Here I go again another doctor.

[angt]

I went to a dry eye doctor. This will be my 8th doctor in last 6 months. I have post lasik dry eye. The other doctors have all said: I don't close my eyes all way, shermier test is 4/5 without plugs, I have wrinkles on the white of my eyes, I have staining, I have mgd. So I go to this new doctor tell him all this stuff and he tells me. My eye closing is fine (everyone from time to time has the same problem. My shermier test came back soak & wet, I have all 4 ducts closed. He said the wrinkles are not be problem that would feel like sand or a rock in your eye and I don't seem to have that problem to often. I have dryness & pain!!. He said my oil glands are working just fine and my tears at this point are good. My eyes look good he said I would never guessed I have a problem by looking at my eyes. He said maybe even have the top plugs taken out after winter. Not sure about that though. He said mine is all nerve related from the lasik. He said when they cut the cornea that the nerves come back funny sometimes. I might have one thats a nub and never came back all the way. That can cause the pain in the eye and he said that it can also cause the dry eye in lasik patients. He told me that its all nerve related and does not believe I have a dry eye issue. (I sure think so but anyway) His advice was to try to ignore it. Log my pain everyday and come see him in 4 months. Do you think there is any truth to this? I am so confused. How do I get all these different diagnoses from different doctors? Well I am off to FL to see my 9th doctor. I can't give up I don't want too! Good Luck to everyone out there and stay positive. Its hard but we have too!!!!

[Rebecca Petris]

Do you think there is any truth to this?

Yes. I can't comment on what he says about the other conditions but I do believe that in many post LASIK patients it really is nerve related more than anything.

It doesn't mean the others were wrong. It's just that a POSSIBLE scenario is that the other things doctors have pointed to are mild (clinically speaking) and none is explaining your pain adequately. That may or may not be right in your case but it makes a lot of sense.

"Ignore it" is not exactly a treatment plan for someone suffering from significant pain.

How do I get all these different diagnoses from different doctors?

Honestly, the more doctors you go to the more diagnoses you will get. That's unpleasant but it's the reality. Each one will have different experiences, and each one may reflect their own experience and in some cases 'pet' diagnoses where they have the most expertise. They all may get an element of the picture - true picture - but not the complete picture. In a challenging health situation often it's up to us as patients to put together the composite. With post LASIk dry eye (and some other types) this outcome is inevitable because the pain does not correspond to any blatant clinical signs and so at the end of the day it's all about the doctor's opinion, not some sophisticated professional guidelines.

I think sometimes (I'm not saying you're there but keep it in mind) there comes a time to stop the doctor shopping cycle and just roll with things for awhile. I understand the drive and the angst. But as a practical matter, trying too many doctors in a short time will hurt your credibility with the new one.

[Sammy B.]

Angt,

I'm pretty positive that we have nerve damage and that some of us feel it, while some of us don't.

See one more doc and then throw in the towel on them for a while. Head to a pain management doctor after that. Find something that works on the pain and stick with it. Many have reported success with pain meds and you could probably forget about your eyes for a while.

You are not out of options.

- Rose

[Sammy B.]

I have a question

Angt,

I got to thinking about you last night and I am curious - didn't you go to see some bigwig doc a while back (was it someone at the Mayo Clinic?) and they put a bandage contact lens on your eye (or maybe both)?

I don't really think an eye doc is going to place a BANDAGE CONTACT LENS on an eye that has zero staining and no obvious signs of dry eye.

Just my $.02

Talk to Dr. Hector. Ask him about the possibility of nerve damage being the only issue in YOUR SPECIFIC CASE. Please report back whether it's on this thread or by PM'ing me. I'm totally curious.

- Rose

[Rebecca Petris]

Well Rose you and I were both on the same track last night. I was thinking about this post last night too, when I was working on my newsletter, especially when I ran across the blurb about another doctor pursuing the conjunctivochalasis (wrinkles) angle for dry eye symptom people.

It's such a classic instance of this trend I'm seeing more and more lately and which has been turning various wheels at the back of my brain somewhere....

If push comes to shove, doctors can probably find 4-5 things wrong with some part of the tear production or distribution system. But at the end of the day, are any of those actually responsible for our pain? And if so, are they causing it directly or indirectly?

