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Treatment for Post Lasik DES (Many Queries)

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  • Treatment for Post Lasik DES (Many Queries)

    Hi All,

    Background - Right eye Lasik in year 2002 (350degrees), Left eye Lasik in year 2004 (150degrees).

    Year 2005 -2008 : blinking increases but did not encounter dry eyes, thought it is tired eyes, been using ordinary eye-mo.

    Year 2009 : dry eye worsens

    Started Medication as follows
    Dec 2009 - Dec 201 0
    - Retasis twice a day
    - Refresh+ as when needed, normally 1-2 tubes/day
    - Visdic gel @ night

    Seeing no improvement, increase Retasis to 4 times/day

    Dec 2010
    - Increases Retasis 4 times/day
    - Refresh+ as when required (normally a tube/day)
    - Visdic gel @ night
    - Theratears capsules x 1/day

    Seeing no improvement, switch to Systane and Duratears gel

    April 2011 ( Schirmer score is 4)
    - Retasis 4 times/day
    - Systane 4 times/day
    - Refresh+ as when required (normally a tube/day)
    - Duratears gel @ night
    - Theratears capsules x 1/day

    Seeing no improvement, try using 2 x lower plugs

    July 2011
    - Retasis 4 times/day
    - Systane 4 times/day
    - Refresh+ as when required (normally a tube/day)
    - Duratears gel @ night
    - Theratears capsules x 3/day
    - 2 x Lower plugs inserted
    - 5mins warm compress twice a day


    1.) My Schirmer score is 4, i assume i fall into the 'moderate to severe' group?

    2.) My DryEye specialists diagnose me as having 'punctate epithelial' and 'lesser nerves' due to lasik surgery. No mention of MGD / posterior blepharitis.

    In this case, does warm compress still help? Since i do not have MGD and my root cause is probably the nerve?

    3.) Should i focus in growing the nerves by consuming more Theratears 3 x capsules/day? Since DHA found in Omega3 helps in regenerating the nerves?

    4.) What are the chances that the nerves could be damaged and can not grow back/regenerate again since i wasted 3 years before i start proper treatment?

    5.) Is it true that nerves take a long time to grow back? say 5 years timeframe?

    6.) Judging at my condition, is there a chance of full recovery? My Dry Eye specialists mentioned can only control it, unlikely full recovery.

    7.) With the 2 x lower plugs inserted, i can feel the Retasis burn/sting more. Is this better sympton? With this sympton, i tend to use more Refresh+ for relief too.


    Method A - Retasis x 2times/day (without 2 x lower plugs), together with Refresh+. Refresh+ 1st, 5mins interval followed by Retasis. Refresh+ uses ~one tube per day.

    Method B - Retasis x 4times/day (with 2 x lower plugs), i need to use Refresh+, Systane together with Retasis, 5mins interval in between 3 kinds of eye drops

    However method A, at evening times after work @ 6pm, my eyes will feel very dry, using Refresh+ will not improve much till i use back Retasis.

    Method B can have much relieve throughout evening time.

    I am thinking whether should i go back to method A, less relying on Retasis, prefer my eyes to try to create own tears instead of relying too much Retasis.

    9.) How can i tell when Retasis starts to work on me? when i feel more eyes are much watery?

    10.) Is it true that Retasis can help to generate the nerves?

    the effects of the immunosuppressive agent cyclosporine 0.05% (Restasis; Allergan) on corneal sensitivity, he found that this drug might actually have a beneficial effect on corneal nerve regeneration, in addition to its use as a treatment for dry eye.

    11.) Using Retasis, after 2-3hrs, i can feel the burning/stinging feeling. Sometimes i do not know if this is due to dry eyes or the side effects of Retasis.

    I use my eye blinking to judge it, if i blink every 1-2 sec, i will assume it as dry, followed by applying Refresh+.

    Is this correct?

    12.) My Dry-Eye specialists prescribed Systane x 4times/day, sometimes in hot weather, i feel the Restasis burn/sting more. Using Refresh+ will not help much, can i just use Systane more than 4times/day? I read the instructions, there is no limitations to 4times/day.

    13.) Using Refresh+, if i do not wipe clean the excess, i noticed it will dry up and form/crystallise some whitish on my eye lips, is this common? i noticed this forms more now with my 2 x lower plugs inserted.

    14.) I noticed doing more exercises, especially when i run, my eyes feel less dry.

    15.) As for diet, i am drinking plenty of water, especially green tea which contains antioxidants which helps in dry eyes. Cutting down on sweet drinks and caffein. If there any other food which helps? Some kind forummers mentioned about in eating raw vegetables.

    Thank you for any kind replies. Pardon me for so many questions.