6 Months post Epi-Lasek. Induced dry eyes

[Guest]

I have been reading this forum since having bi-lateral epi-lasek eye surgery on 24 October 2005. It is such a shame that I didn't read it before hand, as I am certain that I would not have gone ahead with my "procedure".

I am a 37 year old male and I decided on epi-Lasek as I was told that it was far less invasive on the eye and that complications were rare and any complications could be easily treated.

It is amazing that when you read of the "life changing event of laser surgery" one automatically assumes that the benefits are positive, little did I think that there could be such a negative impact on my life.

My pre op vision was L – 2.75, R – 2.0 (with very mild astigmatism), my expectations were to be less reliant on glasses but had no issue accepting that any residual prescription could be corrected with a pair of low prescription glasses should I want/need them.

My post surgery result is good (plano with -0.5 astigmatism in each eye), however, the mild astigmatism does cause me some challenges in low light, my vision does fluctuate depending on my mood and the state of my dry tired eyes.

My challenge is that I started to suffer with dry eyes within weeks of the surgery. I experienced my first corneal abrasion soon after the bandage lenses were removed. The clinic put me on Lacrilube (preservative free) until my new "sticky" cells healed (most likely 2 - 3 weeks).

I stopped using Lacrilube after being instructed by another consultant at my clinic during my 3 week checkup.

This was welcomed advice given that I hate using the stuff and I actually feel that my eyes felt and looked worse whilst using it. I took a holiday in Australia for 2 months (no computers or eye strain) and only experienced very mild discomfort on very rare occasions maybe the humidity helped.

To cut a very long, frustrating and often debilitating story short, I am six months post epi-Lasek and my dry eyes has gotten worse during months 4 - 6.

My eyes have looked like I have been on a month long drinking binge (terribly bloodshot and red bottom lids)

I have tried the following artificial tears/gels
- Refresh Contacts (preservative free)
- Hypromellose (preservative)
- Viscotears gel (preservative free – I think)
- Blink (preservative free)
- Refresh Celluvisc (preservative free)
- Systane (preservative free)
- Lacrilube

In addition to this I have also used the following:
- Vitamin supplements (1 x Multi-Vitamin A – Z with minerals)
- Omega 3 Fish Oil (2000mg/day)
- Humidifier in the bedroom
- Warm and cold compresses
- Eyelid scrubs
- Eye mask of a night

I find that my eyes feel like they are “on fire” by the end of a day. It is a bit like wearing contact lenses that desperately need to come out, unfortunately, it is difficult to get relief.

After getting extremely frustrated and upset with my current clinic constantly dismissing me with “well that was on the consent form” and a fairly debilitating corneal abrasion (severely affecting my vision), I insisted on seeing another doctor at another clinic within the company.

Finally, I was referred to a doctor in London, the first Doctor in this company that I can talk to and understands my position. More importantly, he is committed to working with me to find a solution. At last, I feel that I am back on the right road to recovery.

I started with temporary punctual plugs in my lower lids, this did not resolve the problem but certainly helped.

Then he suggested that I stop using lacrilube, to use a night time gel and Systane as required during the day.

I was very reluctant to stop using Lacrilube at night due to the pain inflicted by a corneal abrasion on waking. Whilst I hate the stuff it seems to help avoid corneal abrasions, instead, I used Viscotears Gel and Refresh Celluvisc.

Since having the surgery, I only get about 3 – 4 hours sleep at a time, so each time I wake up, I reapply Celluvisc. I prey for a night sleep of more than 4 hours, maybe one day I will receive my wish.

My eyes are still very dry when I wake in the morning, so I start the day with a few drops of Refresh Contacts (or Blink).

I regret that I had this surgery but I am not prepared to live a life of regrets. I made the decision to have this surgery and I have accepted that decision as being somewhat questionable. I am not blaming anybody else, I am simply looking for a solution that works for me and makes my induced condition manageable. I am determined that this is not going to rule/ruin my life.

I just hope if anyone reading this post is considering laser surgery that you consider all the options and ask your surgeon about the possible complications. Like you, I thought “These things don’t happen to me”. Well they can happen to anyone and chronic dry eyes can be debilitating and life changing condition.

Thank you for taking the time of reading my post, sorry it is so long. I feel so much better that I have at least broken the silence and feel that I am ready to tackle this condition head on and get it sorted out.

[shells]

Hi Ian!

