‘There is no cure for dry eyes’. This is the only statement I can recall delivered with either unanimity or confidence by many of the ophthalmologists and optometrists who cheerfully pocket my poor mother's money, suggesting in return more hot compresses or increasingly glutinous over-the-counter-lubricants. In my experience, they usually inform me of the chronic nature of my condition only after performing the same inconclusive tests and providing vague, often wildly varying diagnoses short on meaningful detail. To the inexperienced ear, this waffle sounds meaningful, but I have concluded that, in reality, their explanations are generally designed to make the average punter feel like they've got their money’s worth.


Even the specialists who agreed that I have an insufficient lipid layer following roaccutane therapyfour years ago have, after peering at my eyes, (usually with furrowed brows and pursed lips to give the impression that they'’re thinking something enlightening and profound) all announced that I have meibomian gland ‘"dysfunction."’ Most, I have noted, have done so without even properly examining or expressing the glands themselves.
This is a frustratingly imprecise diagnosis. What do they mean by Meibomian gland ‘"dysfunction?’"


Clearly the oil producing glands in my eyes have been rendered dysfunctional by this apparently indiscriminate drug; the purpose of which is, after all, to shrink the oil producing glands in the skin; that much I gathered intuitively, even four years and a half years ago as a seventeen year old. I was paying these very well qualified men in the hope that they may be able to establish the way in which they had been rendered dysfunctional, rather than to vaguely confirm their dysfunctionality. Were the glands atrophied? Blocked? Does the issue lie in what the meibum consists of? Every doctor I have seen - and I have seen some of the big names in British Ophthalmology - has no answers to those questions. Clearly out of their depth, they respond either patronisingly or with more vague answers and nebulous waffle; one in particular said that although he didn't think they were blocked, he thought they looked too 'pristine'. Occasionally I am pleasantly surprised to find they admit they don'’t know.



I decided to find answers elsewhere, and so, on Monday, I underwent a lipiview examination. The purpose of lipiview is to establish the thickness of the lipid layer on the eye, and to provide a numerical score indicative of the level of dryness. Under 75 is abnormal, below 50 is severely dry. I scored 52 and 51. Representing the thickness of the tear film numerically seemed arbitrary and too susceptible to extraneous factors to be precise, and is pretty dubious when a low score is required to 'qualify' (it's your lucky day!) for a treatment which fleeces sufferers of £1200. Nonetheless, it suggested some kind of lipid deficiency, as I had long suspected.


Of more significance to me were the images taken of the glands themselves, which revealed them to be perfectly intact; as they ought to be in a 21 year old. The cause of my low scores were, the lady concluded, the visible blockage of the meibomian glands in my lower eyelids. She recommended lipiflow to me, which is designed to heat and vigorously ‘milk’ the meibomian glands in order to unblock them. I underwent the procedure immediately, despite my cynicism.
During my treatment I was was told once again that my condition as incurable; lipiflow may only improve my symptoms because dry eye is chronic.
This makes no sense to me intuitively.

It is not unwarranted for most people to be told that their dry eyes are incurable. That is because most dry eye is caused by an underlying disease or condition which itself is chronic and incurable. For example:
  • Autoimmune disorders, such as Sjogren's Syndrome, Lupus, or Rheumatoid Arthritis,
  • Ocular Rosacea
  • Disruption of the neural feedback loop caused by damage to nerves after LASIK
  • Physical damage to/atrophy of the meibomian glands - perhaps due to contact lens use or incomplete blinks/nocturnal lagopthalmos.
  • Menopause
  • Old age
Most people who suffer from dry eyes suffer from one or more of the above. I, mercifully, do not. The only circumstance in which I could expect to suffer dry eyes permanently is if my meibomian glands had been atrophied irreversibly by roaccutane, which I had long suspected.

But the images taken by Lipiview have established that this is not the case. Why, then, should I expect further MGD after my glands are unblocked by lipiflow? Why wasn’'t I told lipiflow would simply unblock the glands and would allow me to live my life as I had between the ages of 1-17?
When I asked the lady this question, she had no answer and just asserted again that ‘dry eye is a chronic condition.’ My main ophthalmologist concurred that this was the case.

While I fully expect them to be right, and I am not anticipating this to have any discernible, let alone permanent, effect on my eyes, the question I have is why? I am one of the few exceptions to the rule the rule that dry is caused by an underlying incurable condition. Since the imaging, no one has suggested my glands have been damaged in any way and I'm neither diseased, old, or menopausal - so why am I then told what seems to be a non-sequitur: that my condition will continue to be chronic? Could it be that though ostensibly they look normal that the meibum quality has been affected permanently in some way? After all, if my glands are now unblocked and totally intact, why are they still dry? (Roaccutane has no documented effect on aqueous tear production)

I hope someone more intelligent and better informed than me can provide some insight or theory that may help me in looking for a solution that, I hope, may be permanent after all.

TLDR:

Why, when I have no underlying incurable diseases causing my dry eyes, and my meibomian glands are perfectly intact (just partially blocked), am I told my condition will be chronic? Should I give up on trying to find a cure? While it is true that most people’s dry eye cannot be cured due to underlying incurable disease, I can’t shake the feeling that this intuitively doesn’'t or shouldn'’t apply to my case since I don’t suffer from any of them and I’m only 21. If it does, what can I conclude about what roaccutane has done to my glands in order that the condition is chronic when it hasn’t atrophied them? Is it possible that it has affected the quality of the secretions? That’s the only thing I could conclude, other than Aqueous deficiency (and there is no evidence roaccutane causes this).