young, sudden & severe dry eye

[browneyes]

I am a male in my 20s and suffered sudden and severe dry eye last winter for no clear reason. My Schirmer score without numbing is 3. This is after various treatments. I have tested negative for various diseases and have a lip biopsy scheduled to test for sjogren's. It is unusual for a young person to have "classical" dry eye (e.g. aqueous deficient rather than mgd or bleph) Moreover it seems that factors like contact lens wear or computer use would cause gradual rather than sudden dry eye.

My question is whether there are other people with aqueous deficient dry eye (e.g. low schirmer score) that is not b/c of lasik, autoimmune diseases, or medications ???

[dryeyepete]

I sound very similar to you - I was 19 when I got dry eye. It literally happened overnight for me. I woke up and noticed many more veins in my eye than before, and as the day went on, I found I really struggled to watch TV, be on computer, etc. It's been like this for over a year now. I don't wear contacts though I do use my glassess sometimes during the day.

I had a blood test for sjogren's but it thankfully turned out OK. I've tried all the OTC drops and my eyes just dont seem to respond to eye drops at all. My eyes are only really a problem during the evening - although I am worried that they will get worse as I grow older.

You're not alone though

[Rojzen]

film stability

Browneyes, I believe I have come across symptom patterns like yours here at DEZ and elsewhere, but what strikes me about your description is that you are focusing on the Schirmer test as the mainstay of your diagnosis. Schirmer tests are rather a crude measure of lacrimal gland function, and the clinics most focused on dry eye tend not to judge too heavily on their basis. I have heard that the flourescein clearance test, which must be performed over the course of a half hour, is a much better measure of aqueous production. I have had that test, and found it to produce fairly consistent results for me. In contrast, I have had simple Schirmers as low as 5 and as high as 18 in the same eye, using the same Schirmer method, at different times. Hence I lost interest in my Schirmer number years ago.

Over a decade of living (and doing better and better) with severe dry eye has taught me that the most direct cause of symptoms, in many, many cases, is the instability of the tear film. Tear film instability can be due to a multitude of factors, one of which is surely insufficient lacrimal gland secretion. That said, there are many, many patients with minuscule aqueous production who are not terribly symptomatic, and then there are others (like me) with decent aqueous production who, without the right treatment, are hugely symtomatic. Generally we assume meibomian dysfunction, in the latter situation, but that is also an oversimplification, in my view.

It is smart that you are getting worked up for Sjogren's, and properly so, with the lip biopsy, but I would not stop there, in your case. It is not that I am suggesting endless diagnostic work, but it would, I think, be helpful to get a really thorough assessment of your meibomian function, along with careful measurement of your tear film break-up time. If you have multiple factors contributing to your pain/discomfort, you have all the more possible tools in your arsenal.

Have you looked at Dr. Holly's submittals here at DEZ? I find his writings on the nature and physical operation of the tear film to be the most scientific writings in this area. His products have dramatically improved my condition, and I believe there are success stories with his drops for patients whose primary diagnosis is aqueous deficiency. . .

Also, have you found that protective eyewear tends to make your eyes feel more normal/moist?

[browneyes]

Thanks for the info The reason I mentioned the Schirmer is b/c it is the only test that suggests I have a serious problem (to match my awful symptoms). I do have some mgd though. My schirmer score has been stable over this time. Moreover, from the little I have read, it seems that the schirmer has few false positives. I haven't had the test you suggested though. I am thinking about making a pilgrimage to one of the star dry eye doctors, like Dr Latkany. Do you have any recommendations?

I'm trying to get moisture chamber glasses, but it is proving difficult b/c my high prescription. I'm currently talking to the eye shop at the IL college of optometry. I've tried the Dwelle drops but they sting.

[Rojzen]

MEGs; surface sensitivity; stinging of Dwelle

You're surely on top of things, Browneyes, and please forgive if I seemed to sell you short on that. . .

Now that I've gone ahead and preached more testing, I actually wish to retreat from that a little. . .Though I praised the fluorescein clearance test over a simple Schirmer's, my intention was not actually to encourage you to seek that particular test out. . .Rather, it was to make sure you were considering the multifactorial nature of tear film instability, something that would be easier to do if you learned, during the fluorescein test, that your nonreflex lacrimal production was actually greater than 3.

You say, for example, that you have a bit of MGD. . .Interestingly, I am not sure if that is easy to measure, particularly because MGD is posterior, rather than anterior, in the scheme of things. In my case, most eye docs tell me my meibomians look "a little blocked," and that I have telangiectasia along the lid margins. . .Until they measure my film break-up time, it does not strike them that I am probably secreting absolutely no useful meibum, something that I actually once had documented on a videograph of my tear film behavior.. . .(Closer exam does show gland dropout/atrophy, but most docs never get that far. . .)

