menthol sensation (more debilitating than pain)

[dianat]

No matter the science behind it, I tend to believe I would not experience the menthol sensation if I had the proper oils in my tears and and so long as those tears were sticking to my eyes.

Curiously enough, and I think this is a huge clue, my eyes are less weepy when they are at their best. Since I'm cauterized in all four punctae, I need to blot very frequently. On a really bad, burning day, I might plot twice as often as on a good day. This could be due to reflux tearing, or tears not sticking to the surface of my eye...who knows. On better days, blotting is still necessary, but if far less frequent. The menthol sensation somewhat less of an issue on these days as well.

[Rojzen]

a shared eureka!

Calli66 and dianat, your reasoning about the RATIO of liquid to oil, and its relationship to whether we have menthol sensation and comfort, overall, is EXACTLY what I've hypothesized for years. . .I've always told my eye docs that my BEST days were some of my driest. . .and that the windy/menthol sensation was worst when tears lingered on the lid margins or dripped from the eyes. . .

A small handful of artificial tear products don't immediately worsen my menthol sensation, even though they throw the lipid/water balance off. . .These are Systane, the Dr. Holly drops, and some of the older PVA drops. . .Anything with mineral oil, lanolin, or petrolatum SEVERELY worsens the menthol sensation the moment the oily coat wears off. . .

To answer, my lacrimal production ranges from a little below normal to low (based on flourescein clearance testing, rather than the plain old Schirmers), and I've always felt that the severity of my symptoms cannot possibly be accounted for by such a relatively small lacrimal abnormality. . .In contrast, my meibomians are horribly abnormal. . .Most don't even exist anymore (:^). . .or so I'm told. . .

I suspect there won't be many or any on this thread who report menthol sensation with normal meibomian function. . .We shall see. . .

[LasikLady]

I think you may be describing the sensation I sometimes have. In my early, post surgery days, I described my sensation to feel as if I was "sticking my head in a freezer with my eyes wide open". My surgeon also looked at me like I was nuts. Sometimes I feel a cold air sensation on my eyes and it is maddening. I especially feel it in grocery stores and malls. Not really "pain" but it is uncomfortable to say the least. I have dry eyes from lasik, obviously. I don't know about the oils and such in my tears, I'm not that educated on all these topics yet. I do know a corneal specialist I saw said there are no "dry spots" on my eyes. I thought that meant the oils are sufficient. But my tear testing was a 2 in my left eye and a 3 in the right. This was many months ago before Restasis or my plugs so I assume my numbers are a bit higher now. But the "menthol" description seems to nail what I sometimes feel.
As far as wearing the panoptx goes, they are the #1 thing that relieves all my symptoms. I love them. I can't get over feeling goofy in stores though wearing them. I hate people staring at me. I guess I can be vain and in pain or just get over it.

[Rojzen]

freezer sensation; tongue-in-the-air sensation; sclerals?

Yes, yes, yes. . .Eyes wide open in a freezer describes EXACTLY the maddening so-called menthol sensation. . .Some time ago, one of us described the experience as parallel to the way one's tongue would feel, if one left it hanging out of the mouth, exposed and drying. . .

I think we are raising consciousness about this problem by sharing our subjective experiences with it, and then likening these to experiences that people without dry eye can relate to. . .In turn, maybe our eye doctors and researchers will begin to take an interest in this, using it diagnostically, and also attempting to deal with it. . .

In meantime, I am trying to figure out whether rigid gas permeables of any size might help with menthol sensation. . .

Does anyone have any experience trying to stop the menthol by wearing RGPs?

Pending a truer solution, what on Earth would we menthol types do without Panoptx and other moisture chambers???

[Rebecca Petris]

In meantime, I am trying to figure out whether rigid gas permeables of any size might help with menthol sensation. . .

Does anyone have any experience trying to stop the menthol by wearing RGPs?

Most certainly. Well, I didn't wear lenses specifically for that reason but they sure were effective for it. I should think anything from a corneal-scleral on up would give quite a bit of protection. I wore such lenses for 2+ years before switching to full sclerals.

