Thinking leading to confusion!

[suneetk1]

Hi all again,
I dont understand my new ophthalmologist's treatment plan. She told me my eyes are severely dry as they produce no oil whatsoever.
She recommended a humidifier at night, Systane eye drops, Refresh pm & also prescribed Lotemax. I am going to see her again in two weeks after which if there is no improvement in the oil production she will be putting me on a 6 month trial of Restasis.
I have been taking flax seed oil for 3 mths now so she wants me to continue with that.
What I dont get is that none of these drops increase oil production nor do they assist with oil deficiency, do they? They just increase tear production. I dont see the point in producing more oil-less tears... Dont get me wrong though, at least this opthamolagist wanted to find the CAUSE, which I am grateful for.
I'm pretty sad really to find out my eyes are this severe, I wish I had gone for a second opinion sooner and maybe they wouldn't have gotten this bad.
I hope there's some improvement. I'm a little worried though as it has the preservative Benzalkonium Chloride- is that BAK? What are the known problems with BAK?
I am reluctant to start this new regime, for fear of things getting worse.
Suneet.
I accidently posted this msg on the medical literature section & cant delete it! Sorry Rebecca!

[NYer]

It sounds to me like that's Meibomian Gland Dysfunction (MGD). And it sounds like you need to get the glands pumping out some good oil. And, according to Dr. Latkany, who has a forum on this site and specializes in Dry Eye, the best thing you can do for it is to hold warm compresses on your eyelids for a few minutes and then express the oil glands by pressing gently on the lids with a Q-Tip. It's a bit more detailed than that, though... Here is a link to another thread that explains how to do it:
http://www.dryeyezone.com/talk/showt...ight=mcdonalds
There are lots more threads on here with variations and helpful hints on how to do it.
I highly recommend that you buy a copy of Dr. Latkany's book, "The Dry Eye Remedy". He explains why to do it and shows diagrams. I hope this helps you.

[Rebecca Petris]

I dont understand my new ophthalmologist's treatment plan. She told me my eyes are severely dry as they produce no oil whatsoever.
She recommended a humidifier at night, Systane eye drops, Refresh pm & also prescribed Lotemax. I am going to see her again in two weeks after which if there is no improvement in the oil production she will be putting me on a 6 month trial of Restasis....

What I dont get is that none of these drops increase oil production nor do they assist with oil deficiency, do they?

I think I saw another post about this. I started to respond, then decided to wait and regain my temper. I don't want to be unfair to a doctor because there is almost always more to it. However, I am frequently seeing here, and hearing on the phone, a pattern along these lines: A doctor diagnoses bleph or MGD and then proceeds to prescribe a treatment plan for aqueous deficient dry eye, i.e. any or all of artificial tears, Restasis, plugs and steroids. I don't know if we're just going through a trend of paying lip service to meibomian glands or what. If those same patients are severely aqueous deficient I can understand it but if MGD is diagnosed then presumably it's in the patient's interest to TREAT it. MGD is typically treated with any or all of lid care, heat, expression, omega 3s, oral antibiotics, or lid hygiene and topical antibiotic if there's bleph.

p.s. Agree with NYer on the DrL regimen and book - it's a great resource.

[Rebecca Petris]

Sorry, me again.

I'm a little worried though as it has the preservative Benzalkonium Chloride- is that BAK? What are the known problems with BAK?...
I am reluctant to start this new regime, for fear of things getting worse.

Do you mean in the Lotemax? Personally, I wouldn't sweat it for that short a period. BAK is a toxic preservative and absolutely to be avoided in any long-term medications IMO but at present it is in practically every prescription eyedrop on the market so it's pretty hard to avoid.

As regards starting the regimen... Personally, and sorry if I sound like I'm contradicting myself, and I might just start a firestorm here by taking this view but I would say DO IT. If you have a doctor who seems like she is willing to probe and find the real problems, that's an important asset. Seems very unlikely to me that you could harm yourself with this regimen in only two weeks, and it also won't stop you from doing other things at the same time like start some home MGD therapy. There are few things more frustrating to a doctor than a 'non-compliant' patient. I think a couple of weeks on some drops might be a fair trade for cultivating the relationship.

