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I saw a DES specialist today, an Optometrist. His practice is pretty much limited to DES, Glaucoma and Diabetes. I had corresponded with him online a bit, and he remembered that! He was very personable and very knowledgeable.
I'm going to share with you what he told me, but keep in mind that everyone is different with regard to the cause of their DES so everyone's treatment plan should be tailored for their needs. Keep in mind, since I was diagnosed with the symptom of DES, my only treatment has been plugs and OTC drops, fish oil, Restasis (I'm allergic to it) and some occasional Lotemax. The Lotemax is the only thing that has provided any sort of relief. According to the doctor I saw today:
1. Plugs generally don't help people who have inflammatory dry eye (as I do). I had one plug removed today, and may have the remaining one removed in a month or two.
2. He does not recommend warm/hot compresses for anyone, but especially for people who have ocular rosacea or other inflammatory causes of DES. His take on that matched mine exactly. Whenever you have an inflammatory problem anywhere else in your body, you are instructed to apply ice, not heat. Heat only worsens an inflammatory condition. The eyes are no different.
3. I have severe MGD and ocular Rosacea, with severe inflammatory dry eye. I am both aqueous and lipid deficient. Probably the cause of my DES is either hormonal due to peri-menopause (in which case it should burn itself out in 10 years) or the first indication of an auto-immune disorder such as rheumatoid arthritis, Sjogrens or Lupus.
He did say had I waited another 5 years, there would not be the hope to get my eyes under control that there is now.
4. His only mention of lid hygiene was periodic expression of my meibomium glands, which he did today.
5. Using Patanol every year from April through August is WAY too much. There has to be something other than allergies going on.
For now, my treatment is 4 weeks of Lotemax (steroids) 4 times a day for two weeks, then twice a day for two weeks, then taper off that over an additional two weeks and probably go on low-dose doxy for at least 3 months. I will probably end up going back and forth on these to keep things under control once I get it under control in the first place. He might also prescribe Metrocream for my facial rosacea, with the thought that it might actually help with the ocular rosacea by reducing a source of inflammation.
There is a very remote chance that I might be able to wear contacts again, but not at least for a year. My tear film won't support them, not even Synergeyes.
He explained that Lotemax is one of the safest ocular steroids to use, with a very low incidence of cataracts and glaucoma developing as a result. He did not hesitate to prescribe it at all and won't hesitate to keep me on it if the doxy does not help.
I'm posting this as a triumph because I finally got the diagnoses for the symptoms I have been having for years. This has been a wonderful day. I learned so much and hope that this post helps others.
I'm going to share with you what he told me, but keep in mind that everyone is different with regard to the cause of their DES so everyone's treatment plan should be tailored for their needs. Keep in mind, since I was diagnosed with the symptom of DES, my only treatment has been plugs and OTC drops, fish oil, Restasis (I'm allergic to it) and some occasional Lotemax. The Lotemax is the only thing that has provided any sort of relief. According to the doctor I saw today:
1. Plugs generally don't help people who have inflammatory dry eye (as I do). I had one plug removed today, and may have the remaining one removed in a month or two.
2. He does not recommend warm/hot compresses for anyone, but especially for people who have ocular rosacea or other inflammatory causes of DES. His take on that matched mine exactly. Whenever you have an inflammatory problem anywhere else in your body, you are instructed to apply ice, not heat. Heat only worsens an inflammatory condition. The eyes are no different.
3. I have severe MGD and ocular Rosacea, with severe inflammatory dry eye. I am both aqueous and lipid deficient. Probably the cause of my DES is either hormonal due to peri-menopause (in which case it should burn itself out in 10 years) or the first indication of an auto-immune disorder such as rheumatoid arthritis, Sjogrens or Lupus.
He did say had I waited another 5 years, there would not be the hope to get my eyes under control that there is now.
4. His only mention of lid hygiene was periodic expression of my meibomium glands, which he did today.
5. Using Patanol every year from April through August is WAY too much. There has to be something other than allergies going on.
For now, my treatment is 4 weeks of Lotemax (steroids) 4 times a day for two weeks, then twice a day for two weeks, then taper off that over an additional two weeks and probably go on low-dose doxy for at least 3 months. I will probably end up going back and forth on these to keep things under control once I get it under control in the first place. He might also prescribe Metrocream for my facial rosacea, with the thought that it might actually help with the ocular rosacea by reducing a source of inflammation.
There is a very remote chance that I might be able to wear contacts again, but not at least for a year. My tear film won't support them, not even Synergeyes.
He explained that Lotemax is one of the safest ocular steroids to use, with a very low incidence of cataracts and glaucoma developing as a result. He did not hesitate to prescribe it at all and won't hesitate to keep me on it if the doxy does not help.
I'm posting this as a triumph because I finally got the diagnoses for the symptoms I have been having for years. This has been a wonderful day. I learned so much and hope that this post helps others.
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