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Hi everyone,
I thought I would share my experience of what I have tried up to date. LASIK 03/2009. Dry eye since 06/2009. Major symptom was burning in the eyes.
Here's what I am currently using:
1. Permanent Punctal plugs x 4
2. Genteal Gel at bedtime, followed with Genteal eye drop upon awakening
3. Omega 3 fish oil capsules (I take 4 capsules of Lovaza daily)
Here's what I have tried in the past: :-) I know I am lumping together different treatments for aqueous deficiency vs meibomian dysfunction, sorry.
1. Artifiical Tears (bottle with preservative)
I'm talking about generic drops in general, and not any pariticular brand. These are what I turned to first for Lasik dry eye. Most of the handouts I got from the lasik center said to use eye drops at least four times a day. Although eye drops made my eye good momentarily, they felt dry again after 5 minutes when the drops had dissipated!! When my eyes were really bad I would end up using drops 6x an hour, which was TOO MUCH! My eyes felt drier, more irritated, and burned more. My thought is that after Lasik the surface of the cornea is altered and the innermost tear layer (mucin) is disrupted, making tears less "sticky" and not as adherent to the eyeball as it once was. My own tears were having a hard time sticking to my eyeball and since the tear film does not adhere as well, the eye was drying out quicker. Over use of eye drops constantly washed away my own natural tears and over time left the eye drier. I think it is so easy to use eyedrops constantly and there is a fine line between just enough and too much. Not to mention the preservative in these eye drops in excess are not good for your eye and can cause irritation.
2. Artificial Tears (preservative free vials)
Better in my opinion because they do not have preservative. They are more expensive however. I think I ran into the same problem with these as I did with regular artificial tears....overuse made my eye drier!!
3. Genteal drops/gel
These are my eyedrop of choice. I keep them in the fridge. I like it because it has sodium perborate as the preservative and upon instillation into your eye it is supposed to be neutralized into water...they call it a disappearing preservative. When my eyes would feel dry and burning, these would help. I try not to use them too often though for fear of washing out all my natural tears.
4. Dwelle
Has helped during the bad days. When my dry eye was at its worst, dwelle helped. I remember putting them in the first time and it helped for most of the day. Sometimes I put these drops in when I go to bed if I don't feel like using Genteal gel.
5. Ointments
Never really helped me. I tried different brands. They all left my eye feeling dry, sticky, gunky, and worse off for a few days. I haven't used ointments for months. Recently just last week I was having some fuzziness related to dryeye in my left eye and thought I would try an ointment to see if it would help. I figured it wouldn't hurt to try. It did not help. My eyes felt more dry, burning, aching for 3 days. I couldn't understand it. I've been thinking about this one and think that since Lasik, the tear film is disrupted and your own natural tears are less adherent to your eyeball. Ointments will coat your eyeball in petrolatum and make it even harder for your natural tears to adhere to your eye. Oil and water do not mix. Even though your eye is coated with petrolatum, your own tears are not able to keep your eye moist because there is loss of ability of your tears to adhere to your eye surface. I compared it to if you put vaseline on your arm and try to wash it off with water, the water will slide right off and you're left with a thick coat of vaseline still on your arm. The only way to remove it is to wipe it off or wait over time for it to wear off. And so I think the ointments coat the eyeball and that's why it gave me so much trouble for days.
6. Soothe XP drops
Didn't seem to help very much unfortunately. These contain mineral oil, which is just a liquidy version of vaseline. The box says it has been shown to increase the thickness of the outermost tear layer (lipid layer) but I'm not sure about that.
7. Refresh Endura drops
Also called Refresh dry eye therapy. I read an article that this drop worked by supplementing the aqueous portion of your tears while at the same time the castor oil in it increases the thickness of the lipid layer of your tears. It didn't work for me though. I have read that refresh endura is similar to Restasis minus the active ingredient.
8. Restasis
I did restasis drops for about 9 months total. The first 3 months I didn't think it was helping much. Then after 3 month I felt some improvement. I kept using it and I think it helped maybe 25% at most? I've been off of it for 5 months now. I just stopped it completely. I have not noticed any worsening or recurrence of my severe dry eye thus far. These do burn when you put them in. I used to keep them in the fridge and re-use the same vial the next day to be economical. You end up spending so much money for dry eye....
9. Lotemax
Surprisingly did not help me as much as I thought it would. These steroid drops I thought would help the burning feeling but truth be told I think at times it made the burning feeling worse.
