Dry eyes - post PRK - corneal abrasions

[DeployedPRK]

Good morning all,

I am currently deployed to Afghanistan, so I don't have many resources available. I appreciate any insight that you can offer into my situation that might help me avoid serious injury to my eyes over the long term. Here is my background:

1) PRK in 2010 - August or September
2) Took accutane afterwards (increased dryness)
3) Deployed to Afghanistan earlier this year

I have awoken numerous times here with my eyelids stuck to my eyes. Sometimes it is one eye, sometimes it is both. I noticed that allergy medicine aggravates this condition, so I stopped taking that. Usually the pain is intense but short lasting. I have tried numerous options to help keep my eyes moisturized including lacri-lube, a humidifer, celluvisc, and regular eye drops. No matter which combination I use I always seem to wake up with my eyes at least very dry. About once every two weeks I wake up with my eyes stuck to my eyelids and then I have the intense pain very similar to post-PRK pain.

I don't have an optometrist or opthamologist here, so I'm in a bit of a bad situation. Could you tell me if this is something that could cause long-last or permanent injury to my eyes? I did notice over the last few weeks that I've had difficulty focusing on things, but I am unsure if this is related. That problem doesn't seem to be happening over the last two days.

What could you all recommend for me?

Thanks

[Rebecca Petris]

Hi there and welcome.

Abrasions every couple of weeks is definitely something to be concerned with... you do not want this escalating into greater frequency & severity. Tough to have to deal with this when you don't have access to good eyecare (do you know when you might?). Check out some of the posts and blogs from people who have RCE on this site (recurrent corneal erosions) as they have lots of great practical tips.

I think that in addition to moisturizing your eyes you need to look at ways to immobilize your lids at night, and ways to re-moisten first thing in the morning, in such a way as to help prevent erosions. A simple step would be to tape your lids down at night with medical tape. Plastic wrap is another possibility if you can get some. Having something to soak your eyes/lids as soon as you wake is also helpful... the thing you want to avoid is either involuntary eyelid movements (eg during rem sleep) or opening your eyes so suddenly upon waking that your eyelids basically rip cells off the corneal epithelium. Back when I was facing this I would have some drops or even just plain saline next to the bed so I could reach out and grab it before opening my eyes in the morning and pour a bit on before opening my lids... it would soften things up enough to prevent an erosion. Also you might find that warm compresses e.g. with a warm wet cloth at night might help you get through the night better.

Re: focusing: Absolutely. Your epithelium is getting trashed by the erosions and the dryness and that's bound to affect your vision clarity and stability somewhat. It'll probably fluctuate a bit.

[DeployedPRK]

Thanks for the very helpful response. I'm going to try to get to see an optometrist as soon as possible.

One question for clarification -- If this keeps happening for say 5-6 months before I get home, could I be causing permanent damage, or is this something that is reversible when I get home?

[maf19]

Hi,

I have the exact same issue as you. I had PRK in November 2011 and have battled extreme dryness at night ever since. Thankfully my day time is fairly normal and the issue is limited to night. I've managed it to the point where my eyes always dry out at night, but my lids stick only about 50% of the time now, and a minor erosion may occur once per month or so. By minor I mean pain is usually gone in 20-30 minutes.

What I'm doing now that has reduced the amount of eyelid sticking is about five minutes before I'm ready for bed I put Systane Gel drops in. I let them coat for a few minutes, then follow it up with Systane Night Time ointment. I know it sounds like overkill but it almost seems like the ointment seals in the gel drops. Then top it off with a Thermalon Moist Heat Mask as I lay down to sleep.

Also, as Rebecca said, make sure you have drops or saline within reach and somewhere that you can get them without opening your eyes. Learn to wake up without opening your eyes. If you feel them stuck put the drops or saline along the lid seam and wait for them to work. Don't try to open your eyes! You'll be able to feel when the lids unstick themselves and then you'll be able to open them without tearing your eye surface. I've tried many brands of gels and ointments and by far have had the best result with Systane. You can get a Thermalon mask on Amazon pretty inexpensively. Just microwave it for 25 seconds and it provides a moist heat treatment that's good for 10-15 minutes.

I seem to have periods when it seems like it gets better, then it regresses. My eye doc says he still thinks it will resolve in due time. I'm hoping!