To plug or not to plug

[Jen72]

I have been plugged x4 for about 6 weeks now and I am not sure if they are helping. In the beginning I had tear overflow and my eyes did feel better, I think that I had a breakthrough in healing. However, the past three weeks the tears have stopped and my eyes are dry and painful. Does this mean that I have aqueous deficiency? Should I keep them in, the plugs dont bother me. I am 8 weeks post Lasek. My Dr. recently said that I will be dry for life, how am I supposed to deal with that? Just grasping at straws here to find something that will help. thanks

[Guest]

Jen

I understand completely where you are at this moment in time. I was really dry at about the same period of time. It wasn't until sometime later that I discovered plugs.

I am nearly 3 years post Lasek and I still have plugs inserted in the bottom punctum.

I am not sure if they do my any good but my eyes are certainly a lot better today than they were at 6 months post op.

All I can suggest is that things do get better. It is finding a combination of things that work for you and be prepared to change as it seems that your symptoms change over time.

I wouldn't be too concerned about the "dry for life" comment, at 2 months you have a long way to go in the healing stakes and from what it sounds, things can only improve.

Also the change in dryness could have something to do with the plugs, were they permanent or temporary plugs - sounds like a silly question but one worth asking.

You say they are still there and don't bother you, can you see them?

It may be that a combination of plugs could work, some like permanent lowers with temporary uppers or permanent all round or just two lower permanent (what I have).

Discus some options with your Dr and maybe try a few combinations.


I wish you well.

Regards

Ian

[Jen72]

Ian- Its good to hear from someone who actually had Lasek as well. Interestingly enough, I did look for my plugs and I can not see my bottom left- it must've fallen out. They are permanent plugs. Both eyes are equally dry however. I am just desparately trying to find something that will make me feel more comfortable and heal. So far the Restasis and plugs have not worked. At this point I am really worried about my ocular health and the prospect of erosions because they are so very dry.
So, I take it from your story your a 3 years out and still dry- was this off and on dryness or consistent? Do you think that your DES is strictly from the Lasek? Do you think that there any special issues that only pertain to Lasek? Sorry for all the ?'s but you sound like someone who has a wealth of knowledge. Many thanks, Jen

[Guest]

Jen

Firstly not everyone with dryness experiences erosions. RCE's are generally caused by having some dystorphy of the outer layer (epithelium) attaching to the cornea.

Some people get them from some sort of eye injury or trauma. For those of us that have had lasek,it may be that we had an underlying problem but the lasek has exacerbated it.

Not all permanent plugs can be seen. Mine are the visible ones and I check from time to time for a shiny bit in my puncta then I know they are still there.

I had horrendeous dryness, and still have quite a bit of dryness now, I am much better than I was but I am certainly not out of the woods yet.

I find working on a PC all day very difficult these days and given that is my job in a nutshell, some days are quite tough.

I don't live a life of regrets, I hate the day that I had my surgery, remember it vividly but it is in the past, I can only change my today and hopefully my tomorrows, so I have to do what I have to do to get by.

If you have any specific questions, fire me an email or PM, I'm more than happy to help out where I can.

It does get better - believe me. I've stood in the sand where you are standing today and wouldn't swap you for the world now.

Warm regards

Ian

[LasikLady]

Dry for life!??!!

What kind of doctor at 8 weeks post surgery condems a patient to be "dry for life?" That seems VERY drastic to me! Is this the doctor that did your surgery?
I had Lasik which I read can cause more dryness than lasek and I can tell you I am WAY better now than I was at 8 weeks. At that time I was in a living hell. Things are very managable now.
I am plugged X4 with permanent plugs. When I had 2 permanents in the bottom and 2 temporaries in the top I didn't feel the moisture that I feel with 4 permanents. However at the time when I tried the temps in the top I was only 4 months post op. At 16 months post op I went to 4 permanents and had/have overtearing. Not to the point tears are rolling down my cheeks but I do blot often. It's way better than the bone dryness.
As long as you get a good handle on a routine that works best for you there is no reason things can't really improve for you over time. And you have come to THE best place for advice and help with a routine that will minimize your symptoms.
As for that doctor I would smack him!!!

[Guest]

As for that doctor I would smack him!!!

I can't condone violence but I have felt the same way many times on this post lasek dry eye journey.

I was very fortunate that I found a DR within the same refractive eye factory that did my surgery that actually cared and wanted to find a solution for me.

My original surgeon seemed a little lost when I presented with problems so I guess you should try somewhere else.

It certainly worked for me. Now I am back under treatment from my original DR, he seems a little more clued up these days.

Maybe he has a had a number of other dry dye or problem patients to work on in the mean time.

My view is if you can't fix it don't play with it in the first place.

Just my thoughts

Ian

[Jen72]

Lasiklady- Thats good to know that you are better now. Yes, the Dr. that condemned me to a life of dry eye is the one that did the surgery. I am still perplexed that she would say that, how am I supposed to deal with that? I have silicone plugs that are permanent however, I lost 2 recently. I go back to the Dr. today to try Lacriserts (my suggestion). What else did you try at this stage??? I am desperate, I am in dry eye hell. Thanks- Jen

[Guest]

As for that doctor I would smack him!!!

I can't condone violence but I have felt the same way many times on this post lasek dry eye journey.

I was very fortunate that I found a DR within the same refractive eye factory that did my surgery that actually cared and wanted to find a solution for me.

My original surgeon seemed a little lost when I presented with problems so I guess you should try somewhere else.

It certainly worked for me. Now I am back under treatment from my original DR, he seems a little more clued up these days.

Maybe he has a had a number of other dry dye or problem patients to work on in the mean time.