Gas permeable lenses are made on quite a wide spectrum of sizes for a variety of purposes. You've got the standard small ones that people with nice healthy properly-shaped corneas use. Then you've got larger and larger ones that are used particularly on people with misshapen corneas (keratoconus, post lasik, post rk, etc) till you get to the corneal-scleral lenses which partially vault the cornea. Then you get out to 15mm and beyond which are typically called mini-sclerals, and finally you get out to say 18mm and beyond which are typically called sclerals.

Broadly speaking (no pun intended) the larger the lens, the more comfortable it is, if properly fitted.

I've worn both 14.5mm corneal-scleral lenses and 18.5mm Boston sclerals. I get the best protection from the 18.5s because they're covering the most surface area and do not touch the cornea at all. But I'm thinking it's the in-between ones, like what DrG is working a lot with these days on a highly customized basis, that would probably be most suitable for the purpose you're talking about.

Caveat: Outdoors in the wind, I don't believe ANYTHING but a Panoptx type product can do the job.

[liz56]

When I was reading this forum a lot over the summer, after having been diagnosed with DE, I saw this thread, and Rojzen's words "menthol sensation" kept entering my mind, but I did not know how to respond. It is so hard to describe the feeling, but I cannot think of a better way than Rojzen's.

In fact, for me, for years before I even knew I had a problem, I just responded without knowing what I was responding to. I closed my eyes. That's the only thing that really helps that feeling for me, and it "warms" my eyes. Sealing them off away from the air is exactly what closing them does. It's usually later at night when I get that feeling, and I know it is a "bad eye day" whenever it comes earlier.

Thanks Rojzen, you are so right, and I would not at all be surprised to find that I have MGD or atrophied glands.

Naming our problem, communicating it to doctors, and being able to discuss it is a huge step forward, so I very much appreciate your efforts, Rojzen, and everyone else's input here.

[dianat]

I would love to find myself wearing some kind of lens to prevent the sensations I feel in my eyes. My ultimate goal is to open up my tear ducts a bit so I can drain these excessive tears. But, for now I need to keep myself cauterized. I would so appreciate the opportunity to manage my discomfort without all this blotting I am always doing. After four years I must say I'm tired of it.

Regarding a lens, I was so contact lens intolerant I cannot even imagine finding comfort in a lens. I was intolerant to semi-hard lenses when I was a teenager...I can't imagine trying it now. So, I've not bothered to try. I'd have to travel for this, too, and it's just not that easy right now.

Knowing full well I will always be a dry eye patient, my goal in all this would be to manage my dry eye comfort with a lens, compresses and no cautery. I would love to improve my washed-out, weepy crying look, and be able to wear a bit of eye makeup as well.

[Rojzen]

if gas permeates - (stop the menthol)

Great to know from Rebecca that RGPs may, in fact, potentially stop the menthol sensation. . .I share the background of those here who previously suffered from lens intolerance (long before full-blown DES), and I share with them, as well, the wonder at how our beleaguered eyes could handle lenses of any kind. . .all the while understanding how sclerals have been an absolute godsend for those with abnormal and abnormalized corneas. . .

What amazes me is that lens specifically designed to allow air through them (or am I misunderstanding gas permeability?) could provide protection from the windy sensation. . .Perhaps, as Rebecca says, it is a question of degree. . .For outdoor-level winds, wraparounds and other protective eyewear would seem indispensable, even with sclerals on. . .

Paradoxically, I would have thought that soft bandage lenses would have cut down on menthol sensation. . .and yet when I wore those, my menthol was the worst ever. . .Go figure (:^). . .

[dianat]

Rojzen,

Maybe we need to take a road trip to Boston to find out...

D

[WendyE]

Perfect description

Yes, I also have this sensation. It's worst in my left eye, which is my more problematic eye. When the sensation is at it's worst, I'm usually having constant tearing and stinging as well. I've had this symptom in both eyes for years whenever the wind blew, especially in winter. I thought it was just me.

One less "just me being weird" symptom to check off the list

[Guest]

I've had this feeling for a long time too. In fact i can't even recall when it started. I find it hard to concentrate in class and haven't found any relief whatsoever despite many visits to the doctors and eye specialists. Holding a hot damp cloth against the eyes can provide a bit of temporary relief(very temporary) but so far i haven't found any solution to this problem. It just sucks