Report on my visit with Dr Latkany

[ScottishDave]

Hi,

I'd thought I'd do a quick post on my visit with Dr Latkany and get a bit of feedback on here from people who might have received similar advice.

My background is that I have had dry/painful/red eyes (left mainly) since April 11, slowly getting worse over this time. Previously I had no problems, although I did have, what I thought was, a successful lasik in 2006.

I have had a short vacation to New York planned for mid Sept for most of the year. After reading these forums I thought I'd go see Dr Latkany while I was there. My Opths in the UK have not been much help (the usual drops, lid massages etc..) and of the 3 I have seen, each gave me a different diagnosis.

Upon first meeting Dr Latkany he was very nice. Listened to what I had to say while taking notes. He then examined both my eyes thoroughly. He did pay particular attention to expressing my glands and the under side of my eye lids but did not do a schrminers test.

He said that my eyes looked healthy to him. My glands looked okay and there was oil coming out (not huge amounts but enough, this went against what I was told by 2 Opths in the UK).

He then said that the under side of my eye lids had bumps on them and this might be something to do with allergies. He asked how often I sneezed. I said once every couple of days, sometimes once a day. He was shocked. He said that he doesn't think he has sneezed at all this year!!

He also said that when he first saw me, before examining my eyes, he noticed something. The struture of my eyelids and the skin around them is different than normal, especially on my bad eye. I said that I had noticed this previously but I thought they had always been like this and I had assumed it was genetic (my Grans eyes looked similar to mine). He said that straight away he thought thyroid problems and that I should get a test done. I made the mistake here of not asking any further questions on this.

I did counter some of what he said about my eye health being very good by saying that I wore moisture chambers near all the waking day. He said this might have had a factor in this.

He then went on to summarise what he wanted me to do in order:

1) get Thyroid tested
2) get a comprehensive allergy test
3) get plugs (not the normal silicone one with the caps on the top but the ones that sit further into the opening with no cap on the top, apparently my eyelids aren't right for the first ones)
4) Stop all heat therapy and just use cold compresses 3-4 times a day for 30 secs

He also added an addendum that I should stop all drops immediately and just use a sample of Pataday which he gave me.

He said that I could keep in contact with him by e-mail.

Now when I came out of his office (on my first full day in New York) I made an effort to stop all drops. By the end of the day my eyes were bright red and sore, even when wearing my Wileys. I went back to using drops to not spoil the vacation. However now that I am back in the UK I am not sure wether to stop the drops or not?

I have spoken to my GP and he has agreed to test my Thyroid and do a test on some sort of flag in my blood which might tell him weather I am prone to allergies? My Opth here is also putting plugs in my eyes next week (this was already planed before New York), although I think he might have the silicone ones for me. Do they usually have a few different kinds?

Now I fully respect Dr L and obviously will do what he has said but I would like to sound his advice off of people hear to see what they think. Are there questions I possibly missed asking him. At no point did he think any of this was caused by my lasik? Stopping all drops seems drastic!

Cheers

[ScottishDave]

Oh one further thing.

I have noticed that a lot of other people who have visited with Dr Latkany have had a diagsosis of allergies. Any of these people still reading these forums that have success with treatment?

[markdav]

do your eyes ever itch

Just wondering what allergy can do, other than release of histamine to tear film or bleph

[Rebecca Petris]

Hi there,

Sounds like you had quite a thorough exam, identifying some new possibilities.

If you had LASIK in 2006 and just this year started having dry eye, personally, much as I abominate LASIK, I wouldn't blame it either. For a lot of people, prior lasik is simply another among many possible pre-disposing factors, not a root cause.

On the 'dropping the drops' thing: I've heard a lot of people being advised to do that and I really respect that advice because there are SO many people who are making themselves worse, or at least perpetuating the problem, by taking too many Rx and OTC drops of various sorts. It becomes difficult to sort out what is making eyes worse and what's helping. Sometimes the eyes need to detox for awhile. However, personally, if my eyes became red and sore on stopping drops, I'd probably revert to using just one good quality lubricant drop, probably unpreserved.

I think it's good that you were advised to go off heat therapy since your glands actually are in pretty good condition. I think a lot of people are self-treating with heat without having a really specific, accurate diagnosis that indicates heat will help.

[irish eyes]

".....He then said that the under side of my eye lids had bumps on them and this might be something to do with allergies. He asked how often I sneezed. I said once every couple of days, sometimes once a day. He was shocked. He said that he doesn't think he has sneezed at all this year!!" (Scottish Dave)

I wonder what Dr Latkany would say to me if I went to see him. I sneeze just about every day; sometimes my sneezing can go on and on into double figures! It can ease off and then start again. My consultant doesn't think it's allergies but accepted that my eyes had become so sensitive over the years with all the different treatment that this was probably the reason. I had thorough allergy tests some years ago and nothing was discovered. Anti-histamines can cause the eyes to be drier so I try and avoid them.

Let us know how you go on.

