Investigating my symptoms, I need your help

[Fenix]

I'm pretty sure to have dry eye (shirmer < 5mm),blepharitis and some kind of allergic reaction, but I have a question that I can't answer by myself:

I am able to work in front of a computer for 8 hours if I rest my with some breaks. Working tires the eyes but I have no particular consequences. the next day I can like the day before.

The problem I'm investigating on:
If I read a book, after 15+ minutes my eyes starts to feel tired. I start to lose focus, like I'm a little confused.
If I continue to read for 60+ minutes, I feel a sort of pain/headache around the eyes. The consequences are that I have to stop everything and going to bed early to rest my eyes. The next day the eye discomfort is softened, and If I want to feel better I have to spend the entire day resting my eyes.
(I wear glasses, the eye doctor and the optician says that the glasses correction is correct.)
this problem is caused also when I watch movies and play videogames. This is the reason why I have stopped all my hobbies... I work and rest, work and rest.

I need to study on books, I can give up on movies, videogames etc, but i need to study and read books.
It can be a dry eye consequence, but maybe can be related to glasses or other problems. I don't know.

Does it happen also to you guys?
Do you think that it is related to dry eye?
Let me know.

[Alix]

I have low Schirmers score (8) and Blepharitis, and have problems with eye strain as well, especially when on my PC or reading. This is worse in the office or in the evenings at home where there is artificial lighting. I can’t go to the cinema anymore.

If your eyes are not perfect, then logically it is normal that they are going to start aching when you put them under stress.

When I have been to see private ophthalmologists here in London and overseas (Spain) I have had to complete the Ocular Surface Disease Index questionnaire and thats one of the questions in it (something like do you have problems reading?), so dry eye and eye strain are related.

If the pain is unbearable I would go see your doctor again.

[gilles]

As strange as it may sound: for me it is the complete opposite. My eyes can get dry as soon as I am 20 minutes behind a computer screen reading an article, but I have no problem reading books a whole day long. But it is more the reading of the screen that makes my eyes dry, because I could be using a computer for programming and only start to have dry eyes after an hour.
I recently found out that I can watch series again when using prescription glasses (very low prescription, for far distances), where I always sit a bit farther from my screen. My eyes don't get as dry as they used to when watching series. Maybe my eyes are having it a little bit "easier" with the help of the glasses, thus giving them enough rest and blinking opportunity.
But reading is no problem, even the opposite happens then: my eyes get well hydrated naturally again.
I am also quite sensitive to artificial light, like Alix mentioned. So in the evenings I will hug onto the prescription glasses, which give some relief.

Off topic: I noticed my nose gets dry once my eyes are dry. But I guess this might have something to do with the fact that there is no fluid humidifying the nose via the tear duct (as it already evaporated)

[Fenix]

Yesterday I saw the sixth eye doctor in three years. Tomorrow I will try LipiFlow for the first time cause apparently I also have MGD.

[gilles]

Yesterday I saw the sixth eye doctor in three years. Tomorrow I will try LipiFlow for the first time cause apparently I also have MGD.

You might want to try warmth compresses and massages + cleaning (e.g. blephasol) first.
Then some oral medication against inflammation and bacteria (e.g. minocycline),
then cyclosporine eyedrops.
And after that tear duct plugs.

These steps have more scientific literature about mgd.
Between these steps you could also free lance with lipiflow, sure, but I'd try these steps chronologicly.
Anyway, don't forget to search for the root cause of your dry eyes too, while stopping the syptoms (e.g. an oily skin type, screen use, vision problem and prescription glasses, bacteria, hormones, allergies, ...)

[Alix]

Yesterday I saw the sixth eye doctor in three years. Tomorrow I will try LipiFlow for the first time cause apparently I also have MGD.

Hey there how did the Lipiflow go?

[Fenix]

Hi Alix,
I had the LipiFlow treatment and during the first days I couldn't feel any improvements, but in the last two days I started feel better, the eyes seems more "watery".
I don't know if it is becouse of LipiFlow or the entire treatment.

The eye doctor gave me:

• an equivalent of tobradex eye drops (tobramycin + dexamethasone)
• artificial tears
• warm compresses 2 times at day (but actually I'm using Blephasteam istead of simple warm compresses)

He said that it takes at least one month to get the results of the treatment. I will give you updates in the next weeks.
Let me know if you have any question.

[Alix]

Hi Alix,
I had the LipiFlow treatment and during the first days I couldn't feel any improvements, but in the last two days I started feel better, the eyes seems more "watery".
I don't know if it is becouse of LipiFlow or the entire treatment.

Thanks for the update good to hear you are seeing some positive effects from this.

How long did the treatment take to have done?

Yes please keep us updated on your progress.

[Fenix]

Thanks for the update good to hear you are seeing some positive effects from this.

How long did the treatment take to have done?

Yes please keep us updated on your progress.

Tobradex (3 times at day for 10 days, then 2 times at day for 7 days, then once at day for 40 days.
Artificial tears and warm compresses non stop, I don't think forever, but at least until newer instruction.

Regarding the LipiFlow, the doctor said it can be done once a year if necessary. The Lipiflow lasts 12 minutes.

