Symptoms still not under control

[lady_asphodel]

Hi everyone,

My name's Amanda. I'm 27 years old and was diagnosed with meibomitis about 2.5 months ago after suffering post-LASIK. My symptoms started probably 1.5 years ago when I noticed the outside of my eyelids would get very oily, my eyes would start burning and get a little white discharge near the end of the day. Since my eyelids were oily, I always attributed the burning and problems from excess oil getting into my eyes and causing irritation. Showering always made it feel better, so I ignored my symptoms.

Having had trouble with glasses and also contacts, I got lasik on June 25th of this year. For the most part my vision was improving and becoming awesome with every day of healing. That is, until a couple weeks after the surgery. Suddenly, all the symptoms, mild before, started developing. I was instructed to use artificial tears. They helped at first but eventually started making my eyes feel worse. My surgeon refused to give any advice except artificial tear use, so I sought out help of other doctors.

After being diagnosed with meibomitis, the doctor (not my surgeon, but someone who also does LASIK) said he could put me on doxy. However, I have irritable bowel syndrome (super well controled--almost never have a flare up now! . . . if only I could do the same with my meibomitis), so we scrapped that idea. Instead, I'm taking Nordic Naturals ProOmega (fish oil) twice daily, doing eyelid scrubs, compress, then massage. Because I have had LASIK, it still freaks me out sometimes that I massage my eyelids--even if I am only using the white of my eye as a backdrop.

During the day I use Systane Ultra preservative free artificial tears 4-8 times, and at night I often use Refresh Celluvisc preservative-free gel tears. I got a humidifier for my office (which was only 20% or less humidity--boy what a difference that humidifier has made!) However, I still often have symptoms anywhere from early afternoon to evening that significantly affect my quality of life. The symptoms are: gritty sensation, burning (especially in inner corner of eyes and bottom eyelids), white stringy discharge (though it's usually very little), and sometimes tearing. Sometimes I leave work early or skip out on other activities afterwards just because my eyelids get so oily and my eyes are so irritated and the only thing I've found that significantly helps is a long shower. Even if I wash and do hot compress at work, it's not the same as a shower. I am afraid of long-term occular damage because I do have visual symptoms and because my condition is not completely controled, so that's part of the reason I choose to go home, shower, and relax when I have these symtoms in the latter half of the day. Even showering sometimes does not make it go away completely and any activity requiring sustained focus or eye activity can make the symptoms return or become even worse.

When I followed up with the doctor recently, he didn't suggest alternative therapies but said to increase artificial tear use and press harder with the massage because these methods have improved my condition so far. However, I have been unable to do either of these successfully. Pressing harder with the massage made my vision worsen consistently, so I'm afraid it's irritating or damaging due to the recent LASIK. I stopped that and instead massage longer; the vision symptoms improved. However, I still have signficant problems with glare and starbursts. The starburst for an approaching car may be much bigger than the car itself and make me unable to see detail of the car or anything behind it. It scares me because this symptom has gotten much worse in the past 3 weeks.

Sometimes my right eye ball also feels like it's bulging out and creating issues. It's uncomfortable and feels harder to close my eyelid over that eye. The bulging seems to come and go. Is there something related to meibomitis that could be causing my right eyeball itself to bulge? Using artificial tears sometimes makes my eyes worse, particularly if I am using them often. They may burn more or feel gritty or downright parched after using them. Other times, the tears seem to have a great benefit. I am confused as to why this could be. Is it possible that I am allergic to the tears I'm using?

My eyelids often feel heavy and tried, and I'm just so fed up with this condition. Especially since it has affected my quality of life both with work and social activities, it's very depressing at times. However, I still have a lot of hope (after all, if I cured my irritable bowel syndrome, I can learn to manage this!), and I'm very happy to have found this forum with people dealing with the same difficulties and also searching for a treatment regimine that works for them. If you have any advice, comments, or encouragement, they are much appreciated.

Best,
Amanda

[zoso967]

Lasik Dry Eyes too

Hello Amanda.

If I understand correctly you had some dryness before surgery? If so, it may be that your lack of tears due to dry eye and exacerbated by lasik has prevented proper healing and nerve regrowth. Artificial tears have no nutrients that "feed" the cornea like natural tears do. They may keep your eyes moist but they aren't tears.

Lasik cuts the nerves that signal your brain that your eyes are dry/irritated/dirty and need tears. Ironically, these nerves require the nutrients in tears for maintenance and to regenerate. If your eyes are dry during the healing period of lasik you will most likely end up with long-term and probably permanent dry eyes.

It looks like you are about 6 mos post surgery. Usually most people feel normal by that time. Unfortunately, if you don't, you may have permanent dry eye syndrome.

I am not a doctor but if I were you I'd get plugs ASAP and hope its not too late. The additional REAL tears may help you heal better.

I am now 7 years post op and my eyes are worse than ever. I have learned to manage some symptoms but generally every day is a struggle ...

