What is the connection between Lasik and MGD?

[Natalie06]

I am trying to figure out if Lasik itself can induce MGD and how that could happen?


I was going to post this under MGD but wanted a broader range of experiences.

Thanks for your input.

Natalie

PS. I am now down to Lotemax every other day as my eyes just get dryer and dryer which seems impossible with a Schirmer test score of 0. The last few days the humidity has been 20% with a strong northeast wind. I am supposed to restart the Restasis tomorrow and am already dreading it. I think I'll call the dry eye doc first.

[Eli]

As I understand it, any significant disruption of a single component of the ocular surface (In this case the corneal epithelium from the LASIK flap) can cause problems elsewhere. There is thought to be a nerural connection that links the lacrimal glands, meibomian glands, corneal and facial nerves, etc.. that helps keep the ocular surface moist and healthy. Also, some doctors like using Lotemax right before Restasis to help alleviate some of the possible side effects like burning and stinging. Maybe ask your doc if this is an option for you.

[Cindy]

Hi Natalie,

Sometimes I think the connection between LASIK and MGD is that you may have already had subclinical MGD - meaning you had it slightly but it didn't bother you - prior to having LASIK. LASIK, with the making of the corneal flap, can push subclinical dry eye and MGD symptoms over the edge to where your eyes/body rebel and you are forced to deal with it. The making of the flap severs the nerves in your eyes that tell your body to make tears.

Lotemax is a corticosteroid. My eyes always felt drier when using steroid drops. I have a systemic response to steroid drops. My heart pounds, I get light-headed. In short, I need to avoid steroid drops like the plague. I'm not positive but I believe Lotemax is preserved with BAK. I haven't explored it, but perhaps it's the preservative that my eyes/body rejects and maybe that's why my eyes feel so much drier when using steroid drops. At any rate, you're not alone...steroid drops make my eyes feel drier.

[YGB]

My LASIK MD was telling me that I was just a complete anomaly that was not documented in any of the medical journals because I had a stye that triggered my dry eyes.

Well, either he is a very clueless MD or he makes a large part of his living lying to his patients (or I suppose that maybe it's both). I did not have a stye as my LASIK MD that triggered my full-blown severe dry eye. I had meibomian gland dysfunction (MGD).

Dr. Scheffer Tseng in Miami was able to tell me that I had MGD through one e-mail with him when I referenced the bump on my upper lid that my LASIK MD said was a "stye". When I went back to my LASIK MD, it was then that he told me that I had MGD and not just a stye but "it was getting better".

That was the last straw for me. I was giving my LASIK "MD" the benefit of the doubt until then, but once I realized that he was even lying to me in my post-LASIK treatment, I knew that I had to seek help from someone else (that someone else was Dr. Tseng in my case).

Note that I am not a fan of Dr. Tseng's amniotic surgery. However, based on my patient experienc, I have found that Dr. Tseng and his fellows are very thorough clinicians who are likely to give a very appropriate diagnosis and action plan. Surgeries and alternative experimental treatments are last resorts and likely will not be discussed until all other treatments have been exhausted (that has been the case based on my experience).

Anyway, got a little side-tracked there. On Dr. Tseng's website http://www.ocularsurface.com/ it states the following ...

"Dr. Tseng and his colleagues have discovered that conjunctivochalasis-induced dry eye an be differentiated from aqueous tear deficiency-induced dry eye, and that lipid tear deficiency due to meibomian gland dysfunction is the dominant cause for persistent dry eye following LASIK using kinetic analysis of tear interference images."

[Natalie06]

Thanks very much!!

I too am positive that I had MGD prior to Lasik. My medical history of chemically induced menopause alone would have caused MGD and the dry eye doc I just saw also confirmed facial rosacea, though subtle (I was wearing makeup so duh). I had textbook symptoms of evaporative dry eye pre-Lasik and even had a little itchy scab on my right upper eyelid for years, that no one ever paid attention too, so neither did I. Low and behold, after 6 months on antibiotics and using hot packs, it has gone away.

I am calling my eye MD this morning as there is no way I am going back on Restasis while my eyes feel so bad. I was doing better without all the medication and just using hot packs and lubricating eyedrops. I will investigate the ingredients of Lotemax. It's definitely a cumulative thing. When my eyes would flare up, a few uses worked like a charm but I just can't use it day in or day out. I can now barely walk outside for 30 minutes without needing eyedrops, just like the days immidately following Lasik. I have tried Soothe, Dakrina, Refresh liquigel, Theratears gel, Refresh preservative free and Theratears in the last 2 weeks. Only the Theratears does not feel like Elmer's glue in my eye. I've tried Therateras with a drop of gel or Soothe on top, my old standby, and even that's not working. Yikes.

I am still struggling to understand why Lasik surgeons aren't required to be "experts" in DES if they know that it is the most common side effect of this surgery. If you don't know how to pre-diagnose and/or treat the results of your work, then you shouldn't be inducing it. In my case, I firmly believe that 4 punctal plugs on top of MGD/Ocular Rosacea/hormones was what threw me into outright blepharitis. Yet my surgeon wanted to permanently seal my puntums so he could do an "enhancement". I am just so thankful I stopped listening to him.

On a very sad note , I am giving up most of my caffeine. I am a Starbucks junky but fortunately, they make some awesome decaf.

Thanks again. I don't know what I would do if I couldn't talk about this with people who really understand.

Natalie

[ANT111]

Hi,

Yeah the link between lasik and MGD can be explained: during the LASIK procedure they need to cut a flap in your cornea and in doing so they sever the nerves that innervate the cornea. Although these nerves do grow back over time, there is never anything as good as the original. This results in a decreased sensation felt by the cornea and a decreased blinking response. By the time you feel the pain/burning/irritation/grittiness etc. in your eyes its already too late to sit there and try to blink alot to make up for it. Your cornea does not feel it is drying out, and you blink less. Oil secreted from your Meibomian glands is really dependent on two mechanisms: 1) Your basal body heat provides the temperature to keep it liquified and prevent clogging of your gland (hence the warm compresses). 2) Your continuous blinking response provides the mechanical extraction of your glands and allows distribution through the tear film.

I have given this some thought and have also discussed this with Dr. Tseng in the past. I am currently in my 4th year of medical school and chat with Dr. Tseng about stuff like this. I have had dry eye for a little over 2 years now and it is the most difficult thing I have ever had to deal with in my life. I have hopes of becoming an ophthamologist and make the medical community more aware of just how significantly having this problem impacts all aspects of a persons quality of life. Hope this helps.. as I find myself getting depressed again talking about this.

[sazy123]

in my 4th year of medical school and chat with Dr. Tseng about stuff like this. I have had dry eye for a little over 2 years now and it is the most difficult thing I have ever had to deal with in my life. I have hopes of becoming an ophthamologist and make the medical community more aware of just how significantly having this problem impacts all aspects of a persons quality of life. Hope this helps.. as I find myself getting depressed again talking about this.

Well done, go for it you will make a very good dry eye specialist-having the problem yourself!

I have thought id like to train to be a ophthamologist but im not sure my eyes could cope with all the years..