Your thoughts?

[Cathy]

I posted here about 2 months ago and was given some very good advise. Since then, I have realized I need to get a diagnosis, and have been using a humidifier and have thought about getting new glasses and glasses for nighttime. I also have made an appointment with Dr Majmuder in the Chicago area and will see him in December.

So thank you for all your help!

That brings me to my questions...I did much better with lower plugs but then when got the right lower cauterized because I kept losing that plug it was like nothing was done. Then I had an upper put into my right eye and had lots of tearing at first but that has stopped and now it is not great but that is no longer the "bad" eye. The humidifier I thought was going to be the answer since it was so wonderful for about 2 weeks in that I woke up with just a little bit of eyelid stickiness and dryness which took about 15 minutes of blinking to get better. Now I am back to where it is barely making a dent, and my eyes are constantly dry again.

Is this what happens? ...that you think you have the answer and it works for a short while and then gets worse again?

I am 55 and have gone into menopause this year and have had my eyes bad pretty much since then. But if menopause is the reason, does it ever stop getting worse? It seems like my estrogen would eventually be pretty much gone and the dry eye would then stop progressing. Does anyone know?

Thanks so much for taking the time for me.

Cathy

[No tears in ATL]

Any way for the doc to check to see if the cautery is still shut? I know some experience overtearing with plugs at first and then it tapers off. What type of dry eye do you have? Is it aqueous?

I'll tell you from my own personal experience that plugs have helped me somewhat but I had to address osmolarity before I could get any real relief. Do a search of the threads and you'll see some things come up that maybe you can show to your docs. My overly "salty" tears (for lack of a better word) were causing constant inflammation. I had to get the osmolarity under control to control the inflammation, which was leading to even drier eyes.

[bakunin]

Any way for the doc to check to see if the cautery is still shut? I know some experience overtearing with plugs at first and then it tapers off. What type of dry eye do you have? Is it aqueous?

I'll tell you from my own personal experience that plugs have helped me somewhat but I had to address osmolarity before I could get any real relief. Do a search of the threads and you'll see some things come up that maybe you can show to your docs. My overly "salty" tears (for lack of a better word) were causing constant inflammation. I had to get the osmolarity under control to control the inflammation, which was leading to even drier eyes.

No tears,

How did you address osmolarity? And what tests did you do to know your tear film osmolarity? I wanna talk about it with my doctor in my next appointment this month. He talked about the plugs but nothing about control of osmolarity, and I know by my condition that plugs won't do anything in my present state.

[Blinks]

Cathy, You're on your way to feeling better (even though it may not seem that way just yet) and for most of us there are good days and not so good ones. Glasses, especially close fitting ones really do help conserve moisture. Found a pair of fit-over style sunglasses very helpful.

If you haven't yet, might take a look over the "how to feel better right now" post from Rebecca. She has some excellent tips. http://dryeyezone.com/encyclopedia/coping101part1.html

One thing that may provide relief is taking an omega-3 supplement. My doctor recommended them back in February when my eyes were screaming red and sore and dry after cataract surgery. It took patience though, they've helped in a big way. It took about 5 or 6 weeks to kick in. TheraTears Nutrition Gel caps are my "drug of choice". I take them every single day without fail, and there are lots of others on the market, too. In addition to helping my eyes, my skin is less dry. There are lots of threads on omega-3 so a search might turn up more.

There's lots written about menopause and dry eye. Dr. Latkany's book mentions birth control pills high in estrogen causing dry eye in one of his patients. He seems to say the menopause/dry eye correlation is controversial and inconclusive. But you'd be in plenty of good company who've made that connection. (The book is: The Dry Eye Remedy -- good tips there too.)

My eyes used to be sticky in the AM and a few drops of Unisol saline on a cotton pad (w/eye closed) to kind of gently soak and loosen the stuff helps. The Unisol really feels good and soothing, but probably plain water would do the same.

