New dry eye sufferer, advice/guidance needed

[ScottishDave]

Hi,

First post on this forum but have been following it for a couple of months now since my dry eyes started. I am ideally looking for some opinions on my case from people in a similar situation as I am finding it very difficult to get a clear diagnosis from my Optomitrists/Opthamoligist.

Firstly I'll give you a bit a background summary to my case:

- I'm 35 years old and had lasik surgery mid 2007. I had no significant problems with dry eyes before surgery and post surgery I only used drops for a few weeks that I remember.

- 6th April 11 (the day after my second son was born) one of my work colleagues noticed that the inside white of my left eye, near the nose, was bright red but I had no pain whatsoever. I went to my local chain optician who looked at my eye and told me to get some over the counter generic tears and come back in 3 months!

- 20th April 11 I started feeling some mild discomfort in my left eye so decided to go to another optician. He had a look at my eyes, said that they were both very dry and he said for me to use Viscotears and come back in 2-3 weeks.

- 6th May 11 my left eye was beginning to hurt a lot and the redness in the corner had changed to 8 - 10 horizontal veins which would change between being red and being light yellowish. I got my GP to refer me on an emergency appointment to an NHS Opthamologist. He said that indeed both eyes were very dry and he prescribed me Lacrilube for night, Viscotears during the day and he also said I had mild Bletharitis which he gave me a leaflet to read about cleaning with baby shampoo.

- 7th May 11 I started reading these forums more and ordered a tonne of products. I ordered Thera tears preservative free vials, Thera tears nutrition Omega 3, Sterilid eye cleaner, rice bag and Tranquileyes goggles.

- 10th May 11 I replaced the Viscotears with Thera tears when they arrived, started taking the Omega 3, using the Sterilid twice a day to clean my eye margins/lashes, using the rice bag twice a day as a warm compress, used the goggles to sleep in at night with some Lacrilube applied. Over the next few days I saw no improvement in my eyes and work (as an accountant in front of a computer screen all day) became unbearable.

- 13th May 11 I got signed off my work for two weeks.

- 13th - 17th May 11 I kept up with all treatments, drops were at the worst in every 30 mins, left eye started feeling worse not better. I also started putting drops into my right eye which felt slightly dry but not sore at all. I made an appointment with David Crystal Optometrist (dry eye special in Edinburgh who I saw recommended on these forums and I live very near to).

- 18th May 11 appointment with David Crystal. He seemed very nice. He wanted to know how I was currently feeling and what I was currently doing about it. He then examined my eyes over about 30mins taking pictures and videos. There was not testing of my tear quantity/quality that I noticed. He showed me a picture that I had stuff stuck at the bottom of some of my eye lashes and that my glands in my eye lids very prominent with white bumps. He said that these glands were clogged up and the oil wasn't getting produced (he didn't mention specifically that I had MGD though). He also said that I had some blepharitis and only blinked 3/4 of the way which caused some bumps on my cornea??

He recommended a few things. Blink properly (use Postit notes around the house/work to try to push me to remember), he said the bumps on the Cornea would go away in 72hrs if I did this. Stop Thera tears as they go away too quickly for what I have. He recommended Ocumed drops instead of Thera Tears. He also said the keep up with the Sterilid and Thera Nutrition (which can take 4-6 weeks to start having an effect) and stop using Lacrilube and the warm compress, he also said that plugs wouldn't help me. If anything he said use cold if needed as well. He also said that I shouldn't need to come back to see him again!

- 19th - 24th May 11. Dramatic improvement following what he said. Drops I managed to get out to about every 3 hours rather than 20 mins. I generally woke up fine, cleaned my lids, put drops in every 3 hrs through the day, cleaned lids at night and put a few drops in before bed. I felt okay through the day like this, even by night I felt very little. I was actually thinking that I had been prescribed some miracle cure. I also started putting drops and doing the cleaning to my largely unaffected right eye.

- 25th May 11. Started to feel worse. Felt okayish in the morning but drops needing to go in every hour before the eyes would start hurting again. The right eye was starting to hurt as well now and the pain sometimes rivalled the left eye.

- 26th to now - Much the same as the 25th. There are numerous noticeable red veins in my left eye both under the eye lid and on the visible part of the eye. These become more prominent as the day goes on and flare up a bit after putting drops in. There are now red veins in the right as aswell but less than the left.

I generally put a couple of Ocumed drops in each eye before bed right after my lid scrub. I sleep okay through the night with no goggles and the eyes feeling fine, sleep is broken only by my 8 weeks old son! I feel okayish when I wake up. Both eyes feel a bit gritty when I open them but no visible crusting. The grittiness goes away fairly quickly. I have changed my routine slightly and now do a warm compress/express first thing and them scrub my lids with Sterilid followed by 2 or 3 Ocumed drops in each eye. I then need to put further drops in throughout the day between every 1 1/2 to 3 hrs depending on how I feel.

