Drops make eyes feel DRIER?

[georgiav]

ALL eye drops (I have tried every one on the U.S. market, as well as Serum tears) make my eyes feel much DRIER for several hours after installation.

* Am I a "freak of nature" or does anyone else experience this?

* How could this be possible? (It obviously goes against logic).

* Is it possible that initially drops could make someone feel drier/worse, but with repeated usage healing could take place and they could actually help in the long-run?

Any comments or opinions on any of the above would be very much appreciated!

[robster]

Some people with dry eye have hyper-sensitive eyes that respond badly to any kind of foreign substance being put on them regardless of whether or not they are preservative free. It might also be worth checking the ingredients in the various drops to see if their is a common denominator in them that might be causing your eyes to react badly to them.

[sunshinelover]

I had the same problem for a while . All drops I tried made eyes insanely drier . .doc said that some does experience such a rebound effect . Then I could was not put anything in my eyes without severe stinging . Eyes did sting even with my eyes own tears ! Then I found this pure saline flushing to be the solution . After a couple of months with only saline I Can now that use drops like Optive and Viscotears with only some does effect at least . Don,t know why I had that stinging period ... May be it was after I had got plugs that situation got better in that aspect .

[Joseph]

I think that eye drops could be washing away the oil that your glands are producing and making your eyes drier. I have the same problem with drops making my eyes grittier and gummy so you are not alone. Warm compresses might be better for you. It was for me..

[sunshinelover]

Yes, I agree with Joseph, that could be it. I am now more and more seeing a clear connection with good days ( out in the warm sun!) and bad days (chilly weather) - guess that the oil flows better when eyes are warmed up in the sun?!

[grandsporta]

I think that eye drops could be washing away the oil that your glands are producing and making your eyes drier. I have the same problem with drops making my eyes grittier and gummy so you are not alone. Warm compresses might be better for you. It was for me..

I think that is what it is too. I have the same problem. I don't use drops until I absolutely need to, and it is typically at night.

[Spoon]

This video sums up what you're discovering (I think they've got it right with the delivery mechanism but I'm yet to try their product)

http://www.youtube.com/watch?v=l0gOr8TB45U

It took me a couple of years to make this realization about drops, then a while longer to find anyone else with the same view. The decision between abstaining form drops and trying to work with what you have and using drops which will wash that all away but probably give you some temporary relief is tough and will depend on severity

[bakunin]

Drops didn't make me better either. I think I got wors using them, so I stopped. I went to a doctor today and I will try some others. I dropped a new one some minutes ago, and I get a some minutes relief, and as with the others, I feel my eyes strange, kind of heavy.

[sunshinelover]

This video sums up what you're discovering (I think they've got it right with the delivery mechanism but I'm yet to try their pr9oduct)

http://www.youtube.com/watch?v=l0gOr8TB45U

It took me a couple of years to make this realization about drops, then a while longer to find anyone else with the same view. The decision between abstaining form drops and trying to work with what you have and using drops which will wash that all away but probably give you some temporary relief is tough and will depend on severity

Anyone tried those drops Natures tears?

[sunshinelover]

Hmm ...another video says its a scam ??

[Bill Sonoma County]

Georgia, I'm a fellow DED sufferer for 26 years. Your question is so insightful and relevant to treatment. I wonder whether you or other people with DED pain agree with some of the thoughts that I have as expressed below:

As you said some products "make my eyes feel much DRIER" . Absolutely. One key issue is that "DRIER" sensation--and that sensation, IMHO, derives largely from activities/disruptions that occur at the surface of the cornea. The cornea of course contains the nerves that detect pain and with the exception of a primary disorder in those nerves or in the central processing centers (corneal neuralgia, CNS injury) something has to be going wrong at the tear film-corneal interface for those nerves to get upset. Just as it takes an abrasion, puncture, laceration, poison oak, chemical spill or something similar to get discomfort transmitted to nerves in your hand, it takes something nasty occurring at the interface to get the corneal nerves to fire. For a normal corneal-tear film system, a person would need a major insult, a grain of sand, a splash of soap or acid, a horribly dry wind or something similar to break down the interface and stimulate the nerves. For those of us with precarious interfaces, a small mucin/aqueous/lipid failure, some dust in the air, dry air, some artificial tears that imbalance our chemistry, rosacea, blepharitis, eye lids closed overnight without sufficient lubrication or a host of other traumas can break down the interface to the point of pain. A mild breakdown may just result in the sensation of dryness. More severe breakdown can cause distressing grittiness or burning and major failures lead to disabling foreign body sensation and sometimes even to a corneal abrasion that can be seen at the macroscopic level by an ophthalmologist. Of course the microscopic and sub-microscopic disruptions cannot be directly seen, but nonetheless can terribly distressing.

So while some drops will make our eyes plenty wet with tears dribbling down our cheeks, the DRIER sensation that you describe really is there, arising from a disruption in the delicate balance at the interface--a balance that is even more delicate in those of us with existing tear film-cornea compromise. And even if you do derive some transient benefit, a few minutes after instilling drops, the tear film structure and chemistry are further disrupted and the corneal nerves fire even more furiously, resulting in dry, grit, burn, FB or other sensations.

The outside observer sees a wet eye ("you don't have dry eye") and can't see any physical disruption at the macroscopic level ("your eyes look normal"). There is often no visual evidence to suggest how to proceed with treatment ("keep doing what you're doing").

