8 weeks post Lasek and struggling with very dry eyes

[Jovver]

Hello,

At the age of 43, I decided to have Lasek surgery a couple of months ago, and have been regretting it ever since. Although my vision has now stabilised and is to all intents and purposes better than 20 /20 in both eyes, I've been suffering quite badly from dry eyes. I appreciate that it's very early days, but I truly did not appreciate quite how distressing this would be, and I am looking to see if anyone suffered from this in the early stages and came through it okay.

I have to admit, I have frightened myself terribly with reading some of the tragic cases here, so perhaps I am being paranoid. However, over the past few weeks, I have allowed the stress and the worry to take over my thoughts most of the day with the result that I find it difficult to concentrate on anything else.

My symptoms are not as bad as some of the poor people I have read about here; I haven't suffered any corneal erosions thankfully, but I still have sore and dry eyes a lot of the time. I use Visco tears at night as recommended and usually wake in the middle of the night to put another drop in each eye. I have to use Refresh drops every hour or two, but sometimes it feels as though I could do with instilling more a couple of minutes after I put them in. I try not to use the drops too often as my eyes feel even worse then.

I am ashamed to say I am quite frightened at the moment, so I would really appreciate hearing from anyone who has gone through this, and came out of it the other side okay. Any advice on how to alleviate the symptoms would be gratefully received.

Many thanks

[Joseph]

I had dry eyes for four months after LASIK. Give it more time and congrats on the good vision.

[Jovver]

Well, it's now been 15 weeks since I was stupid enough to go through with the surgery, and my eyes are still very dry unfortunately.

It's been a difficult few weeks and the stress and worry have really taken it out on me. Having to wake up every couple of hours to make sure my eyes aren't sticking to my eyelids is also killing me, I can only hope that I'll be able to get a good night's sleep at some point in the future. The thought of going through the rest of my life like this is one that fills me with dread.

My main problem seems to be a lack of aqueous tears; my eyes no longer tear when exposed to onion vapours, even though I can feel the tingle of irritation. I'm constantly aware of my eyes, and by the early evening they are burning, so much so that I simply have to shut my eyes for an hour or two. About the only time I can feel a decent amount of tears is if I yawn.

I've had temporary collagen plugs put into my lower tear ducts but they only seemed to help for the first few days, so perhaps this was just the placebo effect of having them put in? The laser surgery is not very helpful. One of the receptionists very kindly pointed out that all these issues were pointed out to me in the consent form (well saying you might get dry eyes doesn't really prepare you for the full implications of this), and I had to make a real fuss in order for them to arrange a meeting with the surgeon to go through options try to figure out what's going on. They even had the cheek to send me an email aksing me forward the names of my friends to them, in exchange for which they would give me £50 if they decided to go ahead with the surgery. Needless to say, I wouldn't recommend this to my worst enemy, let alone my friends.

I've had my eyes looked at by an independent optometrist and they have confirmed my meibomian glands generally look okay although there are one or two minor plugs apparently. When expressed the oil coming out of them is nice and clear, so this doesn't appear to be main issue. There is no sign of blephartis, and my eyes look pretty normal to the naked eye with very little redness and very little or no scarring on the cornea. When measured at the laser clinic my TBUT was a miserable 4 or 5 seconds, but the independent optometrist measured it as an appalling 2 or 3 seconds (although thy used different methods which I understand can lead to different results).

I've been using hot compresses in order to see if I can improve things for a few minutes twice a day and have been taking Omega 3 oils etc. for about or 7 weeks now.

Frankly, there have been moments when the pain has just made me want to curl up in ball and give up, but I'm determined not to let this beat me. What's especially annoying is that I went for Lasek as opposed to Lasik specifically to minimise issues with the flap and nerves being cut etc.

I will be seeing the surgeon in a week's time, so I was wondering if I should be asking him any specific questions about what is going on, or what (if any) treatments or drugs might be available?

Has anyone here had laser surgery and had similar symptoms and had the tearing reflex return, either partially or fully?

Any thoughts would be very gratefully received, I would really like to hear from anyone who has gone through this and got better.

[Jovver]

Hmm, I went to see the corneal specialist from the laser clinic yesterday, and he straight away acknowledged there was a problem with dry eyes as the whites of my eyes were looking slightly pink.

