Are Refresh, Soothe, and Theratears making me worse?

[tiff]

Hi everyone,
I am 33, have dry eyes, blepharitis, MGD, and ocular rosacea. I'm on Restasis 4 times a day, doxycycline 100 mg twice per day, lid scrubs, and artificial tears all day.
I've been putting artificial tears in in the middle of the night (we have small children and I sometimes have to get up with one of them) and notice my eyes are much redder in the morning, feel more itchy, and I have crusty stuff (sorry for lack of technical terminology) on my eyelids, when I wake up. Are the refresh and soothe tears making me worse in the middle of the night? My eyes hurt so badly when I have to wake up at night and they clearly are desperate for moisture, but the mornings seem worse if I do this. I also use a cold, wet washcloth on my eyes for 15 minutes when I lay down to sleep (the goggles I got don't work well at all), and do a warm compress in the afternoon.
Should I discontinue nighttime drops and just deal with the pain at night?
Any and all advice is welcome!
Thanks,
Tiffany

[Rebecca Petris]

Hi everyone,
I am 33, have dry eyes, blepharitis, MGD, and ocular rosacea. I'm on Restasis 4 times a day, doxycycline 100 mg twice per day, lid scrubs, and artificial tears all day.

Hi there,

Any indication from any doctor (or your own ideas) about what's behind it all? Sometimes even for young folks hormones play a role.

I've been putting artificial tears in in the middle of the night... and notice my eyes are much redder in the morning, feel more itchy...Are the refresh and soothe tears making me worse in the middle of the night?

It's certainly the first thing I would suspect. You know a good way to test this would be (I know it's no fun but...) put nothing in and tape your lids down really well one night. I know, I know, ripping it off in the middle of the night isn't fun but I've been there & done that and know it can be done. I'd use Micropore paper tape and make an X over each eye with 2 strips, pressing downword on each strip, then remove from the top downwards. If it were me I'd put the same one back on when I went back to bed just to save hassle.

Another step in elimination is switch to something with totally different ingredients at night and seeing what happens. Maybe a simple glycerin drop.

Redness & itching are classic allergy symptoms so if you manage to rule out the drops as the source of the problem, it may be that your dryness is leaving you vulnerable to allergans that never used to bother you. Consider the pillow, and the laundry detergent for the pillowcase. Also check your room for mold.

Residue can happen with any polymer drop, by the way. Blotting with a wet tissue or cloth after applying can help prevent that.

I also use a cold, wet washcloth on my eyes for 15 minutes when I lay down to sleep (the goggles I got don't work well at all), and do a warm compress in the afternoon.

That's a good idea. Though personally I might kind of reverse that.... warm just before bed so I get the benefit of more oil, and cold first thing in the morning to calm my eyes down from whatever they went through in the night.

Should I discontinue nighttime drops and just deal with the pain at night?

Depends how dry you are and what all else might be going on. My concern would be potential for corneal erosions. What about those goggles... by the way if you got them at the shop by all means return them if they didn't work out - if lubricants at night are going to be a problem it may be time to experiment with some other kinds of night eyewear.

[tiff]

Hi Rebecca,
Thanks so much for the comments!
My doctor gave me no reasons why I might be plagued with such issues. My allergist tested my hormone levels to see what the underlying cause was and found no issues whatsoever. Are these problems abnormal at my age?
I will try the tape experiment, thanks.
I'll look for other kinds of drops, but the selection at our drug stores leaves a lot to be desired. Is there somewhere online to find better drops?
I will do heat therapy instead of cold at night, I should have thought of that. And, I got the goggles on another site and, since it's been too long, I will have to keep them.
I thought redness and itchiness were from blepharitis and ocular rosacea, at least that's what my opthamologist told me. I do have allergies and am on Claritin for those. I change my pillowcase nightly, have allergy protectors on all parts of our bed and wash our bed linens in extra hot, with a free and clear organic detergent and change the sheets every three days. Uggh, this is so frustrating!
Thanks so much,
Tiffany

[Rebecca Petris]

Are these problems abnormal at my age?

A little bleph or rosacea, no, but enough of it that you'd be on this much treatment and having this severe night symptoms is not normal.

Is there somewhere online to find better drops?

Most drops are in all the online drugstores. A few are sold mostly through dr's offices. Oasis is a good one (see oasistears.com).

I thought redness and itchiness were from blepharitis and ocular rosacea, at least that's what my opthamologist told me.

Certainly can be, but they're equally common with allergy, and with dry eye (of any type including MGD etc) there is sometimes a chicken-or-the-egg question of what's causing what. Based on how careful you are with the environmental stuff though it sounds like it could be either the condition itself (dry eye is worse at night for a lot of people - poorer tear production, lids not sealing, etc) or drops. I think a surprising number of people have either allergy or sensitivity of some kind to some of the common ingredients in many drops.

[tiff]

Thank you!

So what might be the culprit for the severity of my issues? This has me nervous and pretty frustrated that this is abnormal for my age. Uggh.

Thanks,
Tiffany