Need Information

[Newandconfused]

I could really use some information and advice. Male 40 and having strange symptoms in one eye. It started in March with a feeling of something stuck in my eye and lots of burning. Two eye doctors said infection and prescribed Tobradex (sp?). The foriegn body sensation has eased and now I have a feeling that the eye is constantly tearing, however, very little flows down my cheek. It continues to feel wet and sometimes sticky in the lower corner of my eye. The feeling of the eye filling with fluid is very disconcerting. At times the lower lid flutters.

A doctor friend suggested meibomian issue and suggested another opthamologist. I did Internet research and am worried this is a symptom of underlying medical concerns. The fact that it started at 40 should it be a concern. What type of doctor should I consult and is this dangerous What type of treatment is available. Any other information will be most appreciated

[liz56]

Hi,

The fact that you have burning and tearing suggests that the nerves in your cornea are involved. It makes me think that the pain (burning) causes an automatic reaction (producing tears to soothe).

My suggestion would be to see a corneal specialist who can assess "tear film break-up time" and do a corneal staining to see if there are irregularities in the corneal surface.

Just from personal experience, the foreign body sensation, followed by this burning discomfort, makes me wonder if you have recently sustained an eye injury that you thought was healed. If so, the fact that the foreign body sensation is gone and that burning has begun may suggest that if the nerves in the corneal epithelium have been injured, they now are growing back and working as they should. That's just a possible thought. I certainly have no expertise other than personal experience.

Best wishes,
Liz

[Newandconfused]

Liz:

Many thanks for your reply. The first eye doc did a thorough corneal evaluation and said it was normal. There is a suspiscion of a clocked meibomian gland and this has me scared because no real explanation was provided. I am thinking of a 2nd opinion with a different opthamologist

[Gretchen]

It is confusing

Hi,

Yes, this is all very confusing. You need a doctor to diagnose what your issue is. From your post it sounds like your doctor mentioned blocked meibomian glands (MGs). We have many MGs in the lid margins of our upper and lower eyelids. MGD (meibomian gland dysfunction) is a common cause of dry eye and there is a lot about this condition on the internet and on this board. Rosacea is a leading cause of meibomian gland dysfunction, other times it is a complication of Lasik, Accutane, or sometimes just happens. There are treatments for this - doxy, restasis, steroids, etc., but you need a diagnosis from a doctor who knows what he is doing. Diagnosis is the first step to getting better.

Check the "Plug a Doc" section in here to see if there is anyone in your area featured.

Regards,
Gretchen

[odydnas]

First of all, do not panic. You have had your corneal thoroughly checked out by an ophthalmologist. Many of them may not be good at diagnosing and treating dry eyes, but most of them are very good at checking the corneal for anything that might damage your sight. So, if you have been thoroughly checked, then try not to worry about going blind (I think that's what you're worried about). Nothing dangerous is going to happen.

If you suspect you have dry eye, the next thing to do is to find a dry eye specialist. Check the Plug a Doc section or the Dry Eye Yellow Pages. At your appt, ask about your meibomian glands, your schirmers score, inflammation, etc. If you do have a blocked meibomian gland, it can be unbearably uncomfortable and difficult to manage, but it is unlikely to be dangerous. Browse around the site and i hope that will help.

I don't know what you mean about being concerned that you are having eye symptoms at 40.

[Newandconfused]

This is a wonderful site and I appreciate the information. I am trying not to panic, however, there is so much information on the Internet that suggests MGD is a symptom of other diseases. Everything from diabetes to lupus to HIV seems reported

My reference to 40 is trying to understand why it starts now and does this mean it is a symptom of other things

I think it is good advice to seek out a doctor to diagnose and treat and I will check the "plug" feature. I will continue to read the advice provided in this forum

[Gretchen]

Don't worry

N&C -

You need to go to a dry eye doctor. They can advise you whether they believe the problem to be and help you if they feel that it is systemic. But don't panic. HIV, RA, Lupus, etc can all cause dry eyes but usually these diseases present with many other physical symptoms. Sjogren's is one autoimmune disorder that can cause severe dry eyes but also dry mouth, joint pain, fatigue, etc. And men are much less likely to get Sjogren's than women.

I can speak to my condition - ocular rosacea - and tell you that 40 is a very typical age of onset. I was diagnosed at age 39. I am often glad that it waited this long to rear its ugly head as there are many very young folks on this board that break my heart...

I would first make an appt with a good dry eye doctor. Then educate yourself on dry eye and try to write up as many questions as you can for when you go. One of those questions can be - "do you believe that my dry eye could be a symptom of a systemic illness such as RA or Sjogren's? I also have symptoms x,y,z (if you have other symptoms)." He will then reassure you or refer you to an internist or rheumatologist.

But don't panic. Unless you have some other symptoms or a history or autoimmune diseases in your family, the numbers favor that you have just dry eye - aqueous or lipid deficient.