You're found a wonderful resource here and a community of people with amazing knowledge and support. Good luck with your journey and hope you find relief soon.

[Cathy]

Thanks all for your insights. I will be back to the omega 3. I had tried that but the size of the pills are just too overwhelming for me. Are there others?

I also will get the book. I remembered hearing about that on these boards but hadn't had a chance.

And osmolarity does sound like something I should talk to my doctor about since when I had the upper plug and the over-tearing, at first the tears were very welcome, but soon I had terrible burning and itching from them. It did feel very much like it was salt being poured on my eyes.

Cathy

[Cathy]

No tears in ATL, how do they figure out about the osmolarity and what causes it? Do they know? Is there something in my diet I can change or a vitamin? Or how did you make it better?

[bakunin]

I've been reading the DEWS 2007 ( http://www.tearfilm.org/dewsreport/p...DEWS-noAds.pdf ) in the last hour, and what they say is that every dry eye has increased osmolarity. So if a doctor say we have "dry eyes", it is supposed he knows we have hyperosmolarity. In DEWS 2007, eyedrops and plugs are described as treatments to decrease tear film osmolarity.

[littlemermaid]

http://www.barleans.com/omega_swirl.asp
Cathy, This stuff isn't bad, Barleans Omega swirl in different flavours. Also you can just take flaxseed oil off the spoon. It has to be refrigerated otherwise it goes off and the taste is bitter. I've also used it in salad dressing (can't cook with it or the properties change) but that becomes too much hard work and it's easier just to down it. I love the smell ~ we use it to oil our cricket bats in England, lol.

[Blinks]

There's more discussion on this thread about osmolarity:
http://www.dryeyezone.com/talk/showt...-Tear-Products

Just a guess, Bakunin, using lower osmolarity drops may be better for the eye than high osmolarity ones. As Indrep pointed out, the effect is transient because the drops don't stay in the eye long. So the use of lower osmolarity drops may sting less, and even help briefly but isn't a "cure".

Would be good to know if anyone here is being followed for tear osmolarity and what the treatment is. There are several biomarkers mentioned in DEWS as useful for evaluating dry eye/dysfunctional tear but no clear industry standard seems to have emerged from what I can tell with my limited searches and non-science background.

[spmcc]

I posted here about 2 months ago and was given some very good advise. Since then, I have realized I need to get a diagnosis, and have been using a humidifier and have thought about getting new glasses and glasses for nighttime. I also have made an appointment with Dr Majmuder in the Chicago area and will see him in December.

Cathy,

When you see the doctor in Dec, ask him these questions:

1) How is my tear quantity?
2) Do you see any dry spots?
3) Can you check for staining?
4) Can you press on my meibomian (oil) glands? Are they releasing oil? Is the oil clear and flowing freely? If not, what does it look like?
5) Do you see any signs of allergies?
6) Do I have any lid closure problems (e.g., lagophthalmous)?

As for osmolarity, I'm still confused as to whether or not it's useful. Here are some recent papers on tear osmolarity:

Sept 2012 http://www.ncbi.nlm.nih.gov/pubmed/22868900
Conclusion: No relationships between tear osmolarities and tear meniscus volumes were observed.

Sept 2012 http://www.ncbi.nlm.nih.gov/pubmed/22820444
Conclusion: Patients complaining of epiphora in the absence of other ocular surface pathology have a significantly lower tear osmolarity.

Aug 2012 http://www.ncbi.nlm.nih.gov/pubmed/22580437
Conclusion: Osmolarity measurements with the TearLab system disclosed no ability to distinguish between healthy individuals and patients with dry eye.

In any case, the people who created the Tearlab Osmolarity Test are recommending Blink Drops as the treatment (see http://www.ncbi.nlm.nih.gov/pubmed/20153684)

Good luck at your appointment.

[Cathy]

I am so very grateful to all of you for giving me so many great suggestions. And I really like that they are natural and cheap. I really appreciate your help and will be moving through all of this and letting the boards know how it goes.
Cathy