Making Progress

[np1981]

Well, I'd say the comfort on the my eyes has improved quite a bit since this all began a year ago. I'd say I'm about 50-60% there (100% would be "normal"). Being outdoors no longer irritates me, and the office is much more bearable. At the moment though I've got a cold which isnt helping .

On my last visit to the doc he said my lipid layer had improved a lot. The oil gland secretions are still a little thick, so I may go back onto Doxy. Dr Tseng suggestesd mites were a potential problem, and instructed tea-tree oil scrubs and shampoo. I've noticed that since using the shampoo on the eylashes, I get a lot less debris around there and I think its actually helping (possibly more to do with the cylindrical dandruff removal than the mites). My left eye is worse than my right, in fact sometimes my right eye feels more or less normal! (a huge improvement from a few months ago). I no longer have burning/stinging sensation at all, thank God, but I am having to deal with inflammation still. Hopefully the improvment will continue, but I feel a lot more positive about the future. Eyes are still a little red, but not as much as before. Punctal plugs, Saline rinses twice a day and Tranquileyes all helped. Occasionally a warm compress does a bit of good. I have also started sleeping with a humidifier, although the one I got is a bit noisy adn takes a bit of getting used to. I have changed my diet as well but I don't know how much its contributing. I for one am starting to think that the Omega-3 capsules I'm taking are working.

My advice to everybody is to continue searching, if I had listened to the docs before who suggested/implied there was nothing they or I could do, or that I would simply have to "accept" it, I wouldnt have made the progress I have made thus far.

[Helen26]

It's great to hear some encouraging news! It's good to know that if I stick at things I may (hopefully!) see an improvement. I'd be happy with a 50-60% improvement. I've had dry eyes for 6 months now and so far it just seems to be getting worse and nothing I try makes much difference. Maybe after another 6 months of perseverence I'll be where you are now!

Just a couple of questions ... How do you think the Tranquileyes have helped? I've been using them for about 3 weeks now but haven't noticed any improvement. How long did you take Omega 3 for before you noticed an improvement? How have you changed your diet? I keep trying to eat more healthily and manage it for a few days but if I'm having a bad eye day I just end up eating rubbish because it makes me feel better. Do you have problems with your mucous layer as well as your lipid one. I have problems with all 3 layers. My meibomian glands are clogged, I'm hardly producing any tears and according to my doctor I've only got half the number of goblet cells I should have! So any tips would be greatly appreciated!!!

[Guest]

Helen,

How did your DR test the goblet cell density. The DR I was referred to looked at me like i had two head when I asked this question.

She told me my lipid and aqueous was fine therefore the problem was goblet cell density - my question was, how do we know this for sure and how do we test it? (I didn't think it was a difficult question)

Would you mind sending me a Private Message on the DR that you saw..

Cheers.

Ian

[np1981]

Just a couple of questions ... How do you think the Tranquileyes have helped? I've been using them for about 3 weeks now but haven't noticed any improvement.

I know that I sleep with my eyes slightly open, the mask helps in that respect.

How have you changed your diet?

I eat lots of fruit these days - I hardly eve used to before. And at least 1 portion of veg. Could be better though, my diet aint perfect.
I'm also wondering how you doc measured goblet cell density?

[Rebecca Petris]

measuring goblet cell density

Pretty straightforward - in simple terms they basically scrape some cells off, put them under a powerful microscope and count. Term you'll commonly hear for this is "impression cytology" - eg applying some sort of filter paper to lift off the cells.

[Guest]

Thanks Rebecca, just curious.

This is supposed to be my problem but at the moment, noone is going near my eyes to scrape anything off, regardless of how painless they convince me it is.

I remember a lasek surgeon about 11 months ago saying to me that he was just going to remove a few of my corneal cells, my life has been hell ever since, I should have run when I had the opportunity - live and learn I guess.

I just don't know what advantage you get from knowing how many/few goblet cells you have. How do increase/decrease them anyway? It seems that artificial tears is the vehicle for doing this but what should you look for and what flavour? I have at least 9 different variety in my house at the moment to choose from.

Let sleeping dogs lie is my motto this week. I wouldn't be able to look down the microscope long enough to count them with my TBUT this week.

Cheers and have a great day!

Ian

[np1981]

Pretty straightforward - in simple terms they basically scrape some cells off...

Yikes I don't like the sound of that!

[Rebecca Petris]

Sorry... I have probably used the wrong term... Never had it done and this is one of those things (of which there are far too many!) that I just don't know much about. But honestly, from the descriptions I have read I would guess this is not more invasive or painful than a routine Schirmer test.

Anyone who's had impression cytology, your input would be much appreciated!

[Guest]

Rebecca,

My post was more tongue in cheek, I was having a bad day and I was curious to know how they measure these little puppies (goblet cells). But given that I am not sure what I would do with the information when I had it, I didn't really see a lot of point going through what would be a rather redundant exercise in my case.

