Lasik and MGD: how explain the connection?

[bakunin]

I did a quick search on the forum and didn't find a thread about it, but i think i saw some discussion about it in some thread in the past.

I wonder why Lasik results in MGD.

Most post-lasik dry eyes sufferers have evaporative dry eyes, and most evaporative dry eyes sufferes have MGD. But i can't figure out the connection between a cornea surgery and the dysfunction of glands in the eyelids.

[patrick]

hi bakunin,

to my understanding the whole tear,blink and lipids system is mainly controlled by the nerveendings in your cornea's. once these nerveendings are for whatever reason cut or severed (like in refraction surgery) and do not regenerate to baseline level you have contracted dry eye disease for life.

patrick...

[sunshinelover]

Bakunin,
I read in another thread that you had no problems for six years. What have the docs said? Do they say this is related to the LASIK surgery? Do you have the MGD diagnose? And what age are you? Just wondering since I had refractive surgery in the 80s (yes, one of the pioneers...) and had no or problems (well, minor like fans, dry air and such but that's only on very few occasions). And no one doc said my dry eyes was a function of the surgery and age (50) - but I can't really buy that, it should't be such a dramatic change then I think.

I mean, only a year ago i could use the computer day in and day out without any trouble and WITHOUT and glasses although my vision wasn't perfect.

[bakunin]

Bakunin,
I read in another thread that you had no problems for six years. What have the docs said? Do they say this is related to the LASIK surgery? Do you have the MGD diagnose? And what age are you? Just wondering since I had refractive surgery in the 80s (yes, one of the pioneers...) and had no or problems (well, minor like fans, dry air and such but that's only on very few occasions). And no one doc said my dry eyes was a function of the surgery and age (50) - but I can't really buy that, it should't be such a dramatic change then I think.

I mean, only a year ago i could use the computer day in and day out without any trouble and WITHOUT and glasses although my vision wasn't perfect.

Hi sunshine,

One doctor said it's usual it happens because of Lasik (so in such a way he blamed Lasik). The second doctor said the same thing. The third doctor said nothing about Lasik, and said i was too young to have dry eyes (i'm 38 now, and was 37 when the dry eyes started). The third one, the one i trusted more, said Lasik was a factor but there was something more (he would investigate my eyes but i didn't come back to him because i was begining an homeophatic treatment). So I guess Lasik was a necessary but not sufficient factor.
I didn't get MGD diagnostic by those doctors (but they didn't even try a diagnostic). But i think i have MGD (i have evaporative dry eyes, I feel relief when i express my eyelids and with warm compresses).

I wish i could know for sure that my dry eyes have nothing to do with Lasik: first of all for not being regret about doing Lasik and being angry about that and about doctors; secondly because if Lasik has nothing to do i guess there is more probability for my eyes being healthy and normal again, or even to get better.

10 months ago my eyes were totally normal (no problem with ACs, fans, computer, lights), and i didn't need prescription lenses either.

[sunshinelover]

Yes, I am now six month into this mess. There must be something more to it, but I still hav,ny got a proper diagnos either, so I am planning to go abroad. I wonder where to buy moister glasses, never seen them in Sweden, Could they be worn outside glasses?
I tried cold compress för the first time today. Feels good, but only temporarily like everthing else.

[bakunin]

Yes, I am now six month into this mess. There must be something more to it, but I still hav,ny got a proper diagnos either, so I am planning to go abroad. I wonder where to buy moister glasses, never seen them in Sweden, Could they be worn outside glasses?
I tried cold compress för the first time today. Feels good, but only temporarily like everthing else.

I bought my Wiley-X (it works like a mositure chamber glasses) at the brazilian version of this site: http://www.smartbuyglasses.com/
I put prescription lenses on it.
This one don't fit over other glasses. I don't know if there is someone that you can wear over glasses.

[robster]

LASIK does not cause MGD but what it can do is set off underlying pre-existing MGD. You could have had mildly blocked MG's before LASIK but they never caused you any problems. After LASIK there is an initial reduction in tears and some dryness - everyone gets this. Those who may have underlying MGD then have the added problem of that initial dryness causing the MG's to become more inflamed and the more inflamed the MG's become the more problems you have with dry eye and vice-versa.

The LASIK basically sets off a vicious circle for those who may have the clinical symptoms of dry eye without having the physical symptoms. Many people have some blocked MG's and it never causes them problems until something irritates those blocked MG's. In the case of LASIK that is the irritant that sets off the underlying problem.

[sunshinelover]

LASIK does not cause MGD but what it can do is set off underlying pre-existing MGD. You could have had mildly blocked MG's before LASIK but they never caused you any problems. After LASIK there is an initial reduction in tears and some dryness - everyone gets this. Those who may have underlying MGD then have the added problem of that initial dryness causing the MG's to become more inflamed and the more inflamed the MG's become the more problems you have with dry eye and vice-versa.

The LASIK basically sets off a vicious circle for those who may have the clinical symptoms of dry eye without having the physical symptoms. Many people have some blocked MG's and it never causes them problems until something irritates those blocked MG's. In the case of LASIK that is the irritant that sets off the underlying problem.

