Frothy tear film, keep punctal plugs in?

[lizlou29]

I had a private appointment at Moorfield's last week and although I wasn't entirely happy with the treatment he recommended one thing that I hadn't been told before was that my tear film is "frothy". He asked if it feels like my own tears are soapy and burning my eyes which it does but didn't used to. He said it was because my tears are "toxic" but didn't really give me an answer as to why, perhaps there isn't one answer. I've looked through the forum and I've seen it mentioned that it could be down to thyroid irregularities or bacteria. The Moorfield's guy said my aqueous level was good and MG's looked good which contradicted what I've been told before. He didn't do a Shirmmer's test but didn't believe me that my result is always 0-2mm even with all four punctal plugs in. I'm really starting to wonder of having all 4 punctal plugs in is doing more harm than good now but there I've always had the "might be good, might be bad" answer. Anyone had the soapy feeling and felt better after having punctal plugs taken out? Eye drops are making no difference, my eyes just feel sore, burning gritty and lids are red, swollen and hot, partly due to ocular rosacea. Very difficult to work, trying to grin and bear it.

My regular eye clinic (NHS) has kindly managed to fit me in this week as there was a cancellation. Do NHS do swabs for bacteria? Or is a frothy tear film just normal with dry eyes?

[unicorn]

Liz I have 'frothy' tears too. My doc described it as 'saponification' and says it's one of the factors contributing to the 'sensitization' of my eyes i.e. what's causing them to be more painful than the observable signs would suggest. I think it's something to do with MGD although not quite sure on all the causes. High osmolarity can also cause tears to 'burn'. I had tests which showed my tear osmolarity was quite high.

I have had swabs for bacteria and viruses on the NHS - I had to insist on these being done, though, as one registrar suggested it and the consultant was against it. (Came back negative but I'm very glad I pressed for it).

Will pm you later x

[lizlou29]

Thanks Unicorn.

My ophthalmologist managed to fit me in this afternoon. I have Chemosis (swelling of conjunctiva) and what he thinks are Bitot spots so he's prescribed 4 weeks of Pred Forte and wants me to use the VitaPos again at night though I'm not that keen on it. MG's are still really blocked despite warm compresses and 6 months of Doxy. We are keeping the punctal plugs in for now. Although my eyes look watery the tears aren't running down my face frequently. He ordered a few blood tests including Vit A which I haven't had tested before and i'm having a scan as still having the sinus/aching eye pain.

Won't say what he thought of the Moorfields doc's examination....

[No tears in ATL]

Lizlou,

I was quadra plugged and had to have the lowers removed. Though I've never quite gotten to the bottom of it, I think too much of the inflamed tear was hanging onto the eye surface. Keeping the top plugs seemed to be the best solution. I'm still looking into the reason why I can't tolerate all four plugs or any drops. I believe my tear film may be especially unstable, is all I can figure.

Best of luck.