Good Luck,
Gretchen

[Newandconfused]

I will try and remain calm, however, much of the Internet information makes it tough. The lower corner of my eye keeps feeling like it is filled with tears that need a place to flow. When I exercise the feeling eases, however, the eye becomes very red. I really don't understand what is happening

[odydnas]

Newandconfused,

Yes, many serious diseases affect the eyes, but diagnosis of these diseases cannot simply come from eye symptoms. If you had diabetes, HIV, etc, you would most likely experience other symptoms. No eye doctor will screen you for these diseases if you only have eye symptoms (except for things like Sjogren's, etc but only if the clinical signs are severe). If you are indeed concerned about these other diseases, then see your GP to run an HIV test and other test panels. Your eye doctor will mostly just focus on your eye symptoms. You are worrying yourself for nothing if you are only experiencing eye symptoms. With so much info out there, I would focus on learning out dry eyes first: ocular rosacea, tear deficiency, mgd, inflammation, etc.

Also, meibomian gland dysfunction is very common...many people's symptoms are just so mild that they don't notice it. Chances are, meibomian gland dysfunction would not indicate some other serious systemic disease.

As for being 40, DE tends to affect the older population. But I am 25 and I have severe dry eyes, but that does not seem to alarm my docs.

Good luck with your doctor appts.

[NCRedhead]

Diagnosis websites can be really frightening

MGD may be caused by dozens of things apparently...and those sites like Wrong Diagnosis can scare you to death. I now try to avoid them or take them with a grain of salt as usually....they have not been much help. I learned today that I am badly allergic to dust mites and that may be a contributor...and may also have some ocular roscea (yes, that's the same stuff that can be on your face/nose). So both of these may be causing my MGD glands to be blocked up more than they should. I am making the rounds of doctors to rule things out, but am slowly getting there. Keep asking around about good eye doctors in your area and get to the best you can. If not a good one, then go where there is one. My next step is likely to go about 3 hours away to one near Charlotte if I can't get my eyes cleared up. Hang in there...we are with you!

[Newandconfused]

The people here are wonderful and seem to understand what I am now experiencing. I have found a doctor who appears to focus on dry eye related issues. I have made an appointment and will start new. Perhaps I am permitted to post updated information here on this board

Thing that is scary is wondering why all this is happening and whether it is a symptom/worry

[Newandconfused]

Need Information (updated)

I am really confused and anxious now.

I saw an opthamologist today who ran a test with a drop and then a swab of my eyes. He said my left eye is "very dry" and he prescribed Restasis for 3 months. He also said I have mild blepharitis. He didn't explain the cause. He did predict I will ultimately need plug surgery

I know nothing about Restasis. I also don't undertand why conservative measures were not discussed first. Now I am totally confused and need to make smart decisions without the anxiety impacting my choices

I understand Restasis treats some causes of dry eye, however, others don't respond. Why is it prescribed if they don't know if it will work. I also understand it is a strong medication. Perhaps others here can tell me if it is common to start treatment with 3 months of Restasis

Is Restasis really the front line treatment of choice. Should I take it now. I am an avid marathon runner and have no interest in a medication that will make my eyes burn and more difficult to enjoy my training.

I am willing to travel for a thorough appointment with an eye doctor who treats and communicates about dry eye. Perhaps New York, Cleveland, Philadelphia or another city with lots of teaching facilities. I am new with all of this and need good information and support

It is great to have the opportunity to post in this forum

[Gretchen]

Hi N & C -

Depending on what type of dry eye he believes that you have, Restasis could be a reasonable first line approach - especially if he thinks that you are very dry and wants to be aggressive.

Restasis can work for some, but not for others. The only way if it will work is to try it. Dr's have no really good way to predict. Some think that it is good only for autoimmune dry eye, others think it dandy for ocular rosacea. They don't know.

As for the stinging. It didn't sting for me. If it stings you to the point of discomfort, I would call the Dr and request a mild steroid for a couple of weeks to dose before using the Restasis. It helps.

As for long-term use of Restasis it has shown a much higher safety profile than steroids. And you only use it long term if it works for you. If it works for you, you should count yourself as lucky that there is something that can give you relief.

Hth,
Gretchen

[Newandconfused]

He said it was very dry and alsp prescribed a steroid. He didn't tell me anything about the type. He merely said very dry and prescribed Restasis, a steroid and a cream for the mild blepharitis. I am now NewandVERYCONFUSED

[Gretchen]

When I say that Restasis has a better long-term safety profile than steroids, I mean that Restasis can be used indefinitely with no known, serious complications. Steroids used long-term can lead to glaucoma and cateracts. For short-term use, steroids are pretty safe. Drs use Lotemax or Alrex in conjunction with Restasis in order to lessen the burning that most people experience initially.

As for your doctor not saying "what kind" of dry eye you have is not surprising. They rarely will, unless you ask. Next time ask whether you are aqueous deficient (not producing enough tears) or whether he thinks it is evaporative in nature (your meibomian glands are not producing enough lipids to keep your tears from evaporating). Then there are the multiple reasons why you may have either one or both - autoimmune, rosacea. Or there may not be a "reason" that he can point out, your eyes may just be dry. Anyways, the reason is not very important because the treatments and prognosis are largely the same no matter what the cause.

I would go to the section of the this board for Restasis/Cyclosporine and read, read, read. Then do some research via Google. The boards are good for specific questions, but getting a "big picture" understanding of all of this stuff is better achieved through lots and lots of research.

Regards,
Gretchen