[suneetk1]

Thinking leading to confusion!

Yeah, she prescribed Lotemax, I guess I will give the new regime a try for the next two weeks.
She didn't call it MGD, just said they are not producing any oil...
I will talk to her about it at my next appt & see where we go from there.
Where can I purchase Dr. Latkany's book?
You know what else I realized, I probably didnt help much by using cold compress's & ice for about 6 weeks to reduce the redness.
Thanks alot!

[Rory]

MGD is surely alot more complicated than that.

Some of us are perhaps not producing enough oil from the meibomiam glands, whilst others are producing too much, others still are producing a poor quality oil....others may be producing a perfect oil and aqueous content..but the tearfilm is disrputed by bacteria? I am sure I dont sound as ignorant as any of the opthalmologists that I have met.

For certain types of MGD... prescribing aqueous tears to dilute the thicker oil produced may well be a correct prescription?

I wonder why it is not possible to take a sample of the tears that we produce and analyse what exactly are the deficiencies/problems?

[dianat]

Suneetk,

Don't worry about the ice packs. That won't hurt anything. If it makes you feel better, it's fine. Cold can reduce inflammation as well. But, the warm compresses at least 2x per day are a must.

D

[suneetk1]

Thanks Guys.
I will definitely do the warm compress & will ask the Dr about taking a sample of tears to see exactly what's wrong. I think at this point she will just say that cos I'm not producing any oil thats the problem, but lets see.

[dianat]

Not to add to the confusion, but I was once told at one particular visit that my glands were not plugged, and I was producing oil but it was an inferior, low-quality oil. He suggested staying away from caffeine, etc. to help this out. I never felt any different with dietary changes. I'm convinced I don't have enough oil in my tears, but have managed to control things with my regimen of Nutratear, hot compresses, goggles...

[clairvoyant]

I think I saw another post about this. I started to respond, then decided to wait and regain my temper. I don't want to be unfair to a doctor because there is almost always more to it. However, I am frequently seeing here, and hearing on the phone, a pattern along these lines: A doctor diagnoses bleph or MGD and then proceeds to prescribe a treatment plan for aqueous deficient dry eye, i.e. any or all of artificial tears, Restasis, plugs and steroids. I don't know if we're just going through a trend of paying lip service to meibomian glands or what. If those same patients are severely aqueous deficient I can understand it but if MGD is diagnosed then presumably it's in the patient's interest to TREAT it. MGD is typically treated with any or all of lid care, heat, expression, omega 3s, oral antibiotics, or lid hygiene and topical antibiotic if there's bleph.

p.s. Agree with NYer on the DrL regimen and book - it's a great resource.

I agree with you on restasis, from my expierence it does not treat mgd or blepharitis. But from what I've seen is it does help reduce corneal inflammation which I believe can be a result of MG problems. I've also read that doctors are advised to treat all aspects of the disease seperately because patients are more likely to see benefits that way. I think it boils down to wheather the patient is willing to pay the money for the results they get. If they don't get any results then it is defenitely not worth it but for me I think it is an integral part of my treatment.

[suneetk1]

Update!

Hi all,
Went for my follow up check up today & not much good news.
Seems like the two wk trial of Lotemax didn't help much & eyes are still severely dry. So she has now prescribed me a 6mth trial of Restasis.
She said my eyes are producing good oil, just not anywhere near enough of it. I asked her what I could do to increase the oil production and she said that Restasis will also help with that...I thought that Restasis was to increase tear production, not oil...maybe these come hand in hand?
Apparently Restasis might cause some stinging which shouldnt last longer than 2 weeks & should see some results around 2mths of taking it.
I'm not keen on taking the Restasis, but what I dont know what I can do...I'm gonna continue with the warm compress and udo oil.
I just wanted to update you all & say Thanks for the support.
I will continue to update.
Thanks alot.