He seems to think that my main problem is inflammation, specifically with my eyelids. (not that they look inflamed to the naked eye). He examined my eyes and measured my TBUT (7 to 8 seconds in each eye as he timed it on his watch (although my eyes were welling up a bit as I got upset again so I hope this didn't give a false reading, he didn't seem to think it would) and noted that there was some frothing (his words) on my meimobian glands which he seemed to think is the main cause of my issues.

He seems to think that inflammation in my eyelids is causing the deficiency in aqueous tears as it's interrupting the natural tear cycle, including the lack of tearing with irritants such as onion vapours etc. If we get the inflammation down then things should improve substantially. He also went on to say that out of 14000 people he has treated only 3 or 4 have reacted like this (lucky me) and they generally responded to treatment in time. I desperately hope he is telling the truth.

He has prescribed steroid drop (minim prednisolone) eye drops 4 times per day along with doxycylcine antibiotic. I also need to carry out the warm compresses a couple of times per day for a few minutes each time. I'm due to see him in another 4 weeks to check on progress. He has also prescribed some king of steroid cream to rub onto my lid margins once per day (not sure of the details, just waiting for the letter to arrive confirming all this so my GP can prescribe it).

I must admit, I'm not absolutely convinced that the gland issues are causing a lack of aqueous tears, but I'm hoping he is right as he is the specialist. The cycle explanation seems to make some sense, but I wonder if the reasoning is backwards (i.e. is the lack of tears causing the eyelid inflammation.?)

What a mess...
Does anyone have any thoughts as to if any of this sounds reasonable?

[Jovver]

Is there really no-one here at all with any thoughts on this?

[NotADryEye]

Jovver,
I didn't have Lasik, but I do have frothing. To me it feels like soap in mthe eyes. I can see bubbles in them when I look in a magnifying mirror. The term is saponification.

I am not sure about how aqueous tear deficiency would be affected by frothing specifically. But the soap can be terribly uncomfortable. It can be caused by bacteria or by poor quality meibum that results when there is inflamation in the meibomian glands. The cells lining the inner wall of the meibomian glands break down and turn into meibum. If the cells are inflamed to begin with you will end up with poor quality meibum and possibly saponification.

So, yes, it makes sense. You need to reduce the inflamation in the glands to produce good quality meibum.

I suspect that Lasik is what caused the aqueous deficiency by interrupting the blink feedback loop. And I haven't heard that saponification would impact aqueous production directly. But the eye is a system. And everything needs to work properly in order for everything else to work properly.

[Jovver]

Thanks for the reply, I really appreciate it.

Yeah, I'm not sure that the MGD caused the aqueous deficiency either, but I guess that if I can get this sorted out, then my eyes will be in better shape when (I hope) the nerves or whatever has been disrupted by Lasek sorts itself out over time.

Oh well, I only has the surgery a little under 4 months ago now, but they've been the longest four months of my life...

[littlemermaid]

Here's the sister forum, D'Eyealogues, which might help you with some ideas and chat http://lasermyeye.org/forums/

Do you want to tell us what the LASEK company are offering people with post-op complications? I asked Vision Express and the Optometrist said 'we send them off somewhere'. Eg do you see a Cornea Consultant Ophthalmologist specialist, or is it a prescribing Optometrist? And do you pay?

If you want a second opinion from a cornea and eye surface disorder consultant, here's the UK doc list http://www.drfosterhealth.co.uk/consultant-guide/. I think I'd be looking at an NHS Trust specialist centre where they do refractive surgery so they are used to this.

[Jovver]

Thanks for the links, I think an NHS second opinion will be the next step if things don't improve.

To be fair to them, they've been reasonably good with aftercare, albeit I have had to push them to see the surgeon again. The first few times I saw the optometrist, but last week I saw the corneal surgeon who made the above diagnosis. I'll be seeing him again in a four weeks to see if there's been any progress on the doxy and the steroids. I've not had to pay for any of the aftercare appointments thankfully (but I have spent quite a lot of money on extra drops etc).

The receptionists are the worst however; the surgeon and optometrists at least give you the impression they care, but one of receptionists very helpfully reminded me that I had signed the disclaimer form. Needless to say, the risk of dry eyes was brushed off at my initial consultation, they simply said that I would have to use drops for a few weeks after the surgery.