My view with the RS industry is that there are DR's lined up eager to perform your original surgery but so few of them have enough experience to deal with or manage the complications they create when things can and do go horribly wrong. It is evident from this board that so many of them absolve themselves of all responsibilities because the consent form says "I told you so" or eyes are unique and they have never seen this before. In my opinion, this is COMPLETELY UNACCEPTABLE, if they are prepared to take the risk and perform the surgery on healthy eyes, at least be honest with us and be prepared to work with us if it doesn't go to plan.

Sorry, I will get off my soapbox now, having one of those days.

Just my thoughts

Ian

[Guest]

Jen

There isn't too much I haven't tried, but the difficult thing is that you can't rule something out until you've tried it.

I was so desperate at times I was buying stuff in the states and shipping it to the UK at enornous cost both in shipping and quite frequently customs charges.

For me, I found a gel at night is absolutely necessary, during the day now I use very little but tend to stick with Clinitas Soothe or Clinitas Ultra - these are readily available to me in the UK and I have now convinced my laser clinic to provide them FOC after 3 years of life altering surgery.

When outside in the wind, some sort of moisture chamber or cool wrap around sunglasses.

Occassionaly a heat pack works wonders, and I always have an ice pack in the freezer on standby to deal with another RCE or just to cool things down.

I never put the icepack straight on my eyes, I always wrap it in a microfibre cloth or flannel.

I tried the fish oil and countless other remedies along the way but sooner or later you will find a product or collection of products that work for you.

So sorry to see you going through this. Just about every day I am seeing new members registering with LASIK dryness and it makes me so upset that I think few of us were adequately informed or dry eyes were dismissed during the consultation as easily treatable with a few artifical tears from time to time.

Warm regards

Ian

[Jen72]

[

M

y view with the RS industry is that there are DR's lined up eager to perform your original surgery but so few of them have enough experience to deal with or manage the complications they create when things can and do go horribly wrong. It is evident from this board that so many of them absolve themselves of all responsibilities because the consent form says "I told you so" or eyes are unique and they have never seen this before. In my opinion, this is COMPLETELY UNACCEPTABLE, if they are prepared to take the risk and perform the surgery on healthy eyes, at least be honest with us and be prepared to work with us if it doesn't go to plan.

Ian-

Yes, I agree. I think that my Dr. is working with me but, at times I think that I am the one suggesting more treatments. Or, in my case, I am supposedly unusual because nothing is working. I feel like a lost cause at times. At this point I am willing to try anything, I can see how you were spending so much money and time on some relief. Who knew, 15 seconds of a procedure that is supposed to help would lead to this, huh?

Speaking of that is there an American equivalent to Clinitas?

[indrep]

Jen
The closest to Clinitas in the US is Oasis TEARS PLUS. You can look at www.oasistears.com

[Guest]

Clinitas Ultra is actually rebadged Freshkote that you get in the US.

I am assuming there is some naming/patent issue resulting in a different name in the UK to US.

Both are identical (except I think you need an Rx in the US whereas it is OTC here).

They are based on Dr Holly's Dwelle (that you have no doubt seen on this site).

It is difficult for me to reconcile sometimes that i play such an active role in this site but yet can't/don't buy the products from here simply because the shipping becomes prohibitive. The last time I got some drops sent from the states, I was also hit with a customs import charge and a customs handling fee so this took the drops up quite considerably in price about an extra £20 - US$40 added to a few bottles of drops.

I do however support Clinitas Ultra with the knowledge that Dr Holly invented the primary drop, it has since has a lipid added to make it Freshkote or Clinitas, esentially it is Dwelle with a lipid added.

Take care

Ian

[LasikLady]

At your stage in the healing process I made sure I stuck to preservative free drops in the single vials. They are more expensive but when you are dropping regularly all those preservatives can make your situation worse. I stuck to a regular dropping schedule even if I felt like I didn't need it. I was using them every 3 hours but you will have to see what works for you. I felt dry in between that time but it began to lessen when I stuck to that routine. Like I said I got the punctal plugs too. I drank a TON of water to stay hydrated and used the hot rice baggie 2x per day or more often if I was having a really bad day. Mostly I did what I do now (except now I don't need drops) and gradually over time it improved. I also then and now sleep with Genteal Gel in my eyes. I take flax oil daily and stopped (as much as I can) using any artificial sweeteners or alcohol. And whenever possible I used moisture chamber goggles. I still use them now in the car with air con or heat on and when I am at the computer after a long day. The onion goggles I just started using and I love them.
Refractive surgery patients have a bit of an advantage over other dry eye sufferers in that time usually does bring a certain amount of healing and improvement. Everyone with dry eye can heal and improve of course but with us the healing of the nerves offers us a hope that we will improve with time.
Please try not to panic too much (easier said than done I know!!) You will find a routine that will help you deal with your symptoms while your eyes complete their healing. And if you do have to deal with symptoms "the rest of your life" you will learn about devices and methods that are available to help you cope and acheive the best possible comfort available. But you are so early in the healing process you have a lot of time to heal and improve.
Hang in there!!!

[Jen72]

better!

Ian - Thank you again for suggesting that I check my plugs. Evidently I last 3 plugs, I must have lost them about 10 days ago based on my pain. Anyway, about 30 minutes after new ones were put in, I felt glorious tears! I dont want to jinx it though, fingers crossed it will last.

The Dr. saw many SBKs' on dry spots on my cornea so she put me on Lotemax short term to calm it down. Although I dont show signs of lid problems she gave me an Rx for Azasite, the Dr. said it would not hurt so lets try it.

I asked her to explain her comment about a life of dryness, she reiterated that it will be long term "based on the way the eyes are reacting now". I wont let it get me down because I finally feel some relief today!

Thank you again to everyone, you all have been so helpful and give me hope- Jen