Lasik and MGD: how explain the connection?

[indrep]

Evaporative dry eye is not only related to lipid production. In LASIK there is speculum placed with high suction on the sclera and conjunctiva. the conjunctiva is responsible for production of goblet cells. Goblet cells secrete the mucin. Without the mucin layer to hold tears to the ocular surface the tears will evaporate rapidly or just not coat the cornea which is seen as evaporation by the clinician. So what may be described as evaporative dry eye is really noncoating tear film related to decreased mucin production. As the conjunctiva heals and goblet cell densities increase the tear film begins to recoat the ocular surface, this why many people post LASIK "heal" their dry eyes after about six months.

[unicorn]

Indrep, this is what I was told before: that the allergic reaction I had to the contact lens solutions had disrupted goblet cell function, which in turn increased tear evaporation. (I was actually told my problems were 50/50 MGD/goblet cell dysfunction).

I'm not sure how long the conjunctiva takes to heal though; it seems I still have problems in that my conjunctiva are certainly inflamed (and therefore, I would assume, not producing healthy goblet cells). It is also possible I am allergic or hypersensitive to other chemicals to which I'm still being exposed.

I still need to find a good ophth to discuss this all with.

Littlemermaid, no I haven't been tested for bugs: no-one's even mentioned it as a possibility. I will certainly raise the question next time I am seen.

[sunshinelover]

@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!

Yes, I have read this too in a study, most MGD are asymptomatic. but I don't know if this means that it is an early stage and that all people will sooner or later have symptoms. Or if only some get symptoms?
Actually when I was visiting my hairdresser that I have been seeing for like 20 years I told her of course about my new eye problems, since I didnät wear make up and had to be careful with hair spray etc.... She told me that she had to express her glands every morning, and that in on eye toothpast like meibum was coming out each morning and that it was such a releif. Other than that she had no problems at all, and could wear contacts as usual without any discomfort. The reason she had started with this, however, was a nasty virus infection in her eye, that luckily went away. She thought that hormones could have been a trigger since she had gone to 7 IVF tries.

[Charon]

To littlemermaid: I'm not sure why Restasis ended up giving me yellowish eye goop. It was more whitish-yellowish, actually, so I'm thinking it was actually mostly the restasis that wasn't absorbed. It's gotten better now, but I still get some eye goop (maybe I put in too big of a drop at one time).

I don't think I have an infection due to contact lenses. I haven't worn them in months. I've seen two opthamologists, and both agreed that I didn't have an eye infection--the redness was from ocular rosacea, MGD, and the resulting irritation (plus some allergies thrown in the mix). I am seeing yet ANOTHER opthamologist on Friday (this is sort of my "last resort", in a way--if he doesn't help me out, I should probably stop obsessing about finding a "cure" and accept that at age 26 I will never wear contacts or eye makeup again). I will definitely ask about an infection or about any testing he can do.

I am wondering if it may be more allergy-related than I initially thought. It is very weird that when I go over to my parent's house and stay there for the weekend, my eyes are clear and feel great. But when I am at work, they become super red and irritated (the lower lids get so puffy and sore and red that I want to cry). I don't know.

[littlemermaid]

Charon, Good luck Friday - hope you have a useful consultation. Our eye doc is thinking maybe we should all describe this as sensitivity rather than allergy.

[Charon]

Thank you very much! Yea, sensitivity is probably a good way to phrase it. everything works together, so the allergy/sensitivity worsens the symptoms of the MGD, etc. One thing I am curious about is demodex and possible treatment for that. Neither opthamologist mentioned anything about demodex or tea tree oil, but I've been reading some stuff recently that makes it seem like demodex can be a big factor in blepharitis (including posterior blepharitis/MGD). I'm wondering what else they neglected to tell me!