Plugs and Restatis

[GeorgeT]

Dear Dr. G,

I am a 36 old male with MGD/ocular rosacea (Schirmer =zero, TBUT=10 sec.) and I cannot tolerate Restatis. Upon instillation seems like water but after 1-2h the burning starts and lasts for 7-8 hrs. What can be done to adjust to restatis?
In addition I want to ask why my excessive tearing due to upper flow controllers subsided after 3 months and I am dry again. Should I use full plugs instead?

Thank you very much.


Best Regards,

George

[DrG]

What are your symptoms without Restasis? I find it hard to believe that your Schirmers are zero, and your TBUT is normal, and you have been diagnosed with Rosacea.

I seldom plug all four puncta.

The typical "work arounds" for Restasis are topical steroids or topical NSAIDS.

[GeorgeT]

Dear Dr. G,

Thank you very much for your answer.
Without restatis I am just dry, sandy, gritty and have constant burning.
My doctor says that I have MGD/Rosacea, although the Schirmer is zero and TBUT=10 sec. He tested the reflex tears which were better than normal. He also told me that there is ample proof that my MG's are bad.
Anyway, is there an explanation for tearing I had for 2 months after I had upper plugged. Now the tearing subsided and I am dry again.
Do you think that Moisture Chamber Glasses will be useful?

Thank you very much.

Respectfully,

George T.

[DrG]

You say that without Restasis you have constant burning, and with Restasis your eyes feel OK for a couple of hours, but then the burning starts and lasts 7 hours. Is this the same sensation? Have you been on topical steroids for any length of time? How has doxycycline worked for you?

[GeorgeT]

Dear Dr. G,

Thank you so much for your answer.

Restatis burns me the most, intolerable. I've been on prednisolone for 7 days prior to upper plugs insertion which made me more dry.
I thought that doxy works for me, but I realized that only expression of MG made me to have tears. I am still taking doxy....but pressing the MG's is most important thing.
I don't know how long should I stay on doxy 100mg/day. I heard stories that after years on doxy, MGD goes away..???!!!!
Thank you again.

Sincerely,

George T.

You say that without Restasis you have constant burning, and with Restasis your eyes feel OK for a couple of hours, but then the burning starts and lasts 7 hours. Is this the same sensation? Have you been on topical steroids for any length of time? How has doxycycline worked for you?

[DrG]

If you can't use Restasis even after trying topical NSAIDS, steroids, chilling the drops, etc., then I guess I would keep up with the doxy for at least 6 months. I'm not sure I would continue if I saw no improvement after 6 months. Could it be that the doxy is facilitating the expression by decreasing the viscosity of the sebum? Another thing to consider is the use of hypotonic artificial tears to counteract the hyperosmolarity of your tears. Use saturation dosing as recommended by Jeff Gilbard of Theratears fame. This must be kept up for months as well to see any effect. If you need oil, but cannot produce it, then try the transdermal white petrolatum discussed in other threads. Let's get creative, and maybe even go to a hormonal approach if necessary.

[GeorgeT]

Dear Dr. G,

Thank you so much for your answer.
I have seen so far 3-4 different doctors and I got the same results on my tests:
Schimer zero, TBUT = 10-12 sec, reflex tears = intact; I can produce tears only if I express my MG's.
Just one doctor diagnosed me on MGD/Rosacea based on old acne scars. All the others doctors could not give me a diagnosis.
Would you please tell me what type of condition those scores suggest?
Do you think that moisture chambers might help?

Thank you very much.

George T.