Dry eyes, Can't find relief. Help

[RhinoMan]

Yet another dry eye story.

In the past year I have noticed that my dry eyes have affected my comfort more and more.

3 years ago I started to use "Hypo Tears" when I first woke up. 6 months later I was using eye drops through out the day. Then I started using the ointment (Wallgreen's mineral oil and white petroleum) at night and drops (Wallmart's Equate rewetting drops) at daytime. Now I am using the ointment throughout the day (8 times) and drops once in a while.

I am a commercial pilot and wear contacts when I fly. My eyes feels better with the contacts than glasses, but when I take them out is when I have trouble. They are very scratchy and super dry. I can't function without the ointment with me. It is such a pain to have to deal with this and carry it around and re-apply. There are time when even the ointment is not enough. It hasn't affected my job, but mostly my leisure time after work and at the end of a long day.

Some nights I come home with very tired eye muscles and it is hard to do anything but watch TV. Reading and the computer hurts.

I am seriously considering this plug operation (punctal occlusion).

Any thoughts from others with this condition. Or those who have had the plugs done?

History: Don't think it is a med side effect but (currently taking no prescription drugs. Take prilosec OTC, Claritin OTC) Very healthy and in my mid 20's. Want to get LASIK but don't want to risk it for the profession. Have had seasonal allergies entire life.

[kitty]

Welcome. I am so sorry you are having such discomfort. You have come to the right place. My first question is, have you seen an eye doctor for a thorough evaluation? Do you know what kind of dry eye that you have? As a pilot, I am sure that the cabin air is super dry, and that cannot be helping you. Have you considered some sort of goggles to help keep the moisture in? Panoptyx and Wiley are a couple that are popular with people here, you can get them in prescription or you could wear plain ones and wear your contacts. I have undergone the punctal occlusion. All four of my punctum are plugged. With just the lowers plugged, I did not see much difference. With the uppers plugged, I use many fewer drops during the day. My eyes still burn but they are not as red and don't feel so scratchy. Unfortunately, there is still not enough moisture to permit me to wear contacts. Everyone is different.

[RhinoMan]

No I haven't had a real eye appointment for this condition. I have been reluctant too because we are required to report any visit to the FAA on our medicals and they are eager to disqualify people for things as simple taking Claritin. Which has no side-effects on me. Poor system. It causes many pilots to ignore medical conditions or avoid doctor visits. If I have to I will at the last resort.

I went to a Lasik evaluation and that is where I heard about the plugs. The Dr. was eager to do the Lasik on me despite my dry eyes and said the plugs would solve that problem. Her eagerness to operate turned me off and I decided against it. It wasn't worth the risk for me.

Anyhow I am not sure how the FAA views the plugs, I will have to do more research on that. I can't imagine that it wouldn't be allowed.

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Are the OTC drops and ointment I am using good stuff? Is there better stuff out there that might help me more? The photos are attached in the first post.

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No I haven't worn any goggles. I wear tight fitting sunglasses. Yes the air is dry and there is constantly flowing air, but I am only up there for 3-4 hrs. a day usually. I do spend 2 hrs. driving and 3 hrs on the laptop that I am sure does not help. Less blinking.

Glad to hear that the 4 plugs have helped you. It gets me excited to try that. I know how you feel with the burning red eyes. Not a good feeling. I feel the constant dryness makes my eye muscles work harder and they fatique quicker. Have you noticed this?

[Judy]

Claritan side effects?

Hello RhinoMan,

I seem to remember that most of the prescription allergy eyedrops have the possible side effect of dry eyes. Have you checked this out for Claritan? Also, many doctors would probably tell you if your eyes are so dry, to hold off on the contacts, but you are saying they possibly help you. I've read so many horror stories of post lasik surgery and dry eyes that I'm glad you have held off on doing this for now.

Best wishes from someone who suffers from dry eyes and now has many other eye issues....

[kitty]

No I haven't had a real eye appointment for this condition. I have been reluctant too because we are required to report any visit to the FAA on our medicals and they are eager to disqualify people for things as simple taking Claritin.

Are the OTC drops and ointment I am using good stuff? Is there better stuff out there that might help me more?

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Glad to hear that the 4 plugs have helped you. It gets me excited to try that. I know how you feel with the burning red eyes. Not a good feeling. I feel the constant dryness makes my eye muscles work harder and they fatique quicker. Have you noticed this?

How about if you go to an optometrist for a routine eye exam? Evaluate the kind of contacts you are wearing and discuss the dryness at the same time? I can't really tell you if the drops and ointment you are using are "good". Everyone has a brand that works best for them, trial and error will help you find it. I can tell you that many people here find the ointment products to be more irritating, and prefer a gel-type product. Personally, I use GenTeal gel at night, and rarely during the day if I am extra dry. During the day, I use TheraTears in the single use vials. Whatever products you try, give them a good month to see if they will be of benefit to you.

