other alternatives besides restasis for a low shirmer test

[Peppermint]

Hi -
I went to a new dry eye specialist for an overall opinion on how I was progressing. I had a shirmer test done. My results were 4 (L) and 5(R). This dr wants me to start restasis. It is interesting because I had been told in the past as recently as a few months ago, that my issue was strictly mgd and I did not have aqueous deficiency. (The dr who told me this did not perform a shirmer test).

Are there any other options besides restasis to help increase or improve tear production? Any other avenues to explore before I go on this journey?

Thank you!

[Faith1989]

I think restasis is the only drug I know that increases tear production. It takes an extremely long time (like 5-6 months) and can have side effects why are you hesitant?

[Peppermint]

Thanks, Faith. I'm hesitant bc of the side effects. And what exactly are the guarantees that it'll work? I'm not familiar with its success rate. My dog is actually on it (cyclosporine 2%)and it has worked for her. It's actually more potent than the one approved for people and it's helped her go from a single digit shirmer to the twenties. But I am still hesitant.

Did you experience any side effects? The burning.....?

[Faith1989]

For the first three months I experienced burning, redness, light sensitivity, dryness... But I am now on month 6 .. Those side effects have subsided greatly! I am now using it four times a day and it is working better. I suggest asking for a soft steroid to help at first bring down the inflammation and burning.

How have your eyes been though? I thought you were doing well?

[Peppermint]

I have been doing well but I went to see another dry eye specialist bc my upper glands were never expressed after lipiflow and this specialist is an expression expert and always follows up lipiflow with an upper and lower expression. I wanted him to check out my uppers and see if they were in need of an expression.

Because I was a new patient, they had to run the usual battery of tests they do on all dry eye patients, among which was the shirmer test. He prescribed not only restasis for me but also lotemax gel to be taken 2x a day for 4 weeks. I did one drop of lotemax on Sat and another on Sunday and my eyes were awful! I could not take the extreme dryness and burning! I did not have a good reaction to this medication and was pretty upset bc I was doing pretty good and then this experience happened which was so uncomfortable and scary. That is why I wanted to know more about the restasis bc I do not want to experience side effects like the ones you described. I have gotten to a point now where I am relatively comfortable and I can function pretty well working on the computer and going to classes at night. Pre lipiflow, this was difficult. Of course, I want to continue to improve so now I have to decide what to do, bc I don't want to have my lacrimal glands get worse by not taking the restasis and then I would be in bigger trouble in the long run.

I have read that testosterone supplementation can help and I have gone down that road before and it has helped but I had to stop because it was causing hair loss. I may explore trying it again. I read that saw palmetto blocks dht which is what is responsible triggering hair loss. I'm going to discuss this with my holistic dr.

I asked this dr why if my tests looked they way they did why my symptoms weren't reflecting that. He said bc my eyes have gotten used to the dryness and my nerves may have died so I am not feeling what I should be feeling given the numbers. Ok I accept that but then how were my eyes able to experience the extreme dryness and burning that came about over the weekend after taking lotemax? I surely felt that!

Thanks again for your input, Faith! I am glad that you are doing better on the restasis. Are your eyes feeling more moist? Has the redness improved? Are you able to wear make up?

[Faith1989]

It took almost 6 months until the restasis no longer irritated me. I quit many times, but now use it four times a day. I still do not wear make-up, still nervous about it. Lotemax really helps me, that's one drop that never bothered me. I am finally doing a food intolerance test in a week, and am going to try eliminating the foods I am intolerant to. I am going to see if this does anything.

I now feel I need restasis and won't stop again...

[Peppermint]

That is great! Your perseverance paid off. It's amazing you were able to stick to it despite the side effects you were feeling. I am not sure that I could handle that. Do you remember what your shirmer test was before you started?

[Faith1989]

It was very hard to stay on restasis. My doctor kept telling me it will get better but I kept giving up. This time I told myself I would keep at it. I think it has helped. My main problem though is mgd. I think my scores were like 8 and 5 or something low. I am not sure what they are at now as I don't see my doctor until may. (I have to travel to see him) My eyelids are my biggest problem right now. I still need the doxy, compresses and fish oil. Have you even given restasis a day or two? Maybe it won't be as bad for you? I think it depends in how bad they were to begin with. I also eat really healthy and low sugar.

[Peppermint]

I haven't started it yet. I'm waiting for my eyes to calm down and feel better after the lotemax experience. I may give it a go and see what happens.

I have minor residual swelling in my upper lid margins which is why I wanted this dr to express them. I'm still on doxy too and am going for bloodwork tomorrow to make sure my liver enzymes are in a good range. This new dr wants me to take doxy daily instead of the every other day regimen that I've been on and that switch will depend on what the bloodwork reveals. I guess I was a bit bummed seeing this new dr bc I thought I was doing pretty good and just coasting right now and this dr wants me to amp things up. Maybe that's what I need to do?