Basicly MGD or aqua deficient?

[Cristi]

Hello
I experience moderate severe dry eyes post lasik 1.6 years ago. Immediately after the surgery my eyes were so dry the eyelids were sticking to my eyeballs during the night and i absolutely had to use artificial tears. However with time and especially after I had my lower punctas plugged I do not have this feeling anymore and I only experience a dryness sensation but still have a lot of debris in the inner corner of my eyes first thing in the morning.
Could anyone tell me is this a sign of the MGD that I was diagnosed with a or it means that I am still aqua deficient even if I have lower plugs inserted?
Thanks a lot, I would appreciate very much your answers.
All the best
Cristina

[peter56]

Hi Cristi,
the post LASIK dry eye is first always being caused by a watery tears deficiency.
The laser does damage the nerves in the cornea. These nerves do belong to the neuronal tears reflex arc and thus the aqueous tear glands.
Furthermore the mucin production of the goblet cells does down, so there is no more tear film covering the ocular surface.
Then even the best meibum-fatty layer cannot spread over such an infomplete tear film.

In healthy eyes, the lids and the globe are sliding with almost no resistance on the ocular surface, in dry eyes the lids are rubbing during the movement.
These mechanical irritations - mechanical irritations conjunctivitis is causing many micro traumata at the lid margins - orifices of the meibomian glands.

All these irritations are then causing an Inflammation of the meibomian glands too and that means meibomitis and MGD as well.
So post LASIK dry eye is a combination of aqueous tears deficiancy and MGD.
In order to get out of this vicious circle, the neuronal tears reflex arc and the meibum production have to be restored.

Peter

[Cristi]

Hi Peter
Thanks for your answer is the best explanation I've read since the onset of my severe dry eyes 1.5 years ago after LASIK.
I've also read some other interesting posts of yours.
I'll send you a PM as we might share some information regarding our common disease.
Thanks again
Cristina