I go through the day at work feeling my eyes slightly in the morning but by 1pm I can feel both a fair bit right in the corers next to my nose with the odd pain on other parts. When I get home from work at 5pm they feel very sore in the corners and I do a warm compress/express and then put drops in every 1 1/2 hrs till I do my night time routine again. I have purchased some onion goggles to try but I'm not sure they help much.


Apologies for the lengthy post but it felt good to get all this down on paper!

Does anybody have similar symptoms or could offer some advice on what I might be doing wrong i.e. perhaps different drops to use (I've read about Restasis etc.). Does this seem like something that would be caused by my lasik given that it was 4 years ago? From what I have read my condition seems like it might be the evaporative kind of dry eye, will plugs really not help? Will the red veins ever go away?

Many thanks.

David

[Pat Baker]

Famiar story. Same here, but agter 3 years of misery and trying every conceivable medication, I demanded an eye swab be done and it seems I had the "hospital bug" (see my post under General Forum - "Success at last"). I went on to a course of sulphur tabs (the only thing this bug is sensitive to) and within 4 days my eyes were almost perfect. Now, after almost 3 weeks, I have almost perfect eyes, and no pain at all. Get the surface of your eyes swabbed asap. I developed my problems a year after lasik - don't know it there is a connection. Best of luck!!!

[y-gwair]

I've had similar symptoms and I'm coming to the conclusion that most of my problems are due to MGD, despite being told originally that this wasn't an issue in my case ( I also have severe aqueous deficiency due to autoimmune/thyroid disease). The discomfort usually starts in the inner corners (caruncle, corner of upper lids); red veins then show up nearby on the cornea, then spread to the rest of the white part as the flare worsens. I read somewhere this week this is a typical pattern seen with MGD dysfunction. I rarely get blocked glands, at most times the meibum is clear and seems to flow freely but evidently it isn't of normal constitution; sometimes just stops almost completely without any apparent blockage of the glands.

The first person I saw at Moorfields said I didn't have blepharitis when I saw her last Autumn; by January it was more obvious; last week I saw another ophth. at Moorfields who said there was definitely a problem, and that my worst eye had numerous dry patches despite much improved volume of tears due to plugs. She has given me a prescription for ciclosporine ointment (Restasis isn't licensed in the UK, though Moorfields pharmacy can supply something similar). On private prescription it is very expensive (£240 for 3 month course) so I'm hoping my GP will write an NHS prescription; at the moment I'm in no rush to try it, partly because I know some people have found it difficult to tolerate, also because I'm suffering terrible skin problems which are certainly related to the flare of eye dryness, and don't want to introduce another medication until I've had patch testing/clearer idea of what's going on. My specialist said that most people eventually find it very helpful if they can stick with it.

I don't think it's always very easy to diagnose chronic MGD, I think there are forms that can cause discomfort out of proportion to the visible signs in the early stages. According to one of my ophth everyone has some degree of mild blepharitis, I guess people with lower volume of tears for whatever reason (AI disease, lasik, aging) suffer adverse effects more easily.

Re. red veins, the chronic redness responded very well to a course of steroids, although I found they burned my eyes a lot (apparently this is quite normal, according to ophth. no 2). Since last week, I've been using warm compresses several times a day, and the terrible burning on lid margins/eye surface has improved. In my case, these flares are almost certainly immune-mediated as I suffer from other forms of muco-cutaneous inflammation, but even in people without a dx of one of these conditions, the severity probably waxes and wanes for various reasons. I'd leave it for a couple of weeks on the new regimen and see if it eventually settles; if it's still so bad that you can't work after a month or so, I'd go back and get a re-evaluation as the condition may have worsened over that time, and a different intervention might be appropriate.

[SweetLife]

Bletharitis

I was diagnosed with severe Bletharitis and tried several eye creams and ointments prescribed by my doctor including hydracortasone creams. I suffered for months until eventually it got so bad I was suffering with open sores and yellow discharge in patches under my eyebrows right down to my eyelids and underneath the bottom of my eyes. Absolutely fed up with seemingly no real success medically I decided to see a herbalist which was the best thing I could have done. I'm not saying that my Bletharitis has miraculously disappeared but it is so much better and managable with just a few changes. I use the herbs Calendula, Eyebright and Chamomile making up a cup of tea to drink and a bowl of soaked herbs for an eyewash. I drink the liquid from the soaked herbs every evening and bathe my eye with the soaked up eyewash liquid on a cotton wool pad at least three times a day. I then apply a totally natural Calendula healing cream as much as possible during the day. I also take a good multi-vitamin and extra vitamin C on top. After three days of this regime I noticed a vast improvement, the sores healed, my scabs and scaly skin disappeared. I still get the odd flare up and suffer with redness but I have now got to the point where I can even wear make up again after months of avoidance. The total cost for the herbs and lotion was under £10.00 and the multi-vitamins another £10.00, the herbs will last me over a month as will the vitamins. £20.00 a month is a small price to pay for making this condition manageable. I wanted to share my story as Bletharitis ruined my life for so long, some days I didnt want to leave the house my eye looked so awful.