Some questions (some easy, some hard) ... appreciate the help!

[tommyboy]

I have been reading posts, blogs, and tons of good material on this site, which has been VERY helpful.

I have posted a couple messages .... and got some GREAT responses and help. I have some more questions I was hoping folks could help answer.

Quick summary: 5 months+ post LASIK with dry eye. Here are some questions I was looking for help with (please):

1) I took Rebecca's advice and started "buffering" before (and after) I put my Restasis in. And I am using the "Unisol 4" as suggested on this site. I bought the 3 pack of 4 FL OZ bottles. It's a very big bottle - am I supposed to use this big bottle as I would any other drop bottle? That is what I have been doing, but it is so big and the drops come out so fast, its a bit "tricky" to get the drops in. I know I am supposed to can the bottle after 30 days as there are no preservatives. But I am using them correctly?

2) I have not been putting any gel or ointment in at night (I was using refresh PM for awhile, but stopped). I put a drop of preservative free blink in each eye, hold it in my eyes for around a minute and then goto bed. (I sleep pretty easy as I am currently taking Remeron). When I wake in the morning, my eyes are dry, but they are not killing me. I simply go to the bathroom and put one drop of the blink in each eye - and that is simply the best feeling ever. But it is really the only time these blink tears actually feel good. My doctor said I need to put them in every four hours ... and I have been doing that. But - they never feel good. It's not like, wow... that's refreshing... like it is in the morning. I am told these Blink drops help with the lipid layer and that is why my doc suggested them. I have tried many other drops... none of them really do all that much - most often they just bother me. I am stumbling with what the heck my question is... if I keep wearing my new moisture goggles do I need to put these drops in every four hours even if I do not think they help?

3) I have a question in regards to tear quantity. My doctor said she is solving for both tear quantity and quality (Restasis and warm compress and scrub). I am not sure my MG's are blocked. I guess I need to get that mirror that someone suggested (I think it was Hopeful2). But when I look in a regular mirror I can see a noticeable difference between my left and right eye. My right eye is really the one that bothers me. In my left eye I can see the tear sitting in my lower lid (both eyes semi permanent plugs). But my right eye, I barely see anything. I can see something, but like half of what I see in my left eye. It's crazy when I talk to people, I look at there eyes... my wife's eyes they are SO glossy and I can see the millimeters of tears in her eyes (I am SO jealous). So, do I keep doing the warm compresses? Is there anything else I can do to create more tears?

4) Restasis question. I have been on it for 4 months. I am not sure if it has helped and is helping. And it costs a fortune. Can I stop using these drops and just see what happens? and if it gets worse just start using them again, and if I do that, will I need to wait another 3 - 4 weeks for them to kick back in again?

5) Fresh Kote question. I saw another doctor (corneal specialist) not affiliated to my LASIK center and he said I could try these drops and I did fill the prescription, but never used them as I read some reviews that they burn. I am already dealing with enough burning. Any advice on this? Should I try them?

6) Eye massage after warm compress. I am using the rice baggy trick (pretty cool). And I keep reading about people doing eye massage after the compress. What is that? Can someone point me to a link or post that describes what that is?

Sorry for the long winded post and questions. But, I promise ... once I get smarter on this subject I will return the favor to others and help other people out as they have been helping me.

Thanks,
Tom

[Guest]

2) I have not been putting any gel or ointment in at night (I was using refresh PM for awhile, but stopped). I put a drop of preservative free blink in each eye, hold it in my eyes for around a minute and then goto bed. (I sleep pretty easy as I am currently taking Remeron). When I wake in the morning, my eyes are dry, but they are not killing me. I simply go to the bathroom and put one drop of the blink in each eye - and that is simply the best feeling ever. But it is really the only time these blink tears actually feel good. My doctor said I need to put them in every four hours ... and I have been doing that. But - they never feel good. It's not like, wow... that's refreshing... like it is in the morning. I am told these Blink drops help with the lipid layer and that is why my doc suggested them. I have tried many other drops... none of them really do all that much - most often they just bother me. I am stumbling with what the heck my question is... if I keep wearing my new moisture goggles do I need to put these drops in every four hours even if I do not think they help?

I assume it's probably a good idea to use some kind of quality lubricant every 4 hours as a precaution... the nerves in your flap won't have fully grown back yet, so your eye may be more irritated than what you can feel at this point... Maybe experiment with different brands of preservative-free artificial tears?

Is there anything else I can do to create more tears?

You could try a high quality omega-3 supplement (they are anti-inflammatory)... read the labels carefully to be sure you're getting a worthwhile dose of omega-3's though. I take about 4.5 grams of omega-3's per day... many brands will have too low a dose to do anything. It is controversial whether or not fish-based omega-3 or flax based is better. Our bodies have a tougher time breaking down the flax-based omega-3's... fish oil omega-3's are more easily used by the body... fish oil isn't always tolerated that well though (gas, fish burps, nausea etc) but how well you tolerate it can very enormously from brand to brand (you can have horrible nausea/fish burps with one brand, and no side effects whatsoever with another)

Restasis question. I have been on it for 4 months. I am not sure if it has helped and is helping. And it costs a fortune. Can I stop using these drops and just see what happens? and if it gets worse just start using them again, and if I do that, will I need to wait another 3 - 4 weeks for them to kick back in again?

If you stop, then theoretically, any beneficial effects will slowly dissipate... if you restart, yes, you'd have to wait for it to kick in again.

Regarding the high cost, you can trim that down a LOT by re-using each unit-dose vial until it's empty. Many, if not most of us, do this. Just be very paranoid about not touching the dropper tip (which would contaminate it and increase your risk of infection)... for me, if I accidentally touch the tip, I throw away that vial.

Fresh Kote question. I saw another doctor (corneal specialist) not affiliated to my LASIK center and he said I could try these drops and I did fill the prescription, but never used them as I read some reviews that they burn. I am already dealing with enough burning. Any advice on this? Should I try them?

Everyone is different... if I were you, I'd give it a try.... you might be one of the lucky ones, right?

[Rebecca Petris]

You can buffer the Freshkote the same way as you do Restasis. I haven't used Freshkote in years but I still use Dwelle and if I'm using it first thing in the morning I sometimes first douse my eyes with Unisol 4. I'm (obviously) a big fan of Dr. Holly's drops and think it's certainly worth at least trying.

[PotatoCakes]

I had a doctor tell me that it can take 6-9 months and even more for some patients to increase tear production through Restasis. To be safe, I'd try it for at least a year before giving up and as SAAG suggested, try using vials more than once. I use a compounded version but when I used the vials, I kept open ones in a shot glass in the fridge.

[Guest]

Yes, I had seen studies showing continued improvement up to 6 months before things leveled off...

[tommyboy]

Thanks everyone for the responses! SAAG I am taking fish oil, have been for four months (3000 MG's per day). Today was a good day so far. I even worked out today .... first time in two weeks! and I wore the Oakley goggles I am still borrowing during the workout. I am going to also try the 7eye's again and look for some wiley x's before spending a few hundred bucks (as I need RX).

I also decided to give the FreshKote a try (started today at 1:00) ... Rebecca, I took your advise and did the Unisol buffer first. So I will keep folks posted on how I do on the FreshKote.

Lastly ... I will take the advice and stick with the Restasis as well. I have been using the vial more than once - putting the vial in a shot glass in the fridge - I saw that recommendation on here a couple weeks ago and have been doing that.

Appreciate all the advice and support! You guy's are great