[Rebecca Petris]

Hi Amanda! Sorry to hear what you're going through.

At work: Have you tried some of the strategies we discuss here for the workplace, in addition to the humidifier? - Moisture chamber glasses to reduce evaporation and cut down on drop frequency, some kind of visual reminder to blink more frequently, maybe repositioning your computer so you don't have as much exposed eye surface?

any activity requiring sustained focus or eye activity can make the symptoms return or become even worse.

In light of the above I'd especially recommend moisture chambers in the short term.... The point being that sustained eye focus/activity always means less frequent blinking which means less tear stimulation and distribution, so any strategy to capture more should help.

Are your lids visibly swollen or reddish?

Do you have more diagnostic information? OK you've been told you have meibomitis. But can they tell you more? Are your glands blocked? What's your TBUT? Do you also have reduced aqueous tear production? Any sign of allergy?

However, I still have signficant problems with glare and starbursts. The starburst for an approaching car may be much bigger than the car itself and make me unable to see detail of the car or anything behind it. It scares me because this symptom has gotten much worse in the past 3 weeks.

Don't panic... After LASIK, with or without dry eye you can get fluctuating vision symptoms like this without any implication of anything progressive.

Have you had wavefront aberrometry testing since your LASIK? I would recommend it. You need to know whether these symptoms are from the dryness or from the lasik (maybe exacerbated by the dryness).

Sometimes my right eye ball also feels like it's bulging out and creating issues. It's uncomfortable and feels harder to close my eyelid over that eye. The bulging seems to come and go. Is there something related to meibomitis that could be causing my right eyeball itself to bulge?

My question would be, IS it bulging, or does it just feel that way? I know exactly the feeling you mean by the way. I'd try & see the dr. when you're at your worst if possible. Might need a different specialist though.

Using artificial tears sometimes makes my eyes worse, particularly if I am using them often. They may burn more or feel gritty or downright parched after using them. Other times, the tears seem to have a great benefit. I am confused as to why this could be. Is it possible that I am allergic to the tears I'm using?

Lots of people develop sensitivities to the ingredients in these polymer drops. I'd suggest switching to something completely different for awhile if possible (you might try Oasis Tears Plus), and also I'll beat the moisture chamber drum once again to cut down use of drops if the drops are causing more irritation.

Hang in there. You're right to have lots of hope - you'll get to the bottom of this yet! And with LASIK sometimes it's a matter of a long waiting game... healing is slow.

[robster]

Got to say that i strongly disagree with zoso saying that if you have dry eyes during LASIK healing you will most likely end up with permanent dry eye. Many people have dry eye during LASIK healing and don't end up with permanent dry eye. It's been 15 months since my LASIK and my dry eye is still very slowly getting better.

[Rebecca Petris]

Quite right Robster.

LASIK severs nerves, and nerves regrow. There are reams of studies showing continued nerve healing for up to 5 years or more after LASIK. I don't recall seeing ANY published evidence that being symptomatic at 6 months means you're going to be dry long term and frankly the studies point to the opposite. (Mind, I still hate LASIK with a passion.) The only thing I would conclude personally about someone who's very symptomatic at 6 months is, they've got an unusual healing pattern and may be in for a rough time for awhile. I sure wouldn't assume they're in for long term trouble.

[zoso967]

There are also studies that have found that corneal nerves de-generate even further 2-3 yrs post lasik.

http://www.ncbi.nlm.nih.gov/pubmed/15505047

But its not all about nerve regeneration. Dry eye begets dry eye...

In other words, if you have significantly decreased tear production for an extended period of time, other physiological changes can occur that worsen and perpetuate the disease.
Dry eye causes inflammation, anterior MGD due to "dry" blinking and increased allergic reactions etc... all well known CAUSES of dry eye that further starve the corneal surface.
Even if the original cause is corrected you may still be left with dry eye.

At least that's how I understand it ...

[lady_asphodel]

Sorry it took me so long to repond! I didn't realize that I will not get emails about responses, so I assumed no one responded!

I am not sure if I had dry eye before the surgery. The surgeon who screened me said I did not, but it's always possible that he just saw me at a good time. I think my symptoms were better then. It was beginning of summer. I never was evaluated elsewhere because I had no idea dry eye can cause those symptoms. I always thought it was a problem with oily skin and the oil causing my eyes irritation.

My symptoms have gotten significantly better since I wrote that post. I still have problems, but they are much more controlled. I am on Restasis in addition to the regimine from before, and I also take minocycline. I believe that is a big help. I also think I had developed sensitivities to all the eyedrops I was using. Now I only use Restasis and other artificial tears are used only when completely necessary. I imagine the time has helped significantly, too.

[lady_asphodel]

Thank You!

