My dry eye story

[Fenix]

Hi all, I'm new to this forum. I'm not english, so the text may have some bad grammar.
I'm 30 and I'm a software developer since two years. Everything started several years ago. Between 2013 and 2016 I could remember only a few episodes of dry eye discomfort that lasted at most 3/4 days. When it happened, I had put aside my computer and rested my eyes for days. In that period I was studying at university, and I was really unaware of the problem. Then in 2017 I started working full-time as software developer in a company 40km far from home. Everyday I drive to the office and spend 8 hours in front of a monitor. The problem started exactly in the first month of work. Since then, I had dry eye discomfort every day for all day.

I can stay 8 hour in front of a computer with pauses and eye drops. But when I get back home, I have to forcely rest my eyes. No TV, playstation, books, computer. If I try to do one of these things, the day after I will have painful days (yes, the consequences last 2/3/4 days sometimes).
Also in the weekend, with rested eyes, I can't read books for over 20 minutes. It starts to dry my eyes. I miss reading books, thats is one of my biggest lost.

I have seen 5 ophtamologists since 2017:
The first one diagnosed me "dry conjunctivitis". Schirmer test 0-1mm. I saw that doctor 3 times, he gave me 3 types of eye drops (anti infiammatory, antibiotics, allergy). The last time he gave me Restasis for 6 months, but I chose to see other doctors first.
The second one said "your eyes are good, the problem is something else". Schirmer 8-10mm. He said "see a neurologist or an ENT".
The third one diagnosed "bilateral chronic blepharitis with tear film secondary disfunction". He gave me the 3 types of eye drops too, and also a tea tree cleaning foam and hot compresses. Last he said "see a dry eye expert".
The forth one was a dry eye specialist. He diagnosed me with "MGD and Blepharitis". He gave me the same 3 types of eye drops and said that in future we can try IRPL and punctum plugs. (this has been so rude, fast and expensive that I just never seen him again.)
The fifth one is the one I trust most because he is an authority. Schirmer 2mm. He found an allergic response so he gave me another antiinfiammatory and allergy eye drops (I'm following this cure now.)

What exams I did:
I did blood analysis to check Shjogren Syndrome, negative
I did internal and external eye tampons, all negative

Other significant details:
I have suffered from sinisitis before. After the second ophtamologist I went to an ENT and he found a right maxillary infiammation. I cured it with oral antibiotics one year ago. He gave me a ten days antibiotics cure.
After 7 days of antibiotics my eyes started feeling really good, like new. I was like "OMG, my eyes feels so good." When i finished the ten days antibiotics cure, the dry eye came back....

What is my daily eye routine:
Other than taking eye drops I changed my diet. I'm eating more fish with omega 3 (salmon), dry fruit (walnuts, almonds, peanuts), greens and fruit. I'm also drinking 2 liters of water.
Every day, when I get up, and before going to bed, I clean my nose with a saline solution using a nasal cleansing bottle bought on amazon.
Before sleeping, I do hot compresses with a USB heated mask for 30 minutes.
I don't know if doing this is helping my eyes, but I just keep doing this.
The allergy eye drops is called Ketoftil. I have to take it for 1 month. When I use it, my eyes feels a bit better, but not normal.

What I haven't tried yet:
IRPL and/or Punctum plugs
Restasis

The last ophtamologist said that this condition is reversible. I really hope so, I don't want to give up until I haven't tried all possible solutions.
If you have any advice, I will be happy to hear it.
Thank you for reading this wall of text.

[hopeful_hiker]

Hi there! Sorry to hear about your troubles with doctors. I also had my share of unpleasant experiences with some.

What kind of Schirmer’s did you do? Did they add an anaesthetic drop to numb your eyes?

To definitely rule out Sjogren’s you have to do a lip biopsy or at least do the Sjo blood test (available in the US). Most people don’t do either but I did because I wanted to be a bit more sure about my condition. If your Schirmer’s is low, it may be worth it. Of course, it’s not a 100% accuracy but better than bloodwork.

You mention that antibiotics helped. What was the name? The reason I ask is because many MDG sufferers benefit from the inflammatory properties of doxycycline (taken orally in low doses).

What is your tear break up time by the way?