10. FML drops
These are another type of steroid drops. I think it helps but only minimally. It did not cause any burning. I only used these periodically.
11. Lid Scrubs
Helped in the sense that I think it helped meibomian glands be able to secrete more oil by keeping the surfaces clean and the act of scrubbing your eyelid I think helps your lids pump out oil easier.
12. Rice eye sock
Defintely helped with the oil aspect. I found that heating it up in the microwave I would lie down and firmly apply pressure so it would be pressing against my lids. When I open my eyes I hoped to see blurry vision because that tells me that the rice sock has melted the oil in the lids and allowed it to flow freely into my eye.
13. Fish oil capsules
I think this has helped my eyelids produce more oil. I use lovaza brand which is prescription only and take 4 capsules. That's about 4 grams or 4000 mg daily. I continue taking it. I think it helps. Plus omega fatty acids have an anti-inflammatory effect.
14. Flax seed
Tried both flax seed pills, and grinding up whole flax seeds and adding it to yogurt. Did total of almost 4 grams / day. It did not seem to help. They made me horribly gassy. !!
15. Doxycycline
I decided to try doxycycline to see if it would help minimize any bacteria there would be on my eyelids that would be present. It didn't help me after 2 months. The idea is that you have excess bacteria on your eyelids that interact with the oil being produced from your eyelids. This interaction results in formation of thickened oil plugs. So instead of your eyelid secreting oil, it comes out like toothpaste. These thickened oil plugs chemically resemble soap, which can cause burning in the eye. (ever get soap in your eye?)
16. Allergy pills
Thinking that allergy may contribute to dry eye I tried Zyrtec and Singulair. I did not notice any change. They did not make my eyes drier, but in some people it can dry out your eyes.
17. Lacriserts
This is a prescription only pellet that you put into your eye and it dissolves slowly. It helps for a few hours, but then you're left with a sticky goop in your eye. It helped me for about 3 - 4 hours, not 24 hours like they claim. I had vision problem with this after 8 hours because it formed a hazy film
18. Azasite
Did not help me. I think because my dry eye and meibomian gland dysfunction was not entirely caused by bacteria on eyelid margin. It burns when you put it in your eye (it's supposed to).
19. Prednisone oral tablet
Hmmm. Yes these helped but only to a certain degree. My eyes felt better, but not by a whole lot. This is a steroid medicine to help decrease inflammation. I tried 40mg for 4 days. Not a whole lot of benefit.
20. Punctual Plugs
Yes these helped. Not immediately. You'd think that it would help immediately but for some reason it did not. First I did lower plugs, then both upper plugs. I was frustrated. It took a good 1 month before I felt better. I think one has to be careful of punctual plugs in the sense that if you have a lot of inflammation contributing to your dry eye, that punctual plugs can yes trap your tears, but it also will trap the inflammatory mediators that are released into your tears. I'm talking about histamine, etc. More inflammatory mediators will make inflammation worse and that in turn will make dry eye (i.e., burning feeling) worse. Plugs can trap these unhealthy tears, making symptoms worse basically.
21. Tranquileyes
These can help. One of my problems was that every morning I would wake up and it would be off and on the floor. Even a sleeping mask would help, in my opinion. You are trying to minimize any evaporative effect there may be from say you're heating, air, fan, open window, lagophthalmos, etc.
22. Taping eyelids shut
I used to put a little genteal gel in my eyes and tape my lids shut with medical quality foam tape. I used a brand called 3M microfoam. This helped. I think for me, I do not have lagophthalmos, but I am a hard sleeper and so when I lie on my side or stomach, my face presses against the pillow and my eyelids may become partially open, allowing them to dry out. I don't use this anymore because I find the genteal gel is enough for now.
23. Cold eye mask
For burning eye pain, cold eye mask helped for the symptoms.
24. Moisture chamber glasses
When my dry eyes were at their worse, these definitely helped. I got desperate and made my own. I bought a pair of swim goggles, poked some vents along the side (so it wouldn't fog up) and wore them at home. It was during summertime and I had the fan blowing on me and didn't have to worry about my eyes drying up.
