12 Years After Lasik UP and DOWN

[PeterBelgian]

Hi everyone, i decided to just make a summary about what helped me through those years.

1) Time
2) Protopic
3) Higher concentration of Cyclosporine in different mixtures, either Oil or other ophtalmic gel.

If steroids drops help, Cyclosporine higher concentration might help too.


Wish the best for everyone.

[Hopeinthedark]

Hi PeterBelgina. Thank you for the update. It really does help people like me struggling with dry eyes 5+ years after Lasik. Do you mind sharing, other than Cyclosporine, what was your routine for eye care? Thanks.

[PeterBelgian]

Hi.

Sorry for the delay in my answer.

So, here's a bit of my journey and insights that I hope can be helpful. It all comes down to grasping the reasons behind post-LASIK dryness. LASIK affects the nerves in the stroma, particularly those located directly beneath the Bowman layer, at a depth of approximately 50 to 100 microns in the anterior stroma.

Studies have demonstrated that the nerves in this most anterior stromal region, just below the Bowman layer, are of utmost importance for lacrimal regulation. Understanding this, it becomes clear that LASIK surgery has a direct impact on the delicate balance of tear production, emphasizing the significance of this specific anatomical area in ocular health.
Interesting tidbit: studies hint that the main nerve fibers come from the temporal and nasal sides.
This was a quick overview of challenges for LASIK dryness. Next, I'll compile a list of practical tips for both topical and systemic solutions.

Systemic

Vitamin D3 is a key player—linked not just to dryness but also to mood. Dry eyes and depression often coexist, creating a vicious cycle (Depression has also been linked to Dry eyes).
The discomfort from dry eyes can impact one's quality of life, leading to feelings of frustration and sadness. Managing D3 is crucial, and it's also tied to thyroid health. Speaking of which, thyroid issues have also been associated with dry eyes in numerous studies. (Menopause and dry eyes, but also men).

Now, if I were to choose supplements, it would be Vitamin D3 and essential omega-3 fatty acids—they're vital for inflammation control. And don't forget Lutein and Zeaxanthin, proven to tackle dryness effectively. Quality in supplements is non-negotiable.

OMEGA3
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189026/
Brand "Nordic" is very good. Liquid form.

Lutein Zeaxanthin
https://pubmed.ncbi.nlm.nih.gov/34129210/

Topically:

Tacrolimus, a medication often used in the field of ophthalmology, has been studied for its potential neuroprotective effects on corneal nerves. Corneal nerves play a crucial role in maintaining the health and sensitivity of the cornea, and any damage to these nerves can lead to conditions such as neurotrophic keratitis, which is characterized by impaired corneal healing.

Research studies have suggested that tacrolimus may have neuroprotective properties, helping to support the health and function of corneal nerves. These findings are particularly relevant in the context of ocular surface disorders where corneal nerves may be compromised.

It's important to note that while there is ongoing research in this area, the use of tacrolimus or any other medication should be under the guidance of an eye care professional.

MUST READ.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9419461/
https://www.ijcmr.com/uploads/7/7/4/...mr_1891_v1.pdf


The administration of drugs like cyclosporine or tacrolimus (50 to 100 more potent than cyclosporine), sometimes in vehicles like olive oil or corn oil, may pose challenges. If you're encountering difficulties or discomfort with this method, it's advisable to discuss it with your healthcare provider. They can explore alternative vehicles or formulations to ensure effective treatment while addressing any issues you may have.


Nighttime protection might not feel like a priority at first, friction during nighttime creates inflammation, night ointment is a game-changer in preventing potential damage. I recommend considering Muro 128 ointment or a similar compound.

Here's a gentle reminder: Eye care is not just about products; it's a holistic journey. Be patient, create the right mood, and don't forget to move your body! Exercise isn't just for your physical health; it's a stress-buster. Remember, holding onto stress is like inviting inflammation to the party.