Welcome to dry eye talk! I'm sorry to hear about your experience, but I'm glad that you have found this site. You are in good company. You are exactly 4 months behind me in your lasik (I just had regular lasik though). I had mine on June 24, 2005. I also did not notice the dryness to be a major issue until a few weeks after surgery, and just like you, my symptoms seemed to get worse around the 4 or 5 month mark. I attribute this partially due to the fact that this is when winter was starting (heaters, dry air, etc.), but also due to nerve regrowth. The doctor I see now thinks that my eyes were probably just as dry initially, but since my corneal nerves had been severed during lasik, I just could not feel any major discomfort.

As for the Lacrilube, I believe this is an ointment? If you search around on here, you'll find some information on other products to use at night. I tried ointments for a few weeks and noticed my eyes were worse. Ointments don't mix well with tears, so I think that it really made my tear film unstable when I was using them. It sounds like you may have had a similar experience. Have you tried Genteal gel yet? This is what I use at night now, and it seems to be popular among others here. Another popular item is Dwelle, which is an eye drop that you can buy on this site. Many people have had good luck with Dwelle and the other drops offered here. You can find them in the Dry Eye Shop.

I'm glad that you got a second opinion and found a doctor that you like. I find that alot of us here have went from doctor to doctor until we finally found one that was willing to help and who understood. I also did not get proper post-op car from my lasik center, and had to go elsewhere for help.

From what you've listed it sounds like you have tried quite a bit. You did not mention flax seed oil. You may want to try this as well. I get mine in the liquid form. Apparently it takes several of the capsules to equal just one tablespoon of the liquid. You may also want to consider some sort of eye protection during the day and at night also. It sounds like you have severe problems during the night, have you tried wearing moisture chamber goggles to bed? There is also a product called Tranquil Eye goggles that have a foam insert that you can soak and then put in the goggle at night. It helps keep your eye surrounded my humid air during the night. I think that you can purchase those through this site as well.

Also, how long did your plugs last? If you only had the collagen ones that last a few days, they may not have been in long enough to really determine if they would help you or not. I had 90-day dissolvable ones with little relief, but am having the silicon ones with the cap on them put in tomorrow, and hoping that they will help more than the others did.

I like your attitude about putting aside the regrets and just tackling this problem head on. I hope that you can reach a manageable level soon. I also wanted to mention that at only 6-months out, your eyes still have a very good chance of doing lots of healing on their own. I imagine that you have looked around this site, and read some of the stories. There are many people suffering here from lasik induced dry eye, but even some of those that still suffer from some degree of dryness have seen improvements well past the 6-month mark, so there is still hope for that! Anyway, good luck and again welcome!

-Shells

[Guest]

Thanks

Shells,

Thanks so much for your reply, it is nice to hear that there are others out there somewhere with similar problems and that I am not alone in this. Although it would be nice to think that we didn't both owe this to laser surgery but that would be dwelling in the past and I am absolutely over that now - onward and upward.

I guess it is difficult to compare products as there are a number of products here in the UK that are not available in the states and vice versa. Lacrilube (Allergen) is an ointment - I believe it is the same/similar to Refresh PM in the states, the product here is preservative free and I am told is identical to Refresh PM. Either way, it is a lanolin based product and it doesn't make a lot of sense to me that it could be good for your eyes, after all oil and water didn't mix well in year 8 science, let alone in my tired sore eyes.

My current doctor has suggested that I may have had a slight condition of dry eye prior to surgery but it has definately been exacebated since the surgery and yes at the 4-5 month mark became intolerable.

He is confident (and so am I) that I will get over this, or at least learn to live with and manage it to a tolerable level. I may always experience dry eye but I am certain that it will improve to some degree with time. At least that is the hope that is keeping me on this road at this moment in time.

Do you know if the products available on this site can be sent to the UK or whether there may be a UK link that I could get similar products. I have asked my chemist for Genteal gel but he has not heard of them, but recommended the viscotears gel and Celluvisc instead. So that is what I am using of a night at the moment, although still having to apply it several times a night is a little frustrating but then again so is corneal erosion (and I don't want to go through that again, still healing from a minor incident of erosion on Sunday Morning and another minor incident yesterday morning).

I haven't tried flax seed oil, I just thought this was the vegeterian variety of Fish oil. I am currently taking 2 X 1000mg tabs each day. That is what the health store recommended but I will pop in tomorrow to find out about flax seed oil. I will try anything!!