[ScottishDave]

My eyes do itch sometimes but that is just one of about three or four different types of pain I get

I was also kind of wondering whether I could have developed these bumps after the dry eyes started and that they could be a side effect of the dry eye rather than the cause. Another question I should have asked!

[Guest]

Allergies are such a tough thing to figure out... it's worth it to try and get to the bottom of it though - amazing what a difference it might make to your eyes.

I've been cutting out wheat and processed foods, and it's made a huge difference to me eyes - they are waaaaaay less red, and can handle life much better than they used to. Also, I no longer sneeze all the time, rarely get canker sores in my mouth now, nose is way less stuffy, almost no mucous in the back of my throat like I used to have, and no more stomach cramping (didn't have it all the time, but maybe 3-4 times per week).

I feel like I must sound like an infomercial for focusing on allergies, but since soooo many people are allergic to something these days, odds are that Dr. L. is probably right about you having some kind of allergies too...

I'm still amazed at what a difference this diet change has made for me... haven't 100% figured it all out yet, but hopefully will someday.

Regarding the bumps under your lids that Dr. L. found, I've heard that those can be associated with allergies also, so investigating that possibility seems logical based on that...

Regarding quitting drops making your eyes go all red - no doubt it was worth a try to see what would happen, but it sounds like you do need drops of some sort to get by then. Maybe focus on using 1 quality lubricant as Rebecca suggested, and otherwise just try to baby your eyes as much as possible to minimize your need for drops (ex. moisture chambers, limit computer time as much as possible etc)

[needhelp640]

hey,

dr.L also told me that my problem was mainly allergies. i have sort of the same background as you. my eyes started hurting 9 months after i did lasik and he told me that my eyes weren't dry and that my problem was mainly about allergies. since then i've tried 4 or 5 prescription allergy drops and none of them helped. plugs didnt help either. i'm not really sure what my problem is.

not to let you down, your problem might be an allergy problem but dont get your hopes up too high. let us know what happens with you and good luck!

[Scout]

Hi ScottishDave,

I think it is a good thing to be skeptical of any doctor, even one that has such a good reputation. Everyone is unique and you probably should do your own homework.

That being said, I am always encouraged when I hear DEZ members' stories after they visit Dr. L. Most of what he said to you is pretty much my story and I wish someone would have told me the same things. Instead, I learned by trial and error (mostly error) and it took me years.

I’m not saying we are exactly the same, but there are similarities. It is unfortunate that doctors use the generic term “allergies” when they are really describing an inflammatory cycle that keeps getting triggered by environmental and allergic substances.

If you think “sensitivities that trigger inflammation” instead of “allergies” it makes more sense. Once your eyes are inflamed, they become more and more sensitive to anything that could trigger even more inflammation. And more inflammation makes your eyes even that much more sensitive to even more substances—even substances that you would never be reactive to under normal circumstances like eye drops that usually are helpful.

Think about it from the perspective of your skin. If you accidentally burn yourself, the skin becomes extremely inflamed and red with pain constantly. The next day you take a shower and the water that touches the burn really hurts, the soap causes pain and then your apply your usual moisturizing lotion and practically jump out of your skin with pain. But hey, your skin is moist! But it hurts for hours after because now your skin is inflamed and overly sensitive to EVERYTHING that touches it. That is how I see ocular “allergies” that aren’t really traditional allergies. And how using drops can keep your eyes moist but may also be causing more inflammation.

I am not suggesting you should go cold turkey. But when I realized that anything that touched the surface of my eye (even eye drops that initially gave me relief) were pushing my eyes to become more inflamed over the long run, I did go (almost) cold turkey. I needed wetting drops occasionally but I tried to go the whole day without them. And it got easier after the first week and the whole thing took about a month.

For me, one of the underlying problems that causes me to be susceptible to inflammation is thyroid disease. I have an autoimmune thyroid condition that is part of the problem. It makes sense that he recommends testing for a thyroid condition to rule out whether that is an underlying problem for you as well.

Good luck. I hope you find your answer and start feeling better.

Scout

[Trac]

Scout,
What kinds of tests did you have to find out that you had an autoimmune thyroid condition? I have been tested for autoimmune diseases, twice they came out negative and I have had my thyroid tested and that all came out fine also. I don't know where to go from here.

[Rebecca Petris]

) It is unfortunate that doctors use the generic term “allergies” when they are really describing an inflammatory cycle that keeps getting triggered by environmental and allergic substances.

If you think “sensitivities that trigger inflammation” instead of “allergies” it makes more sense. Once your eyes are inflamed, they become more and more sensitive to anything that could trigger even more inflammation. And more inflammation makes your eyes even that much more sensitive to even more substances—even substances that you would never be reactive to under normal circumstances like eye drops that usually are helpful.

Think about it from the perspective of your skin. If you accidentally burn yourself, the skin becomes extremely inflamed and red with pain constantly. The next day you take a shower and the water that touches the burn really hurts, the soap causes pain and then your apply your usual moisturizing lotion and practically jump out of your skin with pain. But hey, your skin is moist! But it hurts for hours after because now your skin is inflamed and overly sensitive to EVERYTHING that touches it. That is how I see ocular “allergies” that aren’t really traditional allergies. And how using drops can keep your eyes moist but may also be causing more inflammation.

