Dryness due to contacts and computer use

[Deniz]

Hi.. Thanks so much to you all for the insight and recommendations you have provided on this board. My eye problems started around december 2005 when I realized that I had developed intolerance for contacts after using them for 2 years. 3-4 months after stopping using contacts, my eyes started irritating me. At first I ignored the issues and thought it was due to too much computer use and or too little sleep. One day in April, I lost sight of in my left eye and had extreme irritation in both eyes. I went to my Pearl Vision doctor (what a fool I was to trust those guys..) the following day and had lotemax prescribed. When that did nothing after 10 days, I had another and stronger steroid. After 2 weeks of that, I was still uncomfortable with my eyes, had pain, specifically on the left eye. The Pearl Vision doctor recommended me to antoher doctor, which I was not sure was a opthamologist. This doctor was pretty lousy as well, but did manage to recommend me to get off the steroid. After two visits to him, and him not having a clue what my problem was and is, he told me to wait and see.

I went to another doctor in another country in the wait and see period in may, and he said due to the steroids he could not understand what was going on. He recommended me to start using preservative-free eye drops, as he saw some dryness. I started using the drops, and still not all that comfortable, I went to the specialist once again after returning to the states. He was very much optomistic and said I can start wearing contact lenses again. Not sure if this was due to the deal he had with the Pearl Vision doctor, I went to another doctor - again in Pearl Vision, who said: no, no.. No lenses. You gotta check yourself for any autoimmune disease as they may cause dryness in the eye." I had those checks done, and came up with nothing. In the meantime, having lost all belief for Pearl Vision doctors, I visited another doctor abroad again, who said that I had dry eyes, and I should continue the use of preservative free eye drops (theratears) and also go to a "good" eye doctor in the States to have treatment. He said I may require plugs or restasis (sp?).

Finally having some idea as to what was wrong with my eyes, I was happy. This was in August. By this time, the frequency of my needing eye drops increased from twice a day in May to once in 10 minutes in August.

In September, I started going to the NY Eye and Ear Infirmary, which despite the heavy wait periods, ended up being a decent place with good doctors. I was diagnosed with dry eyes, and started using refreshpm at night time, and continued the use of eye drops during the day. Infrequently, I started using fish oil.

After a month of this, I saw little improvement. Due to air conditioning, office environment, air travel, etc, I realized that my eyes were worse (one drop of Systane in 5 minutes). When I was home, I was feeling better (one drop of Systane/ Theratears in 10 minutes).

I went for check up in a month, which was three weeks ago and due to the little improvement in my eyes, was scheduled for punctual plugs in my lower eyes in two weeks. The doctor prescribed me with Lotemax in the meantime, but I did not use it.

The doctor who put in the plugs last week was another doctor, who said using the drops once in 5 minutes was way too much and I should use them once in an hour. After the plugs were inserted, I started using Lotemax as well, and can manage using the drops only once in an hour.

I am definitely better now compared to two weeks ago. Nonetheless, I am not back to normal. Computer use and/or sleeplessness really makes it worse. Then again, I managed to put on some make up and go out on Saturday after soo long.

This was a little long, but I did not want to skip any details. Reading this website in a way helps: it's good to hear that I am not alone in dealing with this seamingly unimportant, but really a life changing disease. Then again, hearing that I may never get over this disease makes me a little upset.

Well, gotta be optomistic right?

Cheers to everyone.

[Rebecca Petris]

Welcome Deniz!!

I am sorry it took awhile to connect with the right doctors, but glad that with the plugs things are getting under better control.

Suggestion: Next time you see the doctor, ask about your meibomian gland function - how the lid margins look, what your TBUT is, etc. In dry eye treatment, after drops and plugs to address low aqueous production, the next step is often working on improving the oil layer. If fish oil supplements aren't enough, oral antibiotics, heat treatment or lid hygiene therapies may be useful.

Well, gotta be optomistic right?

You betcha!

[Deniz]

Thanks

Thanks Rebeccca. Will do.

[Deniz]

Suggestion: Next time you see the doctor, ask about your meibomian gland function - how the lid margins look, what your TBUT is, etc. In dry eye treatment, after drops and plugs to address low aqueous production, the next step is often working on improving the oil layer. If fish oil supplements aren't enough, oral antibiotics, heat treatment or lid hygiene therapies may be useful.


You betcha! [/QUOTE]

Hi Rebecca,

I saw the doctor again today. I did not ask about the glands, but asked what the problem with my eyes were. She said that I was not producing enough tears. She did a test where she dropped a yellow liquid into my eyes and sad that it was "decreased". I am guessing this was the Schimmer's test.

She told me to stop using lotemax, which I was using only for the last week when I had lower plugs inserted on Thursday. I will start with Restasis immediately twice a day, continue with the night gel (refresh pm) and use the theratears. systane free drops as needed (no more than once in an hour).

I feel like I will never be able to get back to normal. Also I felt like Lotemax was helping. Aren't most people using it for weeks? I only used it for 1 week.

Hope you guys have more faith in your doctors and your health, as I am losing it..

[Rebecca Petris]

Hi Deniz,
Thanks for the updates.

I saw the doctor again today. I did not ask about the glands, but asked what the problem with my eyes were. She said that I was not producing enough tears. She did a test where she dropped a yellow liquid into my eyes and sad that it was "decreased". I am guessing this was the Schimmer's test.

That's actual corneal staining. It was probably fluorescein dye that they put in. They apply that and look at you under the slitlamp; they'll see concentrations of the dye on dry spots. This is a common test for surface dryness and as such it's fine. There are additional tests that yield more specific information than "are you dry right now". The Schirmer test measures aqueous tear product. Typically, they would anaesthetize your eyes first, then place small strips of filter paper on the lower part of each eye, sticking out. Here's a picture of what it looks like while it's being done. On the other hand there's TBUT where they see how fast your tears "break up" (fast tear break-up would implicate the oil layer) by again putting dye in and having you hold your eyes open as long as possible.