I have not noticed eye fatigue with my DES, other than when I have needed a new prescription for glasses! Most often, it is the burning that limits my activities, such as with the computer, watching TV or driving.

[Rebecca Petris]

Dear rhinoman,

I read your post with great concern. I took the liberty of consulting an optometrist at the FAA that I'm acquainted with and he gave me some helpful pointers for you along with strong reassurances that by no means should you hesitate to see an eye doctor under the circumstances you've described. I'm going to share some of his (and my) thoughts here and I'll send you a few more FAA-specific thoughts via private message.

I was told that unless you're actually experiencing a decrease in vision below the standard for Class I or Class II pilots as a result of the eye condition it's extremely unlikely that it could affect your recertification. (This doctor had never heard of anyone failing to requalify on the basis of dry eye, unless it was posing some kind of serious problem such as substantial vision loss, constant tearing, bad glare etc.) What COULD happen is that when they do a re-evaluation, you may be required to be seen again every 6 months (if you're Class I) or every 12 months (if you're class II). But overall he felt that if you went into your next medical and mentioned you'd had some dry eye issues at your eye appointment, it would probably not pose any issues, unless again there had been a decrease in the vision you have with your contacts. - Bear in mind that a ton of pilots have dry eyes, it's basically an occupational hazard.

He was (and I am!) much more concerned with the long-term risks if you fail at this stage to get proper diagnosis and treatment. You're early in your career. It sounds like your condition is getting progressively worse and sooner or later it's going to affect your medical. What you definitely don't want to have happen is to leave it until your vision is badly affected. Take the long view on this and don't let the concerns about your medical make you paranoid about being seen for something as common as dry eye.

Now a few thoughts about your treatments & contacts, mostly from me, and I'm not a doctor so take this for what it's worth:

1) Whoever you're getting contacts from, you really need to get with them and explore some better contacts as Kitty says. There are several dry eye friendly contacts such the Oasys and Proclear Compatibles.

2) Constant use of ointment is always a red flag for me when I hear someone's getting worse. It looks like yours is unpreserved, but putting ointment in your eye all day would make me very suspicious that while it may be temporarily alleviating the pain, it may be making the condition progressively worse. You might want to consider going cold turkey on it, toughing it out for a couple of days (only drops - but also other things to help like warm compresses, drinking more water, avoiding air conditioning where possible etc) and seeing how you fare.

3) You've really really really really got to see an eye doctor. You are very young to have dry eye this bad. Assuming this IS all about dry eye and no other conditions (presumably the case as you wouldn't have been approved for LASIK with other active conditions - and frankly you shouldn't have been approved for it with such dry eyes!) I'd be very hopeful that you can get a lot of improvement through better dry eye care, which may include some kind of drops, plugs, maybe Restasis, maybe lid care/warm compresses, maybe other things.

Hope this helps....

[kurt]

Want to get LASIK but don't want to risk it for the profession

Think again. One in four patients will get dry eye from LASIK. If you already have it, you stand to make it worse.

[RhinoMan]

I really appreciate everyone's responses. I don't think I realized how important it is to get this worked out and looked at before I have problems down the road. Thank you Rebecca for pointing that out to me.

I made an appointment next week with a contact eye doctor as Lens Crafters. Now I am double thinking if I should maybe go to someone who is more well-known instead of the generic eye doctors at the retail stores. I will request to try different contacts than the acuve advance with hydroclear. And ask their advice on the dry eyes I am experiencing.

I also stopped Claritin just to be sure that it is not making matters worse. Today my eyes were better and I wore contacts all day, not good, but better. I think I will keep a journal to see what makes it better/worse.

Thank you for the FAA info. That is very helpful to know. It certainly doesn't affect my flying and I can see 20/20 throughout the day. It is more of a quality of life issue as I am sure you all know who are experiencing it.


...It is comforting to know there are others out there with this and who are so helpful and supporting. thank you

[RhinoMan]

Well it is time for an update and hopefully resolution to my dry eyes.

I saw the doctor at the local lens crafters. Here are her recommendations:

1. Switch to the new "Acuvue Oasis" contact lenses.
2. Use "Systane" liguid eye drops during the day.
3. "GenTeal" gel at night
4. "Blink and Clean" drops during the day when contacts are in
5. Wash around my eyes with warm water and warm compresses each night

I have done all of the following and have seen a significant improvement in my eye health. Less dryness and irritation. Less eye strain at the end of the day and the ability to wear my contacts longer. Sure I am still dependent on the eye drops, but at least they take care of the dryness. I didn't know there was such a difference in qualities and brands.