25. Synergeyes contact lenses
I've only had them for 3 days. So far they help! This is a hybrid contact lens with a rigid center and a soft skirt. Basically the middle is a hard lens surrounding by a soft lens periphery. The hard lens portion holds a small layer of tears against your cornea. I wore these all day yesterday without any irritation or dryness. I originally got these because LASIK left me with much night vision problems. GASH (glare, arcs, starbursts, haloes). Very annoying and hard to become accustomed to at night. Plus I have residual astigmatism not correctible by glasses. Synergeyes helped with dry eye and with the night vision problems. I am happy so far!!
26. Scleral lenses
I have not tried this. I considered this more for the night vision problem rather than the dry eye problem. It seems promising as these lenses vault the cornea and hold a layer of tears against the cornea. In my mind I think it's a great concept that would help dry eye and post-lasik GASH. I think getting a good fit is hard to do. I was planning on making a trip to see Dr. G in Texas. I am still considering it, and will see how the synergeyes are in the long run.
I know there are many other modalities that I have not yet tried for my dry eye, but I think the most important thing is TIME. We have to hold on to the hope that over time it will improve, but there will be good days and bad days. It will wax and wane. The reviews I wrote is just what did or did not work for me. There is a lot of stuff marketed for dry eye, and I think it's important to do research before spending money. It's really easy to end up spending a lot of money in hopes of dry eye relief.
I SHOULD have done my research prior to Lasik but I didn't. I just thought….oh well Lasik has been around for so long and so many people are a "success story" that I just jumped into it without hesitation. I was under the impression that post-Lasik if you had dry eye that punctual plugs or drops would take care of it.
I think that when we give our eyes time to heal, that it does get better. Here is my theory. Immediately after lasik I had no DES whatsoever for the first 3 months following Lasik. The lasik surgeon kept telling me that my eyes look so dry and that I needed to use drops frequently. I kept thinking to myself, well my eyes don’t feel dry??? Then around the 3 month post-lasik mark, I started to feel dry, burning eyes that just got worse. My belief is that the nerves are transected during lasik, and so much of the sensory function is temporarily diminished. That is why I did not feel like I had any dry eye whatsoever in the first 3 months. Then over time, the nerves healed or grew new connections and slowly sensory function regained and then I felt the dry burning eyes…..it got real bad. Now over time the cornea continues healing and the nerve impulses that control tear production may slowly improve. It may never be the same as pre-Lasik, but I think it will get better, even a little better is better than nothing.
Well hope this helps!
I thought I would share my experience of what I have tried up to date. LASIK 03/2009. Dry eye since 06/2009. Major symptom was burning in the eyes.
Here's what I am currently using:
1. Permanent Punctal plugs x 4
2. Genteal Gel at bedtime, followed with Genteal eye drop upon awakening
3. Omega 3 fish oil capsules (I take 4 capsules of Lovaza daily)
Here's what I have tried in the past: :-) I know I am lumping together different treatments for aqueous deficiency vs meibomian dysfunction, sorry.
1. Artifiical Tears (bottle with preservative)
I'm talking about generic drops in general, and not any pariticular brand. These are what I turned to first for Lasik dry eye. Most of the handouts I got from the lasik center said to use eye drops at least four times a day. Although eye drops made my eye good momentarily, they felt dry again after 5 minutes when the drops had dissipated!! When my eyes were really bad I would end up using drops 6x an hour, which was TOO MUCH! My eyes felt drier, more irritated, and burned more. My thought is that after Lasik the surface of the cornea is altered and the innermost tear layer (mucin) is disrupted, making tears less "sticky" and not as adherent to the eyeball as it once was. My own tears were having a hard time sticking to my eyeball and since the tear film does not adhere as well, the eye was drying out quicker. Over use of eye drops constantly washed away my own natural tears and over time left the eye drier. I think it is so easy to use eyedrops constantly and there is a fine line between just enough and too much. Not to mention the preservative in these eye drops in excess are not good for your eye and can cause irritation.
2. Artificial Tears (preservative free vials)
Better in my opinion because they do not have preservative. They are more expensive however. I think I ran into the same problem with these as I did with regular artificial tears....overuse made my eye drier!!
3. Genteal drops/gel
These are my eyedrop of choice. I keep them in the fridge. I like it because it has sodium perborate as the preservative and upon instillation into your eye it is supposed to be neutralized into water...they call it a disappearing preservative. When my eyes would feel dry and burning, these would help. I try not to use them too often though for fear of washing out all my natural tears.
4. Dwelle
Has helped during the bad days. When my dry eye was at its worst, dwelle helped. I remember putting them in the first time and it helped for most of the day. Sometimes I put these drops in when I go to bed if I don't feel like using Genteal gel.