She told me to stop using lotemax, which I was using only for the last week when I had lower plugs inserted on Thursday.... I felt like Lotemax was helping. Aren't most people using it for weeks?

Lotemax is a corticosteroid so it carries risk of elevated intraocular pressure (high risk if you're a 'steroid responder'). You don't stay on it for long or if you do, you have to have your pressure checked regularly. As a dry eye treatment, it'll usually make you feel better but is not safe for anything other than intermittent use.

I feel like I will never be able to get back to normal. Hope you guys have more faith in your doctors and your health, as I am losing it..

Keep your chin up Believe it or not you're still early on in this and you have LOTS of hope for getting better than you are now. Re doctors... have a look at our little poll, there are reasons why people doctor-shop. I'm probably risking getting some hate-mail by saying this but frankly, if you've already been prescribed Restasis but have NOT had things like Schirmer testing or any discussion of oil gland involvement, it might be well worth considering a second opinion from a corneal specialist.

Good luck in the meantime & keep us posted...

[Deniz]

Hi Deniz,
Thanks for the updates.

Thank you for all your help and advice!

That's actual corneal staining. It was probably fluorescein dye that they put in. They apply that and look at you under the slitlamp; they'll see concentrations of the dye on dry spots. This is a common test for surface dryness and as such it's fine. There are additional tests that yield more specific information than "are you dry right now". The Schirmer test measures aqueous tear product. Typically, they would anaesthetize your eyes first, then place small strips of filter paper on the lower part of each eye, sticking out. Here's a picture of what it looks like while it's being done. On the other hand there's TBUT where they see how fast your tears "break up" (fast tear break-up would implicate the oil layer) by again putting dye in and having you hold your eyes open as long as possible.

I can easily say that I did not have any of these tests although I have seen numerous doctors.. Actually the doctor that I saw today said that Schirmer's results may be unreliable. ?

Keep your chin up Believe it or not you're still early on in this and you have LOTS of hope for getting better than you are now. Re doctors... have a look at our little poll, there are reasons why people doctor-shop. I'm probably risking getting some hate-mail by saying this but frankly, if you've already been prescribed Restasis but have NOT had things like Schirmer testing or any discussion of oil gland involvement, it might be well worth considering a second opinion from a corneal specialist.

I am switching to Cornell Uni's Ophthalmology division doctors, specifically after ur confirming of my doubts..Unfortunately my appointment will not be before december, until when I will have used Restasis for over a month.. Then again, on a positive note, after using restasis for the first time today, I have to say, it feels good. I have not had any eye drops for the last hour after restasis..

Then again, this cannot be a cure if I have to keep using it to see the results.

Good luck in the meantime & keep us posted...

This website serves a good cause..Thanks sooo much! We are grateful.

Cheers

[Rebecca Petris]

Actually the doctor that I saw today said that Schirmer's results may be unreliable. ?

That's perfectly true, actually - but but but (1) IMHO this is due in large part to wide variety of methods of performing it, and (2) it's pretty well agreed that the unreliability is in the false NEGATIVES. That is, if it says you're dry, you are, but if it says you aren't, you might still be dry anyway. What it WON'T do is tell you you're dry when you're not. So it's still useful. And (3) reliable or not it's employed by corneal specialists routinely all over the world.

Fingers crossed about that Restasis!!

[katia]

schirmer test

I am new on this forum. The best I have found for information.. You all do a great work.
I have started having dry eyes after a long stay in AC and dry air, and strong sun in Spain 3 months ago. I was first poorly diagnosed so the dry eyes possibility was ignored. Since I saw 2 other ophtalmologists one in France and one in Florida. Both told me about dry eyes. Fist one prescribed celluvisc, the second restasis. I had no results with celluvisc. No results so far with restasis either. None of the ophtalmologist did a schirmer test. Is it normal they just judged I have dry eyes.. without wanting to know more???
Complete eyes examination was fine the 3 times.. But I have terrible photophobia that doesn't want to leave me... I was considering having the schirmer test done now, but it seems it doesn't in fact provide a lot of informations. Except photophobia i have almost none of the other problems I see people report on this forum, and to me my eyes don't look that dry as I see some liquid along the inferior part of the eye.
I did a session of acupunture last week and was given thoe chineese pills. No result yet..
I guess the slit lamp examination would maybe be necessary??? what else could give a better indication.
So tired ot this whole thing already as it is so uncapacitating.... and frustrating...
I also take all the supplements that you all talked about... I also take Dioptec french supplement with C B6 Flax seed oil etc etc... and I spray vyseo, Clarimist I think in the US..
On sunny day the difficulties to see right are tiring. Some times ion rainy days I suddenly feel better also because the air is more humid I guess.
What more could I do???

[Niteyorkie]

[QUOTE=Deniz]Hi.. . One day in April, I lost sight of in my left eye and had extreme irritation in both eyes.

Did your sight ever return in your left eye? This first doctor I went to said that people with dry eyes could not wear contacts because they would cause corneal ulcers which could lead to vision loss. However, I went to another doc that specialized in dry eyes and he had no problem prescribing me contacts (Proclear and Focus daily).
I wear glasses now because my eyes feel irritated all the time and the thought of contacts makes me cringe. I too feel like it started with long hours at the computer with my contacts.
My doctor also said that I probablly had an autoimmune disease like Lupus or Sjogren's Syndrome, but all test have been negative so far.
How much fish oil are you taking? I am taking 400 units daily, but I am interested in hearing how much others are using.

Thanks