Thanks for the suggestion on goggles, will look into that more, I have been wearing an airline mask at night and am still using a humidifier (although it is now spring so the air is not as dry as winter) so I don't think it is doing much for me at the moment.

My punctual plugs were collegen (?? spelling) and were supposed to last 6 weeks, although 4 weeks have passed and I think they are losing their effectiveness as my tears seem to be draining quite quickly. Will speak to the Doctor again in two weeks when I go back for my next follow-up. The priority on my last visit (yesterday) was to get me on the Restasis. I am not sure if it is mind over matter, but I feel like my eyes are more comfortable about 15-20 minutes after using it. I have read that some people get a really quick result (usually within 2 weeks) and for others it takes a little longer. I am hoping that I have paid my dues and for the first time since surgery I will be one of the lucky ones.

Good luck with your silicon plugs, that was the next move for me, after another round of temporary ones. It is just a waiting game now, see what happens with Restasis 2 X daily and Systane 4-6 X daily.

Thanks again for taking the time to read this and more importantly for posting a response, I am absolutely confident that this will improve to a manageable level. A few people said they had similar (although not as severe) issues at about the 4-5 month mark but reassured me by saying that it improves with time.

I have found some of the stories on this site very inspirational and reassuring, it is such a great board, I just wish that I had signed up earlier.

I live my life in hope. I have a fantastic friend who constantly reminds me that everyday is a great day, some are just better than others.

Cheers
Ian

[EllenJ]

Hi Ian,
Just a quick bit of advice -- definitely order Dakrina & Dwelle off this website. I'm sure they ship overseas -- don't see why they wouldn't! Give them a few days of serious use and you'll notice a difference. I was limping along with all sorts of products, including these, for several months. Then I decided to try just these 2 for a week, after reading so many stories on this website. Wow -- they have made a tremendous difference in my level of retained eye moisture for some reason. I'm not nearly as well-versed on dry eye stuff as most people on here -- I just know I have the condition -- but this much I can tell you: Dakrina & Dwelle work. Good luck, and keep the positive attitude. It can only help!!

Ellen

[Rebecca Petris]

Hi Ian, welcome to Dry Eye Talk! As always... sorry to know someone else has this problem but happy that you found us!!

It sounds like you have been very diligent and thorough in pursuing a number of treatment options, which is great.

I am very sorry that we cannot ship Dwelle or Dakrina to the UK (although we still hope to in the relatively near future). We have regulatory approval for them but we have to get some new batches labelled with MHRA compliant labelling and the minimum quantities are such that I just haven't managed to squeeze this into the budget yet. (FYI for others - we do not ship to anyone outside the US because of licensing and regulatory restrictions... although these drops are over-the-counter, they are regulated as drugs, so we have a lot of legal limitations on what we can do.) Having said that, it's an open secret around here that many people outside the US use these products and in fact I was living in England when I first began using them myself. Can't begin to tell you how many dry eye buddies I have over there that started sleeping better after switching from Lacrilube to Dwelle. - You can purchase them online in the Dry Eye Shop but they have to be shipped to a US address, so for example many people order them and have them shipped to a friend in the US who forwards them on arrival. - EllenJ thanks for the kind words on the drops - I'm so happy to know they're helping you!!! That's why we took on this daunting little eyedrop project....

[SusieD]

Hi Ian, Im also from the UK, I have sent you a private message regarding this.

I am also VERY interested to hear how you have managed to get restasis - Ive found it like searching for the holy grail!!!

[sazy123]

Hi Ian i am from the UK also, yes please do share with me as well how you got hold of restasis?

Im glad you found a good doctor in the UK who is willing to try different things with you. I know that they are hard to come by, i never found one. Could you tell us his/her name and what hospital they are at?what he/she is like?do they consider your eyes severe thats why they let you have the restasis? just for future reference. how much did it cost you to get restasis? i assume you got it imported over? I am on restasis now, but only after someone from the states sent me a box.

Im interested, were you aware that you had dry eye before surgery or were you a perfect candidate?

[Guest]

I wasn't aware that I had dry eyes prior to the surgery and there was no tests done during consultation to determine if I had dry eyes or not, so I guess I was the perfect candidate.

Of course I was the perfect candidate, I voluntarily came to the clinic with a desire for "perfect vision" (just like the TV commercials portray), I had the money to pay for the procedure and I was a willing patient. Must be music to their ears.