5. Ointments
Never really helped me. I tried different brands. They all left my eye feeling dry, sticky, gunky, and worse off for a few days. I haven't used ointments for months. Recently just last week I was having some fuzziness related to dryeye in my left eye and thought I would try an ointment to see if it would help. I figured it wouldn't hurt to try. It did not help. My eyes felt more dry, burning, aching for 3 days. I couldn't understand it. I've been thinking about this one and think that since Lasik, the tear film is disrupted and your own natural tears are less adherent to your eyeball. Ointments will coat your eyeball in petrolatum and make it even harder for your natural tears to adhere to your eye. Oil and water do not mix. Even though your eye is coated with petrolatum, your own tears are not able to keep your eye moist because there is loss of ability of your tears to adhere to your eye surface. I compared it to if you put vaseline on your arm and try to wash it off with water, the water will slide right off and you're left with a thick coat of vaseline still on your arm. The only way to remove it is to wipe it off or wait over time for it to wear off. And so I think the ointments coat the eyeball and that's why it gave me so much trouble for days.
6. Soothe XP drops
Didn't seem to help very much unfortunately. These contain mineral oil, which is just a liquidy version of vaseline. The box says it has been shown to increase the thickness of the outermost tear layer (lipid layer) but I'm not sure about that.
7. Refresh Endura drops
Also called Refresh dry eye therapy. I read an article that this drop worked by supplementing the aqueous portion of your tears while at the same time the castor oil in it increases the thickness of the lipid layer of your tears. It didn't work for me though. I have read that refresh endura is similar to Restasis minus the active ingredient.
8. Restasis
I did restasis drops for about 9 months total. The first 3 months I didn't think it was helping much. Then after 3 month I felt some improvement. I kept using it and I think it helped maybe 25% at most? I've been off of it for 5 months now. I just stopped it completely. I have not noticed any worsening or recurrence of my severe dry eye thus far. These do burn when you put them in. I used to keep them in the fridge and re-use the same vial the next day to be economical. You end up spending so much money for dry eye....
9. Lotemax
Surprisingly did not help me as much as I thought it would. These steroid drops I thought would help the burning feeling but truth be told I think at times it made the burning feeling worse.
10. FML drops
These are another type of steroid drops. I think it helps but only minimally. It did not cause any burning. I only used these periodically.
11. Lid Scrubs
Helped in the sense that I think it helped meibomian glands be able to secrete more oil by keeping the surfaces clean and the act of scrubbing your eyelid I think helps your lids pump out oil easier.
12. Rice eye sock
Defintely helped with the oil aspect. I found that heating it up in the microwave I would lie down and firmly apply pressure so it would be pressing against my lids. When I open my eyes I hoped to see blurry vision because that tells me that the rice sock has melted the oil in the lids and allowed it to flow freely into my eye.
13. Fish oil capsules
I think this has helped my eyelids produce more oil. I use lovaza brand which is prescription only and take 4 capsules. That's about 4 grams or 4000 mg daily. I continue taking it. I think it helps. Plus omega fatty acids have an anti-inflammatory effect.
14. Flax seed
Tried both flax seed pills, and grinding up whole flax seeds and adding it to yogurt. Did total of almost 4 grams / day. It did not seem to help. They made me horribly gassy. !!
15. Doxycycline
I decided to try doxycycline to see if it would help minimize any bacteria there would be on my eyelids that would be present. It didn't help me after 2 months. The idea is that you have excess bacteria on your eyelids that interact with the oil being produced from your eyelids. This interaction results in formation of thickened oil plugs. So instead of your eyelid secreting oil, it comes out like toothpaste. These thickened oil plugs chemically resemble soap, which can cause burning in the eye. (ever get soap in your eye?)
16. Allergy pills
Thinking that allergy may contribute to dry eye I tried Zyrtec and Singulair. I did not notice any change. They did not make my eyes drier, but in some people it can dry out your eyes.
17. Lacriserts
This is a prescription only pellet that you put into your eye and it dissolves slowly. It helps for a few hours, but then you're left with a sticky goop in your eye. It helped me for about 3 - 4 hours, not 24 hours like they claim. I had vision problem with this after 8 hours because it formed a hazy film
18. Azasite
Did not help me. I think because my dry eye and meibomian gland dysfunction was not entirely caused by bacteria on eyelid margin. It burns when you put it in your eye (it's supposed to).
