6 Months post Epi-Lasek. Induced dry eyes

Aaaarrrrgggghhhh!!!!!

As the title suggests, I am on the fast road to nowhere.

Have just been to the Corneal Specialist and after waiting for 1 1/2 hours to see him, his suggestion was that I need to avoid corneal abrasions if I have any chance of this getting any better. Really - I think I came to that conclusion several months ago with out this expert opinion and I didn't go to medical school.

He has ruled out debridement (as too invasive and unlikely to resolve the issue, and most likely put me back several months). Instead, he suggested that I goop my eyes with gel and tape my right one closed of a night and see how this goes for a month or so.

The problem with this is that no-one can manage my progress with this as I see a different dr each time I turn up, they all keep leaving - I just wish I could check out as well.

He asked how I was getting on with the bandage lenses as they need about 3-4 months of continued use for them to be effective. I told him that my vision is crap with the lens in (they all seem puzzled by this comment). I am convinced that my reshaped cornea is not accepting of even a plano lens and distorts my vision. They don't understand that I have a life to live, a job to do and I drive of a night - something I just won't do with a bandage lens in due to the effect on my vision.

I suggested the Muro of a night and it was his opinion that the last thing my cornea needs is a concentration of salt of a night to dehydrate it even further. I have found on the instances that I have used it that my eye is extremely dry in the morning.

I asked about the warm compress and he ruled it out - saying that I do have a very small amount of meibomitis (??sp) but then so does most of the population. I will keep it the occasional warm compress anyway - at least it makes me feel better.

If I had have gone with the first surgeon, I would have had a debridement by now, I am at least thankful that I sought a second opinion as it seems to be a comon view that debridement is invasive and there is no guarantee of success, when I haven't yet exhausted the less invasive options.

I am confused that this guy is the expert, he just didn't seem to have any answers.

He didn't even offer me a follow up appointment, just said, email the clinic in a month or so to let us know how you are getting on - I will be watching your case - yeah right, the pigs are fed and ready to fly!!!!!

I am still drinking more water than a camel on a desert trek, to wash down my 4g of fish/flaxseed oil and 4500mg of Spirulina and sleeping no more than 4 hours at a time all adds up to a life less lived.

Talk about wandering aimlessly through the woods. I just feel so lost again.

Ian

[DrG]

I would strongly recommend the generic version. I did a quick search on this site, and came up with a reference to the Akorn brand. It is much cheaper, and just as good. It comes in a 3.5 gram tube and is preservative-free.

Thanks Rebecca and DrG.

After your comments DrG I figure it is worth a try. I would like to avoid the debridement so can try the bandage lens for the next 3 weeks and then try the muro after that.

Rebecca, is there someway we can process this through the Dry Eye Shop so that I can cover the costs, I need some tranquil eye replacement pads also so maybe able to so them both together.

Please email me directly so that we can make some arrangements.

Thanks again to both of you for your help, I am ever so appreciative of it.

Ian

[Rebecca Petris]

Muro 128 is not available in the UK to the best of my knowledge. When I lived there, I used to stock up on it during visits to the US. It's an OTC product and if you want some Ian, let me know.

[DrG]

Ian, because of your condition, your options are limited. I agree with the idea of using a bandage contact lens in this situation. In fact, I almost consider this to be the standard of care. Personally, I would not use a bandage lens without an antibiotic, but that is a difference of professional opinion.

I am well aware of the anti-ointment sentiments often expressed, but hear me out. Muro 128 is the Bausch and Lomb brand of a hypertonic ophthalmic ointment. Generics are available. One of the primary uses of this type of ointment, i.e. 5% sodium chloride in a light petrolatum base, is in the management of recurrent corneal erosions (as distinct from dry eye). In order for this to be effective, it must be used as a preventive for a period of months, maybe years. From my professional experience, it can be quite effective. Generic versions are available.

If you are like me and don't relish somebody poking a needle in your eye, or removing a large piece of epithelium, then you may want to try less invasive approaches, *especially* when there is a likelihood of recurrence even after surgical treatments. A quick visit to PubMed or other medical database may serve to reinforce this *conservative* approach.

Anyway, I suspect that you will get over this bout, as you have before.

DrG

Thanks for your reply, I was going to ask you about this in your forum, so I am pleased that you have made an exception.

I was also concerned about the lens staying in 24/7 for 3 1/2 weeks. I called the Dr this morning and he told me that he uses these lenses upto 4 weeks without anitiotics and uses them with corneal transplant patients. It is a focus night n day lens.

