My understanding of the complexity for a cure.

[CalmerThanTheDude]

First I just want to say that I've done a lot of research on the dry eye subject and I found the video below very informative and explanatory of why the problem occurs:

http://youtu.be/ooYcjzNtn58

I think that in order for a cure to happen all of the below points must be met to end the cycle or dry eye spiral:

#1 Inflammation must be stopped.
#2 Tear film must heal or regenerate.
#3 Lacrimal and Meibomian glands must produce tears and oil respectively.
#4 Hormones must be balanced to support gland function.
#5 The nerves in the eye must be functioning properly to tell the brain to produce sufficient tears.
#6 Scarring and blockage of the glands must be cleared.

Correct me if I'm wrong, but it seems to me that unless all 6 of the above steps are cleared or corrected at once, we're still left with just a treatment to the problem rather than a cure. I think that a lot of us are desperate for a cure, I know I am. I just wonder how can we accomplish all of the above at once?

If people have damaged nerves from LASIK or in case of Sjogren's patients it seems like a really steep battle to correct the problem. Does this increase the chances of a cure for people that just have hormonal issues and gland blockage issues, accompanied by inflammation? If we balance someones hormones, clear the inflammation and promote healing of the tear film all at once, then I think we have a higher chance to succeed than any other way by itself.

For example I noticed people do gland expression, or use drops, but if the glands continue to dysfunction then we're back at square one. I wish that a breakthrough opthamologist would incorporate AMX drops or ProKera lenses to help heal the tear film while performing a gland expression or unclogging and at the same time carefully monitoring androgen hormone levels in those that are deficient. This might break part of the cycle, reduce inflammation and let the eyes continue to work properly.

Thoughts?

[spmcc]

I've thought a lot about this too. I have a few chronic diseases so I tend compare them.

For example, I have asthma. While I would love a cure, I am very happy with my treatments that PREVENT my symptoms. I take one puff of an inhaler twice per day and I can do almost anything. I still try to avoid fumes (perfumes, paint, cleaners, smoke, etc.) so I have made some "lifestyle" changes. And my asthma does get worse when I get a cold or other respiratory infection. But as long as I take my medicine as scheduled, I can avoid almost all of my symptoms.

That is what I hope for with my eyes (and my facial rosacea).

So, as much as a cure would be excellent, I guess my hopes are a little more moderate. I wouldn't need all your 6 points to be addressed, I'd just ask for some treatments to reduce/stop my symptoms.

[Faith1989]

CalmerThanTheDude what are you using to treat your problem? Has anything helped you at all?!

[CalmerThanTheDude]

CalmerThanTheDude what are you using to treat your problem? Has anything helped you at all?!

I've tried OTC drops, prescription drops (Restasis made me way worse), fish oil, warm compresses, gland expression and nothing really helps. I just find that the more hydrated I stay the better my eyes feel. I wanted to try cholinergic meds made for sjorgrens, those are designed for dry mouth but have a side effect of creating more tears as well. I've read that some people were greatly helped by those meds and others were not on this board.

[gilligan_1434]

I believe you are on the right track. I would add a nebulous #7; decrease the hypervigilance that we develop to every unpleasant sensation in the eye, in order to start the spiral going backward. This largely deals with perception, placebo, and optimism.

My understanding of cholinergic meds is they increase aqueous tear production.

[Guest]

I think that in order for a cure to happen all of the below points must be met to end the cycle or dry eye spiral:

#1 Inflammation must be stopped.
#2 Tear film must heal or regenerate.
#3 Lacrimal and Meibomian glands must produce tears and oil respectively.
#4 Hormones must be balanced to support gland function.
#5 The nerves in the eye must be functioning properly to tell the brain to produce sufficient tears.
#6 Scarring and blockage of the glands must be cleared.

Correct me if I'm wrong, but it seems to me that unless all 6 of the above steps are cleared or corrected at once, we're still left with just a treatment to the problem rather than a cure.

I think that may be true for some people, but perhaps not all.

ex. what if the initial severe lack of tears immediately post-LASIK triggered inflammation of such a large magnitude that it then caused the tear film to go haywire, which then led to more inflammation, which then tipped the balance such that even the MG's got inflamed (then blocked with thick meibum), the lactimal glands started reacting to the inflammation and they started producing fewer tears simply due to becoming inflamed themselves and so on... the downward spiral goes on...

In a cases like that, would it not be possible that, say once the nerves regrew into the flap and started to function better, IF the patient finally figured out a way to bring down the inflammation for a long time, that perhaps the MG's and lacrimal glands would be able to recover themselves and start to produce more and better quality secretions, which would then bring down any remaining inflammation even more, and the further lessening of inflammation would lead to the lacrimal and MG's functioning still better... and the upward spiral goes on... until maybe, one day they are normal again.

See what I mean? All is not necessarily lost...

