Restasis cause Eye Dryness...Catch-22

[Nozaki]

Hi! I am a 48 year old Man who had Lasik in one eye 4 months ago. Corrected Left Dominant Eye for distance, and left Right Non-dominant Eye alone since it was 20/40. The funny, odd, maddening thing is that, the eye that I feel the dryness in, is the Right Eye, the one that WAS NOT operated on...! I don't know if having surgery on the Left Eye, and cutting the corneal nerves, caused the Right Eye to become hyper-sensitive in some way and thus dry. I mean, eyes are very inter-connected, but not sure why this is happening. When I went in for a follow-up, the Doc said that I had equal dryness in both eyes. Perhaps, I am just not as aware of it in the Left eye because the nerves have been affected by the Lasik? All I know is that, I have to put in drops every 20-30 minutes, especially at work. I work Nights, Indoors in a Nursing Home, Alzheimer's Unit, fluorescent lighting, so not the best conditions. When I put drops in both eyes, esp. drops in the Right Eye, my vision for 30 seconds or so is Very Sharp, where I don't even notice the Monovision Blur much at all, but within a minute, as the lubrication wears off, the blurriness comes back. Have been using Restasis as directed by my Doctor before Surgery and since, so 4 months. Can Restasis cause eye dryness, as a kind of paradoxical affect, hypersentivie effect? Other than the brief stinging, I don't seem to have any allergic issues with it. I even tried stopping the Restasis in the Right, Non-corrected eye for a week, but it didn't seem to matter. Of course, I was still putting it in the Left Corrected Eye, so since the eyes are connected, I would assume some Restasis got to the right eye as well? So now, I am trying the other end of the spectrum, instead of Restasis 2x a day, trying it 4x a day. It does seem to help with the dryness for an hour or so, but I still have to use "Refresh drops" or a host of the other lubricating drops, I now have a collection of...! Thinking of quitting Restasis cold turkey in both eyes as an experiment. When I asked my Doctor about the Dryness in my Non-corrected eye, his response was that as "we age", our eye can get dry. Well, it is Quite the coincidence, that I never had a dry eye issue until immediately after I had Lasik surgery! Now I feel I am in a Catch-22 situation. Did using the Restasis in my Non-corrected eye create a Dry Eye issue, so that I have to USE the Restasis to deal with it...arghh!! If I stop the Restasis completely for a week or so, will the any negative affects reverse themselves?! Anyone else have an issue like this? Look forward to any and all opinions! Thank You!

[Nozaki]

Hi! Forgive Me for being so verbose/wordy in my original post. Just wanted to give as much information as I could, and admittedly a bit of my frustration with my issue prob. caused Me to run-on...Okay, abridged version: Lasik only on Left Distance Eye. Right eye dry as hell, needs constant eye drops. What could be the cause?!

~~Coincidence? (Dry eye just hit exactly after Lasik surgery, though no prior issue)
~~Restasis? (Started this drug right before and since surgery per Doc's instructions)
~~Sympathetic response? (Surgery/trauma in one eye somehow causing other eye to become sensitive/dry. Left eye may be as dry, but not as noticeable)
~~Overuse? (Right eye being 20/40ish, working hard to keep up with Left 20/20ish eye while looking at distance)

Thanks for taking the time and looking forward to any input!

[PhoenixEyes]

Hello, I'm sorry to hear you are going through this.

I would suggest checking the listed side effects on the leaflet for Restasis. Some on the forum have indeed commented that some of the listed side effects can feel similar to dry eye such as eye and eyelid irritation, redness, burning, foreign body sensation etc.

Unfortunately it's also often stated that it can take some months before the benefits of Restasis is felt so it can be a guessing game as to whether it's of benefit or not in that time period. Some say it can take 6 ~ 10 months before seeing a benefit but 4 months is still a good trial and it's not like you were seeking treatment for your right eye anyway so you might try asking your doctor about it.

Be aware that Restasis is an immunosuppressant, it works by reducing the immune system's inflammatory effects on the eyes. Blocking the immune system of course does raise the risk of infection. As you work in a nursing home be sure to check for any signs of eye infection. I'd suggest trying moisture chamber glasses for when you are working at the nursing home. They'll protect your eyes a bit more from the harsh environment and are good for dry eye in general, so even if you're not using Restasis anymore they might help while your eyes are recovering from the surgery.

Also consider the artificial tear / lubricant drops you're using and if there are any preservatives in them your right eye could be reacting to. My left eye reacts more to certain eye medications more than the right eye, doctors are often surprised to hear about one-sided reactions like that so I guess they are rare but they can happen in some cases.

You could also consider how much of the Restasis you're using each time. This is from a leaflet for European Ikervis (which has the same ingredient as Restasis, cyclosporine):

Medication error: The medicine is supplied in single-dose containers sufficient to supply both eyes with the daily dose of one drop. To allow for any spillage each container contains extra volume, corresponding to approximately 10 drops, but only a single drop is supposed to be given.

There is a potential risk that patients might try to use the remaining liquid for subsequent doses. Because it is no longer guaranteed to be sterile once opened, this could lead to infection. Any unused liquid should be discarded once the dose has been given.

Full leaflet "Summary of the risk management plan (RMP) for Ikervis (ciclosporin)":
http://www.ema.europa.eu/docs/en_GB/...C500180545.pdf

I hope you find relief soon.

