New Here With Some Questions

[Michael2]

So firstly I want to thank everyone for their insight, I've been a lurker for quite some time and have found alot of the information useful. Even though I've only been in pain for three months, I've practically forced my ophthalmologists/ optometrists to find an accurate diagnosis...4 ophthalmologists and 2 optometrists later, I seem to have a diagnosis of posterior blepharitis and MGD (and of course, the symptoms don't match the signs- I must be making the pain up?)

My story is similar to some others...man is his early 20s without any history of dry eye begins to experience contact intolerance out of nowhere, and now finds his eyes stinging, burning, dry, etc. 24/7 even without contacts (one eye more than the other). No physical signs whatsoever, no redness, but TBUT score of 6 sec is indicative of MGD. No contacts for 3 months, but still constant pain.

Azasite for 4 weeks brought the pain down to a more manageable level, but there is still constant discomfort. One plug, two weeks of lotemax, three weeks of restasis (still using), two weeks of doxycycline (200mg/day) (still using) hasn't made much difference yet. Of course warm compresses 2x daily. I would diagnose myself at a level of moderate-mildy severe dry eye.

So my question mostly rests on Synergeyes, custom fitted- gas permeable scleral lens, and lens of other types. I would love more than anything to get back into contact lens, but really I would just like my eyes to feel comfortable again. Can anyone explain to me why custom fitted- RGP scleral lenses are considered as such a "last option"? I do not believe I would qualify for Boston scleral lenses, but if I have the money to pay for specialized RGP scleral lens then why should I wait? I'm not using them as a last ditch effort, and do not expect them to be a "cure all." But why wait another 6 months or 2 years to find out if they work or not, when I could find that out now?

Before pursuing the scleral lens option, I'm of course going to look for cheaper alternatives first...Synergeyes, soclear, etc. I don't do well with soft lenses at all, they're not exceedingly painful but seem to dry up within seconds. And I can't imagine corneal RGP's working, if the rest of my eye (from the lid margin to the sclera) hurts. Any other suggestions to dry?

I would also like to add that I see this as much as a blessing as a curse. I have no doubt that with time I will find something to make me comfortable, but I think it adds a bit to the life journey to face something so difficult to deal with, and hopefully find a way to overcome it. There are also times where I hate my life and don't understand why I've been afflicted with this. Thanks for all suggestions, and I enjoy reading your thoughts...

Michael

[Rebecca Petris]

Hi there and welcome. You've got a pretty good handle on your situation for someone who's only been dealing with it for a short time.

Can anyone explain to me why custom fitted- RGP scleral lenses are considered as such a "last option"? I do not believe I would qualify for Boston scleral lenses, but if I have the money to pay for specialized RGP scleral lens then why should I wait?

The main reason they're considered a last option is the cost and difficulty of procuring them, plus hassle factor of ongoing care (insertion, removal, special supplies needed and such). Most patients cannot access sclerals readily and of those who can, not all will be able to get a good enough fit and of those who do, not all benefit equally. Furthermore, I think that someone with moderate symptoms will not find the benefit significant enough to outweigh the inconveniences. But you're right, it all boils down to means and motivation in the end.

Having said that, at three months, you're awfully early in your journey. Sclerals aren't going to treat your problem - they're just going to (at best, if you get a perfect fit) keep you comfortable and keep you in contacts. You will still have to continue dealing with the MGD, continuing to push for better analysis and better treatment of what you've got.

[Stanza]

Rebecca is right, I think it's because they are a nightmare to fit, then to get used to. But you should try if you can, why not? i can wear soft lenses for about 4 hours periodically - very rarely though, they dry up and I get that rebound effect the next day from wearing them.

I've now got sclerals - they are not hugely comfortable but I can wear them for about 4-5 hours, I'm new to them, for me they've needed a lot of build up time. the biggest problem is that they're not hugely practical in some ways, i.e. I haven't dared wear them to work yet as we have a shared bathroom and I haven't quite gotten to the point where I feel like taking the lenses out for a clean in front of people I don't know very well!!! but some people can wear them all day without problem. You never know what will work for you.