Since having the surgery, I have always used Genteal Gel of a night (under my Tranquil Eyes), the only other option we have in the UK is lacrilube which did nothing but make my symptoms worse, I am not sure if Muro 128 is available, the pharmacist told me they hadn't heard of it.

I tend to agree that this is not going to be a permanent fix but I guess I am taking 1 step at a time.

I think the bandage lens is a bit of an experiement, firstly to heal the abrasion, secondly to prevent further abrasions and thirdly to allow the epithelium to reattach properly.

I hope I am doing the right thing. It is just a difficult time at the moment.

Thanks again for taking the time to respond, I appreciate it.

Ian

[DrG]

For Ian

Although I am trying to discipline myself to refrain from posting unsolicited comments into other forums, I'll make an exception, here.

I am concerned that you are using a bandage contact lens 24/7 for a corneal abrasion and NOT concurrently instilling an antibiotic. Please clarify this with the specialist ASAP.

Also, although I expect the bandage lens to effectively help the abrasion to heal, I am not optimistic about this as a permanent fix, given the doctor's observation.

Just for informational purposes, had you been using Muro 128 or other hypertonic ointment prophylactically?

[neil0502]

Aw, Ian....

Aw, Ian....

It's so easy for each of us to relate when any of us goes through this sort of thing. It's a day that we know all too well.

Your ocular world is vastly different from mine, so I don't have any real practical advice. Perhaps Dr. G will.

My initial impression, though, is that you have somebody who's thinking aggressively, but treating conservatively, advocating a "step-wise" fashion of dealing with this. I like that.

Corneal erosions ... um ... suck. I've only had one, and it was so difficult to figure out for sure if there was something else wrong with my eye, but ... once I knew for sure ... I was so aware of the "Hey? Who extinguished their cigarette in my eye??" sensation.

The notion of long-term wear of the new-material plano soft contacts as bandage lenses doesn't scare me that much. Monitoring for infection and such isn't so tough. Maybe you'd want to be seen by your doctor every week (additional load on you, I know) just to be sure.

I feel your pain ... literally, and figuratively. I'm so sorry you're having this welcome home party. Probably thinking about life on the farm about now, huh?

I wish you strength, peace, and freedom from pain as you venture through yet another hiccup in this process.

Neil

Here we go again!!!!

Today has been just one of those days, it is the 18 month anniversary of my Lasek procedure and as an anniversary I woke at 4:03am with yet another corneal abrasion.

I just can’t believe this. Here I was thinking that maybe, just maybe, I had discovered the road to recovery only to be sent on another detour.

It was fortunate I guess that I already had an appointment booked for yet “another follow up visit” at the laser clinic.

This time I saw a corneal specialist (not sure what the others are, but they seem to come and go pretty quickly). This DR seemed to know his stuff and agreed that this has been going on for far too long and we need to find a permanent solution – about time too!!!!

After a slit lamp examination, and a little diagram drawn on a piece of paper, he told me that I have small bubbles below my epithelium, just below my pupil, indicating that my epithelium has not attached itself properly to the underlying tissue. He seemed a little taken back when I said is this called Epithelium Basement Membrane Dystrophy to which he replied “yes, sort of”.

He gave me 5 options to ponder and suggested that I try them in this order.

Option 1 – Artificial Tears (yeah right! What do you think I have been doing for the past 18 months).

Option 2 – A Bandage contact lens for 3 weeks to allow the Epithelium time to reattach itself without constant abrasion from the eye lid.

Option 3 – Debridement of the Epithelium – this is the option he thinks will most likely provide the best outcome but has a painful recovery of about 3 days and disturbed vision for several weeks to follow.

Option 4 – Using a laser to puncture holes in the epithelium to help it anchor to the underlying tissue, however, would result in further long sightedness and not really a desired outcome.

Option 5 – Using a needle to manually do the same thing as option 4 – (similar outcome) at which point I almost fainted, the thought of a needle in my eye.

Anyway, after a lengthy discussion with him, we both agreed that option 2 with loads of option 1 for the next 3 ½ weeks then a reassessment on the next visit on 5 April with debridement booked as an optional procedure.

I have been wearing the bandage lens all day today and the vision in my right eye is just rubbish. I am confident it will settle, however it may take a few weeks.

The lens is a zero prescription but I am a little concerned that it is staying in for 3 ½ weeks, maybe I am an being alarmist but I am just a little concerned about infection. DR seemed insistent and suggested he leaves them in for upto 6 weeks at a time.

It only just covers the cornea but it is sitting quite tightly and not moving around anywhere, so I guess, I will just wait and see.