Rebecca, I really appreciate your response. Sorry it took me so long to get back to you. I didn't realize I won't receive emails! I am feeling much better than before. My current regimen is the same (2x daily occusoft lid scrub, warm compress, massage, and fish oil) plus now I use Restasis 2 x daily and I'm on 50 mg 2x daily of minocycline. I was put on minocycline about 3 weeks ago after a 6 month checkup from being put on the purely natural regimen because they said that my eyelids were much worse (particularly my upper lids had some clogs which they manually extracted). The first time I went to the doctor and was told I have MGD, they said nothing about my eyelids being clogged but more that they looked inflamed and the oil was not the right quality. So it seems they've gotten worse since starting the regimine, but I was surprised by that because I've been feeling significantly better! However, I also avoid my office and campus like the plague and work from home as much as possible. I'm fortunate to have a very humid 3rd floor apartment fueled by steam radiator heat which keeps it nice and toasty. I can't even use a humidifier here, or the windows fog up like crazy!

"Have you tried some of the strategies we discuss here for the workplace, in addition to the humidifier? - Moisture chamber glasses to reduce evaporation and cut down on drop frequency, some kind of visual reminder to blink more frequently, maybe repositioning your computer so you don't have as much exposed eye surface?"

I have not tried moisture chamber goggles. From the sounds of it I may never want to take them off. Are they like a portable humidifier chamber for your eyes, at least in the sense that they recapture lost moisture? If so, I think I might feel like I can conquer the world with them!

I've been using workrave with good results. But the breaks are so frequent at every 3 minutes. Feel like I rest as much as I work.

"Are your lids visibly swollen or reddish?"

I haven't noticed this myself. My doctor said they were. I noticed the inside of my eyelid near to the rim can look pretty red.

"Do you have more diagnostic information? OK you've been told you have meibomitis. But can they tell you more? Are your glands blocked? What's your TBUT? Do you also have reduced aqueous tear production? Any sign of allergy?"

Doctor said I have a rapid TBUT that had gotten worse at the 6 month checkup when I had some actual blocked glands. He didn't say anything about aqueous deficiency or allergy.


"Have you had wavefront aberrometry testing since your LASIK? I would recommend it. You need to know whether these symptoms are from the dryness or from the lasik (maybe exacerbated by the dryness)."

Yes, I have. They said that it looked like I have some remaining aberrations, but they weren't completely sure if they were from dryness or not. I guess sometimes the dryness can cause the problems they saw. They also said that some of the aberrations I experience are probably because of a small optical zone. The surgeon proposed that he could widen the optical zone and make me nearsighted again, then correct that. Of course I felt that was crazy and never wanna go through this again! I told him that my symptoms aren't that bad and I can deal with them. I see some halos at night and multiple images around lights now (like a little spread of semicircles around traffic lights, for example), particularly green ones. I even see multiple images around traffic lights during the day but only with mid to far distance vision. It doesn't bother me that much, so I'm inclined to just deal with it as long as it's not a sign of something more serious or likely to develop and cause worse problems.

"My question would be, IS it bulging, or does it just feel that way? I know exactly the feeling you mean by the way. I'd try & see the dr. when you're at your worst if possible. Might need a different specialist though.

"Lots of people develop sensitivities to the ingredients in these polymer drops. I'd suggest switching to something completely different for awhile if possible (you might try Oasis Tears Plus), and also I'll beat the moisture chamber drum once again to cut down use of drops if the drops are causing more irritation."

I think stopping a lot of those drops I was using before has helped! I think I had allergies to them. Also, I think the bulging sensation was probably from dryness. It got better after a while. However, since I've been using salicylic acid wash on my face recently (careful to keep away from my eyes), I've noticed some of my old symptoms coming back. I even feel that awarness/bulgy eye in my right eye again. I'm afraid to stop using the products for my skin because they work for helping breakouts and keeping my skin healthy can help my eyes, too. My eye doctor was actually the first one to recommend a salicylic acid face wash because of my skin condition, and I guess that less infectious material/cell debris can mean less problems with clogged glands/bacteria. Perhaps I just have to keep looking for something that will work but not hurt my eyes. Have no idea where to start, though. I've tried so many treatments in the past. Almost anything that dries out the skin can dry out the eyes, but drying things are all that have seemed to work for my skin.

"Hang in there. You're right to have lots of hope - you'll get to the bottom of this yet! And with LASIK sometimes it's a matter of a long waiting game... healing is slow."

Thank you so much, Rebecca! I can't tell you how much you reply means to me.

[spmcc]

Hi there Amanda,

You could be just like me -- I have rosacea and ocular rosacea. My skin and eyes are *hypersensitive*. It may not be the active ingredient of some prescription or product, but any of the fillers/additives/inactive ingredients/scents/perfumes/dyes/etc. that make my skin and/or eyes go crazy. I really need to be careful of everything I put in my mouth, on my skin and in/around my eyes.

In any case, I believe that with enough time minocycline will greatly help your skin problems even up to the point where you won't need salicylic acid wash.

Good luck,
Sheila

[lady_asphodel]

Thanks, Sheila. I hope so, but I don't want to be on minocycline forever. I really dislike being on antibiotics, and I think they're so bad for you long-term.