He seems to think it's a transient problem due to inflammation and will disappear in time. I can only hope he's right, but I suppose it's less than four months since I had the surgery, so I need to give it time. However, as you all know, when you're in pain, you simply want it to go away as quickly as possible.

My vision is 20/15 now so at least that's turned out okay. I'm already fairly depressed with the dry eye symptoms, so I don't wan't to imagine how I would feel if my vision was damaged as well.

[littlemermaid]

There is lots of good experience and common sense for healing the eyes here if you can dig through the wealth of information. The value is in the personal stories of what has helped, and some eye specialists do appreciate that these days.

What has helped us is to treat the eyes as very sensitive and make sure we are not overdoing drops that change the eye surface. This has included eliminating chemicals and allergens at home that might be making things worse. We use a humidifier in the bedroom next to the computer plus damp towels on the radiators when the heating's on. She likes Blephasteam goggles every night and says her eyes feel good after (obstructed MGD), but that's not the case for everyone. Daily eye cleaning is important to keep things good, whether eye wipes or a gentle eye rub in a warm shower. We are on a very good anti-inflammatory diet with oily fish (no wheat, sugar, bad fats, red meat etc except special occasions), taking some multivitamins with minerals if we feel we need it, and the flax/fish oil capsules. Lots of fresh air and sunshine and laughing with friends to keep the mood good. Eg I was talking to a lady in a similar situation to you with a very nasty flareup from getting her hair coloured at the hairdresser, and she was reluctant to pick up the grandchildren wearing sunglasses. My teenage d. has never been able to wear any kind of makeup without problems and has to use very pure and simple hypersensitive skin and hair products. Even Thames water makes things worse so we use filtered boiled water to clean the eyes with cotton wool So there we go. So these treatments additional to bunging in the eyedrops do help with healing and mood.

one of receptionists very helpfully reminded me that I had signed the disclaimer form

Yes, any consolation but it's like this in the whole of private medicine, caveat emptor v duty of care. If you can face it, it might be worth checking if the surgeon is a member of the RCOphth, subject to their gentlemen's agreements. I wouldn't hesitate to get GP or Optometrist NHS referral to cornea specialist clinic if needed. NHS Trust private clinics are also looking very attractive to us patients. Top docs, same staff, good equipment, NHS guarantee and backup. Might be helpful to look at how Moorfields manages the parallel refractive surgery and cornea and eye surface disorder work. I think if I was South East and worried, I would go there. Otherwise I would head for a large regional teaching hospital with an ocular surface team, preferably specialist dedicated eye hospital.

[Jovver]

Thanks again, I really appreciate the help.

It's amazing how much this has knocked me off my stride; I had a false alarm with cancer a few years ago, and I breezed through that. This however has knocked me for six.

I'm definitely trying to be sensible with drops and not overdo them, I sometimes feel that the drops are doing more harm than good so I try to be sensible with them and only use them when i feel that I really need to.

So much for the convenience that they promised. The one good thing is that I have personally put a lot of people of risking laser surgery on their eyes. As I've discovered the hard way, it just wasn't worth it (and I'll still be saying that even when (hopefully not if) my eyes recover).

By the look of things, I don't think I've been suffering as badly as some of the unfortunate people on here. I know how this has affected me so they must be a lot stronger than me.

Good idea with the anti inflammatory diet etc. I guess I may have to give up some of my favourite foods...

[littlemermaid]

If you are on/off steroids, careful to get your eye pressures checked. Some high street Optometrists are getting good at co-care with NHS clinics, usually the larger chains who want the NHS business. It's been good to have a backup high street Optometrist to talk things over with, if you can find one up-to-date with a specialist interest. I know Specsavers, Vision Express and some D&A/Boots are supposed to update with a weekly learning programme, whereas we once saw a private guy who hadn't read an article since the 1950s, thinking that because he charged so much he must be good, lol.

I'm with SAAG on the diet thing, off cake completely but then when you do have that one special occasion slice and scrape off that nasty butter icing, it's so very good!

It's more than OK to post up how you feel and no one's keeping score. My d's problems are iatrogenic from topical steroid on the face for minor skin ailment - we trusted the GP who prescribed it and as a child she trusted me as I applied it. We've all been through the mill, that's why we're here. You are right. Good can come of this.