Dry eye after PRK surgery

[Vertigo]

Hi all,

I'm 25 years old, and 14 months ago I decided to do a PRK surgery, so I can finally go without glasses.
I did the surgery on one of the best clinics in my country, where my family and friends went as well.
Before the surgery the doctor tested all kinds of things and he said that he doesn't expect me to suffer from dry eye syndrome after the surgery (also before the surgery I've never had any eye problems/diseases).
Unfortunately, I do suffer from dry eyes ever since the surgery, and I would like to consult with you all about what can be done.

I also went to another doctor that has specialty in dry eye syndromes, and he didn't know what to tell me, as all of the tests he had done to me were normal.

Things I've already tried and didn't help (some of them in advice with the doctors, some of them not):

1. Flaxseed oil
2. Omega 3 capsules
3. Applying FML drops
4. Using Synthomycine every night for a few weeks
5. Instilling gel drops (without preservatives) a few times a day (which I still use, but they only provide a temporary relief)
6. Meibomian gland dysfunction cleaning - my oil glands were found to be clean with minor blockage
7. Using punctal plugs to increase moisture in eyes
8. Hot compresses
9. Eye-lids massage

I'm really helpless - I've tried everything I can think of, I consulted with at least 3 different doctors that told me that everything is fine with me, and yet I feel all the symptoms of dry eyes ever since the surgery! It's driving me nuts...

What if what I'm feeling is not a dry eye syndrome? I do experience all the sensations that people with dry eye tend to feel, but what if there's something else that has the same symptoms and clouds everyone's judgement?

Aside from the dryness, ever since the surgery, my eyes are generally more sensitive: if a drop of shampoo enters my eyes during shower, they get red and burn, if I rub my eye (which I tend not to do because I know it is hazardous to the eye) it gets red, if I'm in a dusty place, my eyes start to itch... all these symptoms never occurred to me before.

Also important for me to note: my eyes aren't relieved at all when I instill the eye drops at mid-day. They are relieved in the morning, but at the middle of the day when I use them again, I don't feel any improvement, which is odd and made me question the assumption of having dry eye syndrome..

I would really appreciate any kind of help and tips...

[edmunder]

Can you get blood serum drops in your country? Maybe its an issue of nerve damage if the oil is good in your eyes.

What did the doctor do to determine the oils in your eyes are good? What tests have you done for oil or tear volume? Can you be more specific what the doctor said?

Consider blood serum or if not available consider finger prick to get that blood and put it in your eye.

If its not oil or tear related and its dry, it very well may be nerves.

[Vertigo]

R

Can you get blood serum drops in your country? Maybe its an issue of nerve damage if the oil is good in your eyes.

What did the doctor do to determine the oils in your eyes are good? What tests have you done for oil or tear volume? Can you be more specific what the doctor said?

Consider blood serum or if not available consider finger prick to get that blood and put it in your eye.

If its not oil or tear related and its dry, it very well may be nerves.

Thanks for the answer.

The tests the doctors had conducted:
- Schirmer test
- Tear break up time test
- Existence of demodex parasite

Also, one of the doctors used a machine that scanned my eyes and outputted some kind of "topographic" map of both eyes, I don't know what he did with that info but he was satisfied with the results so I didn't ask any questions.

There are blood serums treatments in my country, and the last time I visited the doctor he also recommended doing it if nothing else helps.

Before choosing this direction - is there a test that can approve that the problem is with the nerves? What do you mean by finger prick? They take my blood as is and make eye drops out of it? without any treatment?

Also, is this solution permanent, or will I have to instill those "blood-drops" a few times a day for good?

[Guest]

What tests did the well respected doctor do for you? Osmolarity, inflammadry, TBUT, Schirmer, LLT, tear meniscus height, meibeview, lissimine green staining?

The tools sbove should help dusgkise the issue, or at least get your thoughts in the right direction as to what the isssue is.

I agree with Ed, if you can start blood serum it would help with comfort at the very least.

[Vertigo]

What tests did the well respected doctor do for you? Osmolarity, inflammadry, TBUT, Schirmer, LLT, tear meniscus height, meibeview, lissimine green staining?

The tools sbove should help dusgkise the issue, or at least get your thoughts in the right direction as to what the isssue is.

I agree with Ed, if you can start blood serum it would help with comfort at the very least.

Thanks for the answer.
He did some of the tests you mentioned, but not all of them.
I'll reach out to him and ask him whether he is capable of performing the rest of them or not, because clearly there's much more to check.
I'll look into the serum thing as well.

[Guest]

Thanks for the answer.
He did some of the tests you mentioned, but not all of them.
I'll reach out to him and ask him whether he is capable of performing the rest of them or not, because clearly there's much more to check.
I'll look into the serum thing as well.

