Report on my visit with Dr Latkany

[Trac]

Carla I see this as a double edged sword. A lot of us have our tear ducts plugged, then the mucus cannot go any where. But the doctor says the eyes will be drier if the tear ducts are not plugged.

[patrick]

anti histamines

hi all,

i've been following this topic with much interest,because i think allergies can indeed contibute to dry eyes. i suspect it plays a large role in my case of mgd,however my allergietests always turn out negative.
what i'd like to know is could it be possible that taking anti histamines have consequenses for dry eyes even long after you've quit using them?
i took anti histamines (zyrtec) for little over a decade (1994-2005). at that time we had 3 pets and i really didn't want to part with them so i was advised to take the zyrtec on a daily basis as long as i had domestic animals in the house. i stopped the anti histamines cold turkey right after our last dog died in 2005. a short while after that i had lasek...

[ScottishDave]

Thanks for all the good advice.

I have decided to mostly follow Dr L's advice.

I am getting tested for allergies and any problems with my Thyroid this week and am also scheduled to get plugs this Friday. Dr L said normal silcone plugs would not be suitable to me so I'll hopefully talk my Opth into giving me another kind if he has them.

As for stopping the drops I don't think I will be able to fully commit to this immediately. I work at a computer all day as I'm an accountant and this would not be possible without my moisture glasses and drops at the moment.

Question - I have what I term one "good" eye and one "bad" both of which I use drops on at the same rate event though the good eye probably doesn't need as much. If I was to do the Dr L method of stopping all drops but just on my good eye for the moment would this be okay? Is the physiology of both eyes linked or can I treat them and experiment on them separately to see results?

Cheers

Edit - I also forgot to mention in my original post that Dr L said that if the testing/plugs proved to not help then a "bandage" contact lens might help. Yet again I forgot to ask why but I did ask whether it would just be a normal contact lens without prescription and he said yes. I really should have asked why as I'm not sure how this would help.

[Lacey1]

Hoping you get some good answers out of your tests. Just a word of caution about punctal plugs. I had them put in, but they really irritated my eyes. When the doctor went to extract them, one tore. Now I have a piece of one floating around, which may require surgery to remove. Just letting you know potential side effects. From now on any procedure I have done or product I'm going to use I want to know the potential side effects. I wish I would have done that with LASIKS :-(.

Oh and you said Dr. L said you could e-mail him, right? You should definitely ask him the questions you have.

[Trac]

Edit - I also forgot to mention in my original post that Dr L said that if the testing/plugs proved to not help then a "bandage" contact lens might help. Yet again I forgot to ask why but I did ask whether it would just be a normal contact lens without prescription and he said yes. I really should have asked why as I'm not sure how this would help.


ScottishDave,
I had eyeball bandages. I really liked them. They keep the eye moist and keep the environment off the eye. If they dry up it is really bad. They curl and cause triple vision, actually it was kind of cool if I was not doing anything. Also you can get an infection from them because you leave them in for 30 days so I had to take antibiotic eye drops twice a day. My doctor really does not like them, so after a few months he took me off.

[ScottishDave]

Update:

Well I went to my GP and he has taken blood for testing of my Thyroid and for allergies, I get the results on Wednesday.

My Opthamologist fitted me with silicone plugs on Friday afteroon. What a disaster that was. By Friday evening both my eyes were bright red and sore in corner where the plugs were fitted near my nose. I stuck with them until Saturday afternoon and then went to the local hospital where an Opthamologist there removed them. He said they were scratching my sclera, although this was not serious and I could put up with it if I wanted, he would recommed removal.

He removed both plugs and my eyes felt immediately less sore. He asked if I wated him to have a look at the general health of my eyes while he was there. He noted that my meibomian glands were all blocked. He manually expressed them noting what was coming out of them was like toothpaste rather than olive oil.

My glands have a bit of a story behind them. When I first developed dry eye symptoms my Optomitrist noted the same thing about my glands and recommended warm compress, expression and lid hygiene which I did twice a day for 4 months until 2 weeks ago following my trip to see Dr L. Dr L said my glands were all fine and that I should do cold compresses not warm compresses. I also stopped Doxy 3 weeks ago as my 8 week course had finished.

I am wondering if DR L saw the effect of my good lid hygiene and the doxy and wrongly assumed my glands were all fine when in fact it was the treatment I was giving them that was keeping them fine?

This is all getting a bit confusing now as I don't know whether I should be doing cold or warm compresses, doxy or no doxy, plugs or no plugs.

[ScottishDave]

Has the results of my Thyroid and allergy testing.

My TSH level is 1.45 which I was told was well within normal levels.

My GP also said that the 'general' allergy test they did was normal. He did say that this did not say that I did not have allergies but the test was basically an identifier for if I had a serioud allergy. I may try to get more specific tests done in the nar future.

[tearless2]

Thank you for keeping us updated on your investigations and progress into your DES. I hope you find the answers you are looking for. Did the allergy test performed involved skin pricks? I had one once that was 20 skin pricks of the most common allergens by an allergist.

Did the eye doctor say why the plugs did not fit you well? Do you have irregularly shaped ducts? I know a lot of people here have had problems with plugs but I think that is the exception rather than the rule. Do you think the opthamologist who fitted you with plugs did not do a good job? Do they have lots of experience?

Regarding the shape of your eye and the skin that you discussed. Do you think you might have incomplete eyelid closure? Have you tried wearing something over your eyes at night?