I am curious still as to how you adjust your goblet cells, my assumption still remains that it would have something to do with artificial tear formulation or just a natural healing process if you stabalise lipid and aqueous layer, sooner or later mucus may stabilise itself also? I just don't know anymore.

My eyes are supposedly feeling and looking better (according to two Doctors), I just wish they could come to work with me for a day or two just to see that from my perspective, I don't share their enthusiasm.

Thanks again

Ian

[Lucy]

My eyes are supposedly feeling and looking better (according to two Doctors), I just wish they could come to work with me for a day or two just to see that from my perspective, I don't share their enthusiasm.

Ian, I love your sense of humor. I've asked people "if my eyes looked bad" during times when they were absolutely on fire. "Oh, no they look great."

Usually, I mumble something like: Well, if only you could see them from the other side. How my eyes can look "so good" when I literally can't keep them open for more than a few minutes is beyond me. Funny, huh? Others on here complain about their eyes being bloodshot, red and awfuil looking and I certainly don't want that. BUT, YOUR EYES LOOK JUST GREAT. ARE YOU FEELING BETTER? Hmph. Grumble.

[Guest]

I guess I'm lucky (if you can call it that) that when my eyes feel bad, they look the part also (red, bloodshot, roadmap kind of appearance). I guess at least one thing in my life at the moment is consistent.

When someone tells me that my eyes look normal I say to them "how about we swap for a week".

Said this to a DR recently and she didn't think it was very funny. Note to self: don't joke with DR at the hospital she leaves her sense of humor at home whilst dealing with me.

Ian

[Rebecca Petris]

My post was more tongue in cheek

LOL, I know....

But given that I am not sure what I would do with the information when I had it, I didn't really see a lot of point going through what would be a rather redundant exercise in my case.

I am curious still as to how you adjust your goblet cells, my assumption still remains that it would have something to do with artificial tear formulation or just a natural healing process if you stabalise lipid and aqueous layer, sooner or later mucus may stabilise itself also? I just don't know anymore.

Yeah it is unfortunately the case that diagnostic information is not necessarily a big help in decision-making with dry eye treatment. OK, so I don't have Sjogrens-related lacrimal deficiency. Excellent. Does that mean I can quit using artificial tear supplementation or punctal occlusion? Nope. And so on and so forth.

Re the goblets: IMHO, it seems like kind of an easy out to blame something we don't routinely measure and/or can't fix anyway. I think personally that we've still got a long way to go on seeing doctors measure meibomian efficiency better so that we can be sure we're optimizing treatment for that before we even bother switching focus to tackling goblets.

But my guess is that you're right on about improving goblet cell density, I don't mean about adjusting it with tears but rather that any improvement to overall lacrimal & meibomian efficiency (or compensation for deficiency of both) will promote healing that help those goblet cells make a comeback. Some of the research on new dry eye drugs is also going into the area of trying to re-inspire the goblets - keep an eye out for 'mucin secretagogues" etc. I think that some of the limbal stem cell transplantation work that has been done was targeting improved goblet cell density. I don't keep up much on the lab science... kakinda probably knows a lot more though.

[Lucy]

Interesting talk about "goblets." Well, not really - but white blood cells, blah, blah, blah, Sjogren's Syndrome. Hmmmmmmmm. I will make a note of the above information and I will be seeing two more specialists in Rheumatology (ie Sjogrens) and I will ask each if they can tell me anything.

If I'm guessing right, the answer will be a look that we're all aware of. I will try to impress them with this talk of goblet cells etc. LOL. I'm more of a beer mug kind of gal myself as opposed to goblets.

The meds I'm on for Sjogrens have a lot to do with blood cells, white blood count etc. This is all very new to me and will have to learn a whole new set of medical jargon. I know I'm taking folic acid 3xday to prevent my white blood cells from dropping too much. I also have to have blood tests every 6 weeks to measure any possible damage. I have appointments within the next 6 weeks with two docs in different locations and will be very anxious to see if they know about this goblet stuff regarding dry eyes.

[Rebecca Petris]

Sorry if I'm jargon-ifying...

Goblet cells in the cornea and conjunctiva are the "mucus makers" of the eyes - the cells responsible for producing the sticky substance that (among other things) helps our tears adhere properly to the surface of the eye (epithelium). For the basics of why this matters, see Dry Eye for Dummies and also Tear Film.

If I'm not mistaken the Sjogrens patients (as being the group with pretty much the worst dry eye anyway) tend to have a pretty sparse population of these 'mucus makers'. There has also been some work that showed that people who have had laser eye surgery end up with their goblet cells thinner too. Adding up to a good reason why people with Sjogrens syndrome shouldn't have LASIK, and why people like Lucy, with both, are really really hurting.

[Silverlady]

Another thing...

To add to Rebecca's last post, people with Sjogrens OR autoimmune problems also shouldn't have permanent makeup applied. I had permanent eyeliner applied two years before I was diagnosed with Sjogrens. The eye doctor told me they have good evidence that the permanent eyemakeup makes dry eye worse. I really messed up. The only upside is that I never need makeup and I can't wear any.

Billye