I think adding serum isn’t a last resort. I would begin now...there’s literally no downside, only positive. The treatment for nerve damage is serum drops every two hours and a light anti inflammatory drug. I think detecting what’s deficient or abnormal is key. Knowing weather your aqueous and/or lipid deficient is important. Knowing weather the nerves are involved is important. These tests will guide you toward the appropriate treatment. You can get a confocal microscopy to see the nerves, it’s not always reliable, because nerves can look good and still be a problem. The more information you gather and the sooner you do it, the better your outcome will be. Do not stop looking for answers...that’s the best advice I can give you. Every doctor has their own opinion, especially with dry eye. Talk to many qualified people, make sure they can perform the diagnostic tests. Good luck...there are a lot of good people on here that can help you.

[Vertigo]

I think adding serum isn’t a last resort. I would begin now...there’s literally no downside, only positive. The treatment for nerve damage is serum drops every two hours and a light anti inflammatory drug. I think detecting what’s deficient or abnormal is key. Knowing weather your aqueous and/or lipid deficient is important. Knowing weather the nerves are involved is important. These tests will guide you toward the appropriate treatment. You can get a confocal microscopy to see the nerves, it’s not always reliable, because nerves can look good and still be a problem. The more information you gather and the sooner you do it, the better your outcome will be. Do not stop looking for answers...that’s the best advice I can give you. Every doctor has their own opinion, especially with dry eye. Talk to many qualified people, make sure they can perform the diagnostic tests. Good luck...there are a lot of good people on here that can help you.

Thanks for the tips!
I hope I will find a solution eventually.. it can be very depressing not knowing what direction to take.
Can those nerves heal on their own, given enough time? (question is how much more time is needed..)
The serum treatment doesn't sound very pleasant to me, but if there's nothing else to do regarding the nerves then serum it will be.

[Guest]

Why does it sound unpleasant? The only thing that’s annoying is getting your blood drawn. When you put those drops in your eye, they offer immediate relief. They’re one of the most helpful things I’ve found for my eyes. So much so I bought a centrifuge and I make the drops at home now. This is probably the most pleasant treatment I have actually.

The nerves take anywhere from 1-5 years to heal with the average being around two years. I wish I had started serum sooner.

[Vertigo]

Why does it sound unpleasant? The only thing that’s annoying is getting your blood drawn. When you put those drops in your eye, they offer immediate relief. They’re one of the most helpful things I’ve found for my eyes. So much so I bought a centrifuge and I make the drops at home now. This is probably the most pleasant treatment I have actually.

The nerves take anywhere from 1-5 years to heal with the average being around two years. I wish I had started serum sooner.

Maybe it’s a psychological thing, but it sounds weird to pour your blood into your eyes...
But anyways, I was wondering whether the nerves can heal on their own, naturally (without any kind of drops).

[Guest]

Typically nerve abnormalities do not heal on their own.

[Guest]

Not a doctor but from my own research after 14 months I think it's incredibly unlikely the nerve mutations would heal on their own. Best protocol they have for neuropathy right now is serum plus a steriod drop which has been show to reduce nerve abnormalities.

[Guest]

Not a doctor but from my own research after 14 months I think it's incredibly unlikely the nerve mutations would heal on their own. Best protocol they have for neuropathy right now is serum plus a steriod drop which has been show to reduce nerve abnormalities.

Well said!

Serum replicates natural tears pretty damn well, nothing compares really.

[Vertigo]

Well said!

Serum replicates natural tears pretty damn well, nothing compares really.

So there is hope!
And you're saying that it can take up to a few years (!) 'til you don't have dry eyes anymore? A lot of patience is needed here.

[Guest]

It's a long road but there definitely is hope. If you get a neuropathy diagnosis (no signs of dry eye but dry eye like pain) I recommend you join the corneal neuralgia patient group on FB and have a read of this: http://www.ophthalmologytimes.com/op...tears/page/0/1

[Guest]

So there is hope!
And you're saying that it can take up to a few years (!) 'til you don't have dry eyes anymore? A lot of patience is needed here.

This is NOT a cure for dry eye, that doesn’t mean you can’t feel better. What this can do is heal nerves, heal the ocular surface and keep everything functioning as best it can. It reduces pain sensations, most people using serum had a drastic reduction in their OSDI score...which means they felt better. I’ve been on serum about 6 months and I’ve had a huge change for the better. I’ll most likely use these drops until I die or a better option arises.

Ive heard some people coming off serum after a few years. I’ve also heard that to keep the nerves you regrew, you need to stay on serum forever. I’m assuming you would discuss this with your doc.