Finally, are you back to applying a warm compress? It sounds like that was helping you a lot previously.

[ScottishDave]

- The allergy test was purely blood. I do think i'll try and book more comprehesive testing in the near future.

- My Opth has now gotten back to me and thinks, from looking at the state my eyes were in while I had the plugs in, that I had an allergic reaction to the silicone in the plugs. I am not 100% sure that this was the case, it felt more like the rubbing against my eye was causing the problem. This is the second time I have had these plugs put in (by different Opths) and the second time I have had this reaction so I do think that the fit was not the problem.

- My Opth has now suggested that he would be reluctant to try collagen plugs on me for fear of the reaction I may have. He has suggested that he suture my tear ducts to see if this gives me any relief. This sounds a bit drastic and, from searching here, I can't see that anyone else has had this done?

- My eyelid closure seems fine. I wear tranquileyes at night but I am not sure that I need to. I generally wake up with both eyes feeling better than when I went to sleep, it's only after 5 mins or so of opening them that they start to hurt.

- Yes I am back to warm compresses. Once a day, rather than twice and I have decided to go back on doxy. I'll see what that does. Can you do warm compresses in the morning and then cold compresses throughout the day?

[tearless2]

Hi,
The first time I had plugs put in, they rubbed a little against my eyeball. My optometrist said how does it feel. I told him but then said I think I can live with it and I am willing to try anything at this point. He said I'll push them in a bit further, they should NOT rub against your eyeball. He pushed them in and then I had no more problems with them and I've had them for 2 years. Maybe yours weren't in all the way? Although, I guess it would be weird that that happened twice.

People have had their tear ducts permanently closed on this site. Many people with severe dryness who had plugs fall out had them cauterized. Sometimes they reopen up again on their own.

Regarding compresses, perhaps someone else will chime in on if they do that. Sounds like there would be little harm in trying as long as the cold compresses are not too cold. Don't freeze your eyes

[ScottishDave]

Hi,
The first time I had plugs put in, they rubbed a little against my eyeball. My optometrist said how does it feel. I told him but then said I think I can live with it and I am willing to try anything at this point. He said I'll push them in a bit further, they should NOT rub against your eyeball. He pushed them in and then I had no more problems with them and I've had them for 2 years. Maybe yours weren't in all the way? Although, I guess it would be weird that that happened twice.

People have had their tear ducts permanently closed on this site. Many people with severe dryness who had plugs fall out had them cauterized. Sometimes they reopen up again on their own.

Regarding compresses, perhaps someone else will chime in on if they do that. Sounds like there would be little harm in trying as long as the cold compresses are not too cold. Don't freeze your eyes

Yes I think the problem with the plugs might be more how my eye margins turn in towards the eyes slightly thus encouraging more rubbing than normal. Dr L mentioned something about this to me when I saw him.

My point re. closing the tear ducts was more that it was suggested that it was going to get done by suturing them closed and not cauterzing. I have seen lots with cauterizing but none with just suturing?

Thanks

[spmcc]

RE: suturing

I've have one puncta sutured. The other three are cauterized (but on their way to being sutured).

However, I have 16 years of step-by-step trials of plugs (dissolvable, permanent, intracanalicular) and then cautery (about 9 times, but my puncta always reopened). The final step is suturing.

I don't know that doctors will jump from plugs to suturing. It's better to be safe than sorry... to go through all the steps of trying the least-invasive, more-easily-reversed options before permanent suturing. You want to make sure that you aren't going to be worse off than before!!

Good luck.
Sheila

[ScottishDave]

I've have one puncta sutured. The other three are cauterized (but on their way to being sutured).

However, I have 16 years of step-by-step trials of plugs (dissolvable, permanent, intracanalicular) and then cautery (about 9 times, but my puncta always reopened). The final step is suturing.

I don't know that doctors will jump from plugs to suturing. It's better to be safe than sorry... to go through all the steps of trying the least-invasive, more-easily-reversed options before permanent suturing. You want to make sure that you aren't going to be worse off than before!!

Good luck.
Sheila

Thanks for your reply.

However my Opth seems to think suturing is the step before cauterizing. He told me that the suturing was easily reversible.

That's what I hate most about dry eyes (other than the pain!), no two Opths say the same thing!

[spmcc]

He told me that the suturing was easily reversible.

Then I think we're talking about different things.

Mine is permanent. The oculoplastic ophthalmologist cut medially down the canaliculus, sutured the bottom, sutured the top, and then closed. It's supposed to permanently close the puncta AND the canal. However, there's always a chance that it 'grows' back open'.

no two Opths say the same thing!

HAHAHAHA. I find that too. Why is that?!?!?!?

[sazy123]

I saw DR L and was told to investigate allergies, I also have some small bumps (papillary), and most other dr's have also said allergies- but TBH- i think they say that because red inner eyelids gives that impression and they don't know what else it could be! Since DrL I went on a big allergy eliminating spree, Dust, Dust mites, Food allergies, any perfumed products- No difference from any of it. I want to remove a retainer in my mouth- contains nickel and I know im allergic to nickel- i react to cheap earrings. My eyes dont really itch and pat a day didnt help.

My advice to you would be try eliminating any allergan that you can think of that you are in contact with ALL the time (if your symptoms never let up). Have patch tests (get through NHS) these show delayed reactions (prick and blood tests dont), and may be important for food allergies. Although food elimination diets are pretty good if its that.

Hormone issues is the other possible cause for me too, PCOS, and tbh it is the more likely one.