RE: Suggestions of doctors: Over many years of running to doctors, I finally decided to work backwards, and this worked better for me than did the initial impulse always to find a better doctor. Hence, I ultimately treated my DES in many different ways, empirically, and worried less about attributing my problem to a particular cause or causes. . This is not to discourage diagnostics, in general, but, rather, to say that once diagnostics have ruled out anything emergent, like worsening corneal damage or cornea deformities, which may require surgery or other interventions, there seems to be a diminishing return in therapy options, in getting further diagnoses.

RE: the best specialists to see. . .There are so many really smart and well-meaning dry eye docs out there, but while one doctor seems to be magic for one patient, s/he may be useless to another patient. I think this is because most eye docs know relatively little about the real physics behind our problem, and it becomes a question of chance whether a doctor's particular approach (usually pretty rigid and doctrinaire) will help the next DES patient who comes through the door. If you ask me, this state of affairs is due to the failure of eye docs to take interest in studying Dr. Frank Holly's findings. . .So I won't venture any specific suggestions on that front. . .

But I would vote very emphatically for a doctor who understands that you have debilitating surface sensitivity, i.e., some disturbance of sensory function due to the stress on the ocular surface, and that even if your corneas are healthy, and dealing well with this, something must still be done to help you with the sensitivity. . .We have a doctor here in Baltimore who is the first I have ever encountered who zooms right in on helping patients with the sensitivity/pain issue, after ruling out erosions or other pressing corneal health concerns. In some cases, she links up with pain/rehab physicians to seek systemic medications that can greatly reduce sensitivity and pain, and in some cases, she actually prescribes topical pain-reducing drops for short or long-term use, to go along with systemic treatment. She is eager to arrange autologous serum in some cases, and she is very leery about recommending Restasis.

I am hoping that more and more doctors move in this direction. . ..Short of such an approach, even the most renowned practices will tend to try a series of oral and topical antibiotics (sometimes longer than is safe, systemically), Restasis, a series of therapeutically useless OTC drops, a few antihistamine products (topical), and a strong edict for lid cleansing and manual gland expression (even where MGD looks minor). In my case, these were all dead ends. . .Others, however, do brilliantly with these. . .In any case, the medical package I prefer is 1) immediate and effective treatment of surface sensitivity/pain, 2) topicals that will actually improve tear film stability, over time, 3) good moisture chambers for use as needed (24/7 if necessary).

Is there some reason not to try the new MEGs, before seeking a pair of customized moisture chambers, Browneyes? Rebecca reports that the MEGs may not provide a perfect seal, but they look very promising nonetheless, because, as a veteran of custom chambers, I can report that not all opticians know how to make custom chambers airtight, in any case. . .

Finally, yes Dwelle often stings. . .But have you tried to use it a little more frequently (but not more than 8 times daily), to see whether increased use reduces, over time, the burning on each subsequent instillation? And might you be willing to stick with this as an exclusive topical (after ruling out pathology, infection, etc.), just to see how it changes your tear film?

Best to you, Browneyes. . If my thoughts here always seem to go back to me and my own experience, that is only because this is my shorthand way of conveying that these experiences are only one person's, and are not in the nature of medical recommendations. That said, I am the only severe DES patient I know who has taken my particular approach, and since this approach has been wildly successful for me (generally I don't even think of myself as having much DES anymore), I do feel a need to pass that subjective experience along for consideration.

[portrgirl]

I don't really have anything to offer you in terms of advice, but you're not alone. I've worn contacts since I was 14 and at age 18 suffered my first period of DES when I lived in my college dorms. Couldn't wear contacts, my eyes were painful all day... unfortunately I only cared enough to get me back in contacts rather than figuring out how to take care of them.

Since then my eyes have always been "drier" but never to the point of true DES. About 9 months or so ago it got bad again fairly suddenly and I haven't been able to wear contacts since or feel comfortable. This time nothing is helping other than drops for temporary relief. I'm in my mid-20s now.

My doctors said that it's due to decreased mucous layer, likely due to computer usage.

[hkgcomet]

i found dry eye at 23
I play so much online game before, and start to find sensitive to light.
After a period of losing sleep at night coz working pressure and sleeping pills, I get problem on the eye causing very ugly looking...
And sleeping problem fixed won't got my eye back...