I have done punctal plugs and Restasis. I no longer use punctal plugs but I do think it’s really helpful for aqueous deficiency. In your case, I am somewhat concerned about your allergies though. Do you know what you are allergic to?

Restasis could help with inflammation (15% of people recover lacrimal gland production to a degree).

What is IRPL?

Some recommendations for comfort:

-Moisture chamber glasses for work
-Humidifier and humidity sensor for work and home (I keep mine around 60%)

[Fenix]

Hi hopeful_hiker, thank you for your post.

Hi there! Sorry to hear about your troubles with doctors. I also had my share of unpleasant experiences with some.
What kind of Schirmer’s did you do? Did they add an anaesthetic drop to numb your eyes?

Yes, they put me a drop before doing the test.

To definitely rule out Sjogren’s you have to do a lip biopsy or at least do the Sjo blood test (available in the US). Most people don’t do either but I did because I wanted to be a bit more sure about my condition. If your Schirmer’s is low, it may be worth it. Of course, it’s not a 100% accuracy but better than bloodwork.

I think that I have to investigate more on this.

You mention that antibiotics helped. What was the name? The reason I ask is because many MDG sufferers benefit from the inflammatory properties of doxycycline (taken orally in low doses).

Levofloxacin (aka Levaquin, Tavanic, Iquix, others)

What is your tear break up time by the way?

None of the doctors mentioned the TBUT. The dry eye specialist did not even give me the schirmer test.

I have done punctal plugs and Restasis. I no longer use punctal plugs but I do think it’s really helpful for aqueous deficiency. In your case, I am somewhat concerned about your allergies though. Do you know what you are allergic to?

My RAST test was positive only to cats, but I don't have one around. My girlfriend has one, but knowing that I usually stay far from it, and I pass only a few hours in her house every week.
In general the allergy eye drops makes me feel better.

Restasis could help with inflammation (15% of people recover lacrimal gland production to a degree).

Before going on Restatis, I would like to try IRPL first.

What is IRPL?

Intense Regulated Pulsed Light. It is a new treatment that should free clogged meibomiam glands.
See this: http://www.esw-vision.com/wp-content...ch_informa.pdf
It is spreading in many eye clinics here, but none of them is near from me.
I think that in america is known as IPL.
I will try IRPL if the treatments of the latest doctors don't work.

Some recommendations for comfort:
-Moisture chamber glasses for work
-Humidifier and humidity sensor for work and home (I keep mine around 60%)

I will try the glasses if I will start having problems at work.
I have tried the humidifier and the sensor, but generally my house is already near 55%. I haven't noticed changes.


I hope to solve that problem. Sometimes my mood goes up and down, but I'm trying to be positive.

[Fenix]

hopeful_hiker I have to correct a mistake. This week I started taking probiotics for other reasons and my eyes have started feeling a bit better. On thursday I was feeling good like a 9/10. Then I figured out that last year, when I felt really good, it wasn't the antibiotic to make me feel better but the probiotics I was taking along with the antibiotic.

But yesterday and today I'm not good neither bad, I can say 7/10. Maybe probiotics needs time or it depends by the food I am eating. On friday night I ate pizza, beer and smoked a pair of cigarettes. Maybe they started a systemic inflammation from the gut.

[Fenix]

Hi all, an update. Even following every kind of cure, the dry eye occurs.

Two days ago I went to see the last ophtamologist for the third time. He confirmed that he still sees microfollicles in the conjunctiva of my eyes. I remember that the first ophtamologist the first time he wrote "microfollicular conjuntivitis" on the report. He prescribed me some eye tampons (internal and external) to search for bacterial infections and a more specific one for chlamydia trachomatis. The results were negative.
Searching "microfollicular conjuntivitis" on google I found out that often it is caused by that chlamydia. Maybe I have to point to that direction, because ok I have dry eye, but those microfullicles
are always present.

Do any of you have these microfollicles in the conjunctiva?

[Guest]

From my minor research, this can be viral as well. So it may not be chlamydia. Have you had and cold/flu symptoms or any comtracted diseases?

[Fenix]

Hi Dowork123 , nothing that I can remember. I think that we can exclude virus because now are exactly 2 years of symphtoms.
I found that research paper that is really interesting: https://core.ac.uk/download/pdf/55107622.pdf