left eye (the drier eye) to get to the visual acuity it's at now, so maybe the dryness has slowed down the healing process?

    Prior to PRK, the only times my eyes ever felt dry was in the winter when using the computer for too long. In 2009 after complaining to my optometrist that I couldn't wear my contacts comfortably anymore, I was told that I had very low oil secretion and a TBUT of 6 second in both eyes. The doc told me to start taking fish oil and I thought to myself 'what does fish oil have to do with wearing contact lenses?'. The same doc is the one I went to for my PRK pre-screening and told me that there was nothing that would put me at risk for having PRK. I guess she felt that the MGD issue wasn't all that serious and I had no signs of dry eye at the time. I think that the doctors performing these procedures should be required to thoroughly test patients for DE issues prior to surgery considering it is the #1 complication. If I would have been tested, I am sure they would have noticed the MGD issue and perhaps the low tear production in my left eye. Now I get to live out the rest of my life trying to keep this condition under control. Just glad that there is a community of fellow DE sufferers out there to share my experience with and keep hope alive. Thanks for anyone still reading this

  • #2
    First let me say I'm really sorry for all you're going through.

    I found that if I lightly pressed on my eyes and rolled the eyes in the sockets up, down, left, and right I would get a very painful surface sensation and then a flood of tears, which would lubricate the eye and kick-start them again. I would do this eye rubbing exercise nightly and found that I could avoid having to use the drops if I did this.
    Rubbing the eyes is never a good idea, for lots of reasons, but I'll give you an additional one. Painful surface sensation followed by flood of tears = mini erosion/abrasion. Those tears are reflex tears, designed to flood the eye if a foreign body gets in or other irritation happens. They are not related to production of normal tears (basal tear) - the kind you want. In one sense there's nothing wrong with trying to produce more reflex tears (some people do this by things like chewing gum) if it makes you more comfortable but only in safe ways that won't hurt your epithelium which may still be pretty fragile.

    Do you know what kind of plugs you got? Punctal, I hope?

    I'm also hoping, though I know it's highly unlikely at this point, that there will still be some residual healing from the procedure that might improve my DE condition naturally. It took me nearly 4 months for my left eye (the drier eye) to get to the visual acuity it's at now, so maybe the dryness has slowed down the healing process?
    There is absolutely nothing unlikely about additional healing at this point in your DE. You wouldn't believe how many people have come through this forum, camped here for 1-2 years and then gotten better and moved on... people who had LASIK or PRK. I think that emotionally the 1 year mark tends to be a difficult milestone for people because they are torn between wanting to hope for improvement and wondering if they should accept this as their new normal. Speaking both from medical studies of the number of years it takes for nerves to heal, and anecdotally from all the people I've observed over the years, one year is almost always too early to make that call. There's more healing in store.
    Rebecca Petris
    The Dry Eye Foundation
    dryeyefoundation.org
    800-484-0244

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    • #3
      Welcome mydryeyez,
      I had PRK done in 2006, and did not experience severe dry eye until several years post surgery. I did have dry eye prior to the surgery, but it was very mild, with a stable tear film. I also have meibomian gland dysfunction and ocular rosacea. My eyes are much better than they were four years ago, but it has been difficult. I am now quadra-plugged, take an antibiotic daily (and probiotics),take 4 TheraTears Nutrition daily, use hot compresses and do gland expression with scrubbs and rinse. I wear goggles most of the time, and am down to about one vial of tear supplements a day. I've tried IPL, which didn't really work and a number of supplements which also didn't work. Best wishes to you. You are not very far away from your initial surgery, so hopefully you will fully heal. PRK takes a long time to deal, and I seem to remember it took me almost a year. Hang in there!
      Last edited by LaDiva; 26-Sep-2014, 14:22.

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      • #4
        Rebecca,

        It's very comforting to hear that there is still hope that my condition might improve with time. Trying to convince myself that there is hope and trying not to obsesses over the PVD and dry eye is very difficult. For the past few weeks when the condition took a sharp turn for the worse, I was very depressed and anxious about the situation. The dry eye and smudge in vision from the PVD was like a one-two knockout punch for me. I'm slowly learning to ignore the thread in my vision (worse in sunlight and bright backgrounds) and the punctal plugs seem to be making a difference, so I know that there is a light at the end.

        Based on your experience and recommendation, I have emailed my doctor to get further clarification on what type of plugs were inserted. I believe that they were punctal. How would I know the difference?

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        • #5
          Thanks for sharing your experience. Is your MGD due to blockage of the glands or atrophy? I took Accutane as a teenager and I've been told that this can cause gland atrophy due to the Accutane shrinking the glands to the point where they close-up and seal shut permanently (AKA gland drop-out). My primary optometrist said she can only see very tiny amounts of secretion from a few of the bottom glands and no secretion from any of the upper ones. The oil that does come out is of good quality, so it leads me to believe that the others have atrophied - possibly because of the Accutane usage as a teenager. My ophthalmologist rated my MGD as a 1.5 with 0 being best and 3 being no secretion at all, so I guess it's still not too bad.

          I'm going to start doing warm compress again to stimulate the glands. I've also read that gland probing might be able to unseal the atrophied glands, but I'm going to use that as a last resort. Seems like too risky of a procedure unless you've got nothing left to lose.

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          • #6
            My oil problem is poor quality oil and blockage. I am not sure about atrophy. I think it is mainly poor quality. Have you considered probing? My eye doctor feels that is much too invasive. I really don't know much about it, or if it would help in cases of atrophy. Best wishes to you.

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            • #7
              Originally posted by mydryeyez2014 View Post
              For the past few weeks when the condition took a sharp turn for the worse, I was very depressed and anxious about the situation. The dry eye and smudge in vision from the PVD was like a one-two knockout punch for me. I'm slowly learning to ignore the thread in my vision (worse in sunlight and bright backgrounds) and the punctal plugs seem to be making a difference, so I know that there is a light at the end.
              I understand. The ups and downs can be really nerve wracking. It's hard not to take a micro-trend and extrapolate it out - good or bad. - I have a lot of floaters, including some very large, very noticeable ones, from my lasik back in 2001. They bothered me a lot more in that early period (and especially since, as a former high myope, I'm high risk for retina problems) but they're just background noise now for the most part.

              Based on your experience and recommendation, I have emailed my doctor to get further clarification on what type of plugs were inserted. I believe that they were punctal. How would I know the difference?
              Some punctal plugs are visible in the mirror if you know what you're looking for but really you can't know for sure unless they tell you. My main question would just be if they are punctal plugs (the 'umbrella' type) or intracanalicular.
              Rebecca Petris
              The Dry Eye Foundation
              dryeyefoundation.org
              800-484-0244

              Comment


              • #8
                I hate sounding like a shill for AMT or Prokera but I did read that it has been very successful with treating PRK damage.

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