And let's say there are other factors such as allergies or hormonal imbalances, which, pre-LASIK were not severe enough to tip the balance such that the eyes were noticeably affected, now that the eyes are screwed up from LASIK, the resulting overly sensitive eyes has tipped the scales such that the previously small allergy and/or hormonal imbalances are now having a noticeable effect on the eyes. In that case, simply resolving the hormonal imbalances and/or figuring out how to avoid the allergic triggers WOULD now have a positive effect on the eyes, and maybe THAT would tip the scales such that the eyes could even recover from the stress/damage of LASIK...

And of course, there is an entire spectrum in between where rather than a cure, there is merely improvement of varying degrees... Either way, seems to me there is hope. And even if not a total cure, there are varying degrees of improvements that can be had... there are loads of post-LASIKS on this forum who have gone from totally crappy eyes-from-hell to living normal lives again... and of course, there are others who stay like me, with still pretty bad symptoms compared to normal people, but still with much more tolerable symptoms compared to when at their worst.

Stay strong! Keep trying... there's lots of reason for hope!

And, in case anyone reading this is in a pessimistic mood and thinking for SURE they'll end up like me... for what it's worth, even though my eyes still suck, with all my eye-care routines and babying, I'm able to function quite decently these days, and I'm honestly happy despite my problems. Seriously... I really am, and I'm not just saying that to make anyone feel better. It's amazing what your mind can adapt to if you give it time... life is good (and if it's not good for anyone reading this right now, trust me... it's highly unlikely it will stay that way forever!!... so wait for it to get good again... it will!)

[farmgirl]

I have tried them, albeit briefly, for Sjogren's. Made me drool like a dog, didn't help the eyes and there were possible negative side effects. I decided it wasn't worth the risk...F/G

[Mawsky]

I agree, I have felt that every step I've taken or has been offered me by the eye docs, is just to treat the symptoms, I had DCR surgery many years ago, but did not develop my dry eyes until some years later, the Doctor believes it is a because of my surgery and my now super sized punctums that I have DES. I of course agree that the surgery started the ball rolling, but no one is addressing the treatments as a fix, just a bandage. I use OTC drops, and found only one I do not have a reaction to, I've tried Restasis in the past, and didn't feel it helped, and may have caused other problems, I wear contacts now to protect my eyes, and just had extra large plugs put in. I put drops in constantly and if I'm producing any tears of my own they are minimal. My Dr. wants me to try Restasis again, he feels it may help this time, but I haven't picked up the RX yet, I'm kinda afraid to make things worse. The fact that I can't cry has never been seen as a issue that I feel should be looked at, is scar tissue blocking my Lachrymal glands?? I don't have MGD so those glands are OK, but my poor tear glands just don't work. I want a cure!! I've gotten no real answers.
Christine

[farmgirl]

Have you been tested for Sjogren's Mawsky?

[browneyesblu]

I agree you have to try to pinpoint the underlying cause, and if that means seeing a rheumatologist, an endocrinologist and an allergist, you should do it.

However even once you know that doesn't mean there is a cure. Living with chronic conditions is all about effective management. If you pinpoint the cause that will make the management more effective and you can live with it. If you hope for a cure you will only make yourself more unhappy.

[Mawsky]

Farmgirl, yes I was tested and it was negative. Thankful for that, I didn't have any other symptoms of Sjogren's like dry mouth so I was not expecting it to be that, but still was anxious awaiting the results.

[gormz]

I think saag hit the nail right on the head. I don't necessarily think all of the things have to be improved at the same time in order for your eyes to improve...its just a balancing act and you want more of those things on the list functioning properly in order to maybe fix the ones that arent working. I think inflammation in my case was what started my dry eyes...maybe this was brought on by my lack of corneal sensitivity due to contact lens wear. Once the inflammation started ramping up my lacrimal glands quit producing enough tears which eventually led to mild mgd.

I think if i can control the inflammation via restasis, punctal plugs, drops then my mgd will clear up. If my mgd clears up (which it has to some extent for me) the lack of inflammation will allow my lacrimal glands to start producing tears again and this will eventually lead to healing of my corneal sensitivity. This is all just guessing on my part but i think im on the right track. This is also dependent on me not having any significant meibomian gland dropout or permanent damage to my lacrimal glands/corneal nerves which would sorta prevent those steps from occuring.

I agree though that it is an uphill battle for most and most people are just treating the symptoms and not the underlying cause(s). I also think that your eyes can function properly even though not everything is working 100%. I remember reading a study showing that younger (around 30 i think) long term contact lens wearers have meibomian gland dropout comparable to that seen in 60-70 year olds yet the body is still able to function on those few meibomian glands working properly without causing really bad dry eye for those people.

[farmgirl]

Did you just have the blood test Mawsky or have you been biopsied? My mouth is not nearly as dry as my eyes, in fact if it weren't for the fact that I wake up at night feeling like a camel tromped through it I would say it wasn't even an issue. I, as many do, tested negative in the blood work department but a lip biopsy was positive. My point being that a negative blood test is not conclusive for Sjogren's.

Having said that certainly super sized punctums would certainly be a contributing factor to dry eye. Is there nothing that they can do surgically to correct that or is it just that now they have given you the problem you get to live with it?...F/G