I feel like I just need a little moral support today, I can’t believe that I travel along really well for a few weeks/months then have another abrasion that attacks my ability to cope with this DES stuff. It is difficult to think “onward and upward” at times like this.

If anyone has any suggestions or comments, I would welcome them.

Thanks for “listening”, I just needed to air this frustration – not one of my better days.

Ian

[Silverlady]

Great news!!

I'm so glad to see your posts again. You are one of the best and I love the interaction between you and Lucy. Fun in a dreary day!!

My husband has just had back surgery and I'm not getting to spend as much time here as I'd like to, but I'm still trying to speed read all the posts to see if there is anyone I can help.

Welcome back Ian!!

Billye

[dianat]

Ian,

It's great to see your posts again, even if they are just journal entries. I know it's been a tough year for you. I'm glad to know you are coping well, and hope you continue to do so now that your back in the UK.

Diana

Back in the UK

Well I have arrived back in the UK and thought it time for yet another update - sorry to bore you, I find this a good way of keeping a journal of my trials and tribulations on this journey that I didn't really choose to enbark on in the first place.

My flight was nowhere near as bad as I thought it would be. I used lots of genteal gel and tranquil eyes. I had 40+ hours of travelling time (2 trains, 4 flights, 1 more train, 1 car journey) - oh what joy travel is. I had very little sleep but managed to arrive in a relatively sane frame of mind with eyes that were uncomfortable but manageable.

The few months off seem to have worked in my favour.

I have just finished my first day in the office and I have survived pretty well, I have a degree of redness, soreness and dryness but I am starting to think this is the new normal for me.

My eyes still feel quite uncomfortable but the intolerable burning seems to be a thing of the past (thank goodness).

I still use loads of drops (Theratears) during the day (Genteal Gel of a night with the tranquil eyes).

I am finding the heating really savage in the UK, more so than the air conditioning in Australia but hopefully with winter moving swiftly behind us, this will also pass.

I just dread the RCE's so do everything I can now to try and avoid them. I have had pretty severe vision disturbance in my right eye as a result of the RCE's. I see the DR in a week or two so will raise it with them then.

I just hope that I am heading further down my road of recovery and just can't wait for the day that I no longer have to deal with all this - no doubt a sentiment shared by you all.

Sometimes I wonder whether i have gotten any better or whether i have just learned to cope better with it.

I have decided to clear my life of unused drops. I have a cupboard full of the stuff I have tried along the way.

If you live in the UK and are interested in some Viscotears Gel (pres free) send me a PM and I will be happy to send them to you, hopefully they can bring someone some comfort.

I have started back on the Restasis just to see if a second time round makes any difference, I don't expect it to but I have read that some people find it better the second time.

Whilst in Australia, I discovered a generic version of Genteal Gel, it is exactly the same product but loads cheaper, it is distributed by Ciba Vision and is called HPMC PAA it comes in a boring looking tube but it does the job.

I know that loads of you like the product but find it difficult to get hold of at times. I bought mine from the Pharmacy Warehouse so if you have a contact in Oz, they may be able to source it for you, I'd be happy to offer but I am not there right now.

Thanks again to everyone for your kind words and welcome to the new people that have joined us. I will play a more active role now that I am back online.

Take care

Ian

Hi everyone,

Thanks for your messages.

Whilst i have been feeling much better in Oz, I am reluctantly returning to the UK as that is where my work is and I have a few ends to tie up before considering a more permanent relocation back to Oz - which is the most likely outcome.

My eyes are feeling OK in Oz (no heating/ limited air con, etc), certainly not as good as they did pre lasek but certainly the best since lasek.

I am not relying on drops much but still have the nightly routine of gel, tranquil eyes, saline on waking and this seems to be helping.

I am sorry that I have not been participating much lately but that will change when I get back to the UK and have regular internet access again.

Take care and I look forward to participating more soon.

I feel like I have missed out on so many posts but have spent a little time looking through the new ones to see if there is anything I can add.

Cheers

Ian

[Lucy]

Hello Ian-
Happy to "see" you from the frozen tundra of Michigan. Have mightily missed you.
Lucy

[neil0502]

I am starting to plan my return to the UK but I think that it will be very short lived.

My eyes have felt really good in Australia, it must be the hot weather that helps.

They actually look white again and I am starting to feel happy in myself again.

Ian,

If all is going reasonably well in Oz, must you really go back to the UK--where your symptoms seemed so much worse??

I understand there may be a billion reasons and numerous imperatives driving this decision, but ....

If you must, then I hope something has changed and your return is easy and painless--in every sense!

Neil