6 Months post Epi-Lasek. Induced dry eyes

[Guest]

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

[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.

[Guest]

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

[Rebecca Petris]

((((((Ian))))))

I am not given to violence, but honestly, I'd like to reach out across the pond and slap your specialist.

[Guest]

I am not given to violence, but honestly, I'd like to reach out across the pond and slap your specialist.

I'm not either but I should have taken the opportunity when I was within arms reach.

I am just so dissapointed with this guy, I was led to believe he is a leader in his field - maybe he was just having a bad day also, or maybe they just don't know what to do anymore.

I'll get there, it is just so tough sometimes.

In the scheme of things I am still taking three steps forward and two back - nothing much has changed, so long as I keep going forward that is all I ask for........

Thanks for listening

Ian

[calli66]

Ian, I forget--are you a "candidate" for a scleral lens in your problem eye? Sounds like vaulting over the cornea with a protective lens would help you.

C66

[Guest]

C66

I am not sure about Sclerals or their availablity in the UK.

The Dr's that I have seen seem confident it will improve. My eyes feel OK - not good but OK but I keep getting the RCE in my right eye.

I have tried bandage lenses and find them OK, I just struggle with the poor vision I get even with a plano lens. None of the DR's can tell me why the vision is poor with the lens. I am convinced it is because my cornea has been reshaped from the surgery.

The Dr seemed puzzled today when I said that I get abrasions occasionally with the lenses in (of a morning when I wake).

I will put another lens in tonight, goop up, tape my eye closed and see if I can tolerate it. My vision is actually good now (still have night time problems but during the day it is fine). I read the 20/20 line with no problem at all today - not that I am convinced this is a good measure of vision quality.

I am just so convinced that if I could get this RCE under control, my DES symptoms would no longer be the domination of my life. After all, I use very few drops during the day. Maybe I should go back to using them 3 - 4 times just as a preventative measure and see if that helps.

Ian

[Rebecca Petris]

Maybe I should go back to using them 3 - 4 times just as a preventative measure and see if that helps.

I think that might make sense, Ian. For most people it's the other way around, i.e. extra prevention at night helps get their eyes off to a better start for the next day but when nights are the tough time, I don't see why the reverse might not be equally applicable.

[Elegiamore]

Keep on going, Ian

Ian,

I would suggest that you post a question to one of the online eye doctors here about the topic of debridement - when is it appropriate, what works as an option, etc. That would be in keeping with Rebecca's rules for doctor postings, but would get you another approach to consider.

You have gotten so many differing opinions - let's see what the Dry Eye experts have to say on this matter.

FORUM - give Ian your advice, gang!

It was inhuman to tell you to wait another month to see what happens, and not even give you an appointment. This is a sign that this doctor is the wrong guy, expert or not. Rebecca's suggestion to work on it during the day is a good one.

Why don't you see what this so-called expert says if you email him back in a week, instead of a month, with your progress?

Best wishes,
Elegiamore

[sazy123]

am just so dissapointed with this guy, I was led to believe he is a leader in his field - maybe he was just having a bad day also, or maybe they just don't know what to do anymore.

I know what you mean i was dissapointed with a guy at moorfields, supposed to be top in his field. the only usefull thing i got out of it was to finally find out that my TBUT was 6 secs.

Would sceral lenses (bandage lenses) help with your RCEs?

You can get them from ken plunum (sp?) in london, do a search for the web address.

[Rebecca Petris]

Sclerals cannot be worn while sleeping but it is an interesting question whether wearing them during the day for a period could promote enough healing to halt the RCE cycle. Not trying to push anything on you Ian but just to satisfy my own curiosity I've lobbed a question to BFS about their experience with this kind of therapeutic use.

[Guest]

Thanks everyone for your suggestions, at least my mood has lifted a little.

Just arrived home from London, feeling exhausted as always but I am determined to get this sorted.

I will email the clinic in a week and let them know how I am getting on. Thanks Rebecca for investigating the Sclerals let me know what they come back with.

Sazy, I will check out the DR you mentioned and see whether they are an option.

I have the mobile of the first Corneal Specialist I saw a month or so ago (big mistake on his part), I liked him so will call him and see what he has to say about this latest diagnosis.

Have been practising taping my eye closed, not as easy as it sounds I might add.

I rarely use any drops at all during the day, I am finding that whilst my eyes feel a little gritty they have a good meniscus and look generally OK. Nights are my worst time.

I think I will try 3-4 times a day just to see how I go during this next phase.

I think I am most angered by the no follow up appointment thing - just indicates to me the DR is at the end of his professional knowledge and wants me to go away - well THAT AIN'T HAPPENING.

I am going to email the practice owner tomorrow to make sure of it. I felt so much in limbo this morning but I will sort this out. And thanks again for your suggestions, I really needed a lift.

Eliga thanks for your lovely email, it really boosted my spirits. Will reply tomorrow.

Now C66 which surplus product do you suggest I use when I have a DR that is causing me a pain in the A%£&, will Sterilid work for that as well????

Cheers

Ian

[dianat]

Ian,

I'm sorry to read about your struggle with the specialist. I truly wish for you that you'd walked out of there with something to go on. I do wonder as well if sclerals may help you begin to control the situation.

It also came to mind the theory behind blood serum drops. They are alleged to help heal damaged corneas. I know it can't be easy for you to get, but if anybody should offer to prepare them for you, you might consider it.

I'm sorry I don't have anything better to suggest, or offer...I don't even have a good joke to tell.

I do hope things start to to look up for you. We need you in good humor around here.

Diana

[DrG]

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.

Well, in his favor, your epi-lasek was a debridement of sorts. Unless you were specifically told to do so, I wouldn't be using gel plus taping while having the contact lens in your eye.

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.

Naturally, the Focus N&D, being a rather stiff and steep lens, will vault the cornea, causing you to be myopic between blinks.

Regarding how long it takes, I use them acutely when the problem is acute, and long term when the problem is chronic. Most cases of RCE are of the episodic/acute type.

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.

A cornea with an epithelial defect is completely overwhelmed with tears as the barrier function no longer exists. Dr. Holly and I both agree on this. Once the epithelium is healed over, then the cornea is still edematous for a time, until the endothelial pump can clear it. If there is still a defect, then perhaps you shouldn't use the Muro...or find something else, such as one of Dr. Holly's formulations. Throwing salt into a pot of water isn't going to make the water evaporate any faster, and it isn't going to dehydrate your eye any faster, either. What it will do is to remove the excess water from the cornea and cause the epithelium to adhere better.

Please don't misconstrue any of the aforesaid as medical advice, but simply observations. Sometimes, there is just too much information to absorb.

[calli66]

Now C66 which surplus product do you suggest I use when I have a DR that is causing me a pain in the A%£&, will Sterilid work for that as well???? Ian

Ah, I see you read that one, LOL. I can't think of any witty comeback comment; I'm too tired. But I sure hope you can get some decent doctor working for you soon!

Best,

C66