My new doctor has only given me a trial of restasis (as I believe that they feel that this is the last resort), I was told that it is not yet available in the UK but can be sourced through an International Pharmacy in London and most likely costs around Ł100 per month.

I am prepared to try anything, this has turned my life upside down, not only do I wear glasses most of the time, the vision in my left eye has gone to pot. My eyes almost constantly feel like I have dirty contact lenses that desperately need to come out when I realise - I don't wear contact lenses anymore, this is my real eyes, the only pair (and no spares) that I was given, and I CHOSE this.

Gaye has sent me some drops from the US to try and I am keen to give them a go when they get here as I have tried so many other things.

What I would give to have my uncorrected vision back - but as I have to keep reminding myself that the decision has been made, can't be changed and I have to develop a practical solution to cope with this by staying positive about finding a workable solution.

Of a night now, I put in my Viscotears gel (awaiting Genteal Gel), put on my gel filled eye mask and make my way off to snooze land for the 2-4 hours that my god believes that I am entitled to, when I wake up I pop some more drops in and pray for another 2-4 hours sleep.

I have basically given up my consultancy job as I just can't stand the office environment and staring at a PC all day results in burning eyes beyond belief, it is just not worth the effort anymore.

I have stopped the Lacrilube and have noticed that at least my eyes look better even if they don't feel a whole lot better.

I am still absolutely resolute in my belief that a manageable solution is just around the corner and each day I live in hope.

Thanks again for your comments, I see my Doctor again next week and will ask some specific questions about the availability of Restasis in the UK and I will let you know how I get on.

Regards

Ian

[Guest]

A Big Thanks

I would like to say a huge thank you to Gaye for sending me some samples of the DEZ drops and to the DEZ for providing these.

I started on them yesterday and so far just love them. I know that it is really early days but Dakrina is the only thing tht I have used during this whole ordeal that gives me some instant and longer term relief.

I read a really good presentation by Dr Holly (during my countless hours of research) and on the recommendations in his presentation, I decided that it was time to rationalise on my regime and to just use drops compatible with each other - ie, of similar formulation.

The presentation link is here http://www.dry-eye-institute.org/lectures.htm for anyone that wants a read of this very interesting presentation. It helped my to understand my problem a little better and provided some guidance on managing it.

I have decided to stop using Celluvisc, Systane, Refresh Contacts, etc and concentrating my efforts now on the DEZ drops.

Today is the first day in months that I have managed to get through the entire day at my desk without wanting to rip my burning eyes out. I can feel such a difference, still some way to go but I have certainly moved 1 step forward.

I saw my doctor on Tuesday and he was happy with my progress. He said that my Corneas had a healthly glow about them and there was no evidence of dry spots, no mucis or debris at all when he used the orange dye test with blue light.

My punctual plugs have also dissolved so I am pluggless again and he didn't believe it was necessary to replace them.

I see him again in 1 month so it will be interesting to see how I go then, I am commited to using the DEZ drops for the month until I see him again, hopefully next visit both of us will be delighted with the results and I hope that I have found the workable solution that I have been desperately searching for.

I must admit that whilst I still have more readness than prior to my Lasek, my eyes are looking the healthiest they have since the surgery. I think that I will always have a degree of redness now due to the trauma my eyes were subjected to.

I bit the bullet last night and used Dwelle for night time relief (no gel or anything else). I woke 2 - 3 times and reapplied but I am not sure if this was due to my apprehension at just using a drop, fear of waking with an abrasion or whether my body only expects to get 2 - 4 hours sleep at any one time these days as that I have gotten used to since Lasek.

Tonight I am going to use the Genteal Gel again as I am just so concerned about waking with another abrasion as I find them so bebilitating. I think I will use Dakrina for 2 weeks then try Dwelle at night instead of the gels. Just want to be safe, not sorry, I am not as brave as I once was - funny how I have learnt lots of lessons from Lasek - certainly got more than I bargained for.

So I feel folks that I am making progress in the right direction. I am sure that I will still have my 2 steps forward and 1 back days but so long as I keep going forward, I will be a very happy chappy.

I have so much to thank you, the wonderful members of DEZ for, people I have never met sending me samples and just friendly notes of support.

Thanks for your encouragement, support and suggestions. I am so overwhelmed and have no trouble making tears when I think what a positive contribution you have made in helping me address my DES.

