Symptoms "delay" after causative damage?

[lulu]

Hi
I can remember reading somewhere (goodness know where now) that sometimes an episode of dryness/pain can occur sometime after the original causative event. Basically the degeneration on the surface of the eye starts to happen but it might be that your eye can "compensate" for a while until the damage is bad enough and cell death ensures. Conversely the healing may start to happen despite one still suffering, so things drag behind in order. I am asking this because basically I am having an awful time and am trying to find the cause in the hope that things might ease for me a bit. I had a cuatery back in February and things started to get a tiny bit easier and then in April I noticed a new sensation on this eye and in July, bang! Its worse than ever now. Now my eyes are not good even in "better" periods but they were a tiny bit easier for a couple of months in April and May. Could it be the cautery? I swelled like hell and had black eye, I have read that the injection can in rare cases damage the muscle etc etc, does not look like there is any malposition of the lid or could it be that I helped my Mum with making some fairy wings for a play and used UHU glue for over a month in MAY, or a combination, who knows but with Winter coming I can see myself having a very grim time if this does not get any easier.
The problem seems to be worse in the inner corner of the right eye which is my worst eye anyhow. There is a dry patch that sets it into a super grit frenzy which takes my breath away. I still use cyclosporin which has oil in it and although I am not happy about the greasiness with clogging etc, its the only thing that allows the lid to glide.
Any thoughts, pretty low.
Lulu x

[spmcc]

My instant thought is that your cautery has re-opened.

You say you swelled up badly after cautery. Well, the swelling will actually close the punctum even if the actual cautery didn't work. When the swelling subsides, the punctum is back open. I've had my cauteries re-open *countless* times esp after the swelling goes down (altho I don't swell/react like you do).

Another (perhaps off-the-wall) idea is that cautery may have changed the way a lash (or multiple lashes) grow(s) in that area. Have you looked closely at the nasal corner to see if you have a lash or lashes poking you? I've recently had some "lash drama" so I'm a little biased right now.

Anyway, those are my immediate thoughts to your predicament.

Good luck.

[lulu]

Thanks for your prompt reply. I have checked my lashes as this was one of my thoughts but under the magnifying glass, all looks well.
I had my eyes rechecked on the 9th July and my optho says it is closed still. My symptoms had begun a few days before that so I dont know really. Maybe I should get him to recheck but I will not be due to see him until January. He looked at the way the tears were sweeping on the eye and he said that it looked pretty sealed.
Thankyou anyhow.
Lulu x

[spmcc]

I understand your frustration. And my thoughts are all tainted by my own crazy experience with dry eye. Anyway, I've had ophthalmologists say my punctum is closed. Then another will say that it's open. I've actually had a doctor say it's 95% closed. How is that determined?!?! Anyway, I think the only "true" way to know if a punctum is open is to have it flushed with saline. Of course, if it's closed and just hanging on, flushing it may open it wide up! Such a predicament!

I really can't think of anything else. It's only happening to the one eye (nasal OD), correct? So, it's probably not the drops because that would irritate both. Hmmm. I'll do more thinking on this...

[lulu]

Thankyou. Gosh its such a dilemma, isnt it? It is the nasal OD, that is correct. I dont think its the drops either. They are both very dry but the right one which my optho also has determined is the worst one is the problematic one. I keep checking the surface with a magnifying glass to see whats going on on it. I also check the pattern of swollen veins and nothing much has changed. This particular gritty pain is slightly different from the grittiness that started mid September last year which I count as my third big flare. Plugs used to help but then they stopped, cyclosporin used to help and then, yes you guessed it, it stopped also....... I used to think that the sensations I had were bad enough and then you get another one and it blows the previous ones out of the water. I have never had a flare that has gone on as long as this one, a year nearly, because even when it settled down for 2 months, it was not as good as it used to be when it got better in 2007 and 2010.
We still dont know what is really going on but it looks auto immune as I have other stuff going on but mostly sero negative for sjogrens.
Thankyou for your help as tonight I am at my wits end and am going to tape that eye down soon.
Thanks again.
Lulu x

[spmcc]

I do the same thing - tape my eye! In fact, for the last year+, I've been giving myself a "tape tarsorraphy" every evening just so I can keep that eye "open". Otherwise, I'm a cyclops which really ruins vision! But the relief is great with the tape.

Anyway, not to harp on the topic of lashes, but I recently had a doctor pluck an eyelash in the nasal corner of my right eye. And the poking sensation I was getting for over a year stopped! Sheesh. A 2+hour one-way trip to see a doctor and he simply plucks a lash and I'm (relatively) better?!?!?! Crazy!

Well, I came home from that daylong trip and looked in my 20x magnifying mirror. I wanted to see what was going on in that eye. My vision sucks, but I could make out a bunch of *very* fine lashes in the nasal corner of that eye. I plucked them all! 10-15 lashes I pulled! Ouch. But now that eye is SO much better. And no more tape tarsorraphies (so far - it's only been a week).

I've had dry eye for 17 years with no "lash drama". Now, this year, I've had an ingrown lash (upper left lid) and now lashes poking my eyeball (right eye only). So I've got lashes on the mind, and I'm recommending that people who have poking, FBS or pretty chronic irritation in a specific area think of their lashes too.

Good luck!