Fantastic post, Scout. I always learn a lot whenever you post and this one really helped me look at the allergy diagnosis in a new way.

[Schatten]

Scout,
What kinds of tests did you have to find out that you had an autoimmune thyroid condition? I have been tested for autoimmune diseases, twice they came out negative and I have had my thyroid tested and that all came out fine also. I don't know where to go from here.

There are 2 parts of thyroid disease diagnostics:

a) Lab tests
They should contain
1. TSH (thyroid stimulating hormone), anything above a value of 2.5 mU/l or w/e the labs use as unit is suspicious
-> Normal Range is 0.3-2.5 / 4.5 as upper value is from stone age 30 years ago when lab tests were made possible ...
2. Free T4 (the original thyroxin)
3. Free T3 (the biological more active version)
4. if necessary : antibodies for TPO (thyreoperoxidasis) and TG (thyreoglobuline), TRAB (TSH-receptor-antibodies) CAN be made, are not important without hyperthyroid symptoms

b) ultrasonography
Here we need to pay attention to three factors:
1. echogenity (how dense is the tissue -> points to vascularisation)
2. homogenity (the tissue of a healthy gland has the same density pattern)
3. volume, a normal male thyroid gland has around 15-25ml volume, at females a bit larger I think, for pregnancy etc.)
-> around 10 ml or even less is HIGHLY suspicious

The antibodies wether they are positive or not have not yet been found to play any important role for the progression, it's nice for diagnosis if they are there, if not can be ignored.

I am diagnosed with hashimoto's thyroiditis myself and never had measurable antibodies. Seems they appear when they want to for some people.

Diagnostics could be worth an additional shot, if you have symptoms of hypothyroidism lingering.

For myself the treatment didn't bring a lot related to dry eyes, I noticed my DES after I started treatment with thyroid hormones

[Trac]

I had testing done for:
TSH refex to free T4
T3 uptake
T4
TSH
T4 Free
thyroid peroxidase antibodies
Everything came out within range, but some of the tests were close to boarder line.

I have never heard of getting an ultrasongraphy done. What kind of doctor ordered those tests?
I would rather not be treated for something that I don't know I have than have drier eyes. I am sorry that your treatment brought on dry eyes.

[Schatten]

Every *good* doctor should have an ultrasonic device, because you can check lotsa stuff with those (liver, heart, joints etc.). I do all my testing at radiologists (the x-ray dudes) or nuclear physicians/doctors (dunno what you call those in english) they prolly have one, ultrasonography is a standard procedure for thyroid tests in germany because it takes only like 5 minutes.
Normally treating hypothyroidism should *not* cause DES, I suspect the hormonal system to be the cause. That's why I am currently thinking about having a check up at some endocrinologist, it's just hard to find one near my place and on top of that it's a day wasted just to get to one >.>
Meh and they mainly say it's from your psyche - I do not want to take a 1-day trip just to hear to take AD's.

[Carla C]

Some relief because of Specialists

My name is Carla, and I am new to this forum. I am a physician, but I had never heard of "mucus fishing" or "meiobian gland dysfunction" until it happened to me 3 years ago. It has only been this year that I am starting to get some relief. In retrospect, I think my dog is the culprit, as I have had sneezing and wheezing to him for several years. Makes sense, because somewhere in that time my eyes got "dry" and then they got "wet" (ie lots of mucous.) My eye ophthalmologist said my case was among the worse she has seen in a few years. A million different eye drops didn't really work, including Azasite, Pataday, lotamax, xylet, mucomyst, etc. Tobradex works, but it is a dangerous drug if used chronically. Here's what I finally did that worked:

1) Saw a CORNEA specialist at Weill-Cornell in NYC. Dr. Kimberly Sippel. It took us a while and a merry go round of eye drops. Finally, she:
A) Sent me to an allergist ( Dr. Sebastian Lighvani) who diagnosed several allergies (not surprising....cat and dog) I have been getting allergy shots for 6 months now, and I am starting to feel better....but it is a slow process and you don't feel better overnight. The time commitment can be 3-5 years. This mucous stuff can be the later stage of allergic conjuncitivitis. That is exactly what they think happened to me.

B) Sent me to an OCULOPLASTIC doctor, Dr. Gary Lelli, also at Cornell. You see, when you have chronic inflammation from your eyes, your tear duct can scar shut. This is what happened to me. Since this acts like a drain, the mucous and tears have no where to go when the drain is plugged. Dr. Lelli cut the scar tissue in my left eye (more severe eye) and dilated the duct. Almost immediately, I felt better...much better, but not yet 100%. The right eye still gives me symptoms and I am looking to have that done too.

The problem with us is twofold : we make too much secretion and we cannot get rid of it if the drain is clogged. So, having help at the production end (the allergist) and the elimination (the oculoplastic doc.) have helped me. Things are slowly getting better, and I am hoping it clears up.

See a specialist if you can. Your problem is bad enough that you are blogging about it.