Regards

Ian

[neil0502]

Wow, Ian ... it sounds like all great news. Congratulations!

Also--and I hope this doesn't sound like an "indictment" of anything that you're currently trying, doing, or using--it does seem that many people who have dry eye as a result of refractive surgery recover from that particular side effect in 6-12 months.

So ... while I think it's always good to support Dr. Holly and his drops ... maybe ... just maybe ... you're only a short period away from being substantially recovered.

I sincerely hope that's what's going on. Either way, though, if you've found a "care regimen" that's working out well for you, that's phenomenal progress.

Continued success,
Neil

[shells]

Hi Ian,

Wow! So glad to hear of your progress! After hearing yet another success story, I just might have to suck it up and give Dr. Holly's drops another try. My problem is that my eyes fluctuate so much it is very hard to tell what helps me and what doesn't. But, whether this is the drops, or just some healing like Neil pointed out, either way, great news and I hope it continues!!

-Shells

[Rebecca Petris]

Today is the first day in months that I have managed to get through the entire day at my desk without wanting to rip my burning eyes out....I saw my doctor on Tuesday and he was happy with my progress. He said that my Corneas had a healthly glow about them and there was no evidence of dry spots, no mucis or debris at all

Ian, I am SO happy for you!!! Fingers crossed for continued improvement.

Re Dwelle and nighttime use: I think your approach and expectations are very practical. I think that with switching to Dwelle at night it does not necessarily immediately give enough protection to last through the night but with regular use of Dakrina and/or Dwelle for 1-3 weeks the wettability of the ocular surface should be improving to the point that with one application of Dwelle before bed you do not wake during the night needing more. I remember working with a lady (up near Newcastle if I remember) who had severe dry eye after PRK and woke during the night needing ointment for two years. Dr. Holly coached her through the switch to Dwelle and she saw gradual improvement over a period of weeks until one memorable day when she slept through the entire night without needing more lubrication and without erosions.

I love my job

[Guest]

Recovery vs Drops (Good Question????)

Neil thanks for your comments.

I am not sure either whether I am just recovering (lets hope so) or whether it can be attributed to the DEZ drops. Either way I an not that concerned now as I am just so excited about getting some relief and the DEZ drops certainly provided that in the first instance.

I have tried enough things so it could be a combination of anything.
- Omega 3 fish oil (3 X 1000mg/day)
- Vitamins (A, C, E), plus a Multi
- Restasis morning and night
- Warm compresses when needed
- Dakrina 2 - 5 times daily
- Genteal Gel and Gel eye mask at night
- 2+ litres of water per day - I am starting to feel like a camel

So one/some of the above seem to be working. Who knows which, my next challenge will be what do I stop first. It is too early to cross that bridge just yet, I am sticking with this regime for another month or two, then I will start cutting back/substituting things.

Thanks everyone for your encouragement, I have discovered that this road is best travelled with the support of people like yourself, what a blessing to have found this site when I did.

Regards
Ian

[Missy]

Hi Ian!
I'm really glad that you are feeling a little bit better. Every little bit helps! I hope that you continue to improve.

I had lasik about ten months ago and went through a similar process of trying to find things that would help me control my dry eye symptoms. Your daily routine looks similar to mine. I do a whole bunch of stuff for my eyes. Some days I wonder what is actually helping and what's not. I guess eventually I may try to cut some things out, but for now as long as I can be pretty comfy then I'm sticking with everything.

Missy

[Guest]

Update on progress

I can't believe that it is a month since I joined this site, wow, what happens in 1 month.

I thought I would come back for an update.

My doctor is really happy with my progress and I am now starting to share his enthusaism as well, I am getting further through my days with less and less drops.

I hope that most of this is to do with natural healing as Neil suggested and if that is the case, than bring it on with abundance.

I can't help but believe that Restasis, Endura, Dwelle and Genteal Gel are all helping in some way.

I have been using Restasis now for 1 month and I have noticed that my mountain of single use vials at the end of each week is getting smaller and smaller, particularly the last week - it has been my best for months.

After discussion with my DR, I am using Restasis (AM & PM) and Refresh Endura every 3 - 4 hours. I use Dwelle when I need that special boost and Genteal Gel at night, although I am still keen to pluck up the courage to rely on Dwelle of a night, might wait till my next appointment to discuss that (3 weeks).

Anyway, will keep you posted, thanks again for the ongoing support.

Regards

Ian