It's about letting your cornea naturally do its job and supporting nerve regeneration. The body is remarkable. With the right supplements, activities, and a positive mindset, you can aid the process. Results take time, so patience is essential. Consistency in your efforts will contribute to achieving the desired outcomes.

PeterBelgian

[Hopeinthedark]

Hi PeterBelgian,

Thanks for your response. I hope you are doing great. May I ask you some more questions:
1- How long after the LASIK did you have to suffer before you found relief?
2- What medication or routine was the main contributor to your journey of healing?
3- What was the reason behind your dry eyes? I know you had LASIK but other than this, did you have MGD?
4- Did doctor tell you the cause of your MGD, if you had it?
5- What is Tacrolimus? I have never heard of it. What is it used for?

Thank you for your time and reading my post. Have a great day.

[PeterBelgian]

Hi Hopeinthedark

1) I had a severe case of LASIK nevralgia, wich is where nerves regrown in a "bad" way and send pain signals. Thus it took a lot of time, 3-4 years.
For my objective symptoms of dryness, i had it for 4-5 years, around 5 TBUT, it slowly went up, around 8 after my 6 year, i found most relief after my 5 year.
I didnot took care enough of that underlying inflammation and was having a hard time again. Thus i had to find something.

2) Tackling inflammation, nothing else helped that much, would it be Steroids, Cyclosporine or Tacrolimus. Having a medication that suppresses that inflammation and using refresh eye drop 3-4 time a day even if you dont feel it helps. Tackling inflammation is the most important.

I tried cyclosporine in all concentration , from 0.05 to 2% in Olive oil or DURATEAR GEL. I did that because Rikko ( a user of this forum ) used that treatment to improve his dry eyes. He is not around anymore.
At first, it helped but i noticed that my eyelids became a lot puffier, heavier. Ultimately it was doing worse than good. Was it the concentration or Cyclosporine in itself? Whether 0.05 or 0.5 or 0.1%?
I switched to Tacrolimus wich is more potent and i tolerate it absolutely fine.

Actually, i'm using Tacrolimus Ointment 0.1% ( Protopic ) twice a day. It really helps and hope that it will improve even more.

3) I did MGD test twice but never had any doctors telling me i had severe loss of glands or blocked glands. Not 100% functional but not that bad. So i presume nerves disrupt and inflammation.

4) -

5) Tacrolimus is similar to Cyclosporine, same drug in Restasis but very tiny amount in it (0.05% Cyclosporine in Restasis).
Tacrolimus Ointment name is Protopic.

Here is a topic about a lady with MGD, Tacrolimus helped her and she explains well what Tacrolimus really is.

https://forum.dryeyezone.com/forum/d...-to-tacrolimus

Its not a ALL OUT CURE, if you have inflammation it might help. Worth trying.

Have a great day too.

[Hopeinthedark]

Hi PeterBelgian,

Thank you for your reply. It looks like my case is different from yours because my main issue is inadequate oily layer in my tears, not the production of tears. My Meibomian glands are not fully functional due to misuse and over use of contacts for years then getting LASIK in 2018. I use Xiidra twice a day along with HOCL spray and tea tree oil wipes to clean my eyes. None of the eye doctors I visited ever pointed me to get to a good eye lid hygiene. It is only through my own research and reading other people's experiences I came to realize that I had some sort of biofilm on my eye lids that is causing the whole cascade of inflammation. It also explains why my contacts started to bother me before getting LASIK. For someone who is interested, I have noted a link to a good research article that explains the connection between biofilm and dryness. Just like we clean our teeth twice a way, we all should adopt a habit of cleaning our eyelids twice a day with a good quality eyelid wipe/solution to control the bacterial growth. I also wash my eyelids with luke warm water several times a day. I sometimes wonder if I had started a good eyelid hygiene sooner may be I had not have to suffer that much and would not have to quit my contacts and go for LASIK. Good news is that I am slowly getting better after a long and depressing suffering for almost 6 years. I am glad you have found relief. Wish you more success. Thank you and have a great day.

https://www.aao.org/education/curren...role-of-biofil