Most of those things they find wrong are things that loads of people with NO symptoms also have. (This is something we forget to think about with doctors... while they occasionally get people like those here with loads of symptoms and few clinical signs, they also - and probably more frequently - get people with loads of clinical signs and no symptoms!) Next question: irrespective of what's causing the pain, will improving any of those identifiable problems (going after the lowest hanging fruit first) reduce our pain?

Mysteries, mysteries. Until we have answers, often the best relief we get is from lubing up, covering up, cold compresses and the like.

[Rebecca Petris]

And one more thing

He said mine is all nerve related from the lasik. He said when they cut the cornea that the nerves come back funny sometimes. I might have one thats a nub and never came back all the way.... Log my pain everyday and come see him in 4 months.

By the way, if you can get looked at through a confocal microscope they could confirm whether this is in fact the case for you.

Logging pain is a good idea.

[Sammy B.]

Rebecca and Angt,

I totally agree that regardless of the clinical signs, what is going to reduce the pain? In my esteemed opinion , that is a pain medication in drop form that can be used to dull the front of the cornea somehow. I hope it's in the works. I have everything crossed for that.

I guess that is why I suggested that Angt see a pain management doctor. I mean, I recently read in one of Lucy's posts that she started taking Lyrica for something and realized she hasn't thought about her eyes as much. QUEEN LUCY!! That has to be a sign of something. I won't speculate too much and I'll just hope she adds her $.02 to this thread at some point.

I agree that tracking the pain is a good idea. Something I have thought about doing myself. It totally varies from day to day and that is BIZARRE to me.

Also, I notice more pain when I am Googling LASIK and its effects. Must....stay.....away...... Must...get... used to....the new eyes.....

- Rose

[angt]

Thanks you guys I will go see doctor Hector and see what he has to say and take it from there. I know I have been to a lot of doctors but I just don't want give up. I keep thinking one of them has to have something for me. I have considered pain meds but I want to wait a bit first and see if the pain gets any better. It has its on & off days. The doctor out at the mayo was nice but did not give me much of his time. I felt rushed and he gave me two options the bandage lens or scarel lenses. He hardly looked at my eyes the way some doctors have. I will get back to you Rose. Thanks!

[msny]

Angt,

I'm pretty positive that we have nerve damage and that some of us feel it, while some of us don't.

See one more doc and then throw in the towel on them for a while. Head to a pain management doctor after that. Find something that works on the pain and stick with it. Many have reported success with pain meds and you could probably forget about your eyes for a while.

You are not out of options.

- Rose

Yep, i know for a fact that my dry eye, in my right eye was
caused when my doctor put in a scalar buckle for my retina detachment.

I have very little feeling in it, buts its sore and blurry as the
dickens most of the time, since 2001. I'm using a lot
of steriods from time to time to combat Iritis infections, I get
once or twice a year now.

My lid also droups a little down, but I cant do anything about it.

It seems like the two doctors I've seen look at dry eye as
a result of treatment, that we just have to live with.

A third doctor I've seen, a double vision specialist, got me
going with Azasite, rice baggies, fish oil and Restasis. Those have helped
a lot. So I'm staying with him.

[Raginator]

By the way, if you can get looked at through a confocal microscope they could confirm whether this is in fact the case for you.

You read my mind, Rebecca.

Has anyone on this site had a confocal microscopy?
Aberrantly regenerated nerve fibers???
What do aberrantly regenerated nerve fibers look like?
Can a confocal microscopy prove the existence or absence of aberrantly regenerated nerve fibers?

Can a doctor look at a confocal microscopy and say (with 95% certainty), "There's the problem, right there!"

I'm just throwing questions to the wind.

[Michael2]

i'm just gonna add something here...

i did not have LASIK but...
when I was at my worst, I was in pain...I mean reallly really bad pain.
i'm still in pain but its 1/100th of before.
yet my clinical signs have not changed at all except maybe very very little increased tear film stability, that even to the trained eye looks no different. my corneas have always looked pristine. of course my glands were working at 10% and now are up to 50% so it seems that MGD alone can cause significant pain in some people. also, every doctor told me my glands were perfect except Dr Carver and Assil...wow when nothing came out, that means theyre not working? who would guess

I know LASIK can affect the nerves, but it's also important to note that clinical signs or lack of them don't always point you toward where you want. i think the best you can do is try to garner similarities in symptoms to other people so you know what you may have, and then treat the problem via the shotgun approach (treatments for evaporative dry eye, aqueous deficient, as well as the pain (pain management)) good luck