what schrimers means

[alywankin]

I am trying to understand my schrimers tests and the treatments I've received for my post lasik dry eye.

April 2008 - lasik surgery

July 2008 - a 4 on schrimers, had two lower punctal plugs (no real relief)

October 2008 - Dr said my tear pool appeared normal and my eyes would just improve and feel better every day from now on (they haven't)

December 2008 - still a 4 on schrimers, had two upper punctal plugs installed (my eyes feel no better).

Dr said again tear pool appeared normal, but now he's thinking maybe the TBUT is not right.

If that is the case, would punctal plugs even help this? (ps I have been taking fish/flax supplements since 1 month prior to Lasik)

What is best method(s) to improve TBUT? Is it really that there is not enough tears, or are the tears poor quality, how can I tell?

I also was wondering if I've been using too many eyedrops and ointments, I've been using a drop in each eye about every 20-30 minutes since Lasik (preservative free vials)

[kitty]

Did he test your tear pool with dye or just visually? With DES,you can have excess/reflex tearing which can cause a false high reading on the test. Here is a link to some info about this test: http://www.dryeyezone.com/encycloped...ationtest.html

[LasikLady]

Rice Baggie

If you aren't doing this already, I would highly encourage the use of a really warm rice baggie 3x daily. I love mine. They help to thin out the oils and spread them on the eye better.

[alywankin]

Thanks again to members of Dry Eye Talk, whenever I've posed a question or asked for info someone here always has some ideas. I'm going to give these a try.

[alywankin]

more questions on schrimers and punctals

1) are there risks involved with having all 4 punctals plugged, if so, what should I watch for?

2) doctor also gave me some "tobradex" to use 1 drop at bedtime for 7 days. during the 5th night while sleeping a felt alot of pressure, kinda behind eyes and within eyes. has anyone else had this experience? (i hate to stop this early though because my eyes and eye lids actually feel way less swollen than they have in 8 months)

[kitty]

1) are there risks involved with having all 4 punctals plugged, if so, what should I watch for?

2) doctor also gave me some "tobradex" to use 1 drop at bedtime for 7 days. during the 5th night while sleeping a felt alot of pressure, kinda behind eyes and within eyes. has anyone else had this experience? (i hate to stop this early though because my eyes and eye lids actually feel way less swollen than they have in 8 months)

Some will say that plugging all 4 creates a "cesspool" in the eye, not permitting allergens and inflammatory matter to drain from the eye. However, most punctal plugs, from what I have read and from what my own doc told me, will not provide 100% occlusion which puts the "cesspool" theory in question. I have never experienced such a side effect from Tobradex. If you are concerned, you should give your doctor's office a call and see if they want you to finish the course of the medication.

[LasikLady]

I have 4 plugs (maybe 3 now, I think one upper fell out) for 10 months. Knock on wood I have had no infections what so ever. I totally think that "cess pool" thing isn't really true.

[kitty]

I forgot to mention that I am double plugged in one eye (maybe not any longer) and single plugged in the other. I have noticed since the onset of my DES, I am much more sensitive to allergens and other eye irritants like cigarette smoke. However, I think I can attribute that to not as many tears to wash them away, rather than to the cesspool effect.

[alywankin]

do punctal plugs lose effectiveness quickly

Hello Again Everyone,
Another question regarding this horrible post lasik dry eye experience.

The first 1-2 weeks after having my upper plugs inserted I felt some relief from the dryness and I thought this might just work. Now at the 3-4 week mark that relief is gone and it seems my dryness has once again regressed back to constant pain and discomfort. Is this normal? I can tell my plugs are still in. Do your eyes become acclimated to plugs and just decide to send even less tears or less of the protective oils to prevent evaporation.

Nothing else has changed, still on regime of vitamins and humidifiers, and lots of water, and lid cleansing, and warm rice baggies.

I kinda feel like my body is completely rebelling against any healing progress.
ps .I am now 9 months post lasik.

[Lucy]

Hi aliwankin-
Any change in punctal plugs can and often does take awhile to settle down. If they helped at first and have now ceased to help, it could be from an enviornmental issue, or a bodily change (hormones), or just a fluke.

Many times we see people be patient, hoping their eyes return to the more comfortable state and often they report they do. I'd give it another month at least. It's easier to have the plugs pulled than put in. Also, if you have your doc inserting plugs, pulling them, reinserting, etc, you run the risk of having scar tissue. That's me. Two of mine are scarred shut, one is cauterized and one has a plug. Lucy

[irish eyes]

I have 4 plugs (maybe 3 now, I think one upper fell out) for 10 months. Knock on wood I have had no infections what so ever. I totally think that "cess pool" thing isn't really true.

It was true in my case.

[hkgcomet]

I forgot to mention that I am double plugged in one eye (maybe not any longer) and single plugged in the other. I have noticed since the onset of my DES, I am much more sensitive to allergens and other eye irritants like cigarette smoke. However, I think I can attribute that to not as many tears to wash them away, rather than to the cesspool effect.

I am the same as kitty! oh great. But I have 3 because 1 plug can't be remove and go inside that really permanently blocked. I am very sad for it, my body ruined T_T

I found fully plugged eye is sometime little less dry on dry place.
But it is more sensitive to light and allergens, every time redness or feelings come out from plugged eye 1st.

I found my half plugged eye seems recover lots on those year, while fully plugged eye seems a problem maker. I hope some day I can take out the plug, but it have been many years inside my eye...

Saltpool effect >>> cesspool effect !!!

[hkgcomet]

Hello Again Everyone,
Another question regarding this horrible post lasik dry eye experience.

The first 1-2 weeks after having my upper plugs inserted I felt some relief from the dryness and I thought this might just work. Now at the 3-4 week mark that relief is gone and it seems my dryness has once again regressed back to constant pain and discomfort. Is this normal? I can tell my plugs are still in. Do your eyes become acclimated to plugs and just decide to send even less tears or less of the protective oils to prevent evaporation.

Nothing else has changed, still on regime of vitamins and humidifiers, and lots of water, and lid cleansing, and warm rice baggies.

I kinda feel like my body is completely rebelling against any healing progress.
ps .I am now 9 months post lasik.

Eye would send less tear, if using fully plugged or use too much eye drops!

I had stop eye drops at daytime rest at home a long time. (Bedtime must use, very important, no choice before you fully cure)

My half plugged eye have much high socre in tear test.

But I am not fully heal now, I hope 1 day I fully heal and I would tell you the doctor is not helpful, just trust me, haha. ^^