If it doesn't improve, propably he will prescribe me the Restasis eye drops.

[Alix]

Thanks for replying. I am not too familiar with the technical aspects of the lipiflow machine but as far as I understand it’s the same as warm eye compress? I don’t understand how warming your eyelids for 12 minutes can have effects lasting a year?

Did the doctor explain what impact the lipiflow has on your glands?

[Fenix]

Thanks for replying. I am not too familiar with the technical aspects of the lipiflow machine but as far as I understand it’s the same as warm eye compress? I don’t understand how warming your eyelids for 12 minutes can have effects lasting a year?

Did the doctor explain what impact the lipiflow has on your glands?

Before having LipiFlow I said to the doctor that I already have a Blephasteam device, but he said that they are not the same thing without giving any details.
The feeling of the treatment is similar to blephasteam plus an internal and external massage of the eyelids.

This is a description found on google:
"LipiFlow Thermal Pulsation Treatment
LipiFlow is an innovative, FDA-approved procedure designed to treat the root cause of Evaporative Dry Eye, blocked or deteriorated meibomian glands. Opening these blocked glands can allow them to resume natural production of lipids needed for a healthy tear film.
LipiFlow works by applying precisely controlled heat and adaptive pressure to the inner eyelid encouraging your body to resume the natural production of lipids needed for a balanced tear film.
In a clinical study, 80% of patients reported improvement of their overall dry eye symptoms within four weeks, ranging from 10% to 100% of improvement in all evaluated symptoms.
Each LipiFlow Thermal Pulsation Treatment Session lasts 10 to 15 minutes during which the machine delivers a gentle and comfortable massage to the inner eyelid. With virtually no treatment-related complications or unpleasant side-effects reported, LipiFlow can be safely done on patients of any age or skin type."

[Alix]

Thank you. I’ve just seen some interesting videos on YouTube on this but its hard to know what the truth is as quite often people who recommend it are optometrists/eye doctors themselves who have financial interests. I would be interested to hear from people who have had similar success with Lipiflow.

[gilles]

I mentoined dry eye centers to the specialist I am visiting, and he told my he does not believe in IPL nor Lipiflow, he puts his trust in science. I guess what he meant, or a way of interpreting what he meant is: IPL nor Lipiflow have the required science literature to convince him enough for their use. This is the reason why one should try the other chronological steps that I mentoined earlier first. He added: but you are free to test IPL and Lipiflow, if it helps you I'll be happy for you, and you may inform me of the results.

My hypothesis of IPL and lipiflow is that it might get deep enough and hot enough to melt the sebum/bacteria in the blocked glands, releasing/unblocking and thus stopping the cycle of inflammation. Another aspect is that the lights (laser) might be similar to sunlight (and sunlight has UV-induced immunosuppressive and anti-inflammatory aspects).

I should add, in my case he points to my skin type (oily), prone for ocular rosacea and too much sebum secretion (acne/blocked glands). Also screen use affects the blinks (staring), thus not helping in this situation. Methods to counter this:

• warmth compress (did not work for me, also tried blephasteam),
• minocycline (doxy),
• cyclosporine eyedrops (drop the auto-immune reaction, which is inflammation => rosacea and inflamed eyelids if I am not mistaken),
• eyelid hygiene (e.g. blephasol, but I don't do the routine, as it irritates the eyelids and does more bad than good).

[Alix]

I believe IPL and Lipiflow work in different ways so we cant put them in the same category. Based on my experience here in the UK, optometrists and ophthalmologists say its worth giving IPL a go though there is no guarantee it will work for everyone, whilst every single one has told me Lipiflow is an expensive waste of time.

That is why I am interested in hearing from people for whom it has actually worked.

I would say that most people who go ahead with Lipiflow are those who have tried everything else including what is in your list and nothing has worked. It is the last resort as it is very expensive, basically £100 per minute.

[gilles]

I believe IPL and Lipiflow work in different ways so we cant put them in the same category. Based on my experience here in the UK, optometrists and ophthalmologists say its worth giving IPL a go though there is no guarantee it will work for everyone, whilst every single one has told me Lipiflow is an expensive waste of time.

That is why I am interested in hearing from people for whom it has actually worked.

I would say that most people who go ahead with Lipiflow are those who have tried everything else including what is in your list and nothing has worked. It is the last resort as it is very expensive, basically £100 per minute.

Both are being sponsored by big pharma groups, rather than science driven. This is why the specialist I am seeing kind of grouped them, and did not want to give me or anyone else false hope.
I don't know what your diagnosis is, but if the suspected origin is your skin type (mostly reflects in mgd and or ocular rosacea) and or outside factors (screen use, wind, dry air, allergies, etc.) then you could also go further in that direction. On the other hand, in my case, knowing you can't change a skin type, one can try attributes like moisture chamber glasses for in- and outdoor, humidifiers at home and work, diet (flaxseed, sunflower seed, avoid chocolate, avocado; as per anti-inflammatory and gland function influence), reduce screen time, change job. While doing these, also try to find out if there is no other origin: bad eyesight, eye-pressure deficit, auto-immune deficit, check blood results (vitamins, inflammations, allergies, hormones...).