Diagnosed with blepharitis post lasik

[heather g]

Hi everyone. Was hoping someone could shed some light on my dilemma.I had lasik 7 months ago. Had some intolerance to my contacts but passed all the pre op tests and the schimmer test. Dr. Felt I was a good candidate. Since the surgery I have had severe dry eye.Especailly my left. My doctor sent me to the a major hospital recently because after lower plugs and restasis he was at a loss to help me. The specialist diagnosed me with blepharitis and told me my melbomium(sp?) glands were blocked and he pressed on them to unblock them. He also said I have evaporative tear disorder.
I should have asked more questions them but to be honest I was stressed out from the whole exam which was uncomfortable and also relieved to hear there was more treatment for me.
Now I am wondering if anyone else has had something similar to this happen after lasik. was the surgery the cause or was this condition there and undiagnosed before surgery. ( I know this is probaly a question that cannot be answered) And is the steroid or tetracycline a successful treatment? I understand through reading this is a chronic condition but has anyone had success with treatment? Meaning is there hope I will experience some level of comfort again?
Is there any thing else I need to try. Have started the eye lid scrubs and the warm compresses. Oh and finally this Dr. mentioned removing the plugs because they could be worsening the problem. Has anyone heard of this or had success with it?
I will be seeing my former Dr. this week and ask him all of this but was hoping to hear feedback from someone who had experienced it.
Just feeling desperate at this point. I read a post that said they would like to get in a spaceship and return to a time that was post lasik. I would give anything to get on that ship!
Heather

[Jeannie]

I'm sorry to hear what you are going through. I'm not sure that I can be much help, other than supportive. I am only 5 weeks post op lasik today. I am also suffering from severe dry eye, although its only in my left eye. My problem is that there is a dry patch right in the center of my vision, which is what the doctors say is causing my blurry vision. We'll see though. I see the doctor at least twice a week. I go again tomorrow.

I also have permanent plugs put in. Also, when the surgeon saw me the week before last, he said that I had blepharitis as well, so I started the lid scrubs and warm compresses twice a day. Personally, I don't think I have blepharitis. I NEVER had signs of it prior to the surgery. I personally think it was caused by all the "stuff" I have constantly been putting in my eyes since the surgery. In fact, after less than a week of doing the eye scrubs, when I saw the doctor who inserted the plugs, he told me to stop doing the eye scrubs, but to continue with the warm compresses.

I am currently doing the warm compresses twice a day. I am putting drops in every hour (systane free Gel), and I'm using FreshKote twice a day. I'm on the theratears nutrition of which I take four every morning. And actually, every other day or so I DO do a lid scrub, because the freshkote seems to gunk up my eyelashes. I also use tobradex ointment before bed at night. Frankly, I'm afraid to go off a steriod, and my doctor has indicated that same fear right now, because in the five weeks since my surgery, I've been off them several times, and every time I go off it, I take a turn for the worse. My eyes get red, vision deteriorates, the eyes get dryer, and the lid starts to swell!

I guess my best advice to you would be to give everything a chance before changing too much. do the lid scrubs and warm compresses for a week or two before trying or adding in any other thing to determine if that's all you need. I know that I *believe* that the scrubs and warm compresses have helped me. Once we got some of the problem cleared up, THEN we moved on to changing some other stuff. I would personally keep the plugs in and see how the lid scrubs and warm compresses do for you. If in two weeks or so, you don't see any improvement, then go and talk to someone.
But, I'm no expert! I'm new to this as well. But there are people here who have been dealing with problems similar to ours for awhile who I'm sure will be able to provide good insight on what they think you can do or what might help.

Anyhow, you should have comfort in knowing that you aren't alone.

