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[Rebecca Petris]

Rebecca,
I want to mention that I've never had a corneal erosion nor have I ever had any staining at all. Considering my level of discomfort, I do find it difficult to believe.

That is similar to my experience at times, and many others that I know of. There is no shortage of precedents for excessive discomfort (read, pain is driving you mad) without erosions. I've kind of got a sense of a couple of different types of patterns with this but of course it's only guesswork. One example, which I think I might have mentioned to you once, is possibly something like surface toxicity in some cases of severe tear film imbalance. I've seen several people go through severe burning pain when their puncta are plugged, although based on their aqueous deficiency occlusion appeared to be a reasonable step to take.

Also, when I use Dr. Holly's drops multiples times in the night before I get dry and painful, I do much better the following day. I assume that prophylactic use is preventing damage being done during the night due to excessive dryness.

Weird? Typical?

No idea, and this is something I would love to study once we get a little cashflow going to support some studies.

Funnily enough - warning, I'm about to lapse into boring trivia - this precise function has been on my mind enough that I added it to our product labelling. The FDA have very, very specific requirements for product labelling and so basically you see almost every product with the exact same "Drug Facts" box on the back with the only difference being the ingredients. However while reviewing the monograph for ophthalmic demulcents (where the FDA spells out word for word what you must say) I found they have a list of "indications" from which you could choose any one or more. If you look at products on the shelf of a drugstore you'll find that they almost all - except TheraTears, which like us uses multiple indications - say "For the temporary relief of burning and irritation due to dryness of the eye". Ours says that plus "For use as a protectant against further irritation or to relieve dryness of the eye."

This is why I'm almost afraid to try the serum drops. I can't stand to be disappointed.

I sincerely hope you won't be.

[dianat]

Well, here's hoping. Yesterday was a tough day. I had to drive four hours on a sunny day. To boot my doc wasn't optimistic. He seems to think that because my schrimers are normal I must have nerve sensitivity and am not a true dry eye patient. In this case, improvements to my tear film won't make me more comfortable.

I think he's wrong on this. I really do. He didn't take the time to discuss exactly what methods improve things for me (for example, using Dr. Holly's drops during the night). Still, it didn't feel good hearing it.

God help us all.

[Rebecca Petris]

Frustrating.

Schirmer's is notoriously fallible.... I mean, if it indicates an aqueous deficiency, it's almost certainly right, but not vice versa because it won't always identify a true deficiency. Additionally aqueous deficiency really just plain isn't the be-all and end-all of dry eye.

There is an interesting article in this month's Cornea about the role of proteins in eye surface pressure (which is an important factor in tear film stability). I'll try to summarise this in our first newsletter.

[dianat]

It's good to hear your "second" on the schirmers test. I never liked it. Prior to cautery I had very, very low readings. That's why I was cauterized. So, I know I'm aqueaous deficient. Damming up lousy tears just isn't cutting it.

When you mention the proteins and tear stability. I do hope you are referring to blood serum and its properties.

So far so good on that. I know there is a risk of infection and I've been keeping a close watch. I had some redness and itching on my lower lid and I got upset. It was just a bit ago and all seems to be fine now. Probably nothing. I"m just nervous....