I'm sure this is discourse is redundant, but yes DRIER sensation is very real, as are severe pain sensations, even when no macroscopic abnormality can be seen. I think that you and other DED sufferers become the informed experts on your own disease. We've tried just about every drop on the shelf, haven't we? I think that the worst thing we can do is to rely upon poor assesments and advice. Lipid/aqueous/mucin/cornea, and much of the action is microscopic or submicroscopic. Curious about your thoughts and those of others. Sorry for the ramble.

Bill

[bakunin]

Georgia, I'm a fellow DED sufferer for 26 years. Your question is so insightful and relevant to treatment. I wonder whether you or other people with DED pain agree with some of the thoughts that I have as expressed below:

As you said some products "make my eyes feel much DRIER" . Absolutely. One key issue is that "DRIER" sensation--and that sensation, IMHO, derives largely from activities/disruptions that occur at the surface of the cornea. The cornea of course contains the nerves that detect pain and with the exception of a primary disorder in those nerves or in the central processing centers (corneal neuralgia, CNS injury) something has to be going wrong at the tear film-corneal interface for those nerves to get upset. Just as it takes an abrasion, puncture, laceration, poison oak, chemical spill or something similar to get discomfort transmitted to nerves in your hand, it takes something nasty occurring at the interface to get the corneal nerves to fire. For a normal corneal-tear film system, a person would need a major insult, a grain of sand, a splash of soap or acid, a horribly dry wind or something similar to break down the interface and stimulate the nerves. For those of us with precarious interfaces, a small mucin/aqueous/lipid failure, some dust in the air, dry air, some artificial tears that imbalance our chemistry, rosacea, blepharitis, eye lids closed overnight without sufficient lubrication or a host of other traumas can break down the interface to the point of pain. A mild breakdown may just result in the sensation of dryness. More severe breakdown can cause distressing grittiness or burning and major failures lead to disabling foreign body sensation and sometimes even to a corneal abrasion that can be seen at the macroscopic level by an ophthalmologist. Of course the microscopic and sub-microscopic disruptions cannot be directly seen, but nonetheless can terribly distressing.

So while some drops will make our eyes plenty wet with tears dribbling down our cheeks, the DRIER sensation that you describe really is there, arising from a disruption in the delicate balance at the interface--a balance that is even more delicate in those of us with existing tear film-cornea compromise. And even if you do derive some transient benefit, a few minutes after instilling drops, the tear film structure and chemistry are further disrupted and the corneal nerves fire even more furiously, resulting in dry, grit, burn, FB or other sensations.

The outside observer sees a wet eye ("you don't have dry eye") and can't see any physical disruption at the macroscopic level ("your eyes look normal"). There is often no visual evidence to suggest how to proceed with treatment ("keep doing what you're doing").

I'm sure this is discourse is redundant, but yes DRIER sensation is very real, as are severe pain sensations, even when no macroscopic abnormality can be seen. I think that you and other DED sufferers become the informed experts on your own disease. We've tried just about every drop on the shelf, haven't we? I think that the worst thing we can do is to rely upon poor assesments and advice. Lipid/aqueous/mucin/cornea, and much of the action is microscopic or submicroscopic. Curious about your thoughts and those of others. Sorry for the ramble.

Bill

Thank Bill very much!

I think it is a very reasonable explanation for what we feel after using drops.

[sunshinelover]

Yes , I agree . But ... If staying away from drops means that eyes get inflamed due to severe dryness ....then the pain is even worse . So what to do ?

[georgiav]

Hi Bill,

I think you have "hit the nail on the head" with everything you said. I just sent you a Private Message regarding this.

Georgia

[Bill Sonoma County]

Yes , I agree . But ... If staying away from drops means that eyes get inflamed due to severe dryness ....then the pain is even worse . So what to do ?

Ay, there's the rub. And Sunshine, Georgia and everyone, I respect your extensive individual and combined experience, so I'm going to defer to you all on what to do. This also goes back to Georgia's question about whether drops that cause the DRIER sensation could help in the long run.

For me, the most help has come from reading these forums, reading the scientific articles and trying to appreciate both the dysfunction of the lipid/aqueous/mucin/cornea interface and what the nerve signals to our brains are telling us. As a example of the former, when I go to an ophthalmologist and she/he says "everything looks OK" I say thanks, realizing that I don't have a corneal ulcer at the moment, and then go home and focus on what might be occurring at the sub-macroscopic level. When I find condensation on the inside the left lens (most seriously affected eye, puncta cauterized) of my home-made moisture chamber glasses, I guess that the lipid film is allowing evaporation and I move to new meibomian and ointment therapy. I'd love to find a doctor who could help me with this understanding, but recognize that they have patients with a host of vision-threatening conditions and choose to focus on those problems.

As far as the nerve signals and CNS processing are concerned, I think that a lot of us have come to believe that a spectrum of sensations exists. These sensations range from normal through "dry, gritty, burning, FB, severe FB..." and teleologic arguments can support why our nervous system provides these interpretations to us. Another question for everyone is "are all levels of corneal discomfort indicative of ongoing damage?" I vote yes and endeavor, though fail, to avoid even the lower level sensations. I don't avoid drops, but I'm selective about what artificial tears and adjuncts that I will employ. Most of the OTC's feel OK for a minute, then feel worse. So, if the nerves end up firing, I see that as bad, even if the eye is wet. Currently, I'm special ordering short neck Thera Tears PF; that's neither and endorsement nor recommendation, just where i landed after a couple of decades of suffering.

We are our own best advocates. And through staying informed, we become the authorities on our own DED. Sorry, I know that is an unsatisfactory conclusion, and if I missed the intent of your questions too widely, let me know. We have probably all received some really bad medical advice over the years--but focusing on l/a/m/c and nerve signals has helped me to find some of the good info and gain some five and ten percent improvements. Best to all. Bill