19. Prednisone oral tablet
Hmmm. Yes these helped but only to a certain degree. My eyes felt better, but not by a whole lot. This is a steroid medicine to help decrease inflammation. I tried 40mg for 4 days. Not a whole lot of benefit.
20. Punctual Plugs
Yes these helped. Not immediately. You'd think that it would help immediately but for some reason it did not. First I did lower plugs, then both upper plugs. I was frustrated. It took a good 1 month before I felt better. I think one has to be careful of punctual plugs in the sense that if you have a lot of inflammation contributing to your dry eye, that punctual plugs can yes trap your tears, but it also will trap the inflammatory mediators that are released into your tears. I'm talking about histamine, etc. More inflammatory mediators will make inflammation worse and that in turn will make dry eye (i.e., burning feeling) worse. Plugs can trap these unhealthy tears, making symptoms worse basically.
21. Tranquileyes
These can help. One of my problems was that every morning I would wake up and it would be off and on the floor. Even a sleeping mask would help, in my opinion. You are trying to minimize any evaporative effect there may be from say you're heating, air, fan, open window, lagophthalmos, etc.
22. Taping eyelids shut
I used to put a little genteal gel in my eyes and tape my lids shut with medical quality foam tape. I used a brand called 3M microfoam. This helped. I think for me, I do not have lagophthalmos, but I am a hard sleeper and so when I lie on my side or stomach, my face presses against the pillow and my eyelids may become partially open, allowing them to dry out. I don't use this anymore because I find the genteal gel is enough for now.
23. Cold eye mask
For burning eye pain, cold eye mask helped for the symptoms.
24. Moisture chamber glasses
When my dry eyes were at their worse, these definitely helped. I got desperate and made my own. I bought a pair of swim goggles, poked some vents along the side (so it wouldn't fog up) and wore them at home. It was during summertime and I had the fan blowing on me and didn't have to worry about my eyes drying up.
25. Synergeyes contact lenses
I've only had them for 3 days. So far they help! This is a hybrid contact lens with a rigid center and a soft skirt. Basically the middle is a hard lens surrounding by a soft lens periphery. The hard lens portion holds a small layer of tears against your cornea. I wore these all day yesterday without any irritation or dryness. I originally got these because LASIK left me with much night vision problems. GASH (glare, arcs, starbursts, haloes). Very annoying and hard to become accustomed to at night. Plus I have residual astigmatism not correctible by glasses. Synergeyes helped with dry eye and with the night vision problems. I am happy so far!!
26. Scleral lenses
I have not tried this. I considered this more for the night vision problem rather than the dry eye problem. It seems promising as these lenses vault the cornea and hold a layer of tears against the cornea. In my mind I think it's a great concept that would help dry eye and post-lasik GASH. I think getting a good fit is hard to do. I was planning on making a trip to see Dr. G in Texas. I am still considering it, and will see how the synergeyes are in the long run.
I know there are many other modalities that I have not yet tried for my dry eye, but I think the most important thing is TIME. We have to hold on to the hope that over time it will improve, but there will be good days and bad days. It will wax and wane. The reviews I wrote is just what did or did not work for me. There is a lot of stuff marketed for dry eye, and I think it's important to do research before spending money. It's really easy to end up spending a lot of money in hopes of dry eye relief.
I SHOULD have done my research prior to Lasik but I didn't. I just thought….oh well Lasik has been around for so long and so many people are a "success story" that I just jumped into it without hesitation. I was under the impression that post-Lasik if you had dry eye that punctual plugs or drops would take care of it.
I think that when we give our eyes time to heal, that it does get better. Here is my theory. Immediately after lasik I had no DES whatsoever for the first 3 months following Lasik. The lasik surgeon kept telling me that my eyes look so dry and that I needed to use drops frequently. I kept thinking to myself, well my eyes don’t feel dry??? Then around the 3 month post-lasik mark, I started to feel dry, burning eyes that just got worse. My belief is that the nerves are transected during lasik, and so much of the sensory function is temporarily diminished. That is why I did not feel like I had any dry eye whatsoever in the first 3 months. Then over time, the nerves healed or grew new connections and slowly sensory function regained and then I felt the dry burning eyes…..it got real bad. Now over time the cornea continues healing and the nerve impulses that control tear production may slowly improve. It may never be the same as pre-Lasik, but I think it will get better, even a little better is better than nothing.
Well hope this helps!
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