Thanks to those you recommomended that I get this checked out. I didn't think there was much that I could do about my dry eyes, but I was dead wrong.

[Judy]

Hi Rhinoman,

That is great. It is so wonderful to hear of people doing better! I'm gonna try the Genteal gel at night again, because I think that might be helpful. Thanks for updating us with some positive results!

[Lois]

Dry eye

I want to say I had the Punctal occlusion done on both eyes and it did help BUT to make a long story short I have also been on other medication two of which I will tell you about:
Pataday (perscription) is for allergy of the eye
FreshKote (perscription) has made a BIG difference. Check it out on the internet. My doctor started me on it about 3-4 wks ago and immediately it made a big difference. It is a combination of 3 drugs (???) what a difference. I quit taking Restasis (perscription) and only occasionally use Refresh drops during the day.
Ok, I will also tell you about washing your eyes 3 times a day with baby shampoo & warm water. Yes, if the problem has anything to do with the glands in your upper lid it will help keep the glands cleaned out (as I understand it).
Hope this helps.

[RhinoMan]

UPDATE TO MY CONDITION:

27 yr old Male dry eyes for 3 years. Wear Acuvue Oasis, clean with Replenish. Wear glasses 50%.

Dr. #1 Recommend I try fish oil pills for 6 months. Fair enough. Did it for 1 year and no improvement.

Dr. #2 Tested my eyes with the strips to see the tear output. less than half of normal. Told to start with Lower plugs. Did it on the spot. Felt great for 3 months.

Now I am back to worse than before. Often wake up in my sleep with eyes hurting and super super dry. Hard to go throughout the night without waking up because of it. I seem fine during the day when I am well rested and wearing contacts. My vision is 20/20 with glasses still. People sometimes ask why my eyes are so bloodshot?

Started Ristasis 2 months ago. So far not any better (i know it might take 6 months. )

I really need to make another appointment to the doctor and tell her it isn't cutting it. I am calling first thing tomorrow.

My routine:

Wake up with crusty dry eyes.
Use Blink and Clean to make them feel good and clear out some of the gel from the night before.
Insert Ristastis.
Wait 20 mins. then use a little Systane PV drops through out the day.
Towards night I use Genteal
Before bed good amount of Genteal
Middle of the night, wakeup and use a little Genteal on my finger tip to the eye, or Systane PV drops.

I could really use extra help and evaluation of my routine, outside from what the doctor told my 6 months ago. I plan to go again. Thanks for all that your site offers.

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BTW take no meds now other than prilosec OTC. I am very healthy other than this. Exercise daily and my target weight. Have tried rice heat pad once in awhile, didn't do anything.

[ryan77]

RhinoMan,

You have pretty much described my situation to a tee...except, my dry eye started a little over a year ago when I got LASIK surgery...I've been hoping it would get better, but it really hasn't...

All this time, I've been assuming that it was just part of the surgery and there isn't anything else I can do about it (I have lower punctal plugs and take Restasis twice daily, and take fish oil pills and multi-vitamins daily as well). However, lately I've been wondering if there is something that I am doing or eating that could be causing it.

I have allergies and have been taking allergy pills pretty much non-stop for quite a while. Several different kinds actually. I've tried different combinations and even not taking them at all, and nothing really changed, with respect to my dry eye. One undeniable coincidence remains that I feel is worth exploring, however, I'm between a rock and a hard spot...my stomach pills.

About the same time I got LASIC surgery I was going through a lot of stress and developed some heartburn...so I started taking acid blockers. Again, several different kinds, but mainly Zantac 150. All this time, I've had mild dry eye (my eyes look like yours). The Zantac worked for a while, but eventually became less useful and I recently switched to Protonix a few weeks ago, which seemed to work a little better, but still didn't work as well as I wanted...so I decided to try Prilosec OTC the other day...guess what, my dry eye got worse.

Maybe it's coincidence, but I'm starting to think that perhaps either the stomach pills are causing the dry eye, or perhaps an interaction with the restasis or allergy meds may be causing dry eye. None of their websites indicates that dry eye is a complication...but the coincidence seems undeniable.

I'm hoping the Prilosec fixes my stomach issues and I can get off it after the 14 day "treatment." Maybe both my problems will go away. I just noticed that you were taking the same meds...so maybe there's a connection?

[odydnas]

Rhinoman, do you have blepharitis and/or mgd? Crusty eyelids is an indication of eyelid problems....have you had your eyelids evaluated by a doc? Many docs overlook eyelid problems, so you may have to specifically ask to make sure they've checked it out.