Aha, well, then my problem is then probably not LASIK (since it was 25 years ago) but the fact that I the last year have hade increased dry eye problem in the winter in very dry locations (happened about 3-4 times) and then when I had to change office room and wihtout knowing it was sitting in a current stream from the ventilator in an extremely hot room for a couple of month dried my eyes out - and BANG, when the temperature hit minus 15 and the air got even more dry then my MG's got imflammed. it all started with sore lids in fact. I haven't really been able accept the fact that I had to sit in a bad working environment for so long has caused permanent damage to my eyes - it must be able to reverse it!!! Otherwise it is so unnecessary tragic...

[bakunin]

Aha, well, then my problem is then probably not LASIK (since it was 25 years ago) but the fact that I the last year have hade increased dry eye problem in the winter in very dry locations (happened about 3-4 times) and then when I had to change office room and wihtout knowing it was sitting in a current stream from the ventilator in an extremely hot room for a couple of month dried my eyes out - and BANG, when the temperature hit minus 15 and the air got even more dry then my MG's got imflammed. it all started with sore lids in fact. I haven't really been able accept the fact that I had to sit in a bad working environment for so long has caused permanent damage to my eyes - it must be able to reverse it!!! Otherwise it is so unnecessary tragic...

Sunshine,

we have similar stories.

My drye eyes started after i was being exposed six months to a strong current stream of a AC at workplace. It went straight to my eyes. I don't understand either how a bad working enviroment could lead to a permanent damage to my eyes. But i never had any sign of eyelids or glands inflammed.

And i don't undestand how Lasik could damage my MG and six years later!
So, i don't know how much that work enviroment and how much Lasik played a role in my chronic dry eyes. I think it will be a mistery forever.

We can put man on the moon but can't explain dry eyes.

[Charon]

LASIK does not cause MGD but what it can do is set off underlying pre-existing MGD. You could have had mildly blocked MG's before LASIK but they never caused you any problems. After LASIK there is an initial reduction in tears and some dryness - everyone gets this. Those who may have underlying MGD then have the added problem of that initial dryness causing the MG's to become more inflamed and the more inflamed the MG's become the more problems you have with dry eye and vice-versa.

The LASIK basically sets off a vicious circle for those who may have the clinical symptoms of dry eye without having the physical symptoms. Many people have some blocked MG's and it never causes them problems until something irritates those blocked MG's. In the case of LASIK that is the irritant that sets off the underlying problem.

Well put,robster. I think a lot of people on this forum are mistaking correlation for causation. My eye problems started about 9-10 months ago. Really came out of the blue--suddenly I had burning eyes, inflamed lids and zero tolerance for contacts (this is after wearing them for 14 years daily with no problems, including wearing them in the chlorine-infested pool daily as a swimmer). If I had had LASIK last summer (I was actually considering it), there is no doubt in my mind I would have blamed LASIK 100% for my problems. After all, what else could it be? My eyes were fine, then BAM! Miserable symptoms. But since I didn't have that done, I am left with the realization that sometimes MGD (or dry eye, whatever your case may be) can lay dormant for years then, for whatever reason, all hell breaks loose. There doesn't have to be a precipitating event. But obviously LASIK isn't "good" for your eyes, so it may be the event that triggers the worsening of symptoms.

EDIT: Also, I am 26 years old. So just because you are on the younger side doesn't mean you can't be afflicted with these problems. They don't have to be connected to LASIK.

[Joseph]

I had Lasik in 1999 and got dry eyes in 2010. I have been told by three doctors that there is no connection. Dry eyes like other problems can just happen. I would keep looking for a doctor who will help you find out whats going on. Not a doctor who say's " Oh well, thats Lasik " That is the I am not sure so what else can I say diagnosis.

[No tears in ATL]

Like the rest of you, I am completely frustrated because I can't figure out the cause of my dry eye. If I knew the cause (excessive computer use, eating the wrong stuff), then surely I could fix this, right?? The only thing I can link it to is 20-year daily contact lens wear. In 2008, I started to use those darn Acuvue Oasys lenses, supposedly good for dry eye. NOT!

And it was downhill from there. I swear it has gotten worse by the day, especially with my work environment being excessively air conditioned. Trying to be hopeful....

[robster]

@Charon a recent study showed that most MGD is symptomless. I can't for the life of me find the article now to post the link!

[unicorn]

In 2008, I started to use those darn Acuvue Oasys lenses, supposedly good for dry eye. NOT!

I too wore contact lenses for nearly twenty years including 6 years of Oasys lenses. Is there some reason you blame these lenses specifically? Do you know of some study which shows a link between wearing these lenses and the onset of dry eye?

I think I probably always had mild dry eye - for some years now - in fact it was one reason I declined to have LASIK in 2006, as they told me at the consultation I had slightly dry eyes although not bad enough that they wouldn't operate (thank god I decided against it). But no symptoms until, ironically, I reduced my contact lens wear around 3 months ago. Then.. like Charon says... BAM! Dry eye.

[littlemermaid]

Charon and Unicorn, I'm wondering if you've been tested and examined for infections that contact lens wearers can get? We know there was a Bausch & Lomb Renu formulation that didn't kill all the bugs - it must be a trade-off between bug-killing chemicals and healthy eyes. It was the swimming pool that got me thinking. I used to think an eye bug showed dramatically with red eye but no, and there are other bugs an ophth could be checking for that would give us unidentified grumbling keratitis. It's worth asking what they can test for and get them thinking about it.

Charon, I wonder why Restasis gave you yellow discharge? Which eye corner was that?