It would be a health problem causing dry eye, it is different from LASIK

[baddabingtim]

Dry eye

I got dry eye at 15 yrs old - I am now 48

[LNgraphics]

Baltimore Doc

[QUOTE=Rojzen;36113]
We have a doctor here in Baltimore who is the first I have ever encountered who zooms right in on helping patients with the sensitivity/pain issue, after ruling out erosions or other pressing corneal health concerns. In some cases, she links up with pain/rehab physicians to seek systemic medications that can greatly reduce sensitivity and pain, and in some cases, she actually prescribes topical pain-reducing drops for short or long-term use, to go along with systemic treatment. She is eager to arrange autologous serum in some cases, and she is very leery about recommending Restasis.

Rojzen,
I have been suffering with severe dry eyes for 1 year. It came on suddenly, overnight. I've tried almost every possible treatment, but no relief. I live in Baltimore. Can you tell me the name of this doctor who is so wonderful?

[sazy123]

I am now 23, i was 19 (almost 20) when my eyes went bad.

My severe dry eye came overnight.

I definitely had mild dry eye for several years because i couldnt wear contacts- and am conviced it was the contacts that started the MG dropout off, making them mildly dry. Anyway as long as i didnt wear the contacts i r never experienced dry eye- never dry on waking etc.

Then one month i went on antidepressants and in the same month foone week- i was on a trial of ortho-k lenses. After hearing about others falling alseep in contact lenses such as markL another member and waking up with severe dry eye- I now think it was the ortho-k lenses that caused the damage to my eyelids. The optomotrist told me they were a good option for dry eye patients who cant wear contacts since you dont wear them in the day, so i wanted to try them! im angry that with myself that i did this and didnt just wear glasses! and angry at him. Its easier to believe the antidepressants caused it.

I just cant believe one day your eyes can be completely normal and the next day you can wake up with severe chronic dry eye that you cant do anything about!! if you do damage else where in the body it heals but not the eyelids it seems.

[irish eyes]

My eyes have always been on the dry side and as I was not a good candidate for contact lenses, I kept to my glasses.

I vividly recollect the actual occasion when my eyes started to sting and burn. I was on a long haul flight from UK to Hong Kong. I thought that the stinging would abate once I had got off the plane but it didn't. I was doing a `distance learning' course at the time and thought that the stinging might even be a reaction to the print on the paper because the sensation became worse when I tried to read. 3 weeks holiday and 3 weeks exhaustion. No reading got done.

I had great hopes of getting better when I returned to UK. Sadly, not the case. Back then, computers weren't workplace tools so it cannot be blamed on that.

[69Charger]

Contacts caused my dry Eyes

My Dry Eyes started when I was 20 Years old. I kept trying to wear contacts. Contacts would make my eyes very DRY AND IRRITATED. One day I took my contacts out and I didn’t feel the relief that I usually get when taking contacts out. From that day on I have suffered dry and irritated eyes.
One of my thoughts is my subconscious mind created the dry eyes as a defense against me wearing contact lenses. I have some other thoughts as to why my subconscious would create it. I know that may sound hokey, but I have tried everything else under the sun, and why else would a healthy young man have sever dry eyes. I am trying self hypnosis to remedy it. So far no success story, but the interesting thing is it does seem to piss the dry eyes off. With an hour or so of self hypnosis I can make my dry eyes worse. Not exactly the desired effect, but it shows there is a correlation! I encourage you to try it and if it helps. Please let me know.

69Charger

[annamarg]

I am now 23, i was 19 (almost 20) when my eyes went bad.

My severe dry eye came overnight.

I definitely had mild dry eye for several years because i couldnt wear contacts- and am conviced it was the contacts that started the MG dropout off, making them mildly dry. Anyway as long as i didnt wear the contacts i r never experienced dry eye- never dry on waking etc.

Then one month i went on antidepressants and in the same month foone week- i was on a trial of ortho-k lenses. After hearing about others falling alseep in contact lenses such as markL another member and waking up with severe dry eye- I now think it was the ortho-k lenses that caused the damage to my eyelids. The optomotrist told me they were a good option for dry eye patients who cant wear contacts since you dont wear them in the day, so i wanted to try them! im angry that with myself that i did this and didnt just wear glasses! and angry at him. Its easier to believe the antidepressants caused it.

I just cant believe one day your eyes can be completely normal and the next day you can wake up with severe chronic dry eye that you cant do anything about!! if you do damage else where in the body it heals but not the eyelids it seems.

I know! That has always been a mystery to me as well!! People always say that our bodies are so wonderful, that they heal themselves etc. But this is surely not true when it comes to our eyes! My problems started after I tried silicon lenses. Had had hydrogel lenses for 15 years without any problems! Then suddenly after a few days with Acuvue Oasys silicon lenses I got dry eyes. Now I've had it for over 2 yrs and i'm suffering a lot. I WANT A CURE TOO!