[Nozaki]

Hi PhoenixEyes! Thank you so much for taking the time! Moisture chamber glasses, will look into those, did where safety glasses following surgery because some of my Demential Residents are spitters, and scratchers, biters, kickers, and punchers Yes, I did read the side-effects leaflet, but was hoping to have it say clearly, "may cause eye dryness to increase...stop!" But that would be too clear and easy. I am so frustrated, would not have done the Monovision Surgery if I have to use eye drops every 20 minutes! Like You said, hard to figure out if the Restasis is helping or harming at this point? Awful conundrum...when I put the Restasis in, it does seem to help my eyes, well Right One to become "less dry", for at least an hour or two, but then I have to use the lubricant drops every 30 minutes or so on a good day. My concern is if I stop cold turkey with the Restasis, will I have to go through a withdrawal period where my eyes will get very dry before it gets better? Actually using it 4x a day now, and seems to be giving Me more relief, but not sure if I am digging a deeper hole?! Restasis is an auto-immune drug, have my eyes been permanently changed in some way, or will stopping the drops eventually cause them to go back the way theye were...? Again, I started the drops about a week before surgery, but didn't notice the eye dryness until a month or two in, coincidentally the time period where the Restasis was supposed to start working, several weeks either way. The other frustrating thing is that my Left eye doesn't seem dry (although, as I mentioned at my last appt., the Doctor said had similar dryness as the Right). Not sure why Right Eye is seemingly affected so much more, seems "more dry". The REALLY frustrating part is that for a brief minute after I put some kind of lubricant drops in, my sight is nice and sharp, then back to bit more blurry! Still using the Refresh Optive the Doc suggested because it had no preservatives. I have admittedly used some other drops because sometimes the Refresh Optive just feels too too thick and seems to make things worse. Have a follow-up Doc appt. in two weeks to have Eyes Refracted to see where I am, and to get Night driving glasses. I am considering stopping the Restasis completely for the two weeks before my Appt., but I am nervous. Worried that my eye dryness will increase exponentially, and also, not sure it is true, if I stop for too long, will be like re-setting the clock on the Restasis benefits (if it is benefitting), and the past 4 months will be wasted?

[Nozaki]

Hi PhoenixEyes! Thank you so much for taking the time! Moisture chamber glasses, will look into those, did where safety glasses following surgery because some of my Demential Residents are spitters, and scratchers, biters, kickers, and punchers Yes, I did read the side-effects leaflet, but was hoping to have it say clearly, "may cause eye dryness to increase...stop!" But that would be too clear and easy. I am so frustrated, would not have done the Monovision Surgery if I have to use eye drops every 20 minutes! Like You said, hard to figure out if the Restasis is helping or harming at this point? Awful conundrum...when I put the Restasis in, it does seem to help my eyes, well Right One to become "less dry", for at least an hour or two, but then I have to use the lubricant drops every 30 minutes or so on a good day. My concern is if I stop cold turkey with the Restasis, will I have to go through a withdrawal period where my eyes will get very dry before it gets better? Actually using it 4x a day now, and seems to be giving Me more relief, but not sure if I am digging a deeper hole?! Restasis is an auto-immune drug, have my eyes been permanently changed in some way, or will stopping the drops eventually cause them to go back the way theye were...? Again, I started the drops about a week before surgery, but didn't notice the eye dryness until a month or two in, coincidentally the time period where the Restasis was supposed to start working, several weeks either way. The other frustrating thing is that my Left eye doesn't seem dry (although, as I mentioned at my last appt., the Doctor said had similar dryness as the Right). Not sure why Right Eye is seemingly affected so much more, seems "more dry". The REALLY frustrating part is that for a brief minute after I put some kind of lubricant drops in, my sight is nice and sharp, then back to bit more blurry! Still using the Refresh Optive the Doc suggested because it had no preservatives. I have admittedly used some other drops because sometimes the Refresh Optive just feels too too thick and seems to make things worse. Have a follow-up Doc appt. in two weeks to have Eyes Refracted to see where I am, and to get Night driving glasses. I am considering stopping the Restasis completely for the two weeks before my Appt., but I am nervous. Worried that my eye dryness will increase exponentially, and also, not sure it is true, if I stop for too long, will be like re-setting the clock on the Restasis benefits (if it is benefitting), and the past 4 months will be wasted?

[PhoenixEyes]

Hi,

If you feel you're starting to find a benefit on Restasis at the increased dose and wondering if things might improve further then I would wait to see your doctor first. You can discuss with them about your concerns and the future of the treatment. I'm no doctor so best to seek professional advice!

The immunosuppressant aspect of Restasis should cease after you eventually stop the treatment, and as you're getting checked by an eye doctor regularly I'm sure they're checking for infection too. It's good you're using safety glasses to protect against contaminants. Moisture chamber glasses can be more expensive sadly, but add a bit more of a vented seal around the eyes, there's lots of threads on the forum about them such as 7Eye / Panoptx and Wiley-X brands.

If you find the Refresh Optive too thick, I wonder if you can get something similar to Hyloforte (Sodium Hyaluronate) over there, it's very liquid. Only drawback is the thicker drops may last longer on the eye, there's a slightly thicker formulation of Hyloforte called Clinitas to try if so. I use both preservative free and find them helpful but everyone is different.

Best of luck at your next appointment, hope you find things improve further.

[Nozaki]

Started my Restasis Holiday yesterday, so far so good. Been relying on the Refresh Optive drops. Same ol' conundrum, are my eyes doing "better" because I am stopping the Restasis or has the Restasis actually starting to work and I am doing myself a disservice by stopping. Guess time will tell. I wanted to try stopping the Restasis a week or two before my appt. to give my Doc some information, though he was not very informative when I asked why my non-surgery eye was dry?! Thank you for the well wishes!