[heather g]

Thanks Jeannie for your reply. I can relate to what you said about not having the the blepharitis before the surgery. It is possible but I had no symptoms. I have been doing the warm compresses/lid scrubs for almost 3 weeks and they have not helped much at this point. I am waiting for my doctor to prescribe steroid drops or tetracycline that the specialist recommended to see if that helps. The problem was the specialist was slow in sending the records.Sigh!
It is a long frustrateing process finding your way to comfort again. It is so helpful to read the postings on this site. We just have to remember progress can slow! Good luck with your situation. I hope you have continued improvement.
Heather

[YGB]

Heather - Dr. Tseng has published the association of meibomian gland dysfunction after LASIK. Here's an excerpt from the web site http://www.ocularsurface.com/

" Dr. Tseng and his colleagues have discovered that conjunctivochalasis-induced dry eye an be differentiated from aqueous tear deficiency-induced dry eye, and that lipid tear deficiency due to meibomian gland dysfunction is the dominant cause for persistent dry eye following LASIK using kinetic analysis of tear interference images."

Your condition sounds very similar to mine and I am 5 months post-LASIK. Here is my current treatment plan ...

15 minute warm compresses 3x/day followed by lid massage and scrub with q-tip and saline, Restasis 4x/day, Systante/Systane Free/TheraTears as needed, BioTears omega3, 100 mg oral doxycycline, and bilberry supplement. I've also tried warm chamomile tea bags on my upper lids since this is an old anti-inflammotory remedy. It seems like it's helped some so far. I just weaned off of Lotemax (steroid) that I was on for 4 weeks. That helped the redness in my right eye go away.

I was also plugged with all 4 plugs at one point, but had a few pulled to avoid the "cesspool" effect of bad tears and inflammatory agents being left in my eyes. Besides, I think the plugs help for a few days and then the eye adjusts and you get back to your previous dry eye state (at least that was my experience).

I also did some acupuncture and it seemed to help get my aqueous tears jump started again after the first 6 treatments, but the help has dissipated in the last 8 treatments. I'll probably stop going soon. Finding a good acupuncturist is key since the first guy I went to was not very good and the second guy is excellent.

[heather g]

Thanks for the great information. For some reason getting an answer to that question has made me feel better! My Dr.'s asst. has repeatedly told me the blepharitis and lasik have nothing to do with one another. Yet I never had a problem before the surgery.
Regarding your routine... how long have you been on the doxycycline? I was prescribed that today for a month, possibly 2. And have you had any improvement being on this? How many times a day are you using tears?
I feel like you do about he plugs. With the two bottom I have not ever really seen an improvement.I am wondering if I would be better off without them as they aren't helping. The doctor also told me to take a flaxseed supplement. But what is bilberry?
Again thanks for your reply. It does sound as if we have a similar problem. Good luck to you. Hopefully in the next few months we will be seeing relief.
Heather

[YGB]

Heather - I've been on the doxycycline for over 3 months and I will likely be on it for the foreseeable future. As long as your GI system can handle it, there does not appear to be much risk associated with it. The doxy definitely knocked the inflammation down about half way or maybe a little more from its worst point, but I was hoping it would completely knock it out. My MD said that he did not see the doxy reducing the inflammation anymore than it already has to date. That's when it was decided to pull 2 of my 4 plugs to hopefully reduce the inflammation further.

Note that if you only have 2 plugs, I don't know if it would be wise to have them pulled if you have tear deficiency (although I am not an expert, so this is just my opinion). You still have drainage through your top puncta so the bad stuff in your eye is draining (just not as fast). It's not like you're all plugged up with 4 plugs and getting the "cesspool" effect.

I am using drops about every hour now and Restasis 4x/day. I'm trying to use the drops on a schedule to avoid having my eyes get extremely dry and then struggling to recover for the rest of the day. I have been on Restasis for 6 weeks now and I am hoping it will start kicking in soon. The MD says that it usually takes 6-8 weeks to see measurable improvement. I am hoping he is right. As for Bilberry, it is an herbal supplement that supposedly promotes eye health and improves capillary flow to the eye muscles. You can get it at any health food store.

It is definitely a slow process and hopefully we will keep steadily improving although it may be best to gauge improvement on a month to month basis rather than daily or even weekly basis. At least this has worked a little better for me in dealing with this difficult condition.