Dry eyes and running out of ideas

[Loldo]

I have had trouble with dry eyes for around 4 months now. I believe it began with an allergic/irritation reaction to an apartment I used to stay in from time to time. To begin with I would get sore, dry eyes after a few hours in the apartment, which would get back to normal gradually over 2 days of being back in my own apartment. This persisted for around one month.

Then I visited the apartment a lot for around a week, and had dry eyes the whole time. Following that I moved to another city and haven't visited the apartment once since, however my eyes have never got back to normal. I assume the initial cause was an allergic reaction however I did not have red eyes or swelling and also no itching (all symptoms I know are associated with allergic reactions) only dryness. Could this be an allergy? Also why are my eyes still dry months after leaving the apartment which caused the reaction??

Currently i use preservative free drops almost ever 20 minutes and manage to control the symptoms most of the time, however if I am without drops for a few hours or in a very hot dry environment I end up in severe pain.

I was wondering if anyone has experienced something similar/has any ideas as to what this could be? I have no history of allergies and am only 24 years old. Been researching for a while and tried many allergy drops and steroids to little/no avail.

I have good days and bad days, as I imagine many of you do too but I am worried this could be a permanent condition and would do anything to get back to normal (or thereabouts...)

Thanks to anyone who can help!

[rmalecki]

Have you ever had any type of lizik surgery? I know of people that have had dry eye show up several years after the surgery. I am experiencing dry eyes from lazik and have to wear wrap around glasses to go outside now.

[Loldo]

No I haven't. Nor do I wear contacts. I am 99.9% it was a reaction to something at the apartment - allergic or not I do not know...

[littlemermaid]

London docs

How far have you got with ophthalmologists and optometrists? Anyone given you a dry eye, tear film, lid margin, meibomian gland assessment you're happy with? Who prescribed your steroid - was it FML or something stronger? Happy to PM if you want to.

[Loldo]

I have a friend who is a consultant who I have seen and who prescribed the FML drops. He did not do a schirmer test but I think he did the test with the dye in the eye?? Not sure. I think he based most of his diagnosis on my history and then gave FML. He has offered to try and find a colleague who knew more in this area... If and when i see that person I will have much more of an idea what to ask about so hopefully I can get a more satisfying diagnosis.

[littlemermaid]

FML controls inflammation until you can find out if you've got meibomian gland dysfunction. Make sure your intraocular pressure (IOP) is checked during first week, then regular intervals according to judgement of eye doc. A dry eye ophthalmologist who can diagnose is still a rare bird. How about Moorfields NHS or private, at least they have dry eye research.

A dry eye assessment optometrist is a rare bird too. Although interestingly, high street laser clinics are supposed to assess before they 'recommend' for surgery and 'treat' any resulting short term problems before they sneak them off to their private long term disaster clinics. Dry eye diagnosis appears in the recent optom exam papers now, unlike RCOphth.

If you are in a PCT that has them, you might get good ophth triage and 'which consultant' advice through The Practice plc on an NHS pathway, like we did (through GP or any optometrist referral). If you're having a terrible day you can turn up at Moorfields or Western Eye A&E. Long term efficacy of this depends who sees you and how busy they are, but it's always an option if you need them for inflammation out of hours.

It'll be OK when you find docs you are comfortable with. We've got consultants in family and friends. Hmm. Don't let that hold you back from shopping around if you want to because your needs are the priority, once you know what they are. You can do that through NHS Choose and Book GP referral. Wish you the best.

[y-gwair]

It was probably just a coincidence that it started while you were staying in a particular place, maybe the dryness had started a while before, but you noticed the discomfort more in a more irritating environment.

I wasted so many years not looking into my eye problems because I assumed they were allergy-related, until I finally got diagnosed with autoimmune problems (and dry eye was probably the first early symptom). I'm not saying that this is your problem, but dry eye can be related to immunological or hormonal changes which come and go quite a lot in the early stages (mine started in my mid-teens). If it was purely an allergy/sensitivity, the problem would disappear very soon after you stopped exposing yourself to the allergen. Even damage caused to a normal eye/cornea by caustic substances will heal well after a couple of weeks.

[littlemermaid]

I was thinking that too. Don't you think with MGD, it sometimes seems like an event - bacterial, allergic sensitivity, hormonal, viral, autoimmune change, systemic or topical drug reaction, dermatophyte - sets up an inflammation response? I got dust allergy cleaning out an old library and the response is now much less but still there. Like flicking a switch.

Drops every 20 mins to keep the eye from drying, needs help while seeking a good doc. We are using a humidifier and prescription wraparounds.

[y-gwair]

Yes, inflammatory conditions usually follow a flare/remission pattern (certainly I've found my eye flares alone very often follow viruses); the main flares correspond very closely to the levels of antibody activity.

If there is another condition causing the dryness (such as hypothyroidism) it's quite important to get it diagnosed/treated early on - I suffered without treatment from my mid-teens until the age 35 when my problems eventually started to be diagnosed.

[littlemermaid]

Y-gwair: do you think your thyroid function is related to the connective tissue disorders?

[y-gwair]

Yes, they are related autoimmune conditions, something the rheumatologist has confirmed.

[Loldo]

I didn't explain fully why I believed it was allergy related, and this weekend I have finally (i think) worked out what it was.

Firstly I was not staying in the apartment, it was my girlfriends and i stayed there maybe once or twice a week. Each time my eyes would end up watery and a bit stingy, like when you blow menthol in your eyes, making it hard to even keep them open for more than a few seconds. They were not red or itchy at all. After going back to my own apartment they settled down to perfectly normal after 1 or 2 days. This happened every time like clockwork - exactly as an allergy would. Then I had exams, and couldn't afford days where I couldn't read, so stopped staying with her for maybe 4 weeks, and my eyes were perfect the whole time, then after the exam, I stayed there and the next morning my eyes were in agony again. As I had no exams and hadnt seen her much for weeks, and know I was moving away in a week I stayed there every night in spite of my eyes, thinking it was one week more then they would get back to normal.

I moved to another city after that, and didn't see her at all for a number of weeks, but my eyes never got back to normal. they were always a bit dry and sore. My theory now is that the allergy somehow affected my meibomian glands, and after that week of constant dryness and pain they must have got blocked (or maybe something else, I'm not sure of the possibilities), hence the continued dryness.

However this weekend I visited her in her new apartment in a different country and my eyes flared up again! This was the morning after the first night I stayed with her. On a hunch from something a friend had suggested, we decided to avoid latex (condoms) for the next couple of days and after maybe 1 full day my eyes were getting better, even though I was around her the whole time, and now 2 days later they are back to the way they have been since I moved away the first time -not perfect but better than during the reaction itself. So now I'm fairly certain the allergy was to latex, however I'm still a little unsure how to go about treating the general dryness that seems to have been left as a hangover from the original reaction.

If the glands are clogged I have read that compresses and expressing the glands can solve the problem completely, so I'll try that. In case that doesnt work does anyone have any suggestions. Has anyone heard of allergies that affect only the meibomian glands before, or eye allergies that cause eye irritation without causing any redness whatsoever???

I am cautiously (as ever with every new idea) optimistic as this is the best evidence I have found and the surest I've been as to what the cause is, so here's hoping!!!!