What should I do or demand when I see the eye doctor?

[Polsefja]

Hello!

I'v had red eyes for many years. I'v had seen many doctors, mainly "normal" and some eye doctors. They tell me it's allergy and a blood test shows that i'm allergic to x and y which grows in the summer. I don't doubt that, but I might visit that doctor in the winter when it's -15 C and snowing. When I politely ask why I react to that in the winter he says it can be so sometimes and I should take allergy pills and learn to live with it. Then I ask why it's 10 times worse when I sleep (laying in bed awake 10 hours does not affect my eyes), they either don't know or says my eyes might be tired during day and the redness is them finally resting during sleep. And then tell me to live with it...

After searching I found this forum a few months ago. I never knew your eyes could be dry in the night before I came here. Trying eye drops before and during sleep did help me a little bit. Then I heard of MGD, seems like I have that...

But I'm not here to get a diagnos. After reading on this forum I finally decided to visit yet a new eye doctor in a few weeks.
What should I demand? Shimmer test? TBUT? Sjogrens test? Punctal plugs? Restasis?
They never mentioned this for me, maybe I should mention it instead? Is it usefull to do shimmer test or knowing my TBUT?

[spmcc]

RE: questions to ask

In past posts, Rebecca listed a number of questions to ask your doctor. I've cut and pasted them below:

1) How is my tear quantity?
2) Do you see any dry spots?
3) Can you check for staining?
4) Can you press on my meibomian (oil) glands? Are they releasing oil? Is the oil clear and flowing freely? If not what does it look like?
5) Do you see inflammation?
6) Do you see signs of allergy?

One test that I've never had but am hearing a lot about (and am going to ask to have done next time I'm in my doctor's office) is osmolarity. I don't even know how it's performed or if a doctor would need some fancy equipment for it, but recent research has shown it to be a better test (correlates best with symptoms). You could ask about that and maybe report back! Thanks.

Good luck.

[Polsefja]

2) Do you see any dry spots?
3) Can you check for staining?

Thanks for the reply! But i don't understand these.
And I will investigate in that last fancy test you mentioned.

[y-gwair]

What should I demand? Shimmer test? TBUT? Sjogrens test? Punctal plugs? Restasis?
They never mentioned this for me, maybe I should mention it instead? Is it usefull to do shimmer test or knowing my TBUT?

I'd agree with the list of things posted above. Ask your ophthalmologist to write a detailed report listing all of these things. Schirmer tests aren't perfect, they do sometimes give misleading results, but along with staining, TBUT, MG evaluation, vascularisation, they will help to build up a bigger picture of the kind of dry eye disease you are suffering from, and you will have something concrete to refer to should you need to see other eye specialists in the future, or to measure improvements against. I think a good ophth. would do this anyway, but I get the impression a few don't communicate their findings terribly well to patients, so be proactive.

'Staining' is where the ophth. puts some dye in your eye which helps show how much damage there is to the corneal surface. If the tear film is very bad, there may be places where it breaks up completely creating dry spots, which you wouldn't be able to see normally.

Personally I'd never 'demand' a treatment as, depending on the result of the examination, it may not be the most appropriate for your condition, although it is fine to ask if they think a particular treatment would be of help.